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Associated Salmonellosis in Childcare Centers, United States

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Associated Salmonellosis in Childcare Centers, United States LETTERS during the clinical stage of the disease, Hiroyuki Okada, ity in sheep with preclinical scrapie. J In- and in 1 case, at the preclinical or as- Yuichi Murayama, fect Dis. 2010;201:1672–6. http://dx.doi. org/10.1086/652457 ymptomatic stage. Our fi ndings sug- Noriko Shimozaki, 7. Gough KC, Baker CA, Rees HC, Terry gest that PrPSc is likely to be detected Miyako Yoshioka, LA, Spiropoulos J, Thorne L, et al. The in the saliva of BSE-affected cattle Kentaro Masujin, oral secretion of infectious scrapie prions during the clinical stage of disease, af- Morikazu Imamura, occurs in preclinical sheep with a range of Sc PRNP genotypes. J Virol. 2012;86:566– ter accumulation of PrP in the brain. Yoshifumi Iwamaru, 71. http://dx.doi.org/10.1128/JVI.05579- PrPSc was found in the salivary glands Yuichi Matsuura, 11 of BSE-affected cattle at the terminal Kohtaro Miyazawa, 8. Mathiason CK, Powers JG, Dahmes SJ, stage of infection (1). Therefore, once Shigeo Fukuda, Osborn DA, Miller KV, Warren RJ, et al. Infectious prions in the saliva and blood the infectious agent reaches the central Takashi Yokoyama, of deer with chronic wasting disease. nervous system, it may spread centrif- and Shirou Mohri Science. 2006;314:133–6. http://dx.doi. ugally from the brain to the salivary Author affi liations: National Agriculture and org/10.1126/science.1132661 9. Brown P, Andréoletti O, Bradley R, Budka glands through the autonomic nervous Food Research Organization, Tsukuba, Ja- H, Deslys JP, Groschup M, et al. WHO system. pan (H. Okada, Y. Murayama, N. Shimoza- tables on tissue infectivity distribution in Infectivity of saliva and the pres- ki, M. Yoshioka, K. Masujin, M. Imamura, Y. transmissible spongiform encephalopa- ence of PrPSc in saliva have been re- Iwamaru, Y. Matsuura, K. Miyazawa, T. Yo- thies. Geneva: World Health Organization; 2010 [cited 2011 Nov 2]. http://www.who. ported in other ruminants affected koyama, S. Mohri); and Hokkaido Research int/bloodproducts/tablestissueinfectivity. with transmissible spongiform en- Organization, Shintoku, Japan (S. Fukuda) pdf cephalopathy. Infectivity of saliva was DOI: http://dx.doi.org/10.3201/eid1812.120528 demonstrated in deer with chronic Address for correspondence: Yuichi Murayama, wasting disease (3) and in scrapie- References Prion Disease Research Center, National affected sheep (4); the immunolabeled Institute of Animal Health, National Agriculture Sc PrP accumulated in the salivary 1. Murayama Y, Yoshioka M, Masujin K, and Food Research Organization, 3-1-5 Kan- glands of scrapie-affected sheep (5). Okada H, Iwamaru Y, Imamura M, et al. nondai, Tsukuba, Ibaraki 305-0856, Japan; A low level of PrPSc was detected in Sulfated dextrans enhance in vitro ampli- fi cation of bovine spongiform encepha- email: [email protected] concentrated buccal swab samples of lopathy PrPSc and enable ultrasensitive preclinical scrapie-infected sheep by detection of bovine PrPSc. PLoS ONE. using sPMCA (6,7). These results sug- 2010;5:e13152. http://dx.doi.org/10.1371/ gest that small amounts of PrPSc may journal.pone.0013152 2. Okada H, Iwamaru Y, Imamura M, Ma- accumulate in the salivary glands and sujin K, Matsuura Y, Murayama Y, et al. are then secreted into saliva. Detection of disease-associated prion pro- The presence of infectious pri- tein in the posterior portion of the small ons in saliva may explain the facile intestine involving the continuous Peyer’s patch in cattle orally infected with bo- horizontal transmission of scrapie in vine spongiform encephalopathy agent. sheep (4–6) and chronic wasting dis- Transbound Emerg Dis. 2011;58:333–43. Reptile- and ease in deer (4,8). There has been no http://dx.doi.org/10.1111/j.1865-1682. epidemiologic evidence, however, that 2011.01208.x Amphibian- 3. Haley NJ, Seelig DM, Zabel MD, Tell- saliva, milk, blood, and cerebrospinal ing GC, Hoover EA. Detection of CWD associated fl uid from BSE-infected cattle are in- prions in urine and saliva of deer by Salmonellosis in fectious (9). Nonetheless, the potential transgenic mouse bioassay. PLoS ONE. risk for BSE transmission by body fl u- 2009;4:e4848. http://dx.doi.org/10.1371/ Childcare Centers, journal.pone.0004848 ids or excretions from BSE-infected 4. Tamgüney G, Richt JA, Hamir AN, United States cattle is cannot be ruled out by the Greenlee JJ, Miller MW, Wolfe LL, et al. current data. Salivary prions in sheep and deer. Prion. To the Editor: Salmonella spp. 2012;6:52–61. http://dx.doi.org/10.4161/ infection represents a major public pri.6.1.16984 health problem in the United States; This work was supported by a grant- 5. Vascellari M, Nonno R, Mutinelli F, Bigo- laro M, Di Bari MA, Melchiotti E, et al. nearly 1.4 million human cases and in-aid from the BSE and Other Prion Dis- PrPSc in salivary glands of scrapie-affect- 600 associated deaths are reported ease Project of the Ministry of Agriculture, ed sheep. J Virol. 2007;81:4872–6. http:// each year (1). Reptile and amphibian Forestry and Fisheries, Japan. dx.doi.org/10.1128/JVI.02148-06 exposures might cause >70,000 of 6. Maddison BC, Rees HC, Baker CA, Taema M, Bellworthy SJ, Thorne L, et these cases annually (2). Furthermore, al. Prions are secreted into the oral cav- children are at increased risk of acquir- 2092 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 18, No. 12, December 2012 LETTERS ing Salmonella spp. and experiencing Overall, only 50% of states had ous or harmful animals from childcare severe manifestations of disease (3,4). regulations that required staff and/ centers but that did not also specifi - Given the increasing popularity of or children to wash their hands after cally ban reptiles and amphibians was reptiles and amphibians as pets, rep- touching any animals in childcare paradoxical, considering the well-rec- tile- and amphibian-associated salmo- centers. Twelve states banned reptiles ognized risk that these animals pose nellosis is a substantial public health from childcare centers; 3 of these 12 for transmitting Salmonella spp. We concern (5). states also banned amphibians, and do not know how many childcare cen- The public has a generally low these were the only states we found to ters across the United States currently level of awareness that Salmonella spp. have banned amphibians from child- house reptiles or amphibians. Howev- can be acquired from reptiles and am- care centers. While some states did er, our data suggest that there is room phibians (6); a poll conducted by the not allow potentially dangerous or for revision of the regulations in many US Centers for Disease Control and harmful animals in childcare centers, states which could in turn augment ef- Prevention (CDC) during 2003 showed a minority of these states went further forts to prevent Salmonella spp. trans- that as few as 4 of 49 states require pet to expressly ban reptiles as well (of mission from reptiles and amphibians. stores to provide information about sal- the 23 states that banned potentially We believe that the recommendations monellosis to persons purchasing rep- dangerous or harmful animals, 8 states issued by the CDC for the prevention tiles (4). A Food and Drug Administra- also banned reptiles). One state (Colo- of salmonellosis from reptiles and am- tion ban, activated in 1975, on the sale rado) explicitly banned reptiles, am- phibians (4) could serve as a practical of small turtles subsequently prevented phibians, and potentially dangerous or guide as state regulations are updated. an estimated 100,000 cases of salmo- harmful animals from childcare cen- Our own experience has indicated that nellosis in children each year (7). To ters and also required staff and chil- greater collaboration between public further reduce the risk of reptile- and dren in the center to wash their hands health organizations and the agencies amphibian-associated salmonellosis, after touching animals. responsible for setting regulations for the CDC has issued recommenda- This survey has several limita- childcare centers can be informative tions advising that children <5 years tions. Given the ambiguity in the lan- and productive. Similarly, state agen- of age avoid contact with reptiles and guage used in some regulations and cies can work with the pet industry amphibians and that these animals not that the language was not standard- and childcare centers to develop ap- be kept in childcare centers. The CDC ized between states, we might have proaches that are mutually benefi cial. also recommends that all persons wash misinterpreted some of the documents Although pets provide many ben- their hands after handling reptiles and we reviewed. Furthermore, we might efi ts to humans, particularly during the amphibians (8). have unintentionally overlooked regu- early years of life (9), any exposure We reviewed the regulations as lations that were already in place dur- that children have to animals must of December 2011 for childcare cen- ing our investigation, and hence our pose minimal risk to the children’s ters in all US states aimed at prevent- fi ndings might underestimate the true health. Ultimately, keeping reptiles ing reptile- and amphibian-associated number of states that have such poli- and amphibians out of childcare cen- salmonellosis (Table). To gather these cies. In some cases, cities and coun- ters and requiring that staff and chil- data, we searched the websites for ties have regulations that provide dren wash their hands after touching each state’s public health department increased protection beyond those animals offers a simple way to better or the state’s equivalent of an early implemented at the state level. safeguard the health of children while childhood learning agency. When In summary, we found great vari- having a minimal effect on practices searches on the Internet did not yield ation between state regulations for of childcare centers.
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