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Investigation Details
Posted August 16, 2024
CDC and public health officials in several states are collecting different types of data to investigate multistate outbreaks of Salmonella Stanley and Salmonella Poona infections.
Epidemiologic, laboratory, and traceback data show that contact with small turtles is making people sick.
Epidemiologic Data
A total of 51 people infected with one of the outbreak strains of Salmonella has been reported from 21 states (see map). Of these reported illnesses, 38 people were infected with the Salmonella Stanley strain and 13 people with the Salmonella Poona strain. Illnesses started on dates ranging from August 20, 2023, to July 9, 2024 (see timeline). Of 48 people with information available, 23 (48%) have been hospitalized and no deaths have been reported.
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 these outbreaks (“n” is the number of people with information available for each demographic).
| Demographics | Information |
|---|---|
| Age* (n=51) |
Range from <1 to 78 years Median age of 8 years 35% under 5 years 20% ≤1 year |
| Sex (n=51) |
53% female 47% male |
| Race (n=42) |
52% White 45% African American/Black 2% Asian |
| Ethnicity* (n=43) |
60% non-Hispanic 40% Hispanic |
*The Poona Outbreak has higher proportions of children (46% are children one year or younger) and people who identified as Hispanic (67%).
State and local public health officials are interviewing people about the animals they came into contact with the week before they got sick. Of the 41 people interviewed, 27 (66%) reported contact with pet turtles. Of the 23 people who reported the size of the pet turtle, 21 (91%) reported contact with pet turtles with shells less than 4 inches long.
Laboratory and Traceback Data
Public health investigators are using the PulseNet system to identify illnesses that may be part of these outbreaks. 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 these outbreaks likely got sick from the same type of animal.
WGS analysis of bacteria from 49 people’s samples did not predict resistance to any antibiotics. One isolate was predicted to be resistant to the following antibiotics: ampicillin, ceftiofur, ceftriaxone, ciprofloxacin, and trimethoprim-sulfamethoxazole. 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, this resistance is unlikely to affect the choice of antibiotic used to treat most people.
In June 2024, samples were collected from a sick person’s turtle in California for testing. This turtle was purchased from a street vendor. WGS performed by the Los Angeles County Department of Public Health Laboratory showed that Salmonella serotype Poona from the turtle was closely related to the bacteria from sick people.
In July 2024, samples were collected from one turtle and its environment in a sick person’s home in Illinois for testing. The turtle was purchased from a souvenir shop. WGS performed by the Illinois Department of Public Health Laboratory showed the Salmonella Poona on the turtle and its environment were the same as the bacteria from the sick individual.
Eighteen people in both outbreaks reported purchasing or receiving these small turtles from a variety of locations:
- Street vendors, 5 (28%)
- Online retailers, 4 (22%)
- Souvenir shops, 4 (22%)
- Received as gift, 2 (11%)
- Swap meets, 1 (6%)
- Pet stores, 1 (6%)
- Social media, 1 (6%)
A common turtle supplier to these locations has not been identified.
Public Health Actions
CDC advises that you always take steps to stay healthy around your pet turtle: wash your hands, play safely, and keep supplies and the pet area clean.
Do not buy small turtles with shells less than 4 inches long. A federal law bans the sale and distribution of these turtles as pets.
CDC and public health officials in several states are collecting different types of data to investigate multistate outbreaks of Salmonella Altona, Indiana, Infantis, Mbandaka, and Typhimurium infections.
Epidemiologic, laboratory, and traceback data show that contact with backyard poultry is making people sick.
Epidemiologic Data
As of May 16, 2024, 109 people infected with one of the outbreak strains of Salmonella have been reported from 29 states (see map). Illnesses started on dates ranging from February 28, 2024, to April 30, 2024 (see timeline). Of 82 people with information available, 33 (40%) have been hospitalized. No deaths have been reported.
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 with, 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=109) |
Range from <1 to 93 years Median age of 10 43% under 5 years |
| Sex (n=107) |
55% female 45% male |
| Race* (n=74) |
89% White 4% African American/Black 1% Native American or Alaska Native 1% Asian 1% Native Hawaiian or other Pacific Islander 3% reported more than one race |
| Ethnicity (n=74) |
80% non-Hispanic 20% Hispanic |
* Percentages do not total 100 due to rounding.
State and local public health officials are interviewing people about the animals they came into contact with in the week before they got sick. Of the 70 people interviewed, 51 (73%) reported contact with backyard poultry.
Traceback Data
Of 27 people with information available, 18 (67%) reported purchasing or obtaining poultry before their illness started. People reported purchasing poultry from multiple retail stores and directly from a hatchery. Multiple hatcheries supplied birds to the retail stores. A common poultry supplier has not been identified across all outbreaks.
Laboratory Data
Public health investigators are using 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.
Investigators in Ohio and Utah collected samples from inside the boxes used to ship poultry from hatcheries to retail stores, including the box liner and bedding. WGS showed that the Salmonella Altona and Salmonella Mbandaka found in these samples are the same strain as the ones found in sick people.
WGS analysis of bacteria from 101 people’s samples and four environmental samples had no predicted resistance; seven people’s samples predicted resistance to one or more of the following antibiotics: amoxicillin-clavulanic acid, ampicillin, cefoxitin, ceftiofur, ceftriaxone, chloramphenicol, ciprofloxacin, gentamicin, kanamycin, streptomycin, sulfisoxazole, and tetracycline. 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 everyone to take steps to stay healthy around backyard poultry. CDC and state partners are working with hatcheries and stores that sell poultry to educate new poultry owners and control the spread of Salmonella.
