Multistate outbreak of Salmonella infections associated with small turtle exposure, 2007-2008.
OBJECTIVE
Turtle-associated salmonellosis was increasingly recognized in the United States during the 1960s, leading to a federal ban in 1975 on the sale of turtles <4 inches in carapace length (small turtles). Although sporadic reports of turtle-associated Salmonella are frequent, outbreaks are rare. In September 2007, several patients with Salmonella enterica serotype Paratyphi B var Java infections reported recent turtle exposure. We conducted an investigation to determine the source and extent of the infections.


METHODS
Patients with Salmonella Paratyphi B var Java infections with a specific pulsed-field gel electrophoresis pattern (outbreak strain) and illness onset between May 2007 and January 2008, were compared with healthy controls. Reptile exposure and awareness of a Salmonella-reptile link were assessed. Turtle size and purchase information were collected.


RESULTS
We identified 107 patients with outbreak-strain infections. The median patient age was 7 years; 33% were hospitalized. Forty-seven (60%) of 78 patients interviewed reported exposure to turtles during the week before illness; 41 (87%) were small turtles, and 16 (34%) were purchased in a retail pet store. In the case-control study, 72% of 25 patients reported turtle exposure during the week before illness compared with 4% of 45 controls (matched odds ratio [mOR]: 40.9 [95% confidence interval (CI): 6.9-unbounded]). Seven (32%) of 22 patients versus 11 (28%) of 39 controls reported knowledge of a link between reptile exposure and Salmonella infection (mOR: 1.3 [95% CI: 0.4-4.6]).


CONCLUSIONS
We observed a strong association between turtle exposure and Salmonella infections in this outbreak. Small turtles continue to be sold and pose a health risk, especially to children; many people remain unaware of the link between Salmonella infection and reptile contact.
Centers for Disease Control and Prevention, Atlanta, Georgia 30309, USA. ggt5@cdc.gov
Julie R
JR
Harris
David
D
Bergmire-Sweat
Julie H
JH
Schlegel
Kim A
KA
Winpisinger
Rachel F
RF
Klos
Christopher
C
Perry
Robert V
RV
Tauxe
Mark J
MJ
Sotir
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012480:Salmonella Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission; D012484:Salmonella paratyphi B / Q000302:isolation & purification; D014426:Turtles / Q000382:microbiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult