Article thumbnail

Elephant-to-Human Transmission of Tuberculosis, 2009

By Rendi Murphree, Jon V. Warkentin, John R. Dunn, William Schaffner and Timothy F. Jones


In 2009, the Tennessee Department of Health received reports of 5 tuberculin skin test (TST) conversions among employees of an elephant refuge and isolation of Mycobacterium tuberculosis from a resident elephant. To determine the extent of the outbreak and identify risk factors for TST conversion, we conducted a cohort study and onsite assessment. Risk for conversion was increased for elephant caregivers and administrative employees working in the barn housing the M. tuberculosis–infected elephant or in offices connected to the barn (risk ratio 20.3, 95% confidence interval 2.8–146.7). Indirect exposure to aerosolized M. tuberculosis and delayed or inadequate infection control practices likely contributed to transmission. The following factors are needed to reduce risk for M. tuberculosis transmission in the captive elephant industry: increased knowledge about M. tuberculosis infection in elephants, improved infection control practices, and specific occupational health programs

Topics: Research
Publisher: Centers for Disease Control and Prevention
OAI identifier:
Provided by: PubMed Central

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.

Suggested articles


  1. A multiantigen print immunoassay for the development of serological diagnosis of infectious diseases.
  2. (2008). American region studbook for the African elephant. Azle (TX): Indianapolis Zoo;
  3. (2007). Association of Zoos and Aquariums. Asian elephant North American regional studbook update.
  4. (2005). Controlling tuberculosis in the United States. Recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR Recomm Rep.
  5. (1999). Diagnostic standards and classifi cation of tuberculosis in adults and children. This offi cial statement of the American Thoracic Society and the Centers for Disease Control and Prevention was adopted by the ATS Board of Directors,
  6. disease and tuberculosis in elephants. In:
  7. Epidemiology and diagnosis of Mycobacterium tuberculosis in captive Asian elephants (Elephas maximus).
  8. (2005). Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings,
  9. (1982). Hazel elephant redux. Am Rev Respir Dis.
  10. Highly accurate antibody assays for early and rapid detection of tuberculosis in African and Asian elephants. Clin Vaccine Immunol.
  11. (2002). Human exposure following Mycobacterium tuberculosis infection of multiple animal species in a metropolitan zoo. Emerg Infect Dis.
  12. (1998). Mycobacterium tuberculosis infection as a zoonotic disease: transmission between humans and elephants. Emerg Infect Dis.
  13. (2001). Mycobacterium tuberculosis risk for elephant handlers and veterinarians. Appl Occup Environ Hyg.
  14. (1975). Occurrence of tuberculosis in zoo mammals; a critical evaluation of autopsy material from 1970 to the beginning of 1974 [in German]. Dtsch Tierarztl Wochenschr.
  15. Pulmonary Mycobacterium tuberculosis infection in a circus elephant.
  16. Report on the Indian elephant which died in the society’s gardens
  17. (2008). Teaching “one medicine, one health.” Am
  18. (2003). The National Tuberculosis Working Group for Zoo and Wildlife Species. Guidelines for the control of tuberculosis in elephants
  19. (1973). Tuberculosis in a domesticated Asiatic elephant Elephas maximus. Vet Rec.
  20. Tuberculosis in elephants: antibody responses to defi ned antigens of Mycobacterium tuberculosis, potential for early diagnosis, and monitoring of treatment. Clin Vaccine Immunol.
  21. (2008). Tuberculosis in elephants. In: