Human TB in Circus Elephant Herd, McHenry County, IL

The 48-year-old elephant training and rental business named Hawthorn Farm, located in McHenry County, Illinois, closed down on March 2, 2006. Its beleaguered 74-year-old owner named John Cuneo, Jr., finally settled 47 alleged Animal Welfare Act violations for mistreating and mishandling elephants and creating a risk for elephants and the public, first charged by the U.S. Department of Agriculture (USDA) in 2004. (1-5)

Lota, one of Cuneo’s most famous elephants. She developed TB and died in 2004 after removal from Cuneo’s farm to The Elephant Sanctuary in Tennessee. Source of photo: http://www.circuses.com/photos/tuberculosis-sm.gif; accessed June 28, 2007.	Thin, gaunt, tubercular Lota, from the Cuneo herd at Hawthorn Farm. Source: http://www.hsus.org/wildlife/wildlife_news/usda_seizes_the_moment_orders_hawthorn_to_give_up_16_elephants.html; accessed June 28, 2007.

Cuneo started Hawthorn Corporation as a traveling circus in 1957, but later found a more profitable business niche in leasing animals to other circuses and boarding exotic animals. (6) The final straw leading to removal of the elephant heard from Cuneo’s ownership was the death from tuberculosis (TB) of two his elephants in a single week in 1996 while they were traveling in circuses. The Hawthorn Farm elephant herd tuberculosis outbreak is the topic of this report.

How Elephant Tuberculosis in the Cuneo Circus Herd Emerged in the Public View

Some of the public knew about Cuneo’s elephants even before the tuberculosis outbreak. For example, one elephant went on a rampage in 1994 in Honolulu, killing its trainer and running through the streets before police and others shot and killed it. (2,7,8) Two other elephants fought in Charlotte, crashing into a church and demolishing a car. Then, in 1996, the two elephants rented to traveling circuses died of human tuberculosis in California and Colorado.

Cuneo elephant Tyke on a rampage in Honolulu. Source: http://the.honoluluadvertiser.com/dailypix/2004/Aug/20/ln19a_b.jpg; accessed June 28, 2007.

“Tyke, a female African elephant owned by John Cuneo of Hawthorn Corporation, was shot by police in Hawaii in 1994 after crushing her trainer Allen Campbell to death during a circus performance. Ten years later, Cuneo was ordered to pay a $200,000 fine and donate all his elephants to a sanctuary.” Source: Honolulu Star-Bulletin. http://www.sonorannews.com/archives/2006/060510-19/index.html; accessed June 28, 2007.

Dr. Patrick Ryan, a veterinarian with the Los Angeles County Department of Health Services, cared for one of the tubercular elephants. He recalled that in the summer of 1996, “[f]ive elephants were traveling in Los Angeles County with a circus for over two months.” (7) “Two of the elephants had been coughing and one had lost several hundred pounds.” The chronic, unexplained weight loss had begun in October 1995. (8) He and other veterinarians presumed that the weight loss was due to an abscessed tooth. The elephant died following anesthesia for dental work.

California State Diagnostic laboratory staff (San Bernardino County) performed the necropsy, which showed widespread (80%) lung tissue consolidation (pneumonia) with caseous, or cheesy, necrosis of the lungs and lymph nodes in the elephant’s mediastinum. Tissues showed short, fat, relatively scant numbers of acid-fast organisms under the microscope. Culture and polymerase chain reaction (PCR) identified Mycobacterium tuberculosis, the most common Mycobacterium species to cause TB in humans. (7)

Dr. Ryan noted, “All five elephants had been leased from a herd of elephants in Illinois in which tuberculosis had been diagnosed two years earlier. The trainer decided to return the remaining coughing elephant to Illinois and obtain a replacement for the dead elephant and the coughing one. The second elephant died in transit [August 6, 1996] and was autopsied at Colorado School of Veterinary Medicine” where necropsy showed copious respiratory and trunk exudates and caseous necrosis of the lung, consistent with tuberculosis.”

The Los Angeles County Department of Health Services staff learned about the Colorado elephant situation. They placed the remaining three elephants (located at the time at a local high school) under a hold order. The California Department of Health Services, the California Department of Food and Agriculture, the US Department of Agriculture, and the San Bernardino County Health Department consented to shipping the three elephants back to Hawthorn Farm in Illinois. Of the five people who had direct contact with the tubercular elephants, only the head trainer had a positive skin test for TB (more below). (7)

Illinois Local and State Health Departments Respond to the Elephant TB Outbreak

Epidemiologists from the McHenry County Department of Health (Woodstock, Illinois), the Illinois Department of Public Health (Springfield, IL), and the University of Illinois College of Medicine at Rockford, Illinois, initiated their investigation in1996 to screen for tuberculosis among the animal trainers and caretakers at Hawthorn Farm. (8) The investigators also recalled to the farm all the circus elephants in the Cuneo herd and their handlers and trainers to screen them for tuberculosis. All elephants received antituberculous therapy beginning in December 1996. (8)

The epidemiologists repeatedly visited the farm, which was in rural Richmond, McHenry County, about 60 miles northwest of Chicago, noting that barbed wire and trees originally housed 18 Asian and 2 African elephants. “Thirteen elephants were tethered on a chain in one large barn, four were housed in a separate large room (two in a common stall), and a baby elephant was in a third room with 5-6 tigers.” (8) A separate barn housed about 80 tigers.

The epidemiologists learned that that the elephant workers worked in close proximity with the elephants around the clock. Most of the handlers lived on the farm in a separate section of the elephant barn, while four lived in trailers on the grounds. The ventilation system for the handlers’ barn living quarters was separate from the elephants’ however, and the doors between the two quarters were open for unknown periods. (8)

The investigators learned that a veterinarian-performed necropsy of a Cuneo herd elephant in 1994 showed tuberculosis caused by M. tuberculosis. A living elephant in the herd sequestered by the investigators grew M. tuberculosis in the culture in October 1996. All other elephant cultures were negative for TB. The investigators also learned that another elephant from Hawthorn Farm had died of M. tuberculosis infection in 1981. (9)

Tuberculosis Infection in Humans at the Farm

The health officials determined that of 22 handlers at Hawthorn Farm 11 (50%) were PPD (TB skin test) positive. Of the 11 positive handlers, eight reported that they had negative skin tests in the past and had not received BCG vaccine for tuberculosis. (10)
The other three handlers reported some kind of skin reaction, but had previously received the BCG vaccine. (10) One other handler had a known prior positive TB skin test.

The 12 handlers with positive PPDS received a chest x-ray. One handler had active tuberculosis, as determined from irregular nodules and interstitial changes in the right apex (top) of the lung without retraction, which is consistent with active TB. (8) One of his three sputum cultures was positive for M. tuberculosis. He received treatment with isoniazid, rifampin, pyrazinamide, and ethambutol medications beginning in September 1996. After two months, he received only isoniazid and rifampin because his TB isolate showed no resistance to antituberculous drugs.

Molecular Analysis of Elephant and Human TB Isolates at Hawthorn Farm

The TB isolates from the three dead elephants (the one in 1994 and the two in 1996) and the sputum from the handler matched, as demonstrated by molecular techniques (IS6110 RFLP and TBN12 RFLP patterns, differing by less than or equal to 2 bands). (8)

A New Zoonosis!

The transmission of Mycobacterium tuberculosis between humans and elephants at
Hawthorn Farm ranked as a first. There are no data available on TB incidence among domesticated elephants in the U.S. One estimate derived from a retrospective study of 379 zoo elephants in which eight (2.3%) had Mycobacterium tuberculosis infection. Since Mycobacterium tuberculosis is primarily a human pathogen, reasons one large-animal veterinarian, infections in animals (including, now, elephants) have been called “inverse zoonoses”, meaning that the disease goes from humans to animals, rather than the reverse, e.g., rabies goes from animals to humans. (7)

Various species of wildlife are susceptible to Mycobacterium tuberculosis and it presents a potential problem when people and wildlife intermingle, such as in wild animal compounds, zoos, and circuses. (7) Michalak, et al, in the Cuneo herd outbreak avoided the issue of who gave whom the tuberculosis by titling their report “Mycobacterium tuberculosis infection as a Zoonotic Disease: Transmission between Humans and Elephants.” (8)

Summary

In an otherwise tragic situation of abused domesticated elephants, investigators learned that elephants and humans transmit Mycobacterium tuberculosis between them.

Notes:

1. “Update on APHIS’ Settlement with The Hawthorn Corporation and John F. Cuneo, Jr.” at: http://www.aphis.usda.gov/ac/acnews.html; accessed June 27, 2007.
2. Marc Kaufman: “USDA Seizes Circus Elephants: Decree under Animal Welfare Act settles charges of improper care” in Washington Post, March 18, 2004, p. A03. Available online at: http://www.washingtonpost.com/ac2/wp-dyn/A2956-2004Mar17?language=printer; accessed June 27, 2007.
3. Richard Farinato: “USDA Seizes the Moment, Orders Hawthorn to Give up 216 Elephants” in The Humane Society of the United States News, March 25, 2004. Available online at: http://www.hsus.org/wildlife/wildlife_news/usda_seizes_the_moment_orders_hawthorn_to_give_up_16_elephants.html; accessed June 27, 2007.
4. Animal Welfare Act, United States Code Title 7 – Agriculture, Chapter 54 – Transportation, Sale, and Handling of Certain Animals. Available online at: http://www.aphis.usda.gov/animal_welfare/awa.shtml; accessed June 27, 2007.
5. Information published by the United States Department of Agriculture’s Animal and Plant Health Inspection Service (APHIS) on elephants is available online at: http://www.aphis.usda.gov/animal_welfare/publications_and_reports.shtml; http://www.aphis.usda.gov/animal_welfare/downloads/elephant/tb2003.pdf; http://www.aphis.usda.gov/animal_welfare/downloads/elephant/eleph_nec2003.pdf; and http://www.aphis.usda.gov/animal_welfare/downloads/elephant/eleph_tissue2003.pdf; accessed June 27, 2007.
6. Barb Barillec: “The move will put John Cuneo, 74, out of the elephant training and rental business after 48 years” in The Watchdog, March 2, 2006. Available online at: http://animaladvocates.com/cgi-bin/newsroom.pl/noframes/read/11942; accessed June 27, 2007.
7. Patrick Ryan: “Tuberculosis in Circus Elephants” in Pulse, Southern California Veterinary Medical Association, January 1997. Available at:  http://www.lapublichealth.org/vet/pubs/veteltb.pdf; accessed June 27, 2007.
8. Kathleen Michalak, Connie Austin, Sandy Diesel, et al: Mycobacterium tuberculosis infection as a Zoonotic Disease: Transmission between Humans and Elephants” in Emerging Infectious Diseases, April-June 1998, volume 4, number 2. Available online at:  http://www.cdc.gov/ncidod/eid/vol4no2/michalak.htm; accessed June 27, 2007.
9. G. Saunders: “Pulmonary Mycobacterium tuberculosis infection in a circus elephant” in J Am Vet Med Assoc December 1983, volume 183, number 11, pp. 1311-1312.
10. BCG (Bacillus of Calmette and Guerin) vaccine is “the only vaccine that is currently licensed for use in the prevention of tuberculosis in human populations. In fact, live BCG vaccine is the most widely used immunogen in the world in 1998, with nearly three billion doses administered to infants and school children, with surprisingly low incidence of serious side effects. The safety and effectiveness of this attenuated vaccine was demonstrated innumerable times before it was used in 1921 to vaccinate several infants at high risk of developing military tuberculosis. Despite this early success, formal proof of its protective value did not appear until some 30 years later. Over the years, the level of protection achieved in a number of carefully controlled field trials has fluctuated wildly, leading some epidemiologists to question the value of communitywide BCG vaccination programs.” BCG is not favored in the U.S. Source: F.M. Collins: “Animal Models for Tuberculosis Research” in Mycobacteria: Basic Aspects. P.R.J. Gangadharam and P.A. Jenkins (eds.), Chapman and Hall Medical Microbiology Series, International Thomson Publishing, 1998, p. 302.