4. Social sciences and antimicrobial usage

Time: Wednesday 15th May 13 :30-15 :00 hrs
Venue: Meeting room "Nørrebros Runddel"
Moderator: David Kelton


O4-1 - Antibiotics Anonymous - Playing Our Part in Reducing Antibiotic Usage

13:30-14:00 hrs


Kristen Reyher, University of Bristol, UK


Antimicrobial resistance (AMR) is the biggest threat facing human health today - addressing it requires a One Health approach in which we all have a role to play. Farmers have a wealth of experience and expertise about their farms and veterinarians and other industry partners have expertise on antibiotics and animal health. These specialisms have the potential to shed light on the complex issue of antibiotic stewardship, but only through true collaboration and recognising the value and validity of multiple knowledges. This presentation will explore what farmers and veterinarians can achieve when working collectively to reduce antibiotic usage. It will examine how theories of human motivation can inform the AMR conundrum and how we can develop tools to better understand one another and harness motivations to improve animal health and welfare whilst reducing antibiotic use.


O4-2 - Monitoring udder health using census data: evaluating effects of a changed antimicrobial policy



Scherpenzeel, C.G.M., GD Animal Health, Deventer, the Netherlands
van den Heuvel, K.W.H., GD Animal Health, Deventer, the Netherlands
Santman-Berends, I.M.G.A., GD Animal Health, Deventer, the Netherlands
van Schaik, G., GD Animal Health, Deventer, the Netherlands, Utrecht University, Faculty of Veterinary Medicine, Utrecht, the Netherlands


Antibiotic resistance became increasingly important and many actions were taken for prudent and restricted antimicrobial use (AMU) in the dairy industry. In the Netherlands, one of the most important measures was the implementation of selective dry cow therapy (SDCT) in 2013. Both udder health parameters and AMU are monitored in the Dutch cattle health surveillance system based on routinely collected census data (17,000 dairy herds). The aim of our study was to determine an effect on udder health of the policy of antimicrobial restriction in Dutch dairy farms.

In total, six udder health indicators were monitored on a quarterly basis i.e. bulk milk somatic cell count (BMSCC), prevalence and incidence of high SCC (HSCC) cows, herds with >25% incidence of HSCC in heifers and multiparous fresh cows and herds with >25% prevalence of cows with a consistent HSCC before and after calving. The association between these udder health parameters and AMU was analysed using population average multivariable regression techniques with appropriate distributions and link functions.

Our results showed that the antimicrobial policy did not lead to a deterioration in most udder health indicators. Although most udder health parameters were not negatively influenced, the results of the multivariable models showed that not applying antimicrobials at all resulted in a higher BMSCC, a higher incidence and prevalence of HSCC cows and a higher probability to have >25% cows with a new HSCC during the start of lactation. The results indicate that, although AMU decreased with 47%, a decrease in udder health indicators was not observed. Thus, application of SDCT did not seem to affect the general udder health in dairy herds in the Netherlands. However, in dairy herds that did not use any antimicrobials, the SCC of cows was significantly higher compared to the herds with an average AMU.


O4-3 - The effect of peer group education on veterinary prescription practices

14:15-14:30 hrs


Pucken, V.-B. , Clinic for Ruminants, Vetsuisse Faculty, University of Bern, Bern, Switzerland
Bodmer, M., Clinic for Ruminants, Vetsuisse Faculty, University of Bern, Bern, Switzerland
Schouwey, S., Clinic for Ruminants, Vetsuisse Faculty, University of Bern, Bern, Switzerland
Nägele, F. , Clinic for Ruminants, Vetsuisse Faculty, University of Bern, Bern, Switzerland
Schüpbach-Regula. G., Veterinary Public Health Institute, Vetsuisse Faculty, University of Bern, Bern, Switzerland


Considering the need for antimicrobial reduction, the aim of our study was to evaluate the effect of peer-group education on the prescription practices of veterinarians, with the focus on mastitis related antimicrobials.

21 Swiss cattle practitioners were divided into three peer study groups. Each group met every 2 to 3 months, from August 2016 until January 2019, to discuss different topics. In addition, a moderator and a person with expertise in the respective topic were present at each meeting. For the same study period, the antimicrobial prescription data were extracted from the practice software for 5 dairy farm clients per participating veterinarian. Prescription data were divided into intramammary preparations used during lactation (IMM), intramammary preparations used for dry off (DRY) and systemic treatments (SYS). The monthly treatment incidence (TI) for the defined daily dose (DDD) per 1,000 cow-days (IMM and SYS) and the defined course dose (DCD) per 1,000 cow-days (DRY) were calculated on farm level for the intervention period.

Preliminary results show that the monthly TI IMM ranged between 5.04 and 11.51 DDD per 1000 cow-days from August 2016 until January 2018, with a trend to lower TI IMM in the winter season and higher TI IMM in the summer season. The monthly TI SYS ranged between 0.81 and 2.03 DDD per 1000 cow-days. The TI DRY ranged between 0.62 and 3.02 DCD per 1000 cow days with a tendency to decrease over the study period.

In the descriptive statistics, no reduction was recognizable for the intramammary antimicrobials used during lactation and the systemic antimicrobials. However, the observed reduction of intramammary antimicrobials used for dry off might indicate a more prudent use of these substances due to participation in veterinary peer study groups. The data will further be analyzed with hierarchical multiple regression analysis.


O4-4 - Antimicrobial stewardship profiles among Swiss dairy farmers - a latent class analysis



B.H.P. van den Borne, Veterinary Public Health Institute, Vetsuisse Faculty, University of Bern, Bern, Switzerland and Business Economics Group, Wageningen University, Wageningen, the Netherlands
A.-A. Schwendner, Veterinary Public Health Institute, Vetsuisse Faculty, University of Bern, Bern, Switzerland
M. Bodmer, Clinic for Ruminants, Vetsuisse Faculty, University of Bern, Bern, Switzerland
M.-E. Cousin, Consumer Behavior, Institute for Environmental Decisions, ETH Zurich, Zurich, Switzerland
G. Schüpbach-Regula, Veterinary Public Health Institute, Vetsuisse Faculty, University of Bern, Bern, Switzerland
T.J.G.M. Lam, GD Animal Health, Deventer, the Netherlands and Department of Farm Animal Health, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands


The lactational treatment of subclinical (SCM) and mild and moderate clinical mastitis (MMCM) is an important contributor to antimicrobial usage (AMU) in Swiss dairy herds. Given the known importance of attitude on behaviour, scrutinizing farmers' mindset towards antimicrobial stewardship of these mastitis states seems important. This study identified groups of farmers based on their lactational intramammary AMU and antimicrobial resistance (AMR) practices. The groups were described with respect to their demographics and mindset towards intramammary AMU and AMR.

A knowledge, attitude, and practices questionnaire on antimicrobial stewardship of SCM and MMCM was filled in by 542 Swiss dairy farmers. A latent class analysis was conducted to identify groups of farmers regarding 10 AMU and AMR practices towards SCM and MMCM. A multinomial logistic regression analysis on 13 demographic covariates was performed to explain group membership. The relationship between group membership and 10 attitude and 2 knowledge items was assessed using ANOVA. Based on their AMU and AMR practices, five groups of farmers were identified. One group did not treat SCM nor MMCM (18%), one group only treated SCM (14%), one group only treated MMCM (29%), and the largest group treated both mastitis states. The latter group was subdivided into a group of farmers applying guidelines for AMU and AMR (26%) and a group of farmers not strictly applying those guidelines (14%). Regional differences between herds, regarding altitude and language, explained some of the variation in group membership. Group membership was associated with farmers' attitude to use antimicrobials as little as possible and with using antimicrobials only after performing bacteriological and susceptibility testing.

This study gave detailed insight into farmers' knowledge, attitude, and practices regarding AMU and AMR towards SCM and MMCM and provided opportunities to improve antimicrobial stewardship in Swiss dairy herds.


O4-5 - How OIE standards support the dairy sector to apply responsible and prudent use of antimicrobials?

14.45 hrs


Pinto Ferreira, J., World Organisation for Animal Health (OIE)


The World Organisation for Animal Health (OIE) is an intergovernmental organisation recognised by the World Trade Organization as a reference Organisation for intergovernmental standards concerning the sanitary safety of international trade of animals and products of animal origin and zoonoses, and oversees improving animal health, veterinary public health and animal welfare worldwide, as well as transparency of the global animal disease situation. The OIE has developed standards related to Antimicrobial Resistance (AMR) and publishes the List of Antimicrobials of Veterinary Importance including specific recommendations on their use.

In 2016, the OIE has developed a strategy on Antimicrobial Resistance and the Prudent Use of Antimicrobials which includes the development of a database tracing the use of antimicrobial agents in animals (Antimicrobial Use (AMU) Database). The report of the results of the third round of the AMU data collection were published in February 2019. The 2nd OIE Global Conference on AMR, putting standards into practice took place in October 2018 and several of its recommendations are of particular importance to the food producing industry. An ad hoc Group was convened in 2018 to establish priorities of diseases for which the use of improved and new vaccines could reduce antimicrobial use in cattle and small ruminants. Mastitis, lameness, respiratory syndromes and diarrhera were, among others, identified by this ad hoc Group as, focus areas particularly related with cattle.

A communication campaign, entitled "We need you" (to handle antimicrobials with care) has been developed by the OIE, with multiple tools and materials prepared focusing specifically in different stakeholder groups, including Veterinarians, Farmers, Animal feed manufacturers, or Wholesale and retail distributors.



P24 - Using national sales data to describe trends in intramammary antimicrobial use on Irish dairy farms


More S.J, Centre for Veterinary Epidemiology and Risk Analysis, Dublin, Ireland
Clegg T.A., Central Statistics Office, Dublin, Ireland
McCoy F., Animal Health Ireland, Carrick-on-Shannon, Ireland


Since the establishment of CellCheck, the Irish national mastitis control programme, there has been considerable improvement in bulk tank somatic cell counts (SCC). However, there is limited information on how antimicrobials are used as part of mastitis management, with no central collation of data on farm level antimicrobial use. Hence in this study, we analysed national-level sales data to understand trends in on-farm intramammary antimicrobial usage in Ireland between 2003 and 2015. We calculated actual sales of intramammary tubes and the quantity of active substance sold, by year, product type (lactation or dry cow therapy (DCT)), antimicrobial group, World Health Organization antimicrobial classification and, during 2009-15, by prescribing route. We also estimated on-farm usage of lactation and dry cow intramammary antimicrobials, using defined daily dose (DDDvet) and defined course dose (DCDvet) calculations, and dry cow coverage.

The usage of in-lactation intramammary tubes has fallen to 1,398 DDDvet and 457 DCDvet per 1,000 animals per year, a 33% reduction from peak levels of usage in 2008. Sales of intramammary tubes with at least one critically important antimicrobial (CIA) have either risen since 2007 (DCT) or fallen (lactation therapy). However, there were increases in the number of both dry cow and lactation tubes sold containing CIAs considered of highest priority (HP-CIA) for human health. The study also showed an increase in antimicrobial DCT sales, and the estimated national dry cow coverage in 2015 was 1,022 DCDvet per 1,000 cows per year. There has also been an increase in sales of teat sealant to 67 tubes of sealant for every 100 tubes of antimicrobial DCT by 2015.

This study demonstrates a positive national trend in reduced mastitis treatment during lactation, which parallels the progress in national bulk tank SCC. However, it also highlights areas for review, such as the blanket use of dry cow treatment in Ireland and the increase, albeit slowly, in the use of HP-CIAs. Through the forum of the CellCheck Implementation Group, this published work has helped inform national discussions, in areas such as the development of the Irish National Action Plan on Antimicrobial Resistance and the recently published Policy on Highest Priority Critically Important Antimicrobials. This work has also helped to highlight the value of and necessity for central collation of data on farm-level antimicrobial use, to allow objective measurement and benchmarking of on-farm usage in Ireland. In the meantime, work has commenced on collating and analysing the intramammary sales data from 2016-2018.


P25 - Field trial to motivate and support Dutch farmers to treat grade 1 and 2 mastitis more prudent


Monique Driesse, Boehringer Ingelheim Animal Health Netherlands bv
Tine van Werven, University of Utrecht, Kernpraktijken Rundvee


Introduction of a narrow spectrum mastitis injector, as part of prudent use of antibiotics, needs motivational and systematic approaches to change farmers behavior. Changing treatment routines of farmers can be facilitated by showing cure rates and the proportion of grade 1 and grade 2 clinical mastitis (CM) caused by gram-positive pathogens susceptible to the new treatment. A field trial was carried out to motivate Dutch farmers and to support them in the use of first choice, narrow spectrum antibiotic tubes in CM. The objectives were to study the prevalence of causing pathogens of grade 1 and 2 CM and to evaluate the clinical cure rate after treatment with a benzylpenicillin injector (Ubropen®, Boehringer Ingelheim). Eleven practices selected 82 farmers. Milk samples from CM were collected before treatment and stored in the freezer until diagnostics. Farmers were recommended to treat grade 1 and 2 CM with 1 injector per day for 3 to 5 days. Farmers were instructed to record treatment, severity, day of clinical cure and farmer's satisfaction. Day of clinical cure was defined as the first day that milk and quarter had a normal appearance as judged by the farmer. 412 milk samples of all CM were sent in for bacteriologically. Results show 16% no growths, 8% contaminated, 1% yeast or fungi, 59% gram-positive pathogens and 16% gram negatives. From grade 1 and 2 CM 80% of the causing pathogens appeared to be gram positive. For 131 cows data of grade 1 (n=52) and grade 2 (n=79) CM and (days of) clinical cure were available. The clinical cure rate was 81% for both grades. The mean day of clinical cure was 3.7 days and 4 days in grade 1 and 2 respectively. Farmers satisfaction rate of the new treatment was 68%.

The study shows that in the majority (80%) of grade 1 and 2 CM the causing pathogen is gram-positive with a clinical cure rate of 81%. These outcomes can be used to motivate farmers and give them confidence to treat CM more prudent with a first choice injector.


P26 - S. aureus antibiotic-resistance: phenotypic and genotypic analysis of bovine mastitis isolates


Monistero V., University of Milan, Milan, Italy
Biscarini F., Institute of Agricultural Biology and Biotechnology - National Research Council, Lodi, Italy
Barberio A., Istituto Zooprofilattico Sperimentale delle Venezie, Sezione Territoriale di Vicenza - Vicenza, Italy
Bonamico S., Istituto Zooprofilattico Sperimentale delle Venezie, Sezione Territoriale di Vicenza - Vicenza, Italy
Cremonesi P., Institute of Agricultural Biology and Biotechnology - National Research Council, Lodi, Italy
Castiglioni B., Institute of Agricultural Biology and Biotechnology - National Research Council, Lodi, Italy
Moroni P., Universiy of Milan, Milan, Italy


Staphylococcus aureus is frequently isolated from bovine IMI and responds poorly to antibiotic therapy. The aim of this study was to characterize phenotypic and genotypic features associated with antibiotic resistance in S. aureus. A total of 93 S. aureus isolates were recovered from bovine clinical mastitis samples collected at 76 farms situated in 6 countries: Argentina, Brazil, Germany, Italy, USA, South Africa. Antimicrobial susceptibility to ampicillin, erythromycin, oxacillin, penicillin, amoxicillin/clavulanate was tested by Minimum Inhibitory Concentration (MIC) assay. After DNA extraction, PCR was used to study blaZ, mecA, mecC, ermA, ermB, ermC genes, encoding the acquisition of resistance to the 5 antibiotics. The phenotypic results showed that 35% of the strains were resistant or intermediate to erythromycin, the majority of which were isolated from Brazilian and German samples. The penicillin-resistant strains were 19% with 58% being Italian. With the exception of 1 isolate from Italy, the penicillin-resistant strains were also ampicillin-resistant. All isolates were susceptible to association with amoxicillin/clavulanate, while 2 European ones were resistant to oxacillin. Genotypic characterization revealed that 74% of the strains had the blaZ, encoding beta-lactamase; this gene had a lower frequency only in the USA samples (35%). Moreover, 32% of the isolates were positive for erm genes. The most prevalent, ermC (22%), was detected in the Argentinian and Italian samples, followed by the ermB (11%) present in the German and South African ones. All isolates were negative for ermA and mecC genes, while the 2 European strains phenotypically oxacillin-resistant carried mecA. To conclude, the occurence of isolates with phenotypic resistance was not always proportional to the presence of the resistance genes, confirming that the detection of genes does not necessarily implicate their expression; also, multiple mechanisms of resistance may exist.


P27 - Antibiotic resistance and diagnosis of Staphylococcus pseudintermedius from milk of dairy cows.


Joanne Karzis, Department of Production Animal Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa
Inge-Marié Petzer, Department of Production Animal Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa
Edward F. Donkin, Department of Animal and Wildlife Sciences, University of Pretoria, Private Bag X20, Hatfield 0028, South Africa
Vinny Naidoo, Department of Research & Postgraduate Studies; Biomedical Research Centre, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa
Eric M.C. Etter, CIRAD, UMR Animal, Santé, Territoires, Risque et Ecosystèmes (ASTRE), Montpellier, Francee ASTRE, Univ Montpellier, CIRAD, INRA, Montpellier, France


Staphylococcus pseudintermedius has been shown to be clinically relevant in veterinary medicine, showing multi-drug resistance in dogs, cats and horses. However little work has been done on S. pseudintermedius causing mastitis in dairy cattle. From 2009 S. pseudintermedius was isolated from dairy herds in SA, but had low somatic cell counts (SCC) and were susceptible to antibiotics. However, from 2016 S. pseudintermedius with high SCC and antibiotic resistance were isolated. The aim of this study was to analyse trends of S. pseudintermedius over time and to compare the phenotypic and genotypic diagnosis.

This study analysed retrospective data of 269 S. pseudintermedius isolated from milk samples (2009 to 2017). This data was identified phenotypically and differentiated from S. aureus on maltose agar. Further diagnosis of these organisms was done using Maldi Tof (Bruker) and 16s sequencing identification (n=30). MIC testing was done (n=32), using the Microscan walk away system and M32 panels (Beckman Coulter).

This data indicated that most antibiotics available in intramammary products in SA, showed a decrease in resistance to S. pseudintermedius over time (2009 to 2017), which differed between seasons and provinces. This agreed with other similar studies done on S. aureus. The 16s identification of the 30 phenotypically identified S. pseudintermedius samples, confirmed 26 of these as S. aureus FA-1 16s/NTC 13811/ NTC 1803 and 4 as S. pseudintermedius. The MIC testing of the S. pseudintermedius samples showed resistance of all samples to ampicillin, 59% resistant to penicillin and 22% resistant to amox/K clav, cefepime, cefotaxime, cefuroxime, gentamycin, imipenem, meropenem, oxacillin and vancomycin. All the samples were negative for the cefoxitin screen.

S. pseudintermedius is now being isolated from milk of dairy cows and has shown resistance to antibiotics used in human medicine. The phenotypic identification of S. pseudintermedius differs from the genotypic.


P28 - Which factors influence farmers' choices with respect to antimicrobial dry cow therapy?


Clair L. Firth, Institute of Veterinary Public Health, University of Veterinary Medicine, Vienna, Austria
Annemarie Käsbohrer, Institute of Veterinary Public Health, University of Veterinary Medicine, Vienna, Austria
Walter Obritzhauser, Institute of Veterinary Public Health, University of Veterinary Medicine, Vienna, Austria


As part of a larger multidisciplinary research project, 250 dairy farmers were asked to complete an online questionnaire on farm management practices with respect to mastitis detection and prevention. A total of 211 farmers completed the survey (response rate 84.1%).

Of these farmers, 80.1% farmed conventionally, 19.9% according to organic methods (with restrictions on antimicrobial use). Dairy cows were primarily kept in freestalls (65.9%), although a third of all farms had tie-stalls (34.1%). With respect to highest education level, only 2.4% of farmers had obtained a university degree, 11.8% had attended a further education college, and 22.7% had gained a journeyman/master qualification, while 44.1% finished compulsory secondary school and 9.0% had completed an apprenticeship. Overall, 74.4% of farmers in this study population had agricultural qualifications (e.g. attendance at agricultural college or agricultural secondary school). The vast majority farmed full-time (72.0%), with the remainder working part-time on farm and being employed elsewhere (28.0%).

Bacteriological milk cultures were routinely sent to the laboratory by 54.5% of farmers when mastitis signs were noted. Pre-drying off laboratory checks were routinely sent in by 12.8% of farmers and by 69.7% in symptomatic cows. Blanket antimicrobial dry cow therapy (DCT) of all cows was carried out by 47.4% of farmers; a further 20.4% stated that antibiotics were used for DCT when the bacteriological milk culture was positive and 31.3% that antibiotics were used for DCT in cows with mastitis symptoms or a positive California Mastitis Test. Sending bacteriological cultures of milk to the laboratory for pre-drying off checks significantly influenced a farmer's choice of using blanket or selective DCT (Pearson's Chi-squared test, 2-sided p=0.002), whereas agricultural training (p=0.62), being a full or part-time farmer (p=0.53) or having freestalls vs. tie-stalls (p=0.36) did not.


P29 - What are Austrian cattle veterinarians' priorities when choosing antimicrobials to use on farm?


Clair L. Firth , Institute of Veterinary Public Health,University of Veterinary Medicine, Vienna, Austria
Annemarie Käsbohrer, Institute of Veterinary Public Health, University of Veterinary Medicine, Vienna, Austria
Walter Obritzhauser , Institute of Veterinary Public Health, University of Veterinary Medicine, Vienna, Austria


As part of a multidisciplinary project into mastitis management and antimicrobial use on 250 Austrian dairy farms, veterinarians from 18 practices were asked to complete an online questionnaire regarding their antimicrobial use and decision-making processes.

A total of 30 veterinarians completed the questionnaire: 24 reported that they spent at least 40% of their average working day treating dairy cattle. The responses from these 24 veterinarians are included here. Just over half (54.2%) of the respondents worked solely in large animal (i.e. farm and equine) practice, with the remainder working in mixed practice (i.e. farm, equine and companion animals). A quarter of respondents were employees in a veterinary practice, with an additional 45.8% single-handedly owning their own practice and 29.2% being partners in a group practice.

When choosing which antimicrobial to use, the most important criterion for all 24 veterinarians (100%) was the expected efficacy of the drug. The next most important criteria were the results of bacteriological culture and sensitivity testing (classed "very important" by 54.2% of respondents and "important" by 41.7%); the safety profile of the drug and whether there were any known side effects ("very important" and "important" for 45.8% each); the farmers' expectations, and the length of the withdrawal period (both: "important" for 66.7%). At the opposite end of the scale, the least important factor was reported to be application method (classed as "not important" by 33.3% of respondents, and "less important" by 41.7%). The ranking of cost varied between "important" (37.5%) and "less important" (45.8%).

The results from this small population show that Austrian cattle veterinarians are required to consider many different factors, as well as the effects of antimicrobial resistance, in their prescribing decisions.


P30 - Farmer knowledge and attitudes to mastitis in dairy cows


Lundberg Å, Växa Sverige, Stockholm, Sweden
Nyman A-K, Växa Sverige, Stockholm, Sweden
Persson Waller K, National Veterinary Institute (SVA), Uppsala, Sweden


Mastitis is the most common disease in Swedish dairy cows. To improve udder health, farmer knowledge and attitudes to risk factors are essential. The aim of the study was to gather such information from herds with different udder health status in early lactation first parity cows (FPC).

In a study on risk factors for mastitis in FPC almost 180 dairy herds affiliated to the official cow control scheme and with a minimum of 60 cows were included. The herds were classified, based on SCC at the two first test milkings after calving, as having FPC with repeatedly low SCC (100 000/ml) (HH) or high SCC at the first and low SCC at the second test milking (HL). The herds were visited once during winter of 2018 or 2019. In association with the visit the farmers were given a questionnaire on attitudes to statement on udder health. The farmer had 5 options (score 1-4 (1. do not agree, 2. agree partly, 3. agree rather much, 4. agree fully) and don't know). Differences between the 3 groups of herds will be investigated using appropriate regression models.

Preliminary data from 72 herds indicate e.g. that 76%, 38% and 73% of the LL, HH and HL herds, respectively, agreed fully or rather much that udder health was good in their herd. However, only 68%, 25% and 33% of the LL, HH and HL herds, respectively, agreed fully or rather much that the SCC was low in their herd. Moreover, 64%, 79% and 77% of the LL, HH and HL herds, respectively, agreed fully or rather much that poor udder health often depends on spread of bacteria within the herd. Overall, more than 70% of the herds agreed fully or rather much that milk leakage, dirty teats/cubicles/calving areas increase the risk for poor udder health, while many did not agree, only partly agreed or did not know if diseases in calves, housing heifers on dirty floors or housing pregnant heifers with dry cows affect udder health. This is an on-going study and more results will be presented at the conference.