September 2, 2004

TURTLES AND SALMONELLA

The State Department of Health and Family Services has identified 2 children sickened by salmonellosis after handling small turtles illegally sold by vendors in 4 Wisconsin counties. Health officials would not identify where each turtle was purchased, but said that both the 4 year old Kansas girl and 2 year old Wisconsin boy are doing well.

 Salmonellosis associated with reptiles is a continuing public health concern. During the 1970s, small pet turtles were a major source of salmonella infections in the USA . In 1975, the FDA banned commercial distribution of small (that is, <4-inches long) turtles; the majority of states prohibited the sale of such turtles. These measures prevented an estimated 100 000 cases of salmonellosis among children each year. However, reptiles remain popular pets in the US ; during 1991-2001, the estimated number of households with reptiles doubled from about 850,000 to 1.7 million. The increase in pet reptile popularity has been paralleled by an increase in the number of reptile-related salmonella serotypes isolated from humans.

Reptiles are commonly colonized with salmonella and shed the organism intermittently in their feces. Attempts to treat reptiles with antibiotics to eliminate salmonella carriage have been unsuccessful and might lead to increased antibiotic resistance. Salmonella survives well in the environment and can be isolated for prolonged periods from surfaces contaminated by reptile feces. For this reason, even minimal indirect contact with reptiles can result in illness. Increasing evidence suggests that amphibians also are a source for salmonellosis . Frogs and toads are frequent carriers of salmonella and have been linked by epidemiologic evidence to outbreaks. In a population-based, case control study, housing an amphibian was associated independently with salmonella infection. Overall, reptile and amphibian contacts are estimated to account for 74,000 (6 per cent) of the about 1.2 million sporadic salmonella infections that occur each year in the US .

Gaps remain in the public's understanding of amphibian and reptile associated salmonellosis. In one study, fewer than half the families with salmonellosis and known iguana exposure suspected their iguanas might have been the cause of illness. Pet store owners, health care providers, and veterinarians should provide information and prevention messages about salmonellosis to owners and potential purchasers of reptiles and amphibians.

In 1999, the National Association of State Public Health Veterinarians and the Council of State and Territorial Epidemiologists recommended that state and local agencies adopt regulations to prohibit the sale or gift of reptiles without written point-of-sale education to consumers about the risks for and prevention of reptile-associated salmonellosis. In February 2003, CDC polled health departments in all 50 states and New York City (NYC) to determine whether such regulations existed. Among the 49 health departments responding, 4 states ( Colorado , Illinois , Kansas , and Texas ) required pet stores to provide information about salmonellosis to people purchasing any reptile; 5 ( California , Connecticut , Maryland , Michigan , and New York ) required providing salmonellosis information to persons purchasing a turtle but not other reptiles. Tennessee prohibited sale of all turtles. NYC prohibited sale of certain reptiles, including iguanas, small turtles, and boas, and required posting of information about reptile-associated salmonellosis where other reptiles were sold.

Reptiles should be considered to be nonclinical carriers of Salmonella. The organism is intermittently or continuously shed in their feces and, if ingested by humans, may result in a potentially serious illness. Because Salmonella may be shed intermittently in the feces of reptiles, it is not possible to determine whether any individual living reptile is free of Salmonella. Bacterial culture of fecal specimens from reptiles will not detect all carriers.

Attempt to treat reptiles with antibiotics to eliminate salmonellae from their intestinal tract have not proven to be effective. Doing so increases the risk of emergence of antimicrobial-resistant salmonella strains, which, if transmitted to humans, would complicate treatment of the infected person. Attempts to raise "salmonella-free" reptiles have been equally unsuccessful.

With this information in mind, the following guidelines have been developed by the Association of Reptilian and Amphibian Veterinarians (ARAV), in cooperation with the Centers for Disease Control and Prevention (CDC), to help disseminate information to the general public on how to minimize risks of exposure to Salmonella and to help prevent development of reptile-associated salmonellosis in humans.

1. Most, if not all, reptiles carry salmonella bacteria in their intestinal tract and intermittently or continuously shed these bacteria in their feces. Salmonella bacteria usually do not cause any illness in reptiles, but can cause serious illness in people.

2. Salmonella bacteria are easily spread from reptiles to humans. Humans may become infected when they place their hands on objects (including food items) that have been in contact with the stool of reptiles, [and put their hands] in their mouths. For example, infants have become infected after drinking from bottles of infant formula that became contaminated during preparation. Individuals who prepared the formula had not washed their hands after touching a reptile or because reptiles were allowed to walk on kitchen counters. For Salmonella bacteria to spread from reptiles to humans, the bacteria must be ingested. Therefore, simply touching or holding a reptile will not result in spread of bacteria unless something contaminated with reptile feces or the reptile itself is placed in the mouth.

3. Most salmonella infections in humans result in a mild, self-limiting illness characterized by diarrhea, fever, and abdominal cramps. However, the infection can spread to the bloodstream, bone marrow, or nervous system, leading to severe and sometimes fatal, illness. Such severe infections are more likely to occurs in infants and in individuals whose immune system is compromised (for instance, bone marrow transplant recipients, persons with diabetes mellitus, persons infected with the human immunodeficiency virus, and chemotherapy patients).

4. Fortunately the spread of salmonella bacteria from reptiles to humans can be easily prevented by the following routine precautions:

a. Always wash your hands with hot, soapy water after handling reptiles, reptile cages and equipment, and the stool of reptiles.

b. Do not allow reptiles to have access to the kitchen, dining room, or any other area in which food is prepared. Also, do not allow reptiles to have access to bathroom sinks and tubs or to any area where infants are bathed. Consider keeping your reptiles caged or limiting the parts of the house where reptiles are allowed to roam free. Always wash your hands after coming into contact with any area where reptiles are allowed to roam free.

c . Do not eat, drink, or smoke while handling reptiles, reptile cages, or reptile equipment. Do not kiss reptiles or share food or drink with them.

d. Do not use the kitchen sink, kitchen counters, bathroom sinks or bathtubs to bathe reptiles or to wash reptile cages, dishes, or aquariums. Reptile owners may wish to purchase a plastic basin or tub in which to bathe or swim their reptiles. Waste water and fecal material should be disposed of in the toilet instead of the bathtub or household sink.

e. The CDC recommends that children less than 5 years of age avoid contact with reptiles and that households with children less than 1 year of age not own reptiles. The Association of Reptilian and Amphibian Veterinarians encourages reptile owners with young children to discuss steps to minimize risks associated with owning reptiles with their reptiles' veterinarian and their physician. Children should be supervised when they are handling reptiles to ensure that they do not place their hands or objects that a reptile has contacted in their mouths. Reptiles should not be kept in child care centers.

f. Immunocompromised persons should avoid contact with reptiles.

g. Follow instructions from your reptile's veterinarian concerning proper diet and environment for your reptile. Healthy reptiles living in proper environments are less likely to shed Salmonella bacteria.

If you have any questions please feel free to contact Dr. Sandy Snow at 501-661-2102, or fax to 501-661-2300 or e-mail to ssnow@healthyarkansas.com.