title: Evidence and potential risk factors of tuberculosis among captive Asian elephants and wildlife staff in Peninsular Malaysia.
abstract: Elephant tuberculosis (TB) caused by Mycobacterium tuberculosis is an important re-emerging zoonosis with considerable conservation and public health risk. We conducted prospective cohort and cross-sectional studies in elephants and wildlife staff respectively in order to identify potential risk factors associated with TB in captive Asian elephants and their handlers in Peninsular Malaysia. Sixty elephants in six different facilities were screened for TB longitudinally using the ElephantTB STAT-PAK and DPP VetTB assays from February 2012 to May 2014, and 149 wildlife staff were examined for tuberculosis infection using the QuantiFERON-TB Gold In-tube (QFT) assay from January to April, 2012. Information on potential risk factors associated with infection in both elephants and staff were collected using questionnaires and facility records. The overall seroprevalence of TB amongst the elephants was 23.3% (95% CI: 13.8-36.3) and the risk of seroconversion was significantly higher among elephants with assigned mahouts [p=0.022, OR=4.9 (95% CI: 1.3-18.2)]. The percentage of QFT responders among wildlife staff was 24.8% (95% CI: 18.3-32.7) and the risk of infection was observed to be significantly associated with being a zoo employee [p=0.018, OR=2.7 (95% CI: 1.2-6.3)] or elephant handler [p=0.035, OR=4.1 (95% CI: 1.1-15.5)]. These findings revealed a potential risk of TB infection in captive elephants and handlers in Malaysia, and emphasize the need for TB screening of newly acquired elephants, isolating sero-positive elephants and performing further diagnostic tests to determine their infection status, and screening elephant handlers for TB, pre- and post-employment.
authors.affiliation: Universiti Putra Malaysia, Serdang Darul-Ehsan, Selangor 43400, Malaysia(1)(2).
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Yakubu
authors.affiliation: Universiti Putra Malaysia, Serdang Darul-Ehsan, Selangor 43400, Malaysia(1)(2); Universiti Malaysia Kelantan, City Campus, 16100 Kota Bharu, Kelantan, Malaysia. Electronic address: beelee@umk.edu.my.
authors.forename: Bee Lee
authors.initials: BL
authors.lastname: Ong
authors.affiliation: Universiti Putra Malaysia, Serdang Darul-Ehsan, Selangor 43400, Malaysia(1)(2).
authors.forename: Zunita
authors.initials: Z
authors.lastname: Zakaria
authors.affiliation: Universiti Putra Malaysia, Serdang Darul-Ehsan, Selangor 43400, Malaysia(1)(2).
authors.forename: Latiffah
authors.initials: L
authors.lastname: Hassan
authors.affiliation: Universiti Putra Malaysia, Serdang Darul-Ehsan, Selangor 43400, Malaysia(1)(2).
authors.forename: Abdul Rahim
authors.initials: AR
authors.lastname: Mutalib
authors.affiliation: Universiti Malaya Kuala Lumpur, 50603 Kuala Lumpur, Malaysia(3); Universiti Tunku Abdul Rahman, Bandar Sungai Long, 43000 Kajang, Malaysia.
authors.forename: Yun Fong
authors.initials: YF
authors.lastname: Ngeow
authors.affiliation: Ministry of Health, 62590 Putrajaya, Wilayah Persekutuan, Malaysia.
authors.forename: Khebir
authors.initials: K
authors.lastname: Verasahib
authors.affiliation: Department of Wildlife and National Parks Peninsular Malaysia, 56100 Kuala Lumpur, Malaysia.
authors.forename: Mohd Firdaus Ariff Abdul
authors.initials: MF
authors.lastname: Razak
mesh_terms: D000328:Adult; D000818:Animals; D000907:Antibodies, Bacterial / Q000097:blood; D000942:Antigens, Bacterial / Q000097:blood; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004606:Elephants; D005260:Female; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D011446:Prospective Studies; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D014376:Tuberculosis / Q000453:epidemiology* / Q000382:microbiology / Q000662:veterinary*; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial; D000942:Antigens, Bacterial
keywords: Captive Asian elephants; Peninsular Malaysia; Risk factors; Wildlife staff; tuberculosis