Worms and Germs Blog : Animal Health & Diseases : University of Guelph : Ontario Veterinary College : Zoonotic Diseases : Guelph, Hamilton, Ontario

I avoided the "snakes on a plane" title, as ever since the (bad) Samuel L. Jackson movie came out, every reptile smuggling headline seems to use use it. Regardless, would you like to be on a long trans-Atlantic flight with 247 smuggled animals, including a collection of venomous vipers? Probably not.

Fortunately for passengers on a flight from Buenos Aires to Madrid in early December, security screeners took note of the "organic substances moving inside" Karel Abelovsky's baggage. Inside, they found over 200 reptiles and mollusks, including 15 venomous vipers. Among these were two yararas (Bothrops jararaca), a viper that can grow up to 160 cm (~5 ft) in length, and which is a common cause of snakebites in some regions. Two of the animals were dead by the time they were found. Probably many (or most) of the others would have died during transit.

Animal smuggling is a big problem for many reasons:

• It's an major animal welfare issue, since it is reasonable to suspect that only a small minority of smuggled animals survive the process, and even fewer thrive in their new homes.
• Smuggling of endangered species can threaten survival of some species in the wild.
• Smuggling of venomous or otherwise dangerous species can put people at risk. This includes people that purposefully buy dangerous animals but can't handle them, people who buy them not knowing they are dangerous, people at various points of the smuggling process (e.g. security screeners) that might come across the animals, and the general public who can be exposed if the animal escapes.
• Moving animals between regions always carries some risk of bringing along infectious diseases. The less control, the greater the risk.

Mr. Abelovsky has been changed with smuggling and faces up to 10 years in prison, but typically people get off with minimal punishment. Weak enforcement and the potentially lucrative nature of smuggling means that it's going to continue until the problem gets taken more seriously, both in terms of investigation and charging of other people in the process (e.g. where did he get the animals, who was he working with, where were they going to go?) and application of penalties that are severe enough to discourage people.

Unfortunately, while an incident like this gets a lot of attention, it just represents the miniscule minority of smugglers that actually get caught.

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Having pets in school classrooms is a somewhat controversial subject. For every good point that's raised (e.g. promoting empathy, entertainment, learning about animals and their care) there are bad points (e.g. poor environment for the pet, rough handing, disorganized or absent medical care, disease transmission, fear, allergies, distraction). Some organizations have developed detailed guidelines for using animals in classrooms, but animals are often in classrooms with little consideration of the issues. Little is known about what happens with these pets. We tried to do a survey of teachers from some school boards a few years ago and only ended up getting about two responses out of hundreds of eligible teacher participants (the overall lack of support from board administration didn't really help get the survey out and get teachers interested either, but that's another story). So, we really don't have a good idea of the types of animal contact that occur in classrooms or the problems that result, but we know from various case reports that complications like infections can and do occur.

PetSmart and the Pet Care Trust have a "Pets in the Classroom" program where kindergarten to grade six teachers can get support for having a pet in the classroom. Their release outlines a few of their perceived benefits, and some of the complexities of having pets in classrooms. Their points are in italics, with some comments from me.

Hamsters make fun classroom pets because they are active and teach children the importance of schedules and responsibilities.

• Yes and no. They can be entertaining, but they can also be distracting. You have to differentiate something that's a novelty from something that is being used as part of the educational curriculum. Hamsters can be injured with rough handling by young children and close supervision is required. They may also bite when handled, especially when handled by young kids who don't know what they are doing. Plans to take care of the hamster over holidays and the summer are needed, and are often not considered in advance. The disease risks of hamsters are relatively low, but not non-existent. Having nocturnal animals in a busy daytime setting is also questionable ethically.

Guinea Pigs are easily handled and encourage children to follow a regimented routine.

• They are similar to hamsters in their benefits and risk, but their larger size makes them more robust and less prone to handling injury. They are probably one of the better mammals to have in a classroom, but still require good organization, planning and practices.

Fish are a great way to illustrate basic chemistry and biology principles while students follow regularly scheduled water changes.

• Fish can be great classroom animals. There are ways to incorporate them into the curriculum, from behaviour to animal care to feeding to water quality and environmental concerns. They need some care, with regular feeding and proper water maintenance, but with basic supervision and planning, the risks to the animals and people are minimal and they can be of benefit educationally.

Bearded Dragons depend on their environment for heating and cooling and are a great way to teach about geography and the environment.

• Bearded dragons (see image) are great little reptiles with a lot of personality. However, they have specific requirements for care and feeding, something that cannot be easily fulfilled in a lot of classrooms. Also, being reptiles, they are high risk for Salmonella shedding. In a low risk household, it's not a big deal with basic hygiene practices. However, in a classroom with lots of kids, perhaps limited enforcement of hygiene, and kids eating in the area where the reptile is, the risks get higher. General guidelines are that children less than five years of age and people with compromised immune systems should not have contact with reptiles. This means they should not be in kindergarten classrooms or rooms where such students may spend time. More complicated is the issue of immunocompromised individuals. I'm not convinced that teachers always know when one of their students is immunocompromised, and what happens if there's an established pet and a student becomes immunocompromised? Bottom line: Reptiles shouldn't be in classrooms.

Leopard Geckos are docile in nature and teach children about different nocturnal behaviors.

• These are interesting little critters, but not good classroom pets, like other reptiles, for the reasons outlined above.  Nocturnal pets may not be great for classrooms either since the daytime activity and disruption may be harmful to them in the long term.

Certain pets can be good additions to certain classrooms, with some logical planning and common sense, but poor planning and bad animal choices can be harmful to students and animals. School boards should be proactive and develop or adopt sound protocols for classroom pets.

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A UK hairdresser is recovering from necrotizing fasciitis (flesh-eating disease) that was linked to his pet turtle. The problem started when he cut his finger while cleaning out the turtle's tank. An infection developed, which isn't too surprising since a turtle terrarium is full of a variety of bacteria. However, instead of a mild, local infection, he developed an aggressive infection that started to spread up his arm. "His finger turned black and his arm became swollen and red." Amputation was discussed, which is not infrequently necessary in cases of such severe infection.

It doesn't sound like there were any cultures taken from the wound at the start, but after the infection didn't respond to the initial course of antibiotics, the man ended up in hospital in IV antibiotics. The infection progressed from his finger to his bloodstream and a bacterium, a Group G Streptococcus, was isolated from his blood.

Here's where more details would be useful. The news article simply says "...and the terrapin, called Cosmo, was identified as the culprit."

It doesn't say how Cosmo was implicated. To make a link, they'd have to find the same bacterium in the turtle's tank. Ideally, beyond just isolating the bug, they'd show that it was the same strain. It's possible this was done, but rarely do people go to that extent, so it's possible that the link was just presumptively made because the initial injury occurred in the tank. The problem with that is Group G strep can also be found in healthy people (10-25% in some studies). Therefore, while he set the scene for the infection in the tank, by breaking his skin, he could have become infected from bacteria already on or in his body. Additionally, other animal sources are possible, such as dogs (since one type of Group G strep is Streptococcus canis). If he cut his finger, then had contact with another animal, it could have been the source.

Most of the attention paid to turtles and infectious disease revolves around Salmonella, and that risk is real. However, turtles, like any other animal (or person), also carry a variety of other potentially harmful bacteria. These usually don't cause problems, but in certain situations, the risk of disease is higher. The skin is a wonderful barrier to infection, and any time it gets broken, there is a risk of disease. 

In general, we recommend a few things when cleaning out an aquarium of any kind (be it for fish, reptiles or amphibians):

• Avoid having sharp objects in the aquarium. If any sharp or rough objects are present, take care to avoid contact with them while cleaning.
• Wear gloves, particularly if you have open wounds or if there are sharp/rough surfaces in the aquarium.
• Wash your hands thoroughly after having contact with aquarium water or contents. If you were wearing gloves, wash your hands after glove removal.
• Avoid contaminating other areas, especially kitchen sinks or counters, with aquarium water.
• If you cut yourself while cleaning out an aquarium, wash out the wound thoroughly as soon as possible.
• If you have a compromised immune system, try to avoid any contact with aquarium water or contents by getting someone else to clean out the tank.

(click image for source)

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When a particular animal species or breed gets a lot of attention, such as through a popular movie or TV show, there's sometimes a major increase in people wanting one as a pet. The proliferation of Dalmatians after 101 Dalmatians, and people buying Jack Russell terriers in response to Eddie from Frasier are only two examples. Sometimes the trend is fine, but it can result in problems when people get breeds or species that really aren't right for them (this was a big problem with the Dalmatians), and with puppy mills pumping out large numbers of poor quality animals to meet the demand. The problems can be even worse when an exotic species is involved.

Concern has been expressed about the potential for this to occur following the success of the animated movie Rango. The movie features a chameleon, a fascinating reptile but also one that is not that easy to properly maintain in captivity and, like all reptiles, carries a risk of Salmonella transmission to household members. 

PETA and some other groups have expressed concern about a PetSmart promotion whereby people can get a $10 discount on reptiles if they bring in a Rango movie ticket stubs. 

Any increase in demand for chameleons resulting from this promotion will be trouble, because:

• Odds are most of the animals will not do well if purchased on a whim by someone who isn't adequately prepared to take care of them.
• Smuggling or legal importation of wild-caught chameleons will probably increase, with the associated very high death rates during the collection and shipping process.
• Chameleons may end up in households where reptiles are not appropriate, such as those with kids under five years of age, elderly individuals, pregnant women or people with compromised immune systems.

Hopefully the concerns are unfounded, but anyone considering purchasing a chameleon needs to carefully research the care requirements, be aware of the risk of disease transmission in the household, and should look for ethically sourced (i.e. captive bred and properly raised) animals.

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A recent press release from The Pet Care Trust reported on the status of its Pets in the Classroom program, which provides support to teachers to have pets in school classrooms. On the surface, it seems like a fine concept, helping to enrich school activities. However, it's one of those ideas that can do a lot of good, or it can also be very bad, depending on how the program is run.The Pet Care Trust has some useful information about pets in classrooms, and anyone considering having a pet in a classroom needs to be aware of a variety of concerns, including:

• Welfare of the pets (e.g. minimizing stress, preventing abuse)
• Adequacy of pet care, particularly during weekends and holidays
• Access to and cost of veterinary care
• Distraction of students
• Allergies
• Fear
• Infectious disease transmission

Given the topic of this blog, I'll focus on the last one.

Infectious disease transmission from pets in classrooms is a real problem. Zoonotic infections can and do occur in these situations. The risks are quite variable, and depending on the animal, children, classroom and pet care, can range from inconsequential to quite serious.

The type of animal is very important. Certain species are very high risk for carrying particular infectious diseases and for transmitting them to people. Reptiles are notorious for Salmonella, so it is recommended that children under five years of age and immunocompromised individuals (among others) not have contact with reptiles. Even with older kids there's a risk, and older kids have picked up Salmonella in classrooms from reptiles or a reptile's food (e.g. frozen rodents).

So, it's concerning that 435 of the 2066 grants handed out by this program were for reptiles, and included kindergarten to Grade 6 classrooms. A lot of reptiles went into classrooms with a lot of young kids. Typically, elementary school children (at least around here) eat in their classrooms, which raises even more concern. While the majority of students would be five years of age or older, immunocompromised kids are not exactly uncommon, and it's unclear whether teachers have adequate knowledge of whether kids in their classes are immunocompromised, nor whether they understand that such children are at increased risk of disease from classroom pets.

I'm not saying pets in classrooms are a bad idea. However, it's often done poorly and with little forethought. To be effective and safe, you need to consider many things, such as:

• What species should it be? From my standpoint, no reptiles or other high-risk species (e.g. baby chicks) should be in any classroom, because you can't guarantee a high-risk person won't be around. The animal needs to be small enough to be properly housed in a classroom. Its care requirements need to be basic and readily met. It shouldn't be a species that gets stressed easily, and it needs to be an animal that can tolerate all the activities that go on around it (e.g. a nocturnal species is probably not a good idea).
• What types of hygiene/infection control practices need to be used around the animal and how will they be enforced?
• What disease or injury (e.g. bite) risks are present and how will they be managed?
• Who will take care of it? This means who will take care of it for its lifespan, not just the upcoming school year.
• Who will arrange and pay for any medical expenses that arise, either for preventive medicine or treatment of disease?
• Will parents be notified?
• What happens if a child in the class is allergic to or afraid of the animal?
• Will proper supervision be available at all times?
• Who from the school or school board must give permission, and is there a standard approval process? (There should be, but there rarely is.)
• Why is the animal going to be there? Will there be any educational use or it is just there for fun/decoration?

If you can answer all these questions adequately, then a pet might be a good fit in the classroom in question. If you can't answer them, or can't be bothered to try to answer them, then there should be no pets in the classroom until you can.

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Here's a comment from a well-meaning but ultimately misinformed reader. I'm commenting on it because these misconceptions are not uncommon.

"This blog post appears to be based on inadequate knowledge of iguanas. I am an iguana keeper and have been for several years.  Unlike many reptiles, iguanas do not carry salmonella on their skin and are not a high salmonella risk.  Furthermore, as long as the bath tub is disinfected afterward, there is generally no problem with iguanas bathing or even defecating in bath tubs shared with humans (although I do understand concerns of those with babies or immunocompromised people)."

Iguanas can and do carry Salmonella on their skin. It mainly resides in their intestinal tract but can easily contaminate their skin. For example, a 10-week study of 12 green iguanas reported that they all shed Salmonella at least once during the course of the study (Burnham et al, J Am Vet Med Assoc 1998). You have to assume that every iguana is carrying Salmonella.

People can and do get Salmonella from iguanas. There are numerous reports of salmonellosis from pet iguanas, including fatal infections. In a study of salmonellosis in people associated with exotic pets, iguanas were the most common source, accounting for over 50% of infections (Woodward et al, J Clin Microbiol 1997) Babies and immunocompromised people are at greatest risk, but infections occur in people outside of these high-risk groups as well.

Disinfection is far from foolproof. Yes, disinfection will kill Salmonella IF (and that's a big if) it's done properly. That includes properly disinfecting all tub surfaces, along with any other areas that were potentially contaminated (e.g. by splashes). This is far from guaranteed to happen in most cases, since people rarely understand what is required for proper disinfection and how to do it.

I'm not saying people should never have iguanas. Some people shouldn't: households with children under five years of age, elderly individuals, pregnant women or immunocompromised individuals. In other households, the risk is lower, but it's still there. An important part of managing the risk is knowing that the risk does exist. Pretending there is no risk doesn't do anyone any good.

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The UK's Health Protection Agency is warning families who own reptiles about the risks of Salmonella, following the diagnosis of salmonellosis in 9 Merseyside children in the past 6 months. All the affected kids had direct or indirect contact with reptiles. Three of them (all less than three years of age) were hospitalized. One of them, an infant who was infected at four weeks of age, is still sick five months later.

Salmonella is commonly found in or on healthy reptiles. All reptiles should be considered Salmonella carriers, and handled accordingly. Standard guidelines are that children under the age of five, along with immunocompromised individuals, the elderly and pregnant women, should avoid contact with reptiles. The reason for this is clearly evident here, with the bacterium having caused serious illness in these young children.

Thinking that you can eliminate the risk in a high-risk household by making sure the high-risk person  never handles the reptile isn't adequate. There are numerous reports of Salmonella infections in people who never had direct contact with the reptile.  Salmonella can be spread from the reptile's enclosure to other parts of the house, resulting in indirect infections. 

Reptiles can make great pets (I used to have tortoises and turtles). However, reptiles are responsible for a large and disproportionate number of Salmonella infections in people, and high-risk households should not have reptiles. People with reptiles need to take basic infection control measures seriously, including:

• Washing hands after contact with reptiles.
• Never cleaning aquaria or terrariums in kitchen or bathroom sinks.
• Never bathing or soaking reptiles in the bathtub, or kitchen or bathroom sinks.
• Keeping reptiles confined to their enclosures and not allowing them to roam the house.

More information about turtles and Salmonella can be found on the Worms & Germs Resources page.

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An Ocean City, Maryland man was told that he couldn't take his pet iguana on the Boardwalk because of a town ordinance banning "undomesticated" pets in public places. Instead of accepting the ruling, he "registered" his pet iguana as a "service animal". Protection of true service animals is critical but the very broad nature of the Americans with Disabilities Act (ADA) has let people get away with claiming that their pet is a service animal simply because they want to take their pet places where they are banned. The ADA just "celebrated" its 20th anniversary at the end of last month.

In this case, the owner will not disclose what his disability is or what the iguana does. That's his right according to the Act, and it lets people get away with anything they want. All he's saying is "You know it's like a cat. You put a cat on your lap and you pet it. It makes you feel good. There's a whole range of disabilities that allows you to do this." That's a pet, not a specially trained animal that is being used for a specific and necessary service activity, such as a guide dog.

The company that he's registered the iguana with is a bit of a joke. The first paragraph on their website states:

It's no secret that many businesses simply aren't pet-friendly, even though most of the population is. A large number of our clients register their dogs as Certified Service Animals or Emotional Support Animals (ESAs) not just to accompany them into stores, restaurants, motels, or on airline flights (for no extra cost), but to successfully qualify for housing where pets aren't allowed. Our Service Dog Certification documents formalize and simplify these processes and make qualifying for special housing hassle-free. If you and your service dog become certified with NSAR, both of you are immediately protected under federal law (ADA).

They're not separating service animals from pets. This is a very important distinction - service animals and pets need to be treated differently. Also, the implication that you have register to have a service animal protected is false advertising, presumably aimed at selling more registrations. You don't need to be registered by this group, or any other, to be a service animal.

To "register" your dog with this group, you have to

• Click a box saying you have a disability. (Their list of disabilities requiring service animals is vague and includes things like asthma and diabetes, to conditions for which I have seen no indication that service animals are useful).
• Click a box saying your dog can fulfill most of their required criteria (it actually says dog, not animal. Therefore, I guess this iguana is registered as a dog).
• Then - and this is the most important step - you send them money.

Fortunately, there's light on the horizon. The following clarification of the ADA has been released, and will take effect in early 2011.

Service animal means any dog that is individually trained to do work or perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability. Other species of animals, whether wild or domestic, trained or untrained, are not service animals for the purposes of this definition. The work or tasks performed by a service animal must be directly related to the handler´s disability. Examples of work or tasks include, but are not limited to, assisting individuals who are blind or have low vision with navigation and other tasks, alerting individuals who are deaf or hard of hearing to the presence of people or sounds, providing non-violent protection or rescue work, pulling a wheelchair, assisting an individual during a seizure, alerting individuals to the presence of allergens, retrieving items such as medicine or the telephone, providing physical support and assistance with balance and stability to individuals with mobility disabilities, and helping persons with psychiatric and neurological disabilities by preventing or interrupting impulsive or destructive behaviors. The crime deterrent effects of an animal´s presence and the provision of emotional support, well-being, comfort, or companionship do not constitute work or tasks for the purposes of this definition.

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It's not likely going to spark a Hollywood movie, but a turtle on a plane triggered a lot of angst and controversy in the US recently.

A 10-year-old girl was traveling with her pet turtle, Neytiri, on an AirTran flight from Atlanta to Milwaukee. The airline has a no-reptiles policy (actually, a no-pets-at-all-in-the-cabin policy) and when one crew member spotted the turtle in a cage under the girl's seat, she was told that she had to get off the plane.

This is where things start to fall apart a little. Apparently, the girl and her sister threw the turtle and its cage in the trash. They say that they were told to do so, although AirTran disputes this. Regardless, the turtle was tossed and the girls got back on the plane.

Banning turtles from plane cabins makes complete sense. I'm not sure why anyone would really need to travel with their pet turtle, particularly in the cabin. Turtles are notorious vectors of Salmonella and a huge number of Salmonella infections in people are attributed to contact with pet reptiles. People under the age of five, the elderly, pregnant women and people with compromised immune systems are at particular risk and should not have contact with reptiles. The problem with a plane is you can't be sure whether or not such high-risk individuals are on it (or will be on subsequent flights). A turtle in a cage is probably of fairly low risk. The problem would be the owner handling the turtle or its cage, then touching common hand-contact sites in the plane. Those sites could then be touched by someone else, creating a theoretical risk of transmission.

What's the real risk in this situation? Probably minimal. However, you have to think about whether risks, even minimal ones, are worth taking when they are completely avoidable by keeping turtles and other high-risk species out of cramped and hygiene-limited public spaces like airplane cabins - places they don't need to be.

Did the airline over-react? I don't think so (although recommending someone toss a live animal in the garbage, if it happened, is completely unethical). They have a policy. It's a reasonable policy. If you fly on an airline, you have to abide by their rules. If you are going to do something unusual like travel with a pet, it's your responsibility to determine what the rules are.

The story has a happy ending, fortunately. It seems that an airline employee recovered the turtle from the trash, and the girl was re-united with her pet a couple of days later, after flying home on an AirTran plane... in the cargo hold.

One other interesting note about this story - the turtle, Neytiri, was only two-inches long.  In the US, the sale of pet turtles with a carapace length of less than four-inches has been illegal since 1975, due to high rates of turtle-associated salmonellosis among children, who were more likely to extensively handle tiny turtles.

Photo (left): Carley Helm and her pet turtle Neytiri.

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A recent report in the Journal of Pediatrics (Tabarani et al 2010) describes a case of infection around the brain, at the site of a previous subdural hematoma, in a five-month-old child. Four reptiles (all bearded dragons) were present in the child's foster household, but the foster parent reported that the baby did not have any contact with them. Salmonella Houtenae was identified as the cause of the infection.  The reptiles were an obvious potential source given what we know about Salmonella and reptiles, the unusual Salmonella strain that was isolated from the baby, and the lack of any other obvious risk factor. All previous human infections caused by this type of Salmonella have been associated with reptiles, and all occurred in young children. Unfortunately, the reptiles in this case were euthanized before they could be tested.

This report highlights a few important points.

• Direct contact with reptiles is not needed to cause an infection. There are many reports of people (especially infants) being infected by Salmonella from a pet reptile despite them having no direct contact with the animal. The common statement that 'there's no risk to my child because my child is never allowed to touch the animal' is completely false.
• Reptiles should not be in households with children less than five years of age. In this report, the child was in a foster home.  In some jurisdictions, reptiles are banned from foster homes for this very reason.
• The majority of reptiles carry Salmonella. This is expected and impossible to prevent. That's why people at high risk of serious infection (e.g. young children) should not be around them. It's also why euthanasia of the reptiles in this case was highly questionable. Why kill the lizards for carrying a bug that we assume they (and most other reptiles) normally carry? Finding them a new home that doesn't have high risk people would be more appropriate.

Image: Central Bearded Dragon (Pogona vitticeps) (photo credit: Eigene Arbeit, 2007)

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.A public health expert has recommended that an exotic animal dealer's facility be demolished or "completely gutted and sterilized" because it is so contaminated with animal feces and vomit, as well as roach infested and swarming with uncaged animals. No evidence of infection control was present in the facility that "reeked of death and decay on a mammoth and overwhelming scale."

26 000 (yes, twenty-six thousand) reptiles, rodents and mammals were removed from US Global Exotic's Texas facility last week, in a raid prompted by an undercover investigation by PETA. An employee working undercover in the facility for PETA documented various abuses.   The company now stands accused by the city of inhumanely housing the animals as well as denying them proper food, water and medical care. Hundreds of dead animals were found, and some animals had started eating one another to survive. An SPCA spokesperson said she stopped counting at 200 dead iguanas.

Buying certain things on the internet is fine. Buying live animals over the internet is something that you shouldn't even consider. This is a multi-million dollar industry that feeds off the naivety of people, the willingness of people to ignore serious welfare issues in their desire to get a unique pet, and the suffering of animals. Exotic pets can be good pets in certain situations, but tremendous numbers of them suffer and die from inadequate care at distributors, pet stores and homes, with many (many) more dying during smuggling.

If you want an exotic pet:

• Read a lot about it first. Make sure you can properly manage the animal and that it's legal in your area.
• Learn about any infectious disease risks and whether it's appropriate for your household. In general, exotic pets should not be present in households with children under five years of age, pregnant women, elderly individuals and people with compromised immune systems.
• Find a small, local breeder. Buy the animal from a place where you can see how they are raised so you can have more confidence they are healthy and have been properly cared for.
• If you want to buy an exotic pet from a pet shop, ask clear questions about the origin of the animal and request supporting documentation. Only buy a pet that was bred locally. US Global Exotics apparently sold most of their animals through pet stores.

Don't support illegal and unethical activities by buying exotic pets - if you really want to have such a pet, remember that it requires a lot of forethought and investigation of the source.

Click image for source.

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Michael Plank, a California resident, was caught at the Los Angeles airport smuggling 15 lizards from Australia. Two geckos, two monitors and 11 skinks were found worth over $8500 and confiscated. The reptiles were strapped to his body inside money belts.  It's not explained how the smuggling was identified, but I imagine wriggling clothes might be a tip-off to an astute customs agent. The smell that would have almost certainly been generated from reptiles defecating during the trans-Pacific flight also could have played a role.

Importation of reptiles is regulated by the international Convention on International Trade of Endangers Species (CITES), and Mr. Plank faces some pretty severe financial penalties and jail time, although typically people charged with animal smuggling or abuse get off with a slap on the wrist at best. The problem is that people can make substantial amounts of money from smuggling reptiles, and the downside of being caught is often limited, thus making it a lucrative business. However, illegal importation of animals creates risks for disease importation, which can be a major problem for both the human population and native animal populations. Importation of animals is also associated with very high mortality rates - the percentage of smuggled animals that survives transportation is pretty low.

This isn't the first time this guy has been caught illegally importing reptiles, so it's safe to assume that he's done this many times before. Hopefully someone will get serious about the associated human health, animal health and animal welfare problems and start using some of the stiff penalty options that are available. People that buy reptiles should be conscious about the sources of the animals (and their forefathers), and ensure that they are not contributing to illegal activities.

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Three Louisville, Kentucky children and their father recently contracted Salmonella from two lizards (green anoles) that the kids brought home from school. Two weeks after the lizards were brought home, the youngest child got sick. Then the other kids and the father got sick.

This outbreak highlights numerous problems:

Schools are not pet stores: Why is an exotic (and difficult to care for) pet that is a known Salmonella vector being sent home with students? Apparently, the school sent home a standard letter they use when students take home pets. (I assume sending animals home must be a very common event if the school has a standard form for it.) The letter provides "caretaking tips" but apparently mentions nothing about Salmonella and reptiles. The school has now modified the letter to include a "reminder to parents that good hygiene is imperative when dealing with any kind of living organism as a pet, so they need to make sure their kids wash their hands well after handling them or cleaning them out." That's better, but if they are sending home reptiles, they need a clear statement about the risk of Salmonella exposure. They need to be direct and highlight the greater risk associated with reptiles.

Lack of education before getting a pet: Too many pets die and too many people get sick because people don't take the responsible step of finding out about the animal before they adopt it as a pet. This is particularly true with exotic pets, and death of the pet is a common outcome. It doesn't take a lot of effort to find out basic information about reptile care, and information about the risk of salmonellosis should be easy to find.

Poor knowledge (or a poor attempt at damage control) by the school: The teacher "noted that other common pets, such as dogs, can also carry salmonella. Like lizards, they're perfectly safe as long as you practice proper handwashing when you handle them." Except for the fact that 0-1% of healthy dogs carry Salmonella while very high percentages of reptiles do, that tens of thousands of cases of reptile-associated salmonellosis occur every year, that contact with reptiles is a major risk factor for salmonellosis, and that the CDC (among other groups) recommends that children less than five years of age and other high-risk groups not have contact with reptiles.  This type of statement is misleading. It's unfortunately either an indication of ignorance of the issues or an attempt to cover their butts and not take their share of the responsibility for what happened.  Certain reptiles can be good pets in certain situations, but are clearly inappropriate in others.

The "it's never happened before so it must be safe" fallacy: The school's disappointing response was that they've been using lizards in classrooms for years and no one has gotten sick. Well, their luck just ran out. Just because I could drive around without a seatbelt and not get hurt doesn't mean not using a seatbelt is a perfectly safe plan. Risky behaviours tend to catch up with you eventually.

The "it didn't happen here so it's not our fault" excuse: School officials said teachers are well-trained on the proper way to prevent students from getting Salmonella, but that's pretty debatable since three kids got sick because of their actions (i.e. sending the reptiles to the children's home). The infections may not have originated in the school but the school was still the source of the problem.

Poor hygiene associated with reptile contact: The father admitted that they didn't wash their hands regularly after handling the lizards.

There's little excuse for sending reptiles home with kids. Reptiles require specialized care and commitment, and many (many!) die each year from inappropriate care. The last thing we need is to make it easier for people to obtain them without much forethought. Reptile-associated salmonellosis is a serious problem, especially in kids. Serious, including fatal, infections can occur. Schools need to realize the liability they might assume by sending these animals into households, especially with inadequate scrutiny and education. Reptiles should not be kept in  households with kids less than five years of age, pregnant women, elderly individuals or immunocompromised individuals. I doubt they asked whether any such people lived in the household before sending the reptiles home.

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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.

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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.

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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.

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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.

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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.

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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.

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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
 

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Last weekend, my family and I went to an (indoor) aviary for an outing because the weather was particularly miserable. A new addition to this facility was a large reptile encounter exhibit. As part of this, people were encouraged to handle a bearded dragon (a type of lizard) and a large python. Contact with the animals was extremely popular with most people, including one of my daughters. She held the snake (twice) and the bearded dragon. Part of me was enjoying the experience and seeing what she got out of the encounter, but the infectious disease side of me had some concerns.

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.

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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.

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