April showers bring May flowers.
…and I can’t come up with a good rhyme for salmonellosis.
Nonetheless, it’s Salmonella season, courtesy of cute but biohazardous baby poultry.
You can buy chicken, turkey and other bird eggs to hatch every spring. Our local feed mill had the order forms out a while ago, and you can also buy them over the internet. Some schools still buy them.
The problem is baby poultry are high risk for shedding Salmonella (and Campylobacter, another problematic bacterium). Every year, outbreaks of disease in people occur from contact with hatching chicks, so the message isn’t getting around or getting through to people.
In the latest CDC report, 60 people in 23 US states have been diagnosed with salmonellosis linked to a single hatchery that "has been associated with multiple outbreaks of salmonellosis linked to live poultry in past years, including in 2012 and 2013." (How many outbreaks does it take to tell you your company is probably doing something wrong, or in the wrong business?)
The figure of 60 infected people is probably an underestimate, since it’s expected that many people were probably sick but didn’t go to a doctor or submit a stool sample for testing. Of the 60 diagnosed cases, 31% ended up hospitalized, re-enforcing that fact that this is a serious problem.
While the hatchery said they are “working collaboratively with authorities at the Ohio Department of Agriculture and CDC as they proceed with their investigation,” the Ohio Deptartment of Agriculture tellingly stated “The more accurate description of our relationship with that company has been we have tried to provide guidance through the years, but I don't know how many of the recommendations that we have brought to them have actually been implemented.”
Sadly (and bizarrely, from my standpoint) the agiculture department doesn’t have any authority to require the hatchery to implement recommended changes. "We're trying to tell them what they need to do in order to keep this from happening every year." How many people does one company need to sicken before they are forced to do things right (or shut down)?
This report shows a few things.
- Some people just don’t learn (sellers and buyers alike)
- Regulation of animal production for sale to the general public is horribly lax
- Contact with young poultry is a major risk factor for salmonellosis.
- The industrial scale of production of eggs for hatching chicks (and some pet species) means that a problem with a single facility can lead to widespread disease.
- It’s a "buyer beware" world. Don’t trust that the critter you just bought is pathogen free, and take measures to protect yourself.
- High-risk individuals should not be around hatching chicks because of the risk of salmonellosis. This includes kids less than 5 years of age (a key target group for sellers), elderly individuals, pregnant women and people with compromised immune systems.
Photo copyright: piep600 / 123RF Stock Photo
Allegedly, spring is here. The foot of snow on the ground and minus double-digit temperatures don’t really convince me, but the calendar can't lie, I guess.
Anyway, spring brings with it many things, one of which is hatching chicks. I saw signs for them at a local farm supply store a couple of days ago, and perhaps not coincidentally, this week’s edition of CDC’s Morbidity and Mortality Weekly Reports provides an update on the 2012 human Salmonella outbreak that was linked to contact with chicks and ducklings from a single supplier.
This outbreak has been talked about before, but this report gives some final numbers.
- Ultimately, 195 people infected with the outbreak strain of Salmonella Infantis were identified. (That’s probably a major underestimation too, since in outbreaks like this lots of people get sick but don’t have fecal cultures for Salmonella performed.)
- 33% of affected individuals were children 10 years of age or less.
- 79% of people who got sick reported contact with poultry in the week before illness started.
- Birds were obtained from various feed stores or directly from hatcheries, and 87% of people that provided information about chick or duckling sources reported getting them from a single mail-order hatchery in Ohio.
Chicks and Salmonella go hand-in-hard. Chicks are high-risk for shedding the bacterium, and people can get infected by handling chicks or having contact with their environment. Children are at high risk for infection since they tend to have closer contact with chicks and because they are more susceptible to Salmonella. That’s why it’s recommended that kids less than 5 years of age not have contact with young poultry. Day cares and kindergartens planning on their annual hatching chick programs… please take note.
The article includes some more recommendations.
- Feed stores should use physical barriers (e.g., a wall or fence) between customers and poultry displays to prevent direct contact with poultry.
- Educational materials warning customers of and advising them on how to reduce the risk for Salmonella infection from live poultry should be distributed with all live poultry purchases
Part of the last point is keeping young kids away from chicks and stressing good hand hygiene practices. Like most things in infection control, a little common sense goes a long way.
At this time of year, I start to see ads from local feed supply stores about annual chick sales. Overall, it's not a big deal and most people that buy chicks don't have problems. However, it can be a particular concern for certain high risk groups, particularly young children, and outbreaks of salmonellosis are a recurring issue.
Contact with young poultry is considered very high risk for Salmonella exposure, since Salmonella shedding rates amongst the little guys are pretty high. Most outbreaks of salmonellosis disproportionately involve young kids, due to a combination of increased handling, poor hygiene and inherent increased susceptibility of young kids to infection. The problem is that sometimes people buy chicks because their young kids want to raise and handle them. Outbreaks associated with sales of young chicks, as well as hatching chicks in schools and daycare, have been reported.
A recent CDC report describes yet another multistate outbreak of Salmonella, this time associated with a mail-order hatchery.
The outbreak occurred from February to October 2011 and was first noticed through lab-based identification of clusters of Salmonella Altona and Salmonella Johannesburg. Ultimately, 68 cases of S. Altona and 28 of S. Johannesburg infection were identified in 24 states. Here are some highlights:
- 32% of people with S. Altona and 75% with S. Johannesburg were kids 5 years of age or younger.
- 74% of people with S. Altona and 71% of people with S. Johnannesburg reported recent contact with young poultry.
- Most people that had poultry contact reported purchasing chicks or ducklings at local agricultural feed stores. These stores got the chicks and ducklings from a single mail-order hatchery.
Mass production of animals for widespread distribution, whether it's guinea pigs like I wrote about the other day, or chicks and ducklings here, increases the risk of widespread outbreaks because a single focus of infection can have far-reaching effects.
Mass production and mail-ordering of chicks isn't likely to stop, so what can people do to reduce the risk?
- Keep high-risk people (that is kids 5 years of age or less, elderly individuals, pregnant women and people with compromised immune systems) away from young poultry. This includes keeping chicks out of schools, where hatching chicks is still performed in some areas.
- Use good hygiene practices when handling chicks or anything in their environment. Assume that all of the chicks are shedding Salmonella and treat them accordingly. By that I mean use good general hygiene practices, particularly hand hygiene, to reduce the risk of exposure.
- Stores selling chicks should also provide basic safety information to inform and remind people to use appropriate practices to reduce the risk of infection.
The US CDC is investigating yet another multistate outbreak of salmonellosis associated with contact with chicks and ducklings. As of June 18, 39 people have been diagnosed with Salmonella Altona infection (with a large number of others presumably infected, since only a minority of cases tend to be diagnosed). People in at least 15 states have been affected, as indicated by the map on the right.
Reported cases so far occurred between February and the end of May, but the outbreak could still be ongoing. Of all the affected individuals, 28% have been hospitalized but there have been no deaths.
Outbreaks like this lead to investigation of possible sources, starting with the usual suspects of high-risk foods and animal contact. In interviewing people that became sick, 81% of them reported having contact with live poultry before getting sick. In people that identified the type of poultry, all reported contact with chicks, ducklings or both. All 19 people that provided information about the source of chicks or ducklings reported getting them from different locations of a nationwide agriculture feed store (which is not being identified). The same strain of Salmonella was isolated from ill people and chick/duckling displays in two store locations. A single mail-order hatchery was then identified as the source of the animals.
Large distributors of animals, especially high-risk animals like chicks and ducklings, can be the sources of large outbreaks since they can supply large numbers of infected animals to a large region. While cute, chicks and ducklings are high risk for carrying Salmonella and they can shed large numbers of Salmonella in their feces without showing any signs of disease. That's why standard recommendations are that high risk persons (e.g. children less than 5 years of age, immunocompromised or elderly individuals) should avoid contact with baby poultry.
In the context of this outbreak, since the store is not being named (and since it's possible the hatchery sent chicks to other sources), anyone who has had contact with chicks and ducklings needs to be aware of the potential for Salmonella exposure. In reality, this is also true outside of the context of this outbreak, since Salmonella exposure needs to be considered after any contact with chicks and ducklings. It doesn't mean that people who have had contact with baby poultry should go to the doctor, get tested, or do anything different. However, it is important that people notify their physician about poultry contact should they get sick. For more information about reducing the risk of Salmonella exposure from poultry, click here.
Easter is one of those holidays when there are concerns about dumb pet purchases. Spur-of-the-moment purchases of inappropriate pets can lead to animal suffering and death, and risk of human infection. Easter's problems: baby chicks and rabbits.
Rabbits can make great pets. They're a long-term commitment, but they’re relatively low maintenance, a lot is known about how to raise them and they are generally low risk for transmission of infections to people. Chicks are a different story. Chicks are notorious Salmonella vectors and have been linked to numerous outbreaks. They are easily injured and often improperly raised. They also grow up (well, some of them do, at least) to be full sized poultry, something that most people don't really want.
A story from Vidalia, Georgia highlights some of the issues with Easter pets. In it, Tracy Gunn describes his need to buy a chick for his daughter - and not just any old chick, but a dyed chick, something that’s illegal in 36 US states, but not Georgia. Gunn states "I don't know what she's going to do with it." Sounds like a recipe for a few minutes of novelty, followed by a relatively short life for the chick. At least his daughter’s 17, and not in the high risk group for salmonellosis.
Alongside the cage full of multicoloured chicks was a collection of rabbits.
“The bunnies sell real good for Easter. We've been selling a lot of them about the last month. Can't keep enough of them.” said a store employee.
He followed that up with “They buy (rabbits) for their kids for Easter, then they take Easter pictures and stuff like that with them, I'm not sure about what happens to them afterward.”
That’s the problem. Kids get a few minutes of novelty enjoyment, but then a lot of those animals end up dead, released into the wild (not a good thing) or dropped off at an animal shelter, because people don't think about the "afterward" part before they buy.
Pet purchases need to be made with thought and foresight:
- Do I really want this pet?
- Am I committed to taking care of it for its entire life?
- Can I take care of it properly with my current living situation?
- Can I afford to take care of it properly?
- How do I take care of it?
- Are there any disease risks that I need to be concerned about?
- Are there any people in the household who are at high risk for disease caused by this type of animal?
If you can't answer these questions, don't buy or adopt an animal - of any kind.
A sure sign of spring is the proliferation of classrooms hatching out chicken or duck eggs. While chicks may be cute and entertaining, they are also high-risk sources of Salmonella and some other infectious microorganisms. Numerous Salmonella outbreaks have been linked to contact with hatchling chicks, and care must be taken if teachers are considering having chicks in classrooms.
Things to consider:
- Who will be in contact with the chicks? Children under 5 years of age, pregnant women and people with compromised immune systems should not have contact with young chicks. This rules out having chicks in preschool and some kindergarten classes, however not everyone follows those standard recommendations. It's also very hard to know whether there may be immunocompromised kids in the classroom. Unless a teacher/school is sure that there are no high-risk children present, they shouldn't have high risk animals.
- Where will the chicks be hatched and raised? Is it in a contained area?
- Is the chick area easily and always supervised to ensure that rules are followed? This is important for both children and chicks, since chicks can easily be injured or killed through improper handling.
- Are protocols in place regarding safe handling and hygiene?
- Are the chicks going to be in an area where students eat?
- Are parents going to be notified in advance?
- Are there plans for sending the birds to an appropriate home when they're done in the classroom?
- Are the chicks there for a true educational purpose, or just as a novelty?
Hatching chicks can be done relatively safely in appropriate classrooms, with older children, no high-risk individuals, easy access to hand hygiene stations, appropriate protocols and proper supervision. The problem is, these aren't always (or even often) present, and inadequate thought often goes into bringing chicks into classrooms.
It's encouraging to see the number of press reports warning people not to bring home baby chicks or ducklings as Easter presents for kids. The warnings are because of the potential risk of salmonellosis associated with contact with poultry and fowl, particularly among children. Young kids (less than five years of age) are at high risk for this type of infection, and are at higher risk of developing more serious illness and complications. They also tend to be at higher risk for exposure because of the close nature of contact that they may have with pets, or in this case Easter chicks. Add close contact and increased susceptibility to the generally low level of hygiene associated with household animal contact, and you have a perfect recipe for sick kids.
Salmonella carriage is an ever-present concern with chicks and duckings. It doesn't matter how they were raised or from where they came - you can never know by looking it it whether a baby bird is shedding Salmonella, and you should assume that they all are to be on the safe side.
The CDC has some basic advice on the topic. The key points are:
- Never buy chicks or ducklings on a whim. If in doubt, buy a stuffed animal.
- Never buy chicks or ducklings for kids under five years of age or people with compromised immune systems. These individuals should not have any contact with chicks or ducklings.
- Don't let these animals roam freely around the house. They're not house trained and can contaminate the household environment.
- Always wash your hands thoroughly after contact with chicks or ducklings.
- Don't eat around chicks and ducklings, since it increases the chance of inadvertently ingesting Salmonella.
Baby chicks and ducklings don't make good pets because of the Salmonella risk. They also grow up, and become larger, messier, and noisier birds for which many people are not prepared to care. Don't buy a baby bird unless you have a low risk household, can properly implement measures to reduce the risk of exposure to Salmonella, and have a plan to properly take care of the bird when it gets older.
The Centers for Disease Control and Prevention (CDC) has released updated Guidelines for the Prevention and Treatment of Opportunistic Infections Among HIV-exposed and HIV-infected Children. A small but still important part of this document involves recommendations for contact with animals. It's a nice, balanced document that acknowledges the risk but doesn't make unnecessarily restrictive recommendations.
Among the important recommendations regarding animals:
- When getting a new pet, avoid dogs and cats less than 6 months of age or strays: These animals are at higher risk for shedding various infectious diseases and are more likely to have problems with biting and scratching.
- Avoid contact with animals that have diarrhea.
- Wash hands after handling pets.
- Avoid contact with pet feces.
- Avoid contact with reptiles, chicks and ducklings: These are very high risk for Salmonella.
- Avoid contact with calves or lambs at farms or petting zoos: These animals are high risk for various infectious diseases such as Cryptosporidium and Salmonella.
These recommendations also largely apply to other high-risk groups, including people (of all ages) with compromised immune systems and young children (especially less than 5 years of age). A key point is normal contact with common household pest using basic hygiene practices is considered a low risk. Infection control isn't rocket science. It involves basic and practical measures that can reduce risks associated with animal contact.
Just last week I blogged about concerns regarding young children handling baby chicks in classrooms. Baby chicks are high-risk animals because of the potential for transmission of Salmonella. The Centers for Disease Control and Prevention (CDC) recommends that children less than 5 years of age not have contact with baby chicks for this reason. Unfortunately, few people seem to know this (or at least pay attention to it). If I have a problem with baby chicks in kindergarten classrooms, you can imagine the conniption I have about chicks in preschools. These pictures illustrate my concerns in phenomenal fashion.
If you look closely at this first picture (right), you can see the plop of "chick poop" on this child's sweater (which he seems all too happy about). The picture is from a blog written by the child's mother - she gives absolutely no recognition that this is an infectious disease concern.
The second picture (left) is from a news article about a preschool. The preschool obviously has no clue about infectious disease risks because they allowed this c to put the chick on his head and were apparently proud enough of it to have the reporter take a picture.
And last but certainly not least, we have a great picture (below) of a child either kissing a chick or eating very undercooked poultry. Either way, it's a bad idea. This picture is from another parent's blog, who apparently thought it was cute.
Baby chicks should not be in preschools - ever. The novelty factor of having chicks in the facility does not supercede the infectious disease risks and recommendations from public health agencies.
An annual "ritual" in some schools is hatching chicken eggs in the classroom. This can be a great educational experience for children as they learn about eggs and incubation, watch them hatch and see the baby chicks. It can also be a great source of infection for children if certain precautions are neglected. The picture on the right, from an article in the Ilkley Gazette, shows a good example of a bad idea. This four-year-old boy has a newly hatched chick on his shoulder. Why does this bother me?
- Chicks are a great source of potentially harmful bacteria, particularly Salmonella.
- You can't litter train a day-old chick. I wouldn't be surprised if it left a little biohazardous "present" on the child's shoulder.
- Outbreaks of salmonellosis in people associated with baby chicks have been reported.
- The Centers for Disease Control and Prevention (CDC) recommends children under five years of age should not have contact with chicks.
If there are going to be chicks in a classroom:
- They should only be in classrooms with older students.
- Contact with chicks should be restricted and always supervised.
- Careful attention must be paid to handwashing. Everyone who handles chicks or comes in contact with their environment (e.g. box, cage, incubator) should immediately and thoroughly wash their hands.
- Chicks should never be allowed to roam free in the classroom.
- Chicks should never be handled during lunch or snack time.
- Immunocompromised children should not be present in the class.
It's common sense, but it's amazing how uncommon "common sense" seems to be sometimes.
My oldest daughter is in Grade 2, and last year her class hatched chicken eggs in the classroom. As a parent, I was somewhat torn about the idea. My main concern was the risk of exposure to Salmonella. A recent article in Morbidity and Mortality Weekly Reports described outbreaks of salmonellosis associated with contact with live poultry. Most cases were associated with handling baby chicks obtained from agricultural stores or by mail order. Infections from classroom and petting zoo-associated contacts were also reported.
Salmonella contamination of eggs and carriage by baby chicks is very common. The CDC recommends that children less than five years old do not have any contact with baby chicks, and that older individuals pay close attention to hygiene in order to prevent transmission of Salmonella. Being six years old, my daughter was just over this age cutoff (although there's nothing magical about going from five to six years old, so I'd still consider her at somewhat higher risk). So, as long as good infection control practices were used (e.g. hand hygiene), the risk to the children was probably quite low. Were the benefits of hatching eggs in the classroom worth the risk? I don't know, but she enjoyed the experience and did learn a few things along the way. Concerns about infectious diseases are often dismissed, which is a problem, but sometimes excessive concern gets in the way of life. There's rarely a clear answer as to what is acceptable and what is too risky, given the potential benefits.
- Eggs and chicks should not be kept in classrooms where children under five years old will be present, or if there are immunocompromised children in the class. It's unclear whether all teachers would know if they had a high-risk child in the class. Parents of immunocompromised children should make sure teachers know about their child's increased risk.
- It is prudent for teachers to send home a note to inform parents if eggs/chicks will be in the classroom, or if similar activities involving animals are undertaken.
- Eggs and chicks should be kept in a complete enclosure, in an area that is always supervised when children are around.
- Chicks should always be kept in their enclosure. They should never be taken to areas (e.g. a student's desk) where food might be consumed.
- Direct contact with eggs and chicks (and their environment) should be kept to a minimum.
- Hands should be thoroughly washed or an alcohol hand sanitizer used immediately after contact with eggs, chicks or their environment.
- Appropriate thought should go into the use of eggs and chicks in classrooms. They should be there for more than the "novelty factor". There should be a clear teaching plan associated with them so they provide the maximum educational value possible.
- Testing eggs and chicks for Salmonella isn't practical. A negative result cannot guarantee that Salmonella is not there. As well, there are other infectious diseases that are of concern. Consider all eggs and chicks Salmonella-positive and handle them appropriately.