Nepal Elephant TB Control and Mgt Action Plan.pdf - Elephant Care ...

Nepal Elephant Tuberculosis Control andManagement Action Plan (2011-2015)Nepal began in 2006. Culture and experimentalserological tests were used to screen elephantsat this me. One of these tests - the ElephantTBStat-Pak® (Chembio Diagnoscs, Inc, Medford,New York, U.S.A. www.chembio.com) wassubsequently licensed by the United StatesDepartment of Agriculture (USDA) in 2007 as ascreening test for TB in elephants.Cultures collected in 2006 and evaluated atthe Naonal Tuberculosis Instute (NTI) inNepal and the Naonal Veterinary ServicesLaboratories (NVSL) in Ames, Iowa, U.S. provednon-diagnosc due to contaminaon, storage,and transport issues. The same problems wereencountered when elephant respiratory sampleswere submi ed to the Nepal An-TuberculosisAssociaon (NATA) in subsequent years. Theseand other issues, such as intermi ent shedding,limit the value of culture as a primary diagnosctechnique. In Sweden, only 7 of 189 respiratorysamples collected from 5 elephants confirmedTB-infected at postmortem were cultureposive(Moller et al. 2005). In Thailand, TB wasisolated from only 2 of 60 respiratory samplescollected from confirmed TB-infected elephants(Angkawanish et al. 2010).Culture as well as molecular diagnosctechniques such as PCR is nonetheless valuableand improving the methods to apply thesetechniques to elephants remains an importantgoal. Collaboraons have been established withthe Nepal An-tuberculosis Associaon (NATA)and the Center for Molecular Diagnoscs –Nepal (CMDN) for this purpose. In 2009-2010,these laboratories confirmed Mycobacteriumtuberculosis, the human strain of TB, as thecausave agent in three elephants in Nepal.TB can be transmi ed from humans to elephantsand from elephants to humans. In 2008, over100 elephant handlers were tested for TB, butno cases of TB were detected. TB is a longtermdisease and previous handlers, no longeremployed may have been the source of infeconfor the three M.tb-infected elephants. Theseelephants may also have acquired TB from otherinfected elephants. It is presumed that elephantsin Nepal may also harbor the bovine strain of TBhowever laboratory capacity to diagnose M. bovisis limited and this has not yet been confirmed.This is an area for further research.Tuberculosis can be caused by a number ofmycobacterial species and many of these bacteriainfect mulple hosts. The recognion of TB inelephants is smulang a shi! in thinking abouthow disease is perceived. Generally zoonoses arethe concern of the public health community butTB is an anthroponosis (an infecous disease inwhich a disease causing agent carried by humansis transferred to other animals) highlighng theneed for involvement of both animal and humanhealth professionals and agencies. A furthercomplicaon in the human community has beena rise in HIV/AIDS; a disease o!en associatedwith tuberculosis which it promotes throughimmune suppression of the human host and bywhich Nepal is increasingly suffering. Therefore,a more holisc view of tuberculosis surveillanceand control is needed. This requires a muchbroader, “One-Health” (Human - Livestock -Wildlife) approach which is gaining momentumin the global health community. This paradigmtakes into account the enre epidemiologyof the disease, examines all the suscepblespecies, carriers and likely drivers of infecon andepidemics. Part of this elephant TB strategy mustbe to integrate with the other health professionsconcerned with livestock and humans, bringingthe perspecve and knowledge gained from theelephant and wildlife experiences. A One HealthNepal iniave is in the conceptual stage and TBis considered a perfect example to provide proofof concept and be er management, diagnosis,control and prevenon of the disease amongstall animal species and most importantly, humanbeings.3