Published online October 19, 2009
PEDIATRICS (doi:10.1542/peds.2009-0272)

This Article Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Google Scholar Articles by Harris, J. R. Articles by Sotir, M. J. PubMed PubMed Citation Articles by Harris, J. R. Articles by Sotir, M. J. Social Bookmarking                         What's this?

Articles

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, Mark J. Sotir, PhD^a

^aCenters for Disease Control and Prevention, Atlanta, Georgia;
^bEpidemic Intelligence Service, Office of Workforce and Career Development, Atlanta, Georgia;
^cNorth Carolina Division of Public Health, Raleigh, North Carolina;
^dSouth Carolina Department of Health and Environmental Control, Columbia, South Carolina;
^eOhio Department of Health, Columbus, Ohio;
^fBureau of Communicable Diseases, Wisconsin Division of Public Health, Madison, Wisconsin; and
^gChildren'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.

Key Words: Salmonella • turtles • children

Abbreviations: CI, confidence interval

---

Accepted Jun 4, 2009.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				An Outbreak of Turtle-Associated Salmonella Infection Journal Watch Infectious Diseases, December 2, 2009; 2009(1202): 3 - 3. [Full Text]