Investigation Details

Posted February 23, 2021

February 23, 2021

CDC and public health officials in several states are investigating a multistate outbreak of Salmonella Typhimurium infections linked to small turtles.

Epidemiologic, laboratory, and traceback evidence show that contact with small turtles is making people sick.

Epidemiologic Data

As of February 20, 2021, a total of 22 people infected with the outbreak strain of Salmonella Typhimurium have been reported from seven states (see map). Illnesses started on dates ranging from August 27, 2020, to January 16, 2021 (see timeline).

The true number of sick people in an outbreak is likely higher than the number reported, and the outbreak may not be limited to the states with known illnesses. This is because many people recover without medical care and are not tested for Salmonella. In addition, recent illnesses may not yet be reported as it usually takes 2 to 4 weeks to determine if a sick person is part of an outbreak.

Sick people range in age from less than 1 to 59 years, with a median age of 6. Thirty-six percent are female. Of 19 people with information available, 8 were hospitalized. One death has been reported from Pennslyvania.

State and local public health officials interviewed people about the animals they came into contact with in the week before they got sick. Of the 18 people who provided this information, 15 (83%) reported contact with pet turtles. Of the nine people who reported the size of their pet turtle, nine (100%) reported contact with pet turtles with shells less than 4 inches in length. People reported getting their turtles from various places, including flea markets, roadside vendors, and a pet store.

Laboratory and Traceback Data

Public health investigators are using the PulseNet system to identify illnesses that may be part of this outbreak. CDC PulseNet manages a national database of DNA fingerprints of bacteria that cause foodborne illnesses. DNA fingerprinting is performed on bacteria using a method called whole genome sequencing (WGS).

WGS showed that bacteria from sick people’s samples are closely related genetically. This means that people in this outbreak likely got sick from the same source.

On January 29, 2021, the Pennsylvania Department of Health collected samples from a turtle habitat in a sick person’s home for testing. WGS showed that the Salmonella in the turtle’s environment is closely related to bacteria from sick people. This means that people likely got sick from touching small turtles or something in their habitat.

WGS of bacteria isolated from nine people’s samples and two environmental samples from a turtle habitat did not predict any antibiotic resistance. CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory also conducted standard antibiotic susceptibility testing on bacteria isolated from three outbreak samples and found no resistance.

A common supplier of small turtles has not yet been identified. It is often difficult to determine a common farm or supplier of small turtles due to the illegal practice of sales of small turtles by mobile vendors who do not stay in a single location.

Public Health Actions

CDC advises that you always take steps to stay healthy around your pet turtle: wash your hands, play safely, and keep supplies and the pet area clean.

Do not buy small turtles with shells less than 4 inches long. The U.S. Food and Drug Administration bansexternal icon the sale and distribution of these turtles.

Previous Updates

Laboratory and Traceback Data

Connecticut officialsexternal icon collected samples of El Abuelito brand Hispanic-style fresh and soft cheeses for testing from a store where a sick person reported buying these types of cheeses. On February 16, testing results showed that samples of El Abuelito brand queso fresco cheese were contaminated with Listeria monocytogenes. Whole genome sequencing (WGS) is currently being conducted to see if the Listeria bacteria in the product are closely related to the Listeria bacteria from sick people in this outbreak.

Public Health Actions

Do not eat, sell, or serve any El Abuelito brand queso fresco cheese. FDA and state partners are working with El Abuelito to recall the contaminated product and to determine if additional products should be recalled.

Until we identify which cheeses are making people sick in this outbreak, CDC continues to advise people at higher risk for severe Listeria illness to not eat Hispanic-style fresh and soft cheeses (including El Abuelito brand queso fresco cheese) and to contact their healthcare provider right away if they have any symptoms of severe Listeria illness after eating Hispanic-style fresh and soft cheeses.