Outbreak of Multidrug-resistant Campylobacter Infections Linked to Contact with Pet Store Puppies

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Published on December 17, 2019 at 5:00 PM ET

CDC and public health officials in several states are investigating a multistate outbreak of multidrug-resistant Campylobacter jejuni infections linked to puppies purchased from pet stores.

Latest Outbreak Information
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At A Glance
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  • 30 people infected with the outbreak strain of Campylobacter jejuni, which causes diarrheal illness, have been reported from 13 states.
    • 4 hospitalizations have been reported. No deaths have been reported.
  • Epidemiologic and laboratory evidence indicate that contact with puppies, especially those at pet stores, is the likely source of this outbreak.
  • Among 24 people interviewed,
    • 21 (88%) of the 24 people reported contact with a puppy.
    • 15 (71%) of these 21 people reported contact with a puppy from a pet store.
    • 12 (80%) of these 15 people were linked to Petland, a national pet store chain.
    • 5 (42%) of these 12 people were Petland employees.
  • Laboratory evidence indicates that bacteria from ill people in this outbreak are closely related genetically to bacteria from ill people in the 2016–2018 outbreak of multidrug-resistant Campylobacter infections linked to pet store puppies.
  • Campylobacter bacteria isolated from clinical samples from ill people in this outbreak are resistant to commonly recommended, first-line antibiotics. For more information, see CDC’s Advice to Clinicians.
  • The investigation is ongoing. CDC will provide updates when more information is available.
Advice to Pet Owners and Pet Store Workers
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Advice to Pet Owners

Puppies and dogs can carry Campylobacter germs that can make people sick, even while appearing healthy and clean. People who own or come in contact with puppies or dogs should take steps to stay healthy around their pet.

Always wash your hands thoroughly with soap and water after touching your puppy or dog, after handling their food, and after cleaning up after them.

  • Adults should supervise handwashing for young children.
  • If soap and water are not readily available, use hand sanitizer until you are able to wash your hands with soap and water.
  • Wash your hands after cleaning up urine (pee), feces (poop), or vomit from your puppy or dog. Clean up any pee, poop, or vomit inside the house immediately. Then disinfect the area using a water and bleach solution.
  • Don’t let dogs lick around your mouth and face.
  • Don’t let dogs lick your open wound or areas with broken skin.
  • Take your dog to the veterinarian regularly to keep it healthy and to help prevent the spread of disease.

Within a few days after getting a new puppy or dog, take it to a veterinarian for a health check-up.

  • When choosing a pet dog, pick a puppy or dog that is bright, alert, and playful.
  • Signs of illness include appearing lethargic (sluggish or tired), not eating, having diarrhea, and breathing abnormally. However, even a dog that appears healthy can spread germs to people and other animals.
  • If your dog becomes sick soon after purchase or adoption, take your dog to a veterinarian promptly and inform the pet store, breeder, or rescue organization about the pet’s illness. Thoroughly clean the area occupied by your pet by using a water and bleach solution.

Advice to Pet Store Workers

Puppies and dogs can carry Campylobacter germs that can make people sick, even while appearing healthy and clean. People who handle puppies or dogs should take steps to stay healthy around these animals.

Ask store management for training about handwashing, clean-up procedures, and other illness prevention measures.

Wash your hands with soap and water after handling puppies or dogs.

  • Wash your hands thoroughly with soap and water every time you handle dogs or anything in the area where they live and roam, including their food, treats, and food and water containers. Even a dog that appears healthy can spread germs to people and other animals.
  • Wash your hands immediately after cleaning up dog pee, poop, or vomit.
  • Dry hands using a clean paper towel or air-dry them. Do not dry hands on clothing.

Eat and store your food safely.

  • Always eat and drink in designated areas away from places where animals are kept and exercised.
  • Keep your food away from areas where pet food and treats are stored, and away from areas where animals are kept or exercised.
  • If there isn’t a separate refrigerator for pet food, store food for people on top shelves, above food, treats, and other supplies for pets.

Clean up messes safely.

  • Clean up any pee, poop, or vomit immediately, and disinfect the area according to store protocols.
  • Use disposable gloves for clean-ups and wash your hands thoroughly afterwards.
  • Wash work shoes or boots, clothes, and equipment regularly, and do so in an area that is not used to store or prepare food for people.
  • Have shoes or boots that are only worn and stored at the workplace.

Follow store protocols for identifying and reporting sick or injured animals.

Let your employer know if you or other employees become ill, especially with diarrhea or vomiting.

Practice responsible use of antibiotics in pet stores.

  • Only give antibiotics to animals under the direct supervision of a veterinarian.
  • Veterinarians should use appropriate diagnostic tests to ensure that animals receive the right treatment.
  • Monitor and document antibiotic use in pet stores.
  • Educate breeders, brokers, and transporters who supply animals to pet stores about responsible use of antibiotics and the benefit of veterinary supervision of antibiotic use.
Symptoms of Campylobacter Infection in People
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  • Most people infected with Campylobacter infection develop diarrhea (often bloody), fever, and stomach cramps 2 to 5 days after being exposed to the bacteria.
  • The illness usually lasts about a week and most people recover without antibiotic treatment.
  • Antibiotics are needed only for patients who are very ill or at high risk for severe disease, such as people with severely weakened immune systems.
Investigation Details

December 17, 2019

CDC and public health officials in several states are investigating a multistate outbreak of multidrug-resistant human Campylobacter jejuni infections linked to contact with puppies from pet stores.

Public health investigators are using the PulseNet system to identify illnesses that may be part of this outbreak. PulseNet is the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC. DNA fingerprinting is performed on Campylobacter bacteria isolated from ill people by using a standardized laboratory and data analysis method called whole genome sequencing (WGS). CDC PulseNet manages a national database of these sequences that are used to identify possible outbreaks. WGS gives investigators detailed information about the bacteria causing illness. In this investigation, WGS showed that bacteria from people infected with Campylobacter were related genetically to each other. This means that people in the outbreak are more likely to share a common source of infection. WGS also showed that bacteria from people infected with Campylobacter in the current outbreak are related genetically to a 2016–2018 outbreak of multidrug-resistant Campylobacter infections linked to pet store puppies.

As of December 17, 2019, a total of 30 people infected with Campylobacter have been reported from 13 states. A list of the states and the number of confirmed cases in each state can be found on the Map of Reported Cases page.

Illnesses started on dates ranging from January 6, 2019, through November 10, 2019. Ill people range in age from 8 months to 70 years, with a median age of 34; 52% of ill people are female. Of 26 people with information available, 4 hospitalizations have been reported. No deaths have been reported.

Illnesses might not yet be reported due to the time it takes between when a person becomes ill and when the illness is reported.

WGS analysis of 26 isolates from ill people predicted antibiotic resistance to tetracycline (26 isolates), ciprofloxacin (25), nalidixic acid (25), azithromycin (23), erythromycin (23), clindamycin (23), telithromycin (23), and gentamicin (18). Testing of one outbreak isolate using standard antibiotic susceptibility testing methods by CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory confirmed these results.

Investigation of the Outbreak

Epidemiologic and laboratory evidence indicate that puppies purchased from pet stores are the likely source of this outbreak. Many of the cases had contact with puppies or were employees at pet stores, including Petland.

CDC included ill people in this outbreak if

  • their stool (poop) sample grew Campylobacter jejuni in the laboratory (called a culture-confirmed infection) and they also had a link to puppies, or
  • they had a culture-confirmed Campylobacter jejuni infection that was closely related genetically to a confirmed puppy-linked case by WGS.

In interviews, ill people answered questions about dog, puppy, and other exposures they had in the week before they became ill. Of 24 people interviewed, 21 (88%) reported contact with a puppy in the week before illness started, and 15 (71%) of those 21 people reported contact with a puppy from a pet store. When asked about the specific pet store, 12 (80%) of those 15 people reported either having contact with a puppy or working at a Petland store.

Investigators reported eight more ill people who had contact with a puppy at Petland and had a diagnostic test showing they were infected with Campylobacter bacteria. However, CDC did not include these people in the outbreak case count because no bacterial samples were available for WGS. Public health investigators use WGS to identify illnesses that are part of multistate outbreaks.

A single, common supplier of puppies has not been identified. This investigation is ongoing. CDC will provide updates if more information becomes available.