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From the Centers for Disease Control and Prevention
October 3, 2012

Notes From the Field: Outbreak of Salmonellosis Associated With Pet Turtle Exposures—United States, 2011

JAMA. 2012;308(13):1317. doi:

MMWR. 2012;61:79

CDC is collaborating with the Pennsylvania State Health Department in an ongoing investigation of an outbreak of human Salmonella enterica serotype Paratyphi B var. L (+) tartrate + infections associated with pet turtle exposures. Turtles have long been recognized as sources of human Salmonella infections and are a particular risk to young children.1 Although the sale or distribution of small turtles (those with carapace lengths <4 inches [<10.2 cm]) has been prohibited in the United States since 1975 (with exceptions for scientific or educational purposes),2 they are still available for illegal purchase through transient vendors on the street, at flea markets, and at fairs.

During August 5, 2010–September 26, 2011, a total of 132 cases of human Salmonella Paratyphi B var. L (+) tartrate + infection were reported in 18 states. The median age of patients was 6 years (range: <1-75 years), 66% were aged <10 years, and 63% were female. No deaths were reported. Of the 56 patients interviewed, 36 (64%) reported turtle exposure. For 15 patients who could recall the type of turtle contacted, 14 identified turtles too small to be legally traded. Five samples of turtle tank water from patient homes tested positive for the outbreak strain (four from Pennsylvania and one from South Carolina). Investigation to trace the source of these turtles is difficult because the vendors are transient. These cases illustrate that small turtles remain a source of human Salmonella infections, especially for young children.

Although many reptiles carry Salmonella, small turtles pose a greater risk to young children because they are perceived as safe pets, are small enough to be placed in the mouth, and can be handled as toys. Despite a 30-year ban on small turtles, this ongoing outbreak suggests that ban enforcement efforts, as well as public education efforts, have not been fully successful and should be examined. In 2010, in response to a 2007 lawsuit filed by the Independent Turtle Farmers of Louisiana, Inc. seeking to overturn the ban, a federal district court upheld the Food and Drug Administration's authority to enforce the ban.3 Regulating the sale of small turtles likely remains the most effective public health action to prevent turtle-associated salmonellosis.4,5

Reported by:

Andre Weltman, MD, Aaron Smee, MPH, Maria Moll, MD, Marshall Deasy, Pennsylvania Dept of Public Health. Jeshua Pringle, MPH, Ian Williams, PhD, MS, Casey Barton Behravesh, DVM, DrPH, Jennifer Wright, DVM, Div of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases; Janell Routh, MD, Allison Longenberger, PhD, EIS officers, CDC. Corresponding contributor: Janell Routh, jrouth@cdc.gov, 404-718-1153.

REFERENCES
1.
Centers for Disease Control and Prevention (CDC).  Multistate outbreak of human Salmonella typhimurium infections associated with pet turtle exposure—United States, 2008.  MMWR Morb Mortal Wkly Rep. 2010;59(7):191-196PubMed
2.
Code of Federal Regulations.  Turtles intrastate and interstate requirements, 21 C.F.R. Sect. 1240.62 (2011). Available at http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=1240.62. Accessed January 24, 2012
3.
 Independent Turtle Farmers of Louisiana v. United States, 703 F. Supp. 2d 604 W.D. La (March 30, 2010). Available at http://dockets.justia.com/docket/louisiana/lawdce/1:2007cv00856/103949. Accessed January 24, 2012
4.
Harris JR, Neil KP, Behravesh CB, Sotir MJ, Angulo FJ. Recent multistate outbreaks of human salmonella infections acquired from turtles: a continuing public health challenge.  Clin Infect Dis. 2010;50(4):554-559PubMedArticle
5.
Cohen ML, Potter M, Pollard R, Feldman RA. Turtle-associated salmonellosis in the United States.  JAMA. 1980;243(12):1247-1249PubMedArticle
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