Multistate outbreak of human Salmonella typhimurium infections associated with aquatic frogs - United States, 2009.

During April-July 2009, the Utah Department of Health identified five cases of Salmonella Typhimurium infection with indistinguishable pulsed-field gel electrophoresis (PFGE) patterns, predominantly among children. In August, CDC began a multistate outbreak investigation to determine the source of the infections. This report summarizes the results of this ongoing investigation, which, as of December 30, had identified 85 S. Typhimurium human isolates with the outbreak strain from 31 states. In a multistate case-control study, exposure to frogs was found to be significantly associated with illness (63% of cases versus 3% of controls; matched odds ratio [mOR] = 24.4). Among 14 case-patients who knew the type of frog, all had exposure to an exclusively aquatic frog species, the African dwarf frog. Environmental samples from aquariums containing aquatic frogs in four homes of case-patients yielded S. Typhimurium isolates matching the outbreak strain. Preliminary traceback information has indicated these frogs likely came from the same breeder in California. Reptiles (e.g., turtles) and amphibians (e.g., frogs) have long been recognized as Salmonella carriers, and three multistate outbreaks of human Salmonella infections associated with turtle contact have occurred since 2006. However, this is the first reported multistate outbreak of Salmonella infections associated with amphibians. Educational materials aimed at preventing salmonellosis from contact with reptiles should be expanded to include amphibians, such as aquatic frogs.