Mycobacterium avium subsp. paratuberculosis (MAP) causes a chronic infection in cattle. MAP infected cattle with humoral immune (HI) reactions with IgG antibodies are usually those where latency of infection has ceased and their infection is progressing towards reduced milk yield, weight loss and significant bacterial excretion in feces. The proportion of detectable infections among all infected animals that will develop disease is often referred to as ‘the tip of the iceberg’. The purpose of this study was to estimate this proportion. Test-records from 18,972 Danish dairy cows with MAP specific IgG antibodies on their final test-record were used to estimate age-specific sensitivities (Se). These cows were the infected ones considered to develop disease in a population with a representative age-distribution and were defined as cases. The specificity (Sp) of the test was estimated based on test-results from 166,905 cows, which had no MAP IgG antibodies in their final four test-records. The Sp, age-specific Se and maximum Se were used to estimate the probability of having HI at a given age resulting in the proportion of infected cows with HI at a given age. For cows 2 years of age, the proportion of detectable cases was 0.33, while it was 0.94 for cows 5 years of age. Thus, there was a significant shift in the tip of the iceberg with aging. This study provided a model for estimating the proportion of latent chronic infections that would progress to disease, and the results can be used to model infection dynamics.
Nielsen, S. S., Toft, N., & Okura, H. (2013). Dynamics of specific anti-Mycobacterium avium subsp. paratuberculosis antibody response through age. P L o S One, 8(4), [e63009]. https://doi.org/10.1371/journal.pone.0063009