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Salmonella outbreak and pet turtles linked for the second time in two years
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Increases in small-turtle sales, despite an ongoing federal ban in the United States, coupled with a lack of awareness about the link between the animals and disease may be at the root of recent turtle-associated Salmonella outbreaks.
"Physicians and particularly pediatricians might want to consider providing information to patients about Salmonella and its link to reptiles," researchers from the CDC and several other U.S. sites wrote in a recently published study.
They investigated a multistate outbreak of Salmonella Paratyphi B var Java that occurred between May 2007 and January 2008 and affected 107 patients. Interviews were conducted with 78 patients, 47 of whom reported turtle exposure in the week before illness onset, making this the largest turtle-associated Salmonella outbreak reported to date.
Turtle-specific questionnaires were distributed to exposed patients and results revealed that small turtles were the most commonly identified, with 41 patients reporting that the turtle was less than 4 inches in carapace length, and 16 reporting that the turtle was purchased in a retail store.
Additional turtle trace-back information indicated that the remaining turtles were given as gifts from friends or relatives (n=10, 21%); and purchased at flea markets (n=9, 19%), from a street vendor (n=5, 11%) or online (n=1, 2%).
A case control study measuring knowledge of the link between reptile exposure and Salmonella infection indicated that 32% of exposed patients (n=7 of 22) vs. 28% of controls (n=11 of 39) were aware of the association.
Furthermore, more than half of the patients involved in this outbreak were aged 10 years or younger, increasing the likelihood of unsafe handling practices such as kissing or placing the turtle in the mouth, according to the researchers.
"Although some retail shops may provide information on the risk of Salmonella, in many states there is no legal obligation for them to do so, limiting opportunities for consumer education," the researchers wrote. They suggested that the availability of the pets from flea markets and street vendors further limited the ability to inform consumers about the risk for Salmonella.
The American Veterinary Medical Association estimates that U.S. turtle ownership has doubled since 1996, with the number of households reporting turtle ownership increasing from 950,000 in 1996 to 1,991,000 in 2006. "Continued, collective efforts are needed, both on state and federal levels to enforce the ban and protect public health," the researchers wrote.
Harris JR. Pediatrics. 2009;124:1388-1394.
In 1975, the FDA banned commercial distribution of turtles with shells less than 4 inches in length, which resulted in an important and sustained reduction of human Salmonella infections as a result of preventing disease transmission from these reptiles. As the authors report in this large turtle-associated Salmonella outbreak, exposure to these turtles continues to put children at risk. Parents need to be educated about the risk of disease associated with exposure to reptiles and other nontraditional pets for children aged younger than 5 years and for immunosuppressed people of all ages. Pediatricians, nurses, veterinarians and other health care professionals can provide advice on selection of appropriate pets. The AAP has published guidelines on prevention of disease from exposure to reptiles and other nontraditional pets.
– Larry K. Pickering, MD
Infectious Diseases in Children Editorial Board