title: An outbreak of salmonellosis among children attending a reptile exhibit at a zoo.
abstract: OBJECTIVE
  In January 1996, an outbreak of diarrhea caused by Salmonella Enteritidis occurred in children attending a Komodo dragon exhibit at a metropolitan zoo. We sought to determine the extent of the outbreak and mode of transmission.
  
  
  METHODS
  A case-control study was conducted. Controls were randomly selected from zoo membership lists and matched to patients by age group and date of exhibit visit.
  
  
  RESULTS
  Of 65 patients identified, 39 had confirmed and 26 had suspected cases. The median age was 7 years (range, 3 months to 48 years); 55% were enrolled in the case-control study. No patients and two (4%) controls reported touching a dragon; however, 83% of patients but only 52% of controls touched the wooden barrier that surrounded the dragon pen (odds ratio = 4.0, 95% CI 1.2 to 13.9). Washing hands at the zoo after visiting the dragons was highly protective (OR = 0.14, 95% CI 0.03 to 0.7). Cultures from the patients, one dragon, and the exhibit barriers yielded Salmonella Enteritidis, phage type 8. On the basis of an attack rate of 4.3% among exhibit attendees under 13 years old on whom data were collected, we estimate that 315 additional cases of salmonellosis occurred among visitors in this age group.
  
  
  CONCLUSIONS
  This large outbreak demonstrates the importance of environmental contamination in the transmission of Salmonella from reptiles, and the protective value of hand washing. Recommendations regarding reptile exhibits and reptilian pets should emphasize this indirect route.
authors.affiliation: Foodborne and Diarrheal Diseases Branch, Centers for Disease Control and Prevention, Atlanta 30333, USA.
authors.forename: C R
authors.initials: CR
authors.lastname: Friedman
authors.forename: C
authors.initials: C
authors.lastname: Torigian
authors.forename: P J
authors.initials: PJ
authors.lastname: Shillam
authors.forename: R E
authors.initials: RE
authors.lastname: Hoffman
authors.forename: D
authors.initials: D
authors.lastname: Heltzel
authors.forename: J L
authors.initials: JL
authors.lastname: Beebe
authors.forename: G
authors.initials: G
authors.lastname: Malcolm
authors.forename: W E
authors.initials: WE
authors.lastname: DeWitt
authors.forename: L
authors.initials: L
authors.lastname: Hutwagner
authors.forename: P M
authors.initials: PM
authors.lastname: Griffin
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D000836:Animals, Zoo / Q000382:microbiology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003120:Colorado / Q000453:epidemiology; D004196:Disease Outbreaks; D004812:Epidemiologic Methods; D005759:Gastroenteritis / Q000453:epidemiology*; D006235:Hand Disinfection; D006801:Humans; D007223:Infant; D008875:Middle Aged; D012104:Reptiles / Q000382:microbiology*; D012480:Salmonella Infections / Q000453:epidemiology* / Q000635:transmission*; D012477:Salmonella enteritidis / Q000302:isolation & purification*; D011795:Surveys and Questionnaires