title: A Multistate Investigation of Antibiotic-Resistant Salmonella enterica Serotype I 4,[5],12:i:- Infections as Part of an International Outbreak Associated with Frozen Feeder Rodents.
abstract: While most human Salmonella infections result from exposure to contaminated foods, an estimated 11% of all Salmonella infections are attributed to animal exposures, including both direct animal handling and indirect exposures such as cleaning cages and handling contaminated pet food. This report describes the epidemiologic, environmental and laboratory investigations conducted in the United States as part of the response to an international outbreak of tetracycline-resistant Salmonella enterica serotype I 4,[5],12:i:- infections with over 500 illnesses occurring from 2008 to 2010. This investigation found that illness due to the outbreak strain was significantly associated with exposure to pet reptiles and frozen feeder rodents used as food for pet reptiles. Salmonella isolates indistinguishable from the outbreak strain were isolated from a frozen feeder mice-fed reptile owned by a case patient, as well as from frozen feeder mice and environmental samples collected from a rodent producing facility (Company A). An international voluntary recall of all Company A produced frozen feeder animals sold between May 2009 and July 2010 occurred. Only 13% of cases in our investigation were aware of the association between Salmonella infection and mice or rats. Consumers, the pet industry, healthcare providers and veterinarians need to be aware of the potential health risk posed by feeder rodents, whether live or frozen. Frozen feeder rodent producers, suppliers and distributors should follow the animal food labelling requirements as described in 21 CFR §501.5, and all packages of frozen feeder rodents should include safe handling instructions. Persons should wash their hands thoroughly with soap and water after handling live or frozen feeder rodents, as well as reptiles or anything in the area where the animals live. Continued opportunities exist for public health officials, the pet industry, veterinarians and consumers to work together to prevent salmonellosis associated with pet food, pets and other animals.
authors.affiliation: Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, OSELS, CDC, Atlanta, GA, USA.|Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.|Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Cartwright
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: T
authors.initials: T
authors.lastname: Nguyen
authors.affiliation: Center for Veterinary Medicine, Food and Drug Administration, Rockville, MD, USA.
authors.forename: C
authors.initials: C
authors.lastname: Melluso
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: T
authors.initials: T
authors.lastname: Ayers
authors.affiliation: Public Health England, Centre for Infectious Disease Surveillance and Control, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Lane
authors.affiliation: Center for Veterinary Medicine, Food and Drug Administration, Rockville, MD, USA.
authors.forename: A
authors.initials: A
authors.lastname: Hodges
authors.affiliation: Center for Veterinary Medicine, Food and Drug Administration, Rockville, MD, USA.
authors.forename: X
authors.initials: X
authors.lastname: Li
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Quammen
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.|Epidemiology Elective Program, Scientific Education and Professional Development Program Office, OSELS, CDC, Atlanta, GA, USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Yendell
authors.affiliation: Association of Public Health Laboratories, Silver Spring, MD, USA.
authors.forename: J
authors.initials: J
authors.lastname: Adams
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Mitchell
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Rickert
authors.affiliation: Wisconsin Division of Public Health, Madison, WI, USA.
authors.forename: R
authors.initials: R
authors.lastname: Klos
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: I T
authors.initials: IT
authors.lastname: Williams
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: C
authors.initials: C
authors.lastname: Barton Behravesh
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Wright
mesh_terms: D000293:Adolescent; D000328:Adult; D000821:Animal Feed / Q000382:microbiology; D000822:Animal Husbandry; D000818:Animals; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial; D005260:Female; D005511:Food Handling; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D051379:Mice; D008875:Middle Aged; D057805:Pets / Q000382:microbiology; D051381:Rats; D012104:Reptiles / Q000382:microbiology; D012478:Salmonella Food Poisoning / Q000453:epidemiology* / Q000517:prevention & control*; D012480:Salmonella Infections / Q000517:prevention & control* / Q000635:transmission; D012481:Salmonella Infections, Animal / Q000453:epidemiology*; D012477:Salmonella enteritidis / Q000302:isolation & purification*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Salmonella; amphibians; frozen feeder rodents; outbreak; reptiles; zoonoses