37 sick from Salmonella in turtles

Turtles in the 1960s and 1970s were inexpensive, popular, and low maintenance pets, with an array of groovy pre-molded plastic housing designs to choose from. Invariably they would escape, only to be found days later behind the couch along with the skeleton of the class bunny my younger sister brought home from kindergarten one weekend.

Maybe I got sick from my turtle.

Maybe I picked up my turtle, rolled around on the carpet with it, pet it a bit, and then stuck my finger in my mouth. Maybe in my emotionally vacant adolescence I kissed my turtle. Who can remember?

The U.S. Centers for Disease Control reports there are now – in yet another turtle outbreak – 37 people sick with Salmonella Agbeni in 13 states.

Illnesses started on dates ranging from March 1, 2017 to August 3, 2017

Of 33 people with available information, 16 have been hospitalized. No deaths have been reported.

Twelve (32%) ill people are children 5 years of age or younger.

Epidemiologic and laboratory findings link the outbreak of human Salmonella Agbeni infections to contact with turtles or their environments, such as water from a turtle habitat.

In interviews, ill people answered questions about contact with animals during the week before becoming ill. Fifteen (45%) of the 33 people interviewed reported contact with turtles or their environments, such as water from a turtle habitat, before getting sick.

In interviews with 9 ill people about where their turtles came from, 6 reported buying a turtle from a flea market or street vendor, or receiving the turtle as a gift.

In 2015, state and local health officials collected samples from turtles at a street vendor. Whole genome sequencing showed that the Salmonella Agbeni isolated from ill people in this outbreak is closely related genetically to the Salmonella Agbeni isolates from turtles. This close genetic relationship means that people in this outbreak are more likely to share a common source of infection.

Do not buy small turtles as pets or give them as gifts.

Since 1975, the FDA has banned selling and distributing turtles with shells less than 4 inches long as pets because they are often linked to Salmonella infections, especially in young children.

All turtles, regardless of size, can carry Salmonella bacteria even if they look healthy and clean. These outbreaks are a reminder to follow simple steps to enjoy pet reptiles and keep your family healthy.

This outbreak is expected to continue since consumers might be unaware of the risk of Salmonella infection from small turtles. If properly cared for, turtles have a long-life expectancy.

 

124 sick: 4 on-going US outbreaks of Salmonella linked to small turtles

On 20 April 2016, the National IHR Focal Point of the U.S. notified PAHO/WHO of an ongoing investigation of four multistate outbreaks of human Salmonella infections linked to exposure to small turtles (with shell length <4 inches/10 centimetres) or their environments (e.g., water from a turtle habitat) in the U.S.

turtle.kiss_A total of 124 cases with the outbreak strains of Salmonella have been reported from 22 U.S. states. Of these, 33% of patients have been hospitalized, and no deaths have been reported. Of the total, 51 cases (41%) were aged less than 5 years. The earliest illness associated with the four outbreaks began on 1 January 2015. Initial investigations have identified four turtle farms in Louisiana as potential sources of the turtles linked to these 2015 outbreaks. Pond water testing from the four farms resulted in the identification of additional non-outbreak Salmonella isolates.

The U.S. Centers for Disease Control and Prevention (CDC) is investigating these outbreaks and the identified turtle farms which may have exported turtles with Salmonella internationally. Results of the epidemiologic, laboratory and environmental investigations indicate exposure to turtles or their environments (e.g., water from a turtle habitat) as the sources of these outbreaks.

Since the infection is linked to exposure to small turtles that have been exported internationally, there is a risk to pediatric populations in other countries. The risk of morbidity and mortality is higher in patients with severe immunosuppression. PAHO/WHO continues to monitor the epidemiological situation and conduct risk assessment based on the latest available information.

Countries that import reptile or amphibian pets, including small turtles, should pay attention to potential imports of infected pets, and inform local health authorities to consider exposure to small turtles and other reptile or amphibian pets when investigating cases or potential outbreaks of salmonellosis, especially in the pediatric population.

More turtles, more Salmonella

 You see a cute reptile, I see a Salmonella factory.

turtle.kissThe U.S. Centers for Disease Control, multiple states, and the U.S. Food and Drug Administration Center for Veterinary Medicine investigated two multistate outbreaks of human Salmonella infections linked to contact with small turtles in 2015.

51 people infected with the outbreak strains of Salmonella were reported from 16 states between January 22, 2015 and September 8, 2015.

15 ill people were hospitalized, and no deaths were reported.

50% of ill people were children 5 years of age or younger.

Epidemiologic and laboratory findings linked these two outbreaks of human Salmonella infections to contact with small turtles or their environments, such as water from a turtle habitat.

All turtles, regardless of size, can carry Salmonella bacteria even if they look healthy and clean. These outbreaks are a reminder to follow simple steps to enjoy pet reptiles and keep your family healthy.

Wash hands thoroughly with soap and water immediately after handling turtles or anything in the area where they live or roam.

Since 1975, the Food and Drug Administration has banned the sale and distribution of turtles with a shell length of less than 4 inches in size as pets because they are often linked to Salmonella infections, especially in young children.

Small turtles should not be purchased as pets or given as gifts.

CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory conducted antibiotic resistance testing on Salmonella isolates collected from seven ill people infected with one of the outbreak strains.

All seven isolates were susceptible to all antibiotics tested on the NARMS panel.

The outbreak is expected to continue at a low level for the next several months since consumers might be unaware of the risk of Salmonella infection from reptiles, including small turtles. If properly cared for, small turtles have a long life expectancy.

 

Salmonella: Stop kissing turtles and stop touching yourself

The U.S. Centers for Disease Control reports that in May 2014, a cluster of human Salmonella Poona infections was identified through PulseNet, the national molecular subtyping network for foodborne disease surveillance.

turtleHistorically, this rare serotype has been identified in multiple Salmonella outbreaks associated with pet turtle exposure and has posed a particular risk to small children (1,2). Although the sale and distribution of small turtles (those with carapace [upper shell] lengths <4 inches [<10.2 cm]) is prohibited by federal law, they are still available for legal purchase online for “bona-fide” scientific, educational, or exhibition purposes, other than use as pets (3). In addition, small turtles are still available for illegal purchase through transient street vendors, at flea markets, and at fairs.

During April 26–September 22, 2014, a total of 40 persons infected with Salmonella Poona pulse-field gel electrophoresis (PFGE) pattern JL6X01.0055 (the outbreak strain) were reported from 12 states. Patients ranged in age from <1 to 75 years (median = 5 years); 16 (40%) patients were aged ≤1 year, and 14 (35%) were female. Among 29 ill persons for whom information about hospitalization was available, eight (28%) were hospitalized; no deaths were reported. Among 28 ill persons who were interviewed, 13 (46%) reported exposure to turtles. Three ill persons reported the size of the turtles, and all identified turtles <4 inches in length. The outbreak strain was isolated from a pet turtle in a California patient’s home. Turtles had been obtained from several types of locations, including a carnival and a fair. The transient nature of turtle vendors hampered the traceback investigation. No other common food or animals were identified during the course of the investigation.

This outbreak demonstrates that turtles remain a source for human Salmonella infections, especially for young children. Because 40% of ill persons were infants aged ≤1 year and were unlikely to directly handle pet turtles, the potential role of indirect transmission in turtle-associated salmonellosis outbreaks should be considered. Turtles in the home could lead to environmental contamination with Salmonella bacteria and result in human illness. Educational campaigns directed toward parents of young children, in conjunction with the federal turtle ban, might help to prevent future turtle-associated salmonellosis outbreaks.

1Epidemic Intelligence Service, CDC; 2Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC; 3California Department of Public Health; 4City of Long Beach Department of Health and Human Services, Long Beach, California.

Corresponding author: Colin Basler, cbasler@cdc.gov, 404-639-2214.

References

CDC. Eight multistate outbreaks of human Salmonella infections linked to small turtles (final update). Available at http://www.cdc.gov/salmonella/small-turtles-03-12/index.html.

CDC. Notes from the field: outbreak of salmonellosis associated with pet turtle exposures—United States, 2011. MMWR Morb Mortal Wkly Rep 2013;62:213.

Code of Federal Regulations. Turtles intrastate and interstate requirements, 21 C.F.R. § 1240.62 (2014). Available at http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=1240.62External Web Site Icon. 

Notes from the Field: Multistate Outbreak of Human Salmonella Poona Infections Associated with Pet Turtle Exposure — United States, 2014

Centers for Disease Control and Prevention Morbidity and Mortality Report

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6429a7.htm?s_cid=mm6429a7_x

South Carolina business owner sentenced for illegal sale of turtles

I’ve explored my angst with turtles many times over the past eight years of blogging; and while I’m slowly recovering from the childhood trauma (and barfing) I’m always mildly taken aback whenever someone decides to sell the little turtles, even though the act has been banned since 1975.

Because they make little kids sick.

Steve Maleh, 42, who owns and operates Island Breeze on North Forest Beach Drive, Hilton Head Island, was sentenced in federal court in turtle.kissCharleston by U.S. District Judge Sol Blatt Jr., according to a news release from the U.S. Attorney’s Office.

Maleh, of Plantation, Fla., was arraigned last year in U.S. District Court in Fort Lauderdale, Fla., on a seven-count indictment. The U.S. Food and Drug Administration and Hilton Head Island code enforcement officials investigated complaints the store was providing baby turtles to customers.

The federal government has banned the sale of turtles with shells less than 4 inches long since 1975, in an attempt to prevent exposing people, especially children, to salmonella, which can be regularly found on the turtles, according to the FDA and U.S. Attorney’s Office in Charleston.

Hilton Head code enforcement officers and FDA agents made multiple visits to the store over several years, informing Maleh and his staff that distributing juvenile turtles was illegal. But despite numerous warnings, Maleh continued to distribute the turtles to customers, according to a federal prosecutor.

Hulbert said Island Breeze did not sell the turtles outright, but sold small aquariums for about $20 and included a baby turtle with the purchase. The town and U.S. Attorney’s Office had issued numerous warnings to the business, but it continued the practice, he said.

The U.S. Attorneys Office says Maleh also pretended to be an FDA agent. An owner of a competing Hilton Head business received a letter, purportedly from the FDA, telling him to stop selling juvenile turtles or face fines and prosecution. An investigation revealed Maleh sent the letter, according the U.S. Attorney’s Office.

Tourists warned of the dangers of sea turtles

Sorenne is going to a new kindy for two days a week. It seems groovy, and after the intro parent meeting they took me up on my issues and used some extra budget to buy two refrigerators for food safety reasons.

But about the turtle.

There’s a large turtle in an aquarium that attracts the childrens’ attention – and fingers.

According to research published in the RSM Short Reports, researchers found that turtles in captivity carry the risk of exposure to toxic OLYMPUS DIGITAL CAMERAcontaminants and zoonotic pathogens – which able to move from animals to humans – such as bacteria, viruses and parasites.

The review was based on a four-year case study of the Cayman Turtle Farm in Grand Cayman, Caribbean, which attracted an estimated 1.2 million visitors.

Most of the turtles at the farm are green sea turtles.

Clifford Warwick, lead author of the report, said the conditions the turtles are kept in plays a key role in the increased risk factors.

“Significantly, the captive farming of turtles arguably increases the threat to health, in particular from bacteria, due to the practice of housing many turtles in a relatively confined space and under intensive conditions,” he said.

Warwick said the findings highlight the need for further investigation and awareness.

Don’t kiss that turtle: 66 sick, 11 hospitalized, mainly kids, in three multistate outbreaks of human Salmonella infections linked to small turtles

At this time of year it’s usually chicks and ducklings and Salmonella, but why not throw some turtles into the mix. Again.

I still regret cuddling up to my pet turtle, but what did I know?

The U.S. Centers for Disease Control reports a total of 66 persons infected with outbreak strains of Salmonella Sandiego, Salmonella Pomona, and Salmonella Poona have been reported from 16 states; 11 ill persons have been hospitalized, and no deaths have been reported; 55% of ill persons are children 10 years of age or younger.

Results of the epidemiologic and traceback investigations indicate exposure to turtles or their environments (e.g., water from a turtle habitat) is the cause of this outbreak.

Turtles with a shell length of less than 4 inches in size should not be purchased or given as gifts.

CDC is collaborating with public health officials in multiple states to investigate three overlapping, multistate outbreaks of human Salmonella infections linked to exposure to turtles or their environments (e.g., water from a turtle habitat). The first is an outbreak of human Salmonella Sandiego infections, the second is an outbreak of human Salmonella Pomona infections, and the third is an outbreak of human Salmonella Poona infections. These are rare types of Salmonella.

The Salmonella Sandiego and Salmonella Pomona outbreaks have similar geographic distributions, with cases occurring in the Northeast and Southwest. The Salmonella 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 Salmonella bacteria 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 Salmonella infections. Small turtles, with a shell length of less than 4 inches, are a well-known source of human Salmonella infections, especially among young children. Because of this risk, the Food and Drug Administration (FDA) has banned the sale and distribution of these turtles since 1975. Amphibians and reptiles can carry Salmonella germs and still appear healthy and clean. Salmonella germs 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.

Don’t kiss turtle or frogs; additional Salmonella risk

Some federal food safety thingy decided he just had to tell me how disappointed he was because I ran the don’t-kiss-frogs-and-salmonella story and the U.K. version that linked it to a Disney movie, The Frog and the Prince.

“Your non-apology for your role is (sic) amplifying the ‘far-fetched, but sorta fun’ story makes me wonder how serious you are about your posts and your role in our public health community.”

Who is ‘our?’ Writing 101 mistake.

And dude, join the end of the line. Lots of people are disappointed with me.

The headline of the blog post was, Don’t kiss frogs or turtles, whether it’s in a Disney film or not. And with a new report from CDC, let me reiterate, don’t kiss turtles.

On September 4, 2008, the Philadelphia Department of Public Health (PDPH) and the Pennsylvania Department of Health (PADOH) notified CDC of an outbreak of possible turtle-associated human Salmonella Typhimurium infections detected by identifying strains with similar pulsed-field gel electrophoresis (PFGE) patterns in PulseNet. Turtles and other reptiles have long been recognized as sources of human Salmonella infections (1), and the sale or distribution of small turtles (those with carapace lengths <4 inches) has been prohibited in the United States since 1975 (2,3). CDC and state and local health departments conducted a multistate investigation during September–November 2008. This report summarizes the results of that investigation, which identified 135 cases in 25 states and the District of Columbia; 45% were in children aged ≤5 years. Among 70 patients with primary infection, 37% reported turtle exposure, of which 81% was to small turtles most commonly purchased from street vendors. A matched case-control study showed a significant association between illness and exposure to turtles (matched odds ratio [mOR] = 16.5). Increasing enforcement of existing local, state, and federal regulations against the sale of small turtles, increasing penalties for illegal sales, and enacting more state and local laws regulating the sale of small turtles (e.g., requiring Salmonella awareness education at the point-of-sale), could augment federal prevention efforts. …

This S. Typhimurium outbreak is the third multistate, turtle-associated Salmonella outbreak in the United States since 2006. Before 2006, no large multistate turtle-associated Salmonella outbreaks were identified. One reason for this apparent increase might be PulseNet, which has improved the ability to detect multistate outbreaks. Increased pet turtle ownership in the United States also might contribute to the recurrent outbreaks: the proportion of households in the United States owning pet turtles doubled during 1996–2006, from 0.5% to 1.0% (4). Together, the three recent Salmonella outbreaks account for 258 laboratory-confirmed cases of salmonellosis (5–7) and many more unreported illnesses likely occurred. As with past outbreaks, most ill persons reporting turtle exposure were exposed to turtles with shell lengths <4 inches; these turtles were mainly acquired from flea markets, street vendors, and souvenir shops. The case-control study found a significant association of Salmonella infection with turtle exposure; however, 63% of primary cases in the outbreak had no knownturtle exposure, and 60% had no reptile exposure. This might have resulted, in part, from failure to recall a turtle exposure. Parents or guardians were interviewed as proxies for young children and they might have been unaware of their child’s turtle exposure outside of the home. In addition, certain patients might have had unknown indirect turtle exposure through environmental cross-contamination or unrecognized person-to-person transmission or have been sporadic or background cases.

Tiny turtles still making kids sick

Growing up in late-1960s suburbia, I had a turtle.

Turtles were inexpensive, popular, and low maintenance, with an array of groovy pre-molded plastic housing designs to choose from. Invariably they would escape, only to be found days later behind the couch along with the skeleton of the class bunny my younger sister brought home from kindergarten one weekend.

But eventually, replacement turtles became harder to come by. Reports started surfacing that people with pet turtles were getting sick. In 1975, the U.S. Food and Drug Administration (FDA) banned commercial distribution of turtles less than 4 inches in length, and it has been estimated that the FDA ban prevents some 100,000 cases of salmonellosis among children each year.

Maybe I got sick from my turtle.

Maybe I picked up my turtle, rolled around on the carpet with it, pet it a bit, and then stuck my finger in my mouth. Maybe in my emotionally vacant adolescence I kissed my turtle. Who can remember?

A report that will be published tomorrow in the journal Pediatrics documents how 107 people in 34 states became sick with Salmonella from the small turtles between 2007 and 2008 – including two girls who swam with pet turtles in a backyard pool.

The paper notes that one-third of all patients had to be hospitalized, and in many cases, parents didn’t know turtles could carry salmonella.

Julie Harris, a scientist at the U.S. Centers for Disease Control and Prevention and the report’s lead author said other cases turned up elsewhere, many involving direct contact with turtles, including children kissing turtles or putting them in their mouths.

I’m familiar with that.

David Bergmire-Sweat, a North Carolina epidemiologist who investigated the Union County case, said he’s heard of families letting turtles walk on kitchen surfaces where food is prepared, and babies being bathed in sinks where turtle cages are washed.

Veterinarian Mark Mitchell, a University of Illinois zoological medicine professor, has been working with Louisiana turtle farmers in research aimed at raising salmonella-free turtles, says the industry has been unfairly saddled with harsher restrictions than producers of human foods also blamed for recent salmonella outbreaks.

Maybe, but people need to eat.  They don’t need to kiss turtles.
 

Doug dreams about flaming turtles

I’ve taken to going to sleep about 10 p.m. and getting up about 4 a.m. That means Amy stays up later, feeds Sorenne a couple of more times, and apparently gets to listen to me babble in my sleep.

This is nothing new. I’ve given entire lectures in my sleep – and I’m just talking about with Amy, not classrooms.

I’ve written about the trauma of only having turtles as pets while growing up. And the recent story in the Baltimore Sun and the terrible response about how those tiny turtles are OK as long as little kids don’t put the entire turtle in their mouths apparently triggered some sort of response.

"I’m supposed to kill 6 of those f***ing flaming turtles"

Amy says she laughed, Doug started laughing, then said, "See, I’m wasting my resources when I’m not doing what I’m supposed to."

Amy, who likes to ask questions when I talk in my sleep, says,

"What are you supposed to be doing?"

"Keeping those f***ing new zealanders in line."

This probably had to do with the e-mails I was sending to New Zealanders Katie and Gary before I went to sleep. Or not.