A recent rat bite fever death in a six-month-old Pennsylvania baby raises several issues that parents need to consider.
The child died of meningitis and myocarditis (inflammation of the heart) caused by the bacterium Streptobacillus moniliformis. This bacterium is present in the mouths of virtually all rats, and is the cause of rat bite fever. Human infections are uncommon but they can be severe, especially in young children, individuals with compromised immune systems and/or when infection is not diagnosed promptly. Rat bite fever is (not surprisingly, given the name) mainly associated with rat bites, but can also occur if there is other contact of rat (or other rodent) saliva with a person's mucous membranes (e.g. mouth, nose) or broken skin.
In this case, the baby was bitten by a rat that was to be fed to the family’s snakes. A few days later, a fever and rash were noted (classical rat bite fever signs) and the child was taken to an Emergency Room, but discharged with "medication" (probably just something to lower the fever). Two days later, the baby was returned to hospital with fever and lethargy, and died later that day.
Besides the tragedy of the situation, there are several things about this case worth pointing out:
- Babies should not have any contact with rats. Infants are at increased risk of infection from a lot of things, and they get little benefit from touching a rat. The risks outweigh any benefits.
- If an infant is bitten by any animal, antibiotics are often indicated to prevent infection. Good bite first aid and knowing when to get medical care should be an integral part of pet ownership
- Pet owners need to know about infectious disease risks associated with their animals (and any animals they may feed to their animals, as in this case), especially when there are high risk indiviualds in the household.
- Physicians need to know about bites and other animal exposures. It’s not reported whether the physicians asked, and given the fact that rat bite + fever + rash absolutely screams "RAT BITE FEVER," they must not have.
- Patients/parents need to volunteer information about pet ownership and high risk incidents like bites. If the physician had asked about animal contact, or the parents had mentioned the bite, odds are good that the baby would have been treated for rat bite fever the first time the family went to the hospital, and then likely would have survived.
- Snakes (or any other reptile) should not be kept in households with babies. The risk of Salmonella exposure is too high.
- Live rodents should not be fed to reptiles. There are humane issues for both the rodent and the snake, as snakes can be seriously injured by prey.
People talk about "one medicine" and "one health" all the time, but application of the concept is poor. There needs to be better communication about zoonotic diseases and animal exposure, especially in situations like this.
More information about rat bite fever is available on the Worms & Germs Resources - Pets page.
As reported on barfblog.com (with, as ever, an entertaining title: You see a cute turtle, I see a bug factory: Infant botulism from C. butyricum) a recent paper in the journal Epidemiology and Infection (Shelley et al. 2015) reports an unusual turtle-associated disease.
When we think about turtles and infections (especially infections of young kids), the first thing that comes to mind is Salmonella. That’s fair because it’s common and can be serious. However, like any animal, turtles can carry a range of microbes that can infect people. Apparently, we need to add the bacterium Clostridium butyricum to the list.
The paper describes botulism in two infants caused by this bacterium and related to turtle exposure. Botulism is classically caused by Clostridium botulinum, a bacterium that can produce some of the most potent neurotoxins known to science. However, a couple of other bacteria, including C. butyricum, can produce similar toxins and cause the same disease. Infants are highly susceptible to disease caused by ingestion of the bacterium, since it is able to grow in their gut because of their poorly developed intestinal bacterial flora. (In more mature individuals, botulism isn’t usually caused by ingestion of the bacterium itself. Rather, it's caused by eating food that contains the toxin that was produced when the bacterium was able to grow in the food).
The first case was an 11-day-old boy that was presented to a hospital with various neuromuscular abnormalities. As is common, he had to be put on a ventilator to help him breathe, but fortunately he made a full recovery over the next 10 days. Botulism was suspected early in the course of disease and he received antitoxin (antibodies against the toxins), which probably played a key role in his response. However, C. butryicum, not C. botulinum, was identified in his stool and it was confirmed that the bacterium was able to produce botulinum toxin E.
The second case was a child of about the same age admitted to hospital with breathing problems and a few other issues. Botulinum toxin E was found in his stool, and C. butyricum was isolated.
Investigation of possible sources of the bacterium ensued. Various food and environmental surfaces, plus feces from the parents, were tested. For the first boy, C. butyricum was isolated from his mother’s feces, as well as their turtle aquarium water, sediment and turtle food. The same batch of food from the pet store was negative, so the food was probably contaminated in the house.
The only positive location in the second child’s case was the turtle tank water in a relative’s house, not the child’s house. The relative had held and fed the baby.
These cases also led to a review of a case of C. butyricum botulism that had occurred in 2010. It was assumed to have been caused by honey ingestion, but further investigation revealed the presence of the same type of turtle (yellow-bellied terrapin) in the house.
This report doesn’t change anything in terms of recommendations regarding how to manage turtles, but is good to raise awareness. Turtles should not be in households that have kids less than 5 years of age, for multiple disease reasons. Infection of the second child via a relative who owned turtles raises concern about how pathogens can be spread indirectly from turtles to high-risk individuals. The relative was reported to have put her finger in the baby’s mouth to soothe him at one point, and that would be a logical source of exposure, highlighting the need for good hygiene practices after having contact with animals and their environments, especially high-risk species such as turtles.
As the authors conclude “Adherence to advice that reptiles, including terrapins, should not be kept as pets in homes where there are children aged <5 years, primarily to prevent salmonellosis, would also prevent cases of infant botulism associated with terrapins. The importance of hand washing after handling these pets also needs to be stressed, especially while visiting families with small children.”
A recent paper in Zoonoses and Public Health (Whitten et al, 2014) describes reptile-associated salmonellosis cases in Minnesota between 1996-2011. Like similar reports, the data underestimate the problem because it’s thought that for every documented case, approximately 30 cases go undiagnosed. Regardless, there are some useful findings.
Twelve to 30 cases of reptile-associated salmonellosis were identified in the state each year. That represented about 3.5% of all sporadic (non-outbreak-associated) cases.
- This is lower than is often reported, but Minnesota is also known to have one of the lowest pet ownership rates among states, which might account for this discrepancy, at least in part.
Kids bore the brunt of disease (as is normal), with the median age of victims being 11 years. 17% were less than one year of age, 31% were less than five years of age, and 67% were under 20.
- The very young kids presumably had little or no direct contact with reptiles. This highlights the fact that living in the house with a reptile is a risk factor, even if there’s no direct contact. That’s why reptiles shouldn’t be in the house if there are high risk people present (i.e. kids less than five years of age, elderly individuals, pregnant women, immunocompromised individuals). Just trying to keep the high risk people from having contact with the reptile isn’t enough.
23% of cases had to be hospitalized. Fifteen (5%) had invasive infections, where Salmonella made it out of the intestinal tract and into the rest of the body.
- These types of infection are a major concern, and the report included one case where the bacterium was found in the cerebrospinal fluid (indicating the person presumably had Salmonella meningitis).
Fortunately, none died.
Over half of the people who got sick and who were asked (i.e. not including the young kids) reported knowing that reptiles can be sources of Salmonella.
Almost half reported exposure to a lizard, with 20% reporting snake contact, 19% reporting turtle contact and some reporting contact with more than one type of reptile.
A quarter of those who reported turtle contact and indicated the size of the turtle said the turtle was less than four inches in length.
- That’s relevant because it’s illegal to sell turtles that small in the US. The rule was put in place due to the increased risk of kids handling small turtles and getting exposed to Salmonella. The finding isn't surprising, though, since this law is widely ignored.
Some people consented to having their reptile tested. 86% of the tested reptiles were shedding Salmonella at the time the follow-up was performed. 96% of those were the same strain that caused disease in the person.
Overall, not a lot has changed, which is concerning. There’s a risk of disease with any pet contact, but reptiles are undeniably high risk. We’ll never completely eliminate the problem, but logical pet ownership and animal management are needed to reduce the risk. A good start is getting young kids away from reptiles. Reptiles can make great pets… but not for young kids, and not without some risk.
I go on periodic rants about people abusing service animal rules to take their pets places they cannot normally go (while potentially compromising the critically important need for true service animals to have unfettered access).
Sometimes, it's nice to know I'm not the only one.
A recent article (pointed out by a writer from the VIN News Service) in The New Yorker describes the exploits of the article's author, Patricia Marx, as she tested the ability to talk your way into various situations with over-the-top examples.
While I have some concerns about some of the scenarios (e.g. turtle bathing in a bowl of water in a deli, a stressed out turkey...) it showed how easy it is for people to manipulate the system. If you can get away with things like she did, it's easy to see how it's so easy for people with fake service dogs (complete with fake ID, vests and other paraphernalia) to do it.
Not surprisingly (since bacteria don't respect borders), the Salmonella Cotham outbreak in the US associated with bearded dragons has also affected people in Canada. Nine cases of human salmonellosis associated with this rare Salmonella strain have been identified, many with a link to bearded dragons.
It's not particularly remarkable, but should be yet another reminder of the need to take care with reptiles, because they are such common carriers of Salmonella. Remember that basic hygiene and common sense (like keeping reptiles away from any and all food preparation areas, like the kitchen) go a long way to reducing the risk of disease transmission from these critters. High-risk individuals (young children, elderly, pregnant or immunosuppressed) need to be extra careful, or ideally just stay away from reptiles and other high-risk animals.
In some ways, it doesn’t surprise me because it’s happened many times before. However, you’d think that, at some point, things would start to improve.
The US CDC is reporting yet another outbreak of salmonellosis associated with contact with feeder mice, that is, mice produced commercially to feed to pet reptiles. Sadly, this outbreak is quite similar to previous outbreaks. Multiple people (37 confirmed so far) in multiple US states (18 so far) have become ill, and 15% of affected people were hospitalized.
As I mentioned a few days ago about a salmonellosis outbreak linked to a company that sells eggs for hatching chicks, there seems to be no ability or effort (not sure which one is the case) to do anything about the source of these outbreaks. The FDA has issued a notice that “In the absence of a voluntary recall from Reptile Industries, Inc, FDA issued a warning to pet owners who have purchased frozen rodents packaged by Reptile Industries, Inc since 11 Jan 2014 that they have the potential to be contaminated with salmonella. Reptile Industries, Inc packages frozen rodents for PetSmart stores nationwide and are sold under the brand name Arctic Mice.”
The issue may be that these mice are not being sold as human food, so there’s no ability to mandate a recall. Yet, people are clearly getting sick from them, so it makes no sense that a recall and careful investigation of the facility and its practices is not underway. People purchasing feeder rodents need to remember:
- Freezing doesn’t kill Salmonella.
- Frozen rodents can be (and often are) contaminated with Salmonella and presumably various other pathogens.
- All feeder rodents should be considered contaminated and basic hygiene practices should be used when handling them at all times. This includes storing them away from human food, thawing them in sealed containers in a manner that won’t contaminate human food or food-preparation surfaces (including the kitchen sink), and hand washing after contact with rodents or packaging.
The US CDC is reporting yet another multistate Salmonella outbreak linked to reptiles. This one is an outbreak of Salmonella Cotham that, as of April 21, has infected at least 132 people in 31 states.
The story is pretty similar to other reptile-associated Salmonella incidents.
58% of infected individuals are kids five years of age or younger.
- That’s presumably a result of both higher risk contact by young kids (especially kissing reptiles) and the fact that young kids are at increased risk of getting sick when exposed to the bacterium.
42% of infected people have been hospitalized.
- That’s a pretty high number compared to many other outbreaks. However, the actual overall hospitalization rate is probably lower, since it’s likely that many people had mild infections that were not diagnosed. Fortunately, no one died.
This Salmonella type is pretty rare, which makes it easier to trace it to a specific source. The investigation in this case traced it back to bearded dragons purchased as pets from a variety of stores in different states. Further investigation of the source is ongoing, and breeders that supplied the pet stores are being identified.
Of particular concern here was the presence of resistance to ceftriaxone, an important antibiotic, in a strain from at least one person. That’s something we don’t want spreading, since ceftriazone is often used to treat people with serious Salmonella infections.
Bearded dragons have a lot of personality (for reptiles), and are interesting little critters, so they’ve become popular pets. Like all other reptiles, they pose a risk of Salmonella exposure, and they shouldn’t be in households with high-risk individual (i.e. kids less than five years of age, elderly individuals, pregnant women, immunocompromised individuals). People who own "beardies" should use good hygiene practices and a solid dose of common sense to reduce the risk of salmonellosis.
More information about Salmonella and reptiles is available on the Worms & Germs Resources - Pets page.
I would have thought this would fall under the realm of common sense, but as the saying goes: Common sense is like deodorant, the people that need it the most don’t use it.
A recent report out of Scotland is warning people not to kiss their pet reptiles, in response to four people who were hospitalized with salmonellosis after kissing bearded dragons, and other reptiles.
Reptile-associated salmonellosis is a major concern, and while there are ways to make reptile ownership very safe for most people, some risk will always remain. Certain behaviours will increase that risk. A large percentage of healthy reptiles have Salmonella in their intestinal tracts, and anything that’s in the intestinal tract ends up in the animal’s habitat and on its skin. Kissing reptiles is an obvious way to be exposed to this bacterium, which can cause serious disease in some situations.
Among the report's recommendations are:
- Families that own a bearded dragon or similar reptiles are advised to consult their doctor if they become ill with symptoms of fever, vomiting, abdominal pain and/or diarrhoea.
- They should also inform their GP that they keep a reptile. Children are particularly at risk because they like to stroke and handle pets.
- NHS Forth Valley have also issued a guide for pet owners to reduce the risk of catching Salmonella from lizards, which includes supervising children to make sure they do not put the animal, or objects it has been in contact with, near their mouths.
- It also recommended washing hands with soap and water immediately after handling a reptile, its cage or any other equipment, keeping a reptile out of rooms where food it prepared or eaten, and disposing of droppings and waste water down a toilet, rather than in a sink or bath.
Just common sense.
More information about reptiles and Salmonella can be found on the Worms & Germs Resources - Pets page.
The University of Guelph’s Animal Health Laboratory recently published a summary of selected zoonotic disease diagnoses in its monthly newsletter. It’s an interesting summary of what’s gone through the lab in the last year. It also helps to remind us of the zoonotic potential of all of these pathogens, some of which are relatively common and can be found in a variety of species.
Sometimes, people send me links to articles because they think I’d be interested in them. Sometimes, they do it to see what kind of response they can evoke. I’m not sure which one this was:
I was directed by a couple of people to a recent post of PLOS’s blog about snakes in classrooms. (I don’t really know why a scientific journal organization has a blog to which people who aren’t experts in a given field can submit posts. I would have thought a PLOS blog would relate to PLOS papers, but what do I know.)
I’m sure many people would agree with the sentiments in this blog, but (surprise, surprise), I don’t. It’s not that I’m anti-reptile, anti-pet-in-classroom, or think that the writer is clueless. Rather, he seems to be a passionate and well-meaning educator who just doesn’t see the issues with reptiles in classrooms. I’ve seen the issues and have my take on some of his points (in italics) below.
In this post I hope to give other educators a good foundation for keeping snakes in their classroom. A classroom pet is always a good way to teach responsibility. Administrators love any outside-the-box methods of teaching. Let them know students will be using this animal not just to learn science, but to learn important life skills like responsibility and compassion.
- True, but it has to be logical and safe. It also has to be educational. Animals can be used in classrooms for educational purposes, but they can also be distracting. The practice can be questionable from an animal welfare standpoint (especially for nocturnal species). They can be associated with disease. Reptiles are the leaders in that class, and reptile-associated salmonellosis has occurred from classroom snakes and other reptiles. Widespread Salmonella contamination of feeder rodents adds an extra level of concern.
- I also doubt administrators like outside-the-box ideas that pose a health risk to students (and therefore liability).
Your administrator may bring up questions about health risks. Salmonella is often associated with pet reptiles. This can be a bit misleading. Most animals, including pets like hamsters and guinea pigs can carry salmonella, but because turtles are wild caught, and often live in terrariums there is a better chance of salmonella living on their shell.
- No…(multiple no’s actually). While most animals can carry Salmonella, the prevalence of Salmonella shedding by pet mammals is very low. The rate of Salmonella shedding by captive reptiles is, in contrast, very high. Studies looking at snakes over time have shown that virtually all captive snakes are shedding Salmonella.
- It’s not just wild caught turtles that are the issue. Captive turtles are also a big concern (the bigger concern, actually).
Most snakes are kept in the same cage setup as hamsters and have little risk of ever having salmonella on their skin.
- Not a chance. Most do. As mentioned above, studies have shown high (to ubiquitous) carriage of Salmonella by snakes.
I have been handling snakes for 25 years and admittedly have poor hand washing skills and have never had an issue.
- That’s similar to saying “Gee officer, I drive drunk all the time and I’ve never killed anyone, so you have to let me go.” Yeah, that’s an extreme analogy but you hopefully get the point. Reptile contact causes thousands of cases of salmonellosis in people every year. There might be no infections in this classroom over the next ten years - or a child could die next week. It’s more likely that the former will happen, the the latter is possible.
I do keep multiple bottles of hand sanitizer in the classroom and make sure the students properly sanitize after handling and/or cleaning.
- That’s great. It’s an important risk reduction tool, but it’s not perfect and doesn’t compensate for the risk.
I would wager students are more likely to salmonella in the lunch line than they are from snakes in a classroom.
- I doubt it. Even if it was true, eating is a required event. Having a snake in the classroom is not.
Once bitten, the students lose most of their fear and wear it as a badge of honor.
- Multiple issues with this one...
Some issues are often overlooked:
- Do teachers always know if they have any high-risk (immunocompromised) kids in the class?
- Do teachers always know if there will be any high-risk kids visiting the class?
- What if a student is very afraid of snakes? How is that managed? (Is it managed? Might a child be afraid to say anything and instead work in a very stressful situation in silence?)
- Are students eating in the same area as the snake (a high risk activity to be sure)?
Here's my standard disclaimer: I actually like reptiles. Now that our kids are beyond the high-risk ages, Heather would be the main barrier to a request from them for a reptile, not me. However, while I like reptiles, I don’t like them in all situations. When the Salmonella risk can’t be contained and assurances can’t be made that only low-risk people will be exposed, reptiles shouldn’t be kept around. A classroom is a perfect example of just such a situation.
More information about Salmonella and safe management of different pets can be found on the Worms & Germs Resources - Pets page.
As we were heading into our 5th day without power as a result of a nasty ice storm, the power came back on. It’s been a pain, but with the generator, fireplace and family to visit in unaffected areas, it’s more disruptive than anything.
Not everyone’s that lucky.
If you don’t have a generator or someone with power with whom to stay, what do you do (especially when the temperature dipped to -18C last night)?
Also, what do you do if you have pets?
You might be able to find someone with power to take them or you might find a kennel (if there is one with power and space, and if you can afford it). If not, what then? Warming centres have been opened up, but what would happen if we showed up at one with two dogs, two rabbits and a cat? (The sheep would have to get by on hay and snow, and the fish... well... they’d be screwed.) I doubt our menagerie would be welcomed.
So, you’re left with deciding whether to leave the animals at home with a big pile of food and hoping for the best, or staying behind with them.
It is a serious issue, and I can virtually guarantee there are people toughing it out in freezing houses because they didn’t have any place to put their pets.
When large-scale natural disasters occur, animal care can be an even bigger issue. I heard a figure once about the number of people who died in Hurricane Katrina, having refused to evacuate as it approached because their pets couldn’t be evacuated with them. I’m hesitant to repeat the number since I haven’t been able to find it in a well-documented source, but even if it’s a gross over-estimate, it’s still huge.
It’s also relevant on a smaller scale, on many fronts, such as homeless people staying out of shelters because they can’t take their pets (commonly dogs) with them.
Making plans for management of pets is important for situations such as these. Some people dismiss it as “why would you want me to waste time, energy and money saving a few dogs and cats when people are at risk”? Those individuals are missing the point. The goal isn’t to save the dogs and cats (though that’s a nice side-effect) - it’s to remove barriers to assistance that may be in place when people are unwilling to leave their animals behind. It’s not simple, since you have to consider a lot of things like feeding and housing animals, keeping them controlled, making sure there are no problems with bites or people who are fearful or allergic to animals, and taking precautions to prevent zoonotic diseases.
It’s not easy and it needs to be planned in advance - not during a crisis - but it’s something that needs to be done.
Pet aquatic turtles have been implicated in three outbreaks of salmonellosis involving 43 US states over the past year and a half. Disappointing, but not surprising.
Disappointing, obviously, because people are getting sick. Disappointing also because these outbreaks have occurred over and over, despite availability of good information on how to reduce the risks.
It’s not surprising, though, because it’s happened so often.
Why? It’s a combination of people not researching these animals properly before buying them, pet stores not providing information, turtle farmers in denial that there is a problem, people flouting the small turtle ban, and poor overall awareness (and application) of basic infection control measures (more on that in a minute).
The Michigan Department of Community Health (MDCH) has reported that 5 people from Michigan have become ill as part of these outbreaks. As is typical, most were kids.
So, if you own a pet turtle, what do you do?
“We don’t recommend that they release them into the wild. Instead, we recommend that you contact a pet retailer, a pet store, to talk to them about it. Also, you can speak with a local animal shelter or a veterinarian for other options as well.” said MDCH spokesperson Angela Minicuci.
That’s not bad advice. However, the pet store and vet probably aren’t going to take the turtle. The humane society might (and those that do might try to find it a home or might just euthanize it right away). There’s another step here that’s forgotten: doing a risk assessment.
Are there high-risk people in the household (kids less than five years of age, elderly, pregnant women, people with compromised immune systems)?
- If yes, the turtle should be re-homed.
- If no…
Are you willing to accept some degree of risk, risk that can be mitigated with some basic practices?
- If no, the turtle needs a new home. (There’s always some degree of risk with turtle (and any animal) ownership).
- If yes…
Are you willing/able to take some basic measures to reduce the risk of Salmonella exposure, on the assumption that your turtle is Salmonella positive?
- If no… (take a guess here) the turtle needs a new home.
- If yes...
A little knowledge can be a bad thing. We see that with zoonotic diseases. Awareness is great. However, a little bit of awareness can be a problem if it’s enough make people paranoid but not enough to help them understand the real risks. This can lead to excessive and illogical responses (often ending with "...get rid of the cat").
Sound guidelines for preventing infections written by authoritative groups help a lot. An example of that is the recently updated Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents. As a collaborative set of guidelines from the US Centers for Disease Control and Prevention (CDC), the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America, it carries a lot of weight - as it should.
It’s a monster of a document of 416 pages. Pet contact gets a little bit of room and probably just the right amount. Enough to say "it’s something to think about," "we’ve considered the issues" and "here are some basic things to consider.”
Here are their specific recommendations:
Hand-washing also should be recommended in association with the following activities: after handling pets or other animals, gardening or having other contact with soil; before preparing food or eating; and before and after sex (BIII).
HIV-infected individuals—particularly those with CD4 counts <200 cells/μL [i.e. people who have advanced disease]—should avoid direct contact with diarrhea or stool from pets (BIII).
Gloves should be worn when handling feces or cleaning areas that might have been contaminated by feces from pets (BIII).
HIV-infected individuals also should avoid other sources of Cryptosporidium oocysts as much as possible (BIII). These include working directly with people with diarrhea; with farm animals such as cattle and sheep; and with domestic pets that are very young or have diarrhea. If exposure is unavoidable, gloves should be used and practices for good hand hygiene observed.
The letters and numbers indicate the strength of evidence. B means there’s moderate evidence supporting the recommendation and III means it’s based mainly or exclusively on expert opinion, not research trials.
Note that nowhere does it say "get rid of the pet" or "avoid contact with animals altogether." Rather, it endorses the use of basic hygiene practices and common sense. In reality, all these recommendations could apply to any individual, not just people with HIV infection.
The preamble to the pet section includes a great statement:
Health-care providers should advise HIV-infected persons of the potential risk posed by pet ownership. However, they should be sensitive to the psychological benefits of pet ownership and should not routinely advise HIV-infected persons to part with their pets. Specifically, providers should advise HIV-infected patients of the following precautions.
…and those precautions are:
HIV-infected persons should avoid direct contact with stool from pets or stray animals. Veterinary care should be sought when a pet develops diarrheal illness. If possible, HIV-infected persons should avoid contact with animals that have diarrhea.
When obtaining a new pet, HIV-infected patients should avoid animals aged <6 months (or <1 year for cats) and specifically animals with diarrhea. Because the hygienic and sanitary conditions in pet-breeding facilities, pet stores, and animal shelters vary, patients should be cautious when obtaining pets from these sources. Stray animals should also be avoided, and specifically those with diarrhea.
Gloves should always be worn when handling feces or cleaning areas that might have been contaminated by feces from pets. Patients should wash their hands after handling pets and also before eating. Patients, especially those with CD4 cell counts < 200 cells/μL should avoid direct contact with all animal feces to reduce the risk for toxoplasmosis, cryptosporidiosis, salmonellosis, campylobacteriosis, E. coli infection, and other infectious illnesses. HIV-infected persons should limit or avoid direct exposure to calves and lambs (e.g., farms, petting zoos). Paying attention to hand hygiene (i.e., washing hands with soap and water, or alcohol-based hand sanitizers if soap and water are unavailable) and avoiding direct contact with stool are important when visiting premises where these animals are housed or exhibited.
Patients should not allow pets, particularly cats, to lick patients’ open cuts or wounds and should take care to avoid any animal bites. Patients should wash all animal bites, animal scratches, or wounds licked by animals promptly with soap and water and seek medical attention. A course of antimicrobial therapy might be recommended if the wounds are moderate or severe, demonstrate crush injury and edema, involve the bones of a joint, involve a puncture of the skin near a joint, or involve a puncture of a joint directly.
Patients should be aware that cat ownership may under some circumstances increase their risk for toxoplasmosis and Bartonella infection, and enteric infections [although I’d argue data supporting a broad statement of cat ownership increasing those risks that are largely lacking]. Patients who elect to obtain a cat should adopt or purchase an animal aged >1 year and in good health to reduce the risk for cryptosporidiosis, Bartonella infection, salmonellosis, campylobacteriosis, and E. coli infection.
Litter boxes should be cleaned daily, preferably by an HIV-negative, non-pregnant person; if HIV-infected patients perform this task, they should wear gloves and wash their hands thoroughly afterward to reduce the risk for toxoplasmosis. To further reduce the risk for toxoplasmosis, HIV-infected patients should keep cats indoors, not allow them to hunt, and not feed them raw or undercooked meat. Although declawing is not usually advised, patients should avoid activities that might result in cat scratches or bites to reduce the risk for Bartonella infection. Patients should also wash sites of cat scratches or bites promptly and should not allow cats to lick patients’ open cuts or wounds. Care of cats should include flea control to reduce the risk for Bartonella infection. Testing cats for toxoplasmosis or Bartonella infection is not recommended, as such tests cannot accurately identify animals that pose a current risk for human infection.
Screening healthy birds for Cryptococcus neoformans, Mycobacterium avium, or Histoplasma capsulatum is not recommended.
HIV-infected persons should avoid or limit contact with reptiles (e.g., snakes, lizards, iguanas, and turtles) and chicks and ducklings because of the high risk for exposure to Salmonella spp. Gloves should be used during aquarium cleaning to reduce the risk for infection with Mycobacterium marinum. Contact with exotic pets (e.g., nonhuman primates) should be avoided.
This isn't a zoonotic disease issue, but certainly relates to ongoing discussions about keeping exotic pets.
A python from an exotic animal store in New Brunswick apparently escaped its enclosure and found its way into an apartment above the store. There, the python killed two boys, 5 and 7 years of age, possibly while they were sleeping. The snake is in the possession of the police. This is bound to provide more fuel to the fire of recent discussions pertaining to exotic pet ownership, unfortunately from a much more tragic incident that the comical (and somewhat annoying) ongoing saga of Darwin the monkey.
I write a lot about reptiles, and while it's usually in the context of their biohazardous nature, I actually like them. I've owned some before and it's not outside of the realm of possibility that we'll get more in the future (I might be safe with that statement since Heather doesn't read this blog. However, her co-workers that do will likely rat me out).
Reptiles can be good pets in some situations. The key is understanding and accepting the risk. That involves understanding the risks associated with reptiles, understanding the types of households where the risk is high, and knowing what to do to reduce the risk.
Denial isn't an effective infection control measure.
- Uh...no. Reptiles are clearly higher risk when it comes to Salmonella. Reptile contact has been clearly and repeatedly shown to be a risk factor for human salmonellosis. Dogs and cats (and various other animals) are potential sources of salmonellosis, but while many more people have contact with dogs and cats, reptile contact is much more likely to result in Salmonella transmission. It only makes sense. Reptiles are at very high risk for shedding the bacterium. Dogs and cats rarely do (especially when they're not fed raw meat).
"She’s never seen a case in the 30-plus years she’s been working with reptiles."
- Ok. So, since I've never actually seen influenza virus, I'll never get the flu?
- I know a lot of infectious disease physicians who have had a very different experience. In fact, it's rare for me to talk to an infectious diseases physician without him/her providing details of various reptile-associated salmonellosis cases.
Talking about the risk of Salmonella shouldn't be taken as insulting or a threat to reptile enthusiasts. People should accept that the risk is present and try to minimize it. The article actually has some useful information along those line. "Just use common sense - wash hands thoroughly after handling the animal or its cage. A good rule of thumb is to keep hand sanitizer nearby. While children under age 5 should avoid any contact with reptiles, Hart doesn’t advise snakes for children under age 7 or 8 for fear they could unwittingly harm the creature."
Reducing the risk is common sense. Keep reptiles out of high risk environments and use basic hygiene and infection control practices.
However, any semblance of common sense goes out the door when a rescue like this offers programs where you can pay them to bring reptiles to daycares, pre-schools and grade schools. So much for young kids avoiding contact with reptiles.
Reptiles aren't bad, they're just bad in certain situations. Common sense needs to be more common.
The fact that Salmonella and reptiles go together is old news. I often get questions about testing reptiles to see if they are Salmonella carriers and I tell people not to bother since even with a negative result, I'd consider the animal to be positive. A recent study in the Journal of Zoo and Wildlife Medicine (Goupil et al 2012) provides more evidence for this.
This study involved testing 12 snakes used in a public educational program, by sampling them weekly for 10 weeks. Here are the highlights:
- 11/12 snakes were positive at least once.
- 58% of snakes were positive on 5 or more weeks.
- On a weekly basis, between 25-66% of snakes were positive.
- Fifteen (!) different types of Salmonella were identified. Nine snakes shed 2 or more different Salmonella types over the study period.
- Two samples from feeder rodents were also positive.
This shows nicely how a single negative sample doesn't guarantee that a snake is truly negative. It also shows how common Salmonella is in snakes. The positive cultures from the feeder mice aren't surprising either, but shows that even if a snake was truly Salmonella negative, it could be exposed at any time through its food, and that there is potential public health risk from contact with feeder mice (something that large international outbreaks of human infection from infected feeder mice have shown).
This study just reinforces some key concepts:
- Assume all snakes are Salmonella carriers.
- Use good hygiene practices around snakes and feeder rodents.
- Keep snakes away from high risk individuals (e.g. the very young, elderly, pregnant, immunocompromised).
- Don't waste your money testing your snake for Salmonella. Focus your efforts on smart and practical management practices.
More information about reptiles and Salmonella can be found on the Worms & Germs Resources - Pets page.
My youngest daughter Erin is in every-other-day kindergarten and goes to a child care centre on her non-school days. Overall, it's a great place - excellent people, great learning environment and she enjoys herself.
During the initial interview at the centre, what I do for a living came up and we got into a discussion about pets. The person doing the interview talked about how they had policies against bringing in animals because of potential risks and the difficulty in doing it right (e.g. right animals, right supervision, adequate hygiene, informed consent, knowing fears and allergies). In reality, their policies are not quite as strict as they say. I didn't get too worked up about the parent who was apparently bringing a young puppy in for visits. Erin's getting outside the high-risk window now (she turned five this year), she's not afraid or allergic, and she knows how to interact with dogs. Odds were pretty low that anything bad would happen, but it still wasn't right because I doubt there was much supervision or understanding of the dog's health status. As a puppy, he/she was at higher risk for shedding various infectious agents, as well as more likely to bite, scratch and poop on the floor. It's also a risk for high risk dogs owned by people who visit the daycare (e.g. if the puppy happened to be shedding parvovirus and the kids transferred it on their hands or clothes to puppies in their households, like our puppy Merlin). Anyway, like I said, not a great idea but nothing to get too worked up about.
The next issue was a bigger deal. As I was picking Erin up yesterday I saw a bulletin board display that highlighted a recent trip to a pet store by the younger kids. On it was (predictably) pictures of these young kids handling reptiles, including turtles. As I've said before, reptiles can be good pets. But, they are clearly high risk pets and high risk people, including kids less than five years of age, shouldn't have contact with them.
I assume the parents of these kids had to sign a consent form. It probably said something like:
"We will be visiting ___ Pet Store to see and learn about animals."
It probably didn't say....
"We will be visiting ___ Pet Store, where your child may be handling high risk animals."
It definitely didn't say...
"We will be visiting ___ Pet Store, where, contrary to recommendations from the CDC as well as virtually every other public health organization that has put pen to paper, your child will be handling animals that have a high likelihood of being covered in Salmonella. Someone might try to ensure that she washes his/her hands after... maybe... We are optimistic that your child will not join the tens of thousands of people that develop reptile-associated salmonellosis every year and we really hope he/she isn't one of the handful of small children who die from it. Good luck! Please sign here."
There's a difference between a consent form and informed consent.
There's an educational value of interacting with animals and there are animal encounters where the risk exceeds the benefits.
I have no doubt that the field trip was arranged with the best of intentions; however, this shows that there is still a need for education of child care providers about pets and zoonoses. The pet store needs to be considered too, since they probably do this regularly. They should know better, and every pet store employee should know basic information about zoonotic disease risks and preventive measures associated with the pets they sell. Pet store visits aren't inherently bad, but they're "pet stores," not "petting stores," and it should be a look-but-don't-touch interaction.
People sometimes accuse me of being a kill-joy, but they miss the point. My girls would have more fun if we let them roll around in the van while driving rather than restraining them in car seats and booster seats (as often happened when I was growing up). I want my kids to have fun, but I'm not going to let them do things that are that dangerous. I want my kids to have pets and interact with animals, but I want it to be as safe as possible. There will always be a risk of infection or injury, and as someone who's informed and as their parent, I can define the degree of risk that I am willing to accept for them. Child care agencies have to look out for the welfare of the children they supervise. Zoonotic disease exposure prevention is part of that. It's not a matter of taking the fun out of life, it's making sure that we provide safe fun.
I received an email from a relative the other day with a pet question. I get lots of these, but the surprising part is this relative doesn't have any pets (and I think is generally of the opinion that pets are okay, as long as they're not hers). She was asking about turtles. As a responsible prospective pet owner should, she was looking into the issues pertaining to the pet before getting the pet. I think she was more focused on general aspects of care and management, but zoonotic disease risks play into the equation too. This one was a no-brainer, since they have a young child in the house and reptiles shouldn't be present in households with children less than five years of age. So, problem averted, and the need to make a decision later about removing an inappropriate pet from a household was also avoided (along with the awkward "oh, you got a turtle?" Christmas dinner conversation).
But, what happens when people aren't so proactive? Turtles are often passed from house to house as people get bored with them, as they outgrow small aquariums or as parents of young or otherwise high-risk children tune into the Salmonella risks or owning such a pet. If you don't have a friend willing to take your turtle, what do you do?
Petco, a pet products company in the US, has launched a "turtle relinquishment program," whereby they take in "wayward" or unwanted turtles. As of a few weeks ago, 111 people from 10 US states had surrendered their turtles to Petco. The turtles are sent to a turtle farm in Louisiana.
So, this is an option for individuals (at least in the US) with no local way to rehome their turtle. The fact that the turtles are going somewhere to make more turtles (and more Salmonella) is a bit of a concern, but I can see the greater good. Staff at the farm say that turtles are treated for any signs of Salmonella when they arrive. This is a bit strange, since turtles don't typically develop disease from this bacterium - they simply shed it with no signs. Hopefully that doesn't mean the farm is just treating all the animals. It's basically impossible to eradicate Salmonella from turtles, so if they are routinely treating, they're probably breeding drug-resistant Salmonella along with baby turtles.
I know the typical round of emails is going to follow, from reptile advocates who have pretty much done everything except burn me in effigy (or in real life, fortunately). As I've said before, reptiles can make great pets, just not in all households. I've owned various reptiles myself, but reptiles and small kids don't go together. Too many kids get sick every year from pets like turtles. A small number die. That's just unacceptable.
More information about turtles and Salmonella can be found on the Worms & Germs Resources - Pets page.
- The Indian River Reptile Zoo near Peterborough, Ontario, rushed some of their stock of snake anti-venom to Brantford General Hospital (about three hours away) to aid in the treatment of a woman who had been bitten by a Copperhead snake. Hospitals in Ontario don't tend to stock anti-venom for snakes that don't live anywhere near here, and it's fortunate for the woman that a couple of zoos in Canada stock anti-venom and are willing to share it (and that those zoos happen to be in Ontario and not the other side of the country). Circumstances of the bite aren't clear but the woman or someone she visited a) is obviously keeping a dangerous snake and b) obviously isn't handling it properly. Indian River Reptile Zoo president Bry Loyst sums up some of the problems with snake bites, saying "Hospitals are amazing but they don't have the expertise right there,” and “You'd be surprised at how many venomous snakes there are out there [in Ontario homes].”
- JayJay, a pet macaque (a kind of monkey) from Okeechobee, FL, was shot after "flipping out" and attacking its owner, "ripping apart his hand." The primate, who wore diapers and played with kids, had lived with the family for nine years, having been acquired at three weeks of age. He got out of the house and his owner was trying to catch him with a net. Whether it was the net, the joy of freedom or some other reason, JayJay lost it and clamped down on his owner's buttocks, thigh and hand, respectively, refusing to let go. A friend had a gun handy (no comment) and shot the monkey at the owner’s behest. The bite on the hand (in particular) was severe and deep, damaging tendons and a nerve, requiring surgical repair. This is another example of the "loving" exotic family pet going berserk for some unknown reason. The macaque often played with kids and the owners took him out in public (e.g. dressing him up and taking him trick-or-treating at Halloween). If we can say anything good about this, it’s good that it was the adult owner who was attacked and not a child. Fortunately, unlike a large percentage of captive macaques, JayJay wasn’t a carrier of herpes B virus, a virus that can rarely cause fatal infections in people. A good closing statement was made by Lion Country Safari wildlife director "Anybody that keeps a monkey is going to get bit... I haven't heard of a monkey that wouldn't bite someone."
- A zookeeper in Berlin, Germany, was killed by a Siberian tiger that had escaped its enclosure. While not a pet, it’s another example of a fatal attack by a captive large cat. As with venomous snakes, there is a remarkably large number of these animals that are privately owned, and attacks certainly happen. Usually, the lucky survivors say it was a "freak incident" and totally unexpected because the animal was like a pet cat. The unlucky ones can’t talk, but often the same story comes from friends and family… the animal was this apparently loving, docile large cat that for some reason attacked. You can never be confident that these animals are safe, because fatal injuries can occur not just with attacks, but with playful behaviour given their size and strength.
- In a related theme, a cougar was shot and killed in Muskoka Lakes, Ontario, after attacking a pet dog. The fact that the cougar had been declawed was a pretty good indication that it was an escaped pet. The owner of Guha's Tiger and Lion Farm, an "exotic animal menagerie" located down the road from where the cougar was shot, says he is not missing any of his cougars, which would "never want to escape" (except, I guess, for the jaguar that was shot by police after escaping in 2008). Since there's no regulation of exotic animals in the province, no one will know for sure from where the cougar came, how many cougars are present in Ontario and how they are being managed. Hopefully Mr. Guha has a containment plan for his other cougars, lions and jaguar that goes beyond assuming they'd never want to leave. If I was a neighbour, I wouldn't be too confident, however, when he says things like "If I leave the gate open for some reason — like I unlock it, then the phone rings so I pick up the phone — if they do get out they’ll go sit by (my front door) and wait for me."
While I'm certain I'll face more wrath from the keep-reptiles-in-schools group that is currently bashing me on the internet (there's even a Facebook page... at least I'm making an impact!), this brings up a few serious issues. One is the whole idea of putting a python around the neck of a young child. I won't go there, and in reality the risk of injury is very low. The main issue is, obviously, Salmonella exposure, because of the high rate of Salmonella shedding in reptiles and the high susceptibility of young kids to salmonellosis. A recent paper in Zoonoses and Public Health (Hydeskov et al. 2012) provides more evidence that the concerns about Salmonella exposure in such situations are valid.
- This study involved the reptile collection at the Copenhagen Zoo. There, the reptile collection consists of two groups: the main group is comprised of animals in the breeding centre, quarantine station and the primary zoo exhibit; the other group is a smaller collection that's used for education and hands-on teaching. The latter group has direct contact with many people, including kids.
- Salmonella was isolated from 35% of reptiles overall, with the highest prevalence in snakes (62%).
- Reptiles from the education group had a significantly higher prevalence than the other reptiles; 64% vs 23%.
- While these numbers are high, they are presumably an underestimation, since other studies have shown that you will miss a reasonable percentage of positive animals if you only test a single sample from each individual. So, it's fair to say that at least 62% of snakes and at least 64% of education-group reptiles were Salmonella positive.
Has the zoo ever been the source of Salmonella in a person? Nothing's been confirmed; however it's important to note that in Denmark, official investigation of salmonellosis cases only occurs as part of an outbreak. Since reptile-associated salmonellosis would most likely occur as sporadic cases, not an outbreak, cases might not be identified and reported.
It's also possible that the zoo hasn't been a source, because of the short-term nature of contact with the reptiles, contact only by older children and their hygiene practices.
At the Copenhagen Zoo, all reptile contact by kids is supervised, and students are required to wash their hands after touching a reptile. That's a great approach (as long as compliance is good), and the risks should be low for a short-term supervised activity such as this. High-risk kids, from an age standpoint, aren't involved since only 7-18 yr old students participate. So, the main group that would be of concern is immunocompromised children, who comprise a small but important subset of participants, and one that may slip by the established control measures since not all immunocompromised kids are readily identifiable. Unless schools know about all high-risk kids (and I'm far from convinced they do) and know that there are things these kids shouldn't do (e.g. have contact with reptiles), there are still some concerns. Those can be lessened further by ensuring that there is good communication between parents and the school, such that schools are really aware of any high-risk kids. That requires adequate knowledge on the part of the parents and the school, good communication in both directions and trust (since private health information is being disclosed). We have a long way to go to get there, and few people seem interested in starting those discussions.
Back to the Guelph paper photo. This wouldn't happen at the Copenhagen Zoo, since they apparently don't let 3-year-olds have contact with reptiles. I wasn't there so I don't know what was done in terms of hygiene, but even if this girl washed her hands after, there would still be a good chance that Salmonella was present on her skin or clothing based on how she handled the animal. This nature centre does some excellent work but I worry about the shows they offer for birthday parties. Their advertisement for this, with the "bring your cake and touch a snake" approach, and the picture of another young child with a snake draped around her raises concerns.
Reptile contact isn't inherently bad. There are just situations when it's high-risk and should be avoided. Beyond that, if it's going to be done, it must be done right. Unfortunately, more often than not, that's not the case.
I get a lot of emails about this blog. Some are complementary, some... well... not so much.
When it comes to the latter group, the most common (and often the most grammatically-challenged) group is raw meat feeders. They're a constant source of interesting comments about my intelligence and other aspects of my life. Some actually provide well-written explanations of why they do what they do and I've had some good discussions with a few. Others just like to call me stupid and move on. The guy who provides treatment recommendations for dogs based on fish antibiotics (and his buddies) was another interesting one. The dodgy equine protozoal myelitis clinical trial person (and her friends) was another (she also wrote to my Dean... that's another story). The list goes on.
The latest group has been people upset that I have concerns about reptiles in schools. It seems that a post I wrote a while ago about a school reptile club ended up on a reptile website, whose members are now inundating me with emails. While I appreciate the fact that they are reptile enthusiasts and like their pets, they're missing the big picture.
Yes, reptiles can be good pets, in certain situations. I actually like reptiles. I used to own a few, and the first patient I treated in practice was a reptile.
I've also spoken with people whose children have acquired Salmonella from a reptile. I've read numerous papers about kids that died from Salmonella from a reptile, and I think I've yet to meet an infectious diseases physician who doesn't almost immediately launch into reptile-Salmonella stories when they hear what I do.
The fact is, reptile exposure accounts for a very disproportionate number of Salmonella infections in people, and kids bear the brunt of this. That's why the CDC and various other groups say that reptiles shouldn't be in households with young kids (or the elderly, pregnant women or people with compromised immune systems). The same applies for schools and day cares, where young kids are present, parental knowledge of the exposure is often non-existent, and basic infection control practices are spotty, at best.
No one is saying people shouldn't keep reptiles as pets. However, to me, the evidence is clear that certain people shouldn't have reptiles as pets or be in contact with them. Adults can decide to do things that compromise their health. Adults shouldn't make decisions that compromise the health of their kids or kids for whom they are responsible. Ensuring high-risk children stay away from high-risk animals like reptiles is part of that.
Today's Toronto Star has an article about a reptile club in a Toronto Elementary School. Teacher Jim Karkavitsas runs a session every day that teaches students about a range of reptiles. His menagerie has expanded from one snake five years ago to more than 40 different species in his classroom. Some are loaned out to other classroom's on request and two lizards now make their home in the school's main office.
- Learning about, and interacting with, animals can be very important for kids, especially those who don't get exposure to animals at home and outside of school. It can teach responsibility and empathy, and be the springboard for a range of educational discussions.
- The animals are kept in a room adjoining the classroom, so they are relatively contained and all students aren't forced to be around them (since some kids might be afraid of them). Housing the reptiles in a different room also means students presumably aren't eating in the same room in which the reptiles are housed.
- Kids use hand sanitizer before and after contact with reptiles. This is a very important preventive measure for the problems outlined below, but it's not 100% protective (or usually performed all the time or done properly).
- Mr. Karkavitsas takes the animals home during the summer. A problem with some classroom pets is people don't assume ownership for them to take care of them properly when school's not in session. Similarly, the school's parent council provides $5000 to cover the cost of keeping the reptiles. Hopefully, that also means that veterinary care would be provided if something happens, which can be a problem in many cases when classroom pets need care but no one has a mandate to arrange or pay for it.
The bad and the ugly
- Salmonella. That's the big one. Reptiles are classic sources of Salmonella. You can almost guarantee that more than one of these reptiles are shedding the bacterium. If a reptile is shedding Salmonella in its feces, it will also likely have the bacterium on its skin, in its cage and in any areas where it roams. It also means that anyone touching it (or its environment, or contaminated areas) can pick up Salmonella on their hands, with subsequent transfer into the mouth. This is a high-risk situation since reptiles are a major source of salmonellosis, especially in kids. Reptile-associated salmonellosis does occur in classroooms.
- Mr. Karkavitsas buys frozen rats to feed the snakes. Frozen rats can also be contaminated with Salmonella, and frozen rats have caused salmonellosis in kids in a school (which was also brought home and spread other family members). There's also been a large (and likely ongoing) international salmonellosis outbreak associated with frozen rodents.
- Standard recommendations are that children less than five years of age (along with pregnant women, elderly individuals and people with compromised immune systems) not have contact with reptiles. This is a grade 5-6 classroom, so the students would be older than this, but I wouldn't be surprised if younger kids in the school also have contact with the reptiles. Additionally, the immunocompromised group is an issue, since many people have compromised immune systems due to various diseases or treatments. Teachers may not know about all of these and parents may not realize that their high-risk child is having contact with high-risk animals in school. When you can't be sure that high-risk people won't have direct or indirect contact, that's a problem.
The sentiment is great and I applaud the teacher's efforts to engage kids and teach them about animals, However, it's a cost/benefit situation and the potential costs (which may be extreme) outweigh the benefits (significant as they may be). While reptiles can be great pets in certain situations, they're not meant for schools where there are lots of kids, challenges with supervision, difficulty implementing good infection control practices and potentially individuals at high risk for infection.
The CDC is investigating CDC is investigating more cases of salmonellosis associated with feeder rodent contact, caused by the less-than-catchy-named Salmonella I 4,,12:i:-. This strain is the same one that was implicated in a large and prolonged outbreak in the US and UK in 2009-2010 which was also associated with frozen feeder rodents (rodents sold frozen as reptile food) from a single US supplier. The current outbreak has affected people in 22 US states from August 2011-February 2012, and involvement of the same strain from the same source certainly leads to suspicion that this is actually an ongoing problem.
In the latest outbreak:
- 46 people have become sick. As is common, kids have borne the brunt of this outbreak, with the median age of affected persons being 11 years.
- 37% of affected people were kids five years of age or younger. Since this outbreak involved feeder rodents, clearly people aren’t heeding the guidelines that kids of that age shouldn’t be in households with reptiles.
- No two affected people reported buying rodents from the same store. This shows how widespread the problem is and that it must be originating from the place where the rodents are bred and/or distributed, not a focal pet store issue.
Record-keeping at the pet stores complicated figuring out the source. However, two breeders that supplied pet stores received mice from the company that was the source of the 2009-2010 outbreak. This suggests that not only were people exposed from frozen feeder rodents in the earlier outbreak, but that breeding colonies in different areas were infected from that source. This may have allowed wide dissemination of this Salmonella strain into numerous rodent breeding colonies, creating many possible sources of exposure for members of the public purchasing feeder rodents. The large-scale commercial nature of rodent breeding and wide distribution network creates a great opportunity for widespread outbreaks, as is apparent here and with various other outbreaks (including salmonellosis outbreaks from guinea pigs and baby poultry).
If you are going to buy feeder rodents:
- Treat them as if they are carrying Salmonella, because they just might be.
- Keep them away from human food. Keep them in a separate freezer or fridge, or in a sealed container if they have to be in the same fridge as human food.
- Don't handle them in the kitchen.
- Wash your hands thoroughly after handling.
- Keep them away from young children, as well as people with compromised immune systems, elderly individuals and pregnant women. None of these groups should have contact with reptiles either.
Image: A package of frozen rats, as sold commercially for feeding reptiles.
.A five-month-old Britich baby was hospitalized with salmonellosis that was presumably acquired from a family pet. The baby developed severe diarrhea and was rushed to hospital. Fortunately, the child has recovered, something that's far from assured in such cases, since salmonellosis can be life-threatening in infants.
As expected, an investigation followed the diagnosis of salmonellosis. Typically, these investigations focus on food and animal contact, and since this family had a bearded dragon (see picture) and tortoises, the investigation honed in on the reptiles. Reptiles are high risk for Salmonella shedding and are commonly implicated in human infections. Further, the type of Salmonella that infected the infant, S. Pomona, is commonly associated with reptiles. It doesn't sound like they've confirmed that the same strain of Salmonella was present in the reptiles, but I assume that testing is underway.
Reptiles should not be present in households with infants. It doesn't matter if the animal never leaves its enclosure, because while the critter may not leave the enclosure, Salmonella will.
In low risk households (households without kids less than five years of age, elderly persons, pregnant women or immunocompromised individuals), good management practices can be used to minimize the risk of transmission of Salmonella, but given the potentially fatal nature of salmonellosis in infants and other high-risk individuals, these precautions are not adequate in high-risk households. While reptiles can be great pets, they're just not worth the risk in some situations.
The CDC has announced an investigation of three multistate outbreaks of salmonellosis linked to pet turtles. At last report, 66 affected people had been identified, and since most outbreaks like this only identify a minority of cases, it's safe to assume there are many others.
- Three different types of Salmonella have been implicated; S. Sandiego, S. Pomona and S. Poona.
- Infected people have been identified in 16 US states (see map).
- 11 people have been hospitalized, but no one has died.
- Most cases (55%) have involved children under the age of 10.
- Almost all infected individuals who provided information about turtle contact with said the turtles were less than 4 inches long.
This ongoing outbreak, dating back to September 2011, has all the hallmarks of a pet turtle-associated outbreak: a large number of cases over a wide area and prolonged period of time, a predilection for young children, and the potential for severe disease. While far from novel, this outbreak also highlights some recurring themes.
The potential for widespread outbreaks from mass production and distribution of pets has been repeatedly demonstrated with a range of diseases, including recent examples involving chicks and guinea pigs. That doesn't mean that mass production is necessarily higher risk (although it certainly can be), but when something goes wrong, it can go very wrong because of the large number of infectious animals that get sent out.
Sale of turtles with shell lengths under 4 inches has been banned in the US since 1975. This is because small turtles are more likely to be handled (and potentially put in the mouth) by young kids. Despite extensive lobbying by US turtle breeders, the law remains in effect, but it's widely flaunted. It's surprising more efforts aren't put into enforcing this regulation given the number of people who are sickened every year from contraband turtles. (It's also surprising that infected people in the US haven't started large lawsuits against people distributing small turtles.)
Anyway, this is yet another reminder about the risks associated with reptiles and high risk individuals (i.e. young children, elderly, pregnant, immunocompromised) and the need for pet turtle owners to follow basic hygiene and infection control practices. More information about turtles - for owners, veterinarians and healthcare professionals - can be found on the Worms & Germs Resources page.
Yet another outbreak of salmonellosis traced back to pet turtles has been investigated by CDC and Pennsylvania's State Health Department. Pet turtles are notorious Salmonella vectors, for several reasons, including the fact that small aquatic turtles very commonly carry the bacterium, they are marketed towards young kids (who are increased risk of infection), and people tend to use poor (or no) hygiene practices when handling turtles or having contact with their environments. Efforts to restrict the sale of small (less than 4-inch long) turtles have greatly reduced Salmonella infection rates in people in the US, but have come under continual pressure from the turtle breeding industry, and the regulation is often flaunted by pet stores and road-side turtle sellers.
From August 5 to September 26, 2011, 132 cases of Salmonella Paratyphi B infection were identified in 18 US states.
- The median age of infected individuals was 6 years, and 2/3 were less than 10 years of age. This is consistent with a pet-associated outbreak.
- 56 patients (and their families, presumably) were interviewed, and 64% of them reported turtle exposure. That's a lot higher than one would expect if a random sample of the general US population was surveyed, and suggests that turtles were an important source.
- Of the 15 people who could provide details about the turtle, 14 of them described turtles that would have been too small to be legally sold in the US. This isn't surprising, and shows both the risk associated with these small turtles and the fact that this law is being widely ignored.
- The same strain of Salmonella was isolated from turtle tank water in five homes (it's not clear if only five were tested or if there were some negative tanks too). That's further evidence implicating the turtles.
This is yet another reminder of the risks posed by small turtles, particularly to young kids. Small turtles have high Salmonella shedding rates, are easy to handle and are even small enough for kids to put in their mouths (yuck!). That's a bad combination.
In 2007, Louisiana turtle breeders sued to reverse the FDA's small turtle ban. Fortunately they weren't successful, however it's clear that the turtle ban needs to be enforced, but that's hard to do. Perhaps more important, then, is increasing public awareness of the risks. If people are better informed of the issues, they can make better decisions about acquiring pets and how to properly manage them. One such resource for the public is the Turtles fact sheet that we have freely available on the Worms & Germs Resources page.
No, not gravy made from bearded dragons (a type of reptile), but foodborne Salmonella with a link to the reptile.
Reptiles are an important source of Salmonella, which is why standard guidelines recommend that high-risk people (e.g. children less than 5 years of age, elderly individuals, people with compromised immune systems, pregnant women) not have contact with reptiles or have them in the house. A report in Zoonoses and Public Health (Lowther et al 2011) highlights another possible risk.
The report describes a Salmonella outbreak that was traced back to a potluck dinner. Nineteen cases were identified, 17 primary cases (people that attended the dinner) and two secondary cases (household members of people that attended the dinner). Overall, 29% of people that attended the dinner got sick. A further 18 people had some intestinal disease but strictly speaking didn't fit the definition for a case (however it is suspected that they were part of the outbreak). Salmonella subspecies IV (a type mainly associated with reptiles) was isolated from the stool of five people, confirming the occurrence of an outbreak.
As is typical, food consumption history was evaluated. Sixteen of the 17 primary cases reported consuming turkey gravy, which was a statistically higher proportion than that of people who did not get sick. The gravy was made at the private home of a person who didn't attend the dinner. This was the only home of the people involved where reptiles were kept. Two healthy bearded dragons lived in the house, in a terrarium in the living room.
The investigation focused on the reptiles, since the Salmonella strain found is typically associated with reptiles, and the turkey (the source of the gravy) had no evidence of Salmonella contamination based on testing. Samples from the environment of the household where the gravy was made were collected, and two types of Salmonella were identified. One of these Salmonella types (Salmonella Labadi, which was different from the outbreak strain) was isolated from one of the bearded dragons, as well as the inside and outside of the terrarium glass, other terrarium surfaces, surfaces around the terrarium, the bathroom sink drain and kitchen sink drain.
A common question that comes up when people have reptiles and high risk people in the house is "If I don't take the critter out of the cage, I should be ok, right?" Unfortunately, that's not true. Human Salmonella infections have been clearly identified in situations where reptiles don't leave the terrarium because (as was the case here), while the reptile may not leave the terrarium, Salmonella often does.
The person who made the gravy said that the bearded dragons had not been out of the terrarium when food was being prepared. A child was responsible for feeding the reptiles and cleaning the terrarium, and was supposed to use the bathroom for terrarium cleaning. However, it was reported that the reptiles' dishes "might have" been cleaned in the kitchen sink during the the day period when food was being prepared for the party.
The overall conclusion was that this outbreak "probably resulted from environmental contamination from bearded dragon faeces." It's a reasonable conclusion. Even though the same Salmonella strain wasn't found in the reptile, it makes sense because the reptiles were the most likely source of environmental contamination in the household, and that was the most likely source of the foodborne contamination. Reptiles can shed various Salmonella strains and they can shed intermittently. It takes multiple samples over time to get a real idea of the scope of Salmonella shedding, and I assume that one or both of these reptiles were shedding the outbreak strain at some point.
How can something like this be prevented, since the standard recommendation of having high risk people avoid contact with reptiles doesn't apply to this type of situation?
- Good hygiene practices should be used when handling reptiles and their environments. In particular, there should be proper attention to hand hygiene after contact with reptiles or their cages.
- Reptiles should not be allowed in the kitchen. Ever.
- Food and water bowls should not be cleaned in kitchen sinks. Terrariums should not be cleaned in kitchen sinks. Ideally, they shouldn't be cleaned in bathroom sinks either. (If possible they should be cleaned outdoors with a hose.)
- Good food handling practices are critical. Here, gravy wasn't re-heated to a high enough temperature to kill the contaminating Salmonella. Adequate re-heating would have prevented this outbreak.
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.
Maybe the Occupy movement should take some tips from an Indian man who expressed his frustration with government corruption by releasing venomous snakes into a government office. Upset by the slow pace of the bureaucracy and demands for bribes, the man (the local snake charmer) dumped 40 snakes, including 4 cobras, onto the floor of the local land registry office. The people in the office weren't impressed, and neither were the snakes by the look of the video. Not a healthy idea for either species.
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.
I guess I'm lucky I'm married since I'm obviously out of touch with the best ways to attract women. Unlike Dewayne Yarborough of Ford Heights, Illinois, I didn't know that a 4-foot-long alligator is a "chick magnet."
His reason for keeping the reptile was that he claimed it attracted women (I kid you not). While it may have attracted a few dates, it ended up costing Mr. Yarborough, as he was charged with possession of an illegal animal. Investigators found the alligator in a fish tank in the man's kitchen. Apparently, he was keeping it in a small tank and feeding it minimally (aka starving it) to keep it from growing too big. (Apparently, the degree of attraction of women is not directly proportional to the size of the alligator.)
Besides being illegal in many jurisdictions, keeping alligators is rarely a good idea. They can grow very large and can be very aggressive. They need lots of space, a proper environment and a proper diet. Like all other reptiles, they are a potential source of Salmonella (and some other microorganisms), so keeping them in the kitchen is an even worse idea.
I wonder what other animal-associated dating trends I've missed over the past few years...
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.
The Bronx Zoo has closed it's reptile house following the disappearance of an Egyptian cobra. Officials noticed the 20-inch-long snake was missing on Saturday, and they are presumably carrying out a diligent and very careful search.
There's probably no risk to the public (as long as the snake wasn't stolen). It's likely curled up hiding somewhere, not cruising the city looking for trouble. The cold weather also helps since the snake wouldn't be able to survive outside of the enclosure for long, on the off chance it did get out of the building.
There's no explanation as to how it escaped, something that I assume is also being investigated carefully considering the typically strict handling and control measures for venomous snakes.
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.
I've been slow getting around to this topic, which has been covered elsewhere (on Barfblog), but it's an interesting report and one that's still worth discussing. The report from Ireland involves diagnosis of botulism in a baby that was associated with a pet turtle and/or the turtle's feed.
Botulism is a very serious disease caused by a toxin produced by the bacterium Clostridium botulinum. Typically, botulism occurs when a person (or animal) eats food that was contaminated with the bacterium and then was stored improperly, allowing the bacterium to grow and produce its potent neurotoxins. The other form of botulism, one that is largely restricted to infants, occurs when the botulism bacterium itself is swallowed and starts to produce its toxins while it's in the intestinal tract. It rarely occurs in older individuals because their natural intestinal bacterial population helps suppress overgrowth of the C. botulinum.
Not much information is available about the case in Ireland. It involved quite a rare strain of C. botulinum, Type E, and there's no information provided about how the link to the turtle was made. I assume it was toxicoinfectious botulism, whereby the infant ingested the bacterium (as opposed to eating something already containing the toxin) but the reports aren't clear. Fortunately, the child is recovering, since botulism can be fatal.
Botulism isn't high on my list of potential infectious diseases you can get from reptiles, but it can happen - and it has the potential to be very, very bad. Salmonella is the main focus of reptile-associated diseases, but this report should be taken as a reminder that there are other diseases of concern as well, and that reptiles are inappropriate pets for households with children under five years of age.
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
- 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.
Tegus are large South American lizards that are sometimes kept as pets. As with other reptiles, Salmonella is a concern, as highlighted by a recent study in the journal Zoonoses and Public Health (Maciel et al. 2010). In that study, the authors tested feces of 30 captive-born tegus. From the first round of samples, they isolated various types of Salmonella from 87% of the animals. They collected a second fecal sample from the 4 tegus that were initially negative, and found Salmonella in feces of all of them.
It's not particularly surprising to find Salmonella in tegus, just like in other reptiles. The fact that it wasn't too hard for the authors to find this important bacterium in all of the reptiles highlights the public health concerns regarding reptiles and Salmonella. Further, they showed (as has been shown with other reptiles like snakes) that Salmonella can be shed intermittently, so a negative culture doesn't mean the animal is truly Salmonella-free.
Reptiles can make good pets, but they are accompanied by an increased degree of risk with regard to infectious diseases. They are not recommended for households with children less than five years of age, elderly persons, pregnant women or people with compromised immune systems. In low-risk households (i.e. households without people in these categories), the risk can be reduced (though not eliminated) by basic common sense practices, particularly close attention to handwashing after touching the animal or its environment, and preventing the animal from roaming around the house.
Image from http://ns3.powerblogs.com/my_pet_tegu/
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.
The Texas Department of State Health Services has proposed a series of changes to warnings that are already required of retailers that sell reptiles. The warnings are focused on prevention of salmonellosis, and retailers must post signs and provide written warnings to anyone buying a reptile about the risk of salmonellosis from reptiles.
Signs must include the following recommendations (new or revised text is underlined):
- People should always wash their hands with soap and running water after handing reptiles or reptile cages or after contact wtih reptile feces or the water from reptile containers or aquariums. Wash your hands before you touch your mouth.
- Persons at risk for infection or severe complications of salmonellosis, such as children younger than 5 years of age, the elderly, and persons whose immune systems have been weakened by pregnancy, disease or certain medical treatments should avoid contact with reptiles and any items that have been in contact with reptiles.
- Reptiles should be kept out of households or facilities that include children younger than 5 years of age, the elderly, persons whose immune systems have been weakened by pregnancy or disease, or certain medical treatments. Families expecting a new children should remove any reptile from the home before the infant arrives.
- Reptiles should not be allowed to roam freely throughout the home or living area. Wash and disinfect surfaces that the reptile or its cage has contacted.
- Reptiles should be kept out of kitchens or other areas where food and drink is prepared. Kitchen sinks should not be used to bathe reptiles or to wash their dishes, cages or aquariums. If bathtubs are used for these purposes, they should be thoroughly cleaned and disinfected with bleach. Wear disposable gloves when washing the dishes, cages or aquariums.
- The sign must also contain a statement that reptiles may carry Salmonella bacteria, which can make people sick, but reptiles may not appear to be sick.
Image: Texas Horned Lizard, Phrynosoma cornutum (photo credit: Shawn Billerman, click for source)
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.
The Public Health Agency of Canada (PHAC) has issued a public advisory regarding salmonellosis linked to frozen rodents used as pet (reptile) food. The rather vaguely-worded advisory states that there have been seven reported cases of Salmonella caused by a specific strain that has been linked to frozen rodents. No details about the cases or the origin of the rodents are provided, however it presumably involves the large international Salmonella outbreak associated with Mice Direct, a mail-order rodent company. The advisory reminds people to take basic precautions when handling rodents that are used for reptile food.
Basically, the key is to consider all such frozen rodents biohazardous, and handle them accordingly. Remember to:
- Limit contact with the rodents as much as possible.
- Thaw them in a sealed container, preventing any contact with human food.
- Keep them away from kitchen countertops and other food handling surfaces.
- Wash your hands thoroughly after handling them.
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.
MiceDirect, a company that sells frozen mice, rats and chicks as reptile feed, has issued a recall because of Salmonella contamination of their product. Contaminated critters have been sold across the US (except Hawaii) through mail order and pet stores, and recalled product codes can be found in the FDA recall notice. Contamination isn't a big deal for the reptiles, since carriage rates for Salmonella are already high and they are usually healthy carriers. The concern is for people who handle the frozen rodents/chicks (or who can be exposed indirectly from contaminated surfaces in the home). There have been previous outbreaks of human Salmonella infections associated with contaminated frozen rodents.
Unlike many other recalls where the product is recalled because of contamination but without evidence of human illness, human illnesses suspected to be linked to contaminated reptile food have been identified in 17 states. In reality, reported cases may be the tip of the iceberg, and I suspect that if cases in 17 states are confirmed, there will be (or may already be) many more. Other details regarding these cases and the recall, such as the strain of Salmonella involved, haven't been released.
In response to this problem, the FDA report and the company website indicate that products from MiceDirect will be irradiated. It's not clear if this will be a standard protocol from now on, or whether it's a short-term response to the contamination problem. Considering the repeated outbreaks associated with frozen reptile food, irradiation sounds like a good standard practice. Perhaps the best way to help make (or keep) it a standard practice industry-wide is for consumers to vote with their wallets: ask for irradiated or otherwise treated (e.g. high pressure pasteurization (although I'm not sure what that would do to a mouse)) feeds to reduce the risks of contamination.
Because of recurrent problems with contaminated frozen reptile feed, if people are not buying products that are treated to eliminate contamination, they should assume that all such feed is contaminated and handle it accordingly. That means using basic practices such as:
- keeping frozen reptile feed away from human food
- if defrosting it in the refrigerator, keep the reptile feed in a sealed container that is not used for human food and that is disinfected afterward
- washing hands after handling the feed
- disinfecting any potentially contaminated surfaces that come in contact with the feed
- discarding uneaten food promptly, since Salmonella can multiply as uneaten food sits in the open, especially in a nice, warm reptile terrarium
A link to more information about MiceDirect is available through a post on Barfblog.
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.
Among the various things I've been called in response to blog posts is "anti-reptile." Actually, I like reptiles. I've owned and treated them, and think many of them are quite fascinating species. They can be reasonable pets in certain situations. The main problem is that they have high rates of Salmonella carriage and are the cause of a large number of infections in people. That's why the CDC, among other groups, recommends that people under the age of 5, the elderly, pregnant women and people with compromised immune systems avoid them.
Why do I bring this up (again)? I read an article today about the Fall River, Massachusetts, library and their resident tortoise, Franklin. Why am I concerned?
- Who goes to a library? Lots of people. Kids and elderly individuals probably go more than average. Those are the high risk groups.
- You could try to make the argument that having a tortoise in a library wouldn't necessarily pose much of a risk if it was kept in a cage or terrarium. That's probably reasonable, as long as good management and hygiene practices were used, but it's not a guarantee. Infections have been reported in households where the reptile never leaves its enclosure and in people who never have direct contact with it.
- Regardless, Franklin doesn't spend his days in a cage of any kind. He gets out and cruises around the library, especially in the carpeted Children's Room. That's a bigger problem. This tortoise is certainly not house trained (my tortoises' repertoire was pretty much limited to eat, poop, wander around, repeat... I don't think there was an extra neuron for something like litterbox training). Tortoises can also easily contaminate their feet and shell with feces. So, we have a potentially poop-contaminated tortoise who may also leave a fecal present at any time wandering around a carpeted (almost impossible to disinfect) surface on which young kids play. Not a good combination.
- See the picture above. The person is described as a "library senior aide" and is presumably in the high-risk group based on age. The tortoise has its leg (which presumably walked over some tortoise poop sometime in the recent past) practically in her mouth. That's not good either.
What should the library do?
1) Ideally find a good home for Franklin. One with no high-risk people.
2) If that's not an option, a protocol should be in place for how to manage Franklin and reduce the risk of Salmonella transmission. This would involve:
- Keeping him in a proper enclosure. Not letting him roam around public areas. Visits outside to walk around on the grass (during the appropriate seasons) are fine, but there should be no walking around general library areas (especially not the Children's Room).
- Not letting the general public handle him. Reptiles are "look but don't touch" pets.
- Emphasizing hand hygiene for anyone that has contact with Franklin or his environment, and facilitating hand hygiene by having convenient access to a properly equipped sink or alcohol-based hand sanitizers.
- Excluding high-risk groups from contact, if people are allowed to have direct contact with Franklin at all. Any public contact should be supervised and there must be immediate washing of hands or use of a hand sanitizer afterwards. Since this is unlikely to be done properly, avoiding all public contact makes the most sense.
- Using Franklin to help teach. Perhaps he could be brought out in a small glass terrarium and people could watch him as part of stories or other events. He (and the way he's handled) could also be used to explain things about infectious diseases and infection control.
Image source: www.wickedlocal.com
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)
Gurnee's Serpent Safari is being sued by the family of a two-year-old boy who allege the child contracted salmonellosis from a snake at the zoo. The child became ill and was hospitalized three days after visiting the zoo and petting a snake. The boy's mother got sick shortly thereafter. It's unclear if the same Salmonella strain was found in the snake or what degree of proof is present that the zoo was the source, but contact with reptiles is a huge risk factor for salmonellosis.
Exposure to zoonotic infections like Salmonella is an inherent risk of animal contact. We accept some degree of risk in everything that we do. The question is "Did the zoo take reasonable precautions to reduce the risk of disease transmission?" Based on the information in the Chicago Tribune news report, the answer is pretty clearly no.
There are standard guidelines for animal contact events that should be followed. These include:
- Children less than five years of age should not have contact with reptiles.
- There should be good, convenient access to hand hygiene (handwashing stations or alcohol hand sanitizers).
- Signs should be present to encourage people to wash their hands after animal contact and discourage high risk people (e.g. two-year-olds) from having contact with high risk animals (e.g. snakes)
The family alleges that the zoo is negligent because it:
- Did not have notices regarding handwashing after contact with reptiles.
- Did not provide hand sanitizers for patrons.
- Did not provide warnings regarding the risk of Salmonella for high risk groups.
- Allowed and encouraged the child to touch the snake.
We live in a pretty litigious society, but people need to assume responsibility for their (and their childrens') health and safety. However, exhibits that allow people to have contact with animals have a moral and legal responsibility to provide as safe of an environment as reasonably possible. Risk will never be zero and people can get sick from the best run events, but there is no excuse for failing to implement basic measures to reduce the risks.
.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.
My oldest daughter's latest favourite TV show is Cake Boss, a TLC show about life in a bakery (don't ask why... I guess it's better than John and Kate Plus 8). On a recent episode, they were making a cake for a circus sideshow and one of the performers appeared in the bakery's kitchen with a large albino snake. It makes for good entertainment but it's a break with common sense and presumably health codes.
Reptiles should never be allowed in a kitchen, let alone a commercial kitchen (especially one that presumably prepares items often eaten by children). Contact with reptiles is a significant risk factor for salmonellosis, and cross contamination is a concern in kitchens. All pets should be kept out of food preparation areas, but particular care should be taken around high risk species like reptiles, and every reptile should be assumed to be carrying Salmonella.
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.
I heard this on the radio yesterday morning, I kid you not: Butterball has a "Turkey Talk" toll-free helpline, which naturally gets busy around turkey holidays like Thanksgiving and Christmas. Like many helplines, they get stories of every kind, and this year apparently one person called in and asked if it was alright that she thawed her frozen turkey in the bathtub - while her kids were in it taking a bath!
Anyone who has read anything about food safety hopefully knows that raw meat can potentially be (and usually is) contaminated with many different pathogens - that's the biggest reason why observing proper cooking times and temperatures is so important. Raw poultry in particular should basically be treated like it's contaminated with Salmonella and/or Campylobacter until proven otherwise. You can just imagine the field day that these bacteria could have in a nice warm, wet bathtub - it's just the way they like it, and it's exactly what we try to avoid in the kitchen, where food is ideally kept either nice and cold or nice and hot in order to prevent (or at least minimize) bacterial growth. Then of all things to put young children in this veritable cesspool of bacteria - turkey and all - it's just a gastrointestinal disaster waiting to happen. You also needs to consider what the turkey could become contaminated with sitting in bathwater. Even children who don't have diarrhea can be shedding intestinal pathogens - human pathogens which are obviously transmissible to other people. If you really cooked that bird well (maybe deep-fried it) I suppose that should ultimatley eliminate any surface contamination anyway, but I don't think I'd be able to get past the "ick" factor. Don't throw the baby out with the bathwater, but of there's a turkey in there (as far as I'm concerned) that can go.
I realize this is primarily a food safety issue, but it made me think about what else this person (or others) may put in a bathtub. In previous posts in which we've talked about reptiles kept as pets (all of which should be treated as Salmonella carriers), we've mentioned that ideally (if they need a bath) they should be bathed in their own designated container (like a big rubbermaid) and not in the bathtub. If there is no other option and the bathtub must be used, it should be thoroughly cleaned and properly disinfected (keeping contact-time with the disinfectant in mind) before it is used again by a person (especially children).
Ideally the same precautions should be taken if you bathe a dog in the bathtub, but the risks are not as high as with reptiles (unless the dog is very dirty, has skin lesions, or has (or recently had) diarrhea). We've talked about the limited risks of allowing dogs in backyard swimming pools (but of course there is even less chlorine in bath water). I hope no one ever bathes their dog with their kids - we could debate the risks, which likely aren't high anyway, but in the end the risk is simply unnecessary. The pool is one thing, but there's no reason for a dog to be in the tub at the same time as the kids (and really, how clean are the kids going to get with a dirty dog in the tub?). If you're trying to save water you can always throw the dog in after the kids are out.
If you're attempting to bathe a cat in the tub... well, based on most feline behaviour I'd say your primary risks are bites and scratches more than enteric bacteria and parasites. Proceed at your own risk!
A happy (and hopefully healthy) American Thanksgiving to all of our US readers!
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.
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.
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.
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.
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.
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.)
- 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.
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.
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.
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.
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.
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.
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.
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!
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.
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
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.
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.
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
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.
- 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.
2012 International Clostridium difficile Symposium
2012 International Conference on Equine Infectious Diseases IX
2011 ASM-ESCMID Conference on Methicillin-resistant staphylococci in animals
- Miconazole susceptibility of MRSA and MRSP
- Livestock associated MRSA in community hospitals in Ontario
- Equine hospital MRSA surveillance
- Biofilm production by S. pseudintermedius
- Methicillin-resistant staphylococcal pyoderma in dogs, and impact of treatment on colonization rates
- Surgical site infections in a small animal hospital
2011 University of Guelph Centre for Public Health and Zoonoses Symposium
- Pet ownership, interactions and animal-associated disease risks in Canadian households
- Metagenomic investigation of the oral microflora in healthy dogs
2011 Canadian Animal Health Laboratorians Conference
2011 Canadian Association of Clinical Microbiology and Infectious Diseases
- 2011 American College of Veterinary Internal Medicine Forum, June
- 2011 ASM-ESCMID conference on methicillin-resistant staphylococci in animals, Sept