by Deborah Bloch, M.D., FAAP, and
Larry K. Pickering, M.D., FIDSA, FPIDS, FAAP
• CDC Outbreak Advisory: “Multistate Outbreaks of
Human Salmonella Infections Linked to Live Poultry
in Backyard Flocks, 2017,” https://www.cdc.gov/sal
On June 1, the Centers for Disease Control and
Prevention (CDC) issued an outbreak advisory describing nontyphoidal Salmonella spp. outbreaks associated
with backyard live poultry flocks. Ten outbreaks involving 790 cases were reported as of July 17.
In a collaborative effort, the CDC, multiple states and
the U.S. Department of Agriculture’s Animal and Plant
Health Inspection Service are investigating the outbreaks,
which span 48 states and the District of Columbia (see
map). Dates of illness so far include Jan. 4 to June 20,
2017. Of the 580 people with available data, 174 were
hospitalized; there were no deaths. As of June 1, 36% of
cases were children younger than 5 years of age.
The outbreaks were caused by at least 10 different
Salmonella strains of bacteria. Seventy-four percent of
ill people reported contact with live poultry within the
week prior to illness onset. The poultry included chickens and ducks purchased from several sources, including
feed supply stores, websites, hatcheries and relatives.
Nontyphoid Salmonella disease and diagnosis
Salmonella are gram-negative bacilli that belong to the
Enterobacteriaceae family. The main reservoirs of non-en-teric fever serovars are birds, mammals, reptiles and amphibians. The incubation period is usually 12-36 hours.
Symptoms of infection include diarrhea, abdominal
cramps and fever. Illness usually lasts four to seven days.
Bacteremia, which may be transient, also can occur.
Ten percent of patients may develop focal findings,
such as meningitis, brain abscess and osteomyelitis.
Diagnosis of Salmonella gastroenteritis is made by culture or polymerase chain reaction testing of stool. Shedding can be prolonged in young children, with 45% of
children under 5 years of age excreting the organism for
at least 12 weeks after resolution of clinical symptoms.
To treat or not to treat
Antimicrobial therapy typically is not indicated for
noninvasive gastroenteritis because it does not reduce
symptom duration and can prolong fecal excretion.
An antimicrobial agent is recommended for nontyphoidal gastroenteritis in children and adults at risk
for invasive disease, including children younger than
3 months of age and people with chronic gastrointesti-
nal tract disease (such as Crohn’s disease), malignancy,
hemoglobinopathies, HIV or other states of immuno-
suppression. Due to increasing resistance to amoxicillin
and trimethoprim-sulfamethoxazole, local susceptibil-
ity patterns should be considered before choosing an
Prevention is critical
If backyard poultry is desired, there are ways to min-
imize or prevent infection, including washing hands
thoroughly with soap and water after touching poultry
or being in areas where they roam. Children should be
supervised while handling poultry.
Children younger than 5 years of age, adults older
than 65 years of age and anyone with an immunocom-promising condition should not touch poultry, since
they are at higher risk of disseminated and serious
Sal-monella-related disease. Eating and drinking should
not occur in areas where poultry live and roam. Poultry
should not be allowed in the home.
Backyard flocks highlight the need to implement an
important public health measure referred to as the One
Health Initiative ( www.onehealthinitiative.com). This
initiative requires collaborative efforts among multiple
disciplines (physicians, veterinarians and other health
care professionals) at different levels to improve the
health of children, adults, animals and the environment.
Dr. Bloch is a pediatric
infectious diseases fellow,
PGY- 5 at Emory University. Dr. Pickering is adjunct professor of pediatrics
at Emory University School
• AAP Red Book chapter on Salmonella infections, https://
• CDC: Keeping Backyard Poultry, https://www.cdc.gov/
MMWR in Review
Dr. Bloch Dr. Pickering
Salmonella outbreaks linked to backyard poultry
Guidance for egg
collection and handling
Shell eggs may become contaminated with
Salmonella through the egg laying process, and
once eggs are laid, through exposure to the environment, including poultry feed or bedding. The
following guidance should be adhered to when collecting and handling eggs from a backyard flock:
• Always wash hands with soap and water after
handling eggs, chickens or anything in their
• Maintain a clean coop. Cleaning the coop,
floor, nests and perches regularly will help to
keep eggs clean.
• Collect eggs often. Eggs that spend a significant
amount of time in the nest can become dirty
or break. Cracked eggs should be discarded.
• Eggs with dirt and debris should be cleaned
with a brush, cloth or fine sandpaper. Don’t
wash eggs, because colder water can cause the
shell to become porous, allowing bacteria to
enter the egg.
• Refrigerate eggs after collection.
• Cook eggs thoroughly. Raw and undercooked
eggs may contain Salmonella bacteria that can
• If eggs are sold, follow local licensing requirements.
True or False: Washing freshly collected eggs with
cold water is the best way to clean them prior to
A n s w e r: F als e
W ashing eggsin cold w atercanincreasethe chance ofeggs
b e c o m in g infe cte d w ith Salm onella.In c old w ater,th e c o nte nts
ofthe egg contract. Bacteriathen can enterthe eggthrough
porous openingsin the shell. Eggs should be cleaned with a
brush, cloth orfine sandpaper.
People infected with the outbreak strains of Salmonella,
by state of residence, as of July 7, 2017 (n=790)
Source: CDC, https://www.cdc.gov/salmonella/live-poultry-06-17/map.html