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October 9, 2015 (Investigation Announcement) Two Multistate Outbreaks of Human Salmonella Infections Linked to Small Turtles

CDC collaborated with public health, veterinary, agriculture, and wildlife officials in many states and with the U.S. Food and Drug Administration (FDA) Center for Veterinary Medicine to investigate two multistate outbreaks of human Salmonella infections. Results from these investigations indicated that contact with small turtles or their environment were the likely source of these outbreaks.

Contact with reptiles (such as turtles, snakes, and lizards) can be a source of human Salmonella infections. Reptiles can carry Salmonella germs and still appear healthy and clean. Salmonella germs are shed in reptile feces (poop) and can easily contaminate their bodies and anything in areas where these animals live. Reptiles that live in tanks or aquariums can contaminate the water with germs, which can spread to people. 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 FDA banned the sale and distribution of these turtles in 1975.

Public health investigators used the PulseNet system to identify illnesses that may be part of these outbreaks. PulseNet is the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC. DNA "fingerprinting" is performed on Salmonella bacteria isolated from ill people by using a technique called pulsed-field gel electrophoresis, or PFGE. PulseNet manages a national database of these DNA fingerprints to identify possible outbreaks. A total of two DNA fingerprints (outbreak strains) were included in these outbreak investigations.

Investigation of the Outbreaks

A total of 51 people infected with the outbreak strains of Salmonella were reported from 16 states between January 22, 2015 and September 8, 2015. In interviews, ill people answered questions about contact with animals during the week before becoming ill; 20 (59%) of the 34 people interviewed who were ill with one of the outbreak strains reported contact with small turtles or their environments, such as water from a turtle habitat, before becoming ill.  Sixteen (80%) of the 20 ill people who had contact with small turtles reported purchasing the turtle from a street vendor or receiving the turtle as a gift.

The National Antimicrobial Resistance Monitoring System (NARMS) is a U.S. public health surveillance system that tracks antibiotic resistance in foodborne and other enteric bacteria found in people, raw meat and poultry, and food-producing animals. NARMS is a partnership among the CDC, the U.S. Food and Drug Administration (FDA), the U.S. Department of Agriculture (USDA), and state and local health departments.

The NARMS human surveillance program at CDC monitors antibiotic resistance in Salmonella and other bacteria isolated from clinical specimens submitted to NARMS by public health laboratories. CDC's NARMS laboratory conducted antibiotic resistance testing on clinical 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.

Summaries of the two outbreak investigations are provided below.

Outbreak 1: Salmonella Sandiego Investigation

Eleven people infected with the outbreak strain of Salmonella Sandiego were reported from six states. The number of ill people identified in each state was as follows: California (4), Illinois (3), Mississippi (1), South Carolina (1), Texas (1), and Vermont (1).

Among people who reported the date they became ill, illnesses began between January 22, 2015 and August 18, 2015. Ill people ranged in age from younger than one year to 77 years, with a median age of 12. Seventy-three percent of ill people were female. Among the nine ill people with available information, four (44%) were hospitalized. No deaths were reported.

Outbreak 2: Salmonella Poona Investigation

Forty people infected with the outbreak strain of Salmonella Poona were reported from 13 states. The number of ill people identified in each state was as follows: Arizona (1), California (15), Illinois (2), Kansas (1), Missouri (1), Nevada (1), New Jersey (2), New York (5), North Carolina (1), Ohio (1), Oregon (1), Pennsylvania (3), and Texas (6).

Among the people who reported the date they became ill, illnesses began between April 16, 2015 and September 8, 2015. Ill people ranged in age from younger than one year to 82 years, with a median age of 4. Fifty-three percent of ill people were male. Among the 25 ill people with available information, 11 (44%) were hospitalized. No deaths were reported.