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METHODS: A case was defined as infection with one of seven outbreak strains of Salmonella (Sandiego Strains A and B, Pomona Strains A and B, Poona Strains A and B, and Typhimurium) with illness onset from 05/25/2011–11/30/2012. Epidemiologic, traceback, and environmental investigations were conducted.
RESULTS: Two hundred sixty-three cases in 37 states were identified. The median patient age was 4 years (range: <1–94 years), 57% were female, 27% were hospitalized, and 49% were Hispanic. Seventy-one percent (107/150) reported turtle exposure in the week preceding illness, compared with reptile exposure in 5% of the U.S. population (P<0.0001). Among patients exposed to turtles, 92% (61/66) described small turtles. Street vendors were the most commonly reported source of small turtles. Samples from turtle habitats yielded the outbreak strain in 6 outbreaks; ≥2 outbreak strains were identified in samples from 3 outbreaks. Ongoing state and federal traceback investigations have linked 2 outbreaks to turtles from Louisiana farms.
CONCLUSIONS: Epidemiological, laboratory, and traceback evidence link these illnesses to small turtle contact. Despite the federal ban, small pet turtles are a persistent source of zoonotic salmonellosis, especially in young children. Hispanic persons represent a new risk group. Illegal street vendors remain a regulatory challenge. These infections may be reduced through complementary measures: educational messages targeted to Hispanic communities and families with young children and enforcement of the turtle ban through cooperative state and federal investigations.