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Investigation Details
Posted June 14, 2024
CDC and public health officials in several states are collecting different types of data to investigate a multistate outbreak of Salmonella Cotham infections.
Epidemiologic and laboratory data showed that contact with pet bearded dragons made people sick in this outbreak.
Epidemiologic Data
As of June 14, a total of 15 people infected with the outbreak strain of Salmonella Cotham were reported from 9 states (see map). Illnesses started on dates ranging from January 8, 2024, to May 16, 2024 (see timeline).
The true number of sick people in an outbreak is likely much 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 3 to 4 weeks to determine if a sick person is part of an outbreak.
Public health officials collect many different types of information from sick people, including their age, race, ethnicity, other demographics, and the animals they came into contact within the week before they got sick. This information provides clues to help investigators identify the source of the outbreak.
The table below has information about sick people in this outbreak (“n” is the number of people with information available for each demographic).
| Demographics | Information |
|---|---|
| Age (n=15) |
Range from <1 to 67 years Median age of 1 year 60% under 5 years |
| Sex (n=15) |
73% female 27% male |
| Race (n=10) |
90% White 10% African American or Black |
| Ethnicity (n=13) |
69% non-Hispanic 31% Hispanic |
State and local public health officials are interviewing people about the animals they came into contact with during the week before they got sick. Of the 12 people interviewed, 7 (58%) reported contact with a bearded dragon before getting sick. Most people had contact at home while caring for bearded dragons such as touching the animals or their enclosures, feeding them, and putting them on their laps, heads, or shoulders. At least one child did not touch the bearded dragons and might have been exposed through indirect contact from a reptile in the household. For example, after a reptile was allowed to roam freely in the home.
Laboratory and Traceback Data
Public health investigators used 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 gastrointestinal 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 type of animal. WGS also showed that this Salmonella Cotham strain is genetically closely related to a Salmonella Cotham strain which caused an outbreak from 2012–2014 and was linked to bearded dragon exposure. More information on this previous outbreak can be found here.
People in this outbreak reported purchasing bearded dragons at multiple retail locations.
WGS analysis of bacteria from 13 people’s samples did not predict resistance to any antibiotics. Two people’s samples predicted resistance to ciprofloxacin, gentamicin, and streptomycin. More information is available at the National Antimicrobial Resistance Monitoring System (NARMS) site. Most people with Salmonella illness recover without antibiotics. However, if antibiotics are needed, some illnesses in this outbreak may be difficult to treat with some commonly recommended antibiotics and may require a different antibiotic choice.
Public Health Actions
CDC advises that you always take steps to stay healthy around bearded dragons:
- Wash your hands after handling bearded dragons, their food, or items in their environment.
- Don’t kiss or snuggle bearded dragons.
- Keep bearded dragons out of the kitchen or anywhere that food is prepared, stored, served, or eaten and away from areas where young children play.
- Keep its supplies and habitat clean.
- Limit young children’s contact with bearded dragons.
CDC and public health officials in several states are investigating multistate outbreaks of Salmonella Stanley, Salmonella Pomona, and Salmonella Poona infections.
Epidemiologic and laboratory data showed that contact with small turtles made people sick.
Epidemiologic Data
Since the last update on August 18, 33 new illnesses and one new serotype, Salmonella Poona, have been reported. A total of 59 people infected with the outbreak strains of Salmonella Stanley (30 people), Salmonella Pomona (3 people), or Salmonella Poona (26 people) were reported from 18 states (see map). Illnesses started on dates ranging from October 27, 2022, to August 26, 2023 (see timeline).
The true number of sick people in an outbreak is likely much higher than the number reported, and this 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 3 to 4 weeks to determine if a sick person is part of an outbreak.
Public health officials collect many different types of information from sick people, including their age, race, ethnicity, other demographics, and the foods they ate in the week before they got sick. This information provides clues to help investigators identify the source of the outbreak. The table below has information about sick people in this outbreak (“n” is the number of people with information available for each demographic).
| Demographics | Information |
|---|---|
| Age (n=59) |
Range from <1 to 90 years Median age of 7 39% under 5 years |
| Sex (n=59) |
53% female 47% male |
| Race (n=41) |
68% White 27% African American or Black 2% Asian 2% Native American or Alaska Native |
| Ethnicity* (n=50) |
74% non-Hispanic 26% Hispanic |
*Ethnicity by Salmonella serotype: Salmonella Poona (n=20 cases with information available) 50% report Hispanic ethnicity; Salmonella Stanley and Pomona (n=30 cases with information available) 10% report Hispanic ethnicity.
State and local public health officials interviewed people about the animals they had contact with in the week before they got sick. Of the 46 people who provided this information, 33 (72%) reported contact with pet turtles. Of the 26 people who reported the size of the pet turtle, 26 (100%) reported contact with pet turtles with shells less than 4 inches long.
Twenty-seven people provided information about where they obtained their pet turtle: 7 (26%) people reported purchasing their pet turtles from online retailers, 6 (22%) people reported buying their turtle from stores, 6 (22%) people reported buying their turtle from a roadside stand or flea market, 4 (15%) people reported receiving their turtle as a gift, and 1 person each reported getting their turtles at a reptile show, swap meet, finding their turtle in a park, or winning their turtle at a carnival (15%).
Laboratory Data
Whole genome sequencing (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 type of animal. Bacteria from this outbreak of Salmonella serotypes Stanley and Pomona is closely related to a previous outbreak of Salmonella illnesses linked to small turtles.
In August 2023, samples were collected from a sick person’s turtle in Washington State for testing. This turtle was purchased at a flea market. WGS performed by the Washington State Public Health Laboratories showed that the Salmonella serotype Poona from the turtle and its environment are closely related to the bacteria from sick people.
WGS analysis of bacteria from 57 people’s samples, 3 animal samples, and 2 environmental samples did not predict resistance to any antibiotics. Standard antibiotic susceptibility testing by CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory is currently under way.
