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Eight Multistate Outbreaks of Human Salmonella Infections Linked to Small Turtles (Final Update)

Posted October 18, 2013 3:00 PM ET

These outbreaks appear to be over. However, small turtles continue to be an important cause of human Salmonella infections in the United States. More information about Salmonella from reptiles and amphibians and the steps people can take to reduce their risk of infection is available.

At a Glance:

Latest Case Count Map

Highlights

Outbreak Summary

Introduction

CDC collaborated with public health and agriculture officials in many states and the U.S. Food and Drug Administration’s Center for Veterinary Medicine (FDA-CVM) to investigate eight outbreaks of human Salmonella infections linked to exposure to turtles and their environments. Public health investigators used the PulseNet system to identify cases of illness that were part of this outbreak. In PulseNet, the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC, DNA "fingerprints" of Salmonella bacteria are obtained through diagnostic testing with pulsed-field gel electrophoresis, or PFGE, to identify cases of illness that were part of this outbreak. Outbreak strains were defined by PFGE pattern and serotype.

A total of 473 persons infected with the outbreak strains of Salmonella were reported from 41 states, the District of Columbia, and Puerto Rico: Alabama (4), Alaska (2), Arizona (27), Arkansas (4), California (106), Colorado (6), Connecticut (1), Delaware (4), Florida (1), Georgia (10), Illinois (10), Indiana (1), Kansas (2), Kentucky (3), Louisiana (5), Maine (1), Maryland (17), Massachusetts (12), Michigan (5), Minnesota (1), Mississippi (4), Missouri (4), Nevada (11), New Jersey (26), New Mexico (15), New York (55), North Carolina (3), Ohio (6), Oregon (1), Pennsylvania (34), Puerto Rico (1), Rhode Island (1), South Carolina (17), South Dakota (1), Tennessee (7), Texas (45), Utah (1), Vermont (1), Virginia (5), Washington (5), Washington, D.C. (3), Wisconsin (2) and West Virginia (3).

Among 473 persons, reported and estimated illness onset dates ranged from May 23, 2011, to September 9, 2013. Among 462 persons for whom information was available, ill persons ranged in age from less than 1 year to 94 years, with a median age of 4 years. Seventy percent of ill persons were children 10 years of age or younger, and 31% of ill persons were children 1 year of age or younger. Fifty-five percent of ill persons were female. Among 192 persons for whom information was available, 85 (44%) ill persons were of Hispanic ethnicity. Information about the association between reptiles and Salmonella is available in Spanish. Among 272 persons with available information, 78 (29%) were hospitalized. No deaths were reported.

The numbers of new cases have declined substantially since the peak of the outbreak,  which occurred from July 2012 to September 2012, but illnesses are still being reported among people who have contact with small turtles. The outbreak is expected to continue at a low level for the next several months since consumers might be unaware of the risk of Salmonella infection from reptiles including small turtles. If properly cared for, small turtles have a long life expectancy.

Turtles of any size, as well as other reptiles and amphibians, can be a source of human Salmonella infections. However, small turtles have been linked to more outbreaks of human Salmonella infections than other pet reptiles and amphibians. More information about Salmonella from reptiles and amphibians and the steps people can take to reduce their risk of infection is available.

Investigation of the Outbreaks

Epidemiologic, environmental, and traceback investigations conducted by officials in local, state, and federal public health, agriculture, and regulatory agencies linked these outbreaks to exposure to turtles and their environments.

In interviews, ill persons answered questions about contact with animals and foods eaten during the week before becoming ill. One hundred and eighty-seven (69%) of 272 ill persons interviewed reported contact with turtles before becoming ill. Of the 141 ill persons who could recall the size of the turtle with which they had contact, 124 (88%) specifically reported exposure to turtles with shell length less than 4 inches. Fifty-five (80%) of 70 ill persons recalled contact with red eared slider turtles, which are commonly owned as pets. Other types of pet turtles such as yellow bellied sliders and mud turtles were also reported by ill people, however in many cases the specific type of turtle was not known.

One hundred and sixteen ill persons reported where they acquired their small turtle. The most common source of small turtle purchase was street vendors, reported by 36 (31%) patients. Turtles were purchased from multiple other sources, including pet stores [21 (18%)], flea markets [14 (12%)], discount stores [8 (7%)], souvenir/gift shops [6 (5%)], other stores [4 (3%)], and online [3 (3%)]. Nineteen (16%) patients received small turtles as gifts, and 5 (4%) patients acquired turtles from a carnival, car show, fair, festival, or swap meet.

State and local public health departments and regulatory agencies collected swab samples from turtles and turtle tank water from turtle habitats at ill persons’ homes and at retail establishments where ill persons reported purchasing turtles. Salmonella with patterns matching outbreak strains were identified from ill persons’ turtles or turtle habitats in seven of the eight outbreaks: outbreaks 1-6 and outbreak 8.  Turtle tank samples from retail stores where turtles in outbreaks 3 and 6 were purchased yielded the outbreak 3 and outbreak 6 strains, respectively. In four outbreaks, turtle tank water yielded one or more outbreak strains.

Information provided by ill persons infected in several outbreaks was used by investigators from multiple state public health and agriculture agencies and FDA to trace the small turtles in ill persons’ households to retail establishments, turtle brokers, and eventually turtle farms. Traceback investigations of turtles purchased from Florida souvenir shops identified two 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. Salmonella with patterns matching outbreak strains 2 and 3 were identified from a turtle pond at one of the Louisiana turtle farms. 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.  The source of turtles in other outbreaks could not be identified because of the challenges of tracing small turtles that are sold illegally by transient vendors.

October 18, 2013

Outbreak 1: Salmonella Sandiego, Strain A and Salmonella Newport, Strain A

Final Case Count Update

A total of 124 individuals infected with Salmonella Sandiego, strain A and Salmonella Newport, strain A were reported from 22 states. Twenty-four new ill persons have been reported from Arkansas (2), Arizona (3), California (9), Delaware (1), Massachusetts (2), Missouri (1), New Jersey (1), New Mexico (1), New York (1), Pennsylvania (1), and Washington (2).

Illness onset dates ranged from August 3, 2011, to September 4, 2013. Ill persons ranged in age from less than 1 year to 85 years, with a median age of 6 years. Sixty-two percent of ill persons were female. Ethnicity was reported for 47 ill persons, and of these, 33 (70%) were Hispanic. Among 72 persons with available information, 15 (21%) were hospitalized. No deaths were reported.

The numbers of new cases have declined substantially since the peak of the outbreak, which occurred from July 2012 to September 2012, but illnesses are still being reported among people who have contact with small turtles. The outbreak is expected to continue at a low level for the next several months since consumers might be unaware of the risk of Salmonella infection from reptiles including small turtles. If properly cared for, small turtles have a long life expectancy.

Outbreak 2: Salmonella Pomona, Strain A

Final Case Count Update

A total of 23 individuals infected with Salmonella Pomona, strain A were reported from 13 states and Puerto Rico. Four new ill persons have been reported from New Mexico (1), Puerto Rico (1), South Dakota (1), and Texas (1).

Illness onset dates ranged from December 9, 2011, to August 6, 2013. Ill persons ranged in age from less than 1 year to 89 years, with a median age of 5 years. Sixty-one percent of ill persons were female. Ethnicity information was available for 10 ill persons, and of these, 6 (60%) were Hispanic. Among 18 persons with available information, 5 (28%) reported being hospitalized. No deaths were reported.

The numbers of new cases have declined substantially since the peak of the outbreak, which occurred from July 2012 to September 2012, but illnesses are still being reported among people who have contact with small turtles. The outbreak is expected to continue at a low level for the next several months since consumers might be unaware of the risk of Salmonella infection from reptiles including small turtles. If properly cared for, small turtles have a long life expectancy.

Outbreak 3: Salmonella Poona, Strain A and Salmonella Sandiego, Strain C

Final Case Count Update

A total of 58 individuals infected with Salmonella Poona, strain A and Salmonella Sandiego, strain C were reported from 22 states. Three new ill persons have been reported from New York.

Illness onset dates ranged from October 20, 2011, to August 7, 2013. Ill persons ranged in age from less than 1 year to 84 years, with a median age of 3 years. Sixty-three percent of ill persons were female. Ethnicity information was available for 20 ill persons, and of these, 5 (25%) were Hispanic. Among 40 persons with available information, 16 (40%) were hospitalized. No deaths were reported.

The numbers of new cases have declined substantially since the peak of the outbreak, which occurred from July 2012 to September 2012, but illnesses are still being reported among people who have contact with small turtles. The outbreak is expected to continue at a low level for the next several months since consumers might be unaware of the risk of Salmonella infection from reptiles including small turtles. If properly cared for, small turtles have a long life expectancy.

Outbreak 5: Salmonella Pomona, Strain B

Final Case Count Update

A total of 120 individuals infected with Salmonella Pomona, strain B were reported from 28 states and the District of Columbia. Sixteen new ill persons have been reported from Arizona (4), California (7), Kentucky (1), New York (1), Pennsylvania (1), and Texas (2).

Illness onset dates ranged from May 23, 2011, to August 21, 2013. Ill persons ranged in age from less than 1 year to 94 years, with a median age of 2 years. Fifty-three percent of ill persons were female. Ethnicity information was available for 52 ill persons, and of these, 19 (37%) were Hispanic. Among 69 persons with available information, 19 (28%) were hospitalized. No deaths were reported.

The numbers of new cases have declined substantially since the peak of the outbreak, which occurred from July 2012 to September 2012, but illnesses are still being reported among people who have contact with small turtles. The outbreak is expected to continue at a low level for the next several months since consumers might be unaware of the risk of Salmonella infection from reptiles including small turtles. If properly cared for, small turtles have a long life expectancy.

Outbreak 6: Salmonella Poona, Strain B

Final Case Count Update

A total of 78 individuals infected with Salmonella Pomona, strain B were reported from 13 states. Thirty-five new ill persons have been reported from Arizona (11), California (14), Illinois (1), Michigan (2), New Mexico (1), Ohio (1), Texas (3), and Washington (2).

Illness onset dates ranged from April 1, 2012, to September 9, 2013. Ill persons ranged in age from less than 1 year to 83 years, with a median age of 3 years. Forty-four percent of ill persons were female. Ethnicity information was available for 29 ill persons, and of these, 14 (48%) were Hispanic. Among 30 persons with available information, 8 (27%) were hospitalized. No deaths were reported.

The numbers of new cases have declined substantially since the peak of the outbreak, but illnesses are still being reported among people who have contact with small turtles. The outbreak is expected to continue at a low level for the next several months since consumers might be unaware of the risk of Salmonella infection from reptiles including small turtles. If properly cared for, small turtles have a long life expectancy.

May 24, 2013

Investigation Overview

Four of the eight 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. Turtles are an important cause of human Salmonella infections in the United States, particularly in infants and young children. More information about Salmonella, and steps people can take to reduce their risk of infection, can be found on the CDC Salmonella Web Page.

Illnesses that occurred after April 12, 2013 might not yet be reported due to the time it takes between when a person becomes ill and when the illness is reported. For more details, please see Salmonella Outbreak Investigations: Timeline for Reporting Cases.

Outbreak 1: Salmonella Sandiego, Strain A and Salmonella Newport, Strain A

Case Count Update

A total of 100 individuals infected with Salmonella Sandiego, strain A and Salmonella Newport, strain A have been reported from 18 states. Seven new ill persons have been reported from Arizona (1), California (3), Illinois (1), Massachusetts (1), and Ohio (1).

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

Outbreak 2: Salmonella Pomona, Strain A

Final Case Count Update

A total of 19 individuals infected with Salmonella Pomona, strain A were reported from 11 states.

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

This outbreak appears to be over. However, turtles are an important cause of human Salmonella infections in the United States. More information about Salmonella from reptiles and amphibians, and the steps people can take to reduce their risk of infection is available.

Outbreak 3: Salmonella Poona, Strain A and Salmonella Sandiego, Strain C

Case Count Update

A total of 55 individuals infected with Salmonella Poona, strain A and Salmonella Sandiego, strain C have been reported from 22 states.  Illness onset dates range from October 20, 2011 to January 28, 2013. Ill persons range in age from less than 1 year to 84 years, with a median age of 3 years. Sixty-six percent of ill persons are female. Ethnicity information is currently available for 18 ill persons; of these, 3 (17%) are Hispanic. Among 35 persons with available information, 12 (34%) reported being hospitalized. No deaths have been reported.

Investigation Update

Traceback investigations of turtles purchased from Florida souvenir shops identified two 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.

Outbreak 5: Salmonella Pomona, Strain B

Case Count Update

A total of 104 individuals infected with Salmonella Pomona, strain B have been reported from 27 states and the District of Columbia. Eight 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 May 23, 2011 to April 28, 2013. Ill persons range in age from less than 1 year to 94 years, with a median age of 2 years. Fifty-two percent of ill persons are female. Ethnicity information is currently available for 41 ill persons; of these, 14 (34%) are Hispanic. Among 53 persons with available information, 16 (30%) reported being hospitalized. No deaths have been reported.

Outbreak 6: Salmonella Poona, Strain B

Case Count Update

A total of 43 individuals infected with Salmonella Pomona, strain B have been reported from 9 states. Five new ill persons have been reported from Arizona (2) and California (3).

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

April 3, 2013

Investigation Overview

The eight multistate outbreaks of human Salmonella infections linked to small turtles are numbered in the order in which they were identified. The details of each investigation are described below. Three of the outbreaks appear to be over; however, five outbreaks remain under active investigation. Turtles remain an important cause of human Salmonella infections in the United States, particularly in infants and young children.  More information about Salmonella, and steps people can take to reduce their risk of infection, can be found on the CDC Salmonella Web Page. Illnesses that occurred after February 18, 2013 might not yet be reported due to the time it takes between when a person becomes ill and when the illness is reported. For more details, please see Salmonella Outbreak Investigations: Timeline for Reporting Cases

Outbreak 1: Salmonella Sandiego, Strain A and Salmonella Newport, Strain A

Case Count Update

A total of 93 individuals infected with Salmonella Sandiego, strain A and Salmonella Newport, strain A have been reported from 17 states. Four new ill persons have been reported from California.

Illness onset dates range from August 3, 2011 to March 17, 2013. Ill persons range in age from less than 1 year to 86 years, with a median age of 7 years. Sixty-two percent of ill persons are female. Ethnicity was reported for 37 ill persons, and of these, 26 (70%) were Hispanic. Among 59 persons with available information, 13 (22%) reported being hospitalized. No deaths have been reported.

Investigation Update

Among the 59 ill persons for whom information is available, 45 (76%) reported contact with turtles before becoming ill. Thirty-one ill persons described the size of the turtle they were exposed to; 30 (97%) described a turtle with a shell length of less than 4 inches.

Outbreak 2: Salmonella Pomona, Strain A

Case Count Update

A total of 19 individuals infected with Salmonella Pomona, strain A have been reported from 11 states.

Illness onset dates range from December 9, 2011 to February 5, 2013. Ill persons range in age from less than 1 year to 90 years, with a median age of 4 years. Sixty-three percent of ill persons are female. Ethnicity information is currently available for 8 ill persons; of these, 5 (63%) are Hispanic. Among 15 persons with available information, 4 (17%) reported being hospitalized. No deaths have been reported.

Outbreak 3: Salmonella Poona, Strain A and Salmonella Sandiego, Strain C

Case Count Update

A total of 55 individuals infected with Salmonella Poona, strain A and Salmonella Sandiego, strain C have been reported from 22 states. Four new ill persons have been reported from Alabama (1), Georgia (1), and Louisiana (2).

Illness onset dates range from October 20, 2011 to January 28, 2013. Ill persons range in age from less than 1 year to 84 years, with a median age of 3.5 years. Sixty-seven percent of ill persons are female. Ethnicity information is currently available for 18 ill persons; of these, 3 (17%) are Hispanic. Among 34 persons with available information, 12 (35%) reported being hospitalized. No deaths have been reported.

Investigation Update

Among the 41 ill persons for whom information was available, 31 (76%) reported contact with turtles before becoming ill. Twenty-three persons who reported contact with turtles also reported the size of the turtle; of these, 19 (83%) reported a turtle with a shell length of less than 4 inches.

Traceback investigations of turtles purchased from Florida souvenir shops identified two turtle farms in Louisiana as the source of the turtles. Investigations of these farms are ongoing.

Outbreak 4: Salmonella Sandiego, Strain B

Final Case Count Update

A total of 7 individuals infected with Salmonella Pomona, strain B, were reported from 3 states.

Illness onset dates ranged from February 25, 2012 to September 29, 2012. Ill persons ranged in age from less than 1 year to 65 years, with a median age of 10 years. Fifty-seven percent of ill persons were female. Ethnicity information was available for 5 ill persons; of these, 3 (60%) were Hispanic. Among 6 persons with available information, 1 (17%) was hospitalized. No deaths were reported.

This outbreak appears to be over. However, turtles are an important cause of human Salmonella infections in the United States. More information about Salmonella from reptiles and amphibians, and the steps people can take to reduce their risk of infection, is available.

Outbreak 5: Salmonella Pomona, Strain B

Case Count Update

A total of 96 individuals infected with Salmonella Pomona, strain B have been reported from 26 states and the District of Columbia. Eight new ill persons have been reported from New Jersey (1), New York (1), South Carolina (3), and Texas (4).

Illness onset dates range from May 23, 2011 to March 23, 2013. Ill persons range in age from less than 1 year to 94 years, with a median age of 2 years. Fifty-four percent of ill persons are female. Ethnicity information is currently available for 40 ill persons; of these, 14 (35%) are Hispanic. Among 51 persons with available information, 15 (29%) reported being hospitalized. No deaths have been reported.

Investigation Update

Among the 53 ill persons with available information, 39 (74%) reported contact with turtles in the week before becoming ill. Twenty-six ill persons who reported contact with turtles also reported the size of the turtle; 22 (85%) reported a turtle with a shell length of less than 4 inches.

Environmental Sampling Update

In February 2013, samples from the environment of a Minnesota turtle to which a Wisconsin case was exposed, yielded the outbreak strain Salmonella Pomona, strain B.

Outbreak 6: Salmonella Poona, Strain B

Case Count Update

A total of 38 individuals infected with Salmonella Pomona, strain B have been reported from 9 states. Six new ill persons have been reported from California (2), New Mexico (1), Texas (2), and Utah (1).

Illness onset dates range from April 1, 2012 to March 3, 2013. Ill persons range in age from less than 1 year to 83 years, with a median age of 2 years. Thirty-eight percent of ill persons are female. Ethnicity information is currently available for 16 ill persons; of these, 9 (56%) are Hispanic. Among 18 persons with available information, 5 (28%) reported being hospitalized. No deaths have been reported.

Investigation Update

Among the 19 ill persons with information available, 11 (58%) reported exposure to turtles before they became ill. Ten ill persons reported the size of the turtle they had contact with, and 8 (80%) described turtles with a shell length of less than 4 inches.

Outbreak 7: Salmonella I 4,[5],12:i:-, Strain A

Final Case Count Update

A total of 19 individuals infected with Salmonella I 4,[5],12:i:-, strain A were reported from 4 states.

Illness onset dates ranged from June 8, 2012 to September 27, 2012. Infected individuals ranged in age from less than 1 year to 33 years, with a median age of 2 years. Fifty-six percent of ill persons were female. Ethnicity information was available for 6 ill persons; of these, none were Hispanic. Among 7 ill persons with available information, 3 (43%) were hospitalized. No deaths were reported.

This outbreak appears to be over. However, turtles are an important cause of human Salmonella infections in the United States. More information about Salmonella from reptiles and amphibians, and the steps people can take to reduce their risk of infection, is available.

Outbreak 8: Salmonella Typhimurium

Final Case Count Update

A total of 44 individuals infected with Salmonella Typhimurium, strain A have been reported from 13 states and the District of Columbia. One new case has been reported from Connecticut. 

Illness onset dates range from July 7, 2012 to January 15, 2013.  Infected individuals range in age from less than 1 year to 70 years, with a median age of 3 years. Fifty-five percent of ill persons are female. Ethnicity information is currently available for 17 ill persons; of these, 5 (29%) are Hispanic. Among 25 ill persons with available information, 9 (36%) have been hospitalized.

This outbreak appears to be over. However, turtles are an important cause of human Salmonella infections in the United States. More information about Salmonella from reptiles and amphibians, and the steps people can take to reduce their risk of infection, is available.

Final Investigation Update

Among the 24 ill persons with information available, 15 (63%) reported exposure to turtles before they became ill. Eight ill persons reported the size of the turtle they had contact with, and all 8 (100%) described turtles with a shell length of less than 4 inches.

February 15, 2013

Investigation Overview

Contact with reptiles (such as turtles, snakes, and lizards) and amphibians (such as frogs and toads) can be a source of human Salmonella infections. Small turtles, with a shell length of less than 4 inches, are a well-known source of human Salmonella infections, especially among young children. Because of this risk, the Food and Drug Administration (FDA) has banned the sale and distribution of these turtles since 1975. Amphibians and reptiles can carry Salmonella germs and still appear healthy and clean. Salmonella germs are shed in their droppings and can easily contaminate their bodies and anything in areas where these animals live. Reptiles and amphibians that live in tanks or aquariums can contaminate the water with germs, which can spread to people.

CDC continues to collaborate with public health officials in multiple states and the FDA to investigate 8 overlapping, multistate outbreaks of human Salmonella infections linked to exposure to turtles or their environments (e.g., water from a turtle habitat). Because the majority of ill persons who reported contact with small turtles purchased the turtles from a street vendor, it is difficult to determine the original source of the turtles.

Public health investigators are using DNA "fingerprints" of Salmonella bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis, or PFGE, to identify cases of illness that may be part of these outbreaks. Using this method, a total of 347 persons infected with the outbreak strains of Salmonella Sandiego, Newport, Pomona, Poona, I 4,[5],12:i:-, and Typhimurium have been reported from 37 states and the District of Columbia in overlapping, multistate outbreaks linked to contact with small turtles and their habitats. Twenty-eight percent of ill persons have been hospitalized, and no deaths have been reported. Seventy 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. Forty-four 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 source of these outbreaks. Seventy percent of ill persons reported exposure to turtles prior to their illness. Ninety percent of ill persons with turtle exposure specifically reported exposure to small turtles. Thirty-three percent of ill persons with small turtles reported purchasing the turtles from street vendors, and 11% reported purchasing small turtles from pet stores. Illnesses that occurred after January 3, 2013 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported. For more details, please see Salmonella Outbreak Investigations: Timeline for Reporting Cases.

The 8 multistate outbreaks of human Salmonella infections linked to small turtles are numbered in the order in which they were identified. The details of each investigation are described below.

Outbreak 1: Salmonella Sandiego, Strain A and Salmonella Newport, Strain A

Case Count Update

A total of 88 individuals infected with Salmonella Sandiego, strain A and Salmonella Newport, strain A have been reported from 16 states. Four new cases have been reported from California (1), Kentucky (1), Maryland (1), and Nevada (1).

Illness onset dates range from August 3, 2011 to January 15, 2013. Ill persons range in age from less than 1 year to 86 years, with a median age of 7 years. Sixty percent of ill persons are female. Ethnicity was reported for 35 ill persons, and of these, 24 (69%) were Hispanic. Among 58 persons with available information, 13 (22%) reported being hospitalized. No deaths have been reported.

Investigation Update

Among the 57 ill persons for whom information is available, 43 (75%) reported contact with turtles before becoming ill. Thirty patients described the size of the turtle they were exposed to; 29 (97%) described a turtle with a shell length of less than 4 inches. Among those reporting exposure to small turtles, 12 (41%) of the 29 with information available were exposed to turtles purchased from a street vendor.

Outbreak 2: Salmonella Pomona, Strain A

Case Count Update

A total of 19 individuals infected with Salmonella Pomona, strain A have been reported from 11 states. One new case has been reported from New York.

Illness onset dates range from December 9, 2011 to January 22, 2013. Ill persons range in age from less than 1 year to 90 years, with a median age of 4 years. Sixty-seven percent of ill persons are female. Ethnicity information is currently available for 7 cases; of these, 4 (57%) are Hispanic. Among 15 persons with available information, 4 (27%) reported being hospitalized. No deaths have been reported.

Outbreak 3: Salmonella Poona, Strain A and Salmonella Sandiego, Strain C

Case Count Update

A total of 51 individuals infected with Salmonella Poona, strain A and Salmonella Sandiego, strain C have been reported from 22 states. Sixteen ill persons infected with Salmonella Sandiego, strain C are included in the case count based on epidemiologic and laboratory evidence linking them with this outbreak. Eighteen new cases have been reported from California (1), Georgia (2), Illinois (3), Maine (1), New Jersey (2), New York (2), Pennsylvania (1), Rhode Island (1), South Carolina (2), Tennessee (1), and Texas (2).

Illness onset dates range from October 20, 2011 to December 27, 2012. Ill persons range in age from less than 1 year to 84 years, with a median age of 3 years. Sixty-seven percent of ill persons are female. Ethnicity information is currently available for 15 cases; of these, 2 (13%) are Hispanic. Among 29 persons with available information, 11 (38%) reported being hospitalized. No deaths have been reported.

Investigation Update

Among the 39 ill persons for whom information is available, 29 (74%) reported contact with turtles before becoming ill. Twenty-two persons who reported contact with turtles also reported the size of the turtle; of these, 18 (82%) reported a turtle with a shell length of less than 4 inches.

Environmental Sampling Update

In August 2012, samples taken from turtle tank water at the home of an ill person in Georgia who purchased a turtle from a souvenir shop in Florida yielded the outbreak strain Salmonella Sandiego, strain C. Turtle tank water from this store and another souvenir shop in Florida also yielded the outbreak strain, Salmonella Sandiego, strain C.  Salmonella Poona, strain A and Salmonella Sandiego, strain C have been isolated from turtle tanks housing turtles from a common supplier, indicating that infections with these two strains are a single outbreak.

Outbreak 4: Salmonella Sandiego, Strain B

Case Count Update

There have been no new updates since the December 6, 2012 update.

Outbreak 5: Salmonella Pomona, Strain B

Case Count Update

A total of 88 individuals infected with Salmonella Pomona, strain B have been reported from 24 states and the District of Columbia. Three new cases have been reported from Washington, D.C. (1), New Mexico (1), and Wisconsin (1).

Illness onset dates range from May 23, 2011 to December 20, 2012. Ill persons range in age from less than 1 year to 94 years, with a median age of 2 years. Fifty-two percent of ill persons are female. Ethnicity information is currently available for 35 cases; of these, 14 (40%) are Hispanic. Among 46 persons with available information, 13 (28%) reported being hospitalized. No deaths have been reported.

Investigation Update

Among the 47 ill persons with available information, 34 (72%) reported contact with turtles in the week before becoming ill. Twenty ill persons who reported contact with turtles also reported the size of the turtle; 17 (85%) reported a turtle with a shell length of less than 4 inches.

Outbreak 6: Salmonella Poona, Strain B

Case Count Update

A total of 32 individuals infected with Salmonella Pomona, strain B have been reported from 5 states. Eleven new cases have been reported from California (4), Nevada (1), New York (1), and Texas (5).

Illness onset dates range from April 1, 2012 to January 23, 2013. Ill persons range in age from less than 1 year to 83 years, with a median age of 2 years. Forty-one percent of ill persons are female. Ethnicity information is currently available for 14 cases; of these, 7 (50%) are Hispanic. Among 15 persons with available information, 3 (20%) reported being hospitalized. No deaths have been reported.

Investigation Update

Among the 16 ill persons with information available, 9 (56%) reported exposure to turtles before they became ill. Nine ill persons reported the size of the turtle they had contact with, and 7 (78%) described turtles with a shell length of less than 4 inches.

Outbreak 7: Salmonella I 4,[5],12:i:-, Strain A

Initial Investigation Announcement

As of February 11, 2013, a total of 19 individuals infected with Salmonella I 4,[5],12:i:-, strain A have been reported from 4 states. The number of ill persons identified in each state is as follows: Maryland (2), New York (4), Ohio (1), Pennsylvania (7), and South Carolina (5).

Illness onset dates range from June 8, 2012 to September 27, 2012. Infected individuals range in age from less than 1 year to 33 years, with a median age of 2 years. Fifty-six percent of patients are female. Ethnicity information is currently available for 6 cases; of these, none are Hispanic. Among 7 patients with available information, 3 (43%) have been hospitalized. No deaths have been reported.

Among the 13 ill persons with information available, 9 (69%) reported exposure to turtles before they became ill. Three ill persons reported the size of the turtle they had contact with, and all 3 (100%) described turtles with a shell length of less than 4 inches.

This outbreak PFGE pattern was associated with widely geographically dispersed cases, and exposure data suggested a smaller, focal outbreak. Multiple-Locus Variable-number tandem repeat Analysis, or MLVA, is being used in addition to PFGE to differentiate outbreak cases from unrelated illnesses.

Outbreak 8: Salmonella Typhimurium, Strain A

Initial Investigation Announcement

As of February 11, 2013, a total of 43 individuals infected with Salmonella Typhimurium, strain A have been reported from 11 states and the District of Columbia. The number of ill persons identified in each state is as follows: Alabama (1), Florida (1), Massachusetts (4), Maryland (7), Missouri (1), Mississippi (1), New Jersey (10), New York (11), Pennsylvania (4), South Carolina (1), Tennessee (1), and Washington, D.C. (1).

Illness onset dates range from July 7, 2012 to January 15, 2013. Infected individuals range in age from less than 1 year to 70 years, with a median age of 3 years. Fifty-six percent of patients are female. Ethnicity information is currently available for 14 cases; of these, 4 (29%) are Hispanic. Among 21 patients with available information, 7 (33%) have been hospitalized.

Among the 20 ill persons with information available, 13 (65%) reported exposure to turtles before they became ill. Eight ill persons reported the size of the turtle they had contact with, and all 8 (100%) described turtles with a shell length of less than 4 inches.

In August 2012, samples from a turtle belonging to an ill person in Florida yielded the outbreak strain of Salmonella Typhimurium, strain A. Also in August, the outbreak strain was isolated from turtle tank water at a New York City discount store where a patient infected with a non-outbreak strain of Salmonella purchased a small turtle.

December 6, 2012

Outbreak 1: Salmonella Sandiego, Strain A and Salmonella Newport, Strain A

Case Count Update

A total of 84 individuals infected with Salmonella Sandiego, strain A, and Salmonella Newport, strain A, have been reported from 15 states. Two new cases have been reported from Illinois and New Jersey.

Illness onset dates range from August 3, 2011 to November 11, 2012. Ill persons range in age from less than 1 year to 86 years, with a median age of 7 years. Sixty percent of ill persons are female. Ethnicity was reported for 34 ill persons, and of these, 22 (65%) were Hispanic. Among 56 persons with available information, 13 (23%) reported being hospitalized. No deaths have been reported.

Illnesses that occurred after October 1, 2012 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Investigation Update

Among the 55 ill persons for whom information is available, 42 (76%) reported contact with turtles before becoming ill. Among those reporting exposure to small turtles, 12 (41%) of the 29 with information available were exposed to turtles purchased from a street vendor.

Environmental Sampling Update

In August 2012, samples taken from a turtle and its tank water at the home of an ill person in Texas yielded the outbreak strain Salmonella Sandiego, strain A.

Outbreak 2: Salmonella Pomona, Strain A

Case Count Update

A total of 18 individuals infected with Salmonella Pomona, strain A, have been reported from 11 states. Two new cases have been reported from Colorado and New York.

Illness onset dates range from December 9, 2011 to October 24, 2012. Ill persons range in age from less than 1 year to 90 years, with a median age of 4 years. Sixty-seven percent of ill persons are female. Ethnicity information is currently available for 7 cases; of these, 4 (57%) are Hispanic. Among 15 persons with available information, 4 (27%) reported being hospitalized. No deaths have been reported.

Illnesses that occurred after October 4, 2012 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Investigation Update

Among the 13 ill persons who reported contact with turtles before becoming ill, 7 (54%) described the size of the turtle they had contact with. All 7 (100%) of these individuals identified turtles with a shell length of less than 4 inches.

Outbreak 3: Salmonella Poona, Strain A

Case Count Update

A total of 33 individuals infected with Salmonella Pomona, strain A, have been reported from 17 states. Five new cases have been reported from Georgia (1), Kansas (1), Louisiana (2), and Pennsylvania (1).

Illness onset dates range from October 20, 2011 to October 18, 2012. Ill persons range in age from less than 1 year to 70 years, with a median age of 3 years. Fifty-eight percent of ill persons are female. Ethnicity information is currently available for 9 cases; of these, none are Hispanic. Among 21 persons with available information, 8 (38%) reported being hospitalized. No deaths have been reported.

Illnesses that occurred after October 10, 2012 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Investigation Update

Among the 24 ill persons for whom information is available, 18 (75%) reported contact with turtles before becoming ill. Fifteen persons who reported contact with turtles also reported the size of the turtle; of these, 11 (73%) reported a turtle with a shell length of less than 4 inches.

Outbreak 4: Salmonella Sandiego, Strain B

Case Count Update

A total of 7 individuals infected with Salmonella Pomona, strain B, have been reported from 3 states. One new case has been reported from Texas.

Illness onset dates range from February 25, 2012 to September 29, 2012. Ill persons range in age from less than 1 year to 65 years, with a median age of 10 years. Fifty-seven percent of ill persons are female. Ethnicity information is currently available for 5 cases; of these, 3 (60%) are Hispanic. Among 6 persons with available information, 1 (17%) reported being hospitalized. No deaths have been reported.

Illnesses that occurred after October 18, 2012 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Environmental Sampling Update

In August 2012, samples of turtle tank water from a souvenir store in the Florida panhandle linked to Outbreak 3 yielded the Outbreak 4 strain, Salmonella Sandiego, strain B.

Outbreak 5: Salmonella Pomona, Strain B

Case Count Update

A total of 85 individuals infected with Salmonella Pomona, strain B, have been reported from 23 states. Twelve new cases have been reported from California (1), Georgia (1), Maryland (1), Missouri (1), New Mexico (4), Texas (3), and West Virginia (1).

Illness onset dates range from May 23, 2011 to November 17, 2012. Ill persons range in age from less than 1 year to 94 years, with a median age of 2 years. Fifty-two percent of ill persons are female. Ethnicity information is currently available for 30 cases; of these, 11 (37%) are Hispanic. Among 38 persons with available information, 12 (32%) reported being hospitalized. No deaths have been reported.

Illnesses that occurred after October 30, 2012 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Investigation Update

Among the 39 ill persons with available information, 28 (72%) reported contact with turtles in the week before becoming ill. Fourteen ill persons who reported contact with turtles also reported the size of the turtle; 13 (93%) reported a turtle with a shell length of less than 4 inches.

Outbreak 6: Salmonella Poona, Strain B

Case Count Update

A total of 21 individuals infected with Salmonella Pomona, strain B, have been reported from 5 states. Seven new cases have been reported from California (6) and Pennsylvania (1).

Illness onset dates range from April 1, 2012 to November 15, 2012. Ill persons range in age from less than 1 year to 83 years, with a median age of 2 years. Thirty-nine percent of ill persons are female. Ethnicity information is currently available for 9 cases; of these, 6 (67%) are Hispanic. Among 10 persons with available information, 3 (30%) reported being hospitalized. No deaths have been reported.

Illnesses that occurred after November 4, 2012 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Investigation Update

Among the 11 ill persons with information available, 8 (72%) reported exposure to turtles before they became ill. Eight ill persons reported the size of the turtle they had contact with, and 7 (88%) described turtles with a shell length of less than 4 inches.

Environmental Sampling Update

In October 2012, samples from a turtle belonging to an ill person in California yielded the outbreak strain of Salmonella Poona, strain B.

October 19, 2012

Outbreak 1: Salmonella Sandiego, Strain A and Salmonella Newport, Strain A

Case Count Update

A total of 82 individuals infected with Salmonella Sandiego, strain A, and Salmonella Newport, strain A, have been reported from 15 states. The 6 new ill persons are from California (3), Georgia (1), and New York (2).

Illness onset dates range from August 3, 2011 to September 13, 2012. Ill persons range in age from less than 1 year to 86 years, with a median age of 7 years. Fifty-seven percent of patients are female. Ethnicity was reported for 32 ill persons, and of these, 22 (69%) are Hispanic. Among 54 persons with available information, 13 (24%) reported being hospitalized. No deaths have been reported.

Illnesses that occurred after August 12, 2012 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Outbreak 2: Salmonella Pomona, Strain A

Case Count Update

No new illnesses have been reported since the September 7, 2012 update.

Outbreak 3: Salmonella Poona, Strain A

Case Count Update

A total of 28 individuals infected with the outbreak strain of Salmonella Poona, strain A, have been reported from 16 states. The 3 new ill persons are from Arkansas (2) and Missouri (1).

Illness onset dates range from October 20, 2011 to August 28, 2012. Ill persons range in age from less than 1 year to 70 years, with a median age of 3 years. Sixty-five percent of patients are female. None of the 6 patients for whom ethnicity information is available are Hispanic. Among 18 persons with available information, 6 (33%) reported being hospitalized. No deaths have been reported.

Illnesses that occurred after August 31, 2012 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Outbreak 4: Salmonella Sandiego, Strain B

Case Count Update

No new illnesses have been reported since the May 10, 2012 update.

Outbreak 5: Salmonella Pomona, Strain B

Case Count Update

A total of 73 individuals infected with Salmonella Pomona, Strain B, have been reported from 21 states. The 6 new ill persons are from California (2), Michigan (1), New York (1), South Carolina (1), and Texas (1). One ill person in Outbreak 2 infected with Salmonella Pomona, Strain A, sought further medical care several weeks after the initial test result.  Additional laboratory tests for this ill person yielded Salmonella Pomona Strain B, suggesting that Outbreak 2 and Outbreak 5 may be linked. This ill person is not included in the Outbreak 5 case count.

Illness onset dates range from May 23, 2011 to September 3, 2012. Ill persons range in age from less than 1 year to 94 years, with a median age of 2 years. Fifty-four percent of patients are female. Ethnicity information was reported for 23 patients; of these, 8 (35%) are Hispanic. Among 35 persons with available information, 11 (31%) reported being hospitalized. No deaths have been reported.

Illnesses that occurred after September 7, 2012 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Outbreak 6: Salmonella Poona, Strain B

Case Count Update

A total of 14 individuals infected with Salmonella Poona, Strain B, have been reported from 5 states. The 8 new ill persons are from California (6), Texas (1), and Wisconsin (1).

Illness onset dates range from April 1, 2012 to September 26, 2012. Ill persons range in age from less than 1 year to 83 years, with a median age of 2 years. Forty-three percent of patients are female. Ethnicity information was reported for 4 patients; of these, 1 (25%) is Hispanic. Among 4 persons with available information, 1 (25%) reported being hospitalized. No deaths have been reported.

Illnesses that occurred after September 17, 2012 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

September 20, 2012

Outbreak 1: Salmonella Sandiego, Strain A and Salmonella Newport, Strain A

Case Count Update

A total of 76 individuals infected with Salmonella Sandiego, strain A, and Salmonella Newport, strain A, have been reported from 15 states. The 6 new cases are from California (1), New Jersey (2), New York (1), and Pennsylvania (2).

Illness onset dates range from August 3, 2011 to August 14, 2012. Ill persons range in age from less than 1 year to 86 years, with a median age of 8 years. Fifty-seven percent of patients are female. Ethnicity was reported for 30 ill persons, and of these, 21 (70%) were Hispanic. Among 53 persons with available information, 12 (24%) reported being hospitalized. No deaths have been reported.

Illnesses that occurred after July 15, 2012 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Investigation Update

Among the 51 ill persons for whom information is available, 41 (81%) reported contact with turtles before becoming ill. Thirty persons who reported contact with turtles also reported the size of the turtle; of these, 30 (100%) reported a turtle with a shell length of less than 4 inches. Among those reporting exposure to small turtles, 12 (41%) of the 29 with information available were exposed to turtles purchased from a street vendor. Of the 15 ill persons who reported the type of turtle they had contact with, 13 (87%) reported contact with red-eared slider turtles.

Outbreak 2: Salmonella Pomona, Strain A

Case Count Update

A total of 16 individuals infected with Salmonella Pomona, strain A, have been reported from 10 states. The new case is from New Jersey.

Illness onset dates range from December 9, 2011 to July 21, 2012. Ill persons range in age from less than 1 year to 90 years, with a median age of 16 years. Sixty-nine percent of patients are female. Ethnicity information is currently available for 4 cases; of these, 3 (75%) are Hispanic. Among 13 persons with available information, 4 (31%) reported being hospitalized. No deaths have been reported.

Illnesses that occurred after August 14, 2012 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Outbreak 3: Salmonella Poona, Strain A

Case Count Update

A total of 25 individuals infected with the outbreak strain of Salmonella Poona, strain A, have been reported from 12 states. The 4 new cases are from Georgia (1), Kansas (1), North Carolina (1), and Tennessee (1).

Illness onset dates range from October 20, 2011 to August 12, 2012. Ill persons range in age from less than 1 year to 70 years, with a median age of 3 years. Sixty-five percent of patients are female. None of the 6 patients for whom ethnicity information is available are Hispanic. Among 18 persons with available information, 6 (33%) reported being hospitalized. No deaths have been reported.

Illnesses that occurred after July 30, 2012 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Investigation Update

Among the 21 ill persons for whom information is available, 17 (81%) reported contact with turtles before becoming ill. Eleven persons who reported contact with turtles also reported the size of the turtle; of these, 9 (82%) reported a turtle with a shell length of less than 4 inches.

During interviews, six ill persons reported recent travel to the Florida panhandle and either purchased or handled small turtles at local souvenir stores. As a result, souvenir stores in the Florida panhandle have voluntarily agreed to stop selling turtles at the urging of the local health department.

Investigations conducted by the Florida Fish and Wildlife Commission identified brokers and turtle farms that supplied turtles to souvenir stores in the Florida panhandle area associated with ill persons.  This information has been shared with officials from the U.S. Food and Drug Administration. The investigation is ongoing.

Environmental Sampling Update

In August 2012, five samples of turtle tank water from 6 souvenir stores in the Florida panhandle yielded the outbreak strain, Salmonella Poona, strain A.

Outbreak 4: Salmonella Sandiego, Strain B

Case Count Update

No new cases have been reported since the May 10, 2012 update.

Outbreak 5: Salmonella Pomona, Strain B

Case Count Update

A total of 67 individuals infected with Salmonella Pomona, Strain B, have been reported from 21 states. The 17 new cases are from Arizona (1), California (9), Delaware (1), Illinois (1), Nevada (1), South Carolina (1), Texas (1), Virginia (1), and West Virginia (1).

Illness onset dates range from May 23, 2011 to August 19, 2012. Ill persons range in age from less than 1 year to 94 years, with a median age of 2 years. Fifty six percent of patients are female. Ethnicity information was reported for 22 patients; of these, 8 (36%) are Hispanic. Among 33 persons with available information, 11 (33%) reported being hospitalized. No deaths have been reported.

Illnesses that occurred after August 14, 2012 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Outbreak 6: Salmonella Poona, Strain B

Case Count Update

No new cases have been reported since the June 26, 2012 update.

August 8, 2012

Outbreak 1: Salmonella Sandiego, Strain A and Salmonella Newport, Strain A

Case Count Update

A total of 70 individuals infected with Salmonella Sandiego, strain A, and Salmonella Newport, strain A, have been reported from 15 states. The 8 new cases are from California (2), Illinois (1), Massachusetts (2), Nevada (1), Pennsylvania (1), and Texas (1)

Illness onset dates range from August 3, 2011 to July 9, 2012. Ill persons range in age from less than 1 year to 86 years, with a median age of 8 years. Fifty-seven percent of patients are female. Ethnicity was reported for 26 ill persons, and of these, 19 (73%) were Hispanic. Among 50 persons with available information, 12 (24%) reported being hospitalized. No deaths have been reported.

Illnesses that occurred after June 9, 2012 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Investigation Update

Among the 51 ill persons for whom information is available, 40 (78%) reported contact with turtles before becoming ill. Thirty persons who reported contact with turtles also reported the size of the turtle; of these, 29 (97%) reported a turtle with a shell length of less than 4 inches. Among those reporting exposure to small turtles, 12 (46%) of the 26 with information available were exposed to turtles purchased from a street vendor. Of the 14 ill persons who reported the type of turtle they had contact with, 13 (93%) reported contact with red-eared slider turtles.

Outbreak 2: Salmonella Pomona, Strain A

Case Count Update

A total of 15 individuals infected with Salmonella Pomona, strain A, have been reported from 10 states. The 4 new cases are from California (1), Nevada (1), Pennsylvania (1), and Virginia (1).

Illness onset dates range from December 9, 2011 to July 16, 2012. Ill persons range in age from less than 1 year to 90 years, with a median age of 16 years. Sixty-seven percent of patients are female. Ethnicity information is currently available for 4 cases; of these, 3 (75%) are Hispanic. Among 12 persons with available information, 4 (33%) reported being hospitalized. No deaths have been reported.

Illnesses that occurred after June 28, 2012 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Investigation Update

Among the 12 ill persons for whom information is available, 7 (58%) reported contact with turtles before becoming ill. Among the 4 ill persons who described the size of the turtle they had contact with, all 4 (100%) identified turtles with shell length of less than 4 inches.

Outbreak 3: Salmonella Poona, Strain A

Case Count Update

A total of 21 individuals infected with the outbreak strain of Salmonella Poona have been reported from 11 states. The 4 new cases are from Louisiana (1), Mississippi (1), and Tennessee (2).

Illness onset dates range from October 20, 2011 to July 2, 2012. Ill persons range in age from less than 1 year to 70 years, with a median age of 3 years. Seventy percent of patients are female. None of the 5 patients for whom ethnicity information is available are Hispanic. Among 17 persons with available information, 5 (29%) reported being hospitalized. No deaths have been reported.

Illnesses that occurred after June 8, 2012 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Investigation Update

Among the 20 ill persons with available information, 16 (80%) reported contact with turtles in the week before becoming ill. Eleven persons who reported contact with turtles also reported the size of the turtle; of these, 9 (82%) reported a turtle with a shell length of less than 4 inches. Among the 9 ill persons who had contact with small turtles, 4 (44%) were exposed to turtles from beach gift and souvenir shops and 3 (33%) reported buying turtles from a street vendor.

Environmental Sampling Update

In July 2012, two samples of turtle tank water from the home of an ill person in Mississippi yielded the outbreak strain, Salmonella Poona, strain A.

Outbreak 4: Salmonella Sandiego, Strain B

Case Count Update

No new cases have been reported since the May 10, 2012 update. Among the 5 cases for whom ethnicity information is available, 3 (60%) are Hispanic.

Outbreak 5: Salmonella Pomona, Strain B

Case Count Update

A total of 50 individuals infected with Salmonella Pomona, Strain B, have been reported from 20 states. The 3 new cases are from Illinois (1), New Mexico (1), and Texas (1).

Illness onset dates range from June 21, 2011 to July 11, 2012. Ill persons range in age from less than 1 year to 86 years, with a median age of 2 years. Fifty percent of patients are female. Ethnicity information was reported for 18 patients; of these, 8 (44%) are Hispanic. Among 31 persons with available information, 9 (29%) reported being hospitalized. No deaths have been reported.

Illnesses that occurred after July 3, 2012 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Investigation Update

Among the 33 ill persons with available information, 21 (64%) reported contact with turtles in the week before becoming ill. Nine ill persons who reported contact with turtles also reported the size of the turtle; 8 (89%) reported a turtle with a shell length of less than 4 inches.

Outbreak 6: Salmonella Poona, Strain B

Case Count Update

No new cases have been reported since the June 26, 2012 update. Ethnicity information is extremely limited for cases in this outbreak; the single case for whom ethnicity was reported is not Hispanic.

June 28, 2012

Investigation Overview

Contact with reptiles (such as turtles, snakes, and lizards) and amphibians (such as frogs and toads) can be a source of human Salmonella infections. Small turtles, with a shell length of less than 4 inches, are a well-known source of human Salmonella infections, especially among young children. Because of this risk, the Food and Drug Administration (FDA) has banned the sale and distribution of these turtles since 1975. Amphibians and reptiles can carry Salmonella germs and still appear healthy and clean. Salmonella germs are shed in their droppings and can easily contaminate their bodies and anything in areas where these animals live. Reptiles and amphibians that live in tanks or aquariums can contaminate the water with germs, which can spread to people.

CDC continues to collaborate with public health officials in multiple states and the FDA to investigate 6 overlapping, multistate outbreaks of human Salmonella infections linked to exposure to turtles or their environments (e.g., water from a turtle habitat). Because the majority of ill persons who reported contact with small turtles purchased the turtles from a street vendor, it is difficult to determine the original source of the turtles.

The 6 multistate outbreaks of human Salmonella infections linked to small turtles are numbered in the order in which they were identified. The details of each investigation are described below.

Outbreak 1: Salmonella Sandiego, Strain A and Salmonella Newport, Strain A

Case Count Update

A total of 62 individuals infected with Salmonella Sandiego, strain A, and Salmonella Newport, strain A, have been reported from 15 states. One ill person infected with Salmonella Newport was included in the case count based on epidemiologic and laboratory evidence linking them with this outbreak. The 7 new cases are from California (3), New Mexico (1), Nevada (1), and Texas (2).

Illness onset dates range from August 3, 2011 to May 24, 2012. Ill persons range in age from less than 1 year to 86 years, with a median age of 8 years. Sixty-one percent of patients are female. Among 44 persons with available information, 10 (23%) reported being hospitalized. No deaths have been reported.

Illnesses that occurred after April 24, 2012 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Investigation Update

Among the 47 ill persons for whom information is available, 36 (77%) reported contact with turtles before becoming ill. Twenty-six persons who reported contact with turtles also reported the size of the turtle; of these, 25 (96%) reported a turtle with a shell length of less than 4 inches. Among those reporting small turtles, 10 (45%) of the 22 with information available were exposed to turtles purchased from a street vendor. Of the 11 ill persons who reported the type of turtle they had contact with, 10 (91%) reported contact with red-eared slider turtles.

Environmental Sampling Update

Salmonella Newport, strain A, was isolated from turtle tank water from the household of an ill person infected with Salmonella Sandiego, strain A.

Outbreak 2: Salmonella Pomona, Strain A

Case Count Update

A total of 11 individuals infected with Salmonella Pomona, strain A, have been reported from 8 states. The 2 new cases are from New York (1) and Pennsylvania (1).

Illness onset dates range from December 9, 2011 to May 29, 2012. Ill persons range in age from less than 1 year to 90 years, with a median age of 16 years. Seventy-three percent of patients are female. Among 10 persons with available information, 3 (30%) reported being hospitalized. No deaths have been reported.

Illnesses that occurred after May 22, 2012, might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Outbreak 3: Salmonella Poona, Strain A

Case Count Update

A total of 17 individuals infected with the outbreak strain of Salmonella Poona have been reported from 9 states. The 2 new cases are from Tennessee (1) and Texas (1).

Illness onset dates range from October 20, 2011 to April 6, 2012. Ill persons range in age from less than 1 year to 70 years, with a median age of 3 years. Sixty-nine percent of patients are female. Among 12 persons with available information, 4 (33%) reported being hospitalized. No deaths have been reported.

Illnesses that occurred after May 2, 2012, might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Environmental Sampling Update

In May 2012, two samples of turtle tank water from the home of an ill person in New York yielded the outbreak strain Salmonella Poona, strain A.

Outbreak 4: Salmonella Sandiego, Strain B

Case Count Update

No new cases have been reported since the prior update on May 10, 2012. Illnesses that occurred after June 9, 2012, might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Environmental Sampling Update

In May 2012, turtle tank water obtained in the home of two ill persons from the same Nevada household yielded the outbreak strain, Salmonella Sandiego, strain B.

Outbreak 5: Salmonella Pomona, Strain B

Case Count Update

A total of 47 individuals infected with Salmonella Pomona, strain B, have been reported from 18 states. The 8 new cases are from Alabama (1), Arizona (1), California (2), Nevada (1), South Carolina (1), Tennessee (1), and Texas (1).

Illness onset dates range from June 21, 2011 to June 16, 2012. Ill persons range in age from less than 1 year to 86 years, with a median age of 2 years. Forty-nine percent of patients are female. Among 30 persons with available information, 9 (30%) reported being hospitalized. No deaths have been reported.

Illnesses that occurred after May 26, 2012, might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Investigation Update

Among the 30 ill persons with available information, 19 (63%) reported contact with turtles in the week before becoming ill. Seven ill persons who reported contact with turtles also reported the size of the turtle; all 7 of these persons (100%) reported a turtle with a shell length of less than 4 inches. Four (57%) of the 7 ill persons who had contact with small turtles reported buying their turtles from a street vendor.

Outbreak 6: Salmonella Poona, Strain B, Initial Investigation Announcement

As of June 25, 2012, a total of 6 individuals infected with Salmonella Poona have been reported from 3 states. The number of ill persons identified in each state is as follows: Arizona (1), Pennsylvania (4), and Texas (1).

Illness onset dates range from April 1, 2012 to May 26, 2012. Infected individuals range in age from less than 1 year to 74 years, with a median age of 8 years. Fifty percent of patients are female. The 1 patient with available information has been hospitalized. No deaths have been reported.

Among the 4 ill persons with information available, 3 (75%) reported exposure to turtles before they became ill. Three ill persons reported the size of the turtle they had contact with, and 3 (100%) described turtles with a shell length of less than 4 inches. Three ill persons who had contact with small turtles reported where they purchased the turtles, and 3 (100%) purchased the turtles from a street vendor.

In May 2012, samples of turtle tank water from a pet store where two ill persons from the same Pennsylvania household purchased small turtles yielded the outbreak strain, Salmonella Poona, strain B. Also in May 2012, Salmonella Poona, strain B (the Outbreak 6 strain) was identified in turtle tank water from a pet store where a Delaware person infected with Salmonella Pomona, strain B (the Outbreak 5 strain) had purchased small turtles.

Illnesses that occurred after June 1, 2012, might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

May 10, 2012

Investigation Overview

Contact with reptiles (such as turtles, snakes, and lizards) and amphibians (such as frogs and toads) can be a source of human Salmonella infections. Small turtles, with a shell length of less than 4 inches, are a well-known source of human Salmonella infections, especially among young children. Because of this risk, the Food and Drug Administration (FDA) has banned the sale and distribution of these turtles since 1975. Amphibians and reptiles can carry Salmonella germs and still appear healthy and clean. Salmonella germs are shed in their droppings and can easily contaminate their bodies and anything in areas where these animals live. Reptiles and amphibians that live in tanks or aquariums can contaminate the water with germs, which can spread to people.

CDC continues to collaborate with public health officials in multiple states and the FDA to investigate 5 overlapping, multistate outbreaks of human Salmonella infections linked to exposure to turtles or their environments (e.g., water from a turtle habitat). Because the majority of ill persons who reported contact with small turtles purchased the turtles from a street vendor, it is difficult to determine the original source of the turtles.

The 5 multistate outbreaks of human Salmonella infections linked to small turtles are numbered in the order in which they were identified. The details of each investigation are described below.

Outbreak 1: Salmonella Sandiego, Strain A

Case Count Update

A total of 55 individuals infected with Salmonella Sandiego, strain A have been reported from 13 states. The 5 new cases are from Illinois (1), New Jersey (1), New York (1), Pennsylvania (1), and South Carolina (1).

Illnesses began between August 3, 2011 and April 16, 2012. Ill persons range in age from less than 1 to 86 years, with a median age of 7 years. Sixty-two percent of patients are female. Among 39 persons with available information, 10 (25%) reported being hospitalized. No deaths have been reported.

Illnesses that occurred after March 19, 2012, might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Investigation Update

Among the 41 ill persons for whom information is available, 32 (78%) reported contact with turtles before becoming ill. Twenty-two persons who reported contact with turtles also reported the size of the turtle; of these, 21 (95%) reported a turtle with a shell length of less than 4 inches. Among those reporting small turtles, 8 (42%) of the 19 with information available were exposed to turtles purchased from a street vendor. Of the 9 ill persons who reported the type of turtle they had contact with, 8 (89%) reported red-eared slider turtles.

Environmental Sampling Update

In March 2012, samples of turtle tank water and turtles from the homes of 2 ill persons in New York yielded the outbreak strain, Salmonella Sandiego, strain A.

Outbreak 2: Salmonella Pomona, Strain A

Case Count Update

No new cases have been reported since the March 30, 2012 investigation announcement. Among the 9 cases, 3 (33%) have been hospitalized. Illnesses that occurred after March 28, 2012 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Investigation Update

Among the 5 ill persons who reported contact with turtles before becoming ill, 3 (63%) described the size of the turtle they had contact with. All 3 (100%) identified turtles with shell length of less than 4 inches.

Environmental Sampling Update

In March 2012, one sample of turtle tank water from the home of a person in New York who was infected with Salmonella Sandiego, strain A yielded 2 outbreak strains. These strains were Salmonella Pomona, strain A and Salmonella Sandiego, strain A. This suggests that the turtles causing Outbreak 1 and Outbreak 2 may originate from a common source.

Outbreak 3: Salmonella Poona, Strain A

Case Count Update

A total of 15 individuals infected with the outbreak strain of Salmonella Poona have been reported from 8 states. The 3 new cases are from Alabama (1), New York (1), and Texas (1).

Among persons for whom information is available, illness onset dates range from October 20, 2011 to April 6, 2012. Ill persons range in age from less than 1 year to 70 years, with a median age of 3 years. Sixty-seven percent of patients are female. Among 11 persons with available information, 3 (27%) reported being hospitalized. No deaths have been reported.

Illnesses that occurred after March 18, 2012, might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Investigation Update

Among the 14 ill persons with available information, 12 (86%) reported contact with turtles in the week before becoming ill. Eight persons who reported contact with turtles also reported the size of the turtle; of these, 6 (75%) reported a turtle with a shell length of less than 4 inches. Three (50%) of the 6 ill persons who had contact with small turtles reported buying their turtles from a street vendor. Of the 8 ill persons who could recall the type of turtle with which they had contact, 7 (88%) reported red-eared slider turtles.

Outbreak 4: Salmonella Sandiego, Strain B Initial Investigation Announcement

As of May 8, 2012, a total of 6 individuals infected with Salmonella Sandiego, strain B have been reported from 3 states. The number of ill persons identified in each state is as follows: Colorado (3), Nevada (2), and Texas (1).

Among the persons who reported the date they became ill, illnesses began between February 25 and April 27, 2012. Infected individuals range in age from less than 1 year old to 65 years old, and the median age is 17 years. Fifty percent of patients are female. Among the 6 ill persons, 1 (17%) has been hospitalized. No deaths have been reported.

In interviews, ill persons answered questions about contact with turtles and foods consumed during the week before becoming ill. Four (67%) of 6 ill persons interviewed reported contact with turtles before becoming ill. Four persons who reported contact with turtles also reported the size of the turtle, 4 (100%) reported a turtle with a shell length of less than 4 inches and 4 (100%) identified red-eared slider turtles. Four ill persons who reported contact with small turtles also reported where the turtle was purchased. Two purchased turtles from pet stores, one purchased a turtle from a street vendor, and 1 purchased a turtle from a flea market.

In April 2012, one sample of water from a turtle habitat associated with an ill person in Colorado who was infected with Salmonella Sandiego, strain B was tested. This sample yielded the outbreak strain, Salmonella Sandiego, strain B.

Illnesses that occurred after April 20, 2012, might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Outbreak 5: Salmonella Pomona, Strain B Initial Investigation Announcement

As of May 8, 2012, a total of 39 individuals infected with Salmonella Pomona, strain B have been reported from 16 states. The number of ill persons identified in each state is as follows: Alaska (2), Arizona (1), California (9), Colorado (2), Delaware (3), Georgia (2), Michigan (1), Nevada (2), New York (1), Ohio (2), Oregon (1), Pennsylvania (1), South Carolina (2), Texas (7), Virginia (2), and West Virginia (1).

Illness onset dates range from June 21, 2011 to March 30, 2012. Infected individuals range in age from less than 1 year to 83 years, with a median age of 1 year. Fifty-four percent of patients are male. Among the 20 patients with available information, 2 (10%) have been hospitalized. No deaths have been reported.

Among the 19 ill persons with information available, 13 (68%) reported exposure to turtles before they became ill. Five ill persons reported the size of the turtle they had contact with, and all 5 (100%) described turtles with a shell length of less than 4 inches. Three ill persons who had contact with small turtles reported where they purchased the turtles, and 3 (100%) purchased the turtles from a street vendor.

In March 2012, samples from a turtle tank were collected from the home of an ill person in New Mexico infected with Salmonella Sandiego, strain A (the Outbreak 1 strain). Samples yielded Salmonella Pomona, strain B (the Outbreak 5 strain). This suggests that the turtles causing Outbreak 1 and Outbreak 5 may originate from a common source.

Illnesses that occurred after April 3, 2012, might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

April 5, 2012

Outbreak 1: Salmonella Sandiego, Strain A

Case Count Update

A total of 50 individuals infected with the outbreak strain of Salmonella Sandiego have been reported from 10 states. The 5 new ill persons have been reported from California (4) and Minnesota (1) and have onset dates in August 2011. The Salmonella Sandiego outbreak definition was expanded to include cases whose illness began in August 2011, because new epidemiologic evidence suggested that the outbreak began earlier than what was previously reported. Twenty-eight (82%) of 34 ill persons interviewed reported contact with turtles before becoming ill. Of the 19 ill persons who could recall the size of the turtles with which they had contact, 18 (95%) identified turtles less than four inches in size. Of the 6 ill persons who could recall the type of turtle with which they had contact, 5 (83%) identified red-eared slider turtles.

Among the persons who reported the date they became ill, illnesses began between August 3, 2011 and March 11, 2012. Infected individuals range in age from less than one year old to 86 years old, and 50% of ill persons are 8 years of age or younger. Fifty-eight percent of patients are female. Among the 32 patients with available information, 8 (25%) have been hospitalized. No deaths have been reported.

Salmonella Sandiego Environmental Sampling Update

In March 2012, swabs taken from the turtle tank of a Virginia case yielded the outbreak strain.

Outbreak 3: Salmonella Poona, Strain A

Case Count Update

A total of 13 individuals infected with the outbreak strain of Salmonella Poona have been reported from 7 states. The 1 new ill person has been reported from Texas. At this time, interview information is not available for this person.

March 30, 2012

Initial Announcement

CDC is collaborating with public health officials in multiple states to investigate three overlapping, multistate outbreaks of human Salmonella infections linked to exposure to turtles or their environments (e.g., water from a turtle habitat). The first is an outbreak of human Salmonella Sandiego infections, the second is an outbreak of human Salmonella Pomona infections, and the third is an outbreak of human Salmonella Poona infections. These are rare types of Salmonella. The Salmonella Sandiego and Salmonella Pomona outbreaks have similar geographic distributions, with cases occurring in the Northeast and Southwest. The Salmonella Poona outbreak has a slightly different geographic distribution, with cases occurring in the Midwest and Southwest. Public health investigators are using the PulseNet system to identify cases of illness that may be part of these outbreaks. In PulseNet, the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC, DNA "fingerprints" of Salmonella bacteria are obtained through diagnostic testing with pulsed-field gel electrophoresis, or PFGE, to identify cases of illness that may be part of this outbreak.

These outbreaks can be visually described with a chart showing the number of persons who became ill each day. This chart is called an epidemic curve or epi curve. Illnesses that occurred after January 26, 2012 might not yet be reported due to the time it takes between when a person becomes ill and when the illness is reported. This takes an average of 2 to 3 weeks. Please see the Salmonella Outbreak Investigations: Timeline for Reporting Cases for more details.

Contact with reptiles (such as turtles, snakes, and lizards) and amphibians (such as frogs and toads) can be a source of human Salmonella infections. Small turtles, with a shell length of less than 4 inches, are a well-known source of human Salmonella infections, especially among young children. Because of this risk, the Food and Drug Administration (FDA) has banned the sale and distribution of these turtles since 1975. Amphibians and reptiles can carry Salmonella germs and still appear healthy and clean. Salmonella germs are shed in their droppings and can easily contaminate their bodies and anything in areas where these animals live. Reptiles and amphibians that live in tanks or aquariums can contaminate the water with germs, which can spread to people.

Outbreak 1: Salmonella Sandiego, Strain A Outbreak Investigation

As of March 26, 2012, a total of 45 individuals infected with the outbreak strain of Salmonella Sandiego have been reported from 10 states. The number of ill persons identified in each state is as follows: California (3), Georgia (1), Massachusetts (2), Maryland (5), New Jersey (5), New Mexico (3), New York (18), North Carolina (1), Pennsylvania (6), and Virginia (1).

Among the persons who reported the date they became ill, illnesses began between September 1, 2011 and March 16, 2012. Infected individuals range in age from less than one year old to 86 years old, and 50% of ill persons are 9 years of age or younger. Fifty-eight percent of patients are female. Among the 25 patients with available information, 7 (28%) have been hospitalized. No deaths have been reported.

In interviews, ill persons answered questions about contact with turtles and foods consumed during the week before becoming ill. Nineteen (76%) of 25 ill persons interviewed reported contact with turtles before becoming ill. Of the 13 ill persons who could recall the size of the turtles with which they had contact, 12 (92%) identified turtles less than four inches in size. Of the 6 ill persons who could recall the type of turtle with which they had contact, 5 (83%) identified red-eared slider turtles.

In February 2012, one sample of turtle tank water from an ill person's home in Pennsylvania yielded the outbreak strain.

Outbreak 2: Salmonella Pomona, Strain A Outbreak Investigation

As of March 26, 2012, a total of 9 individuals infected with the outbreak strain of Salmonella Pomona have been reported from 8 states. The number of ill persons identified in each state is as follows: California (2), Massachusetts (1), Maryland (1), New Jersey (1), New York (1), Pennsylvania (1), Texas (1), and Vermont (1).

Among the persons who reported the date they became ill, illnesses began between December 9, 2011 and February 6, 2012. Infected individuals range in age from less than one year old to 90 years old, and 50% of ill persons are 4 years of age or younger. Seventy-five percent of patients are female. Among the 8 patients with available information, 2 (25%) have been hospitalized. No deaths have been reported.

In interviews, ill persons answered questions about contact with turtles and foods consumed during the week before becoming ill. Five (63%) of eight ill persons interviewed reported contact with turtles before becoming ill. Of the 2 ill persons who could recall the size of the turtles with which they had contact, 2 (100%) identified turtles less than four inches in size.

In January 2012, one sample of turtle tank water from the home of 2 ill persons in the same California household yielded the outbreak strain.

Outbreak 3: Salmonella Poona, Strain A Outbreak Investigation

As of March 26, 2012, a total of 12 individuals infected with the outbreak strain of Salmonella Poona have been reported from 7 states. The number of ill persons identified in each state is as follows: Arizona (2), California (3), Indiana (1), Kentucky (1), Michigan (1), New York (2), and Texas (2).

Among the persons who reported the date they became ill, illnesses began between October 20, 2011 and February 18, 2012. Infected individuals range in age from less than one year old to 70 years old, and 50% of ill persons are 4 years of age or younger. Sixty-seven percent of patients are female. Among the 7 patients with available information, 2 (29%) have been hospitalized. No deaths have been reported.

In interviews, ill persons answered questions about contact with turtles and foods consumed during the week before becoming ill. Nine (90%) of 10 ill persons interviewed reported contact with turtles before becoming ill. Of the five ill persons who could recall the size of the turtles with which they had contact, four (80%) described turtles less than four inches in size. Of the 7 ill persons who could recall the type of turtle with which they had contact, 7 (100%) identified red-eared slider turtles.

 
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