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BACKGROUND: In 1975, the Food and Drug Administration (FDA) banned the sale of turtles with shell length less than four inches except for educational purposes. This has prevented an estimated 100,000 Salmonella infections in children annually. However, turtle-associated salmonellosis cases have increased, culminating with 473 cases in eight multistate outbreaks during 2012. In 2013, 3% of salmonellosis cases in Kansas reported turtle exposure. On July 30, 2013, a salmonellosis case was reported to the Kansas Department of Health and Environment (KDHE). Investigation revealed the family had recently purchased turtles less than four inches in length from a pet store. A traceback investigation was conducted to determine the source of the turtles and prevent additional illnesses.
METHODS: The case-patient’s parents were interviewed with a hypothesis-generating questionnaire. The Kansas Department of Agriculture (KDA) inspected the pet store and confiscated small turtles; these were submitted to the Kansas State Veterinary Diagnostic Laboratory for testing. KDA collected six samples of the store’s turtle tank water; KDHE collected three water samples from the case-patient’s turtle aquarium. All water samples were submitted to the Kansas Health and Environmental Laboratories for testing. Serotyping and pulsed-field gel electrophoresis (PFGE) were performed on the Salmonella isolate from the case-patient, select isolates from water samples, and one isolate from each turtle.
RESULTS: The case-patient was a ten-year-old male with symptom onset five days after the family purchased three small turtles. He was hospitalized for four days; laboratory testing confirmed Salmonella Sandiego. Inspection of the store revealed turtles for sale; all 28 turtles less than four inches were confiscated. Laboratory testing identified 135 Salmonella isolates from the turtles and 18 isolates each from the store’s and family’s tank water. Three isolates from turtles and one from the family’s aquarium were identified as Salmonella Sandiego. One Salmonella Sandiego isolate from a turtle was 94% homologous by PFGE to the case-patient’s strain; the Salmonella Sandiego isolate from the family’s tank water matched by PFGE to the case-patient’s strain.
CONCLUSIONS: Despite a federal ban, illegal sale of small turtles continues, resulting in salmonellosis cases. As a result of this case investigation, KDA has proposed a regulation that will make the sale of turtles less than four inches in length for any purpose illegal in Kansas, which will positively impact the health of Kansans by reducing the risk of turtle-associated salmonellosis. This collaboration between public health and animal health can serve as a model for states without such regulations.