Sharing clinical cases amongst elephant veterinatians and caretakers will increase our knowledge, so we can treat elephants better. Knowledge Elephant medicine is a specialism that is usually obtained after many years of working with elephants. Compared to the amount of literature that is available for equine practicioners, the amount of literature about elephant medicine is very limited. Recognition On this website we collect clinical data from field workers in range countries and zoos. By showing these experiences on this website, we hope to help you, veterinarians and elephant care takers, when you are confronted with a clinical problem. Maybe you recognize similar symptoms and syndromes in your sick animal and learn how your case might be treated. Sharing By using the contact button, you can share your information and questions with us, so we can add new opinions to the existing case reports or add a new report. WHY THIS WEBSITE?

EEHV hemorrhagic disease in elephants is often fatal as a result of DIC. Antibody assays and PCR monitoring may help to treat affected elephants in an early stage. This page describes the virus, the disease, its treatment, plasma transfusion, cross matching and standing sedation. To infectious diseases Elephant Endotheliotropic Herpes Virus-Hemorrhagic Disease (EEHV-HD) Compiled by Willem Schaftenaar History: EEHV-HD is caused by a delta-herpesvirus. The virus has evolved with the elephant species and is older than the currently living elephant species. Most (if not all) adult elephants are latently infected with EEHV. Young elephants between 1 and 9 years of age can be susceptable for an often fatal syndrom: EEHV-Hemorrhagic Disease. It is hypothesized that the long half-lifetime of maternal antibodies (EEHV maternal antibodies can circulate for up to 36 months in a calf) protects the calf against developing this syndrome. If this is true, it means that calves need to be exposed to EEHV during the phase in which antibodies are decreasing, but still protecting the calf. Fatal cases in Asian elephants have been reported over 20 times more than in African elephants. One of the hypotheses is that African elephant are shedding the virus much more frequent than Asian elephants, which offers a better opportunity for the calf to build up a solid immunity during the period that it is still protected by maternal antibodies. Asian elephants can carry EEHV1a, EEHV1b, EEHV4 and EEHV5, of which EEHV1a has caused the vast majority of the fatal cases. African elephants can carry EEHV2, EEHV3a, EEHV3b, EEHV6 and EEHV7. EEHV3 and EEHV6 have been associated with fatal cases, while the other African EEHV-subtypes are associated with lymphoid nodules in lungs and skin of African elephants. There is one report of a fatal case caused associated with EEHV3 in an Asian elphant. Like all herpesviruses, EEHV has a latent phase in a so far unknown tissue of the elephant body. For reasons that are not yet known, the virus can be reactivated, probably due to a (temporary) weakening of the elephant's immune system. The virus migrates to the mucous membranes of the mouth, trunk, eyes and the female genital tract. Shedding in semen or mucous membranes of the penis has not yet b een reported. Shedding has been observed in a zoo-kept herd of Asian elephants after the introduction of a bull and on a second occasion after the introduction of 2 females (Titus, 2022). In another zoo, 2 young Asian elephant calves died of EEHV1 within 2 weeks after the introduction of a breeding bull (Dublin zoo, 2024). Both calves appeared to have no antibodies against EEHV1a and EEHV1b. These findings suggest that the introduction of adult elephants in a herd can induce virus reactivation and consequently virus shedding. (Maternal) antibodies Humoral antibodies can be demonstrated by using recently developed antibody assays. A fluorescence based assay (Lips assay) has become available in the USA (Fuery, 2020) and an ELISA-based assay in the Netherlands (Hoornweg, 2021 ) . Serological studies using these assays demonstrated that maternal antibodies remain circulating for up to 36 months in elephant calves (Fuery, 2020). These maternal antibodies are transmitted in the uterus. The long period during which they are circulating at high levels in a young elephant, suggests that this species is able to absorb antibodies excreted by the dam in her milk. This is also suggested by Takehana et al 2024 , who described that the antibody level in a bottle-fed elephant calf decreased within 14 months as compared to 2 other calves in the same herd, in which antibodies remained high for more than 2 years. However, this hypothesis still needs to be proven. EEHV-subspecies and subtype-specificity has been demonstrated for these assays (Hoornweg, 2023 ) . Another finding was that antibodies against EEHV4 were not protective against fatal EEHV1a infections, while antibodies against EEHV1a seem to protect against illness caused by EEHV4 and EEHV5. Hoornweg et al. studied 23 fetal EEHV-HD cases in European zoos and found that all fatalities had low antibody levels against gH/gL of the EEHV (sub)species they succumbed to (Hoornweg, 2024) . During the first 12 months of life, maternal antibodies seem to remain stable at a high level, which seems to protect the calf from developing Hemorrhagic Disease when infected by EEHV. This may explain why clinical EEHV-cases have never been reported below the age of 1 year. This has lead to the hypothesis that young elephants need to be exposed to EEHV while they are still (partly) protected by maternal antibodies. Shedding of EEHV by herd mates is therefore essential for the calf to build up natural immunity. In an elephant that is permanently infected with EEHV, shedding takes place after reactivation of EEHV. In 2 elephant orphanages in Sri Lanka (31 and 93 elephants), all calves had high levels of EEHV-gB antibodies. These 2 institutions never lost a calf to EEHV-HD. This leads to the conclusion that the larger herd sized in these 2 orphanages (compared to zoos increases the likelihood of cantact between EEHV-shedders. Herpes viruses in general can become reactivated during a stressful situation, when the immune system of the host seems to become weaker, possibly under the influence of endogenous glucocorticosteroids. Specific stress inducers that result in EEHV-reactivation are not yet known for elephants. It is tempting to hypothesize that social stress could be one of those factors, as elephants are highly social animals. Zoos generally try to avoid stress situations for their animals, including elephants, especially when there is a young calf in the herd. In the light of the recent findings, the absence of stress might as well work against the development of acquired immunity against EEHV in young calves. The same hypothesis could be valid for elephants in wild situations: if social stress factors are absent in some of the wild situations (less contact with other herds due to habitat fragmentation, less contact with bulls in musth), reactivation frequency of EEHV may be reduced in (sub)adults, preventing calves younger than 12 months from building up immunity during the crucial time frame when they are still protected by maternal antibodies. Clinical signs and diagnosis: 10-14 days before the elephant shows clinical signs of EEHV-HD, the presence of the virus can be demonstrated in the blood by qPCR (EDTA blood sample). It is important to monitor the presence of EEHV in calves between 1 and 9 years of age on a weekly base. As soon as the presence of EEHV has been confirmed, the number of monocytes and platelets are indicative for the further development of the virus in the days to come. When monocytes and platelets are stable and the viral load remains below 5.000 Viral Genome Equivalents (VGE's)/ml, close observation is required. As soon as the viral load in the blood increases or monocytes or platelets drop, immediate treatment is required. If the initial viremia has passed unnoticed, the young elephant may display one or more of the following unspecific symptoms: lethargy, reduced appetite, lameness, abnormal sleeping pattern, soft feces. In more advanced cases petechiae are seen on the tongue, edema on the head and front legs and finally cyanosis (purple tongue). Sometimes the severe symptoms are the first ones to be discovered. Photo: courtesy of Florence Ollivet-Courtois The most relevant tools needed for the diagnosis of EEHV-HD are: qPCR and total WBC, platelet count and blood smear (manual count of monocyte and heterophyls). The monocyte/heterophil (M/H) ratio is an important prognostic indicator for EEHV-HD. A ratio below 1 is reason for great concern and immediate treatment should be started. Blood smears are essential for manual differentiation of the white blood cells and recognition of the morphology. Note that the presence band-heterophils in young elephants is a bad sign! Lactate is an important serum parameter to monitor in a EEHV-HD case. Normal values are between 0--0.11 mmol/L (0-1 mg/dL). Values >0.44 mmol/L (4 mg/dL) are indicative for perfusion problems due to DIC (see below). EEHV-HD patients often have lactate value > 0.22 mmol/L (2 mg/dL) (Wiedner, pers. comm. 2022). Reports from Thailand suggest that a (primary?) infection with EEHV4 is generally associated with intestinal problems (Kittisirikul, 2025). At rectal examination, edema of the rectal mucosa can be diagnosed. This finding is supported by histopathological findings in fatal EEHV-HD cases ( Sripiboon, 2013) . Disseminated Intravascular Coagulopathy (DIC) One of the main reasons an EEHV infection can lead to severe illness or death is the development of DIC in young calves that are not adequately protected by (maternal) antibodies. DIC results from a severe, dysregulated immune response triggered when endothelial cells are damaged by the virus (endothelial glycocalyx degradation). Two independent studies have clearly demonstrated the occurrence of DIC in fatal cases of EEHV-HD (Guntawang, 2021; Perrin, 2021). In the treatment protocol for EEHV-HD, addressing DIC is a top priority. Cytokine Storm? In recent years, researchers have questioned whether a cytokine storm—described in human hemorrhagic fevers such as Ebola and Dengue—also plays a role in the development of EEHV-related DIC in elephants. A recent study reported a significant increase in interleukin-6 (IL-6) and interleukin-10 (IL-10) levels in the tissues and blood of six elephants suffering from clinical EEHV1a-HD (Hoornweg, 2025). Moreover, 2 elephants with clinical EEHV1a-HD that were treated with glucocorticosteroids, had lower serum levels of IL6 and IL10 than those that were not treated and even lower than the assumed reference level. Both elephants survived the clinical EEHV-HD infection. Elevated levels of these two interleukins are commonly associated with cytokine storms, suggesting that this phenomenon may also occur in EEHV-HD. These findings support the theory that the administration of glucocorticosteroids are indicated in the early phase of the hemorrhagic disease. Photo: courtesy African Lion Safari Park Photo: courtesy Amersfoort Zoo Pathological findings at necropsy The most prominent signs of EEHV-HD at necropsy are those that resulted from DIC: cyanosis of the tongue, subcutaneous edema, hemorrhages in most of the organs, joints and muscles, ranging from petechiae to large hematomas. There may also be a hydro-or hemopericardium. Especially in the case of EEHV4, the cecum and colon can be congested, hemorrrhagic and containing abnormal watery dark-brown content. Hemorrhages in the heart, intestines, brain and liver of a yound elephant that died of EEHV1a-HD. Photos by Arun Zacharia Coinfection of EEHV-HD and Clostridium perfringens α, βand ε. One report describes a coinfection of EEHV4 and Clostridium perfringens in a 7-month-old Asian elephant bull calf (Boonsri et al., 2018). The animal died within 2 days after the onset of the first clinical signs. At necropsy, basophilic intranuclear inclusion bodies were identified in the endothelial cells of blood vessels in the heart, lungs, liver, and spleen. This finding is indicative of a primary EEHV4 infection, despite the calf being suckled by its mother. Under normal circumstances, maternally derived antibodies would be expected to confer partial protection; however, this protection may have been insufficient, possibly due to a lack of prior immunity in the dam. Alternatively, the concurrent C. perfringens infection may have predisposed the calf to viral disease by compromising mucosal barriers or inducing systemic stress, thereby reducing the effectiveness of existing maternal antibodies against the virulence of the virus. The same authors also describe a coinfection involving EEHV1a and C. perfringens in a 3-month-old, female, wild-born Asian elephant that died within 6 hours after the onset of clinical signs. Although samples from the heart, lungs, liver, and spleen tested positive for EEHV by polymerase chain reaction, no intranuclear inclusion bodies were observed upon histopathological examination. This discrepancy suggests that, in this case, maternally derived antibodies may have partially inhibited viral replication within endothelial cells, thereby preventing the formation of characteristic inclusion bodies. Nevertheless, the rapid clinical deterioration indicates that other pathogenic mechanisms, potentially including the effects of C. perfringens toxins, may have played a decisive role in the fatal outcome. Taken together, these cases highlight the potential for synergistic interactions between EEHV and C. perfringens infections. Such interactions may exacerbate disease severity through combined effects on vascular integrity, immune function, and systemic homeostasis. Click here for the EAZA elephant TAG EEHV treatment protocol Treatment of EEHV-HD Early treatment of EEHV-HD is essential for the survival of the elephant. The list of recommended drugs is shown below. The clinician should not hesitate to administer all these drugs and should even sedate the sick elephant if needed for its treatment. Repetitive sedations have been given to sick calves without negative effects. If butorphanol is used to obtain sedation, it should not be antagonized as it will help to relieve the pain in the patient. Circulatory support: Rectal fluids: Luke-warm water 10-20 ml/kg BW TID or QID, up to every 2 hours NB: As repeated rectal fluid administrations may be needed, the anus of the elephant may become sensitive to these procedures. Rx: mix 15 ml lidocaine 2% with some lubricant and carefully apply on the anus. Wait for 10 minutes before placing the tube in the rectum for the administration of fluids. Repeated rectal exploration may be cause painful irritation of the anal sphincter and perianal skin. Adding lidocain to the lubricant may facilitate the exploration. Crystalloids: IV as a bolus of 0.3-4 ml/kg BW When blood or plasma is available, the administration of those products has preference over crystolloids. Whole blood transfusion: Indicated in case of anemia or severely delayed coagulation. The advantage of whole blood administration lays in the rapid availability: no waiting time for preparing plasma. A practical strategy is to collect sufficient blood from a donor elephant to make it available for whole blood (1-2 L) and save the rest to prepare it for plasma transfusions. Dosage whole blood transfusion: 1-2 L. Cross matching needs to be done prior to the transfusion. Plasma transfusion: IV bolus of 0.5-2 ml/kg BW (after minor cross matching of donor and recipient blood) For plasma transfusion in elephants see: Emergency care for elephants clinically ill from Elephant Endotheliotropic Herpes Virus–hemorrhagic disease (EEHV-HD, EAZA Elephant TAG, compiled by Fieke Molenaar (ZSL-Whipsnade zoo), Mads Bertelsen and Kathryn Perrin (Copenhagen zoo), Imke Lueders (GEOLifes), Lauren Howard (Houston zoo), Willem Schaftenaar (vet adv. EAZA Elephant TAG, 9 February 2021) Plasma is currently considered one of the best supportive therapies to provide, as platelets, clotting factors and potentially protective antibodies can thus be provided. Note that the freezing process activates platelets, which may render them useless at the time of transfusion. Therefore - where possible - freshly collected plasma is preferred. The following should be considered for plasma transfusions: If frozen plasma is available, this can be given in an early stage of the disease to save time (despite the activated and spent platelets). Blood collection from an adult elephant (plasma donor) should be initiated to provide fresh plasma as soon as possible. Cross-matching the donor animals with the recipients, especially if one donor will be used on multiple occasions. For more information about plasma transfusion: click here Anti-inflammatory treatment : Gluco-corticosteroid drugs are indicated in case of suspicion of DIC. Recent research could demonstrate an increase of interleukin 6 (IL6) and interleukin 10 (IL10) in tissues of elephants that succumbed to EEHV-HD and below-normal levels in blood of 2 survivors that were treated with glucocorticosteroids (Hoornweg, 2025). Dexamethasone: Used in 2 EEHV1a-HD survivor cases: Case 1: started with 0.2 mg/kg (200 mg) IV and continued daily for 12 days (final dose 0.007 mg/kg = 7 mg). Case 2: 2 mg/kg iv SID for 5 days, followed by 1 mg/kg iv SID for 2 days Triamcinolon : 0.067 mg/kg IV SID for 1-3 days (used in 1 EEHV1a-HD survivor case). Methylprednisolone sodium succinate: 0.5 mg/kg IV or IM; much higher doses are used for treatment of shock in horses: 10 - 20 mg/kg IV. Please note that in human medicine DIC (e.g. in Covid-19 cases) is treated with Dexamethasone 0.1mg/kg SID for 7-10 days ( https://www.who.int/news-room/q-a-detail/coronavirus-disease-covid-19-dexamethasone#:~:text=Recommendation%201%3AWHO%20strongly,medication%20for%20another%20condition .) Antiviral treatment: Several antiviral drugs are routinely used, although none of these have proven to be effective; preliminary studies are suggesting that the TK-gene of EEHV does not make the virus sensitive for the group of “ciclovirs” that is currently used. Famciclovir has been used most frequently, followed by ganciclovir. In the absence of the former antivirals, aciclovir has been given in several cases. Famciclovir: 15 mg/kg orally or rectally, TID Aciclovir: 15 mg/kg BID orally, rectally or IV (Ganciclovir: 5 mg/kg BW BID 5 mg/kg IV, BID, each dose given slowly diluted in 1 liter of NaCl. NB Ganciclovir is not preferred, as it is considered a potential human carcinogen, teratogen, and mutagen) Antibiotic treatment: A broad-spectrum antibiotic is recommended as the integrity of the intestinal wall may be disrupted and gut bacteria may leak into the abdominal cavity. Pain management: Pain management (opioids, NSAIDs) is recommended if there are clear signs of pain or discomfort Butorphanol (first choice): 0.008-0.014 mg/kg IM Q 4 hrs Flunixin: 0.25 to 0.5 mg/kg IM SID Omeprazole: 0.7 to 1.4 mg/kg PO SID Immunostimulating drugs: Immunostimulants have been used in one case of EEHV1a-HD: Interferon alpha 2a or 2b (25 mIU/2.5 ml Intron A, Merck or 4.5 mIU/0.5 ml Roferon A, Roche) were administered at 27–33 mIU intramuscularly once a day on days 1–12 then every 48 hours to day 20, administered by dart on days with no treatment session, incomplete delivery on days 8 and 14. Bacterial plasmid DNA in a liposome carrier (Zelnate DNA immunostimulant, Bayer HealthCare LLC) was given to the same elephant (2 ml intramuscularly on days 0, 4, 7 and 12). It should be noted that the same elephant was also given anti-inflammatory treatment (dexamethasone). WS personal note: It should also be noted that interferon levels are expected to be elevated in case of a cytokine storm. As there is no scientific proof of the benefits of interferon treatment in EEHV-HD, care must be taken to use any interferon-containing drug formulation! Adjunctive drugs: Oxygen should always be standby and administered as soon as signs of hypoxemia are seen. Furosemide (1 mg/kg IM ) has been given occasionally. Vitamin C, routine used in Asia (dos age depends on product; use equine dose). Vitamin E (dosage depends on product; use equine dose). Monitoring the course of the disease: The serum lactate level gives an indication of the organ perfusion. In EEHV-HD patients, the lactate level is often higher than 2 mmol/L (normal value: 0-1 mmol/L). Rehydration by the fluid administrations will help to decrease an elevated lactate. Platelet counts during the treatment course are helpfull in evaluating the success of the treatment. The administration of whole blood and plasma will compensate partly the loss of platelets and also provide antibodies if the donor is an adult elephant. It is advisable to make sure that the donor does have antibodies. Blood pressure : in severe EEHV-case, the blood pressure may decrease or decrease. Fluid administration may help to stabilize the blood pressure. When the patient has a vascular shock, the blood pressure may be low. A fast administered bolus of rectal fluids (0.5-5 ml/kg BW) within 15-30 minutes may help to increase the blood pressure. To standing sedation Treatment of EEHV-HD Cross-matching procedure Based on design elaborated by Houston Zoo, Inc. Step one: Prepare a 3-5% red cell suspension. 1. Collect blood from both donor and recipient in EDTA. 2. Centrifuge the tube and separate the plasma from the red cells. Save both. 3. Place 1 drop of recipient red cells into a small (2-5 ml) clean test tube. 4. Add approx. 1-2 ml of normal saline to the tube with the red cells (or 1 drop RBC to 40 drops saline) 5. Centrifuge at 2500 RPM for 20 seconds. 6. Remove the supernatant, leaving the red cell button on the bottom. 7. Repeat steps 4-6 three times (for a total of 4 washes). 8. Add 1 drop of newly washed recipient red cells to a new test tube. 9. Add approximately 20-40 drops of saline and mix to suspend the red cells. This should be an approximate 3-5% cell suspension to work with. Step two: Minor cross-match (for plasma transfusion). 1. Add 1 drop of the recipient’s 3-5% red cell suspension to a labeled test tube. Add 1 drop of the recipient’s 3-5% red cell suspension to another labeled test tube to be used as a control. 2. Add 2 drops of donor plasma or serum to the test tube. 3. Add 2 drops of saline to the control tube. 4. Incubate these tubes at 37oC for 15 minutes. 5. Centrifuge the tubes for 20 seconds at 2500 RPM. 6. Observe the supernatant for signs of haemolysis. If present in the cross-match tube and not the control tube, the match is not compatible. If present in both, start again with a new cell suspension. 7. If no haemolysis, then gently rock the test tube back and forth to re-suspend the cell button. Observe the cell button while rocking the tube and grade for the presence of agglutination. Grade on a 0-4 scale where 0 is no agglutination and 4 is heavy clumping. Record your results. Step three: Major cross-match (for whole blood transfusion). 1. Add 1 drop of the donor’s 3-5% red cell suspension to a labeled test tube. Add 1 drop of the donor’s 3-5% red cell suspension to another labeled test tube to be used as a control. 2. Add 2 drops of recipient’s plasma or serum to the test tube. 3. Add 2 drops of saline to the control tube. 4. Incubate these tubes at 35-37oC for 15 minutes. 5. Centrifuge the tubes for 20 seconds at 2500 RPM. 6. Observe the supernatant for signs of haemolysis. If present in the cross-match tube and not the control tube, the match is not compatible. If present in both, start again with a new cell suspension. 7. If no haemolysis, then gently rock the test tube back and forth to re-suspend the cell button. Observe the cell button while rocking the tube and grade for the presence of agglutination. Grade on a 0-4 scale where 0 is no agglutination and 4 is heavy clumping. Record your results. Anchor 1 References: Boonsri K, Somgird C, Noinafai P, Pringproa K, Janyamethakul T, Angkawanish T, Brown JL, Tankaew P, Srivorakul S, and Thitaram C. 2018. Elephant Endotheliotropic Herpervirsus associated with Clostridium perfringens infection in two Asiane elephants ( Elephas maximus ) calves. Journal of Zoo and Wildlife Medicine 49(1): 178–182, 2018 Fuery, A, Pursell,T., Tan, J, Peng, R, Burbelo, P.D., Hayward, G.S., Ling, P.D.2020. Lethal Hemorrhagic Disease and Clinical Illness Associatedcwith Elephant Endotheliotropic Herpesvirus 1 Are Caused by Primary Infection: Implications for the Detection of Diagnostic Proteins. J. Vir. Volume 94 Issue 3. Guntawang T, Sittisak T, Kochagul V. ,Srivorakul S., Photichai K., Boonsri K., Janyamethakul T., Boonprasert K., Langkaphin W.5, Chatchote Thitaram C. and Pringproa K. 2021. Pathogenesis of hemorrhagic disease caused by elephant endotheliotropic herpesvirus (EEHV) in Asian elephants (Elephas maximus ). Scientific Reports (2021). 11:12998. https://doi.org/10.1038/s41598-021-92393-8 Hoornweg TE, Schaftenaar W, Maurer G, van der Doel PB, Molenaar F, Chamour-Galante A, Vercammen F, Rutten V and de Haan CAM. 2021. Elephant Endotheliotropic Herpes Virus is omnipresent in elephants in European zoos and an Asian elephant range country. Viruses 2021, 13, 283. https://doi.org/10.3390/v13020283. Hoornweg TE, Perere VP, Karunarathne NS, Schaftenaar W, Mahakapuge AN, Kalupahana AN, Rutten VPMG, de Haan CAM. 2022 . Young elephants in a large herd maintain high levels of elephant endotheliotropic herpesvirus-specific antibodies and do not succumb to fatal haemorrhagic disease. Transboundery and Emerging Diseases 69-5 . https://doi.org/10.1111/tbed.14644. Hoornweg TE, Schaftenaar W, Rutten VPMG, de Haan CAM. 2024. Low gH/gL (Sub)Species-Specific Antibody Levels Indicate Elephants at Risk of Fatal Elephant Endotheliotropic Herpesvirus Hemorrhagic Disease. Viruses. 2024; 16(2):268. https://doi.org/10.3390/v16020268. Hoornweg TE, Schaftenaar W, IJzer J, Mulder MMP, Lugtenburg M, van Beest A, de Haan CAM and Rutten VPMG (2025) Elevated IL-6, IL-10, and IFN-g levels in fatal elephant endotheliotropic herpesvirus – hemorrhagic disease cases suggest an excessive proinflammatory cytokine response contributes to pathogenesis. Front. Immunol. 16:1645752. doi: 10.3389/fimmu.2025.1645752 Howard L.L. & Schaftenaar W. 2017. Elephant Endotheliotropic Herpes Virus. In: Fowler’s Zoo and Wild Animal Medicine Current Therapy, Volume 9. Kittisirikul N, Angkawanish T, Langkaphin W, Chaopong O, Thaitam B and Sripiboon S. 2025 Challenging management of clinical EEHV4 infection in an adult Asian elephant. 21st International Elephant Conservation and Research Symposium. Fort Worth IEF, December 5-8. Luz S & Howard L.L. 2017. Elephant Endotheliotropic Herpesvirus (EEHV) in Asia. Recommendations from the 1st Asian EEHV Strategy Meeting (On behalf of the Asian EEHV Working Group), second edition. Perrin KL, Kristensen AT, Bertelsen MF, Denk D. 2021. Retrospective review of 27 European cases of fatal elephant endotheliotropic herpesvirus‑haemorrhagic disease reveals evidence of disseminated intravascular coagulation. Scientific Reports (2021) 11:14173, https://doi.org/10.1038/s41598-021-93478-0. Sripiboon S, Tankaew P, Lungka G and Thitaram C. 2013. The occurrence of Elephant Endotheliotropic Herpes Virus in captive Asian elephants (Elephas maximus ): first case of EEHV4 in Asia. Journal of Zoo and Wildlife Medicine 44(1): 100–104, 2013. Takehana K, Hoornweg TE, Schaftenaar W), Rutten VPMG, de Haan CAM, Matsuno K. 2024. Elephant endotheliotropic herpesvirus gB-specific antibody levels in sera of Asian elephants (Elephas maximus) in Japanese zoos. J Vet Med Sci 86(12): 1279–1283, 2024 doi: 10.1292/jvms.23-0503. Titus SE, Patterson S, Prince-Wright J, Dastjerdi A, Molenaar FM. 2022. Effects of between and within Herd Moves on Elephant Endotheliotropic Herpesvirus (EEHV) Recrudescence and Shedding in Captive Asian Elephants (Elephas maximus ). Viruses, 14(2) 2022. doi:10.3390/v14020229. Wissink N. et al. 2018. Using in-house hematology to direct decisionmaking in the successful treatment and monitoring of a clinical and subsequently subclinical case of Elephant Endotheliotropic Her Vitus 1B. J. of Zoo and Wildlife Med., 50(2): 498-502 For more information see: http://eehvinfo.org/ To page top

The dermatology-page will direct you to the chapters about skin wounds, skin abscesses, skin infections, tempral gland infection and temporal gland surgery. To case report index Dermatology Skin wounds Abscesses (needs your input) Skin infections (needs your input) Cutaneous filariasis Vaginal vestibulotomy Temporal gland impaction Temporal gland impaction/surgery

An adult Asian elephant suffered form a severe infection of Salmonellosis (S. saintpaul). It went down and was unresponsive. Hematology and treatment results are discussed. To Salmonellosis Next case Next case Case Report Next case Salomonella saintpaul septicemia in an adult Asian elephant Next case Date: 2021 Location: Italy (zoo) Submitted by: Fieke Molenaar DVM and Pasqualino Silvestre DVM History Three months after the move to another zoo, a 37 year-old female Asian elephant (Elephas maximus) presented mild lethargy and a reduction of food and water intake. Mild colics were suspected and the elephant was treated with non-steroidal anti-inflammatories (NSAID, meloxicam i.m. ~ 0.2 mg/kg) and spasmolytics (metamizole and butylscopolamine bromide i.m., ~ 80 and 5mg/kg). As no improvement was noticed on Day 2, a standing sedation was carried out (detomidine i.m., ~ 0.018 mg/kg, and butorphanol (i.m., ~ 0.017 mg/kg). Rectal fluids (20 L of hand-warm tap water) and i.v. fluids (4 L of 0.9% saline solution) were administered, as well as i.m. injections with amoxicillin (~ 15 mg/kg), vitamin B-complex and vitamin E/selenium. Flunixin meglumine was given in the auricular vein. Sedation was reversed using atipamezole (i.m., ~ 0.05 mg/kg). Blood was collected during this procedure. Unfortunately, the elephant collapsed 9 hours later in lateral recumbency. The animal was unresponsive and could be approached while it kept its eyes wide open (see videos). The araol mucosa was very pale. After 25 minutes it managed to stand up without any assistance but remained lethargic. Respiration was shallow. During the night the elephant went down in lateral recumbency again. During the following 5 days, the elephant was sedated every day for treatment and blood collection. Next case Collapsed Asian elephant due to septicemia caused by Salmonella saintpaul . Note the pale oral mucosa. The state of paralysis very much looks like the paralysis seen in botulism ( see case report ). Laboratory results: Hematology: Leucopenia was evident on the first blood smear that was made, with a clear increase of bands and a reduction of matured heterophils. An interesting finding was the presence of immature granulocytes (myelocytes) that could not be identified exactly. The platelet count was low and schistocytes (fragments of erythrocytes) were observed in each view. The presence of schistocytes is suggestive for the presences of a coagulopathy. In conclusion: based on the hemogram, a diffuse intravascular coagulopathy (DIC) was suspected, most likely associated with septicemia caused by a bacterial infection or a toxicosis. Interestingly, EEHV 3/4 was detected by a combined PCR test for subtype 3 and 4 in a blood sample and in trunk swabs. The elephant had been tested PCR positive for EEHV4 previously. A trunk swab taken from the conspecific that shared the enclosure was PCR-negative. For photos of elephant heterophils, bands, platelets and schitsocytes: click here . Human myelocyte, containing both primary (azurophilic) and secondary/specific (pink or lilac) cytoplasmic granules. The proportion of secondary granules increases as the cell matures. The nucleus is round and lacks a nucleolus. Courtesy: ASH Image Bank Myelocyte of the Asian elephant in this case report. The quality of this photo is poor as it was taken with a cell-phone through the ocular lens of the microscope. Urinalysis: Daily urine samples were taken and analyzed using a dipstick and refractometer from Day 3 onwards. Initially a high specific gravity with a low pH was determined, suggestive for severe dehydration and metabolic acidosis. Fecal culture and treatment: A fecal sample collected on Day 3 was submitted for bacteriology. The treatment plan focused on the suspected septicemia. Treatment with NSAID was continued and the antimicrobial treatment was switched to enrofloxacin (per rectum, ~ 2.5 mg/kg) and metronidazole (per rectum, ~ 11 mg/kg). Administration of vitamin B-complex and E/selenium was repeated on day 4 and day 5. Preventive measures In an attempt to find the causative agent of the suspected septicemia, stored hay was inspected for mould and other conditions that favor (an)aerobic growth of toxin producing bacteria, more specifically Clostridium spp. All sand in the enclosure was replaced; drains and surfaces were disinfected with 5% sodium hypochlorite before new sand was brought in. Treatment (continuation) On Day 9 Salmonella saintpaul sensitive for enrofloxacin was isolated from the feces. Until Day 6, dehydration was getting worse, based on hematological findings (increased Ht) and urinalysis (increased specific gravity). On Day 7 no feces were produced (probably caused by the anorexia and repeated administration of detomidine) and diphteric necrotic tissue was observed during the administration of rectal fluids. In the mean time, hematology results started to show evidence of recovery from the septicemia: bands had dropped from 36% (Day 5) to 11%, while platelets increased from 320 (Day 2) to 437 x109/L. WBCs increased from 3.3 (Day3) to 10.5 x 106/L. Interestingly, the number of myelocytes increased to 35% on Day 7, but sharply dropped to 5% on Day 8 and they totally disappeared after that day. All hematological parameters were normal when checked again on Day 48 and 55. In order to stimulate the appetite and the intake of fibrous food, daily sedations were discontinued as from Day 8, and the focus of treatment moved to provide gastro-protection and stimulation of the duodenal motility by the administration of ranitidine (oral, ~ 0.25 mg/kg) twice daily. Water soaked bran and hay ad lib, bamboo browse and banana tree-trunks were offered as much as possible. Sugar-containing food items were restricted to treats for compliance to vocal commands by the keepers in order to get cooperation from the elephant for the necessary treatment procedures. The animal regained its strength and body condition over the 3 month-period following this clinical episode. The presence of EEHV3/4 in the blood and trunk swab can be explained by a virus reactivation due to the sudden deficiency of the immune system as a result of the septicemia and DIC. No clinical impact is to be expected from this finding, as the animal known to be a carrier of EEHV4. References Molenaar, F.M. and Silvestre S. 2021. Clinical approach to colic and collapse in an Asian elephant ( Elephas maximus ) with Salmonella saintpaul septicaemia and subsequent ileus. Vet Rec Case Rep. 2021;e214. https://doi.org/10.1002/vrc2.214 . To page top

Rabies has been diagnosed in a few elephants and was fatal in all reported cases. The source of the infection was attributed to canids (Wimalaratne et al. 1999, Nanayakkara et al. 2003, Sharma et al. 2005, Aravind et al. 2006). The incubation time for rabies in elephants is unknown. Depending on the distance between the bite wound and the elephant's brain, a long incubation period can be expected. Rabies should be included in the differential diagnosis whenever there are neurological signs. To infectious diseases Rabies General information Rabies is a viral disease that is usually fatal. It is caused by a neurotropic Lyssa virus. Several species of Lyssaviruses have been identified, of which the rabies virus (worldwide), the Mokola virus (Africa), the Duvenhage virus (South Africa) and the European and Australian bat lyssaviruses are responsible for fatal encephalomyelitis. Rabies is transmitted by a percutaneous bite from a rabies-infected animal or by wound contamination with saliva from a rabid animal (MSD, 2021). Air born infection through aerosols can occur when visiting bat caves. Reservoir hosts vary geographically. In the U.S. hosts include skunks, bats, raccoons, foxes, and coyotes. Civets, mongooses and hyenas are the main hosts in Africa; domestic dogs are hosts in Asia, South America, and Africa. Certain bat species in southern Africa are host for a Lyssa virus After infection of the bite wound, the virus migrates from the wound to the brain via the nerves that run from the wound area, resulting in neurological signs. Virus replication takes place in the brain, from where the virus migrates to the salivary glands. The incubation period varies from 3 weeks to many months. In most species affected by rabies, the animal shows an increase of aggressive behaviour and will try to bite other animals. Hydrophobia can be one of the accompanying symptoms. In a few species (e.g. domestic cat), the animal becomes more quite or even soporous. Once the virus has reached the brain, there is no cure. Treatment is only possible in the short period between infection and start of the migration. In this short time window, the animal should be treated daily with a rabies vaccine (described below). If available, locally anti-rabies serum should be injected around the wound area. Diagnose of rabies is based on PCR or histopathology of brain tissue by demonstrating the presence of typical Negri bodies using a special stain especially in pyramidal cells within the Ammon's horn of the hippocampus. Wound tissue, saliva and cerebrospinal fluid can be used when the animal is still alive (CDC, 2021). Rabies in elephants Rabies has been diagnosed in a few elephants and was fatal in all reported cases. The source of the infection was attributed to canids ( Wimalaratne et al. 1999, Nanayakkara et al. 2003, Sharma et al. 2005, Aravind et al. 2006). The incubation time for rabies in elephants is unknown. Depending on the distance between the bite wound and the elephant's brain, a long incubation period can be expected. Rabies should be included in the differential diagnosis whenever there are neurological signs. The initial signs of rabies in elephants may be vague but most often the elephant (FAO 2005): Is listless. Prefers to stay in dark places. Eats very little. As the disease progresses the elephant likely: Writhes in pain. Does not recognize the mahout. Chases and attacks humans and animals. Has eyes that roll and wander. Does not eat. Walks unsteadily and the legs lose strength. Goes to the ground in paralysis. Has locked jaws and the tail hangs still. Has saliva flowing continuously. Death may shortly follow the appearance of these more severe signs. The differential diagnose in case of rabies comprises any disease that can cause central nervous system symptoms, like: Tetanus Trauma Snakebite Toxicity (e.g. heavy metal; pesticide) Anytime an elephant is bitten, particularly if the bite has drawn blood, the mahout and owner should take four actions: 1. Write the day on a calendar; then you will be able to predict when the elephant may show clinical signs if it was infected. 2. Talk to people who know the dog and ask about its behaviour in the days prior to the attack; if the dog has been acting strangely (staring fixedly, foaming at the mouth, etc.) there is a good chance the dog is rabid. 3. Inform everybody in the community of the health hazard, because the disease also attacks humans, and ask them to help track down the dog. 4. Very carefully capture the dog, confine it securely, and observe its condition; if after ten days it is normal then the elephant does not have rabies. If the elephant dies, consult Disposal of carcasses, page 55 of the FAO manual . Treatment of rabies in elephants Immediately after a suspected dog bite, wash the wound intensively with soap and water. Then apply tincture of iodine or Povidone-iodine 1% in and around the wound (FAO 2005). There is no effective treatment once the symptoms have appeared. Even though the disease is not contagious to other elephants, separate the elephant, taking it to a shady, clean and quiet place. Make sure the elephant is chained tightly and securely (FAO 2005). Although there is no report on post-exposure vaccination, emergency vaccination of the elephant can be considered, if a rabies vaccine is available. One study describes the successful post-exposure treatment in pigs that where heavily exposed to rabies. The affected pigs were repeatedly vaccinated with an inactivated rabies vaccine 0, 3, 7, 14 and 30 days after the bite incident, while equine rabies immune globulins were injected in and around the bite wound (Mitmoonpitak et al. 2002). When an elephant is exposed to rabies, consider to inject the animal intramuscularly with a 2 ml dose of an (inactivated = killed) rabies vaccine as soon as possible after it was bitten by a rabid animal. These vaccinations should to be given daily for at least 5 days. During this period the elephant should be kept under close observation. Anytime an elephant is bitten, particularly if the bite has drawn blood, the mahout and owner should take four actions: Write the day on a calendar; then you will be able to predict when the elephant may show clinical signs if it was infected. Talk to people who know the dog and ask about its behaviour in the days prior to the attack; if the dog has been acting strangely (staring fixedly, foaming at the mouth, etc.) there is a good chance the dog is rabid. Inform everybody in the community of the health hazard, because the disease also attacks humans, and ask them to help track down the dog. Very carefully capture the dog, confine it securely, and observe its condition; if after ten days it is normal then the elephant does not have rabies. If the elephant dies, consult Disposal of carcasses, page 55 of the FAO manual . Prevention Regular rabies vaccination is recommended for all elephants kept under human care in areas where rabies is endemic. Because rabies is incurable the best prevention is to annually vaccinate all the dogs and cats in the community. For many years, following the recommendation for rabies vaccination in horses has been considered prudent: (inactivated!) vaccine (2 ml IM) given from the age of 6 months, to be repeated after 3-4 weeks and annually boostered. When using this vaccination schedule in elephants, antibodies against rabies could be demonstrated after 24 months (Isaza et al. 2006, Miller et al. 2009). However, this rabies vaccination strategy was evaluated in a herd of 9 African elephants, including two calves, four subadults, and three adults which lead to new conclusions about rabies vaccination strategy. Prior to 2017, elephants were vaccinated opportunistically IM. Starting in 2018, calves at least 4 months of age were administered 2 ml of a commercially available inactivated vaccine and received boosters at 1 y of age. Adults and subadults underwent annual vaccination at the same dose. After 1 year, neutralization titers in five of nine elephants were below levels considered protective in domestic animals (< 0.5 IU/ml). Therefore the dose of rabies vaccine was increased to 4 ml, which resulted in titers more consistently greater than or equal to 0.5 IU/ml for at least 6 months. Institutions with elephants under human care may consider performing rabies vaccination neutralizing titers when possible to help guide vaccination. See also: vaccination. References Aravind B., Anilkumar M., Raju S., and Saseendranath M.R. 2006. A case of rabies in an Indian elephant (Elephas maximus) . Zoo's print journal 21 (2) 2170. Browning G.R., Peters R., and Howard L.L. 2021. Rabies vaccination and antibody response in African elephants ( Loxodonta africana ) as part of a comprehensive program of veterinary care. Joint AAZV EAZWV Conference Proceedings 2021. CDC 2021: https://www.cdc.gov/rabies/diagnosis/animals-humans.html FAO 2005: Elephant care manual for mahouts and camp managers. 2005. Isaza R., Davis R.D., Moore S.M., and Briggs D.J. 2006. Results of vaccinat i on of Asian elephants (Elephas maximus) with monovalent inactivated rabies vaccine. AJVR, Vol 67 (11), 1934-1936, 2006 Miller M.A. and Olea-Popelka F. 2009. Serum antibody titers following routine rabies vaccination in African elephants. JAVMA, Vol 235 (8),978-981 2009 Mitmoonpitak C., Limusanno S., Khawplod P., Tepsumethanon V, and Wilde H. 2002. Post-exposure rabies treatment in pigs. Vaccine 20 (2002) 2019–2021. MSD, 2021: https://www.msdmanuals.com/home/brain,-spinal-cord,-and-nerve-disorders/brain-infections/rabies Nanayakkara S, Jean S. Smith, and Charles E. Rupprecht. 2003. Rabies in Sri Lanka: Splendid Isolation. Emerging Infectious Diseases • Vol. 9, No. 3, March 2003. Sharma A.K., Choudhury B, and Singh K.P. 2005. Rabies in a captive elephant . Indian Journal of Veterinary Pathology 29(2): 125-126 Wimalaratne O, and Kodikara D.S. 1999. First reported case of elephant rabies in Sri Lanka. Vet. Rec. 144 (4): 98. To page top

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Anchor 1 Gastro-intestinal problems

This chapter describes the feeding ingredients, fibre, protein, fatty acids, minerals, vitamins, food presentation and diet examples. -Nutrition -Elephants Nutrition Written by Christian Schiffmann & Marcus Clauss Contents of this chapter: General feeding ecology and feeding behaviour Digestive physiology Nutritional management of elephants in captivity and recommendations for feeding Feed storage and preparation Feed items Staff behaviour Food analyses Examples for daily ration quantities Diet monitoring Fecal quality control References General feeding ecology and feeding behaviors Both elephant species are herbivores and consume a wide variety of plant material including grasses, leaves, twigs, fruits, barks, herbaceous material and soil (Sukumar 1990; Kabigumila 1993). A thorough review of diet breakdown, feeding behaviour, seasonal variation and summary data on broad nutrient ranges in natural diets for African elephants (Loxodonta africana) is covered in Sach et al. (2019). Variance between species does occur, with Asian elephants consuming a greater proportion of grasses in the diet when available (Sukumar 1990; Cerling et al. 1999). However, in our view, this does not mean that elephant species should be considered fundamentally different in their nutritional ecology. Although described as generalist herbivores, consuming over 400 species of plants, it appears populations may vary regionally and seasonally in their plant choice. However, it is clear that elephants are predominantly seasonal grazers and browsers with fruit, barks and soil being consumed as secondary food choices (Kabigumila 1993). The natural diet is characterised by a high fibre content (crude fibre 30-50%) and a low to moderate protein content (crude protein 8-12%). In summary, elephants are designed to eat large quantities of nutrient poor fibrous material which passes quickly through the gastrointestinal tract. Several studies indicate free living elephants of both species spend a considerable proportion (48-76.4%) of their day feeding, although where feeding conditions are improved and food availability increased, elephants have been seen to reduce the total amount of time spent feeding (Dougall and Sheldrick 1964; Beekman and Prins 1989). There is debate surrounding the feeding pattern; several reports indicate that elephants feed almost continuously throughout a 24-hour period (Laws 1970; Beekman and Prins 1989). However, there is also evidence that elephants feed in distinct peaks (Sukumar 1990). It is thought the feeding pattern may vary depending upon food availability, temperature (time spent in shade) and migration (usually to water). It has been suggested that free-ranging elephants make use of specific sites where they eat soil (geophagy) in order to cover their nutritional requirements of minerals (Holdo et al. 2002; Holdo and McDowell 2004). The body weight ranges overlap; however, Asian elephants (Elephas maximus) tend to be lighter than African elephants (Loxodonta africana). The weight range of wild adult Asian elephants is 1,800-5,000 kg compared with a range of 2,700-6,000 kg for adult African elephants (Wittemyer 2011). Individual body weights are influenced by age, sex, health, food availability and according to recent findings by the molar state (Schiffmann et al. 2019b). General feeding Back to Top Digestive physiology Digestive physiology With respect to their high-fibre and low-energy diet, elephants express a relatively high daily dry matter intake of 1-2% of body weight (Ullrey et al. 1997; Clauss et al. 2003). Feeding trials have shown a significantly reduced digestibility in elephants compared to horses (Clauss et al. 2003). Although heavily dependent on the provided diet, digestibility in elephants seems to range between 40 and 60% of dry matter. But even a digestibility as low as 22-32% has been detected in free-ranging African elephants (Rees 1982). According to an experimental study, digestibility decreases with increasing fiber content of an elephant’s diet (Clauss et al. 2003). Studies have demonstrated that passage of food through the elephant’s digestive tract is rapid compared to other monogastric hindgut digesters such as horses. Total gut transit time is 11-46 hours (Bax and Sheldrick 1963; Rees 1982; Hackenberger 1987; Loehlein et al. 2003), and they have a correspondingly low digestive efficiency (Clauss et al. 2003; Hatt and Clauss 2006). Elephants have a single stomach and a short but voluminous hindgut fermentation chamber (similar to equids), inhabited by anaerobic bacteria and protozoa similar to those found in the rumen and reticulum of the ruminant. These micro-organisms digest plant fibre that otherwise could not be used, since elephants, like other herbivores, have no fibre-digesting enzymes of their own (Ilmberger et al. 2014). Microbial fermentation of plant fibre in the hindgut provides the main energy source for these animals. They are adapted to eat complex plant fibres and thus in captivity, high fibre components must contribute a very significant part of their diet. As herbivores, elephants fulfil their needs in vitamins through their plant diet. This is the case for fat soluble as well as water soluble vitamins. Our knowledge on vitamin nutrition in elephants is still very limited and further research is needed (Fowler and Mikota 2006). Monitoring the quality of the feces is an important part of the health surveillance in each individual elephant. Body mass (BM, kilograms) and length measurements (meters) of an African (Loxodonta africana ) and Asian (Elephas maximus ) elephant (Clauss et al. 2007). Back to Top Nutritional management Nutritional management of elephants in captivity and recommendations for feeding Within each zoo, captive elephant diets should be formulated in line with the zoo’s dietary management programme using the skills of zoo nutritionists, curators, veterinary staff and keepers. The diet should be reviewed at least annually by appropriate staff, and proposed modifications raised in line with the individual institution’s diet management strategy. Forage consisting of grass, hay and browse should be the staple dietary ingredient, comprising a minimum of 80% of the total dry matter (Ullrey et al. 1997). Nutritionally appropriate pellets should be fed according to the individual dietary needs, but in the range of no more than approx. 20% of the total dry matter. Exceeding this may lead to excess energy consumption. Dietary items that deliver readily digestible energy, such as grains, bread, fruits, vegetables and low-fibre pellets should not be used in any significant quantity, although they may have uses for the administration of medication, or in geriatric animals. We want to emphasize that training should generally not be used as an excuse to feed unnatural feeds such as bread, fruits or sweets, and that training can often be done successfully using fresh green vegetables as well. This is not because a single piece of fruit is dangerous, but because often, one excuse leads to another. Excluding these items as training incentives is thus based on the concern about dietary drift. All food fed to the animal as part of the daily routine as well as used for training, enrichment or public activities must be included in the daily diet ration calculations. A review of the nutrient recommendations for both elephant species was published by Sach et al. (2019). Although species-specific differences may be present in the physiology of African and Asian elephants, evidence-based findings on corresponding requirements for are lacking and further research is recommended (Bechert et al. 2019). Hence, based on the current knowledge we consider our recommendations to be valid for both elephant species kept in European facilities, and emphasize that the difference to other herbivores is much greater than that between the two elephant species. Back to Top Feed storage Feed storage and preparation As with all animal feed, appropriate storage conditions are essential to retain product quality, including appropriate insect and rodent control measures. All food storage must be designed in such a way to enable safe access by staff and limit wastage. A clear system for stock control and product traceability must be implemented. Forage – must be protected from the weather (wet) and with good ventilation to prevent mould and degradation Browse- must be protected from weather (wet) to prevent mould/degradation and consumption from other pest species Pellets - purchased supplies should not exceed the amounts needed over a 4 to 6-month period to prevent degradation of vitamins, assuming ideal storage conditions. Most vitamins within pelleted feeds are stabilized for shelf life of up to 1 year – products must be individually checked and an inventory with record of expiry date, maintained within the animal feed store. Produce – must be kept under refrigeration Feed items Feed items Back to Top Forages 1. Fresh grass paddocks Ideally, access to grass paddocks should be provided to all elephants within the collection, although this may not be possible for some zoos due to space limitations, and in those with paddocks, not consistently throughout the year due to weather limitations. Paddocks must have appropriate drainage, especially around high use areas, such as gateways and feeding stations to maximise the amount of time in which they may be used by animals. A paddock management system must be in place for maintaining the paddock and preventing overgrazing. The time taken for elephants to consume small amounts of food via grazing is extremely important from a behavioural perspective and can assist in increasing the proportion of an elephant’s time spent foraging. For facilities without copious grass paddocks, implementation of a comprehensive feeding enrichment as a substitute is imperative. The latter may present an opportunity to compensate for limited space as recently reported by Scott and LaDue (2019). 2. Hay and fresh forages Grass hay is an ideal forage source for species adapted to eating plants high in fibre. It is important that the hay is of high hygienic quality, properly dried and cured. Hay should look green, and be free of weeds, insects, mould, twine, wire or any other foreign objects. Hay must be visually inspected before a delivery is accepted, and should be rejected if found to be substandard (mouldy, excessively dry and dusty, off-colour). During the process of unloading a delivery, this testing should continue, and not only be applied to the first few bales or batches that may have been deliberately chosen by the merchant to give a good impression. Given that elephants should have hay available at all times, and that obesity rather than energy deficiency is the primary concern, the hay used should be of a low nutritional quality (e.g., crude protein 5-8%, neutral detergent fibre 60-70%, acid detergent fibre 40-50 % in dry matter). Ideally, the grass should have been cut at a very late growth stage, with long, lignified stems. Hay typically used for production animals, with cut at an earlier growth stage with soft, pliable stems and a high proportion of grass leaves, is not ideal for elephants due to its high energy content. Because hay suitable for elephants is typically not produced for the hay market, and because farmers cannot sell the same amount of hay if cutting their fields as late as reasonable for elephant hay compared to what they could sell cutting the same field several times, prospective contracting of farmers and fostering long-term relationships is recommended. Notably, local farming conditions, e.g. subsidies for an extensive land use with late cuts, will influence costs and practicalities. Considering differences in the dietary needs of individual elephants (e.g. breeding vs. non-breeding females), it is recommended to have various badges of hay with differing energy content/digestibility on site. Differences in energy requirements should rather be met by different hay qualities than by the addition of other feedstuffs. Hay of peculiar grass species, such as reeds, has been used successfully by some elephant facilities. For the use of fresh forage, the same principles apply (grass of late maturity stage with long, lignified stems). If at all possible, the use of fresh forage should receive priority over dried forage, but will be necessarily limited to the non-winter season. Reedgrass or elephant grass, or other tall grasses, may be suitable. In theory, using whole maize plants without the cobs would also represent a suitable elephant feed. When feeding fresh forages, their dry matter content needs to be accounted for in ration calculation. 3. Browse Browse is an essential dietary component, both nutritionally and from a behavioural perspective. It must be fed daily to all elephants throughout the year and may contain twigs, branches and stems up to entire tree logs. Consuming browse increases foraging time and has additional benefits for dental health. A plan must be in place for adequate browse provision throughout the year, including the winter months when leafy material is not available. Browse can be preserved for other species by silaging, freezing or drying, but for elephants, due to the volumes required, this is mostly not feasible. Rather, stems and twigs without leaves should be provided on a daily basis, as well as evergreen species such as evergreen oak(Quercus ilex), bramble (Rubus fruticosus) or stinging nettle (Urtica spp.). Feeding conifers has proven successful for some collections. It may be logistically beneficial to additionally use branches that have been plucked clean of leaves and small twigs by other species of the same zoological institution for final consumption by the elephants, given that no hygienic concerns speak against this. 4. Straw Straw can be a suitable low-caloric fibre addition to the diet of elephants and can be mixed in with the hay ration to prolong foraging time, especially in high feeding nets. Due to the high amount of forage required by elephants, mixing of hay and straw generally appears the less feasible option compared to the acquisition of long-stem grass hay of low nutritional (but high hygienic) quality. If mixing of hay and straw is done, the ratio should be determined in accordance with the dietary needs of the individual elephant. Like hay, straw must be of high hygienic quality, free of weeds, insects, mould, twine, wire or any other foreign objects and should be visually inspected before a delivery is accepted. Wheat or barley straw should be preferred, because oat straw typically contains a higher energy content. 5. Lucerne The elephants’ requirements for bulky, low-energy roughage can be easily met with grass hay and straw, so that the more costly lucerne hay is typically not required. The feeding behaviour of elephants makes a loss of leafy material particularly likely when dealing with lucerne hay. Therefore, fresh lucerne or lucerne haylage would be considered more suitable due to the reduced leaf losses. Fresh lucerne or lucerne haylage might be used to increase the calorie and protein content of a specific animal’s diet under specific circumstances such as with geriatric animals or animals of compromised health. However, providing a grass hay of higher nutritional quality most likely is a more feasible solution. For all forage items, gradual changes with a slow introduction of new material over the course of two weeks is recommended. In other words, the amount of the new diet item should be gradually increased so that only after one week, it represents 50% of the forage portion, and is given as the only forage only after the second week. Other feed items 6. Pellets Except for special circumstances of particularly low forage quality or mishaps (e.g., sudden detection of forage spoilage due to roof leakage), there should be no need to provide elephants with pellets for maintenance energy requirements. A variety of pelleted feedstuffs is available. Some are manufactured specifically for elephants and are designed to be fed in very small quantities, with forage making up most of the diet (hay, grass, browse, straw). These pellets provide high levels of vitamins, minerals and protein, in a concentrated form so only a small amount is required to meet the elephants’ nutritional needs. A combination of such a product with forages represents an easy and comparatively safe approach, because potential variation especially in the mineral composition of the forages is of little concern, given the baseline provision by the mineralized pellet. With this approach, the individual provision of specific amounts to each individual, according to its body mass, is prerogative. It is advised that pellet selection is made by the zoo’s nutritionist or, if no nutritionist is on staff, by a nutritional consultancy service, which is sometimes also provided by renowned manufacturers. To avoid digestive upsets, the introduction of any pellet into the diet should be gradual (increasing slowly over 2 weeks). 7. Fruits and vegetables (produce) These should be fed in very limited amounts (less than 1 kg per elephant per day) and be documented as part of the daily diet ration. Produce is comparatively expensive, and amounts fed should not be required to contribute to vitamin and mineral provision. Even small quantities of higher sugar fruits, however, may significantly contribute to energy levels in the diet, adding to the risk of obesity. High sugar fruits should be replaced with vegetables – ideally leafy greens. In appropriate quantities, their use in training may be valuable. As it is easy to condition animals to the use of high-sugar items, but difficult to then reverse the conditioning, it appears prudent to refrain from the use of such items from the very beginning, and establish the use of leafy greens as training items. 8. Bread This should be avoided – should this be required for the administration of medication, use must be monitored. 9. Bran Elephants can be reluctant to consume unfamiliar foods- therefore it is appropriate to offer potential carriers for medication such as a bran mash periodically, so they will be consumed when needed. However, it should not be necessary to offer such items daily. 10. Vitamin and mineral supplements The dietary concentrations of minerals and vitamins recommended for horses should in the most part be sufficient for elephants (Ullrey et al. 1997). Mineral deficiencies have rarely been reported and are best avoided through the adequate use of appropriate forages, supplemented with pelleted feed, rather than additional external supplementation where consumption is more challenging to ensure and monitor. In specific situations such as an expected birth, the monitoring of serum calcium levels is recommended in order to avoid dystocia due to hypocalcemia (Hermes et al., 2008). Although the species-specific vitamin D and calcium metabolism in elephants is not fully understood so far (Childs-Sanford et al., 2020), efficacy of a dietary calcium supplementation has been reported (van Sonsbeek et al., 2013). Back to Top Staff behaviour Food analysis Staff behaviour In particular when changing the diet of elephants, it may be appropriate to avoid eating those diet items (apples, bread) within their range of vision. In doing so, negative reactions by the elephants may be avoided. Food analyses Typically, it is recommended to analyse all feeds on a regular basis. However, the question each zoo has to ask itself is, how will that information be used. Analysing feeds appears mainly reasonable if there is a nutritionist on staff that makes use of that information. Yet, even with a nutritionist on staff, or the use of a consultancy service, it may be a more cost-efficient approach to design a diet based on forages and a concentrated pelleted food that covers a range of possible nutrient values of the forages, rather than adapting the pelleted component each time a batch of forage is analysed. Having stated the potentially limited use of nutrient analyses, there is no excuse at all not to perform hygienic assessments of all feeds delivered to the zoo. Even if there is no nutritionist on staff, or even if there is no dedicated commissary manager, it cannot be excused if there is no personnel trained in evaluating the hygienic quality of forages, vegetables and pellets. In particular for forages, given their relevance and bulk in herbivore diets, personnel dedicated to evaluating and either accepting or rejecting a delivery, and dedicated to proper storage and assessment of storage quality, is indispensable. Food presentation Food presentation It is commonly accepted that feeding in captivity must mimic feeding behaviour of wild counterparts. A variety of complex feeding opportunities to prolong foraging time throughout the day and night must be provided. Provision for food delivery in evening/early morning must be made when personnel is typically absent. With respect to the temporal occurrence of major sleep periods, no additional food should be presented between midnight and 6.00am to avoid sleep disturbance (Schiffmann et al. 2018b), which is evidently not difficult to achieve. Keepers must periodically monitor this via night-time video recording of all animals, to ensure all animals are able to obtain access to food and ensure feeding events do not encourage anticipatory or stereotypical behaviours. Examples for daily ration quantities Please note that the following daily rations serve as examples, making individual adaptation necessary before application. Ideally, a zoo should have a nutritionist on staff. If that is not the case, this task may fall to a veterinarian with some basic nutritional training, or can be outsourced – for a simple ration calculation – to a nutritional consultancy, of which there is a growing number in Europe. Alternatively, several manufacturers of zoo diets also provide nutritional consultancy. As with any business, the credibility of the service should be assessed, by asking for references from other zoos, and by plausibility checks. In particular, advice that appears to be tuned to use a maximum of pellets should be viewed with caution. Target overall diet composition (ingested roughage and non-roughage items) may be in the area of crude protein 10%, neutral detergent fibre 60%, acid detergent fibre 40 % in dry matter. Accurate calculation of the quantities required to cover the individual needs of an elephant would require constant analysis of the diet as well as monitoring roughage intake (by measuring offer and refusals) to allow estimation of the proportion of roughage and non-roughage diet items, which is impractical – all the more so if the recommendation of multiple feeding stations spread across the whole enclosure is heeded. Hence, continuous monitoring of an elephant’s physical condition by weighing and body condition scoring is strongly recommended (Schiffmann et al. 2019a). Subsequently diet composition and quantities can be adapted accordingly. Examples of ration Back to Top A Adult breeding female, body mass: 3´348kg, Body Condition Score (BCS): 5/10 Estimated daily dry matter intake [kg]: 3´348kg * 0.015 -> 50.22kg B) Adult breeding male, body mass: 5´278kg, BCS: 7/10 Estimated daily dry matter intake [kg]: 5´278kg * 0.01 -> 52.78kg C) Geriatric (non-breeding) female, body mass: 2´934kg, BCS: 4/10 Estimated daily dry matter intake [kg]: 2´934kg * 0.015 -> 44.01kg D) Sub-adult male/female, body mass: 2´237kg, BCS: 8/10 Estimated daily dry matter intake [kg]: 2´237kg * 0.01 -> 22.37kg Calculations based on the following parameters: maintenance requirement of daily dry matter intake 1-1.5% of an elephants body mass (Ullrey et al. 1997). Dry matter hay: 90% (Ullrey et al. 1997); recommended quantity pellets: elephant pellets, KasperFaunafood: 1kg/1´000kg BM per day. Diet monitoring Diet monitoring Appropriate monitoring of body condition and weight is essential and should be conducted at least four times per year. Visual body condition scoring has been demonstrated as a practical and simple monitoring tool (Fernando et al. 2009; Schiffmann et al. 2018a; Chusyd et al. 2019) and is of peculiar importance if weighing is not feasible. Records must remain with the animal throughout its life and be recorded as appropriate e.g. via ZIMS. Consequences of obesity in captive elephants are extremely serious and will affect the animal’s long term captive health and welfare. There is strong evidence that obese animals are at increased risk of foot and joint lesions, altered metabolic markers and reduced reproductive success with increased labour length, dystocia, stillbirths and ultimately cow and calf death (Olson 2004; Freeman et al. 2009; Chusyd et al. 2018; Norkaew et al. 2018). Where animals are not achieving an optimum Body Condition Score (BCS), a documented plan must be in place to achieve this with records kept of progress made. Daily, keepers must monitor diet consumption and report variations as appropriate. Individual diet plans must be made for each elephant and recorded. Regular fecal check Regular fecal check is strongly recommended as an integral part of continuous health monitoring in elephants under human care. Click here for more information. Fecal quality control References References Bax P, Sheldrick D (1963) Some preliminary observations on the food of elephant in the Tsavo Royal National Park (east) of Kenya. East African Wildlife Journal 1: 40-53 Bechert US, Brown JL, Dierenfeld ES, Ling PD, Molter CM, Schulte BA (2019) Zoo elephant research: contributions to conservation of captive and free-ranging species. International Zoo Yearbook 53: 1-27 Beekman JH, Prins H (1989) Feeding strategies of sedentary large herbivores in East Africa with emphasis on the African buffalo, Syncerus caffer. Journal of African Ecology 27: 129-147 Cerling TE, Harris JM, Leakey MG (1999) Browsing and grazing in elephants: the isotope record of modern and fossil proboscideans. Oecologia 120: 364-374 Childs-Sanford, S. E., Makowski, A. J., & Wakshlag, J. J. (2020). The vitamin D status of Asian elephants (Elephas maximus) managed in a Northern temperate climate. Journal of Zoo and Wildlife Medicine, 51, 1-12. Chusyd DE, Brown JL, Hambly C, Johnson MS, Morfeld KA, Patki A, Speakman JR, Allison DB, Nagy TR (2018) Adiposity and reproductive cycling status in zoo African elephants. Obesity 26: 103-110 Chusyd DE, Brown JL, Golzarri-Arroyo L, Dickinson SL, Johnson MS, Allison DB, Nagy TR (2019) Fat mass compared to four body condition scoring systems in the Asian elephant (Elephas maximus). Zoo Biology: Clauss M, Loehlein W, Kienzle E, Wiesner H (2003) Studies on feed digestibilities in captive Asian elephants (Elephas maximus). Journal of Animal Physiology and Animal Nutrition 87: 160-173 Clauss M, Steinmetz H, Eulenberger U, Ossent P, Zingg R, HummEl J, Hatt JM (2007). Observations on the length of the intestinal tract of African Loxodonta africana (Blumenbach 1797) and Asian elephants Elephas maximus (Linné 1735). Eur J Wildl Res (2007) 53: 68–72 Dougall H, Sheldrick D (1964) The chemical composition of a day´s diet of an elephant. Journal of African Ecology 2: 51-59 Fernando P, Janaka HK, Ekanayaka SKK, Nishantha HG, Pastorini J (2009) A simple method for assessing elephant body condition. Gajah 31: 29-31 Fowler ME, Mikota SK (2006) Biology, Medicine, and Surgery of Elephants. Blackwell Publishing, Iowa, USA Freeman EW, Guagnano G, Olson D, Keele M, Brown JL (2009) Social factors influence ovarian acyclicity in captive African elephants (Loxodonta africana). Zoo Biology 28: 1-15 Hackenberger MK (1987) Diet digestibilities and ingesta transit times of captive Asian (Elephas maximus) and African elephants (Loxodonta africana), MSC Thesis University of Guelph, Guelph Hatt JM, Clauss M (2006) Feeding Asian and African elephants Elephas maximus and Loxodonta africana in captivity. International Zoo Yearbook 40: 88-95. Hermes, R., Saragusty, J., Schaftenaar, W., Göritz, F., Schmitt, D., & Hildebrandt, T. B. (2008). Obstetrics in elephants. Theriogenology, 70, 131-144. Holdo RM, Dudley JP, McDowell LR (2002) Geophagy in the African elephant in relation to availability of dietary sodium Journal of Mammalogy 83: 652-664 Holdo RM, McDowell LR (2004) Termite mounds as nutrient-rich food patches for elephants. Biotropica 36: 231-239 Ilmberger N, Güllert S, Dannenberg J, Rabausch U, Torres J, Wemheuer B, Alawi M, Poehlein A, Chow J, Turaev D, Rattei T, Schmeisser C, Salomon J, Olsen PB, Daniel R, Grundhoff A, Borchert MS, Streit WR (2014) A comparative metagenome survey of the fecal microbiota of a breast- and a plant-fed Asian elephant reveals an unexpectedly high diversity of glycoside hydrolase family enzymes. PLoS ONE 9: e106707 Kabigumila J (1993) Feeding habits of elephants in Ngorongoro Crater, Tanzania. Journal of African Ecology 31: 156-164 Laws R (1970) Elephants and habitats in North Bunyoro Uganda. Journal of African Ecology 8: 163-180 Loehlein W, Kienzle E, Wiesner H, Clauss M (2003) Investigations on the use of chromium oxide as an inert, external marker in captive Asian elephants (Elephas maximus): passage and recovery rates. In: Fidgett A, Clauss M, Ganslosser U, Hatt JM, Nijboer J (eds) Zoo animal nutrition, vol 2. Filander, Fuerth, Germany Norkaew T, Brown JL, Bansiddhi P, Somgird C, Thitaram C, Punyapornwithaya V, Punturee K, Vongchan P, Somboon N, Khonmee J (2018) Body condition and adrenal glucocorticoid activity affects metabolic marker and lipid profiles in captive female elephants in Thailand. PLoS ONE 13: e0204965 Olson D (2004) Elephant husbandry resource guide Rees PA (1982) Gross assimilation efficiency and food passage time in the African elephant. African Journal of Ecology 20: 193-198 Sach F, Dierenfeld ES, Langley-Evans S, Watts M, Yon L (2019) African elephants (Loxodonta africana) as an example of a mega-herbivore making movement choices based on nutritional needs. PeerJ: Schiffmann C, Clauss M, Fernando P, Pastorini J, Wendler P, Ertl N, Hatt JM (2018a) Body condition scores of European zoo elephants (Elephas maximus and Loxodonta africana): Status quo and influencing factors. Journal of Zoo and Aquarium Research 6: 91-103 Schiffmann C, Hoby S, Wenker C, Hard T, Scholz R, Clauss M, Hatt JM (2018b) When elephants fall asleep: A literature review on elephant rest with case studies on elephant falling bouts, and practical solutions for zoo elephants. Zoo Biology 38: 1-13 Schiffmann C, Clauss M, Hoby S, Hatt JM (2019a) Body Condition Scores (BCS) in European zoo elephants´ (Loxodonta africana and Elephas maximus) lifetimes - a longitudinal analysis. Journal of Zoo and Aquarium Research 7: 74-86 Schiffmann C, Hatt JM, Hoby S, Codron D, Clauss M (2019b) Elephant body mass cyclicity suggests effect of molar progression on chewing efficiency. Mammalian Biology 96: 81-86 Scott NL, LaDue CA (2019) The behavioral effects of exhibit size versus complexity in African elephants: A potential solution for smaller spaces. Zoo Biology: Sukumar R (1990) Ecology of the Asian elephant in Southern India - II. Feeding habits and crop raiding patterns. Journal of Tropical Ecology 6: 33-53 Ullrey D, Crissey SD, Hintz H (1997) Elephants: nutrition and dietary husbandry. In: Allen M, Edwards M, Roocroft A (eds) Nutrition Advisory Group Handbook, pp 1-20 Van Sonsbeek, G. R., van der Kolk, J. H., van Leeuwen, J. P. T. M., Everts, H., Marais, J., & Schaftenaar, W. (2013). Effect of calcium and cholecalciferol supplementation on several parameters of calcium status in plasma and urine of captive Asian (Elephas maximus) and African elephants (Loxodonta africana). Journal of Zoo and Wildlife Medicine, 44, 529-540. Wittemyer G (2011) Order Proboscidea. In: Wilson DE, Mittermeier RA (eds) Handbook of the Mammals of the World - Volume 2. Lynx Edicions, pp 50-79 Back to Top

This case report describes a colic episode in an adult Asian elephant. Salmonella sp. was identified in a fecal sample taken during this period of colic. - colic -Salmonella To salmonellosis CAse report Next case Colic and Salmonellosis in an adult Asian elephant History This adult multiparous female had been on GnRH-vaccine for over 4 years. Because of chronic joint disease, the elephant had been on phenylbutazone for over 1 year in combination with omeprazol. Sudden onset of apathy, anorexia and hardly drinking water. Normal feces. Occasionally the elephant goes into a sitting position or lateral recumbancy, showing moderate straining activities. After this labor-like behaviour, herd mates investigate the perineal area of the elephant with their trunk. Differential diagnose: Labour, colics (intestinal, uterine or urinary) Treatment The administration of phenylbutazone was discontinued No specific treatment was given on the first day. Treatment results During the night the elephant became more active and the symptoms decreased. The next morning, the animal behaved normal. Diagnostic notes Salmonella sp. was cultured from the feces on the day it showed the above mentioned symptoms To page top

Description of a surgical repair of a perineal hernia in an Asian elephant in Myanmar. Oo Z.M., et al. 2016 Surgical treatment of a cervico-vaginal prolapse in an Asian elephant in Myanmar. Gajah 44, 36-39 To perineal hernia Case report Perineal hernia, surgical repair Date: 2016 Place: Myanmar Data provided by: Gajah History A 47 years old captive female Asian elephant, working in the logging industry, displayed a large bulging mass below the tail since 10 years, which increased in diameter from 4 inches to 22 inches. At ultrasonographic examination it was diagnosed as a cervico-vaginal prolaps. Better described as perineal hernia with cervico-vaginal involvement (WS). The elephant did not suffer of any limitations in relationship to this condition. Previous cases in other female elephants of the company had died of this condition. As the mass was increasing in size, it was decided to perform a correcting surgery. At the time of surgery the animal was in healthy condition. Read the article in Gajah Treatment A standing sedation procedure with xylazine and ketamine was used. A incision of the skin and the vaginal vestibule was made 7 inches lateral to the perineal midline, allowing manual passage to explore the subcutaneous area. A catheter (1/4 inch diameter) was advanced into the uterus (or was it into the urthra?) and the uterus (bladder?) could be drained. The catheter was replaced by a larger catherter (½ inch) and more fluid, which contained several stones was drained. The the cervix uteri and the vagina (bladder?) were pushed back into the p elvic cavity through the herniated pelvic diafragm using the arm that was advanced into the vagina . The vaginal vestibule was closed using a continuous catgut suture. The skin was closed using 3 continuous nylon matrass sutures. At each knot a protecting plastic plate was placed underneath the knot to protect the skin from perforation by the nylon suture. Finally, a wooden block with a foamy protection layer was tightly tied to the (formerly) bulging area using ropes around the elephants body. Treatment results The ropes and the supporting block remained in place and the hernia did not recur between surgery and publication of this paper. However, it is not know for how long this animal stayed without recurrence. Complete report: Oo Z.M., et al. 2016 Surgical treatment of a cervico-vaginal prolapse in an Asian elephant in Myanmar. Gajah 44, 36-39 To page top

Foot and sole or pad lesions are common in elephants and should be treated. Abnormal wear of the pad can be the result of joint disease. Sole lesions can result in fistulas. Pedicure must be part of the management. Foot and mouth disease and cowpox virus can cause complete slaughing of the pad. Back to index orthopedic problems Foot problems Foot problems in elephants under human care are frequently seen. Several anatomical structures can be involved in foot problems: the sole (pad or slipper), the nails, the joint ligaments, the tendons, the distal phalanges and the joints. Many of the problems are management-related. Abnormal wear, inappropriate substrate, stereotypic repetitive movements and lack of space to move around are some of the major causes of orthopedic problems in elephant feet. A separate chapter on regular foot care in elephants under human care can be found here . An elephant suffering of foot problems will often demonstrate one or more of the following symptoms: Swelling, pain Lameness, reluctance to move Black tracts on or beneath nails Discharge / bad odor Nail cracks Overgrowth / over-wear (nails and/or sole) Dry or overgrown cuticles Examination of the foot If the animal is well trained, it should lift its legs to allow inspection of the nails and pad of each foot. Alternatively the feet can be examined with the elephant in lateral recumbency. Check the nail cuticles. Remember that elephants have sweat glands in their cuticles. Cuticles should not be too short as this may facilitate the invasion of microorganisms. However, they should also not be too long. Elephants seem to care for their nails by rubbing them along hard objects or their own legs. Overgrown cuticles may result in accumulation of sweat: when trimmed or when pressure is exerted on the cuticles, watery fluid may be discharged ( see video ). The nails and the sole are interconnected by a structure that is an equivalent of the white area in horses and cattle. It forms a delicate connection, where microbes can penetrate into deeper layers to cause an infection (pododermatitis) ultimately resulting in osteitis and arthritis of the interphalangeal joints. The nails should never be longer than the pad, as they should not bear weigth when the elephant is standing still nor during walking (see video) . Long nails can easily develop a tear, giving access to microbes. The pad of the sole must be thick and have a distinct pattern of grooves. When wear is insufficient, the grooves may become too deep and form an easy entrance for stones, dirt and microbes, which may result in a sole abscess. Too much wear results in a smooth surface and a thin pad, vulnerable for deeper sole lesions. African elephant walking in Namibian desert (slow motion). Note how the pad and the nails form one supporting surface. The nails are not used for support. (Footage of BBC documentary) Sole lesions Sole lesions Normal sole of an Asian elephant kept in a zoo Normal sole of an Asian elephant semi-free ranging in the forest. Normal sole preparation of a free-ranging African elephant (Kruger National Park, South Africa) In order to maintain a healthy sole and nails, there should be a balance between wear and (re)growth of sole and nail tissues. The main factors that determine the wear are the type of substrate, activity of the elephant and the humidity. Best Practice Guidelines The EAZA Best Practice Guidelines for Elephants recommend: Indoor and outdoor substrates should: 1. Provide choice to the elephant, allowing elephants to explore and investigate a range of substrates within their enclosure. This can provide increased activity and the cognitive benefits of decision-making. 2. Provide a degree of flexibility and accommodate the vast body mass of an elephant. Flexible ‘soft substrate’ works to absorb impact, easing the pressure on the joints and feet. 3. Provide good drainage which is beneficial for respiratory, skin and foot health. Soft substrate (such as sand) can act as a “bio floor”, allowing drainage of urine and ensuring animals are not standing in their own quite aggressive urine or lying on wet/cold floors. 4. Provide opportunities for enrichment, such as digging/hiding food which can improve musculature. 5. Allow dust bathing which provides enrichment and is beneficial for skin health. Hard floors Should be used only in places where long standing of elephants is not expected to occur and the elephant’s time in these areas should be minimised where possible. Concrete or rubber floors should have a non-abrasive but not smooth finish. Solid floors should be cleaned regularly and disinfected where appropriate and should provide appropriate drainage to avoid pooling of urine where elephants stand. Sand floors If used, type of sand should be considered. It should not be dusty, should drain well and not be able to compact (in the enclosure or gut). Sand that includes fine sand, silt or clay grades is likely to result in a dusty enclosure and compact into a solid floor. Sand grains need to be of a single size to reduce compaction. A grain with a round, rather than angular, shape will reduce compaction and will not be over wearing on the feet. Sand depth should be of 0,8 m minimum depth, but 1,5 m is recommended. Daily maintenance of sand includes daily watering to prevent excessive dust. Sand must be regularly turned to prevent compaction and build-up of bacteria that can grow in anoxic conditions. Sand floors need to be easily accessed by specially designed heavy machinery (such as truck loaders), and purposely built concrete ramps are a must. Where sand is retro fitted into enclosures, drains should be protected with permeable membranes and sand depths maximised where possible. Door runners should be subject to increased maintenance procedures to mitigate sand ingress. Alteration of door runners can be considered in preference to removal of substrates. Benefits of sand include the ability to build up pillows or mounds which may be used by older animals to sleep against or aid older/arthritic elephants when getting up. Animals also can benefit from rolling/ playing in or on mounds and they can act as visual barrier. The drainage provided is beneficial to aid calves in standing up quickly post birth. Sand can be used in outdoor areas, in all weather, and can withstand extreme cold or wet weather (with appropriate drainage). Grass If possible (i.e. space available will not be significantly compromised with paddock rotation technique), allow grazing access for elephants, which prolongs foraging times. Under improper environmental conditions the following sole lesions can develop: Figure 1. Excessive wear: too much wear results in a smooth surface and a thin pad, vulnerable for deeper sole lesions.The sole of an adult elephant should be at least 20 mm thick. Figure 2. Insufficient wear: the grooves may become too deep and form pockets, which are an easy entrance site for stones, dirt and microbes and can lead to a sole abscess. Figure 3. Crack/tear Figure 4. Sole fistula/ulcer/abscess Figure 5. Sole detachment (partial or complete) Result from primary infection (cowpox and Foot-and-mouth disease) Secondary infection after trauma, moisture, weight overload, dirt: Figure 1. The sole of this zoo-kept African elephant is too thin and health a smooth surface, making it vulnerable to cracks, perforations and nail lesions. Note the small cracks in the nails. Figure 2. Overgrown pad and nails. See also: International Elephant Foundation. Figure 3. Crack in sole of African elephant kept on a concrete floor Figure 4. Fistula/ulcer/abscess in the sole of an Asian elephant spending most of the time on the streets in Laos. Figure 5. Partial sole detachment in an Asian elephant orphan at the Dak Lak Elephant Conservation Center (Vietnam), caused by keeping him on a wet floor (rainy season). Injuries to the sole of the foot are particularly difficult to manage because it is hard to keep them clean and prevent infection. Careful pedicure of the sole may reveal bruces in the soft horn tissue, that resulted from abnormal local pressure on the sole. (Courtesy: Susan Mikota). These bleedings are blood lines in the horn lamellae (not to be confused with sole bruses) that may be seen when abnormal forces have been excerted on the nail (e.g. too long nail) (Courtesy: Susan Mikota). Perforated, infected sole lesions due to trauma (Courtesy: Susan Mikota) Partial pad and nail loss in a 54-yrs-old female Asian elephant. Click here to read the case report. Foreign body pad perforation One case report describes the treatment of a pad abscess resulting from the penetration of a wire through the pad in a 19-yr-old female Asian elephant (Elephas maximus ) housed at the Paris Zoo (Ollivet-Courtois 2003). The cow presented with acute right forelimb lameness and swelling that persisted despite 4 days of anti-inflammatory therapy. Under anesthesia, a 10 x 0.5 x 0.5 cm wire was extracted from the sole of the right foot. There was a 2-cm-deep, 7-cm-diameter abscess pocket that was subsequently debrided. Regional digital i.v. perfusion was performed and repeated 15 days later, using cefoxitin and gentamicin on both occasions. Between treatments, the cow received trimethoprim–sulfamethoxazole and phenylbutazone orally. Within 2 days of administering anesthesia and the first perfusion treatment, the lameness improved dramatically. When phenylbutazone was discontinued 1 wk after the first treatment, the lameness had completely resolved. At the second treatment, there was no evidence of further soft tissue infection, and the abscess pocket had resolved. A 10 x 0.5 x 0.5 cm piece of curved wire was found penetrating the right front foot of a female Asian elephant. A rope tourniquet was placed above the right carpus, and venous access was obtained using a 21-gauge, 0.8 mm butterfly catheter in a palmar superficial vein of the right foot to perform regional interdigital perfusion. Complete sole detachment can be caused by: Foot-and-Mouth disease (FMD) Generalized Cowpox infection. Foot and Mouth disease Both elephant species are susceptible to FMD. However, severe disease has been reported (anecdotically) more in Asian elephants than in African elephants. A description of FMD in African elephants after experimental (!) infection is found here (Howell, 1973). In range countries it is important to avoid direct and indirect contact between cattle and elephants, especially during FMD-outbreaks in the cattle population. Vaccination of cattle is important to reduce the risk of FMD to elephants living in the same area as cattle. For vaccination data, see also: The use of Vaccination of FMD in zoo animals (Schaftenaar, 2002) Complete sole detachment in an African elephant after experimental infection with FMD-virus. Cowpox Both elephant species are susceptible to cowpox infections, though more severe clinical impact is seen in Asian elephants. Symptoms can range between external pox lesions on the skin to complete sole detachment, as well as internal pox lesions in various organs. Vaccination is practiced in European zoos (for vaccine information, click here ). NB: Cowpox disease is a zoonotic disease! To reduce the pressure on a thin or perforated sole, a rubber sole can be glued on the thin sole. This material can last for 2-6 weeks when properly glued to the sole. Avenir Light is a clean and stylish font favored by designers. It's easy on the eyes and a great go-to font for titles, paragraphs & more. A more frequently used tool to reduce the pressure on the sole, is a sandal or boot made locally, fitting the foot of the elephant. This shoe should be removed daily to inspect and treat the injury. Custom-made sandal, Fowler & Mikota 2006 Custom-made boots, Singapore zoo 2007 Another example of custom-made sandals to protect an injured sole (Myanmar. Courtesy Susan Mikota) These sandals were made by commercial companies Teva and Nike (Courtesy Susan Mikota) Edges of the sole bordering the sole defect were thinned (Dak Lak Elephant Conservation Center, Vietnam) Treatment of sole lesions Excessive wear: the thin and smooth horn layer has to regrow. This means that wear has to be reduced. This can be achieved by reducing the time spent by the animal on a hard floor, changing the floor surface and substituting it by softer materials; i.e. concrete floors can be covered by an epoxy layer or deep sand. A concrete sleeping area should be replaced by a sand floor (see EAZA Best Practice Guidelines for Elephants) . The thickness of the pad can be measured by ultrasound examination. Overgrown sole: horn can be trimmed away using a hoof knife. Usually the nails will also need trimming. The use of a drawknife is not recommended, as it easily removes too much from the sole. Make sure that the nails are always shorter than the sole! Crack/tear: as these are usually the result of a too thin sole, measures to increase the sole thickness should always be taken. If the crack hasn't perforated the sole completely, the edges of the crack can be cut away using a hoof knife with the aim to prevent accumulation of dirt and to reduce the pressure on the thinnest part of the crack. A sandal should be considered is there is a risk of sole perforation. Sole fistula/ulcer/abscess: if the sole is perforated, microbes will have entered the underlying tissue. Frequent pedicure will be required in order to drain the affected tissues. The edges of the fistula need to be made as thin as possible with a smooth transition to the thicker part of the sole. This will reduce the pressure on the infected area. The fistula/ulcer/abscess must be flushed daily with saline solution and a mild disinfectant. Soaking the foot in a foot bath should be considered (see images below). Several solutions have been used in elephants (see table below). Epsom salt is probably superior to the other solutions, while copper sulfate might be too caustic for this type of injury. As long as the effluent is sufficiently drained with the help of frequent trimming, the use of systematic antibiotics is not indicated. List of foot bath solutions as described in Fowler & Mikota 2006 Simple foot soaking bath by a well trained Asian elephant, Dak Lak Elephant Conservation Center (Vietnam) Custom-made foot soaking bath, Laos (courtesy Dionne Slagter) Partial sole detachment: this condition can be the result of long exposure of the sole to water and dirt. Standing on a hard floor will predispose for this lesion. P arts of the sole that are detached from the underlying tissue must be entirely trimmed away using a hoof knife. Leaving a sole flap - even a small one - will result in extension of the infected area. The edges of the sole bordering the defect, must be made thin and smooth in order to avoid pressure of the remaining sole on the fragile exposed tissues. Regular trimming of the edges of the sole around the defect and daily flushing and foot bath are required. In some cases the use of a sandal or boot may be needed. Foot bath Complete sole detachement: this condition is usually the result of trauma or a viral infection : Foot and Mouth Disease and Cowpox have been associated with complete sole detachment, always accompanied by other severe symptoms caused by these viruses. As there are no specific treatment options for these viral diseases, only symptomatic treatment can be given. Bandaging the affected legs has been practiced, but one should not be optimistic about the results. In some cases, humane euthanasia will be the only option to prevent the animal from suffering. Traumatic sole detachment can be expected if the elephant has been trapped in a snare. Cleaning, disinfection (mild solution soaking foot bath) and sometimes bandaging of the affected foot will be necessary until the wound has closed. In some cases, the regenerated tissue that covers the wound is strong enough to withstand the pressure of the body weight. If that is not the case, a prosthesis will be needed to provide sufficient protection. References: Cowpox infection in elephants. 1996. Proceedings of the annual conference of the European Association of Zoo and Wildlife Veterinarians. Fowler ME 2006. Foot disorders. In: Biology, Medicine, and Surgery of Elephants. Fowler & Mikota, 271-290. Howell P.G. , Young E , Hedger R.S . 1973. Foot-and-mouth disease in the African elephant (Loxodonta africana ). Onderstepoort J Vet Res. 1973 Jun;40(2):41-52. Johnson G., Smith J., Peddie J., Peddie L., DeMarco J., Wiedner E. 2018. Use of glue-on shoes to improve conformational abnormalities in two Asian elephants ( Elephas maximus ). J. Zoo&Wildl Med. 49(1): 183–188, 2018. Ollivet-Courtois, F., Lécu, A., Yates R.A., Spelman L.H. 2003. Treatment of a sole abscess in an Asian elephant (Elephas maximus ) using regional digital intravenous perfusion. Journal of Zoo and Wildlife Medicine 34(3): 292–295, 2003 Schaftenaar W. 2002. Use of vaccination against foot and mouth disease in zoo animals, endangered species and exceptionally valuable animals. Rev. sci. tech. Off. int. Epiz., 2002, 21 (3), 613-623. To page top

Prevalence, symptoms, treatment and vaccination against anthrax (Bacillus anthracis) in elephants are described. To infectious diseases Anthrax This figure gives a nice overview of the epidemiological cycles of Bacillus anthracis (https://anipedia.org/resources/anthrax/1203 ). Anthrax infection in humans Human anthrax infections are often contracted during work activities in oneofthe following fields: Tanneries Wool sorters Bone processors Slaughterhouses Laboratory workers When humans become infected, the disease is usually presented as skin wounds that heal very slowly. The bacteria can penetrate the skin if they come in contact with a fresh skin wound. These photos demonstrate the type of wound that results from such an infection. The person with the wound on the left image worked on a cattle carcass that died from anthrax. While handling this carcass, he injured himself by a sharp bone fragment that was infected with the anthrax bacteria ( https://www.microbiologybook.org/ghaffar/anthrax-pennsylvania.htm ). The person on the right image is probably a tannery worker, who infected himself by rubbing his knuckles on the skin of an animal that died of anthrax ( http://www.fao.org/ag/againfo/programmes/en/empres/news_070212.html ) If untreated or if the infected wound is big, the bacteria can spread in a large area around the wound, as is shown here. This severe wound needs immediate treatment with the right antibiotic. Anthrax spores can also be inhaled. In the lungs the anthrax bacteria can cause a very severe inflammation. On the left image you can see an X-ray of healthy lungs, with a clear heart shadow. On the right X-ray you can distinguish a big mass in the thorax that does not allow the x-rays to get through. If this disease is left untreated until obvious symptoms occur, it is usually fatal. This patient had a business where he made drums using cattle and goat skins imported from Africa. He died 1 day after this X-ray was made. (https://www.microbiologybook.org/ghaffar/anthrax-pennsylvania.htm ) Anthrax infection in animals Typically, the incubation period is 3–7 days (range 1−14 days). The clinical course ranges from peracute to chronic. The peracute form (common in cattle and sheep) is characterized by sudden onset and a rapidly fatal course. Staggering, dyspnea, trembling, collapse, a few convulsive movements, and death may occur in cattle, sheep, or goats with only a brief evidence of illness. Often, the course of disease is so rapid that illness is not observed and animals are found dead. A very characteristic feature of acute anthrax is free non-coagulating blood running from body openings, due to the disturbed coagulation. The disease in horses may be acute. Signs may include fever, chills, severe colic, anorexia, depression, weakness, bloody diarrhea, and swellings of the neck, sternum, lower abdomen, and external genitalia. Death usually occurs within 2–3 days of onset. Anthrax bacteria disturb the natural blood coagulation. This results in bleedings in the skin and all internal organs. Non-coagulated blood is collected in the lymph nodes, while free-running blood appears from all openings. These symptoms usually lead to a sudden death. Anthrax can affect multiple species, like cattle and wild ruminants (greater kudu), zebras as well as predators (lion). Note the running blood from nostrils or eyes in all these animals and the small bleedings in the skin of the kudu. (https://anipedia.org/resources/1203) Multiple outbreaks of anthrax in wild hippopothamus has been reported in several southern African countries ( https://www.sciencealert.com/anthrax-outbreak-suspected-to-have-killed-more-than-100-hippos-in-namibia ) Animal to animal transmission There are several ways of transmission of B. anthracis between animals. Animals grazing in areas where anthrax victims have been buried, can be infected when the carcass remnants are digged up either by the feeding animal or through human activities (road or building constructions). Flies that have fed on an anthrax-carcass can easily spread the bacteria through their droppings that remain on leaves. Predators (big cats) that feed on infected carcasses can become infected and die of anthrax. Flies that feed on an infected carcass may spread B.anthacis through their droppings as illustrated on these images (https://anipedia.org ). Anthrax in elephants Anthrax in elephants is usually a gastro-intestinal infection. The animal ingests the spores while feeding food or water contaminated with spores. After an incubation period of a few days, the animal dies of septicemia. Multiple cases have been reported from several range countries in Asia (Kumaraguru A. et al. 2015). In some areas Asian elephants play a role in the transmission of anthrax between wildlife and farm animals (Walsh M.G. et al. 2019). Like in other mammals, symptoms consist of rapid detoriation after infection. Usually the elephant is found dead before symptoms were observed. Running blood from the trunk, mouth, eyes, rectum or vagina should alarm the finder of the carcass for this being an anthrax case. Anti-PA antibodies were detected in elephants, which suggests that they can mount adaptive immune responses against anthrax. In addition, these results suggest that elephants can be infected with anthrax and survive infection under some circumstances (Cizauskas et al. 2014). A fatal case of anthrax in a 15-yrs-old African elephant was reported from a wildlife park in Nigeria (Okewole, 1993). Frequent urination, restlessness and weakeness of the hind quarters were observed prior to death. A co-infection with Cowdria ruminatium was diagnosed at post mortem examination (coccoid intracytoplasmatic bodies in the endothelia of the brain). A wild Asian elephant that died of anthrax in the forest of Myanmar. Note the amount of free running blood around the head. Photo courtesy: Myanmar Forest Police A wild Asian elephant that died of anthrax in the forest in India (Kumaraguru A. 2015) Treatment Early detection of the disease is essential, though difficult. Multiple classes of antibiotics can be used if treatment is started in time: oxytetracycline, penicillins, aminoglycosides, fluoroquinolones, macrolides, and sulfonamides. Dosages can be obtained from the website of Elephant Care International: https://www.elephantcare.org/formulary Diagnosis (post-mortem) Post mortem findings in elephants are: Bleedings In and under the skin Around muscles In organs Free blood in the intestines Free blood in the lungs Free blood in the abdomen Edematous swelling of the skin Swollen spleen with bleedings Liver and lymph nodes are swollen and contain a lot of blood Disposal of an anthrax carcass If a dead elephant is suspected of anthrax, a full necropsy is not recommended. A blood smear from a small incision made in an ear should first be made and examined microscopically for the presence of Gram-positive stained rods, lying in chains, sometimes accompanied by spores. The carcass should be disposed off as soon as possible in a proper way. The disposal must be done following the next steps: To minimize the spread of blood, you should try to plug the openings (trunk, ears, mouth, anus, vulva) with non-absorbent material. You can also wrap the head of the elephant in plastic and tape it with duct tape or tie it with a rope to the skin of the neck. Don’t move the animal around Incinerate the carcass if possible If incineration is not possible, burry the carcass as deep as possible. Use heavy excavating equipment (backhoe loader) to dig a deep, large hole, at least 2 meters deep Disinfect all materials that have been in contact: 10% formalin or 5% lime solution (sodium hydroxide) Necropsies of any animal should always be performed with great care. If there are signs of anthrax, a peripheral blood smear should always be examined first. If accidently the diagnose was missed, any signs of internal bleedings should alarm the prosector. B. anthacis can be cultured quite easily. Every necropsy should be performed with adequate body protection: proper eye protection, a respiration mask, long gloves, rubber boots and protective clothing. Vaccination Elephants can be vaccinated against anthrax with commercially available vaccines. This is highly recommended in areas where anthrax is seen in farm animals or if there is a history of anthrax in elephants in that area. References/further reading Berry HH. 1993. Surveillance and control of anthrax and rabies in wild herbivores and carnivores in Namibia. Rev Sci Tech 12(1):137–146.Cizauskas CA, Bellan SE, Turner WC, Vance RE, Getz WM. 2014. Frequent and seasonally variable sublethal anthrax infections are accompanied by short-lived immunity in an endemic system. J Anim Ecol 83(5):1078–1090 Hanna P., 1998. Anthrax pathogenesis and host response. Curr Top Microbiol Immunol 225:13–35 Turnbull PC, Bell RH, Saigawa K, Munyenyembe FE, Mulenga CK, Makala LH. 1991. Anthrax in wildlife in the Luangwa Valley, Zambia. Vet Rec 128(17):399–403. Kumaraguru A., Kumaraguru Arumugam , N.S. Manoharan , Ramakrishnan Balasundaram . 2015. Prevalence and disease management with reference to anthrax in the Asian elephant (Elephas maximus) in the Sathyamangalam Wildlife Santuary, Tamil Nadu, India & Indash; A case study. Scientific Transactions in Environment and Technovation, 5(1): 48-51. Okewole P.A., Oyetunde I.L., Irikanulo E.A., Chima J.C., Nwankpa N., Laleye Y., Bot C. 1993. Anthrax and cowdriosis in an African elephant (Loxodonta africana). Walsh, M.G., Mor, S.M., Hossain, S., 2019. The elephant–livestock interface modulates anthrax suitability in India. Proceedings of the Royal Society B: Biological Sciences 286 EAZWV Transmissible Disease Fact Sheet ANTHRAX American Association of Zoo Veterinarians Infectious Disease Manual ANTHRAX Recommended websites: Merck Veterinary Manual. 2021. https://www.merckvetmanual.com/generalized-conditions/anthrax/overview-of-anthrax OIE (Organization for Animal Health: https://anipedia.org/resources/anthrax/1203 FAO: http://www.fao.org/home/search/en/?q=anthrax Microbiology and Immunology On-line: https://www.microbiologybook.org/ghaffar/anthrax-pennsylvania.htm To page top General information Merck Veterinary Manual (2021) : Anthrax is a zoonotic disease caused by the sporeforming bacterium Bacillus anthracis . Anthrax is most common in wild and domestic herbivores (eg, cattle, sheep, goats, camels, antelopes) but can also be seen in people exposed to tissue from infected animals, to contaminated animal products, or directly to B anthracis spores under certain conditions. Depending on the route of infection, host factors, and potentially strain-specific factors, anthrax can have several different clinical presentations. In herbivores, anthrax commonly presents as an acute septicemia with a high fatality rate, often accompanied by hemorrhagic lymphadenitis. In dogs, people, horses, and pigs, it is usually less acute although still potentially fatal. Toxins are the source of most of the disease symptoms associated with anthrax. Edema toxin complex (EdTx) causes the fluid and edema seen in cutaneous anthrax infections, and lethal toxin complex (LeTx) causes shock and death from systemic anthrax (Hanna, 1998). B anthracis spores can remain viable in soil for many years. During this time, they are a potential source of infection for grazing livestock but generally do not represent a direct risk of infection for people. Grazing animals may become infected when they ingest sufficient quantities of these spores from the soil. In addition to direct transmission, biting flies may mechanically transmit B anthracis spores from one animal to another. The latter follows when there have been rains encouraging a high fly hatch and reporting has been delayed on the index ranch, such that there are 4–6 moribund or dead cattle for the flies to feed on. Feed contaminated with bone or other meal from infected animals can serve as a source of infection for livestock, as can hay muddy with contaminated soil. Raw or poorly cooked contaminated meat is a source of infection for zoo carnivores and omnivores; anthrax resulting from contaminated meat consumption has been reported in pigs, dogs, cats, mink, wild carnivores, and people. Human cases may follow contact with contaminated carcasses or animal products (raw meat, skins of animals that died of anthrax). Flies that have fed on a carcass from an anthrax victim can spread the disease over longer distances. Diagnosis Anthrax can be diagnosed in fresh blood smears taken from the ear. Microscopically, B. anthracis can be recognized as long chains of Gram-positive bacteria. If the smear has been exposed to air, the bacteria may have formed spores that can be easily detected. B. anthracis differs in shape from other Bacillus species, that may contaminate the sample in case the animal has been dead for a longer period. Whereas the bacteria chains of B. anthracis seem to be sharply cut off with a knife, the chains of B. cereus have round edges.