A 14-month-old African elephant presented with colic caused by colon obstipation. Due to the severity of the symptoms, it was decided to perform abdominal surgery.  A second surgery was required after 3 months. To colic general information Case report Colic and abdominal surgery in 14-month-old African elephant Date: 2018 Place: South Africa Data provided by: History A 14-month-old African elephant presented with colic caused by colon obstipation. Due to the severity of the symptoms, it was decided to perform abdominal surgery. A second surgery was required after 3 months. Treatment The animal was anesthetized with etorphin, intubated in the trachea, maintained on isoflurane and positioned in dorsal recumbancy. A midline incision was elected to approach the intestines. An obstruction of the colon was found and surgically removed. The peritoneum and muscle layers in the ventral midline were closed in one layer with Number 1 Maxon loop sutures, used in horse colic surgery to close the abdomen. Each suture knot was thrown 5 times, instead of the normal 3 times. The subcutis was closed with 2/0 Vicryl (continuous sutures) and the skin with Number 1 Nylon (single sutures). Reaction of the wound occured both times and she developed an incisional infection . This infection was treated by keeping the wound clean and both times the wound finally healed well. Treatment results The elephant recovered completely without further complications. Paramedian incision Instead of a midline incision, aparamedian incision can be used, just several centimeters left or right of the ventral midline. The advantage of this approach is the possibility to suture more muscle tissue compared to the connective tissue of the linea alba. There may, however, be more bleeding during surgery and access may be more limited than when a midline incision is used. Diagram of the closure of a paramedian incision. A) Skin B) Abdominal tunic C) Aponeurosis of the external abdominal oblique muscles D Rectus abdominal muscle E) Aponeurosis of the transverse abdominal muscle F) Peritoneum To page top

Colic is a condition that is often seen in elephants. This page describes the symptoms of colic and connects to several case reports To non-infectious diseases Colic Compiled by: Willem Schaftenaar Definition of colic Colic can be defined as a symptom of pain in the abdomen. Elephants that suffer of colic can show a variety of symptoms, ncluding: Frequent looking at the abdomen. Touching the abdomen with the trunk. Hitting the abdomen with the trunk. Throwing sand or water towards the abdomen. Throwing sand or water over the backside. Restlessness. Vocalization. Standing with open mouth. Frequently going down and standing up. Lifting a hind leg, supporting it on an object. Kicking a hindleg in the direction of the abdoemn. Bilateral bending the hind legs. Straining. Additional symptoms that may occur simultaneously: increased respiratory rate, increased heart beat, bloating. To colic case reports Causes of colic Gastro-intestinal tract: One of the most frequent causes of colics in elephans is sand impaction. Enteritis, gut spasms, constipation and tympany can also cause colics. Peritonitis. Torsio mesentericum. Abdominal organs: Although not reported in elephants, all abnormal conditions in abdominal organs can cause colics (inflammation, abscess, tumor). The elephant has no gall bladder, but gall stones stuck in the biliary ducts might result in colic. Reproductive tract: Normal parturition. Abnormal parturition. Herniation of the uterus. Large leiomyoma. Urinary tract: Calculi in the urethra. Herniation of the urinary bladder. Bladder stones. Treatment Text to be provided Diagnostic results Text to be provided To page top

Clinical examination is the fundament of clinical interventions. It includes extended anamnesis, observation, clinical examination, palpation, collecting samples (blood, urine, feces, mucosal swabs, skin scrapings, wound materials, broncho-alveolar lavage), ultrasonographic examination (ultrasound), radiology (X-ray), and thermography. Physical examination This chapter serves as a checklist for conducting a complete clinical examination. Performing the full examination as outlined here will not always be necessary. However, it is generally better to collect more information than strictly required, rather than risk overlooking something potentially critical. An excellent and detailed description of the complete clinical examination is provided by E. Wiedner (2015). Elephants can live for 50–70 years, and most will experience health issues at some point in their lives. Determining the exact cause of a problem—the definitive diagnosis—can be challenging. Due to the elephant’s size, not all diagnostic tools and technologies used in domestic species are applicable. Despite these limitations, the overall approach to patient evaluation in elephants is the same as for other large mammals. When presented with a sick elephant, the typical sequence of evaluation begins with taking the history, followed by a physical examination. If these steps do not provide enough information for a diagnosis, laboratory tests are performed. A list of possible causes—the differential diagnosis—is then compiled. Using all available information, we arrive at a final diagnosis and develop an appropriate therapeutic plan. . 1. History It is important to collect as much information about the history of the animal as is available. The information consists of the elements that are directly related to the animal and its surrounding and elements related to the presence of a disease. (Some) symptoms may be absent at the time of clinical examination, but may have been observed by the caretaker. Describe each symptom as clearly as possible. Basic background information: Age; if no data about the age can be provided, the age can be estimated by checking the molars. Gender ID-number Body weight Reproduction history and current status Management related data (single kept, part of a herd, part of bachelor group, natural- or hand-raised, previous diseases history, free/protected contact) Disease monitoring history (TB, parasites , Salmonella , EE HV ) Characteristic normal behavior Physical signs: Symptoms observed (appetite, drinking, alert/inactive/slow/lethargic/apathy, weight loss). Has the elephant shown signs of pain (colic or lameness)? Describe the part of the body, expression of the pain, degree of pain, frequency, throwing sand to the painful body part. Defecation: frequency, amount per defecation, description of feces (soft, firm, watery, smelly, size of bolus, well/poor digested). See also: Fecal quality control . Urination: frequency, amount per urination, description of urine (color, clarity, smell). When did the elephant lose its most recent dental element? Respiration: increased/decreased rate, coughing, discharge from trunk (describe) Salivation: free dropping saliva from the mouth? Has there been discharge from the temporal gland recently? Describe if seen. Discharge from vulva or penis? Describe if seen. Has the elephant been regurgitating food or fluids? If so: describe. Has the elephant shown signs of bloat? Has the elephant shown signs of edema (ventral part of abdomen, head, neck, leg)? Have there been signs of ‘ hiccup ’ or other forms of rhythmic muscle spasms? Has there been a temporary or permanent swelling in the perineal area? When were the above-described symptoms seen for the first time? Continuous or sporadic? Has there been any other disease symptom not yet described here? Are other animals showing similar or different symptoms? If yes, describe. Since when? Have there been traumatic interactions with other elephants? Have there been traumatic interactions with humans? Additional questions for calves: Has there been discharge from the umbilicus (navel) How long before the calf was standing unsupported after it was born? How long before the calf was drinking after it was born? Was the calf rejected by the mother? Describe. Was the calf accepted in the herd? Describe. Additional questions for reproductive females: If the estrous cycle is monitored: describe its pattern (luteal phase, follicular phase, estrous periods, regularity, absence/flatliner, lactation-related anestrous period). When was the last mating? When was the last calving? Were there any problems in the calving process(es)? If yes: describe. Has the placenta come off completely? Milk production: any historical problems in the milk production? If yes: describe. Additional questions for reproductive males: Has the bull produced offspring before? When, how often? Musth periods: age of first musth, frequency of musth, musth behavior, draining temporal gland, swelling of bulbo-urethral gland. 2. Physical Examination Start by observing the elephant from a longer distance before making contact with the animal. Evaluate its behavior with its caretaker and herd mates (alert, depressed, lethargic, aggressive). Describe its posture and demeanors. Any abnormal posture may be an indication of lameness. Make an assessment of its body condition . Then move closer and make contact with the animal (voice, feeding). Only start making physical contact by touching and palpation when the animal trusts you. The more the animal trusts you, the more clinical data you may retrieve from your examination. Thoroughly observe the animal from a shorter distance. Count the respiratory rate at rest (normal value 4-12/minute). As thoracic movements may be hard to distinguish, it maybe necessary to feel the exhaled air streaming from the trunk nostrils. Count the pulse rate at rest (25–30 beats/minute, standing). This can be done on a large artery at the backside of an ear or by auscultation in an elephant less that 2500 kg BW. Pay attention to the regularity of the heart beat. Look for gross lesions or abnormalities (wounds, swellings, lameness, abnormal position of a body part, vulva/penis discharge, urine loss, edema, draining temporal gland(s), salivation, trembling, spasms, colic, bloat). Does the elephant stand quietly on 4 legs, or is it trying to avoid body support on one or more legs? Elephants never stay completely still. Take the body temperature (normal value 36–37°C /97–99°F) by measuring the thermometer in a freshly passed fecal bolus. The center of the bolus provides a more reliable value than rectal insertion would. Examination of the skin: Check for wounds, edema, scars, swellings and warm areas. Wart-like growths are often present in (older) elephants and usually have no clinical implications. The same applies to (large) papillomas in the vulva of old female elephants. However, vesicles or swellings on mucous membranes should always be investigated. Old Asian elephants may lo se pigmentation on the edges of the ears, the trunk and even the rest of the body. In neonates, the navel should be inspected. The mammary glands should be part of the skin examination. Salivary gland: this gland can be observed behind the ears, where it shows as a round, firm swelling ( see image below ). In elephants that receive a natural diet, the gland is usually much bigger than in captive elephants, due to insufficient provision of branches. Examination of the feet: If the animal is well enough trained, it should lift its legs to allow inspection of the nails and pad of each foot. 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 micro-organisms. 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 these cuticles or when pressure is excerted on the cuticles, watery fluid may be discharged ( see video ). The nails should not be longer than the pad, as they do not bear weight when the elephant is standing still nor during walking (see video) . Long nails can easily develop a tear. 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 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. Examination of the eyes: Elephants have no nasolacrimal duct, so tears run constantly through skin grooves down their face. The area around the eyes is often wet. The cornea should be clear. Congestion of the scleral blood vessels may be an indication for heart failure. The iris of an elephant varies in color from tan, yellow, brown or combinations. Blepharospasm is a strong indication for ocular disease. Cataract (white central spot) and keratitis (diffuse, superficial cloudiness of cornea) is frequently seen in elephants. Vision can be checked by passing the light bundle of a flashlight (cell phone) from the ear over the eye (blinking reflex). Ophthalmoscopy in elephants is quite a challenge, as the animal will usually not allow this kind of close examination that moreover uses a light source. The eyelashes should be long in order to protect dirt and objects from touching the eye ball. Oral examination: If the elephant is trained to open its mouth, an oral inspection should be done. The oral mucosa should be wet (shiny aspect) and pink. Lesions in the palate may have been caused by eating branches and are not necessarily associated with disease. They should be distinguished from ulcers and vesicles. Vesicles may be associated with avirus infection, one of these being EEHV. The mucosa of the soft palate may contain several small nodules, which are assumed to be lymphoid tissues (see photo). Tongue: the surface of the tongue should be light pink, smoth and wet. The molars can only be inspected if the elephant is trained to open its mouth. Lower molars are harder to visualize than upper molars, as the elephant tends to cover them with its tongue and cheeks. Check the status of the molars (number, size, position). See also the dentis try chapter. Tusk examination: Tusks in most African elephants are present in males and females. The tusks of female Asian elephants are very small or absent and are called tushes. The bull's tusks grow continuously during his entire life (approximately 10 mm per month) Tusks should be checked for the presence of cracks, fractures, excessive wear and color. A brown color can be an indication that the tusk is not vital anymore. The sulcus should be inspected if the behaviour of the elephant indicates irritation in that area. See also the dentistry chapter. Examination of the circulatory system: Edema : common areas for edema in elephants are the ventral part of abdomen, head, neck, leg. Congestion of the scleral blood vessels may be an indication of heart failure. Heart auscultation : pulse 25–30 beats/minute, standing (72–98 in lateral recumbency). The heart beat can best be heard on the left side when the elephant has brought its left front leg forward or has lifted that leg. The heart beat cannot be heard in most elephants over 2500 kg. An easier way to measure the pulse frequence is by palpation of one of the arteries on the backside of the ears. ECG : by using a so called DUO ECG + Digital Stethoscope it may be possible to make an ECG while visualizing the heart beat at the same time, however, this method still needs to be validated (see photo). Blood pressure can be measured on the tail; the compression pad should be placed at the level of the heart. To obtained the best results with minimal bias caused by stress, the elephant should be trained for this examination. There are very few references of this parameter; one study reported an average systolic pressure of 178 ± 3 mmHg and a dyastolic pressure of 118 ± 3 mmHg in the unsedated standing elephant, with a mean blood pressure of 146 ± 3 mmHg. The blood pressure increased over time to when the elephant was positioned in left lateral recumbency. (African elephants n=7, Asian elephants n=8) Examination of the respiratory system : Respiratory frequency: 10-12/minute (standing) and 4-5 (sleeping) Counting the respiratory rate is best done by feeling the expired air at the tip of the trunk. Check the type of respiration: abdominal, thoracic, panting, forcing Has the elephant been coughing? Auscultation: lung sounds are hard to distinguish by auscultation in elephants (only in very young calves). Check the smell of the exhaled air for abnormal odour that may be associated with pulmonary disease. Check the trunk openings for discharge. Examination of the vulva: The vulva in elephants in the reproductive age should not prolapse. If possible, the mucosa of the vaginal vestibule should be inspected and should be pink and moist. Sometimes hyperemic areas and/or vesicles can be observed higher up in the vaginal vestibule. This could be an indication of a reactivation process of EEHV, which has no clinical implication for the elephant, but this could be a source of virus shedding. In old, non-reproductive females the vulva can be prolapsed, exposing the clitoris. The mucosa in these animals is often pale. Swelling of the vulva can be caused by edema (check by"pitting edema assessment"), hyperplasia or tumors. To page top Salivary gland of an Asian elephant kept under semi free ranging conditions, provided with a 100% natural diet. The temperature measured by placing the thermometer in the middle of a fresh fecal ball, gives an accurate indication of the elephants body temperature (normal value 36–37°C /97–99°F) Thermometer Salivary gland Blinking reflex using a smartphone's flash light in an Asian elephant with chronic keratitis Auscultation of the heart beat and the ECG in an adult Asian elephant by using a combined electronic stethoscope. The left front leg is lifted. The sound cannot be heard, but visualized by the electronic device. Visualization of the heart beat and the ECG in the same animal by using a combined electronic stethoscope. The upper line represents the heart beat, while the right part of the lower line represents the ECG. This method still needs to be validated. Blood pressure can be measured on the tail. Make sure that the compression pad is located at the level of the elephant's heart. Training of the elephant for this procedure is required. Small nodular lumps in the oropharynx are assumed to be lymphoid tissue and can be found in healthy elephants. Whether they increase in size during certain infections is not yet known. The cuticles, the lengths and the shape of the nails in this adult Asian elephant look very nice. Pedicure was never done in this animal. Cuticles The cuticles of this elephant were overgrown and had blocked the draining of the sweat glands. Pressing on the tissue resulted in the release of a "stream" of accumulated clear sweat fluid (for a better view, enlarge the image). The sole pad of this elephant has the right thickness as can be appreciated from the presence of natural grooves. 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) Video locomotion 0.5x A swelling of the bulbo-urethral gland is sometimes seen in the perineal area during the musth period Full vulva relaxation in an old Asian elephant. Note the slightly pale mucosa. Firm mass in the vulva of a 19 yr-old nulliparous African elephant. The mass could be retracted into the vaginal vestibule. This animal was a flatliner. Poor digestion of long fibers in an old Asian elephant with molar teeth problems (rotated and insufficient dental wear. See also: Fecal quality control. 'Hiccup' in an adult Asian elephant bull 3. Laboratory tests Feces: Points of interest are: amount, frequency of defecation, size (small sizes are seen shortly before parturition), consistency, degree of digestion (long fibers are seen in elephants with molar problems), presence of sand (can be palpated or washed out in a bucket filled water), presence of blood, mucous or parasite. A fecal sample should be submitted for parasitology or bacteriology if an intestinal infection is suspected. These samples should be submitted fresh. In case of a suspicion of intoxication, a large fecal sample should be submitted to a relevant lab (always check the possibilities of the lab before you send the sample). Feces quality control Urine Blood Collection Blood (hematology/chemistry) Discharged fluids Wound swab Oral swab Vulva swab Eye swab Trunk wash sa mple Skin scraping Biopsy 4. Additional testing: Ultrasonography : ultrasonographic examination is possible in trained or sedated elephants to assess the reproductive organs and the kidneys, for pregnancy diagnosis and to evaluate abscesses and joints. Measuring the thickness of the foot pad will provide useful information about the degree of wear of the sole. Transcutaneous ultrasound examination can give some information about the liver, intestines, uterus and fetus. Transcutaneous ultrasound examination to assess the internal organs can only be performed in the small triangular window between the caudal side of the last ribs, the pelvic bones and the ventral midline. For good visualization, it can best be done while water (for example from a hose pipe) is running over the skin of the examination area; the ultrasound probe should be kept in the water stream. Drenching the skin with water before examination is also a good option; the probe should be well covered with ultrasound gel. Transrectal ultrasonography is used for examination of the reproductive organs, the fetus and the kidneys. The rectum needs to be cleaned out as much as possible by manual removal of the feces. Best results are obtained after flushing the rectum thoroughly with running water from a hose. Convex 1-5 MHz probes are best used for transrectal and transcutaneous examination of the abdomen. Linear 5-7.5 probes can be used for visualization of the ovaries during transrectal examination. A probe extender is helpful for reaching the ovaries. Special designed metal extenders have been developed. If these are not available, a home made extender can be tried. Ultrasonography is a useful tool to diagnose ocular diseases. The cornea, anterior eye chamber, lens, posterior eye chamber and retina can be visualized with linear or convex probes 5 and more mHz. The probe can be placed on the closed eye lid or on the cornea, in which case local anesthesia is required. The mammary gland can be examined transcutaneously using a convex 1-5 MHz probe. The thickness of the skin and more importantly that of the sole pad can be measured by ultrasound examination. Monitoring this thickness over time can help evaluate treatment started in case of abnormal padthickness. For pregnancy confirmation, click here. Thermography Thermography is an imaging technique using a specialized heat sensitive infrared camera, mapping body surface temperature changes which may indicate inflammatory, vascular or neurological disorders. It is a helpful tool to diagnose from a distance hot spots that are correlated with inflammation and abscesses in the elephant limb or any other place of the body. Click here for more technical details. To page top Hematology and urinalysis manual Transient hot spot (31.4°C) on the left thigh of an adult Asian elephant 1 day after vaccination with Modified Vaccinia Ankara-strain (MVA) Thermographic image of normal elephant feet Thermographic image of a swelling of the left front leg of an Asian elephant with severe chronic lameness. Note that the hot spot is on the proximal part of the abscess. Click here to download an overview on the use of infrared-thermography in Asian elephants by Kumar, 2024. 5. Radiography Most indications for radiographic examination are related to foot problems, anomalies in the carpal and tarsal joints and rarely more proximal joints. The reason is obvious: the elephant leg is too radiodense to allow sufficient penetration of the X-ray beam. A powerful portable X-ray machine (100 kV or more) is required to visualize the bony structures. Digital plates largely increase the quality of the image. It is important to work under safe conditions, which often requires training of the elephant to collaborate with the procedure. Fractures and joint anomalies of the carpal and tarsal areas and below can be visualized in most elephants. Radiographic images of the tusk can give an indication of the position of the tusk pulp cavity, which is important when potential exposure of the pulp tissue is suspected. The radiography procedure for the feet is described on the webpage about nail problems. Click he re for further reading. Some examples of radiographs are shown below. Radiograph showing pathological fractures consistent with secondary hyperparathyroidism (Courtesy: Charles Reid in: Fowler en Mikota, 2006). Fibula fracture and tibia dislocation in an adult Asian elephant (Courtesy: Taweepoke Angkawanish, Lampang elephant conservation center, Thailand) Radiograph of the remnant of a fractured tusk of an asian elephant. Note the pulp cavity that was not involved in this fracture. Radiograph of normal distal phalangeal joints of D3 of an Asian elephant (Courtesy: Rotterdam Zoo) Radiograph of the tarsal joint of a 21 yr-old Asian elephant with severe degenerative joint disease. Note the narrow joint spaces (Courtesy: Rotterdam Zoo). Radiograph of part of the tail of a 30 yr-old Asian elephant and an 18 yr-old Asian elephant. Note that the growth plates are not yet fully closed (Courtesy: Rotterdam Zoo) 6. Gastroscopy (needs your input) 7. Bronchoscopy and broncho-alveolar lavage 8. Differential Diagnosis (needs your input) 9. Final diagnosis (needs your input) 7. Therapeutic Plan (needs your input) References Wiedner, E. 2015. Proboscidea. In R. E. Miller & M. E. Fowler (Eds.), Fowler´s Zoo and Wild Animal Medicine (Vol. 8). St. Louis, Missouri: Elsevier Saunders. Avni-Magen, N., Zaken, S. Kaufman, E. and Kelmer, G. 2017. Use of Infrared Thermography in early diagnosis of Pathologies in Asian Elephants (Elephas maximus ). Israel Journal of Veterinary Medicine Vol. 72 (2) Honeywell V.L., Pettifer G.R., and Dyson D.H.,1992; Arterial blood pressure and blood gases in normal standing and laterally recumbent African (Loxodonta africana) and Asian (Elephas maximus) elephants. JZWM 23(2) 205-210 To page top

Kidney disease is quite common in elephants. The analysis of urine is important. This page describes the routine urinalysis and some specific features related to elephant urine. Protein detection can be done by refractometry and sulfosalicylic acid (SSA)precipitation. Comparing osmolarity in serum and urine gives an indication for the presence of kidney failure. To lab diagnosis Urinalysis The routine urinalysis is a quick and relatively inexpensive test which can be readily performed in a field laboratory. Ideally urine should always be collected at the same time as blood for hematology and clinical chemistry (if possible) and before any treatment is administered. Urine should be examined as soon as possible after collection, because artifacts will occur in the urine over time (cells lyse, crystals form in vitro). If a delay is anticipated before analysis, the urine should be refrigerated. Refrigerated urine should always be brought to room temperature before testing. A complete urinalysis consists of 1) evaluation of physical characteristics, 2) measurement of specific gravity, 3) dipstick analysis and 4) examination of sediment. Equipment and Materials Microscope Refractometer Slides Urinalysis dipsticks Urine sediment stain Physical Characteristics of Urine 1. Evaluate and record urine color Normal mammalian urine is yellow to amber. Urine volume and concentration affect the depth of the color. Some examples of various urine colors and corresponding common possible causes: 2. Evaluate and record urine turbidity Fresh urine is clear to very slightly cloudy. Urine may become more cloudy if left standing or if refrigerated. The turbidity of the urine sample is reported as: clear, slightly cloudy, cloudy, opaque, or flocculent. Excess turbidity results from the presence of suspended particles in the urine. The cause can usually be determined based on the results of the microscopic urine sediment examination. Common causes of abnormal turbidity include: increased cells (RBC, WBC) numerous crystals bacteria lipiduria (lipids often rise to the surface) mucus (especially in horses) semen fecal contamination 3. Odor Ammonia is formed from urea by bacterial action. An ammonia smell may be prominent in retained or old urine samples. An acetone small may suggest ketosis. Some drugs may impart a characteristic odor. 4. Volume Urine volume may be estimated from urine specific gravity. In general, volume and specific gravity (S.G.) are inversely related in health and in most diseases. Exceptions include: Diabetes mellitus. Polyuria and high S.G. coexist because of glucosuria. Acute and chronic renal disease. Oliguria (↓ urine volume) may be accompanied by a lack of renal concentrating ability. 5. Measure specific gravity (S.G.) Specific gravity is the ratio of the refractive index of urine compared to water. Refractometry is the easiest method to measure urine S.G.Dipsticks are not as accurate. Glucose and protein may falsely ↑ urine S.G. Knowledge of the hydration status is necessary to interpret the S.G. Urine S.G. can vary from 1.001 to 1.065 in most healthy animals but this range also includes values associated with renal abnormalities. S.G. has been inadequately studied in elephants and obtaining a baseline during health and evaluating sequential samples during illness is recommended. Isosthenuria (fixed S.G.) is the constant maintenance of urine S.G in the range of the glomerular filtrate (1.008-1.012). Isosthenuria means the kidney is neither concentrating nor diluting urine. Hyposthenuria is a S.G. < 1.008. In hyposthenuria the kidneys still have some water-balance function. 6. Perform dipstick analysis and record results. Mix the urine Dip the dipstick; remove extra urine Start timing Compare to chart on bottle in good light The dipstick method is not reliable for protein detection in elephants. Using the SSA-method is more reliable (see 6.1) 6.1 Urine protein detection. "PROT-SSA" represents the reaction observed on the sulfosalicylic acid (SSA)precipitation test. The SSA reagent is added to a small volume of urine. Acidification causes precipitation of protein in the sample (seen as increasing turbidity), which is subjectively graded as trace, 1+, 2+, 3+ or 4+. Unlike the "PROT-STIX" test, the SSA reaction will detect albumin andglobulins (although it is more sensitive to albumin). In addition, the SSA detects Bence-Jones proteins, although it often underestimates them. In alkaline urine, the SSA reaction is a more accurate measure of urine protein content than the dipstick. The most accurate measurement of urine protein output is measurement of urine protein excretion over 24-hours. False positives Contrast media Antibiotics in high concentration, e.g. penicillin and cephalosporin derivatives Uncentrifuged turbid urines can look positive. Therefore, SSA should always be performed on urine supernatant. False negatives Highly buffered alkaline urine. The urine may require acidification to a pH of 7.0 before performing the SSA test. Dilute urine Turbid urine - may mask a positive reaction. https://www.klimud.org/public/atlas/idrar/web/www.diaglab.vet.cornell.edu/clinpath/modules/ua-rout/protssa.htm 7. Urine sediment examination Centrifuge a fresh urine sample for 5 minutes at about 1500 RPM Remove supernatant Add 1-2 drops of stain to sediment Tap the bottom of the tube to mix Transfer one drop to a slide and place a coverslip Examine the entire coverslip at 10X and 40X * Low maginification (10x): casts, large crystals, debris, parasitic ova are visible * High magnification (40x): leukocytes, erythrocytes, epithelial cells, fat droplets, small crystals, sperm, debris and bacteria are visible To page top

Molar teeth in elephants: development, age estimation, malformation, malpositioning, molar extraction and shortening of molar teeth are presented in this chapter. Back to dentistry Inspection of the molars Inspection of the molars can be difficult even in elephants that are trained to open the mouth. The elephant usually covers the molars by its cheeks. By using 2 targets, one on each side of the mouth, the elephant can learn to open its mouth. A very informative article about the development of molar teeth and several disorders in molars and tusks has been written by D.A. Fagan, J.E.Oosterhuis, and A. Roocroft (Colyer Institute). Click here to read the entire manuscript. Molar development Written by Willem Schaftenaar Dental formula in elephants The molars in elephants differ from other mammalians. In each side of the mandible and the maxilla a single molar tooth develops at a time. This molar consists of lamellae that are compressed together to form one dental element, which slowly progresses in forward direction, pushed as it is by a new molar that is developing caudal to the functional molar. During their entire life span, an elephant develops only 6 molars on each side of the mandible and upper jaw. The lamellae are fused together with cement and at the grinding side covert with enamel. The different length of the lamellae give the molars its irregular shape at the grinding surface, which is extra supported by the difference in hardness between enamel and dentine. During the development of molar teeth, two processes are very important: Dentinogenesis: the formation of dentin. Amelogenesis: the formation of enamel. Any disturbance in these processes may result in malformation or poor quality of that molar, which is manifested as dental dysplasia. Such an abnormal molar may be weak and prone to deformity, malposition and malocclusion. This can lead to food impaction and consequently infection of the peridontal structures. The condition of the molar teeth is important for the physical condition of the elephant. The body mass of both breeding and non-breeding female zoo elephants shows a cyclic undulation with peaks separated by many years, and correlated with the total surface of the functional the molar teeth (Schiffmann 2018). Molars are important for the estimation of the age of an elephant. The numbers of the lamellae are quite specific for the sequential number of the molar. These numbers differ slightly between Asian and African elephants. So, by counting the lamellae of the presented molar, the sequential number of that particular molar tooth can be estimated. The lamellae of molars that have not yet erupted are loose. The same applies for molars in the embryonic stage. A drawing of the distinctive Occlusal Wear Patterns characteristic of Asian and African elephant molar dentition. It is this unique diamond shaped patten which provides the origin of the African elephant's scientific name Loxodonta - from the Greek word loxos - meaning oblique. (Modified from KINGDON 1971 & STERNDALE 1929) Age estimation This table shows when a new molar erupts and at which age this particular molar is replaced by a new one. When the number of lamellae has informed us about the sequential number of the molar tooth, we can simply look at this table to estimate the age of the elephant. The final molar tooth that appears is the 6th one, that erupts at the age of 40 years. When this molar is gone (usually between 60 and 80 years), no new molar develops and the elephant will have no proper molars to mastigate its food. This radiograph shows the tusks and the molar teeth in the skull of a young elephant. Each tusk has a large, distinct pulpa chamber (Courtesy: Basel Zoo). This radiograph shows you the mandibles. As indicated on the picture, each side contains a very small erupted molar on the left side, followed by another (erupted) molar in the middle and finally a large molar on the right side. (Courtesy: Basel Zoo). The erupted molar in the middle consists of 6 lamellae. This means that it is the second molar tooth that has developed in this elephant. There is still a small remnant of the first molar. The 3rd molar is at the point of eruption. The dentition of the jaw on the X-ray corresponds with the dentition of the jaw preparation. Both elephants was approximately 2,5 years old. Molar tooth disorders Molar tooth disorders are quite common in elephants, especially in the older ones. The progressive changes of the molars make them prone to malpositioning. Pathological changes during the development of the molar before it erupts, can result in a deformed or rotated tooth. Like in all animals with teeth, the quality of the food correlates with the quality of the teeth. If the speed of the abrasive wear is faster than the mineralization, the pulp of the molar tooth can become exposed. Insufficient abrasive wear (for example if the diet contains insufficient branches) will result in the opposite: long molar teeth, which often often are rotated. A loose piece of an old molar in this 40 yrs-old Asian elephant caused pain, which became manifest by the animal's reluctance to eat hard food items. Video: Willem Schaftenaar Sometimes, especially when there is a certain degree of molar mal-positioning, the peridontal area can become infected. This is a painful condition which may lead to reduced appatite or selective food consumption, avoiding hard items. An example of mal-formation and rotation of the molar tooth in an Asian elephant. Click here to read a case report about this condition. Courtesy: Christian Schiffmann Excessive abrasive wear of the molar teeth in this elephant had opened the pulp cavity of the anterior lamella of this lower molar tooth af an African elephant. Courtesy Peter Kertesz. Insufficient abrasive wear or disturbed pre-eruption molar development has resulted in excessively long molar teeth in this 60 yrs-old female Asian elephant. As a result the animal could not masticate her food properly, which was expressed by the poorly digested, long fibers present in the feces. The photo in the middle was taken a few years after the first one. Impacted Molar Dentition: Clinical Observations, Management, and Preventive Considerations Place: Kolmarden Zoo Date: April 2026 Data provided by: Malin Wiklund Impacted molar dentition is a relatively common condition in captive elephants, particularly in older individuals. This condition was also found in ancestors of the current elephantid species (Sanders, 2018). It is characterized by abnormal positioning and impaired progression of the molar teeth within the jaw. In affected animals, the enamel plates may become inclined obliquely relative to the anterior–posterior axis of the tooth. This pathological process typically begins when the preceding molar fails to advance forward at the same rate as the developing successor. As a result, the emerging molar becomes progressively compressed within the alveolar socket, leading to deformation of the molar lamellae. The degree of deformation is generally proportional to the extent of compression. Insufficient dental abrasion is considered a primary contributing factor to this condition. In captive settings, diets lacking sufficient fibrous and abrasive components necessary to support normal tooth wear and forward progression, predispose animals to molar impaction and associated abnormalities. Displacement of a molar tooth caused by a tumor in the maxilla of an African elephant has been described by Steenkamp (2003). Figure 1 shows an impacted mandibular molar dentition in an aged, captive Asian female elephant. The enamel plates of the right mandibular sixth molar are clearly oriented obliquely relative to the anterior–posterior axis of the tooth. This pattern indicates that enamel dysplasia likely began several years earlier, when the fifth molar was still in functional position and was unable to advance forward at the same rate as the developing sixth molar. A similar condition is present in the left mandibular sixth molar, although in a more severe form. Here, the enamel dysplasia is accompanied by marked dilaceration of the entire developing tooth. In contrast, the right maxillary molar appears to have been the most actively used tooth, showing relatively normal wear. This suggests a unilateral chewing preference in this animal. The left maxillary molar appears morphologically normal but shows minimal wear, likely due to reduced functional opposition with the deformed left mandibular molar. Figure 1. Skull of a geriatric Asian elephant (Courtesy of The Colyer Institute) Figure 2 illustrates the maxillary molars of a 27-year-old female Asian elephant exhibiting severe compression of the erupting fifth molars. The anterior part of the right 4th molar showed limited movement within its socket, whereas the left 4th molar was firmly attached to its socket. Overall, analysis of this animal’s dentition suggests that, over an extended period, the abrasiveness of the diet was not well matched to the natural rate of dental growth and development. Figure 2. Severe compression of maxillary molars of a 27-year-old female Asian elephant Treatment and Management A conservative management approach was implemented, consisting of the application of daily mechanical pressure to the molars using a target device with markings expressed in centimeters. This method allowed for consistent monitoring of the inter-molar distance while promoting gradual loosening and forward movement of the impacted teeth. Over a period of three months, the molars had advanced and almost touching each other (Figure 3). Within the next 3-7 months, fragments of the molars could be removed or came off on their own (Figures 4-7). Figure 3: 2023 06 -11 Figure 4: 2023 06 18 Figure 6: 2025 09 02 Figure 6: 2025 09 02 Figure 7: Fragments of affected molars Prevention The development of pathological molar impaction and displacement in elephants is most likely associated with inadequate dental wear. Preventive strategies should therefore focus on dietary management, specifically by increasing the provision of coarse, fibrous, and abrasive materials such as branches. Such measures are essential to ensure proper tooth wear, facilitate normal molar progression, and reduce the risk of impaction and related dental pathologies. References: Fagan DA, Oosterhuis JE, and Roocroft A. Captivity Disorders in Elephants Impacted Molars and Broken Tusks D.A. Fagan, J.E.Oosterhuis, and A. Roocroft (Colyer Institute). Sanders, W J. (2018). Horizontal tooth displacement and premolar occurrence in elephants and other elephantiform proboscideans. Historical Biology, 30(1–2), 137–156. https://doi.org/10.1080/08912963.2017.1297436 Steenkamp G. 2003. Oral biology and disorders of tusked mammals. Vet Clin Exot Anim 6 (2003) 689–725. Molar extraction and shortening The extraction of a molar tooth in an elephant is quite challenging. The indication for an extraction is usually mal-positioning and abnormal abrasive wear of the tooth, which has a negative impact on the elephant's well being. Click here to watch the video about the extraction of the mal-positioned molar tooth in a female Asian elephant. This photo shows the extracted molar tooth. The cut in this tooth was made to get sufficient grip on the tooth for the extraction. Note the abnormal abrasive wear on the anterior side of the molar I n another adult Asian elephant the lower molar had been worn down insufficiently and this obstructed t he normal chewing action. By using a special pneumatic oscillating saw and chisel the length of the molar was reduced sufficiently to restore the normal chewing activities. The photos show stills from a video ; note the special designed gingiva protector, a high potent vacuum cleaner and the oscillating saw in use. The short video fragment shows the end result of the shortened molar tooth. References Biology, Medicine, and Surgery of Elephants. Fowler & Mikota, 271-290. Fagan DA, Oosterhuis JE, and Roocroft A. Captivity Disorders in Elephants: Impacted Molars and Broken Tusks. Colyer Institute, San Diego (Ca) USA. Kertesz P. 1993. A colour atlas of Veterinary dentistry and oral surgery. Wolfe Publishing. ISBN 0 7234 1542 0. Schiffmann C, Hatt J-M, Hoby S, Codron D, Clauss M. 2018. Elephant body mass cyclicity suggests effect of molar progression on chewing efficienc y . Mammalian Biology, Volume 96, May 2019, Pages 81-8. Treatment insufficient molar wear Lucha the elephant visits the dentist (youtube.com) To page top Molar issues Molar development Age estimation Molar tooth disorders Molar tooth extraction Molar development Age estimation Molar disorders Molar extraction Molar impaction

Leptospirosis in elephants has been described in Asian elephants. This page describes clinical cases and treatment as well as serological evidence of leptospirosis in apparently healthy elephants and the presence of leptospiresin elephant urine. Leptospirosis General information Leptospirosis is a bacterial infection caused by Leptospira spp . It is a common disease in many species of domestic animals. Leptospirosis is zoonotic. The bacteria are dispersed by urine of rodents, especially rats. The organism can survive many weeks in a slightly alkaline moist environment. The route of infection is by percutaneous inoculation of wounds or through mucous membranes. Several serovars have been associated with disease. Usually the liver is the target organ of Leptospira sp . Icterus, anemia, weight loss, (ventral) edema and general malaise are the main clinical signs. Ocular involvement (uveitis and hypopyon) may also occur. In elephants only a few clinical cases of leptospirosis have been reported. In one study in Sri Lanka, urine samples from 13 healthy domesticated elephants were collected on three consecutive days and analyzed for leptospiral DNA (Athapattu, 2019). Four elephants (31%) were confirmed to shed pathogenic leptospires in their urine. DNA sequencing followed by phylogenetic distance measurements revealed that all positive elephants were infected with L. interrogans. This study reveals the possibility that elephants may act as a source of infection for humans and recommends that all domesticated elephants that are in close contact with humans be screened to detect leptospiral shedding. In a study in India, serum samples were collected from 51 captive elephants kept in three different forest ranges (Shivraj, 2009). The samples were subjected to screening for leptospirosis using the microscopic agglutination test (MAT). It was found that out of the 51 samples seven elephant sera (13.72%) showed antibody titers against two serovars of Leptospira interrogans (L. australis and L. canicola) by MAT indicating the presence of infection or due to the past exposure of captive elephants to leptospiral antigens. In Thailand serum from 113 Asian elephants residing in 10 different tourist camps were tested using the microscopic agglutination test against 22 serovars of Leptospira interrogans (Oni, 2007). A seroprevalence of 58 % was found. The prevalent serovars were L. interrogans Sejroe, L. interrogans Tarassovi, L. interrogans Ranarum and L. interrogans Bataviae and L. interrogans Shermani . These results were similar to studies in domestic livestock and stray dogs in the Bangkok district. Because of the potential risk of indirect transmission of Leptospira spp from elephants to humans, 24 environmental samples were collected from an elephant camp area in western Thailand (Chaiwattanarungruengpaisan, 2019). Eighteen samples (75%) were culture-positive for Leptospira spp . The recovered leptospires were mostly derived from water and soil samples from a river and a mud pond, the main areas for recreational activities. The majority of the isolates were classified into the “Pathogens” clade (89%, 16/18) and more than half of the isolates (61%, 11/18) contained species of the “Saprophytes” clade. Notably, two soil isolates from the river beach sampling area were found to contain leptospiral DNA with high similarity to the pathogenic L. interrogans and L. santarosai . The evidence of diverse Leptospira spp ., particularly those belonging to the “Pathogens” clade, suggest that the shared environments of an elephant camp can serve as potential infection sources and may pose a risk to the elephant camp tourists and workers. It was not clear from this study whether the elephants were the source of these Leptospira spp. Leptospirosis in elephants One clinical case described the following clinical signs: chronic weight loss (400 kg) over a 4-month period (Fowler, 2006). Anorexia was profound. Leptospirosis was included in the differential diagnosis when the elephant developed uve itis and hypopyon . Titers for multiple serovars of Leptospira reached 1:12,800. The liver was the organ system infected. Icterus was marked. The sclera and hypopyon were both bright yellow. Total bilirubin reached 160 μmol/L (9.4 mg/dl), and liver enzymes were elevated. Ventral edema became pronounced, accompanied by ulcerating lesions of the vulva and various areas of the skin. The tip of the tail necrosed from vasculitis. Blood urea nitrogen and creatinine levels remained normal throughout the course of the disease, indicating that the urinary tract was not involved. Diagnosis was based on elevated titers for Leptospira serovars plus hypopyon and uveitis. The organism was not isolated nor could antigens be detected by PCR. Two other elephants cohabitating with the ill elephant developed low titers (1:200–400) for Leptospira icterohemorrhagica , but they did not develop clinical disease. Another case was described by Govindarjan (2006): A 16 yr-old Asian elephant bull was off food for one week. He developed icteric mucous membranes and his urine stained yellow (the author of this report did not mention the color in comparison with the color of normal urine, which is yellow as well). An 8-fold increase of antibodies against L. pyrogenes was observed within a 20-day interval. Diagnosis of leptospirosis is based on serological assays (Micro Agglutination Test MAT, ELISA), PCR, dark field microscopy, and silver impregnation staining. Treatment of elephants with clinical leptospirosis consists of the administration of antibiotics (tetracycline, doxycycline). In the case described above by Govindarjan, amoxicillin was given at a dose of 30 g/day IV for 14 days. References Fowler M. 2006. Infectious diseases. In: Biology, Medicine and Surgery of Elephants, Ed. Fowler and Mikota, 2006, 148. O. Oni, K. Sujit, S. Kasemsuwan, T. Sakpuaram, D. U. Pfeiffer. 2007. Seroprevalence of leptospirosis in domesticated Asian elephants (Elephas maximus) in north and west Thailand in 2004 Veterinary Record (2007) 160, 368-371. Sjivraj, M.D. Venkatesha, Sanjeevkumar, B.M.Chandranaik, Rajkumari Sanjukta, P.Giridhar, and C. Renukaprasad (2009). Detection of leptospiral antibodies in thesera of captive elephants. Veterinary World, Vol.2(4): 2009, 133-134. T. P. J. Athapattu, B. R. Fernando, N. Koizumi and C. D.Gamage. 2019. Detection of pathogenic leptospires in the urine of domesticated elephants in Sri Lanka. Acta Tropica Vol. 195 Pages 78-82 Chaiwattanarungruengpaisan, S., Thepapichaikul, W., Paungpin, W., Ketchim, K., Suwanpakdee, S., Thongdee, M., 2020. Potentially Pathogenic Leptospira in the Environment of an Elephant Camp in Thailand. Tropical Medicine and Infectious Disease 5, 183.. doi:10.3390/tropicalmed5040183 Leptospirosis AAZV fact sheet (2018) Leptospirosis EAZWV fact sheet (2003) To infectious diseases

This chapter describes (standing) sedation, general anesthesia, intubation and epidural anesthesia using xylazin, ketamine, azaperone, detomidine, medetomidine, etorphin, carfentanil, gas anesthesia and lidocain. To procedures This page describes the following procedures Standing sedation General anesthesia Epidural anesthesia Anesthesia Standing sedation Sedation: In case the elephant does not cooperate voluntarily with the manipulations needed for the diagnosis or treatment the animal should be sedated (including herd mates if needed to reduce stress in the herd) Standing sedation can be performed using xylazine or (preferred) detomidine in combination with butorphanol. Medetomidine works as good as detomidine, but is more expensive. Young elephants need the higher dose range compared to older elephants. Elephants that are excited can be premedicated with azaperone (Asian elephant 0.024-0.038 IM, African elephant 0.056-0.107 IM, IV). Detomidine 0.01-0.022 mg/kg IM (can be reversed by atipamezole at 3-5 times the dose of detomidine). Young calves may need a higher dose of detomidine (0.02-0.04 mg/kg). AND Butorphanol 0.015-0.025 mg/kg given at same time as detomidine. Butorphanol can be reversed with naltrexone at 2.5-5 times the dose of butorphanol in emergency situations, but reversal is not essential and should preferably not be carried out if the calf is considered to be in pain. Alternative option for sedation (if the above mentioned drugs are not available): Xylazine : 0.04-0.08 mg/kg IM for adult Asian elephants and 0.08-0.1 mg/kg for African elephants. Juvenile Asian elephants: 0.09–0.15 xylazine mg/kg IM (Jansson 2021) If insufficient sedation is obtained by xylazine alone, an additional (low) dose of ketamine (0.03 – 0.06 mg/kg) can be given IM or IV. Xylazine can be reversed with yohimbine (0.073-0.098 mg/kg slowly IV) or atipamezole (0.1 x xylazine dose IM or 30/70 IV/IM) Another alternative option for sedation of Asian elephants: Dexmedetomidine : 2 μg/kg BM IM will provide sufficient standing sedation for approximately 70 minutes. (Buranaprim, 2022). Dexmedetomidine can be antagonized by atipamezole (10 times the dexmedetomidine dosage). If a young calf needs to be sedated, it may be necessary to sedate the dam or other adult herd mates so they are not stressed during manipulations on a calf. This can be done by the administration of: Butorphanol 0.006 mg/kg IM and detomidine 0.0026 mg/kg IM (In adult female Asian elephants, 20mg butorphanol and 10mg detomidine have been effective) Sedation can be reversed as described above but is not necessary Alternatively, xylazine (0.04–0.08 mg/kg) or other sedative agents (e.g. Azaperone at 0.024–0.038 mg/kg) can be used if detomidine is unavailable. Laubscher LL et a. 2021 described a fixed drug combination of butorphanol, azaperone and medetomidine (BAM) for African elephants. The dose is given per cm shoulder height. The composition of this anesthetic mixture is: 30 mg/ml butorphanol, 12 mg/ml azaperone, and 12 mg/ml medetomidine. The use of this combination can be recommended in captive, trained African elephants at a dose of 0.006 6 ± 0.001 ml/cm shoulder height. Oral or rectal administration of detomidine in the form of a gel (Domosedan gel, 20-50 mcg/kg) to obtain mild sedation has been described (2020, Molter). The gel must be rubbed into the oral mucosa or rectal wall. Initial, mild sedation is seen after 15-20 minutes. The maximal effect is at 30-45 minutes. A full standard sedation is characterized by the following signs: Salivation Relaxation of the trunk; the tip of the trunk will touch the ground. Relaxation of the penis and (less obvious) relaxation of the vulva. Snooring sounds. It is important to cover the eyes with gauze pads (taped to the skin with Leucoplast or ducttape) and put cotton plugs in the ears. This will deepen the sedation and reduce the risk of sudden wakening. One should always be prepared that the elephant may wake up. Safety procedures need to be discussed in advance with everyone involved in the procedure. Summary agonist - antagonists Xylazine can be reversed by atipamezole : 0.1 x xylazine dose or yohimbine : 0,05-0,13 mg/kg IV Detomidine is reversed by: atipamezole: 3-5 times the detomidine dose IM or slow IV (30/70 IV/IM) Butorphanol is reversed by naltrexone: 2.5-5 x butorphenol dose IV. Skip naltrexone if pain relieve is desirable. The naltrexone dosage provided by Laubscher LL et a. 2020 is much lower: 1 mg naltrexone per mg butorphanol. References: Buranapim, N., Kulnanan, P., Chingpathomkul, K., Angkawanish, T., Chansitthiwet, S., Langkaphin, W., Sombutputorn, P., Monchaivanakit, N., Kasemjai, K., Namwongprom, K., Boonprasert, K., Bansiddhi, P., Thitaram, N., Sharp, P., Pacharinsak, C., Thitaram, C., 2022. Dexmedetomidine Effectively Sedates Asian Elephants (Elephas maximus ). Animals 12, 2787.. doi:10.3390/ani12202787 Fowler M.E. and Mikota S.K. 2006. Chemical restraint and general anesthesia. In: Biology, medicine and surgery of elephants. Blackwell Publishing. Jansson T., Vijitha P.B., Edner A., and Fahlman A. 2021. Standing sedation with xylazine and reversal with yohimbine in juvenile Asian elephants ( Elephas maximus ). Journal of Zoo and Wildlife Medicine, 52(2) : 437-444. Liesel L. Laubscher , Silke Pfitzer , Peter S. Rogers , Lisa L. Wolfe , Michael W. Miller , Aleksandr Semjonov , Jacobus P. Raath. 2021. Evaluating the use of a butorphanol-azaperone-medetomidine fixed-dose combination for standing sedation in African elephants (Loxodonta africana). J. of Zoo and Wildlife Medicine, 52(1) :287-294 (2021). Molter C. 2020. Diagnosis and treatment of EEHV-hemorrhagic disease. Proceedings of the annual AAZV- symposium 2020. Neiffer D.L. , Miller M.A., Weber M., Stetter M., Fontenot D.K., Robbins P.K., and Pye G.W. 2005. Standing sedation in African elephants (Loxodonta africana) using detomidine–butorphanol combinations. Journal of Zoo and Wildlife Medicine 36(2): 250–256, 2005. E. Wiedner. 2015. Proboscidea. In: Fowler's Zoo and Wild animal Medicine 8. Standing sedatin General Anesthesia General remarks: General anesthesia is required in those cases where standing sedation alone or in combination with local anesthesia does not suffice for the intervention that needs to be done. We can devide the indications in: Capture immobilization Immobilization for painful procedures Capture immobilization is mostly done in range countries. However, the escape of a captive elephant may also require capture immobilization. Elephants from this category have not been prepared for the immobilization. This means that they have been able to take food an water shortly prior to the immobilization. It aslo nmeasn that the circumstances have not (or insufficiently) been prepared for the procedure as compared to an immobilization under full captive conditions. Preparation : If possible, prepare a safe area for the people and elephant involved. Avoid an area with water and select a place that is reachable for heavy equipment. Provide shadow whenever possible. Make sure you can ccol the elephant with cold water when necessary. Heavy equipment to position the elephant in lateral recumbancy may be needed, as sternal recumbancy is highly associated with anesthetic death. If an elephant has gone down in sternal position and cannot be rolled over in lateral recumbancy, the anesthesia must be reversed immediately. Whenever possible, provide a soft bedding, preferably a deep sand layer covered by a deep layer of straw or matrasses. Straps or belts are required in case the elephant needs to be rolled over. It is important to thraw them under the elephant before the animal will go down. It helps if the elephant lays on sand and straw to get straps or a belt under the elephant's body with the help of a hooked steel wire. To protect the tusks against fractures, a car tyre can be placed under the head just before the elephant goes down. Trained elephant can be anesthetized when brought lateral recumbency. If the elephant is trained to ly down in sternal position, general anesthesia can be induced but this is very risky! Once the drugs have reached their effect, the elephant MUST be rolled over into lateral recumbency, which requires heavy equipment. Especially in trained elephants, ropes can be used to guide the elephant into lateral recumbency. Trained captive African elephant brought under general anesthesia while guided by ropes. Courtesy: Osterhaus and Fagan. For correct positioning of the elephant during general anesthesia, the use of a crane is highly recommended. First, a standing sedation is induced. After a net has been brought into position, this can be connected to the crane. This will support the elephant when the general anesthesia is induced by IV or IM injection of the narcotic drug (etorphine or ketamine). By lifting the elephant it can be positioned in the correct lateral recumbancy. Protecting cushions, matrasses and soft bedding materials should be placed underneath the head and the body. See the images of the use of a net below (Courtesy basel Zoo): Elephants should be fastened for 24-48 hours prior to anesthesia. Water should be withheld for 24 hours before the procedure. Capture immobilization is mostly done in range countries. The escape of a captive elephant may also require capture immobilization. Elephants from this category have not been prepared for the immobilization. This means that they have been able to take food an water shortly prior to the immobilization. It also means that the circumstances have not or insufficiently been prepared for the procedure as compared to an immobilization under full captive conditions. Preparation: if possible, prepare a safe area for the people and elephant involved. Avoid an area with water and select an area that is reachable for equipment. Provide shadow whenever possible. Make sure you cool the elephant with cold water when necessary. Heavy equipment to position the elephant in lateral recumbancy may be needed, as sternal recumbancy is highly associated with anesthetic death. If an elephant has gone down in sternal position and cannot be rolled over in lateral recumbancy, the anesthesia must be reversed immediately. Whenever possible, provide a soft bedding, preferably sand covered by a deep layer of straw or matrasses. If straps are required in case the elephant needs to be rolled over, it is important to thraw them under the elephant just before the animal will go down. It helps if the elephants lays on sand and straw to get straps or a belt under the elephant's body with the help of a hooked steel wire. The use of a suitable net is highly recommended as slings may slide away from the desired place of the elephant's body. Oxygen supplementation Oxygen must always be provided, even if the anesthetized elephant is not intubated. Arterial blood pressure will drop if no oxygen is provided (Heard 1986). An oxygen flow of 10-15 L/min for a juvenile up to 39-40 L/min for an adult elephant is required for maintaining arterial blood pressure at an acceptable level. Oxygen supply during general anesthesia of a 5 yr-old Asian elephant under field conditions. Due to lack of proper equipment, intubation was not possible. Oxygen was provided at a flow rate of 10 L/min via a small tube inserted in the trunk. Drugs used for general anesthesia: Captive elephants that are excited can be premedicated with azaperone (Asian elephant 0.024-0.038 IM, African elephant 0.056-0.107 IM, IV). Fast acting immobilizing drugs that are used for capture immobilization: Etorphine : 0.002-0.004 mg/kg IM (Asian elephant) and 0.0015-0.003 mg/kg IM (African elephant) OR Carfentanil : 0.002-0.004 mg/kg (Asian elephant) and 0.0013-0.0024 mg/kg IM (African elephant) These drugs can be antagonized with naltrexone 0.004 mg/kg IM (or 50/50 IV/IM) If carfentanil and etorphine are not available, xylazine (0.1 mg/kg) and ketamine (0.3-0.7 mg/kg) can be given together. The disadvantage is the large volume required for an adult elephant. For capture immobilization this combination is therefore not recommended. At the end of the procedure xylazine can be reversed with atipamezole (0.1 x dose of xylazine IM or slowly IV) or yohimbine (0.05-0.13 mg/kg IV). Under controlled conditions (if a crane is available) a standing sedation can be induced first, allowing to put a net or slings in place. When well secured, ketamine can be given i.m. (0.3-0.7 mg/kg). or i.v. using a long infusion tube for safety reasons. Once in lateral recumbancy, the elephant can be intubated and anesthesia can be maintained on isoflurane or halothane (1.5-3%). Inhalation anesthesia and intubation: Intubation in elephants is straightforward. A 30-50 mm diameter cuffed endotracheal tube can be inserted into the trachea. A rope around the lower jaw can be used to open the mouth. A gloved hand can reach the epiglottis and advance a lung tube (e.g. stocha tube for horses) into the trachea, while pushing the soft palate upward. Once in place, the endotracheal tube can be advanced into the trachea guided by the smaller tube. A special portable pressure ventilater has been developed and described by William et al. Jeff Zuba made some modifications to this design, which is now commercially available (http://www.incaseofanesthesia.com/Home_Page.html ). Schematic overview of a portable pressure ventilation device for elephants. "Zuba" ventilator used in an adult African elephant under field conditions Captive African elephant intubated for gas anesthesia using a "Zuba" ventilator. "Zuba" ventilator Under less favorable circumstances when a pressure ventilator is not available, intubation can be done in the trunk using 2 cuffed horse endotracheal tubes and 2 separate (portable) anesthetic machines (Tamas 1983). The advantages of this method are the easy intubation and the ample space in the oral cavity in the absence of the large tube. However the disadvantages are substantial: Two tubes increase the airway resistence Risk of regurgitation and aspiration of stomach contents An elephant can breath through its mouth, which will bypass the inhalation of the anethetic gas General anesthesia in a captive Asian elephant using bilateral trunk intubation (Rotterdam Zoo, 1989) Monitoring: Pulse oximetry is a reliable tool for monitoring heart frequency and venous oxygen saturation. A capnagraph is recommended to monitor the respiration. If not available, one individual should be assigned just to monitor respiratory rate and depth. ECG and arterial blood gases are recommended. As hypotension is quite common in anesthetized elephants, blood pressure measurement is also recommended. Hypotension has been treated successfully with ephedrine and dobutamine. Recovery support: Weak or debilitated animals may need help to get back on their feet during recovery. A deep sand layer is essential for the elephant to getting grip on the ground. A crane may be needed to lift the animal from the ground, using straps or belts applied around the body. References. Fowler M.E. and Mikota S.K. 2006. Chemical restraint and general anesthesia. In: Biology, medicine and surgery of elephants. Blackwell Publishing. Heard D.J., Jacobson E.R., and Brock K.A. 1986. Effects on oxygen supplementation on blood gas values in chemically restraint juvenile African elephants. J Am Vet Med Ass 189 (9)1071-1074. Tamas PM. and Geiser D.R. 1983. Etorphine analgesia supplemented by halothane anesthesia in an adult African elephant. JAVMA 183, 11 (1312-1314) . Wiedner E.. 2015. Proboscidea. In: Fowler's Zoo and Wild animal Medicine 8. Zuba J.R., Osterhaus J.E. 2012. Anesthetic complications and clinical intervention in opiod anesthetized captive elephants. In: Proceedings of the AAZV Conference, Oakland (1-6). Zuba J.R. http://www.incaseofanesthesia.com/Home_Page.html General anesthesia Always bring the elephant into LATERAL RECUMBANCY for general anesthesia Epidural anesthesia Epidural anesthesia in elephants is recommended when a vaginal vestibulotomy is performed in order to reduce tail movements of the elephant and provide additional analgesia in the perineal region. Procedure: Restrain the elephant as appropriate in a chute and sedated if necessary. Disinfect the injection site. Move the tail up and down to determine the position of the most mobile intercoccygeal space. Inject local anaesthetic (2% Lidocaine) into the skin over the injection site. Palpate the intercoccygeal space wearing a sterile glove and insert the needle (14 gauge, 3 inch) at approximately a 60 - 70 degree angle cranially. The epidural space is about 6.5 cm below the skin surface. Inject Lidocaine : 30 ml was sufficient to produce tail relaxation in a 3,000 kg elephant, and the elephant remained standing. Epidural anesthesia

Elephants in captivity can be vaccinated against Rabies, Foot-and mouth disease, Cowpox, Clostridiosis, Pasteurellosis and Anthrax. Vaccination Written by Willem Schaftenaar Introduction Based on historical data on infectious diseases which may have severe clinical impact on elephants kept under human care, vaccination against some of these diseases is recommended. The choice for a certain vaccine depends on the environmental pathogen pressure, the way the elephant is kept (zoo – semi free ranging) and the location/climate. Unfortunately there is not much scientific evidence of the efficacy for some of the vaccines available, as true vaccination challenge trials are not possible in the case of elephants. Data on vaccine induced antibody titers are scarce (Muir, 2021; Lindsay, 2010). In a study about maternal antibody transmission and the lifespan of antibodies, it was found that maternal antibody levels in the elephant calf were as high as in the dam after vaccination of the pregnant dam against tetanus and rabies. These antibodies remained elevated for 144 days (Noffs, 2013). Similar results were found for EEHV-antibodies in naturally infected elephants in which case the antibodies remained elevated until 36 months (Fuery, 2020). Vaccination has been practiced against the following diseases: Tetanus Anthrax Cowpox Clostridium spp. Rabies Pasteurellosis (Hemorrhagic septicemia) Foot-and-mouth disease References 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. Lindsay, W. A., Wiedner, E., Isaza, R., Townsend, H. G., Boleslawski, M., Lunn, D. P. 2010. Immune responses of Asian elephants (Elephas maximus) to commercial tetanus toxoid vaccine. Vet Immunol Immunopathol 133 (2-4), 287-289. Muir, Y.S.S., Bryant, B., Campbell-Ward, M., Higgins, D.P., 2021. Retrospective anti-tetanus antibody responses of zoo-based Asian elephants (Elephas maximus) and rhinoceros (Rhinocerotidae). Developmental & Comparative Immunology 114, 103841. doi:10.1016/j.dci.2020.103841 Nofs S.A., Atmar R.L., Keitel W.A., Hanlon C., Stanton J.J., TanJ., Flanagan J.P., Howard L., Ling P.D., 2013. Prenatal passive transfer of maternal immunity in Asian elephants (Elephas maximus). 2013. Veterinary Immunology and Immunopathology, Volume 153, Issues 3–4, 2013, Pages 308-311. 1. Tetanus (Clostridium tetani ) Only a few cases of clinical tetanus in elephants have been described in the literature (Goss 1947, Burke 1975, Fowler et al 2006) or have been reported anecdotally for Asian elephants in Southeast Asia. In a preliminary study, measurable titers against tetanus were achieved in Asian elephants vaccinated with a 1 ml dose of monovalent equine tetanus toxoid followed by a booster at 4 weeks. The titers remained elevated for >1 year; however, the appropriate vaccination interval has not yet been determined. Annual vaccination is commonly practiced, although it is likely that the duration of immunity may be longer. In a study in which 9 Asian elephants were involved, Muir et al (2021) demonstrated that the antibody titers in these elephants remained at adequate levels with little fluctuations when 3-5 years intervals were applied. Elephants kept in European zoos are recommended to adhere to the suggested vaccination regime for horses with booster vaccinations every 2-3 years. Government owned elephants in Myanmar are routinely vaccinated against tetanus using an equine tetanus toxoid vaccine (5 ml, s.c.); (pers. comm. Khyne U Mar, 2018). The initial course consists of two injections given approximately four to six weeks apart followed by a booster at one year and further boosters annually. References tetanus Goss, L.J. 1942. Tetanus in an elephant. Elephas maximus. Zoologica NY 27:5–6. Burke, T.J. 1975. Probable tetanus in an Asian elephant. JZ&WM, vol 6 – 1 22-24 Mikota, S.K. 2006. Preventive Health Care and Physical Examination. In: Fowler, M.E. and Mikota, S.K.(eds). Biology, Medicine, and Surgery of the Elephant. Blackwell Publishing, Ames, IA. Pp. 67-73. Lindsay, W. A., Wiedner, E., Isaza, R., Townsend, H. G., Boleslawski, M., Lunn, D. P. 2010. Immune responses of Asian elephants (Elephas maximus) to commercial tetanus toxoid vaccine. Vet Immunol Immunopathol 133 (2-4), 287-289 Transmissible Diseases Handbook. 2019. Infectious diseases Fact sheet TETANUS. Muir, Y.S.S., Bryant, B., Campbell-Ward, M., Higgins, D.P., 2021. Retrospective anti-tetanus antibody responses of zoo-based Asian elephants (Elephas maximus) and rhinoceros (Rhinocerotidae). Developmental & Comparative Immunology 114, 103841. doi:10.1016/j.dci.2020.103841 2. Anthrax (Bacillus anthracis ) Outbreaks of Anthrax in livestock are a threat to wildlife, including elephants (Walsh, 2019). Anthrax affects African and Asian elephants, free ranging as well as elephants kept under human care (Lindeque,1994; Yasothai, 2013). The disease can be fatal, however antibodies have been detected in healthy elephants as well (Cizauskas, 2014). Annual vaccination of livestock is the only way to protect wild elephants against this disease. Elephants kept under human care, however, can be vaccinated annually with a commercially available vaccine. 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. An attenuated vaccine (Sterne strain 34F2, https://www.cdc.gov/anthrax/resources/anthrax-sterne-strain.html ) developed for farm animals, has been widely used in government kept elephants in Myanmar under the following recommendations: annual vaccination (1 ml s.c.) in April of elephants older than 6 months, with the exception of sick elephants and pregnant elephants if the fetus is under 8 months (pers. comm. Khyne U Mar, 2018). References Anthrax Lindeque, P.M.; Turnbull, P.C.B.; Verwoerd, Daniel Wynand. 1994. Ecology and epidemiology of anthrax in the Etosha National Park, Namibia. http://hdl.handle.net/2263/33072 Cizauskas ,C.A., S.E. Wendy C. Turner , Vance , R.E., and Getz , W.M. 2014. Frequent and seasonally variable sublethal anthrax infections are accompanied by short-lived immunity in an endemic system. In: Animal Ecology, 83 ( 5 ), 1078-1090 Walsh M.G., Mor S.M., and Hossain S. 2019. The elephant – livestock interface modulates anthrax suitability in India. Proc. R. Soc. B 286: 20190179. http://dx.doi.org/10.1098/rspb.2019.0179 . Yasothai R. 2013. A report on outbreak of anthrax in elephant. International Journal of Science, Environment and Technology, Vol. 2, No 4, 2013, 757 – 759. 3. Cowpox Cowpox (= Orthopox) virus infections have been reported in both Asian and African elephants. Most cases have occurred in Western Europe. Symptoms may vary from minor lesions to fatal infection. Severe cases have been reported more frequently in Asian elephants than in African elephants, but both species are susceptible. The European Association of Zoo and Wildlife Veterinarians (EAZWV)has produced a fact sheet about cowpox infections in zoo animals, including several references to cowpox infections in elephants (Transmissible Diseases Handbook 2019). Prevention: preventive vaccination of African and Asian elephants is strongly recommended by the EAZWV and encouraged in the coordinated European Association of Zoos and Aquaria (EAZA) EAZA breeding programs of both species. The only vaccine available is a Modified Vaccinia Ankara (MVA) vaccine, which is specially produced on request and distributed by the Institut für Infektionsmedizin und Zoonosen, Dr. Robert Fux (Robert.fux@lmu.de ), Veterinärstrasse 13, 80539 München, Germany. MVA has been used for many years in elephants, rhinos and tapirs without any side effects. Primo-vaccination of keepers or other staff members in contact with vaccinated animals is not required. Cowpox vaccination schedule: First vaccination (s.c. or i.m.) of 4 ml MVA at the age of 12-16 weeks. Second vaccination (s.c. or i.m.) of 4 ml MVA 4 weeks after the first injection. The producer of the vaccine advices and offers antibody titer measurement before the vaccination and 3-4 weeks after the second vaccination. In young and untrained elephants this may not be possible, and vaccination should be practiced without titer monitoring. Booster vaccinations: generally once every 2-3 years, depending on the antibody titer. Vaccination during pregnancy: following this vaccination advice, elephants should be immune before they become pregnant. There are no sound studies about the possible side effects of vaccination on the fetus. New non-vaccinated imports or elephants with unknown vaccination status should not be bred before they are properly vaccinated. Remarks: for ordering and using this noncommercial vaccine, a special permit from your official veterinarian is required. Please contact your official veterinarian for further instructions regarding the import of MVA from Germany. Some countries may impose restrictions regarding the contact between humans (staff, visitors) and elephants for the first two weeks after vaccination. However, there is no recommendation for this measure and it is not supported by scientific evidence or by the producer. As MVA only replicates once in mammalian tissues, it is safe and developed for use in humans. References cowpox: Chantrey J, Meyer H, Baxby D, Begon M, Bown KJ, Hazel SM, Jones T, Montgomery WI, Bennett M. 1999. Cowpox: reservoir hosts and geographic range. Epidemiol Infect. 122: 455-460. Eulenberger K, Bernhard A, Nieper H, Hoffman K, Scheller R, Meyer H, Zimmerman P, Essbauer S, Pfeffer M, Kiessling J. 2005. An outbreak of cowpox infection in black rhino (Diceros bicornis) at Leipzig Zoo. Verh ber Erkrg Zootiere. 42:77-85 Kurth A, Nitsche A. 2011. Cowpox in Zoo Animals. In: Miller ER, Fowler ME (eds) Fowler's zoo and wild animal medicine current therapy, Volume 7. Elsevier, St. Louis, Missourri. pp: 32-37. Kurth A, Wibbelt G, Gerber HP, Petschaelis A, Pauli G, Nitsche A. 2008. Rat-to-elephant-to-human transmission of cowpox virus. Emerg Infect Dis. 14: 670-671. Pilaski J, Jacoby F. 1993. Die Kuhpocken-Erkrankungen der Zootiere. Verh ber Erkrg Zootiere. 35: 39-50. Pilaski J, Rosen-Wölff R. 1987. Poxvirus infection in zoo-kept mammals. In: Darai G (ed) Virus diseases in laboratory and captive animals. Martinus Nijhoff Publishing, Boston. pp: 83-100. Pilaski J, Schaller K, Matern B, Klöppel G, Mayer H. 1982. Outbreaks of pox among elephants and rhinoceroses. Verh ber Erkrg Zootiere. 24: 257-265. Pilaski J, Kulka D, Neuschulz N. 1992. outbreak of pox disease in African elephants (Loxodonta africana) at the Thuringer Zoopark Erfurt. Verh ber Erkrg Zootiere. 34: 111-118. Transmissible Diseases Handbook. 2019. Infectious diseases fact sheet: Cowpox virus Wisser J, Pilaski J, Strauss G, Meyer H, Burck G, Truyen U, Rudolph M, Frölich K. 2001. Cowpox virus infection causing stillbirth in an Asian elephant (Elephas maximus). Vet Rec. 149: 244-246. 4. Clostridium spp. Several zoos have vaccinated their elephants against multiple-strain Clostridium spp, with Clostridium perfringens being the major target. Not much is known about the impact of these potential pathogens on the health of elephants. Boonsri et al. describe 2 fatal cases in which C. perfringens was involved (Boonsri, 2018). Both cases were associated with EEHV-infection. A study performed in healthy elephants kept in zoos demonstrated the presence of Clostridium spp . in 3.5% of the Asian elephants (n=85) and no prevalence in African elephants (n=50) (Scharling, 2021). Preliminary data from necropsy reports revealed 13 cases of Clostridium spp involved in the death of Asian elephants (n=226), excluding 5 botulism victims. Of these cases, 5 were attributed to C. perfringens, 1 to C. septicum and 7 were unclassified Clostridium spp. In the same preliminary report, 1 case of C. perfringens involvement was found at necropsy of 112 African elephants (Bacciarini, 2001, Hess A, personal communication 2021). Two cases were identified as C. difficile (Bojesen A.M. 2006). However, it is not clear from most of the necropsy reports whether Clostridium spp. were involved in the primary disease process or just an additional finding. For a long time it was assumed that Clostridium was a fatal pathogen in young elephant, but possibly EEHV-HD cases have been wrongly identified as Clostridium cases. Now that we look more closely at necropsies, the involvement of Clostridium as primary pathogen has become more questionable. Quite severe skin lesions have been anecdotally reported after the use of oil-based vaccines containing multiple Clostridium spp . If the veterinarian decides to use a multiple-strain Clostridium -vaccine, water-based formulations should be used. References Clostridium spp .: Boonsri K., Somgird C., Noinafai P., Pringproa K., Janyamethakul T., T., Brown J.L., Tankaew P, Srivorakul S., Thitaram C. 2018. Elephant endotheliotropic herpesvirus associated with Clostridium perfringens infection in two Asian elephant (Elephas maximus ) calves. Journal of Zoo and Wildlife Medicine 49(1), 178-182. Scharling F.S., Bertelsen M.F., Sós E., Bojesen A.M., 2020. Prevalence of Salmonella species, Clostridium perfringens , and Clostridium difficile in the feces of healthy elephants (Loxodonta species and Elephas maximus) in Europe. Journal of Zoo and Wildlife Medicine 51(4), 752-760. Bacciarini, L. N., Grone, A., Pagan, O., & Frey, J. 2001. Clostridium perfringens 2-toxin in an African elephant (Loxodonta africana) with ulcerative enteritis. Veterinary Record, 149(20), 618–620. doi:10.1136/vr.149.20.618. Bojesen A.M., Olsen K.E.P., Bertelsen M.F. 2006. Fatal enterocolitis in Asian elephants (Elephas maximus ) caused by Clostridium difficile . Veterinary Microbiology , 116 (4), 329-335 5. Rabies 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. References: Aravind B., Anilkumar M., Raju S. and Saseendranath M.R. 2006. A case of rabies in an Indian elephant (Elephas maximus). Zoos’ print journal 21(2): 2172. 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. Isaza R., Davis R.D., Moore S.M. , and Briggs D.J. 2006. Results of vaccination of Asian elephants (Elephas maximus) with monovalent inactivated rabies vaccine. Am J Vet Res. 2006;67(11):1934-6. Miller, M.A., Olea-Popelka, F., 2009. Serum antibody titers following routine rabies vaccination in African elephants. J. Am. Vet. Med. Assoc 235, 978-981. Wimnalaratne, O., & Kodikara, D. S. 1999. First reported case of elephant rabies in Sri Lanka. Veterinary Record, 144(4), 98–98. http://outbreaknewstoday.com/rabies-kills-elephants-at-kaziranga-national-park-according-to-media-account-anti-rabies-vaccination-drive-underway-36933/ Rabies 6. Pasteurellosis (Hemorrhagic septicemia, Pasteurella multocida ) Hemorrhagic septicemia, caused by Pasteurella multocida (more recently renamed as Mannheimia multocida ) has been reported as a cause of death in elephants (Chandranaik, 2016). 43 out of 85 elephant sera tested positive on antibodies in a newly developed ELISA. As in other mammals, P. multocida is a pathogen that can present on a spectrum from inapparent to a fatal disease. In areas with a pressure of P. multocida in livestock, vaccination of elephants against hemorrhagic disease is recommended. In Myanmar a commercial aluminium-precipitated (inactivated) vaccine has been used for many years in government kept elephants. Elephants older than 6 months are vaccinated twice a year (June and December, 5 ml, s.c.) with the exception of sick elephants and pregnant elephants if the fetus is under 8 months (pers. comm. Khyne U Mar, 2018). References: Chandranaik, B. M., Shivashankar, B. P., Giridhar, P., & Nagaraju, D. N. (2016). Molecular characterisation and serotyping of Pasteurella multocida isolates from Asiatic elephants (Elephas maximus). European Journal of Wildlife Research, 62(6), 681–685. Tankaew P, Singh-La , Titaram C, Punyapornwittaya V, Vongchan P, Sawada T, Sthitmatee N. 2017. Evaluation of an In-house indirect ELISA for detection of antibody against haemorrhagic septicemia in Asian elephants, Journal of Microbiological Methods, Volume 134, 2017, Pages 30-34. https://www.tribuneindia.com/news/nation/elephant-deaths-in-odisha-caused-by-bacteria-central-investigation-team-216885 7. Foot-and-mouth disease (FMD). Very few cases of FMD have been reported in elephants (Rout, 1988; Schaftenaar, 2001) and are always related to outbreaks in livestock. Asian elephants are far more susceptible than African elephants (Schaftenaar, 2001) with a high mortality rate in the Asian species. Outbreaks have been described in India. In most countries vaccination against FMD is strictly regulated by the government in order to conytrol FMD outbreaks in the livestock industry. Whenever elephants are at risk for FMD, government authorities should be contacted and a vaccination program for the animals at risk should be started. The type of vaccine to be used, depends highly on the availability in the country and the FMD-strain that caused the outbreak. Dosages used for cattle should be applied. References: Schaftenaar W. 2001. The occurrence of Foot-and-mouth disease in zoological gardens: a review. Implications of legislation for the present situation in zoos. 2001. Special issue on the 40th international symposium on diseases of zoo- and wild animals. Annual meeting of the EAZWV. 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 Rout M, Nair, N. S. , Biswajit Das , Saravanan Subramaniam , Mohapatra, J. K. , Bramhadev Pattnaik . Foot-and-mouth disease in elephants in Kerala state of India during 2013. Indian Journal of Animal Sciences 2016 Vol.86 No.6 pp.627-631.H. RAHMAN, P. K. DU-ITA and J. N. DEWA. 1988. Foot and Mouth Disease in Elephant (Elephas maximus) J. Vet. Med. B 35, 7C-71 (1988). Transmissible Diseases Handbook. 2019. Infectious disease fact sheet: Foot-and-mouth disease. *Sick elephants and pregnant elephants carrying a fetus is 8 months should not be vaccinated Overview of recommended vaccinations * To page top