Milk fever and subclinical hypocalcaemia--an evaluation of parameters on incidence risk, diagnosis, risk factors and biological effects as input for a decision support system for disease control.

The present review analyses the documentation on incidence, diagnosis, risk factors and effects of milk fever and subclinical hypocalcaemia. It is hereby evaluated whether the existing documentation seems sufficient for further modelling in a decision support system for selection of a control strategy. Several studies have been carried out revealing an incidence of milk fever most often in the level of 5-10%. Few studies indicate that the incidence of subclinical hypocalcaemia is several times higher than milk fever. The diagnosis based on clinical or laboratory methods or based on presence of risk factors is outlined. The clinical symptoms of milk fever are highly specific and the disease level may thus be determined from recording of treatments. Diagnosis of subclinical hypocalcaemia needs to include laboratory examinations or it may be determined by multiplying the incidence of milk fever by a certain factor. From the documentation on risk factors, it is very complex to predict the incidence from the exposure level of the risk factors. Due to uncertainty, sensitivity analyses over a wide range of values for each parameter are needed. The documentation of cow characteristics, nutrition, environment and management as risk factors are described. Among cow characteristics, parity or age, body condition and production level were found to be important. Risk factors associated with nutrition included most importantly dietary cation-anion difference and calcium level whereas the importance of general feeding related factors like type of feed stuff and feeding level were less clear. Environment and management included season, climate, housing, pasturing, exercise, length of dry period and prepartum milking. Several of the parameters on environment and management were confounded among each other and therefore firm conclusions on the importance were difficult. The documentation of the effect of milk fever includes the downer cows, reproductive disorders, occurrence of other diseases and the effect on milk production, body weight and culling. The reproductive disorders included most importantly dystocia, uterine prolapse, retained placenta, metritis and repeat breeding, and occurrence of other diseases included ketosis, displaced abomasum and mastitis. The documentation was substantial and often quantifiable within certain limits. Overall it is concluded that the present documentation on milk fever concerning incidence, diagnosis, risk factors and effects seems sufficient for a systematic inclusion in a decision support system. A model on milk fever should take into consideration the variation in biological data and individual herd characteristics. The inclusion of subclinical hypocalcaemia would be more uncertain and probably should await further documentation on possibilities of determining the herd level incidence and also the effect of this condition on production.