Multistate reptile‐ and amphibian‐associated salmonellosis outbreaks in humans, United States, 2009–2018

Abstract

Non-typhoidal Salmonella cause an estimated 1.4 million human illnesses, 26,000 hospitalizations and 400 deaths annually in the United States. Approximately 11% of these infections are attributed to animal contact. Reptiles and amphibians are known sources of salmonellosis; young children (aged <5 years) are disproportionately affected by reptile-and amphibian-associated salmonellosis (RAAS) outbreaks. We describe multistate RAAS outbreaks to characterize illnesses and inform prevention efforts. RAAS outbreaks were defined as ≥2 culture-confirmed human Salmonella infections with similar pulsed-field gel electrophoresis patterns and epidemiologic, laboratory or traceback evidence linking them to a common reptile/amphibian exposure. Data sources included the Animal Contact Outbreak Surveillance System; CDC Outbreak Response and Prevention Branch's outbreak management database; PulseNet, the national molecular subtyping network for foodborne disease surveillance in the United States; and the National Antimicrobial Resistance Monitoring System. Twenty-six RAAS outbreaks were reported during 2009-2018, resulting in 1465 illnesses and 306 hospitalizations. The outbreaks were associated with turtles ( 19), lizards (5), snakes (1) and frogs (1). Sixteen (61.5%) outbreaks were linked to small turtles (<4 inches), resulting in 914 illnesses. Forty-nine percent of outbreakassociated patients were aged <5 years. Of 362 patients/caregivers interviewed, 111 (30.7%) were aware that reptiles/amphibians can carry Salmonella. Among 267 patient isolates with antimicrobial susceptibility information, 20 (7.5%) were non-susceptible to ≥1 antibiotic used to treat human salmonellosis. RAAS outbreaks result in considerable morbidity, particularly among young children. Illnesses linked to small turtles are preventable through education, targeted outreach to caregivers and paediatricians, and when appropriate, enforcement. Historically, individual states and jurisdictions have enforced existing or promulgated new authorities to address outbreaks.

Animal sources of antimicrobial-resistant bacterial infections in humans: a systematic review

“…Sixteen studies started at the outcome and either estimated the contribution of one specific source to it [11, 39, 42, 45] or attributed it to different sources [19, 25–33, 46, 47]. All microbial subtyping studies [19, 30–33, 46, 47], all investigations of outbreaks [25–29], and four risk assessments [11, 39, 42, 45] adopted such ‘top-down’ concepts (Figure 3a). Eleven studies attributed infections at the point of consumption or contact (exposure), and the remaining five partitioned the outcome to animal reservoirs.…”

“…Based on the authors' descriptions and reported methods, 16 articles were categorised as source attribution studies, including seven microbial subtyping studies [19, 30-33, 46, 47], five investigations of outbreaks [25][26][27][28][29], three comparative exposure assessments [22][23][24], and one multi-directional dynamic risk model [34]. Twelve were classified as risk assessments [11,20,21,[38][39][40][41][42][43][44][45]48], and the remaining three were of a different study type [35][36][37].…”

Multistate outbreak of turtle‐associated salmonellosis highlights ongoing challenges with the illegal sale and distribution of small turtles

“…to small turtles, resulting in 914 illnesses and 200 hospitalizations (Waltenburg et al, 2022). To our knowledge, we describe the first reported patient death in a small turtle-associated salmonellosis outbreak in the United States since 2007 (CDC, 2007;Waltenburg et al, 2022).…”

“…Despite the long‐standing federal ban and some state prohibitions, retailers continue to sell small turtles to the public; this report documents the continued public health issue of multistate salmonellosis outbreaks linked to pet turtles and the resulting preventable illnesses. From 2009 to 2018, 16 outbreaks of Salmonella were linked to small turtles, resulting in 914 illnesses and 200 hospitalizations (Waltenburg et al, 2022). To our knowledge, we describe the first reported patient death in a small turtle‐associated salmonellosis outbreak in the United States since 2007 (CDC, 2007; Waltenburg et al, 2022).…”

Non-Typhoidal Salmonella Infections Among Children in Fuzhou, Fujian, China: A 10-Year Retrospective Review from 2012 to 2021

“…Enteritidis have been consistently reported as the serotypes that contribute to the highest rates of clinical human salmonellosis worldwide. 22 , 29–32 , 37 The variation in serotype distribution in a region may be associated with the presence of a local animal reservoir especially pets like turtles 38 or food source mainly come from eggs and poultry. 21 Meanwhile, the cause of the increase in S .…”