Red Book Online Outbreaks: Salmonella Outbreak Linked to Small Turtles

As of November 17, 2023, these outbreaks are over.

Overview

As of November 21, 2023, a total of 80 people infected with the outbreak strains of Salmonella Stanley, Salmonella Pomona, and Salmonella Poona have been reported from 24 states: Salmonella Outbreak Linked to Small Turtles| CDC. Illnesses started on dates ranging from October 27, 2022 to August 26, 2023. Sick people range in age from less than one year to 90 years, with a median of 9 years, and 36% of ill people are under 5 years.

A federal law bans the sale and distribution of turtles with shells less than 4 inches long as pets because they have caused many illnesses, especially in young children. Despite the ban, these turtles can sometimes be found illegally online and at stores, flea markets, and roadside stands. Pet turtles of any size can carry Salmonella in their droppings even if they look healthy and clean. These germs can easily spread to their bodies, tank water, and anything in the area where they live and roam. People can get sick from touching a turtle or anything in its environment and then touching their mouth or food with unwashed hands and ingesting Salmonella.

Clinical Guidance

• Presentation: Most people infected with Salmonella experience diarrhea, fever, and stomach cramps. Symptoms usually start 6 hours to 6 days after ingesting Salmonella. Most people recover without treatment after 4 to 7 days.
• Who is at highest risk/complications: The incidence of Salmonella infection is highest in children younger than 4 years of age. In the United States, rates of invasive infections and mortality are higher in infants, elderly people, and people with hemoglobinopathies (including sickle cell disease) and immunocompromising conditions (eg, malignant neoplasms, HIV infection).
• Patients should be seen by their pediatrician if they present with the following symptoms of Salmonella infection:
  • Diarrhea and a fever higher than 102°F
  • Diarrhea for more than 3 days that is not improving
  • Bloody diarrhea
  • Not tolerating oral liquids
  • Signs of dehydration, such as:
    • Decreased urine output
    • Dry mucous membranes
    • Orthostatic hypotension
• Diagnosis: Isolation of Salmonella organisms from cultures of stool, blood, urine, bile (including duodenal fluid containing bile), and material from foci of infection is diagnostic. Salmonella gastroenteritis is diagnosed by stool culture or molecular testing (including PCR); stool testing should be obtained in all children with bloody diarrhea or unexplained persistent or severe diarrhea. See Red Book Salmonella diagnostic tests.
• Risk Mitigation: To stay healthy around a pet turtle, people should:
  • Always wash hands thoroughly with soap and water right after touching or feeding a turtle and after touching or cleaning the area where it lives and roams.
  • Adults should make sure young children are washing their hands properly.
  • People should not kiss a turtle or eat or drink around it.
  • Keep the turtle out of the kitchen and other areas where people eat, store, or prepare food.
  • When washing a turtle, pet owners should use a wash tub and sponge or scrub that are just used for the pet. A laundry sink or bathtub can be used, but people’s items should be removed from the sink and tub before cleaning pet items, and the sink or tub should be thoroughly cleaned and disinfected immediately after use. Using a kitchen sink may spread germs to food. If the kitchen sink is the only place to clean pet items, people should thoroughly clean and disinfect the sink and the area around the sink immediately after.
• Treatment: Antimicrobial therapy usually is not indicated for patients with either asymptomatic infection or uncomplicated gastroenteritis caused by Salmonella because therapy does not shorten the duration of diarrheal disease, can prolong duration of fecal shedding, and increases symptomatic relapse rate. Antimicrobial therapy is recommended for gastroenteritis caused by Salmonella in people at increased risk for invasive disease, including infants younger than 3 months and people with chronic gastrointestinal tract disease, malignant neoplasms, hemoglobinopathies, HIV infection, or other immunosuppressive illnesses or therapies. Antibiotics should also be considered for those experiencing severe symptoms such as severe diarrhea or prolonged or high fever. If antimicrobial therapy is initiated in patients in the United States with presumed or proven Salmonella gastroenteritis, a blood and a stool culture should be obtained prior to antibiotic administration. Most cases of Salmonella gastroenteritis are treated empirically. If the person appears ill or has evidence of disseminated infection, hospitalization along with initiation of a broad spectrum parenteral cephalosporin often is prescribed. Oral antimicrobials, such as azithromycin may be considered for patients who do not appear ill or have evidence of disseminated infection. If cultures are obtained, definitive therapy should be based on the susceptibility of the organism isolated.
• Reporting: Suspected cases should be reported to the local department of public health.

Resources

• For more information see the Red Book chapter on: Salmonella Infections