Published online October 19, 2009
PEDIATRICS Vol. 124 No. 5 November 2009, pp. 1388-1394 (doi:10.1542/peds.2009-0272)

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ARTICLE

Multistate Outbreak of Salmonella Infections Associated With Small Turtle Exposure, 2007–2008

Julie R. Harris, PhD^a,b, David Bergmire-Sweat, MPH^c, Julie H. Schlegel, MSP^d, Kim A. Winpisinger, MS^e, Rachel F. Klos, DVM^f, Christopher Perry, BS^a,g, Robert V. Tauxe, MD^a and Mark J. Sotir, PhD^a

^a Centers for Disease Control and Prevention, Atlanta, Georgia
^b Epidemic Intelligence Service, Office of Workforce and Career Development, Atlanta, Georgia
^c North Carolina Division of Public Health, Raleigh, North Carolina
^d South Carolina Department of Health and Environmental Control, Columbia, South Carolina
^e Ohio Department of Health, Columbus, Ohio
^f Bureau of Communicable Diseases, Wisconsin Division of Public Health, Madison, Wisconsin
^g Children's Healthcare of Atlanta, Atlanta, Georgia

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.

PATIENTS AND 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.

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Key Words: Salmonella • turtles • children

Abbreviations: FDA—US Food and Drug Administration • NCDPH—North Carolina Division of Public Health • PFGE—pulsed-field gel electrophoresis • CDC–Centers for Disease Control and Prevention • mOR—matched odds ratio • CI—confidence interval

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Accepted Jun 4, 2009.

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