Notes from the Field: Multistate Outbreak of Human Salmonella Poona Infections Associated with Pet Turtle Exposure — United States, 2014

MMWR Weekly Vol. 64, No. 29 July 31, 2015

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Notes from the Field: Multistate Outbreak of Human Salmonella Poona Infections Associated with Pet Turtle Exposure — United States, 2014

Weekly

July 31, 2015 / 64(29);804

Colin Basler, DVM1, 2; Lyndsay Bottichio, MPH2; Jeffrey Higa, MPH3; Belinda Prado, MPH4; Michael Wong3; Stacey Bosch, DVM2 (Author affiliations at end of text)

In May 2014, a cluster of human Salmonella Poona infections was identified through PulseNet, the national molecular subtyping network for foodborne disease surveillance. Historically, this rare serotype has been identified in multiple Salmonella outbreaks associated with pet turtle exposure and has posed a particular risk to small children (1,2). Although the sale and distribution of small turtles (those with carapace [upper shell] lengths <4 inches [<10.2 cm]) is prohibited by federal law, they are still available for legal purchase online for "bona-fide" scientific, educational, or exhibition purposes, other than use as pets (3). In addition, small turtles are still available for illegal purchase through transient street vendors, at flea markets, and at fairs.

During April 26–September 22, 2014, a total of 40 persons infected with Salmonella Poona pulse-field gel electrophoresis (PFGE) pattern JL6X01.0055 (the outbreak strain) were reported from 12 states. Patients ranged in age from <1 to 75 years (median = 5 years); 16 (40%) patients were aged ≤1 year, and 14 (35%) were female. Among 29 ill persons for whom information about hospitalization was available, eight (28%) were hospitalized; no deaths were reported. Among 28 ill persons who were interviewed, 13 (46%) reported exposure to turtles. Three ill persons reported the size of the turtles, and all identified turtles <4 inches in length. The outbreak strain was isolated from a pet turtle in a California patient's home. Turtles had been obtained from several types of locations, including a carnival and a fair. The transient nature of turtle vendors hampered the traceback investigation. No other common food or animals were identified during the course of the investigation.

This outbreak demonstrates that turtles remain a source for human Salmonella infections, especially for young children. Because 40% of ill persons were infants aged ≤1 year and were unlikely to directly handle pet turtles, the potential role of indirect transmission in turtle-associated salmonellosis outbreaks should be considered. Turtles in the home could lead to environmental contamination with Salmonella bacteria and result in human illness. Educational campaigns directed toward parents of young children, in conjunction with the federal turtle ban, might help to prevent future turtle-associated salmonellosis outbreaks.

1Epidemic Intelligence Service, CDC; 2Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC; 3California Department of Public Health; 4City of Long Beach Department of Health and Human Services, Long Beach, California.

Corresponding author: Colin Basler, cbasler@cdc.gov, 404-639-2214.

References

1. CDC. Eight multistate outbreaks of human Salmonella infections linked to small turtles (final update). Available at http://www.cdc.gov/salmonella/small-turtles-03-12/index.html.
2. CDC. Notes from the field: outbreak of salmonellosis associated with pet turtle exposures—United States, 2011. MMWR Morb Mortal Wkly Rep 2013;62:213.
3. Code of Federal Regulations. Turtles intrastate and interstate requirements, 21 C.F.R. § 1240.62 (2014). Available athttp://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=1240.62.