Deja vu all over again: Turtles and Salmonella
You'd think, after countless outbreak of salmonellosis associated with pet turtles, that people would learn and things would start to improve. I guess not. A paper published this week in Pediatrics (Harris et al) described a large outbreak of Salmonella Java associated with pet turtles. Between May 2007 and January 2008, 107 infections were identified. The median age (the age in the middle of the range of affected people) was seven years old. Sixty percent of infected people reported exposure to turtles during the week before they got sick; 87% were small (<4 inch) turtles, and 34% were purchased at a retail store (despite the fact that the sale of turtles less than 4 inches long is banned in the US). Five infected people, all less than 10 years of age, reported kissing the turtle or putting it in their mouths.
When they compared people with Salmonella Java infection to people without the infection, 72% of people with Salmonella reported contact with turtles versus only 4% of controls.
Salmonella is far from rare but it's nothing to ignore. Thirty-three percent of infected people were hospitalized. Fortunately, no one died.
The link between turtles and Salmonella has been known for a long time. Healthy turtles can carry the Salmonella bacterium and be a source of infection, particularly for children. The sale of small turtles is banned in the US to reduce the likelihood of close contact between turtles and kids, but this law is widely flouted. An understanding of the link between turtles and Salmonella is surprisingly uncommon - only 32% of Salmonella patients in this study (and 28% of controls) reporting knowledge of this link. Clearly, there are a lot of areas which could be improved.
- If banning the sale of small turtles is truly an effective measure, then it should be enforced. "Black market' turtles are far too easy to find.
- More public education is needed, among the general population and particularly people buying turtles. You shouldn't be able to take a turtle home from a store without an information sheet about the risk of Salmonella and how to avoid it.
- People with turtles (or any reptile) need to recognize the risk and act appropriately. Good general infection control and hygiene measures are needed to reduce the risk of Salmonella exposure.
- Households with children under five years of age, or with immunocompromised individuals should not have pet turtles.
- Antibiotics are not the solution. Attempts to create Salmonella-free turtles with drugs have just led to the production of turtles carrying antibiotic-resistant Salmonella.
- Common sense needs to be a little more common. The picture above (from http://www.familylovezone.com/js_DeepAndWide.htm) was proudly posted by a parent.
More information about infectious disease risks associated with turtles can be found on the Worms & Germs Resources page.
More about turtles and Salmonella
In response to recent posts about Salmonella and turtles, a reader posed these questions:
Okay, so turtles and tortoises can carry salmonella. Does that mean that all do?
- Not all, but a lot of them do. Aquatic turtles are probably a greater risk than tortoises.
If a vet analyzes a poop sample from my Russian Tortoise and there is no Salmonella, does that mean we can quit worrying about it?
- Unfortunately no. We can never be confident in declaring a reptile "Salmonella-free." Salmonella can be shed intermittently, so a single negative sample doesn't mean the reptile is truly negative. We don't know what the optimal testing protocol is in terms of what to sample, how often to do it and how many samples are needed. I'd never tell anyone a turtle or tortoise is Salmonella-free. To err on the side of caution, we have to assume that all reptiles are carrying Salmonella.
Conversely, if the poop does show Salmonella, is there any way to eliminate it from the tortoise and then quit worrying about it? Our tortoise is isolated from other pets and only eats what we consider clean, fresh produce - so I am hoping the chance of reinfection would be minimal.
- Unfortunately, no again. There's no proven way of eliminating Salmonella from a reptile. Getting rid of Salmonella in an animal that is a carrier is different than treating a typical bacterial infection. Salmonella is a commensal bacterium in reptiles, meaning it can be a normal component of the animal's bacterial microflora. It is very difficult to eliminate commensal bacteria since they have evolved to survive in (or on) their host. Unlike in clinical infections, which tend to be short term infections of a site where the bacterium does not normally live, using antibiotics to eliminate Salmonella carriage is unlikely to be successful. Giving antibiotics can also upset the normal intestinal bacterial population, which can actually make it more likely for bacteria like Salmonella to proliferate. Salmonella can also live inside intestinal cells, where most antibiotics can't reach them. Treatment, therefore, is unlikely to be ineffective, and might just result in increased antibiotic resistance (something we certainly want to avoid).
Check out the Worms & Germs Resources page for more information.
Red eared slider turtle rebuttal
Following a report on black market turtle sales in Maryland, a letter to the Baltimore Sun by Maryland veterinarian Dr. Jeffery Rhody wanted to "set the record straight".
"All reptiles carry salmonella as part of the normal bacterial population in their body."
- Not really true, however Salmonella can commonly be found in healthy reptiles, so the overall sentiment is valid.
"The risk of getting infected with salmonella from a reptile can be greatly reduced with common sense hygiene practices."
- Absolutely. General infection control practices are critical to reduce (but they do not eliminate) the risk of Salmonella transmission.
"In fact, the incidence of reptile-borne salmonella infections is much less than salmonella infections obtained from improperly handled poultry products."
- Statistics can be manipulated to either support or refute this. The absolute number of Salmonella cases from food is certainly greater than those from turtles. However, I'm not so sure turtles end up looking good when you consider the number of cases compared to the number of people exposed to these factors - a lot more people eat food than own turtles. The number of cases of Salmonella associated with reptile contact every year is stunning, even though only a small percentage of people own reptiles. Fatal infections can occur, so it's not something to take lightly. Statements like the one above can get into some questionable logic, like saying that a machine gun can kill more people than a handgun, so handguns must be safe. Certainly, Salmonella is a risk with handling raw poultry, and efforts are taken to get people to reduce risky behaviours (like contaminating kitchen surfaces with raw meat). The same should apply to reducing risky behaviours with regard to pet contact.
"Of course, if you lick a turtle, the risk of salmonella infection is greatly increased."
- Yep. That's why the focus is on small turtles. But, people get Salmonella from larger turtles too.
"No one who owns a slider should be concerned about breaking the law."
- They should, however, be concerned about getting sick. Turtle owners should learn about risks and preventive measures from sources such as a the information sheet in our Resources page.
As someone who has owned turtles, I understand the appeal of these animals. As someone involved in zoonotic diseases, I understand the risks. People need to have enough information to understand the risks and benefits, to make logical, informed decisions. The risks to healthy adults who handle the animals properly is quite low. That's why the focus is on high risk households like those with young children, the elderly or immunocompromised individuals. There are good reasons for the ban on the sale of small turtles. Banning the sale of small turtles doesn't hurt anyone (except for people wanting to profit from selling them), and may prevent disease. Seems logical to me.
Black market turtles in Baltimore
There is apparently a thriving black market for baby red-eared slider turtles in Baltimore. The sale (and possession) of small turtles is illegal in Maryland, like many other regions, largely because of public health concerns regarding Salmonella.
Over 100 hatchling turtles have been seized in the past 2 weeks. Baby turtles offer a good profit margin for black market vendors. They can be purchased from farms in the southern US for about $1 each and then resold for many times that amount. One person was caught selling turtles out of the back of a van. (Why anyone would buy anything from someone selling out of the back of a van is beyond me!)
People buy turtles thinking they make cute pets, not realizing what they need to do to keep them healthy as they grow. Turtles that are fortunate enough to be raised properly create another problem, since most people are not willing or able to take care of adult turtles that reach 10-12 inches in length. This can result in turtles being killed or abandoned.
Another major problem in the risk of Salmonella. Turtles very commonly carry this potentially harmful bacterium, and they are an important source of infection in people. The concerns are greatest with young children who may handle small turtles and put them in their mouths. People need to think before they buy. Before getting any pet, learn about the animal, including requirements for care and human health risks (and also if it's legal). A little common sense goes a long way.
More information about Salmonella and turtles can be found on the Worms & Germs Resources page.
Exotic animals in daycares... another bad idea
One more post about illogical and dangerous activities associated with animals and young children and I'll hopefully get off the subject for awhile. I came across this daycare's website today. Keep in mind (again) that the the Centers for Disease Control and Prevention (CDC) recommends that children less than 5 years of age not have contact with reptiles, and that the Compendium of Measures to Prevent Disease Associated with Animals in Public Settings published by the National Association of State Public Health Veterinarians states that wild or exotic animals may not be appropriate in school settings. The photo gallery from this particular daycare included some great pictures of things that you should NOT do with young children. Some of the more striking example are below:
1) Letting a large snake wrap its body around the neck of a young child.
2) Letting a young child kiss a snake.
3) Letting a child touch a turtle.
4) Letting a young child pet a pygmy hedgehog. (Like reptiles, hedgehogs very often carry infectious pathogens, including Salmonella.)
I wonder...
- whether anyone made sure these children immediately washed their hands after they touched the animals.
- how may kids but their hands in their mouths before they washed their hands. (Probably almost all of them, considering the "animal visit" probably went on for quite a while.)
- whether this activity took place in the same area where the children later ate lunch or a snack.
- whether the parents knew that this was going to happen.
I'm not against young children having contact with animals. I think pet contact can be very rewarding for young children. However, these individuals are at higher risk for infection and it is our responsibility to protect them. Putting them in high risk situations like these is inappropriate. Animal visitation in daycares is not necessarily a bad thing, if it involves animals that are a low risk species (e.g. dogs and cats), that are healthy, and that have been temperament tested (to show they are at low likelihood of biting). It is also important that parents provide consent for their children to participate, that good hygiene practices are used (and enforced), and that the people bringing in the animals know what they are doing.
Salmonella and turtles info sheet
BarfBlog is a food safety blog run by Dr. Doug Powell, who used to be at the University of Guelph, before moving to Kansas State. (I played hockey with him and can confidently state that he is one of the better hockey goalies working in food safety in Kansas). Doug and his group have put together numerous useful, and often entertaining, fact sheets about food safety issues, as well as some related infectious disease and infection control topics. One of those is about Salmonella in pet turtles, something we've discussed on Worms&Germs periodically. The info sheet, and associated commentary from Ben Chapman, can be found here.
Nontraditional Pets and Children: Beware
A report about the health risks in children associated with nontraditional pets was recently published in Pediatrics, the official journal of the American Academy of Pediatrics. The report also discusses diseases associated with animals in public settings such as petting zoos and pet stores. Although contact with pets and animals can be beneficial to growth and development in children, it is very important to be aware of the risks associated with certain kinds of animals. Physicians, veterinarians and public health personnel can help parents select appropriate pets in order to maximize the benefits while minimizing the risks to children.
One of the most important pathogens discussed in the report is Salmonella. Although Salmonella can be transmitted by many animal species, including traditional pets like dogs and cats, it is a particularly high risk with certain other kinds of pets, including reptiles, amphibians and baby poultry (chicks and ducklings). It has been estimated that direct or indirect contact with reptiles or amphibians is responsible for 6% of all sporadic Salmonella infections in the US, and 11% of cases among people younger than 21 years. There is also a relatively high risk of Salmonella transmission associated with animal-derived pet treats, such as pig ears, and raw meat.
The report makes several recommendations about how to reduce the risk of infection, injury and allergies from nontraditional pets, many of which you may have seen before on the Worms & Germs website. Just a few of these are:
- Always wash your hands after contact with animals, animal products or their environment, and after contact with animal-derived pet treats.
- Supervise hand washing for children less than five years old
Children less than five years of age and individuals with weakened immune systems should avoid contact with reptiles, amphibians, rodents, ferrets and baby poultry. These animals:
- Should not be kept as pets in households where children less than five years of age or individuals with a weakened immune system live.
- Should not be brought to childcare centres.
- Should not be allowed to roam freely in ANY house or living area.
- Should not be permitted in kitchens or anywhere food is prepared.
More information about Salmonella in pets and the risks associated with feeding raw meat and animal-derived treats to pets can now be found on the Worms & Germs Resources page.
Salmonella outbreak linked to turtles
Yet another reminder of the risks associated with handling turtles (and other reptiles) comes to us from a report published earlier this year regarding an outbreak of salmonellosis in people tied to contact with turtles. In this case, more than 100 people in 33 US states were affected. The report sparked additional public education efforts in Los Angeles county, CA, where eight of the cases occurred.
The report comes as no surprise - turtles are actually relatively commonly implicated in cases of salmonellosis in people (although still not nearly as commonly as foodborne transmission). It's particularly a concern in children, because kids may have close contact with pet turtles and may be more susceptible to serious infection.
In response to the cases in Los Angeles, the county Department of Public Health emphasized that parents must be wary of buying turtles for their children. Even though the sale of small turtles (less than 4 inches long) was banned in the US over 30 years ago, unfortunately these animals are still widely available in many pet stores, flea markets, and from other sources. Los Angeles Public Health personnel reported that children were getting sick because they were kissing their pet turtles - something that is very risky and should never be done by anyone, especially children. If people have pet turtles, they must be very diligent to practice good hygiene to reduce the risk of transmission of Salmonella.
More information about the risks associated with pet turtles, and measures that should be taken by people who own turtles, is available on the Worms & Germs Resources page.
Information Sheets for Pet Owners
INFORMATION SHEETS specifically for KIDS, for VETERINARIANS, for PHYSICIANS and for PUBLIC HEALTH PERSONNEL are also available on the Worms & Germs RESOURCES page!
Click on the highlighted topics below for information sheets. Topics that are not highlighted are in development and coming soon. Sheets for other animal species and diseases are also under development and will be added when they are available.
| Animals | Diseases | Other |
| Dogs | Rabies | Litter Boxes |
| Cats | Giardia | Sandboxes |
| Turtles | Toxoplasma | Cat Bites |
| Hamsters | Leptospira | Raw Meat |
| Rabbits | Clostridium difficile | Petting Zoos |
| Pet Birds | Cryptosporidium | Needlestick Injuries |
| Reptiles | MRSA | |
| MRSP | ||
| Salmonella | ||
| Ringworm | ||
| Campylobacter | ||
| Bartonella henselae | ||
Please Remember:
- Your veterinarian and physician are your ultimate resource for information about the health of your pets or your family.
- Information provided here is accurate to the best of our knowledge, but infectious diseases can be unpredictable and these sheets are for general information purposes only.
- There can be great variation in disease risks in different geographic areas. The information provided was developed for Ontario, Canada, but most of the information is relevant for other regions as well.
