Geue Lutz, Köhler Heike, Klawonn Wolfram, Dräger Klaus, Hess R G, Conraths Franz J
Friederich-Loeffler-Institut, Bundesforschungsinstiut fũr Tiergesundheit, Institut für Epidemiologie,Wusterhausen.
Berl Munch Tierarztl Wochenschr. 2007 Jan-Feb;120(1-2):67-78.
Paratuberculosis or Johne's Disease, caused by Mycobacterium avium subspecies paratuberculosis (MAP), is a notifiable disease in Germany which produces enormous economical losses in dairy farms. At present,there is no confirmed data about the actual number of infected livestock herds in Germany. A countrywide monitoring program to evaluate the prevalence in dairy herds would only be economically feasible on the basis of bulk milk testing. In this study, we evaluated two ELISA test kits (SVANOVIR Ptb-ELISA, IDEXX-M.pt. Milk test kit) for the detection of antibodies against MAP in bulk milk. First, the Paratuberculosis-status of the herd derived from the history of the farm was used as a gold standard. Paratuberculosis-negative farms were tested negative with each test, but paratuberculosis-positive or Paratuberculosis-serologically-positive farms were detected only in one case (Svanovir) or three cases (IDEXX), respectively. Even if inconclusive results are counted as positive, 82.9 % (Svanovir) or 80 % (IDEXX) of the paratuberculosis-positive or serologically paratuberculosis positive farms were not detected. Nevertheless, a re-validation of both ELISAs by means of ROC and TG-ROC analyses was attempted by searching for ideal cut-offs, optimised for bulk milk. If a high specificity was selected, no acceptable sensitivity could be reached. The best results were obtained using a sensitivity of 32.3 % at a specificity of 100 % (Svanovir). With a small change of the cut-off value, the sensitivity increased to still 57 %, but this reduced the specificity to 67 %. Similar results were obtained with the IDEXX-ELISA. We then evaluated the Svanovir-ELISA for the detection of bulk milk samples on the basis of the current paratuberculosis prevalence within 69 dairy herds from Rhineland-Palatinate using individual milk samples.When the bulk milk samples were tested in two different laboratories using the same ELISA, considerable differences in the results became evident. Nearly all samples were tested with a higher relative test result in one laboratory, which often led to differences in the classification of the prevalence levels. The estimated within-herd seroprevalences ranged between 0 % and 37 %. There was little agreement between the historical paratuberculosis herd status and the within-herd prevalence in milk serum, as reflected in a kappa-index of 0.146. To determine the sensitivity and specificity of the bulk milk ELISA by ROC and TG-ROC analysis, 116 bulk milk samples were used that had been obtained from the 69 dairy herds participating in the study. The optimal ratio of sensitivity (81 %) and specificity (77 %) relative to a "gold standard" was obtained when the cut-off was set at the 10 % level. These values for sensitivity and specificity were better than those obtained in an evaluation of the same ELISA in which the historical Paratuberculosis herd-status was used as a "gold standard." The results of this study question the suitability of the available ELISAs for bulk milk testing. Taking into account that the Svanovir-ELISA for individual milk samples has a sensitivity of 60 96% relative to the blood serum variant of the test, and that the latter has also a limited sensitivity due to the pathogenesis of paratuberculosis, the available test systems examined in this Study do not seem to be suitable for herd diagnosis by using bulk milk samples.
副结核病或约翰氏病由副结核分枝杆菌(MAP)引起,在德国是一种应报告的疾病,给奶牛场造成巨大经济损失。目前,德国感染牲畜群的实际数量尚无确切数据。只有基于全脂牛奶检测,一项评估奶牛群患病率的全国性监测计划在经济上才可行。在本研究中,我们评估了两种用于检测全脂牛奶中抗MAP抗体的ELISA检测试剂盒(SVANOVIR Ptb - ELISA、IDEXX - M.pt.牛奶检测试剂盒)。首先,将根据农场历史得出的畜群副结核状态用作金标准。副结核阴性农场在每次检测中均呈阴性,但副结核阳性或血清学副结核阳性农场分别仅在1例(Svanovir)或3例(IDEXX)中被检测到。即使将不确定结果计为阳性,82.9%(Svanovir)或80%(IDEXX)的副结核阳性或血清学副结核阳性农场也未被检测到。尽管如此,通过寻找针对全脂牛奶优化的理想临界值,试图借助ROC和TG - ROC分析对两种ELISA进行重新验证。如果选择高特异性,则无法达到可接受的灵敏度。在特异性为100%时,使用Svanovir获得的最佳结果是灵敏度为32.3%。临界值稍有变化,灵敏度仍可提高到57%,但这会使特异性降至67%。IDEXX - ELISA也得到了类似结果。然后,我们基于莱茵兰 - 普法尔茨州69个奶牛群当前的副结核患病率,使用个体牛奶样本评估了Svanovir - ELISA用于检测全脂牛奶样本的情况。当在两个不同实验室使用相同的ELISA检测全脂牛奶样本时,结果出现了明显差异。几乎所有样本在一个实验室的相对检测结果都更高,这常常导致患病率水平分类的差异。估计的畜群内血清阳性率在0%至37%之间。历史上的副结核畜群状态与牛奶血清中的畜群内患病率之间几乎没有一致性,kappa指数为0.146就反映了这一点。为了通过ROC和TG - ROC分析确定全脂牛奶ELISA的灵敏度和特异性,使用了从参与研究的69个奶牛群中获取的116个全脂牛奶样本。当临界值设定在10%水平时,相对于“金标准”获得了灵敏度(81%)和特异性(77%)的最佳比例。这些灵敏度和特异性值优于在将历史副结核畜群状态用作“金标准”评估同一ELISA时获得的值。本研究结果对现有ELISA用于全脂牛奶检测的适用性提出了质疑。考虑到用于个体牛奶样本的Svanovir - ELISA相对于该检测的血清变体灵敏度为60% - 96%,并且由于副结核的发病机制,后者的灵敏度也有限,本研究中检测的现有检测系统似乎不适合通过使用全脂牛奶样本进行畜群诊断。