title: Point prevalence and incidence of Mycobacterium tuberculosis complex in captive elephants in the United States of America.
abstract: BACKGROUND
  Captive elephants infected with tuberculosis are implicated as an occupational source of zoonotic tuberculosis. However, accurate estimates of prevalence and incidence of elephant tuberculosis from well-defined captive populations are lacking in the literature. Studies published in recent years contain a wide range of prevalence estimates calculated from summary data. Incidence estimates of elephant tuberculosis in captive elephants are not available.
  
  
  OBJECTIVE
  This study estimated the annual point prevalence, annual incidence, cumulative incidence, and incidence density of tuberculosis in captive elephants within the USA during the past 52 years.
  
  
  METHODS
  We combined existing elephant census records from captive elephants in the USA with tuberculosis culture results obtained from trunk washes or at necropsy. This data set included 15 years where each elephant was screened annually.
  
  
  RESULTS
  Between 1960 and 1996, the annual point prevalence of tuberculosis complex mycobacteria for both species was 0. From 1997 through 2011, the median point prevalence within the Asian elephant population was 5.1%, with a range from 0.3% to 6.7%. The incidence density was 9.7 cases/1000 elephant years (95% CI: 7.0-13.4). In contrast, the annual point prevalence during the same time period within the African elephant population remained 0 and the incidence density was 1.5 cases/1000 elephant years (95% CI: 0.7-4.0).
  
  
  CONCLUSIONS
  The apparent increase in new cases noted after 1996 resulted from a combination of both index cases and the initiation of mandatory annual tuberculosis screening in 1997 for all the elephants. This study found lower annual point prevalence estimates than previously reported in the literature. These discrepancies in prevalence estimates are primarily due to differences in terminology and calculation methods. Using the same intensive testing regime, the incidence of tuberculosis differed significantly between Asian and African elephants.
  
  
  CONCLUSIONS
  Accurate and species specific knowledge of prevalence and incidence will inform our efforts to mitigate occupational risks associated with captive elephants in the USA.
authors.affiliation: Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Feldman
authors.forename: Ramiro
authors.initials: R
authors.lastname: Isaza
authors.forename: Cindy
authors.initials: C
authors.lastname: Prins
authors.forename: Jorge
authors.initials: J
authors.lastname: Hernandez
mesh_terms: D000818:Animals; D004606:Elephants; D015994:Incidence; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D015995:Prevalence; D013045:Species Specificity; D013997:Time Factors; D014376:Tuberculosis / Q000453:epidemiology / Q000382:microbiology / Q000662:veterinary*; D014481:United States / Q000453:epidemiology