SALMONELLOSIS, MULTIPLE SEROTYPES - USA: (PET TURTLES)
******************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases <http://www.isid.org>
Date: Fri 30 Mar 2012
Source: CDC [edited]
<http://www.cdc.gov/salmonella/small-turtles-03-12/index.html>
CDC is collaborating with public health officials in multiple states to investigate 3 overlapping, multistate outbreaks of human salmonellosis linked to exposure to turtles or their environments (e.g., water from a turtle habitat). The 1st is an outbreak of human _Salmonella [enterica_ serotype] Sandiego infections, the 2nd is an outbreak of human _S._ Pomona infections, and the 3rd is an outbreak of human _S._ Poona infections. These are rare types of salmonellae.
The _S._ Sandiego and _S._ Pomona outbreaks have similar geographic distributions, with cases occurring in the Northeast and Southwest.
The _S._ Poona outbreak has a slightly different geographic distribution, with cases occurring in the Midwest and Southwest.
Public health investigators are using the PulseNet system to identify cases of illness that may be part of these outbreaks. In PulseNet, the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC, DNA "fingerprints" of salmonellae are obtained through diagnostic testing with pulsed-field gel electrophoresis, or PFGE, to identify cases of illness that may be part of this outbreak.
Contact with reptiles (such as turtles, snakes, and lizards) and amphibians (such as frogs and toads) can be a source of human salmonellosis. Small turtles, with a shell length of less than 4 inches, are a well-known source, especially among young children.
Because of this risk, the FDA has banned the sale and distribution of these turtles since 1975. Amphibians and reptiles can carry salmonellae and still appear healthy and clean. The bacilli are shed in their droppings and can easily contaminate their bodies and anything in areas where these animals live. Reptiles and amphibians that live in tanks or aquariums can contaminate the water with germs, which can spread to people.
_S._ Sandiego outbreak investigation
----------------------------
As of 26 Mar 2012, a total of 45 individuals infected with the outbreak strain of _S._ Sandiego have been reported from 10 states.
The number of ill persons identified in each state is as follows:
California (3), Georgia (1), Massachusetts (2), Maryland (5), New Jersey (5), New Mexico (3), New York (18), North Carolina (1), Pennsylvania (6), and Virginia (1).
Among the persons who reported the date they became ill, illnesses began between 1 Sep 2011 and 16 Mar 2012. Infected individuals range in age from less than 1 year old to 86 years old, and 50 percent of ill persons are 9 years of age or younger. 58 percent of patients are female. Among the 25 patients with available information, 7 (28
percent) have been hospitalized. No deaths have been reported.
In interviews, ill persons answered questions about contact with turtles and foods consumed during the week before becoming ill.
Nineteen (76 percent) of 25 ill persons interviewed reported contact with turtles before becoming ill. Of the 13 ill persons who could recall the size of the turtles with which they had contact, 12 (92
percent) identified turtles less than 4 inches in size. Of the 6 ill persons who could recall the type of turtle with which they had contact, 5 (83 percent) identified red-eared slider turtles.
In February 2012, a sample of turtle tank water from an ill person's home in Pennsylvania yielded the outbreak strain.
_S._ Pomona Outbreak Investigation
--------------------------------
As of 26 Mar 2012, a total of 9 individuals infected with the outbreak strain of _S._ Pomona have been reported from 8 states. The number of ill persons identified in each state is as follows: California (2), Massachusetts (1), Maryland (1), New Jersey (1), New York (1), Pennsylvania (1), Texas (1), and Vermont (1).
Among the persons who reported the date they became ill, illnesses began between 9 Dec 2011 and 6 Feb 2012. Infected individuals range in age from less than 1 year old to 90 years old, and 50 percent of ill persons are 4 years of age or younger. 75 percent of patients are female. Among the 8 patients with available information, 2 (25
percent) have been hospitalized. No deaths have been reported.
In interviews, ill persons answered questions about contact with turtles and foods consumed during the week before becoming ill. 5 (63
percent) of 8 ill persons interviewed reported contact with turtles before becoming ill. Of the 2 ill persons who could recall the size of the turtles with which they had contact, both identified turtles less than 4 inches in size.
In January 2012, a sample of turtle tank water from the home of 2 ill persons in the same California household yielded the outbreak strain.
_S._ Poona Outbreak Investigation
--------------------------
As of 26 Mar 2012, a total of 12 individuals infected with the outbreak strain of _S._ Poona have been reported from 7 states. The number of ill persons identified in each state is as follows: Arizona (2), California (3), Indiana (1), Kentucky (1), Michigan (1), New York (2), and Texas (2). [For a map of locations of cases and a table showing the latest case count, see <http://www.cdc.gov/salmonella/small-turtles-03-12/index.html>. - Mod.MPP]
Among the persons who reported the date they became ill, illnesses began between 20 Oct 2011 and 18 Feb 2012. Infected individuals range in age from less than 1 year old to 70 years old, and 50 percent of ill persons are 4 years of age or younger. 67 percent of patients are female. Among the 7 patients with available information, 2 (29
percent) have been hospitalized. No deaths have been reported.
In interviews, ill persons answered questions about contact with turtles and foods consumed during the week before becoming ill. 9 (90
percent) of 10 ill persons interviewed reported contact with turtles before becoming ill. Of the 5 ill persons who could recall the size of the turtles with which they had contact, 4 (80 percent) described turtles less than four inches in size. Of the 7 ill persons who could recall the type of turtle with which they had contact, all identified red-eared slider turtles.
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[In 2008, CDC reported on an ongoing outbreak of _S._ Paratyphi B var.
Java (CDC: _Salmonella_ Infections Associated with Exposure to Turtles
- USA, 2007-2008. Morbid Mortal Weekly Rep 2008; 57(03): 69-72; <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5703a3.htm>. Some of the discussion of the report is reproduced below:
"The prohibition on the sale and distribution of small turtles was enacted in 1975, after public health investigations demonstrated that small turtles were a major source of human _Salmonella_ infections, particularly in children. In 1972, a study in New Jersey indicated that small pet turtles accounted for approximately 23 percent of _Salmonella_ infections in children (4). In 1980, the 1975 prohibition was estimated to have prevented 100 000 _Salmonella_ infections in American children each year since going into effect (5). However, this prohibition has an exception: small turtles may be sold legally for scientific, educational, or exhibition purposes. During 2001-2006, the number of turtles kept as pets in the USA increased 86 percent to nearly 2 million turtles (6), suggesting that this exception might provide a mechanism by which small turtles become household pets.
"Turtles, like other reptiles, commonly carry _Salmonella_, and fecal carriage rates can be as high as 90 percent (1). Small turtles sold as pets frequently come from breeding farms, where turtles are housed in crowded ponds and nesting areas in a way that promotes _Salmonella_ transmission (7). Attempts to treat turtles, turtle eggs, and turtle breeding ponds with antibiotics to eliminate _Salmonella_ have not been successful and have resulted in a high prevalence of antibiotic resistance (7,8). Other treatments reduce but do not eliminate shedding from turtles (8), and the turtles that continue to shed might recontaminate other turtles during rearing or shipment. Because shedding might be intermittent and stress related, determining whether turtles are free of the bacteria is difficult (1).
"Direct or indirect contact with a reptile is associated with an estimated 6 percent of human salmonellosis in the USA (9). Persons coming into contact with reptiles, reptile habitats, or surfaces contaminated with reptile fecal matter risk infection from salmonellae shed by the reptile (10). Although most reptiles carry _Salmonella_, small turtles are likely to be handled differently than other reptiles and thus carry a greater risk of transmitting _Salmonella_ to children. In contrast to the obvious risk for a bite or scratch, for example, from a snake or an iguana, a small turtle is likely to be perceived as safe, and thus might be given directly to small children to play with. In addition, a young child placed in charge of caring for a turtle has direct contact with water in the turtle habitat, where salmonellae are likely to multiply to high numbers. Although approximately half of the infections associated with this outbreak occurred in young children, who are at greater risk for severe illness from salmonellosis (2,10), several illnesses occurred in adults with turtle exposure, demonstrating that turtle-associated salmonellosis is not unique to children. Additionally, only 20 percent of case-patients interviewed reported awareness of the link between salmonellosis and contact with reptiles, indicating that measures to educate the public about this link have not been successful. CDC has provided recommendations to prevent reptile-associated salmonellosis in humans (2). However, because of the particular hazard associated with small turtles, prohibiting the sale and distribution of small turtles likely remains the most effective public health action to prevent turtle-associated salmonellosis.
References
----------
1. Chiodini RJ, Sundberg JP: Salmonellosis in reptiles: a review. Am J Epidemiol 1981; 113(5): 494-9.
2. CDC: Turtle-associated salmonellosis in humans - United States, 2006-2007. MMWR 2007; 56(26): 649-52. Available at <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5626a1.htm>.
3. CDC: Salmonellosis associated with pet turtles -- Wisconsin and Wyoming, 2004. MMWR 2005; 54(09): 223-6. Available at <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5409a3.htm>.
4. Lamm S, Taylor A, Gangarosa E, et al: Turtle-associated salmonellosis. I. An estimation of the magnitude of the problem in the United States, 1970-1971. Am J Epidemiol 1972; 95(6): 511-7. Abstract available at <http://aje.oxfordjournals.org/cgi/content/abstract/95/6/511>.
5. Cohen ML, Potter M, Pollard R, Feldman RA: Turtle-associated salmonellosis in the United States: effect of public health action, 1970 to 1976. JAMA 1980; 243(12): 1247-9. Abstract available at <http://jama.ama-assn.org/content/243/12/1247.full.pdf>.
6. American Veterinary Medical Association: US pet ownership and demographics sourcebook. Schaumburg, IL: American Veterinary Medical Association; 2007:2.
7. D'Aoust JY, Daley E, Crozier M, Sewell AM: Pet turtles: a continuing international threat to public health. Am J Epidemiol 1990;
132(2): 233-8. Abstract available at
<http://www.ncbi.nlm.nih.gov/pubmed/2372004>
8. Mitchell MA, Adamson T, Singleton C, et al: Evaluation of a combination of sodium hypochlorite and polyhexamethylene biguanide as an egg wash for red-eared slider turtles (_Trachemys scripta elegans_) to suppress or eliminate _Salmonella_ organisms on egg surfaces and in hatchlings. Am J Vet Res 2007; 68: 158-64. Abstract available at <http://cat.inist.fr/?aModele=afficheN&cpsidt=18496347>.
9. Mermin J, Hutwagner L, Vugia D, et al: Reptiles, amphibians, and human _Salmonella_ infection: a population-based, case-control study.
Clin Infect Dis 2004;38: S253-61. Abstract available at <http://www.ncbi.nlm.nih.gov/pubmed/15095197>.
10. Mermin J, Hoar B, Angulo FJ: Iguanas and _Salmonella_ Marina infection in children: a reflection of the increasing incidence of reptile-associated salmonellosis in the United States. Pediatrics 1997; 99(3): 399-402. Abstract available at <http://pediatrics.aappublications.org/cgi/content/abstract/99/3/399>."
A photograph of the red-eared slider turtle, the small turtle usually involved in this issue, is available at <http://en.wikipedia.org/wiki/Red-eared_slider>. - Mod.LL]
[For a map of the USA showing states, see <http://www.mapsofworld.com/usa/usa-maps/maps_of_world_usa_states_city.jpg>.
- Mod.MPP]
[see also:
2011
----
Salmonellosis, serotype Paratyphi B - USA: (PA, SC) pet turtles 2011
20120202.1031013
2008
----
Salmonellosis, human, pet turtles - USA (05) 20081023.3356 Salmonellosis, human, pet turtles - USA 20080125.0317
2007
----
Salmonellosis, human, pet turtles - USA (multistate): 2006-2007
20070709.2186
Salmonellosis, human, fatal, pet turtles - USA (FL): FDA
20070409.1182
2005
----
Salmonellosis, human, pet turtles, 2004 - USA (WI, WY) 20050311.0715
2004
----
Salmonellosis, human, turtle - USA (WI, KS ex WI) 20040819.2298 2000
----
Salmonellosis, pet reptiles - USA (02) 20000308.0314 Salmonellosis, pet reptiles - USA 20000229.0274 Salmonellosis, pet reptiles - UK: alert 20000227.0267
1999
----
Salmonella, reptile-associated - USA: Summary 19991112.2022
1997
----
Salmonellosis, reptile-associated (02) 19970616.1262 Salmonellosis, reptile-associated, health-regulations: RFI
19970612.1234
1996
----
Reptile-Associated Zoonoses 19960402.0613 Salmonella & reptiles 19960213.0290 Salmonella, fatal, iguana-associated - Indiana (USA) (6)
19960207.0262
Salmonella, fatal, iguana-associated - Indiana 19960202.0245
1995
----
Salmonella & reptiles 19950901.0782]
.................................................ll/mpp
*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held responsible for errors or omissions or held liable for any damages incurred as a result of use or reliance upon posted or archived material.
0 comments:
Post a Comment