title: Outbreaks of Salmonellosis From Small Turtles.
abstract: OBJECTIVE
  Turtle-associated salmonellosis (TAS), especially in children, is a reemerging public health issue. In 1975, small pet turtles (shell length <4 inches) sales were banned by federal law; reductions in pediatric TAS followed. Since 2006, the number of multistate TAS outbreaks has increased. We describe 8 multistate outbreaks with illness-onset dates occurring in 2011-2013.
  
  
  METHODS
  We conducted epidemiologic, environmental, and traceback investigations. Cases were defined as infection with ≥ 1 of 10 molecular subtypes of Salmonella Sandiego, Pomona, Poona, Typhimurium, and I 4,[5],12:i:-. Water samples from turtle habitats linked to human illnesses were cultured for Salmonella.
  
  
  RESULTS
  We identified 8 outbreaks totaling 473 cases from 41 states, Washington DC, and Puerto Rico with illness onsets during May 2011-September 2013. The median patient age was 4 years (range: 1 month-94 years); 45% percent were Hispanic; and 28% were hospitalized. In the week preceding illness, 68% (187 of 273) of case-patients reported turtle exposure; among these, 88% (124 of 141) described small turtles. Outbreak strains were isolated from turtle habitats linked to human illnesses in seven outbreaks. Traceback investigations identified 2 Louisiana turtle farms as the source of small turtles linked to 1 outbreak; 1 outbreak strain was isolated from turtle pond water from 1 turtle farm.
  
  
  CONCLUSIONS
  Eight multistate outbreaks associated with small turtles were investigated during 2011-2013. Children <5 years and Hispanics were disproportionately affected. Prevention efforts should focus on patient education targeting families with young children and Hispanics and enactment of state and local regulations to complement federal sales restrictions.
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia; Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia;
authors.forename: Maroya Spalding
authors.initials: MS
authors.lastname: Walters
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia;
authors.forename: Latoya
authors.initials: L
authors.lastname: Simmons
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia; Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia;
authors.forename: Tara C
authors.initials: TC
authors.lastname: Anderson
authors.affiliation: Florida Department of Health, Jacksonville, Florida;
authors.forename: Jamie
authors.initials: J
authors.lastname: DeMent
authors.affiliation: Florida Department of Health, Jacksonville, Florida;
authors.forename: Kathleen
authors.initials: K
authors.lastname: Van Zile
authors.affiliation: Florida Department of Health, Jacksonville, Florida;
authors.forename: Laura P
authors.initials: LP
authors.lastname: Matthias
authors.affiliation: Florida Department of Health, Jacksonville, Florida;
authors.forename: Sonia
authors.initials: S
authors.lastname: Etheridge
authors.affiliation: Florida Department of Health, Jacksonville, Florida;
authors.forename: Ronald
authors.initials: R
authors.lastname: Baker
authors.affiliation: Florida Department of Health, Jacksonville, Florida;
authors.forename: Cheryl
authors.initials: C
authors.lastname: Healan
authors.affiliation: Los Angeles County Department of Health, Los Angeles, California;
authors.forename: Rita
authors.initials: R
authors.lastname: Bagby
authors.affiliation: Los Angeles County Department of Health, Los Angeles, California;
authors.forename: Roshan
authors.initials: R
authors.lastname: Reporter
authors.affiliation: California Department of Public Health, Gardena, California;
authors.forename: Akiko
authors.initials: A
authors.lastname: Kimura
authors.affiliation: New York City Department of Health and Mental Hygiene, New York, New York;
authors.forename: Cassandra
authors.initials: C
authors.lastname: Harrison
authors.affiliation: New York State Health Department, Albany, New York;
authors.forename: Kadri
authors.initials: K
authors.lastname: Ajileye
authors.affiliation: Texas Department of State Health Services, Austin, Texas;
authors.forename: Julie
authors.initials: J
authors.lastname: Borders
authors.affiliation: Maryland Department of Health and Mental Hygiene, Baltimore, Maryland;
authors.forename: Kia
authors.initials: K
authors.lastname: Crocker
authors.affiliation: Pennsylvania Department of Health, Reading, Pennsylvania;
authors.forename: Aaron
authors.initials: A
authors.lastname: Smee
authors.affiliation: New Mexico Department of Health, Albuquerque, New Mexico.
authors.forename: Meg
authors.initials: M
authors.lastname: Adams-Cameron
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia;
authors.forename: Lavin A
authors.initials: LA
authors.lastname: Joseph
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia;
authors.forename: Beth
authors.initials: B
authors.lastname: Tolar
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia;
authors.forename: Eija
authors.initials: E
authors.lastname: Trees
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia;
authors.forename: Ashley
authors.initials: A
authors.lastname: Sabol
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia;
authors.forename: Nancy
authors.initials: N
authors.lastname: Garrett
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia;
authors.forename: Cheryl
authors.initials: C
authors.lastname: Bopp
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia;
authors.forename: Stacey
authors.initials: S
authors.lastname: Bosch
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia; CBartonBehravesh@cdc.gov.
authors.forename: Casey Barton
authors.initials: CB
authors.lastname: Behravesh
mesh_terms: 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; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011634:Public Health; D012475:Salmonella / Q000302:isolation & purification*; D012480:Salmonella Infections / Q000453:epidemiology*; D014426:Turtles; D014481:United States / Q000453:epidemiology; D055815:Young Adult