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Published Date: 2013-05-25 23:40:48
Subject: PRO/AH/EDR> Salmonellosis, multiple serotypes - USA: pet turtles
Archive Number: 20130525.1737232

SALMONELLOSIS, MULTIPLE SEROTYPES - USA: PET TURTLES
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International Society for Infectious Diseases
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Date: Thu 24 May 2013
Source: CDC [edited]
http://www.cdc.gov/salmonella/small-turtles-03-12/index.html

Highlights
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-A total of 391 persons infected with the outbreak strains of Salmonella have been reported from 40 states and the District of Columbia.

-29 percent of ill persons have been hospitalized, and no deaths have been reported.

-71 percent of ill persons are children 10 years of age or younger, and 33% of ill persons are children 1 year of age or younger.

-45 percent of ill persons are of Hispanic ethnicity.

-Results of the epidemiologic and environmental investigations indicate exposure to turtles or their environments (e.g., water from a turtle habitat) is the cause of these outbreaks.

-70 percent of ill persons reported exposure to turtles prior to their illness.

-89 percent of ill persons with turtle exposure specifically reported exposure to small turtles (shell length less than 4 inches).

-30 percent of ill persons with small turtles reported purchasing the turtles from street vendors, and 13 percent reported purchasing small turtles from pet stores.

-4 of the outbreaks remain under active investigation. However, turtles are an important cause of human salmonellosis in the USA.

-The FDA has banned the sale and distribution of turtles with a shell length of less than 4 inches in size as pets since 1975. These small turtles should not be purchased as pets or given as gifts.

Investigation Overview
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4 of the 8 multistate outbreaks remain under active investigation and updates for these outbreaks are listed below. The outbreaks are numbered in the order in which they were identified.

Outbreak 1: _Salmonella [enterica_ serotype] Sandiego, Strain A &_S._ Newport, Strain A
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Case Count Update:
A total of 100 individuals infected with _S._ Sandiego, strain A and _S._ Newport, strain A have been reported from 18 states. 7 new ill persons have been reported from Arizona (1), California (3), Illinois (1), Massachusetts (1), and Ohio (1).

Illness onset dates range from 3 Aug 2011 to 6 May 2013. Ill persons range in age from less than 1 year to 86 years, with a median age of 6 years. 63 percent of ill persons are female. Ethnicity was reported for 38 ill persons, and of these, 27 (71 percent) were Hispanic. Among 60 persons with available information, 13 (22 percent) reported being hospitalized. No deaths have been reported.

Outbreak 2: _S._ Pomona, Strain A
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Final Case Count Update:
A total of 19 individuals infected with _S._ Pomona, strain A were reported from 11 states.

Illness onset dates ranged from 9 Dec 2011 to 22 Jan 2013. Ill persons ranged in age from less than 1 year to 90 years, with a median age of 4 years. 63 percent of ill persons were female. Ethnicity information was available for 8 ill persons; of these, 5 (63 percent) were Hispanic. Among 15 persons with available information, 4 (27 percent) reported being hospitalized. No deaths were reported. This outbreak appears to be over.

Outbreak 3: _S._Poona, Strain A and _S._ Sandiego, Strain C
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Case Count Update:
A total of 55 individuals infected with _S._ Poona, strain A and _S._ Sandiego, strain C have been reported from 22 states. Illness onset dates range from 20 Oct 2011 to 28 Jan 2013. Ill persons range in age from less than 1 year to 84 years, with a median age of 3 years. 66 percent of ill persons are female. Ethnicity information is currently available for 18 ill persons; of these, 3 (17 percent) are Hispanic. Among 35 persons with available information, 12 (34 percent) reported being hospitalized. No deaths have been reported.

Investigation Update:
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Traceback investigations of turtles purchased from Florida souvenir shops identified 2 turtle farms in Louisiana as the source of the turtles. The Florida Department of Health and the Florida Fish and Wildlife Conservation Commission have collaborated to stop the sale of turtles with a shell length of less than 4 inches from these shops. The Louisiana Department of Agriculture and Forestry issued cease and desist orders in March 2013 for the source farms; therefore, turtles with a shell length of less than 4 inches from these farms are no longer being sold domestically.

No new ill persons in Outbreak 3 have been reported since February 2013; however, this outbreak investigation remains open because investigations of the Louisiana turtle farms are ongoing.

[No Outbreak 4 in original source. - ProMED]

Outbreak 5: _S._ Pomona, Strain B
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Case Count Update:
A total of 104 individuals infected with _S._ Pomona, strain B have been reported from 27 states and the District of Columbia. 8 new ill persons have been reported from Arizona (1), California (2), District of Columbia (1), Mississippi (2), New Jersey (1), and Washington (1).

Illness onset dates range from 23 May 2011 to 28 Apr 2013. Ill persons range in age from less than 1 year to 94 years, with a median age of 2 years. 52 percent of ill persons are female. Ethnicity information is currently available for 41 ill persons; of these, 14 (34 percent) are Hispanic. Among 53 persons with available information, 16 (30 percent) reported being hospitalized. No deaths have been reported.

Outbreak 6: _S._ Poona, Strain B
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Case Count Update:
A total of 43 individuals infected with _S._ Pomona, strain B have been reported from 9 states. 5 new ill persons have been reported from Arizona (2) and California (3).

Illness onset dates range from 1 Apr 2012 to 29 Apr 2013. Ill persons range in age from less than 1 year to 83 years, with a median age of 3 years. 38 percent of ill persons are female. Ethnicity information is currently available for 18 ill persons; of these, 11 (61 percent) are Hispanic. Among 19 persons with available information, 5 (26 percent) reported being hospitalized. No deaths have been reported.

--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

[Salmonellosis acquired from small turtles continues to be a significant problem despite current laws. The size (less than 4 inch) relates to the fact that larger turtles are less likely to be handled by small children. - Mod. LL]

[Photo of small turtle of illegal size for trade
http://www.foodsafetynews.com/small-turtle-200px%20(1).jpg
- Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1hiS.]

See Also

Salmonellosis - USA (03): multiple serotypes, live poultry contact 20130428.1678626
Salmonellosis - USA (02): (NM), live poultry contact 20130427.1676459
Salmonellosis, st Infantis - USA: (MN, CO) live poultry contact 20130424.1669381
Salmonellosis - USA: (SD) live chick contact 20130421.1662050
Salmonellosis, serotype Heidelberg - USA: chicken 20130217.1546450
2012
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Salmonellosis, multiple serotypes - USA (05): pet turtle 20120814.1243731
Salmonellosis, multiple serotypes - USA (04): pet turtle, strains 20120702.1186450
Salmonellosis, multiple serotypes - USA (02): pet turtles, more strains 20120511.1129971
Salmonellosis, multiple serotypes - USA: pet turtles 20120331.1086557
Salmonellosis, serotype Paratyphi B - USA: (PA, SC) pet turtles 2011 20120202.1031013
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