Deja vu all over again: Turtles and Salmonella
You'd think, after countless outbreak of salmonellosis associated with pet turtles, that people would learn and things would start to improve. I guess not. A paper published this week in Pediatrics (Harris et al) described a large outbreak of Salmonella Java associated with pet turtles. Between May 2007 and January 2008, 107 infections were identified. The median age (the age in the middle of the range of affected people) was seven years old. Sixty percent of infected people reported exposure to turtles during the week before they got sick; 87% were small (<4 inch) turtles, and 34% were purchased at a retail store (despite the fact that the sale of turtles less than 4 inches long is banned in the US). Five infected people, all less than 10 years of age, reported kissing the turtle or putting it in their mouths.
When they compared people with Salmonella Java infection to people without the infection, 72% of people with Salmonella reported contact with turtles versus only 4% of controls.
Salmonella is far from rare but it's nothing to ignore. Thirty-three percent of infected people were hospitalized. Fortunately, no one died.
The link between turtles and Salmonella has been known for a long time. Healthy turtles can carry the Salmonella bacterium and be a source of infection, particularly for children. The sale of small turtles is banned in the US to reduce the likelihood of close contact between turtles and kids, but this law is widely flouted. An understanding of the link between turtles and Salmonella is surprisingly uncommon - only 32% of Salmonella patients in this study (and 28% of controls) reporting knowledge of this link. Clearly, there are a lot of areas which could be improved.
- If banning the sale of small turtles is truly an effective measure, then it should be enforced. "Black market' turtles are far too easy to find.
- More public education is needed, among the general population and particularly people buying turtles. You shouldn't be able to take a turtle home from a store without an information sheet about the risk of Salmonella and how to avoid it.
- People with turtles (or any reptile) need to recognize the risk and act appropriately. Good general infection control and hygiene measures are needed to reduce the risk of Salmonella exposure.
- Households with children under five years of age, or with immunocompromised individuals should not have pet turtles.
- Antibiotics are not the solution. Attempts to create Salmonella-free turtles with drugs have just led to the production of turtles carrying antibiotic-resistant Salmonella.
- Common sense needs to be a little more common. The picture above (from http://www.familylovezone.com/js_DeepAndWide.htm) was proudly posted by a parent.
More information about infectious disease risks associated with turtles can be found on the Worms & Germs Resources page.
Salmonella Apapa from a reptile
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A recent case report in the Journal of Clinical Microbiology (Cooke et al. 2009) described isolation of Salmonella Apapa from the feces of a 67-year-old woman with abdominal pain. The patient had a history of various medical disorders but no clear evidence of a compromised immune system. She was hospitalized, and Salmonella Apapa was identified from a stool sample collected the day after admission. Fortunately, her abdominal disease resolved (whether it was caused by Salmonella or whether Salmonella was an incidental finding can't be stated definitively), and she was ultimately discharged from the hospital.
Salmonella diagnoses usually lead quickly to questions about food and reptiles. In this case, the woman's son had recently moved in with her, along with his two bearded dragons. The lizards were kept in a tank, and the woman reported having no direct contact with them. Samples from the lizards' feces and the tank environment were collected, and the same Salmonella strain was isolated. While getting Salmonella from a reptile is certainly nothing new, this case report highlights some important points.
- The person that was infected did not report any contact with the reptiles or their tank. Therefore, some type of indirect exposure must have occurred. This is why reptiles should not be kept in high-risk households even if the high-risk people don't have direct contact with them. High-risk households include households with young children (less than 5 years of age), elderly individuals, pregnant women and immunocompromised individuals.
- It's not just high-risk people that get sick. This person was perhaps on the crux of being considered high-risk based on her age and previous medical problems, but she was certainly not a clear example of the people we assume are at higher risk. A huge number of reptile-asociated cases of salmonellosis are reported every year. While high-risk people are more likely to get sick (and more likely to develop severe illness), healthy individuals can be infected as well.
Reptiles can make good pets. I used to have a pair of Red-Footed tortoises, so I'm certainly not anti-reptile (despite what the emails I typically get after posts like this say). People who have or who are comtemplating getting a reptile for a pet need to be aware of the associated risks, as they are certainly real and should be taken seriously.
More about turtles and Salmonella
In response to recent posts about Salmonella and turtles, a reader posed these questions:
Okay, so turtles and tortoises can carry salmonella. Does that mean that all do?
- Not all, but a lot of them do. Aquatic turtles are probably a greater risk than tortoises.
If a vet analyzes a poop sample from my Russian Tortoise and there is no Salmonella, does that mean we can quit worrying about it?
- Unfortunately no. We can never be confident in declaring a reptile "Salmonella-free." Salmonella can be shed intermittently, so a single negative sample doesn't mean the reptile is truly negative. We don't know what the optimal testing protocol is in terms of what to sample, how often to do it and how many samples are needed. I'd never tell anyone a turtle or tortoise is Salmonella-free. To err on the side of caution, we have to assume that all reptiles are carrying Salmonella.
Conversely, if the poop does show Salmonella, is there any way to eliminate it from the tortoise and then quit worrying about it? Our tortoise is isolated from other pets and only eats what we consider clean, fresh produce - so I am hoping the chance of reinfection would be minimal.
- Unfortunately, no again. There's no proven way of eliminating Salmonella from a reptile. Getting rid of Salmonella in an animal that is a carrier is different than treating a typical bacterial infection. Salmonella is a commensal bacterium in reptiles, meaning it can be a normal component of the animal's bacterial microflora. It is very difficult to eliminate commensal bacteria since they have evolved to survive in (or on) their host. Unlike in clinical infections, which tend to be short term infections of a site where the bacterium does not normally live, using antibiotics to eliminate Salmonella carriage is unlikely to be successful. Giving antibiotics can also upset the normal intestinal bacterial population, which can actually make it more likely for bacteria like Salmonella to proliferate. Salmonella can also live inside intestinal cells, where most antibiotics can't reach them. Treatment, therefore, is unlikely to be ineffective, and might just result in increased antibiotic resistance (something we certainly want to avoid).
Check out the Worms & Germs Resources page for more information.
Black market turtles in Baltimore
There is apparently a thriving black market for baby red-eared slider turtles in Baltimore. The sale (and possession) of small turtles is illegal in Maryland, like many other regions, largely because of public health concerns regarding Salmonella.
Over 100 hatchling turtles have been seized in the past 2 weeks. Baby turtles offer a good profit margin for black market vendors. They can be purchased from farms in the southern US for about $1 each and then resold for many times that amount. One person was caught selling turtles out of the back of a van. (Why anyone would buy anything from someone selling out of the back of a van is beyond me!)
People buy turtles thinking they make cute pets, not realizing what they need to do to keep them healthy as they grow. Turtles that are fortunate enough to be raised properly create another problem, since most people are not willing or able to take care of adult turtles that reach 10-12 inches in length. This can result in turtles being killed or abandoned.
Another major problem in the risk of Salmonella. Turtles very commonly carry this potentially harmful bacterium, and they are an important source of infection in people. The concerns are greatest with young children who may handle small turtles and put them in their mouths. People need to think before they buy. Before getting any pet, learn about the animal, including requirements for care and human health risks (and also if it's legal). A little common sense goes a long way.
More information about Salmonella and turtles can be found on the Worms & Germs Resources page.
Exotic animals in daycares... another bad idea
One more post about illogical and dangerous activities associated with animals and young children and I'll hopefully get off the subject for awhile. I came across this daycare's website today. Keep in mind (again) that the the Centers for Disease Control and Prevention (CDC) recommends that children less than 5 years of age not have contact with reptiles, and that the Compendium of Measures to Prevent Disease Associated with Animals in Public Settings published by the National Association of State Public Health Veterinarians states that wild or exotic animals may not be appropriate in school settings. The photo gallery from this particular daycare included some great pictures of things that you should NOT do with young children. Some of the more striking example are below:
1) Letting a large snake wrap its body around the neck of a young child.
2) Letting a young child kiss a snake.
3) Letting a child touch a turtle.
4) Letting a young child pet a pygmy hedgehog. (Like reptiles, hedgehogs very often carry infectious pathogens, including Salmonella.)
I wonder...
- whether anyone made sure these children immediately washed their hands after they touched the animals.
- how may kids but their hands in their mouths before they washed their hands. (Probably almost all of them, considering the "animal visit" probably went on for quite a while.)
- whether this activity took place in the same area where the children later ate lunch or a snack.
- whether the parents knew that this was going to happen.
I'm not against young children having contact with animals. I think pet contact can be very rewarding for young children. However, these individuals are at higher risk for infection and it is our responsibility to protect them. Putting them in high risk situations like these is inappropriate. Animal visitation in daycares is not necessarily a bad thing, if it involves animals that are a low risk species (e.g. dogs and cats), that are healthy, and that have been temperament tested (to show they are at low likelihood of biting). It is also important that parents provide consent for their children to participate, that good hygiene practices are used (and enforced), and that the people bringing in the animals know what they are doing.
CDC recommendations for people with HIV
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The latest edition of the Centers for Disease Control and Prevention (CDC)'s publication Morbidity and Mortality Weekly Reports consists of the revised Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents.
Among the highlights relevant to pets:
- HIV-infected patients should be advised to wash their hands after handling pets or other animals.
- They should avoid direct contact with diarrhea or any stool from pets, particularly stray pets or dogs and cats less then six months of age.
- Gloves should be worn when handling stool or cleaning areas that might have been contaminated with stool from pets.
- Contact with calves or lambs (e.g. on farms or at petting zoos) should be limited or avoided. Attention should be paid to hygiene and avoiding direct contact with animal manure when visiting such premises.
- Contact with reptiles, chicks and ducklings should be avoided because of the risk of Salmonella.
So, nothing earth-shattering or nothing we and others have not been saying all along. That's because basic measures, while not flashy, are the most useful tools. Use common sense, avoid contact with stool and high risk animals, and above all wash your hands.
Stupid things done with snakes
A Las Vegas woman reportedly agreed to babysit a friend's pet python. She brought the 18-foot snake into her house, where her three-year-old son also lived. Bad move, for many reasons. At one point, the woman returned from the bathroom to find the snake wrapped around her son, who was turning blue. The mother stabbed the snake 17 times before it released the child.
Large snakes can be dangerous, particularly to young children. Without proper (escape proof) enclosures and people who know how to handle them (and some common sense), there is a real risk of injury or death, as was clearly demonstrated here. Also, reptiles of all kinds (including snakes) are prime sources of Salmonella infection. Allowing reptiles to roam the house and/or have direct or indirect contact with young children is an unnecessary risk. Various groups have stated that reptiles are not appropriate pets for children less than five years of age, nor for people with weakened immune systems, primarily because of the risks of Salmonella.
Hopefully the child in this terrifying case is alright, although he was also bitten, which can lead to complications of its own. The snake had to be euthanized because of the stab wounds. So, we have an injured child and a dead snake resulting from the stupidity of a couple of adults who didn't apparently see a problem with leaving a large predatory carnivore free in the same location as a prey-sized child. Authorities are still deciding whether to charge the mother with child endangerment.
Salmonella and turtles info sheet
BarfBlog is a food safety blog run by Dr. Doug Powell, who used to be at the University of Guelph, before moving to Kansas State. (I played hockey with him and can confidently state that he is one of the better hockey goalies working in food safety in Kansas). Doug and his group have put together numerous useful, and often entertaining, fact sheets about food safety issues, as well as some related infectious disease and infection control topics. One of those is about Salmonella in pet turtles, something we've discussed on Worms&Germs periodically. The info sheet, and associated commentary from Ben Chapman, can be found here.
Bathing iguanas - Good ideas done in a bad way
A recent report in the Daily Gleaner discusses the book Iguanas for Dummies. In this book, the author recommends frequent bathing of iguanas because they normally soak in the wild. Bathing iguanas in the tub is also recommended on various websites. Letting iguanas soak in water is a good recommendation for their health, but there are good ways to do this and bad ways to do this. Soaking them in a bathtub (or sink) is a bad idea.
The Daily Gleaner article points out that bathing iguanas in bathtubs when there are children or immunocompromised people in the house is a bad idea, and that a separate bathtub should be used. I'm glad to see the risks of infectious disease to immunocompromised people are considered, however I'd take it a step further.
- Reptiles are high risk pets in terms of Salmonella infection. There is a disproportionate rate of Salmonella infections in people that have contact with reptiles, not just immunocompromised people. Fatal infections are rare, but do occur. People that own reptiles need to be aware of this and take practical measures to reduce these risks.
- Iguanas should never be bathed in the bathtub, regardless who lives in the house.
- Iguana cages should be of adequate size and design so that they can soak in their own enclosure. Otherwise, a container (e.g. a large plastic storage bin) that is only used for bathing the iguana should be used. Waste water should not be dumped in kitchen or bathroom sinks. The container should be disinfected regularly. Hands should be washed immediately after handling the iguana, the container or the waste water.
- Households with immunocompromised people or young children should probably not have iguanas.
More information that is applicable to iguanas can be found in the Turtle information sheets on the Womrs & Germs Resources page. There are also sheets with more information on Salmonella.
Pets and immunocompromised people
There was an interesting article in USA Today about the increasing recognition of the positive role that pets can play in patients recovering from serious disease, and how contact with pets can sometimes conflict with disease transmission concerns in these same patients. The attitude towards pet ownership among physicians is highly variable - some recognize the strong human-animal bond and its positive effects, while others see pets as unnecessary infectious disease risks. The infectious disease concerns are heightened in patients with compromised immune systems, to the point that sometimes people are told to get rid of their pets if they are severely immunocompromised. However, more and more pet owners, veterinarians and physicians are beginning to question if this is truly the best approach.
The USA Today article describes the experiences of a cancer patient whose greyhounds were "banished to a caregiver on doctors’ orders". Considering she was at high risk for (potentially fatal) infectious disease because of chemotherapy, bone marrow transplant, stem cell transplant and immunosuppressive drugs, it’s not surprising that there was concern about the pets. After researching the risks, and measures she could take to reduce those risks, the patient convinced her doctors that the risks from her dogs were not as great as the benefits from having them around, and so the dogs returned home. While everyone’s relationship with their pets is different, the patient felt that the return of her dogs was an important step in her recovery, stating "There's no question that having (the dogs) with me these past few months made a huge difference in my recovery".
Infectious disease transmission from pets to people is certainly a real issue, and it is of particular concern in people with weakened immune systems. There is not, nor will there ever be, a "no-risk" pet. Every contact with a pet, just like every contact with another person, carries with it some degree of risk of disease transmission. What needs to be considered is the trade-off, the risks versus the benefits. In some people, the risks are greater than the benefits because of the severity of disease, type of pet, the person's ability (or more likely inability) to interact with the pet. In other people, especially those who have a very strong bond with the animal, the positive social and emotional benefits of pet ownership may greatly outweigh the associated disease risks. The article contains a great quote from Dr. Ray Pais, a pediatric hematology/oncology specialist, saying "Our young patients have already given up so much, I see no reason at that moment for them to also lose the dog."
People that have compromised immune systems need to have a serious discussion with their physician, veterinarian and family about the best thing to do with their pets while they are sick. While there is very little research in this area, taking a few common sense precautions should reduce the risks of disease transmission. These include:
- Avoiding contact with stool
- Frequent handwashing
- Preventing licking of the person by the pet
- Proper training to reduce the risk of bites and scratches
- Keeping cats indoors
- Following a good preventive medicine program for the pet
More information about Immunocompromised Pet Owners will be available soon on the Worms & Germs Resources page. The CDC also has useful information on its website about this topic.
Thanks to Dr. Doug Powell of Barfblog for forwarding this article.
Nontraditional Pets and Children: Beware
A report about the health risks in children associated with nontraditional pets was recently published in Pediatrics, the official journal of the American Academy of Pediatrics. The report also discusses diseases associated with animals in public settings such as petting zoos and pet stores. Although contact with pets and animals can be beneficial to growth and development in children, it is very important to be aware of the risks associated with certain kinds of animals. Physicians, veterinarians and public health personnel can help parents select appropriate pets in order to maximize the benefits while minimizing the risks to children.
One of the most important pathogens discussed in the report is Salmonella. Although Salmonella can be transmitted by many animal species, including traditional pets like dogs and cats, it is a particularly high risk with certain other kinds of pets, including reptiles, amphibians and baby poultry (chicks and ducklings). It has been estimated that direct or indirect contact with reptiles or amphibians is responsible for 6% of all sporadic Salmonella infections in the US, and 11% of cases among people younger than 21 years. There is also a relatively high risk of Salmonella transmission associated with animal-derived pet treats, such as pig ears, and raw meat.
The report makes several recommendations about how to reduce the risk of infection, injury and allergies from nontraditional pets, many of which you may have seen before on the Worms & Germs website. Just a few of these are:
- Always wash your hands after contact with animals, animal products or their environment, and after contact with animal-derived pet treats.
- Supervise hand washing for children less than five years old
Children less than five years of age and individuals with weakened immune systems should avoid contact with reptiles, amphibians, rodents, ferrets and baby poultry. These animals:
- Should not be kept as pets in households where children less than five years of age or individuals with a weakened immune system live.
- Should not be brought to childcare centres.
- Should not be allowed to roam freely in ANY house or living area.
- Should not be permitted in kitchens or anywhere food is prepared.
More information about Salmonella in pets and the risks associated with feeding raw meat and animal-derived treats to pets can now be found on the Worms & Germs Resources page.
Your mother was right! Wash your hands
You may notice a recurring theme in many of our posts and on virtually all of the information sheets on the Worms & Germs Resources page: an emphasis on handwashing. There is increasing emphasis on hand hygiene (i.e. hand washing and use of alcohol hand sanitizers) education in hospitals because the hands of healthcare workers are a major (if not the most important) means of disease transmission between patients. Despite hand hygiene being easy, cheap and effective, people rarely wash their hands as often as they should, and they often don't do it properly.
Most of the research about hand hygiene that has been published has focused on its use and impact in human hospitals, but this area is now also being studied more with regard to animals and veterinary medicine. A study published earlier this year in Veterinary Microbiology provided more evidence that hand hygiene is a critical infection control measure when dealing with animals. The study, coordinated by Dr. Maureen Anderson (of Worms&Germs fame) looked at MRSA carriage rate in veterinarians who work with horses. In addition to finding a high rate of MRSA carriage among these veterinarians (which was consistent with other reports indicating that equine vets are at higher than average risk for exposure to MRSA), the study looked at factors associated with MRSA carriage. Vets that reported routinely washing their hands between farms and those that reported washing their hands after contact with potentially infectious cases had a significantly lower rate of MRSA carriage. That should come as absolutely no surprise, but it's one more piece of evidence that we need to pay more attention to this routine infection control measure, in human hospitals, in veterinary environments and in households.
Remember, the 10 most important sources of infection are the fingers on your hands!
Click here for instructions on how to wash your hands properly.
Salmonella outbreak linked to turtles
Yet another reminder of the risks associated with handling turtles (and other reptiles) comes to us from a report published earlier this year regarding an outbreak of salmonellosis in people tied to contact with turtles. In this case, more than 100 people in 33 US states were affected. The report sparked additional public education efforts in Los Angeles county, CA, where eight of the cases occurred.
The report comes as no surprise - turtles are actually relatively commonly implicated in cases of salmonellosis in people (although still not nearly as commonly as foodborne transmission). It's particularly a concern in children, because kids may have close contact with pet turtles and may be more susceptible to serious infection.
In response to the cases in Los Angeles, the county Department of Public Health emphasized that parents must be wary of buying turtles for their children. Even though the sale of small turtles (less than 4 inches long) was banned in the US over 30 years ago, unfortunately these animals are still widely available in many pet stores, flea markets, and from other sources. Los Angeles Public Health personnel reported that children were getting sick because they were kissing their pet turtles - something that is very risky and should never be done by anyone, especially children. If people have pet turtles, they must be very diligent to practice good hygiene to reduce the risk of transmission of Salmonella.
More information about the risks associated with pet turtles, and measures that should be taken by people who own turtles, is available on the Worms & Germs Resources page.
Snakes, mice and Salmonella: a bad classroom combination
Reptiles are common pets, and the risk of transmission of Salmonella from reptiles is fairly well known. Most of the attention regarding Salmonella in these cases involves direct contact with reptiles, especially turtles. However, both direct and indirect contact with other reptiles also carry risk, as can contact with other animals. A recent report about a 2005/2006 outbreak of salmonellosis in 4 people from Minnesota highlights this:
- Three affected people were from the same junior high classroom, which contained pet snakes.
- Two of the people reported contact with the snakes, and one other student from the school did not handle the snakes but was often in the classroom, while the fourth infected student had a sibling in the class.
- The same Salmonella Typhimurium strain was found in the classroom snakes, various classroom surfaces and vacuum-packed rodents that were purchased over the internet and fed to the snakes.
- Presumably, the snakes became infected from the rodents, and the students became infected from handling the snakes, or from touching contaminated surfaces in the classroom (they reportedly had no contact with the rodents).
A broader US investigation identified 7 other people infected with the same Salmonella strain from handling vacuum-packed rodents. The outbreak was eventually traced back to the (unlicensed) rodent supply facility.
Pets can be educational and entertaining in classrooms, however some pets are better than others. Educational value, ability to properly (and humanely) care for the pet, and classroom safety need to be considered when determining what pet might be appropriate. Careful consideration of measures to reduce the risk of disease transmission is required. The teacher in this case reported that he did not know snakes could carry Salmonella, that he did not wash his hands after cleaning the cage, and that he did not tell students to wash their hands after touching the snake, so it is clear that there was inadequate consideration to these issues.
This case report also highlights the potential risks of reptile ownership in households. Reptiles are high risk for Salmonella, and not appropriate for all households. Good hygiene should be used when handling reptiles, their environment and their food. More information about reptiles can be found in the Turtles information sheet on the Worms & Germs Resources page.
Image: Corn Snake (Pantherophis guttatus) by Mike Wesemann
Exposure to animal blood
In people, there are detailed protocols for avoiding blood exposure in healthcare situations, and protocols for managing people exposed to human blood in hospitals and in the community. This is mainly driven by concerns about HIV and hepatitis viruses that can be transmitted by contact with blood. But these viruses are not present in animals, and the risks of transmission of disease from pets to people through blood are very low. Even contact with blood from a rabid animal is not considered rabies exposure, because the virus is found in the saliva, not the blood. This has led to a rather cavalier approach towards blood exposure in veterinary medicine, which is understandable but not ideal. New infectious diseases continue to emerge in animals and people, and eventually there is likely to be one that can be transmitted between species by blood. Therefore, it is prudent to try to reduce exposure to animal blood when possible, but without getting overly concerned (or paranoid).- Direct contact with animal blood should be avoided whenever possible.
- In particular, avoid getting animal blood on any cuts, scrapes or other broken skin, and avoid getting the blood in your mouth, nose or eyes.
- If you do get animal blood on your skin, wash it off as soon as possible.
- While it is extremely unlikely for a person to get sick from touching animal blood, make sure you tell your physician about the incident if you do become ill.
Reptile shows....wash your hands!!
Petting zoos and similar animal contact events carry an inherent risk of infectious disease transmission. Outbreaks of various infectious diseases have been reported, mainly associated with farm animals. Reptiles are a particular concern because they can have high rates of Salmonella carriage. Terrestrial reptiles like bearded dragons and pythons are lower risk than species like aquatic turtles, but these animals can still be the source of salmonellosis in humans. Petting zoos can be entertaining and educational, and fairly safe if run properly. However, deficiencies are often present. At this facility, there were multiple hand hygiene stations, consisting of alcohol-based hand sanitizers, which are very effective. Food and drink were banned in the area and there were staff supervising all animal contacts. These are all good things, however the best measures are useless if they are not used or enforced. While I made sure that my family carefully cleaned their hands, we were definitely in the minority. The hand hygiene stations were not particularly easy to access and there was't one present at the exit, so if you weren't looking for it you would probably just leave. Further, despite the signs, staff allowed people to eat and drink in the area where they were handling reptiles. Allowing people to eat and drink, and not providing easy access to the hand sanitizers (two pretty basic measures) were major problems and greatly increase the risk of disease transmission.
I'm not suggesting we should avoid petting zoos. My kids enjoy them and we will surely attend a few this summer. The key with animal contact exhibits is common sense....avoid high risk animals, keep you hands out of your mouth and wash your hands thoroughly when leaving (even if you didn't touch an animal since you probably touched other surfaces). Some animal species are particularly high risk, including young poultry and young ruminants (e.g. calves, lambs, goats). Reptiles fit into this high risk group, which is why I had more concern about this event than a standard petting zoo. People with compromised immune systems should avoid animal contact, particularly with calves, chicks, lambs and reptiles.
And above all, WASH YOUR HANDS.
A good source of information about animal contact events and infectious diseases is available from the National Association of State Public Health Veterinarians.
Pet turtles and Salmonella...When will we learn?
A report in the Centers for Disease Control and Prevention (CDC)'s journal MMWR described a multistate outbreak of human salmonellosis caused by contact with pet turtles. Officials investigated 103 cases of disease cause by a specific type of the Salmonella bacterium. Contact with turtles was identified as an important risk factor for disease. Sixty-three percent (63%) of people infected by this strain of Salmonella reported contact with turtles in the week before getting sick, compared to only 4% of others. Many people that became ill reported having touched a turtle. Some even reported kissing a turtle (don't ask me why... I'm not making this up). Salmonella was cultured from turtles or their aquariums in some households. No fatalities were reported but some people were seriously ill and required hospitalization.
The association between turtles and Salmonella is nothing new. Upwards of 90% of healthy turtles may carry Salmonella bacteria. Antibiotic treatment is not effective at eliminating Salmonella carriage and there is no way to declare a turtle 'Salmonella-free'. People can become 
infected through direct contact with turtles or their environment. Sale of turtles with a shell length of less than 4 inches was banned in the US over 30 years ago. This was because of the strong association between turtles and salmonellosis, particularly in children. Small turtles are more likely to be handled by children and put in their mouths.This measure has been estimated to have prevented 100 000 infections every year, however it is clear that (illegal) small turtles can still be readily purchased from pet stores or other sources. Turtles were less than 4 inches long in 86% of cases in this report where turtle size was reported.
While turtles can be fascinating, they are definitely a high-risk pet. I used to have turtles but wouldn't consider it now that I have young children. There are much better and safer pets for children. They should be avoided by households with children or people whose immune systems may be compromised. People who have pet turtles need to take precautions to reduce the risk of infection, but it cannot be completely eliminated.
More information about turtles can be found in our
section.
Information Sheets for Pet Owners
INFORMATION SHEETS specifically for KIDS, for VETERINARIANS, for PHYSICIANS and for PUBLIC HEALTH PERSONNEL are also available on the Worms & Germs RESOURCES page!
Click on the highlighted topics below for information sheets. Topics that are not highlighted are in development and coming soon. Sheets for other animal species and diseases are also under development and will be added when they are available.
| Animals | Diseases | Other |
| Dogs | Rabies | Litter Boxes |
| Cats | Giardia | Sandboxes |
| Turtles | Toxoplasma | Cat Bites |
| Hamsters | Leptospira | Raw Meat |
| Rabbits | Clostridium difficile | Petting Zoos |
| Pet Birds | Cryptosporidium | Needlestick Injuries |
| Reptiles | MRSA | |
| MRSP | ||
| Salmonella | ||
| Ringworm | ||
| Campylobacter | ||
| Bartonella henselae | ||
Please Remember:
- Your veterinarian and physician are your ultimate resource for information about the health of your pets or your family.
- Information provided here is accurate to the best of our knowledge, but infectious diseases can be unpredictable and these sheets are for general information purposes only.
- There can be great variation in disease risks in different geographic areas. The information provided was developed for Ontario, Canada, but most of the information is relevant for other regions as well.
