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

Nepal Elephant Tuberculosis ulosisControl andManagement agemenAction Plan (2011-2015)2015)that have had no known exposure to an infectedelephant or human may elect Opon 2. Opon2 may also be suitable for old elephants or asa temporary opon for pregnant elephants.Elephants in this sub-group should not workand must remain segregated from serologicallynon-reacve elephants and from wild elephantsand other wild ungulates unl they have had twonon-reacve DPP tests.Group 2 TB-suspect elephant may or may not beshedding TB organisms. Staff caring for elephantsin this group should consider personal protecon(see secon 1.6).The combinaon of a reacve Elephant TB Stat-Pak ® test and a non-reacve DPP ® VetTB testmay be due to the one of the following:1. Early sero-conversion. The elephant is trulyinfected but seroconversion on the ElephantTB Stat-Pak ® has preceded seroconversion onthe DPP. TB is a chronic disease and the body’sanbody response may vary with the stage ofthe disease which can affect test results. Furtherresearch to be er understand the elephantimmune system is on-going (Landolfi et al. 2009,Landolfi et al. 2010). In almost all cases to dateculture posive (shedding) elephants have beenreacve on both the Elephant TB Stat-Pak ® andthe DPP ® VetTB tests. While elephants thatare Elephant TB Stat-Pak ® reacve and DPP ®VetTB non-reacve are probably less likely tobe shedding they may convert to DPP ® VetTBreacve status and / or become TB cultureposiveand shed TB organisms at any me. Thishas occurred in a several cases including a case inNepal.2. Prior treatment for TB.3. In rare instances, the Elephant TB Stat-Pak ®may produce false posive results. The ElephantTB Stat-Pak ® may cross-react with certain NTMsuch as M. szulgai, which caused the death oftwo African elephants (Lacasse et al. 2007).It has been demonstrated however, that theElephant TB Stat-Pak ® and DPP ® VetTB tests donot react with 11 other NTMs nor with M. avium(Greenwald et al. 2009). In one study, only 4 of147 cases in the U.S. and Europe were consideredto be false-posives (Greenwald et al. 2009).Group 3. TB-infected. An elephant that is reacveon the Elephant TB Stat-Pak ® and the DPP ®VetTB tests and /or from which M. tuberculosiscomplex organisms have been idenfied byculture or molecular techniques.• Segregate according to procedures in Secon1.4.• Collect respiratory samples for culture andmolecular diagnoscs (see procedure below)before iniang treatment.• If culture is posive perform drug sensivitytesng.• Iniate treatment as soon as possible andsuspend work and public contact unl theelephant has completed 90 consecuve daysof treatment (90 full doses). Treat accordingto protocols in secon 1.5• Elephants that have a posive culture areknown to be shedding, are a higher risk totransmit TB and should be segregated for theduraon of treatment.• Instute precauons to protect human health.• Document that treatment is carried out inaccordance with these guidelines. The TBPlan Veterinary Officer will be responsible formonitoring treatment.• Monitor post-treatment with culture andmolecular techniques as the Elephant TB Stat-Pak ® test will remain reacve for some me.6