This paper aims to describe clinical disease incidence in early lactation and explore its association with fertility and culling in 13 commercial grazing dairy herds in Uruguay. Seven farms with less than 250 dairy cows considered small herds (SH) with a herd size average ± (SD) of 144 ± (56) cows and six farms with more than 500 cows considered large herds (LH) with a herd size average ± (SD) of 830 ± (239) cows were selected. Herd managers recorded health events during the first 90 days in milk in 5375 Holstein dairy cows [24.5% (n=1316) of them were primiparous cows, (PP)] during one year. Overall, 36.5% (n=1959) of the cows had at least one clinical health event between 1-90 days in milk. The cumulative incidences were 2.2% for twin birth and 4.9% for stillbirth. Cumulative incidence was 4.4% for retained placenta-metritis (RP-metritis), 27.6% for clinical mastitis and 5.0% for lameness. Our data showed that parity and herd size were risk factors for postpartum disease in grazing dairy herds. In PP cows, stillbirth incidence was higher than in multiparous (MP) cows (PP=6.9 ± 3.4, SD vs. MP=4.3 ± 2.6, SD), while in MP cows twin births (MP=2.7 ± 1.7, SD vs. PP=0.7 ± 2.7, SD), RP-metritis (MP=4.6 ± 3.9, SD vs. PP=3.8 ± 3.7, SD) and mastitis incidence (MP=30.9 ± 11.4, SD vs. PP=17.2 ± 13.9, SD) was higher. Clinical mastitis (LH=29.4 ± 9.6, SD vs. SH=19.1 ± 11.3, SD) and lameness incidence (LH=5.6 ± 1.9, SD vs. SH=2.3 ± 2.1, SD) was higher in large herds than in small herds. RP-metritis was increased by stillbirth (OR=4.4, 95 % CI=2.9-6.5) and twin birth (OR=2.8, 95 % CI=1.5-5.1). Diseases had a negative impact on time to first service and pregnancy rate and increased culling hazard rate. Disease incidence in early lactation was high and showed a wide variation among herds (10.4%-48.7%), which highlights the relevance of a herd health program prioritizing the early lactation disease control.
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