You see a cute turtle, I see a salmonella factory

Tiny turtles, a staple of many school science labs and an appealing family pet for people allergic to cats and dogs, may be responsible for a growing number of salmonellosis outbreaks, a study suggests.

turtle.salm.16Sales of turtles with shells less than 4 inches long have been banned in the United States since the 1970s because the creatures are known carriers of Salmonella, which can cause fever, abdominal cramps and diarrhea so severe that some patients need hospitalization.

Despite the sales ban and the known risk, salmonellosis outbreaks tied to turtles have increased since 2006, a research team led by scientists from the Centers for Disease Control and Prevention report in the journal Pediatrics.

“All turtles — healthy and sick, big and small — can carry Salmonella,” said lead author Dr. Maroya Walters, an epidemiologist at the CDC in Atlanta. “Because young children have less developed immune systems and are more likely to engage in hand-to-mouth behaviors, turtles of any size are not appropriate pets for households, schools or daycares with children younger than 5 years of age.”

Salmonella is part of the normal gut flora of turtles, and there’s no way to distinguish a healthy turtle from an infected one, researchers note. The bacteria are present in feces as well as surfaces and water that the animals touch, making it easy for infections to spread to kids who touch the turtles or play with the tank or habitat.

Always the kids: It’s not a cute turtle, it’s a Salmonella factory

Brandon Childs and Cordelia Roass  write for 2 Minute Medicine that a total of 8 multi-state Salmonella infections were identified during the 29-month study period, which included 473 individually confirmed cases.

turtle.salm.dec.15The majority of cases were seen in children younger than 5 years old, and 68% of patients reported a recent exposure to a small turtle.

In the past, exposure to reptiles and amphibians led to thousands of Salmonella infections, particularly in young children. Due to these infections and the potential for developing invasive disease, a federal ban was created in 1975 on the sale and distribution of small turtles less than 4 inches. However, recent multistate outbreaks prompted the current investigative study. Authors of this study sought to understand the epidemiology of turtle-associated salmonellosis and turtle care by case-patients, and to determine where these outbreaks originated. A total of 8 individual, multistate outbreaks were identified. The majority of cases were accounted for by young children, who reported recent exposure to small turtles. A minimal amount of participants were previously aware of the Salmonella reptile association. Investigative efforts traced many cases to 2 turtle farms in Louisiana. After distribution from these farms was halted, the number of new cases of Salmonella infections decreased drastically. Data may be limited as several cases were linked to untraceable sources. Nonetheless, this study should encourage pediatricians to warn their patients and parents about the potential dangers of animal exposure, particularly to small turtles.

In order to identify outbreaks of Salmonella, researchers used data between May 2011 and September 2013 from local and state reference laboratories as well as from the Centers for Disease Control and Prevention. Outbreaks were described as epidemiological and environmental sampling links between ≥2 case-patients including multiple serotypes. Cases were defined as an infection with ≥1 of the outbreak strains. Case-patients were interviewed and completed a questionnaire detailing contact with turtles and their knowledge of the association between reptiles and Salmonella. Swab and water samples were collected by state and local health agencies from patient homes and retail establishments where cases were reported. Researchers identified 8 separate, multi-state Salmonella outbreaks for a total of 473 individual cases. Affected patients <5 years old accounted for 55% of all cases and Hispanic ethnicity was reported in 45% of cases. Turtle exposure was identified in 68% of interviewed patients, and 88% of these were due to contact with small turtles. The association between reptiles and Salmonella was previously known in only 15% of case-patients. Salmonellae were confirmed to be present in 5 retail stores in Florida, which were subsequently traced back to 2 separate Louisiana turtle farms.

Incidence of campy in pets and petting zoos

Animal contact is a potential transmission route for campylobacteriosis, and both domestic household pet and petting zoo exposures have been identified as potential sources of exposure.

courtlynn.petting.zooResearch has typically focussed on the prevalence, concentration, and transmission of zoonoses from farm animals to humans, yet there are gaps in our understanding of these factors among animals in contact with the public who don’t live on or visit farms.

This study aims to quantify, through a systematic review and meta-analysis, the prevalence and concentration of Campylobacter carriage in household pets and petting zoo animals. Four databases were accessed for the systematic review (PubMed, CAB direct, ProQuest, and Web of Science) for papers published in English from 1992–2012, and studies were included if they examined the animal population of interest, assessed prevalence or concentration with fecal, hair coat, oral, or urine exposure routes (although only articles that examined fecal routes were found), and if the research was based in Canada, USA, Europe, Australia, and New Zealand. Studies were reviewed for qualitative synthesis and meta-analysis by two reviewers, compiled into a database, and relevant studies were used to create a weighted mean prevalence value. There were insufficient data to run a meta-analysis of concentration values, a noted study limitation.

The mean prevalence of Campylobacter in petting zoo animals is 6.5% based on 7 studies, and in household pets the mean is 24.7% based on 34 studies. Our estimated concentration values were: 7.65x103cfu/g for petting zoo animals, and 2.9x105cfu/g for household pets. These results indicate that Campylobacter prevalence and concentration are lower in petting zoo animals compared with household pets and that both of these animal sources have a lower prevalence compared with farm animals that do not come into contact with the public.

There is a lack of studies on Campylobacter in petting zoos and/or fair animals in Canada and abroad. Within this literature, knowledge gaps were identified, and include: a lack of concentration data reported in the literature for Campylobacter spp. in animal feces, a distinction between ill and diarrheic pets in the reported studies, noted differences in shedding and concentrations for various subtypes of Campylobacter, and consistent reporting between studies.

 

A systematic review and meta-analysis of the Campylobacter spp. prevalence and concentration in household pets and petting zoo animals for use in exposure assessments

18.dec.15

PLoS ONE 10(12): e0144976

Pintar KDM, Christidis T, Thomas MK, Anderson M, Nesbitt A, Keithlin J, et al.

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0144976

 

22 sickened: Lambing Live farm now faces civil claim after £120,000 fine and costs

A farming attraction ordered to pay £120,000 after an E. coli O157 outbreak now faces a civil claim from families whose children were left seriously ill.

lambing-live-preston-300x277London-based personal injury solicitor Jill Greenfield is putting together the case on behalf of families whose children were hospitalized with the potentially deadly illness.

Huntley’s Country Stores in Samlesbury pleaded guilty on last week to three breaches to health and safety rules after many people were suspected of contracting E. coli during a three-week ‘Lambing Live’ event at Easter 2014.

Twenty-two children became ill with 15 confirmed cases of E-coli.

The firm was fined £60,000 and ordered to pay £60,000 costs.

One mother, Clitheroe’s Juliette Martin, who attended the lamb-feeding event said it had ‘left a permanent scar on the entire family which we will never forget’.

Ms Greenfield won more than £1 million when she represented ten children affected by an E. coli outbreak at a petting farm in Surrey in 2009.

She is particularly concerned about the possible complications to the victims kidney function in later life but said she could not put a figure on the likely total claim against the firm.

Ms Greenfield, a partner at Fieldfisher solicitors, said she was acting for four families.

She said the government had failed to bring in health recommendations by an inquiry into a similar incident at Godstone Farm in 2009.

87104305_huntleys_google-300x169Ms Greenfield said: “If they had been, the tragedy of Huntley’s may never have happened.”

The court heard the tragically typical litany of errors:

  • visitors allowed uncontrolled access to lambs – children could enter animal pens and roll in feces-covered straw;
  • during bottle-feeding, lambs were allowed to climb onto seats, leaving them soiled with feces;
  • pens had open bar gates allowing contaminated bedding to spill onto main visitor area;
  • animals were densely packed, allowing bacteria build-up; and,
  • hand washing basins meant for visitors were used to clean animal feeding dishes.

A table of petting zoo outbreaks is available at http://barfblog.com/wp-content/uploads/2014/04/Petting-Zoo-Outbreaks-Table-4-8-14.xlsx.

Best practices for planning events encouraging human-animal interactions

Erdozain , K. KuKanich , B. Chapman  and D. Powell

03.Apr.14

Zoonoses and Public Health

Educational events encouraging human–animal interaction include the risk of zoonotic disease transmission. ‘It is estimated that 14% of all disease in the USA caused by Campylobacter spp., Cryptosporidium spp., Shiga toxin-producing Escherichia coli (STEC) O157, non-O157 STECs, Listeria monocytogenes, nontyphoidal Salmonella enterica and Yersinia enterocolitica were attributable to animal contact. This article reviews best practices for organizing events where human–animal interactions are encouraged, with the objective of lowering the risk of zoonotic disease transmission.

http://onlinelibrary.wiley.com/doi/10.1111/zph.12117/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false

‘Lambing Live’ featuring E. coli O157: UK farm shop admits failures

In April 2014, at least 15 people, primarily children, who visited a petting farm in Lancashire were stricken with E. coli O157.

When the outbreak was first reported, the UK National Farmer’s Union reassured people that petting farms are safe as long as hygiene rules are followed and that they should continue to go despite the E. coli outbreak.

_87104305_huntleys_googleNot quite.

You people are assholes.

There have been outbreaks where pathogens have been aerosolized and that handwashing was not a significant control factor.

Yesterday, a UK court heard that four children suffered potentially life-threatening kidney failure after an E. coli outbreak at a Lancashire farm shop.

Huntley’s Country Stores, near Preston, admitted health and safety breaches at a lambing event in April 2014.

The four children needed life-saving kidney dialysis with one needing three operations and blood transfusions.

The farming attraction was fined £60,000 and told to pay £60,000 costs at Preston Crown Court on Monday.

In total, 15 people were struck down by the bug – 13 of them children – with nine needing hospital treatment. A further 15 possible cases were also recorded.

The court heard the tragically typical litany of errors:

  • visitors allowed uncontrolled access to lambs – children could enter animal pens and roll in feces-covered straw;
  • during bottle-feeding, lambs were allowed to climb onto seats, leaving them soiled with feces;
  • pens had open bar gates allowing contaminated bedding to spill onto main visitor area;
  • animals were densely packed, allowing bacteria build-up; and,
  • hand washing basins meant for visitors were used to clean animal feeding dishes.

Juliette Martin, of Clitheroe, took her daughter Annabelle, 7, to the ‘Lambing Live’ event at Easter last year.

lambing-live-prestonThe youngster, who had bottle-fed a lamb, suffered kidney failure and needed three operations, three blood transfusions and 11 days of dialysis.

Mrs Martin said: “If we ever thought that by feeding lambs that our daughter would be fighting for her life we would never have visited Huntley’s.”

A spokesman for the farm shop in Samlesbury said: “Everyone at Huntley’s Country Stores deeply regrets that its Lambing Live event in 2014 resulted in the serious ill health of children and an employee.

“At the time of the events, and following the reports of the outbreak of E. coli, the company co-operated with South Ribble Borough Council and has accepted responsibility in court for failings in the assessment of risks.”

A table of petting zoo outbreaks is available at http://barfblog.com/wp-content/uploads/2014/04/Petting-Zoo-Outbreaks-Table-4-8-14.xlsx.

Best practices for planning events encouraging human-animal interactions

Erdozain , K. KuKanich , B. Chapman  and D. Powell

03.Apr.14

Zoonoses and Public Health

Educational events encouraging human–animal interaction include the risk of zoonotic disease transmission. ‘It is estimated that 14% of all disease in the USA caused by Campylobacter spp., Cryptosporidium spp., Shiga toxin-producing Escherichia coli (STEC) O157, non-O157 STECs, Listeria monocytogenes, nontyphoidal Salmonella enterica and Yersinia enterocolitica were attributable to animal contact. This article reviews best practices for organizing events where human–animal interactions are encouraged, with the objective of lowering the risk of zoonotic disease transmission.

http://onlinelibrary.wiley.com/doi/10.1111/zph.12117/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false

What about the epi? Tests don’t link E. coli that killed child to county fair in Maine

The Maine Center for Disease Control and Prevention says the strain of E. coli that sickened two children in October, killing one, can’t be linked to the Oxford County Fair.

ekka.petting.zooState health officials sent samples to the U.S. Centers for Disease Control and Prevention. Those tests came back inconclusive.

“While we know the two children were infected by the same molecular strain of Shiga toxin-producing E. coli, or STEC, that same strain was not found in any of the samples that we tested here in Maine, or in the samples we sent to the U.S. CDC,” Maine’s state epidemiologist Dr. Siiri Bennett, said.

Bennett said the majority of E. coli cases that are investigated end with an undetermined cause.

The families of the two children thought they contracted the illness from the petting zoo at the fair.

Twenty-month-old Colton Guay of Poland died of E.coli. Seventeen-month-old Myles Herschaft of Auburn recovered after treatment at Maine Medical Center.

Officials said four samples collected from the Oxford County Fairgrounds tested negative for E. coli at a state lab, and one sample from animal pens tested positive for the presence of STEC. The Maine CDC said lab tests from the U.S. CDC confirmed that the sample that tested positive for the presence of STEC did not match the strain that caused the children’s illness.

62 sickened with E. coli at North Dakota fair, no cause found

The North Dakota Department of Health says an investigation yielded no cause of an E. coli outbreak centered on the Red River Valley Fair earlier this year.

fargo.margThe final report says 62 people were sickened over the course of the Fair this summer. State health officials are unsure if the cause came from one of the food vendors or rather close contact with farm animals.

The report also says no investigation was conducted at the fairgrounds in West Fargo because the first symptoms came to health officials after the fair’s conclusion. Therefore, there were no food vendors or animal attractions still there to be looked at. However, all food vendors are inspected prior to the Fair’s opening.

Handwashing is never enough: 60 sickened in E. coli outbreak at Washington fairgrounds

A total of 60 people likely were sickened during an E. coli outbreak at the Milk Makers Fest in April, according to a report issued Friday, Oct. 30, by the Centers for Disease Control and Prevention.

Fair E coli 1About 1,325 Whatcom County first-grade students, plus the teachers and parents who accompanied them, from all school districts in Whatcom County went to the annual event April 21-23 at the Northwest Washington Fairgrounds in Lynden.

The event was designed to introduce young students to farming. It also gave them a chance to pet farm animals, including small horses, sheep, rabbits, chickens and a calf. There was a hay maze and scavenger hunt as well.

People who helped set up and take down the event — on April 20 and April 24 — also were among those who were sickened.

The new report provided additional details about the incident.

preliminary report was put out in June by health officials investigating the outbreak, and the findings were similar. Whatcom County and state health departments as well as the CDC were the investigators.

The CDC’s Oct. 30 report found that:

▪ Of the total number of people who were ill, 25 were confirmed through tests and 35 were probable. Eleven were hospitalized. Six developed hemolytic uremic syndrome, a life-threatening complication. There were no deaths.

In the earlier stages of the investigation, health officials identified cases that were confirmed or probable. Then they switched to confirmed cases only. The latest report returned to tracking both types of cases.

▪ Forty people who attended the event were sickened — 35 first-graders, three high school students, one parent and one teacher.

Twenty secondary cases — people who had contact with someone who went to the Milk Makers Fest — were identified in 14 siblings, four caretakers and two cousins of those who went to the event, the CDC wrote.

▪ The strain of Shiga toxin-producing E. coli O157: H7 that caused an outbreak was found in the north end of the dairy barn where the Milk Makers Fest was held, which was reported previously.

“Animals, including cattle, had been exhibited in the barn during previous events. Before the dairy education event, tractors, scrapers, and leaf blowers were used to move manure to a bunker at the north end of the barn,” the CDC reported stated.

▪ While it wasn’t possible to disinfect the barn, steps could have been taken to minimize risk, including hand-washing.

“Students attending the setup and breakdown might have had higher rates of illness because they consumed food in the barn and might not have washed their hands before eating,” the CDC stated. “Facility cleaning procedures and location of the manure bunker (inside the barn) might have contributed to an increased risk for infection among the attendees.”

What jumps out is leaf blowers used to move manure. That’s going to aerosolize and E. coli in the cow poop and no amount of handwashing will remove it.

Be the bug, think where these things are going to go and how they are going to make people barf.

Keep food out of animal education events

Next week I’m tagging along on a field trip with Jack’s first grade class. They’ve been studying the solar system and we’re headed to the planetarium to view the stars and learn about space missions.

No animal exhibits involved in this trip, but I’m sure those are in the future.

I plan on chaperoning any school trips the boys take to the farm, the fair or the petting zoo to help with the onsite risk management.070414.T.FF_.AGEDCENTER1

But, as today’s MMWR highlights, a lot of the disease risk stuff needs to be taken care of before with good planning and procedures.

Yeah, hand washing matters, but so does not letting kids bring lunch/snacks into a contaminated environment.

Or serving food directly in the barn to a 1,000 kids.

Or as Curran et al. say,  ‘These environments should be considered contaminated and should not be located in areas where food and beverages are served’
During April 20–June 1, 2015, 60 cases (25 confirmed and 35 probable) were identified (Figure). Eleven (18%) patients were hospitalized, and six (10%) developed hemolytic uremic syndrome. No deaths occurred. Forty primary cases were identified in 35 first-graders, three high school students, one parent, and one teacher who attended the event. Twenty secondary cases were identified in 14 siblings, four caretakers, and two cousins of attendees.

Food was served inside the barn to adolescents who set up and broke down the event on April 20 and April 24. During April 21–23 approximately 1,000 first-grade students attended the event, which included various activities related to farming. Crude attack rates were higher among those who assisted with setup on April 20 or breakdown on April 24 (three of 14 high school students; 21%) and among attendees on April 21 (22 of 254 students; 9%), than among attendees on April 22 (six of 377 students; 2%) and April 23 (seven of 436 students; 2%).

Animals, including cattle, had been exhibited in the barn during previous events. Before the dairy education event, tractors, scrapers, and leaf blowers were used to move manure to a bunker at the north end of the barn. Environmental samples collected in this area yielded E. coli O157:H7 PFGE patterns indistinguishable from the outbreak strains.

Although it might not be possible to completely disinfect barns and areas where animals have been kept, standard procedures for cleaning, disinfection, and facility design should be adopted to minimize the risk for exposure to pathogens (1). These environments should be considered contaminated and should not be located in areas where food and beverages are served. Hands should always be washed with soap and clean running water, and dried with clean towels immediately upon exiting areas containing animals or where animals have been kept previously, after removing soiled clothing or shoes, and before eating or drinking. Event organizers can refer to published recommendations for preventing disease associated with animals in public settings.

Here’s a set of guidelines we came up with for folks to use when choosing whether to take a trip to these animal events.

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petting2-791x1024-791x1024

 

The kids are not alright: STEC in England

Between 1 January 2009 and 31 December 2012 in England, a total of 3717 cases were reported with evidence of Shiga toxin-producing E. coli (STEC) infection, and the crude incidence of STEC infection was 1·80/100 000 person-years.

kids.are.alrightIncidence was highest in children aged 1–4 years (7·63/100 000 person-years). Females had a higher incidence of STEC than males [rate ratio (RR) 1·24, P < 0·001], and white ethnic groups had a higher incidence than non-white ethnic groups (RR 1·43, P < 0·001). Progression to haemolytic uraemic syndrome (HUS) was more frequent in females and children. Non-O157 STEC strains were associated with higher hospitalization and HUS rates than O157 STEC strains.

In STEC O157 cases, phage type (PT) 21/28, predominantly indigenously acquired, was also associated with more severe disease than other PTs, as were strains encoding stx2 genes.

Incidence of STEC was over four times higher in people residing in rural areas than urban areas (RR 4·39, P < 0·001). Exposure to livestock and/or their faeces was reported twice as often in cases living in rural areas than urban areas (P < 0·001). Environmental/animal contact remains an important risk factor for STEC transmission and is a significant driver in the burden of sporadic STEC infection.

The most commonly detected STEC serogroup in England was O157. However, a bias in testing methods results in an unquantifiable under-ascertainment of non-O157 STEC infections. Implementation of PCR-based diagnostic methods designed to detect all STEC, to address this diagnostic deficit, is therefore important.

 The epidemiology, microbiology and clinical impact of Shiga toxin-producing Escherichia coli in England, 2009–2012

Epidemiology and Infection / Volume 143 / Issue 16 / December 2015, pp 3475-3487

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=10012382&utm_source=Issue_Alert&utm_medium=RSS&utm_campaign=HYG