MedPage Today: Those tiny turtles banned from sale in the U.S. because of their potential to transmit Salmonella are still on pet store shelves and have been linked to disease outbreaks, researchers say.
During a 2007 outbreak, youngsters who handled a small turtle were at a 41-fold increased risk of contracting Salmonella, compared with controls (95% CI 6.9 to unbounded), the CDC's Julie R. Harris, PhD, and colleagues reported online in Pediatrics.
"Small turtles continue to be sold and pose a health risk, especially to children," the researchers said. "And many people remain unaware of the link between Salmonella infection and reptile contact."
In 1975, the FDA banned the sale of turtles with a carapace length of less than four inches to reduce turtle-associated Salmonella transmission, especially among young children who love to handle the tiny pets.
Salmonellae are natural intestinal flora for all reptiles, but turtles likely pose a greater hazard for children than other reptiles, the researchers said, since they may be handled differently from pet snakes, lizards, or iguanas.
The authors noted that "the recent development of domestic turtle farms in Asia has placed pressure on the U.S. turtle industry, previously exporting millions of turtles each year to China, to find new markets for turtles."
They cited American Veterinary Medical Association estimates that America's household turtle population doubled from roughly 950,000 in 1996 to almost 2 million in 2006. Market penetration doubled from 0.05% of households to 1% over the same period.
Now, evidence suggests that reptile-transmitted Salmonella outbreaks may be on the rise again.
Public health officials discovered what turned out to be the largest reported outbreak in the U.S. in September 2007, when several patients with Salmonella enterica serotype Paratyphi B var Java infections reported recent turtle exposure.
The researchers ultimately identified a total of 107 infections involving the same Salmonella strain in 34 states between May 2007 and January 2008. The median age of those infected was 7 years, and a third of those infected were hospitalized. For the case-control portion of the study, they compared 25 sick patients with 45 controls.
The researchers found that Salmonella infection was associated with exposure to a turtle during the week before illness onset. In fact, 47 of 78 patients interviewed (60%) reported exposure to turtles during that time.
Some 87% of those turtles were under four inches in shell length, classifying them as small turtles under the terms of the ban.
More than a third of them (34%) were purchased in a retail pet store.
In the case-control study, 72% of case patients reported turtle exposure during the week before illness, compared with 4% of controls (OR 40.9, 95% CI 6.9 to unbounded).
Illness was not associated with exposure to other reptiles or to exposure to aquariums containing tropical fish, the researchers said.
They explained that the "appeal of playing with terrarium water from a turtle's habitat, where Salmonella bacteria can amplify greatly," could contribute to increased infection among young children, but they noted that transmission can occur via many other routes, such as kissing or licking the turtle.
In most cases, neither cases or controls were aware of the link between Salmonella and little turtles (only 32% and 28%, respectively, were aware of the danger).
"Although some retail shops may provide information on the risk of Salmonella, in many states there is no legal obligation for them to do so, limiting opportunities for consumer education," the researchers said. They also warned that some pet stores sell turtles under the uninvestigated claim that they are "Salmonella-free."
The researchers said that physicians, particularly pediatricians, "might want to consider providing information to patients about Salmonella and its link to reptiles."
They concluded that despite the ongoing federal ban on small turtle sales in the U.S., "turtles under four inches in carapace length remain available to the public and continue to cause Salmonella infections, particularly in children."
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