Regulations do not equal enforcement, and (partly) why the other parents hate me: reptile- and amphibian-associated Salmonellosis in childcare centers

Sorenne starts a new kindy at the end of Jan. 2013, which is the end of summer in Brisbane.

Because it’s now the beginning of summer (google schoolies and Gold Coast), I went to an information meeting last night for new parents, which was also the annual general meeting and incredibly dull.

My neighbors already refer to me as grumpy, but this was over the top; and I had an engineer friend to share our collective quinquagenarian grumpiness.

We were the only two 50-somethings in the crowd; the other parents probably thought we were the grandparents of our respective 4-year-olds (and that’s apparently going to happen soon enough).

I haven’t heard such nonsense about sustainability since I had to debate self-proclaimed environmentalist types about genetically engineered foods 12 years ago.

(I was told by a current child care type this morning that every center is working sustainability into everything to comply with government funding requirements; yet they still require vast amounts of paperwork because e-mail is somewhat baffling, and that paper has to be protected in a plastic enclosure; my friend said they must go through a lot of toner.)

We heard about all the things the kids did in the past year, like plant a garden and harvest and eat their own produce, the beehive they established, how they had potlucks with exotic foods, and all the reptiles they got to pet over the year.

But when the nice lady talked about how they had a nude food policy – food without packaging, and encouraged healthy foods, but that refrigeration was only offered for lunches — I dutifully raised my hand.

“My daughter arrives at 8 a.m., and you want healthy snacks, like produce, but afternoon tea isn’t until around 2ish so that’s six hours at room temperature. Isn’t there a health risk there?”

Three parents immediately chimed in and said, don’t be dumb, just put it in a little cooler.

I’d like to see the verification studies of microbial growth on cut produce in one of those coolers and six hours of temperature abuse (it gets a little hot here in the summer; and spring; and fall).

I didn’t pursue the issue any further, but earned the wrath and derision of a bunch of use-stereotype-here-like-hippie-yuppie-earthtone parents who will hate me next year.

I love my work.

And this report from Emerging Infectious Diseases will get passed on to the kindy.

Salmonella spp. infection represents a major public health problem in the United States; nearly 1.4 million human cases and 600 associated deaths are reported each year (1). Reptile and amphibian exposures might cause >70,000 of these cases annually (2). Furthermore, children are at increased risk of acquiring Salmonella spp. and experiencing severe manifestations of disease (3,4). Given the increasing popularity of reptiles and amphibians as pets, reptile- and amphibian-associated salmonellosis is a substantial public health concern (5).

The public has a generally low level of awareness that Salmonella spp. can be acquired from reptiles and amphibians (6); a poll conducted by the US Centers for Disease Control and Prevention (CDC) during 2003 showed that as few as 4 of 49 states require pet stores to provide information about salmonellosis to persons purchasing reptiles (4). A Food and Drug Administration ban, activated in 1975, on the sale of small turtles subsequently prevented an estimated 100,000 cases of salmonellosis in children each year (7). To further reduce the risk of reptile- and amphibian-associated salmonellosis, the CDC has issued recommendations advising that children <5 years of age avoid contact with reptiles and amphibians and that these animals not be kept in childcare centers. The CDC also recommends that all persons wash their hands after handling reptiles and amphibians (8).

We reviewed the regulations as of December 2011 for childcare centers in all US states aimed at preventing reptile- and amphibian-associated salmonellosis. To gather these data, we searched the websites for each state’s public health department or the state’s equivalent of an early childhood learning agency. When searches on the Internet did not yield the desired information, the appropriate state agencies were contacted by phone or email. In some instances, we corresponded with the designated State Public Health Veterinarian.

Overall, only 50% of states had regulations that required staff and/or children to wash their hands after touching any animals in childcare centers. Twelve states banned reptiles from childcare centers; 3 of these 12 states also banned amphibians, and these were the only states we found to have banned amphibians from childcare centers. While some states did not allow potentially dangerous or harmful animals in childcare centers, a minority of these states went further to expressly ban reptiles as well (of the 23 states that banned potentially dangerous or harmful animals, 8 states also banned reptiles). One state (Colorado) explicitly banned reptiles, amphibians, and potentially dangerous or harmful animals from childcare centers and also required staff and children in the center to wash their hands after touching animals.

This survey has several limitations. Given the ambiguity in the language used in some regulations and that the language was not standardized between states, we might have misinterpreted some of the documents we reviewed. Furthermore, we might have unintentionally overlooked regulations that were already in place during our investigation, and hence our findings might underestimate the true number of states that have such policies. In some cases, cities and counties have regulations that provide increased protection beyond those implemented at the state level.

In summary, we found great variation between state regulations for childcare centers aimed at reducing transmission of Salmonella spp. from reptiles and amphibians to humans. The discrepancy in the regulations of states that banned potentially dangerous or harmful animals from childcare centers but that did not also specifically ban reptiles and amphibians was paradoxical, considering the well-recognized risk that these animals pose for transmitting Salmonella spp. We do not know how many childcare centers across the United States currently house reptiles or amphibians. However, our data suggest that there is room for revision of the regulations in many states which could in turn augment efforts to prevent Salmonella spp. transmission from reptiles and amphibians. We believe that the recommendations issued by the CDC for the prevention of salmonellosis from reptiles and amphibians (4) could serve as a practical guide as state regulations are updated. Our own experience has indicated that greater collaboration between public health organizations and the agencies responsible for setting regulations for childcare centers can be informative and productive. Similarly, state agencies can work with the pet industry and childcare centers to develop approaches that are mutually beneficial.

Although pets provide many benefits to humans, particularly during the early years of life (9), any exposure that children have to animals must pose minimal risk to the children’s health. Ultimately, keeping reptiles and amphibians out of childcare centers and requiring that staff and children wash their hands after touching animals offers a simple way to better safeguard the health of children while having a minimal effect on practices of childcare centers.

Neil M. Vora , Kristine M. Smith, Catherine C. Machalaba, and William B. Karesh

Author affiliations: Author affiliations: Columbia University, New York, New York, USA (N.M. Vora);EcoHealth Alliance, New York (N.M. Vora, K.M. Smith, C.C. Machalaba, W.B. Karesh)


We thank Casey Barton Behravesh, Carina Blackmore, Bryan Cherry, John Dunn, Karl Musgrave, Joni Scheftel, Sally Slavinski, Faye Sorhage, and Carl Williams for their clarification on state and national regulations aimed at reducing the risks of salmonellosis and their advice on conducting this survey. We also thank members and staff of the National Association of State Public Health Veterinarians and the National Resource Center for Health and Safety in Child Care and Early Education for their assistance.

This survey was generously funded by the Mars Foundation and New York Community Trust.


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Mermin J, Hutwagner L, Vugia D, Shallow S, Daily P, Bender J, Reptiles, amphibians, and human Salmonella infection: a population-based, case-control study. Clin Infect Dis.2004;38(Suppl 3):S253–61. DOIPubMed

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;99:399–402. DOIPubMed

Centers for Disease Control and Prevention. Reptile-associated salmonellosis—selected states, 1998–2002. MMWR Morb Mortal Wkly Rep. 2003;52:1206–9 .PubMed

Pickering LK, Marano N, Bocchini JA, Angulo FJ. Exposure to nontraditional pets at home and to animals in public settings: risks to children. Pediatrics. 2008;122:876–86. DOIPubMed

Centers for Disease Control and Prevention. Multistate outbreak of human SalmonellaTyphimurium infections associated with aquatic frogs—United States, 2009. MMWR Morb Mortal Wkly Rep. 2010;58:1433–6 .PubMed

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;243:1247–9. DOIPubMed

Centers for Disease Control and Prevention. Turtle-associated salmonellosis in humans—United States, 2006–2007. MMWR Morb Mortal Wkly Rep. 2007;56:649–52 .PubMed

National Association of State Public Health Veterinarians, Inc. Compendium of measures to prevent disease associated with animals in public settings, 2011: National Association of State Public Health Veterinarians, Inc. MMWR Recomm Rep. 2011;60(RR-04):1–24.

Siloed agencies hindered in efforts to fight animal-to-human diseases

The multiple agencies in the U.S. at the local, state and federal level – operating in their own silos – is restricting public health efforts to control zoonoses.

New York University sociologist Colin Jerolmack found even though many newly emerging infectious diseases readily spread from one species to another, “agency members interpret certain diseases as ‘livestock diseases’ or ‘wildlife diseases,’ and they view categories of animals outside their purview as irrelevant to their institutional prerogatives. Consequently, there is little sense of mutual understanding and common goals – and thus little coordination – across these various organizations.”

Jerolmack’s study, which appears in the journal Sociology of Health and Illness, examined the following agencies and departments: a state Department of Health (DOH); the Department of Agriculture (USDA); a state Department of Wildlife; a state Department of Agriculture; and the Centers for Disease Control and Prevention (CDC). Through interviews with agency or departmental personnel, he looked at how the distinct organizational cultures of these agencies produced incompatible or even competing agendas that hampered efforts to respond to zoonoses—infectious diseases that can be passed between species.

Jerolmack’s interviews revealed several instances in which agencies and departments adopted a siloed, rather than cooperative, approach when faced with zoonoses:

• A state Department of Agriculture official who bristled at efforts to remove livestock that may have posed a health risk to residents because, “We’re here to support anyone doing farming [and] keeping animals… We want people to continue keeping animals on their property.”

• “Strained” relationships between a state’s Department of Health and Department of Agriculture “sometimes meant that the DOH did not receive information on circulating diseases in animals that may become a problem for humans later on.” A DOH employee, noting that bird flu strains, particularly those found in livestock, can mutate quickly, said such outbreaks should be considered vital public health information—a view not shared by that state’s Department of Agriculture.

• A city public health official, responding to an outbreak of salmonella, did not turn to the state’s Department of Agriculture, the USDA, or any other agencies involved in animal health for help or information. Nor did it share information with them. The official “mentioned the need to change residents’ cultural practices, but neglected veterinary medicine solutions,” Jerolmack recounts.

• The same agency adopted a siloed approach in addressing other zoonoses, such as Lyme disease and West Nile virus: “It did not regularly communicate with animal agencies or analyze surveillance data on disease outbreaks in animals, but instead responded with medical and educational campaigns once one or more people became infected,” Jerolmack writes.

Jerolmack notes the CDC has recognized the need to do a better job of building relationships with the veterinary world. In 2006, it created the Geographic Medicine and Health Promotion Branch, which tracks the flows of both humans (as travelers) and animals (as they are imported or exported), and its director, Dr. Nina Marano, is a veterinarian. He adds that during an outbreak of rabies in the 1990s, state agencies worked together to stem the tide of the disease—a response he views as an “example of the successful alignment of priorities and action among the myriad agencies responsible for human and animal health.” However, his study found these instances to be the exception rather than the norm.

Gonzalo Erdozain: TV doctors are not real doctors; don’t know jack about risks involved with petting zoos

Unfortunately, TV doctors are often idolized and imitated. Seeing Ellen Pompeo (Meredith Grey from Grey’s Anatomy) take her almost two-year-old daughter to a petting zoo demonstrates there is a long way to go reducing zoonotic diseases transmission and prevention awareness at petting zoos.

Children under the age of five are considered a high-risk group, add a pacifier, petting a baby goat, and a rabbit, and there is a high-risk situation for zoonotic disease transmission. Baby ruminants and poultry intermittently excrete substantial numbers of germs, which is why it is not recommended to have these young animals at petting zoos. Pacifier, bottles, or any items that will end up in the visitor’s mouth are all conduits for the fecal-oral route of exposure to pathogens. Keep children under five on your arms at all times, prevent strollers and baby items from entering the human-animal contact areas, and if you pet an animal, thoroughly wash your hands with soap and water afterwards.

Petting zoo-related outbreaks have been recorded worldwide; an updated table is available at

Happy cows come from British Columbia, too

I like having a glass of wine with my dinner every now and then. It tastes good and they say it’s good for you, so I don’t even have to feel guilty about it.

Apparently, a group of farmers in British Columbia think the health benefits also apply to cattle. The idea is a variation of the Kobe beef, where cattle are fed beer. Unlike Kobe beef, the wine is not fed every day.

“It’s during the final 90 days leading up to their slaughter that they are fed red wine supplied by a number of wineries in the Okanagan Valley.”

The final product is sweeter-tasting meat that is supposedly more tender. Plus, the cows get to die buzzed.

I wonder, if they did this with dairy cows, would wine and cheese parties become obsolete?

Is grass-fed and organic beef microbiologically safer than conventional? No

There are any number of agricultural production systems out there, each with their own way of making a buck and each with a certain level of hucksterism involved. I focus on whether the system and the end product are microbiologically safe. The best producers use techniques – regardless of political ideology – that fit best in their production system in their geographic location.

A new study in Foodborne Pathogens and Disease compared bacterial contamination rates and antimicrobial resistance in bacteria from 50 grass-fed and 50 conventionally produced beef products. The researchers from Purdue University and China concluded there was no safety advantage for either group.

The abstract is below:

Contamination rates and antimicrobial resistance in bacteria isolated from “grass-fed” labeled beef products
Foodborne Pathogens and Disease
Jiayi Zhang, Samantha K. Wall, Li Xu, Paul D. Ebner
Grass-fed and organic beef products make up a growing share of the beef market in the United States. While processing, animal handling, and farm management play large roles in determining the safety of final beef products, grass-fed beef products are often marketed as safer alternatives to grain-finished beef products based on the potential effects of all-forage diets on host microbiota. We conducted a series of experiments examining bacterial contamination rates in 50 beef products labeled as “grass-fed” versus 50 conventionally raised retail beef products. Coliform concentrations did not differ between conventional and grass-fed beef (conventional: 2.6 log10 CFU/mL rinsate; grass-fed: 2.7 log10 CFU/mL rinsate). The percentages of Escherichia coli positive samples did not differ between the two groups (44% vs. 44%). Enterococcus spp. were frequently isolated from both grass-fed beef products (44%) and conventional beef products (62%; p=0.07). No Salmonella or E. coli O157:H7 isolates were recovered from any of the meat samples. Enterococcus spp. isolates from conventional beef were more frequently resistant to daptomycin and linezolid (p<0.05). Resistance to some antimicrobials (e.g., chloramphenicol, erythromycin, flavomycin, penicillin, and tetracyline) was high in Enterococcus spp. isolated from both conventional and grass-fed beef. There were no differences in the percentages of antimicrobial resistant E. coli isolates between the two groups. Taken together, these data indicate that there are no clear food safety advantages to grass-fed beef products over conventional beef products.


Never Kiss a Froggy Frog

To entertain Sorenne today, we stopped by the Hallmark store at the Manhattan Mall. In addition to her favorite Webkinz, we found miniature (living) frogs in little glass cubes. Sorenne was fascinated with what she called, “fish.”

Accompanying the display was a clearly posted warning about handling reptiles. Although frogs are amphibians, I was delighted to see the information. I asked the store staff if I could take a picture. They were taken aback by the request but didn’t mind. The poster from the CDC highlights what Doug has often said in the past: “Do not nuzzle or kiss your pet reptile.” Other tips include:

– Always wash your hands thoroughly after you handle your pet reptile, its food and anything it has touched.
– Keep your pet reptile in a habitat designed for it; don’t let it roam around the home.
– Keep your pet reptile and its equipment out of the kitchen or any area where food is prepared.
– Keep reptiles out of homes where there are children under 1 year of age or people with weakened immune systems. Children under 5 should handle reptiles only with adult/parental guidance. And, they should always remember to wash their hands afterwards.

We didn’t buy a frog today, but I’m sure that request will come in time.

Gonzalo Erdozain: Don’t eat poop, take my dog’s bark for it

One of my favorite songs of all time, Friday I’m in Love, by The Cure, pretty much states that Friday is the best most awesome day of the week. This is true, except for this past Friday, when my wife and I were woken up at 3 a.m. by a foul stench coming from our kitchen.

Our lovely puppy – 56-pound yellow lab – decided to go for an all-poop-that-you-can-eat buffet in our backyard, when she was just supposed to be frolicking and enjoying the cold weather after having dinner. So, if your dessert consists of poop, you will most likely barf it all out, unless you are a rabbit, in which case you are fine. That’s what our dog did. She barfed all that poop all over our kitchen floor.

The question is, besides whether you still love your dog or not, how to clean all that poop?

– If you own a pair of disposable or rubber gloves, now is a good time to put them on.

– Tie the dog outside somewhere, so that she won’t keep stepping on poop and spreading it.

– Remove the dog’s bed, which is covered in poop and place it in the washer, with detergent and if available, bleach.

– Collect excess poop with paper towels and put them in a leak-proof trash bag.

– Once all the excess is gone, spray everything with the disinfectant of your choosing.

– Wipe with paper towels and repeat.

I went a step further and cleaned the whole floor with a swiffer and bleach, and then I even polished it, just to try to get rid of the smell from my hardwood floor. By the time I was done cleaning this mess it was around 4 a.m.

Don’t eat poop. And wash your hands. Often.. Often, like this banner at 810 Zone in Kansas City states, means after every use of the bathroom, every time you touch raw foods, and every time you touch your pet or its food or its barf.

Kevin Smith got kicked off a Southwest airplane for being fat; should pet owners be kicked off for being inconsiderate?

Movie director Kevin Smith, known for the witty and obscene dialogue in movies he’s penned like Clerks, Chasing Amy and Dogma, was deemed a flight risk by a Southwest airlines pilot last weekend and ordered off the plane.

"I know I’m fat, but was Captain Leysath really justified in throwing me off a flight for which I was already seated?" he ranted through his Twitter account to over 1.6 million followers.. "Again: I’m way fat… But I’m not THERE just yet. But if I am, why wait til my bag is up, and I’m seated WITH ARM RESTS DOWN.”

Smith posted this pic of himself (above, right, exactly as shown) puffing out his cheeks and captioned it, "Look how fat I am on your plane! Quick! Throw me off!"

Another emerging issue on airplanes is those travelling with small pets.

An editorial in the current issue of the Canadian Medical Association Journal notes that air travel has become increasingly difficult, with tightened security restrictions and a decreased number of services. But now Air Canada is adding to the difficulty by allowing small pets to travel airplane cabins.

Pets can be accommodated comfortably and safely in airplane cargo holds, which is where they belong. Airlines must choose to put the needs of their human passengers first, or be forced to do so.

Flying should not include avoidable health risks, especially, for passengers with allergies to pets. Many people with allergies to animals will have a reaction when they’re trapped in an enclosed space, often for hours.

The Canadian Transportation Agency ruled that people allergic to nuts should be considered to have a disability under the Canada Transportation Act and must therefore be accommodated. The agency is now receiving passenger complaints about pets on airplanes and considering whether those with allergies to pets should also be considered as having a disability. Such a finding would force Canadian airlines to safeguard passengers with pet allergies.

Shortage of food animal veterinarians puts our food supply at risk

As a veterinary student at Kansas State University, I hear quite a bit about the growing demand for food animal veterinarians. With the increasing cost of tuition for vet school, it’s understanding that many of my colleagues are choosing to specialize in small animal medicine to help pay off school loans. But the looming threat of agroterrorism, emerging diseases and heightened food security shows an increased demand for food animal vets.

The American Veterinary Medical Association (AVMA) reports, Only about 17 percent of veterinarians work in food supply, including practicing veterinarians and veterinarians working for governmental and corporate organizations. This is in contrast to the turn of the 19th century, when virtually every veterinarian was a food supply veterinarian. Moreover, research forecasts a shortfall of 4-5 percent per year in the ranks of food supply veterinarians.
Philip Lowe, from the Centre for Rural Economy at the University of Newcastle, has said the proportion of time vets in private practice spent treating animals used for food halved between 1998 and 2006 – due in part to the fact most vets run their own businesses, and pet owners have proved a more sustainable and lucrative source of income than farmers.
Professor Lowe argues in the journal Veterinary Record that due to this shift there has been a failure to make use of vets’ considerable and wide ranging expertise.
Various programs have been proposed to encourage vet students to enter food animal practice and help alleviate the problem of an enlarging veterinary student debt to salary ratio. Two programs that have been implemented are the Student Loan Repayment Program through the USDA and the National Veterinary Medical Service Act
These programs and future opportunities will help veterinary students join the nation’s food safety task force, and hopefully also increase our knowledge base and preparedness for foreign animal diseases within the United States. This is a critical time in the veterinary world, in which veterinarians must take full advantage of their skill sets to protect the nation’s food supply.
To read more about the food animal vet shortage, visit the AVMA’s Food Supply Veterinary Medicine media page.

Wal-creatures in need of food safety information

The hottest word (in my opinion) of 2009: wal-creature. If you’re a late night Wal-Mart shopper like me (I’d rather avoid the daytime crowd), then there’s a pretty good chance that you’ve come across one. A wal-creature is anyone shopping at Wal-Mart wearing outlandish or ridiculous clothing, whether it be too tight or blindingly bright. A wal-creature could be Mimi from Drew Carey. Wal-creatures may be encountered in real life, but more often are photographed and put up on one of my favorite sites: The site has daily updates with pictures and captions of the craziest people spotted in Wal-Mart. 

First off, I’m pretty surprised that some of these people leave their house dressed as they are. Secondly, I can’t believe how many of these people have been photographed in the store with animals. There aren’t too many Wal-Marts around without a food section, so there’s a very good chance that these animals have accompanied their owners on that side of the store. includes photos of wal-creatures with monkeys (2 of them), raccoons, snakes, pigs, and even macaws.
In my opinion, the photo with the macaw is the most disturbing. The caption says it best: “Oh no Ms., it’s cool, I love stepping in parrot sh*t whenever I’m buying celery. Nothing says sanitary like a parrot in the produce section…” I cannot believe this lady got away with bringing a giant Salmonella factory into the produce section of a grocery store. I’m a big proponent of service dogs – dogs only. This bird’s rectum is pointed precariously close to the cases of strawberries. Unfortunately the manager at the store couldn’t have done anything about it (whether he was aware of the bird in the store or not). Laws are in place to protect disabled people with service animals from being asked to leave stores. Managers are not even allowed to ask what their disability is (which isn’t overly apparent in this situation) and disabled patrons are not required to show documentation for their service animals. I wish this could be regulated somehow because I have suspicions that the bird isn’t a real service animal, instead it’s just a pet.
Pets in grocery stores gross me out and tick me off. Wal-creatures just scare me.