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.


Mead PS, Slutsker L, Dietz V, McCaig LF, Bresee JS, Shapiro C, Food-related illness and death in the United States. Emerg Infect Dis. 1999;5:607–25. DOIPubMed

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.

Salmonella controls for duck flocks working in Ireland; reptiles remain a source of infection

The Food Safety Authority of Ireland says that procedures put in place to control Salmonella in ducks and duck eggs are working, according to the National Salmonella, Shigella and Listeria Reference Laboratory (NSSLRL). In its Annual Report for 2011, the laboratory reports a decrease in the number of cases of illness caused by a particular strain of Salmonella
which has been linked to duck eggs (S. Typhimurium DT8). Because duck eggs can occasionally contain Salmonella, they must not be eaten raw, but fully cooked until the yolk and white are solid. 

Sometimes, subtyping can actually detect outbreaks.  In 2009, the NSSLRL noticed an increase in cases of illness caused by a particular strain of S. Typhimurium (phage type DT8) and alerted public health colleagues to the possibility of an outbreak.  Over 30 cases were detected and investigations by the Outbreak Control Team pointed to the consumption of duck eggs as the source. 

In order to control the outbreak, consumers were advised not to eat raw or undercooked duck eggs and to handle them hygienically.  Also, new legislation setting down a legal basis for the control of Salmonella in ducks and duck eggs was introduced (S.I. No 565 of 2010).  This legislation requires anyone keeping ducks (even a small ‘backyard’ flock) to register with the Department of Agriculture, Food and the Marine (DAFM).  Also, anyone selling even small quantities of duck eggs must put in place a biosecurity plan to prevent Salmonella entering their flock and spreading.  Guidelines are available on DAFM’s website at:

According to the NSSLRL, these control measures have worked.  The number of cases of human illness caused by S. Typhimurium DT8 has dropped from 28 in 2010 to nine in 2011.

Salmonella infection is a notifiable disease in Ireland.  All cases diagnosed by doctors or clinical laboratories must be notified to the Health Protection Surveillance Centre (HPSC), which manages the surveillance of infectious diseases in Ireland.  The HPSC provisionally reported 314 cases of Salmonella infection in 2011, which follows a decline in numbers of cases since a peak in 1998.

According to the NSSLRL, Salmonella Typhimurium and S. Enteritidis were the strains which caused most Salmonella illness in humans in 2011, as in previous years.   Of the 320 Salmonella isolates from patients referred to the NSSLRL in 2011, 27% were identified as S. Typhimurium and 18% as S. Enteritidis. 

Reptiles as a Source of Infection

Reptiles often carry Salmonella and can be a source of infection, especially for children.  The HPSC advises that households with children under five years of age should not keep reptiles as pets; and neither should reptiles be kept in childcare facilities such as crèches.  However, the NSSLRL is concerned that this public health message is not being heeded because reptile-associated cases in children continued to be reported in 2011.  Subtyping of isolates from a number of these cases revealed that the strain which caused illness in the child or children was the same as that carried by the household’s pet reptile.  

NSSLRL annual reports are available at:

Pets in the classroom program

That’s what veterinarian, blogger and OK hockey player Scott Weese explored in his latest Worms and Germs entry, reprinted below.

A recent press release from The Pet Care Trust reported on the status of its Classroom Program, which provides support to teachers to have pets in school classrooms. On the surface, it seems like a good idea, helping to enrich school activities. However, it’s one of those areas that can be good, but can also be very bad, depending how it’s applied.

The Pet Care Trust has some useful information about pets in classrooms, and anyone considering a pet in a classroom needs to be aware of a variety of concerns, including:

* Welfare of the pets (stress, adequate care, abuse…)
* Adequacy of pet care, particularly during weekends and holidays
* Problems with access to veterinary care
* Distraction of students
* Allergies
* Fear
* Infectious disease transmission

Infectious disease transmission from pets in classrooms is a real problem. Infections can and do occur. The risks are quite variable, and depending on the animal, children, classroom and pet care, can range from inconsequential to quite serious.

The type of animal is very important. Certain species are very high risk for carrying certain infectious diseases and for transmitting them to people. Reptiles are notorious for Salmonella and it is recommended that children under 5 years of age and immunocompromised individuals, among others, not have contact with reptiles. Even with older kids, there’s a risk and older kids have picked up Salmonella in classrooms from reptiles or their food (e.g. frozen rodents).

So, it’s concerning that 435 of the 2066 grants handed out by this program were for reptiles, and the program involved kindergarten to Grade 6 classrooms. A lot of reptiles went into classrooms with a lot of young kids. Typically, elementary school children (at least around here) eat in their classrooms, which raises the concern. While the majority of students would be 5 years of age or older, immunocompromised kids are not exactly uncommon, and it’s unclear whether teachers have adequate understanding about whether kids in their classes are immunocompromised and that this poses an increased risk.
I’m not saying pets in classrooms are a bad idea. However, it’s often done poorly and with little forethought. To be effective and safe, you need to consider many things, such as:

* What species should it be? From my standpoint, no reptiles or other high risk species should be in any classrooms because you can’t guarantee a high-risk person won’t be around. The animal needs to be small enough to be properly housed in a classroom. It’s care requirements need to be basic and readily met. It shouldn’t be a species that gets stressed easily and one that can tolerate all the activities that go on around it. A nocturnal species is probably not a good idea.
* What types of hygiene/infection control practices need to be used and how will they be enforced?
* What disease or injury (e.g. bite) risks are present and how will they be managed.
* Who will take care of it? This means who will take care of it for its lifespan, not just the upcoming school year.
* Who will arrange and pay for any medical expenses that arise, either for preventive medicine or treatment of disease?
* Will parents be notified?
* What happens if a kid in the class is allergy or afraid of the animal?
* Will proper supervision be available at all times?
* Who from the school or school board must give permission, and is there a standard approval process? (There should be, but there rarely is).
* Why is the animal going to be there? Will there be any educational use or it is just there for fun/decoration?

If you can answer all those questions adequately, then a pet might be a good fit in a classroom. If you can’t answer them, or can’t be bothered to try to answer them, then there’s no reason for a pet to be in a classroom.

Pet snakes and babies don’t mix: 4-month-old hospitalized with Salmonella in UK

I don’t know what it is with parents in the U.K. letting pet snakes hang out with their babies.

For the third time in recent memory, a 4-month-old baby fell seriously ill with salmonella she caught from the family’s pet snake.

The baby girl was admitted to intensive care at St Thomas Hospital with a fever and high heart rate in August, where hospital tests revealed she was suffering from a strain known as salmonella Arizona, which is commonly associated with snakes.

She has recovered since then and an investigation by environmental health officers at Sutton Council identified the most likely source to be the family’s two royal python snakes, which can carry the infection in their gut and spread it through their droppings.

The council has now issued a hygiene warning to owners of exotic reptiles, saying it is essential for them to wash hands thoroughly after handling a reptile and keep the animal away from anywhere food is prepared.

My parents probably saved me from Salmonella

I always wanted a pet turtle. When I was 10, I was really into comics (nerd alert). There was a comic book store in between my school and house, that I used to spend lots of time at, and all of my allowance. Right around that time, an underground comic book from creators Kevin Eastman and Peter Laird made its debut: Teenage Mutant Ninja Turtles. What a ridiculous concept, but the coolest thing to this 10-year-old comic nerd. This was before the really cheesy cartoon, and even cheesier movies. When the Ninja Turtles were cool.

I made nunchaku and a bo staff out of broomsticks and chains from the hardware store.  I was a 10-year-old blonde-haired Canadian Napoleon Dynamite.

All of this background to set this up: I also begged my parents for a pet turtle. I was going to keep him in my room, and call him Leonardo. My parents refused and got me a cat instead.

I know it had little to do with pathogen concerns, and lots to do with the potential smell.  However, I’m grateful they shielded me from Salmonellosis.

This week’s food safety infosheet is all about reptile-related food safety concerns.

Download the infosheet here.

Salmonella can come from pets

Yesterday, a local story in a county newspaper in Texas carried the headline, “Salmonella can come from pets.”

The story reported,

“Three cases of salmonella among children in Lubbock County since December 2008 are likely the result of exposure to reptiles, said Judy Davis, a spokeswoman for the city of Lubbock health department.”

The spokeswoman explained that handwashing is the key to preventing salmonella associated with reptiles and amphibians, such as snakes and turtles.

I just wanted to point out that, although less of a problem, handwashing is also important for preventing salmonella infections from furry pets.

In 1999, the CDC received reports from three state health departments of outbreaks of multidrug-resistant Salmonella serotype Typhimurium infections in employees and clients of small animal veterinary clinics and an animal shelter.

The CDC’s report stated,

“Salmonella infections usually are acquired by eating contaminated food [including produce and peanut butter]; however, direct contact with infected animals, including dogs and cats, also can result in exposure and infection.”

Doug and Phebus, at the end of the lengthy video (from September 2008) below, also recommend washing your hands after handling food and treats for your pets… especially when they’ve been recalled.

Don’t kiss turtles, even in Britain

The UK Health Protection Agency reports that cases of Salmonella Arizonae have been on the increase and can be particularly harmful to infants.

The Telegraph reports that Dr Tansy Peters told the HPA’s annual conference,

"Although it is comparatively rare in humans, a study of samples submitted to our laboratory for testing from January 1998 to December 2007 shows that there has been a significant increase in both numerical and percentage terms.

"That may be a reflection of the increased popularity of reptiles as pets.

"This is a very worrying trend and infants and young children with their immature immune systems and weaker gastric acids are disproportionately affected. We even find cases in breast and formula-fed infants and it is unlikely that they acquired their infection from a source other than indirectly, via the parents, from the family’s pet reptile. Reptiles shed salmonella in their faeces and carry it on their skin and the public health implications of this inside the home should not be underestimated."

And if you have them in the home, don’t kiss them.