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Elephant TB Initiative - Nepal TB Project

   

The Nepal Elephant Healthcare and TB Surveillance Program

 

Summary

Why TB in Elephants Must Not Be Ignored

Conservation Impact

Science: Diagnostic methods

Costs of Treatment

Nepal Elephant Veterinary Fellowship

NTNC and One Health-Nepal

ECI Elephant TB Scientific Advisory Board
More info on TB
Program Partners

Donate Now via our secure site

Previous Announcements
     Nepal: A World Leader in Addressing Tuberculosis in Elephants
     Tourism and Elephants: Why you should not be overly concerned
     The Nepal Team
     Goals and Objectives
 

Summary
 

Tuberculosis (TB) infects 11-25% of tested captive elephant populations (USA, India, Nepal).  In Nepal, Elephant Care International and partners have initiated the first comprehensive range-country testing of elephants for TB.  A treatment program for infected elephants has been launched and national elephant TB guidelines and management policies are under development.

 

TB can be managed—and must not be ignored.  It is a leading cause of death among some captive elephant populations.  By controlling TB in captive elephants, we not only save individual animals, we mitigate transmission to wild populations and humans as well. 

 

The Nepal Elephant Healthcare and TB Surveillance Program is assuring that Nepal will continue to have the patrol elephants and elephant-based tourism so important for protection of (and revenue for) its endowment of national parks and preserves.  Nepal has become a model for how a country can develop a progressive plan that:

  Protects government patrol elephants
  Protects elephant handlers
  Protects elephant-based tourism
 

Below you will find information on scientific diagnostic methods, the costs of treatment, fellowships, our Scientific Advisory Board, and project partners.  For more detailed information, please follow the internal links provided.

 

The Nepal Elephant Healthcare and TB Surveillance Program is a collaboration among the Department of National Parks and Wildlife Conservation (DNPWC), the Institute of Agriculture and Animal Science (IAAS), World Wildlife Fund - Nepal (WWF-Nepal) the National Trust for Nature Conservation (NTNC), Elephant Care International (ECI), the Cummings School of Veterinary Medicine at Tufts University (Tufts), and the Zoological Society of London (ZSL).

 

Why TB in Elephants Must Not Be Ignored

 

Seven elephants (~4% of the total Nepal population) with tuberculosis (TB) died in Nepal between 2002 and 2009. Until our Nepal elephant TB work in 2006-2008, there had been no systematic scientific study of TB in range country elephants. Thus far, 36 of 164 captive elephants (22%) in Nepal have tested positive for TB using the ElephantTB STAT-PAK® Assay, a serological test licensed by the U.S. Department of Agriculture (USDA). (See also the Science: Diagnostic Methods below)

 

 

Continuing our ground-breaking TB work is essential to avoid consequences like those experienced in South Africa where mortalities in African buffalo due to bovine TB occur at an annual rate of 11%.TB has spread to almost all the buffalo herds as well as to10 other mammalian species in only 15 years (Michel 2006) .

 

 

 

Conservation Impact

 

Captive elephants are critical to Nepal’s conservation program. They patrol the National Parks, including Chitwan, a World Heritage site that provides habitat for elephants, tiger, rhino, gaur, and other endangered species.  Private elephants engage in eco-tourism activities and generate support for the parks. Elephants in other countries have similar conservation roles.

 

The Nepal Elephant Healthcare and TB Surveillance Program safeguards tourism and reduces the potential spread of TB to wild populations by managing TB in captive elephants. The program demonstrates that TB must and can be managed.

 

Science: Diagnostic Methods

 

The principle method for evaluating Nepal’s elephants for TB has been the ElephantTB STAT-PAK® assay (Chembio Diagnostic Systems, Inc.), a serological screening test licensed by the U.S. Department of Agriculture (USDA).  Serological tests allow for early detection and treatment before shedding and spreading can occur.

 

In the past, cultures obtained from trunk wash samples was the only method available to U.S. and European zoos.  However, this method yields significant false negative results and is rendered even more difficult in Asia because of different collection and lab procedures.  In a Swedish case, TB was recovered from only 7 of 189 trunk wash samples collected from 5 elephants confirmed infected at post mortem.

 

The intradermal tuberculin skin test is not accurate in elephants and is not recommended.

 

Clinical signs may or may not be present in infected elephants.  Many elephants with no outward sign of the disease have died from TB.  Likewise, clinical signs that suggest TB (for example, weight loss) may be due to other diseases, thus emphasizing the importance of accurate testing.  

 

Costs of Treatment

     

The cost of drugs to treat one typical adult elephant averages about $3,500 (in Nepal; U.S. dollars).  This does not include the overhead costs of transportation, supervision, veterinary care, laboratory fees for monitoring treatment, and other expenses, which vary greatly depending on the number of elephants being treated, their locations, method of treatment, and other factors.

 

Nepal Elephant Veterinary Fellowship

 

Following the 2006 Nepal Elephant TB pilot study ECI established a Nepal Elephant Veterinary Fellowship to address elephant healthcare issues with a focus on TB.

 

Dr. Sarad Paudel was appointed as the first fellow in July 2007 and Dr. Thapa joined our program in December 2007. Dr. Paudel is responsible for the day to day management of program activities including TB testing; clinical and monitoring of elephants under treatment; collection and processing of laboratory and research samples; and record keeping. Dr. Thapa is now the veterinarian for the Kathmandu Zoo but continues to assist with our program.

 

NTNC and One Health-Nepal

 

In March of 2009 ECI joined One Health-Nepal, an NTNC/ZSL initiative to integrate the human, livestock, ecosystem, and wildlife health systems at the interfaces among environment, species, and multi-host diseases. One-Health Nepal will bring together government, NGO, academic, and human clinical and research resources in Nepal to address TB and other cross-species health issues.

 

In September ECI and NTNC signed a Memorandum of Understanding to jointly develop the ongoing activities of the Nepal Elephant Healthcare and TB Surveillance Program. Our lab and field office are located in the NTNC Biodiversity Center adjacent to the Chitwan National Park and in close proximity to many of the elephants. NTNC also maintains a center at Bardia that is available to our program. In this project period, NTNC staff will supervise Dr. Paudel and NTNC/ZSL will work with ECI and other partners to develop a Government of Nepal Elephant TB Control Program.

 

ECI Elephant TB Scientific Advisory Board

 

ECI established an Elephant TB Scientific Advisory Board in 2008. These recognized professionals generously volunteer their time and expertise to advise our organization on technical aspects of preventing, diagnosing, monitoring, and treating tuberculosis in elephants and elephant handlers.
 

More info on TB

 

Through this Open Access website (ElephantCare.org), ECI offers the world’s largest repository of elephant healthcare information.  A medical database and drug formulary for elephants are among featured resources. Extensive information is available about elephant TB. Please see Comprehensive reference list on TB in elephants. 

 

Program Partners

 

      Elephant Care International, USA

      WWF-Nepal

      Tribhuvan University Institute for Agriculture and Animal Science, Nepal

      Department of National Parks and Wildlife Conservation, Nepal

      National Trust for Nature Conservation, Nepal

      The Zoological Society of London (ZSL)

      Tufts Center for Conservation Medicine (Cummings School of Veterinary Medicine at
      Tufts University), USA

 

 

We have an opportunity to resolve the TB problem in elephants in Nepal, if we act decisively and in time.  Your donation will make a defined and measurable difference.

Help the elephants.  Support the Nepal TB Projectdirect your funds to this project.
This is something we can and must do.

Can you donate air miles to cover international flights?  If so, please contact us.

$200,000 will cover our entire Nepal TB Project costs and treatment of all infected Nepal elephants for one year.
Click the button below to donate the amount of your choice via our secure connection.

Our priority will be to use your contributions for the project or projects you select.  If funding for those projects is sufficient, funds will be used at our discretion for purposes consistent with our mission.  Some funds may support international projects.

 

Previous announcements
Update September 2006:
 

Nepal: A World Leader in Addressing Tuberculosis in Elephants

Nepal has taken a leadership role in dealing with this issue. The government has endorsed a nationwide program of testing all elephants (whether government or privately owned) for TB. This important testing allowed us to compare several novel new methods of diagnosis for TB. 

Most elephants have now been tested and all infected elephants safely quarantined to protect the public and to prevent further spread of this disease. Approximately 17 percent of elephants in Nepal have tested positive for TB.  With support from Elephant Care International, these elephants are being analyzed to determine specific and appropriate treatment regimens (this should prevent the development of resistance to drugs and the dreaded MDR). Additionally, a sound regimen for monitoring the health of all elephants and their handlers has been instituted.  Because of their huge size, the costs to treat elephants are substantial (about $7,500-10,000 per elephant in Nepal).

Nepal is thus a world leader in assuring its important tourism industry that Nepal is safe both for elephants and for  tourists. This model will then be expanded to other Asian elephant range countries. 

Tourism and Elephants: Why you should not be overly concerned

The U.S. Center for Disease Control (CDC) publishes its Travelers' Health: Yellow Book every two years.  Health Information for International Travel, 2005-2006 has information on risks of TB in traveling
http://www.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=tb.htm.  Though it does not mention elephants, in brief,

"To become infected, a person usually has to spend a relatively long time in a closed environment where the air was contaminated by a person with untreated tuberculosis who was coughing and who had numerous M. tuberculosis organisms (or tubercle bacilli) in secretions from the lungs or voice box (larynx). Infection is generally transmitted through the air; therefore, there is virtually no danger of its being spread by dishes, linens, and items that are touched, or by most food products."

Most elephant encounters are not in closed environments, nor for long duration, so there is at most a minor to moderate risk for contracting TB in countries that are not monitoring their elephants (once under monitored treatment, elephants stop shedding and are not infectious).  Nepal has safeguards in place and we hope other Asian elephant range countries will soon follow Nepal's example. TB is treatable in humans and can be detected by a simple skin test and follow-up diagnosis.

We would advise HIV patients, because they are immune-compromised, to avoid elephants.  We would advise all persons to avoid any sickly looking or emaciated elephants, though that alone is no guarantee as apparently healthy elephants may also have TB. 

The CDC also advises "those who could be expected to come in contact routinely with hospital, prison, or homeless shelter populations, should be advised to have a tuberculin skin test before leaving the United States. If the reaction is negative, they should have a repeat test approximately 12 weeks after returning.  We would suggest the same if you will have extended contacts with elephants, such as at an elephant training school or sanctuary.

June, 2006
The Nepal Team

Romeo is the name of this wild bull elephant in Nepal. He had just been darted to calm him down after raiding this village.

Our TB work is vitally important. Since 1994, 12 percent of Asian elephants in the U.S. have been diagnosed with TB.  Infection rates among captive elephants in Asia were unknown prior to our recent study in Nepal.  We have now determined that approximately 17 percent of Nepal's elephants are infected (now isolated and under treatment)

As noted above, TB has not yet been reported in wild elephants, but where wild and captive elephants commingle there is potential for introduction.  For example, Romeo has mated with many captive elephants in Nepal—hence his name), and could have easily become infected and introduce the disease to other wild elephants.  Thanks to the progressive TB program adopted in Nepal, we may be able to prevent this spread (if we have acted soon enough).


We must prevent the spread of TB to wild elephant populations
where diagnosis and treatment might be impossible.


This TB Project originated from work by Dr. Kamal Giri, a veterinarian studying for his Masters degree at the Institute of Agriculture and Animal Science (IAAS) in Nepal.  Here he is testing blood samples from elephants for TB with the new Elephant TB STAT-PAK®, a rapid test developed by Chembio Diagnostic Systems, Inc., Medford, NY, USA.  Kamal was instrumental in obtaining the critical CITES permits necessary to transfer samples to the U.S. for additional testing. See collaborators below.

 

 


 

Mr. Giri, Kamal's father, has managed elephant care for many years in Chitwan National Park, Nepal.  This park was the scene of many historical visits by Kings, Queens, and Princes of British Royalty.  It is now home to one of the most successful breeding centers of endangered Asian elephants.

 

 

 

Dr. Sarad Paudel  is a recent graduate from the veterinary school at IAAS.  Together with Mr. Giri and Dr. Giri, he was the translator and collected medical history information from the mahouts (elephant handlers). 

This is a collaborative project with many institutions and individuals.  A full list is here. 

 

 

December 2005
Goals and objectives
: The goal of this project is to evaluate serologic techniques ((Rapid Test (now known as Elephant TB STAT-PAK®), MAPIA, ELISA, Immunoblot)) as screening tools that will accurately and quickly identify tuberculosis-infected elephants. The specific objective is to compare results of culture (the technique currently recommended by the United States Department of Agriculture) with the four experimental serological assays.

One-third of the estimated 45,000 Asian elephants remaining on earth are captive.  The vast majority of these 15,000 elephants live in Asia where they are used for work, ceremonies, and eco-tourism. To date, captive elephants in Asian range countries have not been systematically evaluated for TB. The close proximity to humans; the high prevalence of TB among humans in range countries; and the intermingling of captive and free-ranging elephants in some areas make TB a serious threat to this endangered species.

Tuberculosis - Estimated TB prevalence -
 Asian elephant range countries compared to U.S.

Country

Year

Prevalence
per
100,000 persons

Nepal

2003

258

United States of America

2003

3

As you can see from the above chart, the prevalence of TB among humans in Nepal far exceeds that of the United States.  Since 1994, 12 percent of Asian elephants within the U.S. have been diagnosed with TB. In Nepal, researchers will sample 100 elephants from a herd that had two cases of TB identified post-mortem.  The elephant handlers will also be tested and given full treatment if they test positive for TB. 

Serological tests would reduce the time to diagnosis, decrease animal and human exposure, and provide a cost effective means to increase surveillance of TB. These improvements will lead to fewer deaths from TB (by decreased environmental contamination and exposure of the susceptible population). Importantly, these technologies have potential application to a broad range of endangered species susceptible to TB for which suitable diagnostic techniques are currently lacking.

Elephant Care International is supporting this project financially and with personnel. Dr. Susan Mikota, our co-founder and the Director of Veterinary Programs & Research, was in Nepal for the month of January in Nepal, giving oversight and assistance to veterinary students from Nepal and the U.S. in sample collection.  Drs. Mikota (ECI) and Miller (Disney's Animal Kingdom) were awarded a $4,500 Mazuri grant to fund the first phase laboratory fees of this Nepal TB Project.  We now need additional funds to complete the testing and to maintain the permanent elephant healthcare and monitoring program.

Suggested reading:

World Health Organization (WHO) TB Fact Sheet: http://www.who.int/mediacentre/factsheets/fs104/en/
Center for Disease Control: Advice for Travelers with regard to the risks of getting tuberculosis,
              http://www.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=tb.htm          

Timebomb: The Global Epidemic of Multi-Drug Resistant Tuberculosis,
                     by Lee B. Reichman, Janice Hopkins Tanne

 
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