Can salmonella be prevented

• Salmonella bacteria live in the intestinal tract of humans and animals and are excreted in feces. Poultry, beef, milk, and eggs all can contain Salmonella bacteria.
• Salmonella infection is a foodborne illness that occurs from consumption of raw meats and eggs, contaminated dairy foods such as unpasteurized (raw) milk, or fruits and vegetables contaminated by food handlers.
• A Salmonella bacterial infection causes gastrointestinal symptoms, including
  • diarrhea,
  • abdominal pain,
  • nausea, and
  • vomiting.
• Symptoms develop within 12-72 hours and typically last four to seven days.
• The two most common types in the U.S. are S. typhimurium and S. enteritidis. Some types of Salmonella bacteria cause the illness known as typhoid fever.
• In most cases, no specific treatment is needed other than adequate hydration.
• Most cases of salmonellosis are not life-threatening and resolve on their own without complications.
• People at risk for complications or those with particularly severe illness or a weakened immune system may need antibiotic therapy.
• There is no vaccine to prevent Salmonella infection.
• Salmonella may infect reptiles, rodents, and birds. Contact with these animals increases the likelihood of getting the infection.
• People may prevent infection by following established food safety practices, including attention to hygiene during food preparation and handling of animals.

Many of the members of the bacterial genus Salmonella are contagious. The organisms can be transferred from person to person, by both direct (via saliva, fecal/oral spread, kissing) and indirect contact (for example, using contaminated eating utensils). In addition, a number of Salmonella species can be transmitted from animals (snakes, turtles, chickens, hamsters, cats, and dogs) to humans, usually by direct contact.

Salmonella infection, or salmonellosis, is another name for Salmonella food poisoning. Salmonella are a type of bacteria known to cause food-borne illness for over 125 years. The organism is named for a scientist named Daniel Elmer Salmon, who discovered the bacteria. Salmonellosis is a food-borne infection typically caused by consumption of contaminated foods. Salmonella causes an estimated 1 million food-borne illnesses every year in the U.S. and about 19,000 hospitalizations.

Different types (called serotypes or serovars) of the Salmonella bacteria can cause the illness. The two most common serotypes in the U.S. are S. typhimurium and S. enteritidis. Specific strains of the bacteria can be responsible for outbreaks of the disease. For example, an outbreak in 2013-2014 was linked to multidrug-resistant serotype Salmonella Heidelberg. This strain and some other strains have become resistant to many drugs traditionally used to treat the infection, posing a risk to public health.

Some types of Salmonella bacteria (S. typhi) cause typhoid fever, a serious illness that occurs most often in nonindustrialized areas of the world.

Salmonella illness causes an inflammation of the gastrointestinal tract; this is known as gastroenteritis.

• Symptoms of Salmonella poisoning usually begin 12-72 hours after infection.
• Diarrhea, abdominal cramping, and fever are common symptoms.
• The diarrhea is typically loose and not bloody.
• Nausea
• Vomiting
• Headache
• Muscle aches

The symptoms usually go away on their own after four to seven days.

Poultry, beef, milk, and eggs may contain Salmonella bacteria, since the bacteria live in the intestines of humans and animals. Thorough cooking of these foods destroys the bacteria.

Foods, including vegetables and fruits, may also be contaminated during handling or processing of the food, and this is another common source of outbreaks. For example, food may be contaminated by the feces of infected people or animals or from the unwashed hands of a person handling or preparing the food.

Small rodents such as hamsters, as well as baby chicks and ducklings, may also carry the bacteria, and contamination of food after handling these animals may also result in salmonellosis. Reptiles may also harbor Salmonella bacteria. In the 1970s, outbreaks were associated with baby turtles kept as pets. Further, the infection may be spread by contaminated surfaces (such as cutting boards) that have had contact with contaminated foods.

Contaminated foods usually look and smell normal. Over the past years, outbreaks of salmonellosis have been associated with a number of different foods, including chicken, cucumbers, alfalfa sprouts, bean sprouts, ground beef, mangoes, peanut butter, and cantaloupe. These are just a few examples. An outbreak in February 2016 caused by the strain Salmonella muenchen was linked to contaminated alfalfa sprouts. In 2017, an outbreak was linked to papayas from Mexico. A breakfast cereal known as Honey Smacks caused an outbreak in 2018.

Since foods contaminated with Salmonella are not obvious, anyone may consume contaminated foods. Owning pets such as small rodents, chicks, ducklings, small turtles and some other reptiles, and some birds may increase the risk of coming in contact with Salmonella bacteria. People who are exposed to many people, such as those living in group housing, may have an increased risk. Young children (under 5 years of age) have the highest reported incidence of infection.

People with medical conditions that lead to immune suppression are at risk for a more severe illness when they do become infected.

Salmonella is a kind of bacteria, with many different types. The type responsible for most infections in humans is carried by chickens, cows, pigs, and reptiles (such as turtles, lizards, and iguanas). Another, rarer form — called Salmonella typhi — causes typhoid fever.

Salmonella infection, or salmonellosis, is a foodborne illness caused by infection with Salmonella bacteria. Most infections spread to people through contaminated food (usually meat, poultry, eggs, or milk).

A Salmonella infection typically causes:

Because many different kinds of illnesses can cause these symptoms, most doctors will take a stool sample to make an accurate diagnosis.

Salmonella infections usually clear up without medical treatment.

Salmonella bacteria are often found in the feces (poop) of some animals, particularly reptiles. People who have these animals as pets can get salmonellosis if they handle the reptiles and get the bacteria on their hands.

Salmonella can spread to people in foods contaminated by infected animal feces. This can happen when foods such as poultry, eggs, and beef are not cooked enough. Fruit and vegetables can also be contaminated from feces in the soil or water where they're grown.

Yes. People with salmonellosis can spread the infection from several days to several weeks after they've been infected — even if their symptoms have disappeared or they've been treated with antibiotics.

Not everyone who ingests Salmonella bacteria will become ill. Children, especially infants, are most likely to get sick from it. About 50,000 cases of salmonellosis are reported in the United States each year and about one third of those are in kids 4 years old or younger.

People at risk for more serious complications from a Salmonella infection include those who:

• are very young, especially babies
• have problems with their immune systems (such as people with HIV)
• take cancer-fighting drugs or drugs that affect their immune system
• have sickle cell disease
• have an absent or nonfunctioning spleen
• take chronic stomach acid suppression medicine

In these higher-risk groups, most doctors will treat an infection with antibiotics to prevent it from spreading to other parts of the body. Antibiotics do not appear to help a healthy person whose infection is not severe — and may actually lengthen the amount of time the person will carry the bacteria.

Because many different illnesses can cause similar symptoms (such as nausea, fever, cramping, and diarrhea), doctors may send a stool (poop) sample to the lab for testing.

A severe Salmonella infection will require more testing to see which specific germ is causing the illness and which antibiotics can be used to treat it.

If your child has salmonellosis and a healthy immune system, your doctor may let the infection pass without giving any medicines. But any time a child develops a fever, headache, or bloody diarrhea, call the doctor to rule out any other problems.

If your child is infected and has a fever, you may want to give acetaminophen to lower the temperature and relieve cramping. As with any infection that causes diarrhea, it's important to give your child plenty of liquids to avoid dehydration.

Salmonellosis symptoms can take from 6 to 72 hours to start after someone ingests the bacteria. In most people, the illness lasts for 4 to 7 days after symptoms begin.

Hand washing is a powerful way to guard against Salmonella infections. So teach kids to wash their hands well and often, particularly after trips to the bathroom and before handling food.

Here are some other ways to protect your family from Salmonella infections:

• Cook food thoroughly.Salmonella bacteria are most commonly found in animal products and can be killed by the heat of cooking. Don't serve raw or undercooked eggs, poultry, or meat. Microwaving is not a reliable way to kill the bacteria. If you're pregnant, be especially careful to avoid undercooked foods.
• Handle eggs carefully. Because Salmonella bacteria can contaminate even intact and disinfected grade A eggs, cook them well and avoid serving poached or sunny-side up eggs (with runny yolks).
• Avoid foods that might contain raw ingredients. Caesar salad dressing, the Italian dessert tiramisu, homemade ice cream, chocolate mousse, eggnog, cookie dough, and frostings can contain raw eggs. Unpasteurized milk and juices also can be contaminated with Salmonella.
• Clean cooking surfaces regularly. Keep uncooked meats away from cooked and ready-to-eat foods. Thoroughly wash your hands, cutting boards, counters, and knives after handling uncooked foods.
• Take care with pets. Avoid contact with the feces of family pets — especially reptiles. Wash your hands well after handling an animal and make sure that no reptiles are permitted to come into contact with a baby. Even healthy reptiles (especially turtles and iguanas) are not safe pets for small children and should not be in the same house as an infant.
• Don't cook food for others if you are sick, especially if you have vomiting or diarrhea.
• Keep food chilled. Don't leave cooked food out for more than 2 hours after serving (1 hour on a hot day) and store it promptly. Also, keep your refrigerator set to under 40°F (4.4°C).

Rod Brouhard is an emergency medical technician paramedic (EMT-P), journalist, educator, and advocate for emergency medical service providers and patients.

Andy Miller, MD, is board-certified in internal medicine and infectious disease. He is an associate professor at Weill Cornell Medicine in New York City.

Taking steps to prevent getting a salmonella infection can save you and your family from being one of the 1.2 million people in the United States who contract this illness each year.   The bacteria responsible for salmonella is spread by contaminated food and by handling animals such as pet turtles that carry it in their feces. Avoid raw or undercooked meat and eggs and ensure raw meat is handled separately from other foods when preparing a meal.

Preventing infection is especially important for those most at risk of a severe illness, including young children, the elderly, and those with weakened immune systems.

While most people get diarrhea that runs its course in a few days, approximately 450 people die every year from acute salmonellosis .

There is no vaccine for salmonella and you can catch the illness multiple times, so it is important to avoid contact with the bacteria.

Transmission

Salmonellosis is an illness that includes diarrhea, fever, and abdominal cramps.   The bacteria are spread in the feces. Some people are healthy but are carriers of the bacteria. Use these tips so you don't give salmonella to others or get it from them:

• Always wash your hands thoroughly after using the toilet, changing diapers, and before preparing food.
• A person who has salmonellosis should not prepare food or pour water for others until they have had no symptoms for 48 hours.
• A person who has salmonellosis should not return to work, child care, or school until they have had no symptoms for 48 hours.
• Don't go swimming if you have had diarrhea in the past 24 hours.

Food Preparation and Handling

There are many food handling practices that are aimed at preventing salmonella infection from food. These practices are important while eating, cooking at home, and preparing food in restaurants.  

Clean

• Wash your hands before and after you handle food items.
• Wash kitchen work surfaces and utensils with soap and water after preparing each food item.
• It is better to use disposable paper towels to clean kitchen surfaces than sponges or cloth towels. If you use cloth towels, they should be washed in hot water in a washing machine after each use.
• Thoroughly wash produce before consuming.
• Peel and discard outer leaves or rinds of fruits and vegetables.
• Scrub hearty vegetables, such as potatoes and carrots, if you want to eat the skin.

Separate

• When shopping, keep raw meat, poultry, and seafood separate from the other items. Store them separately in the refrigerator.
• After contact with raw meat or poultry, wash hands, kitchen work surfaces, utensils, plates, bowls, etc. with soap and water immediately. It is especially important that you don't use unwashed utensils and other items for food that will be served uncooked or for the meat once it has been cooked.
• It is best to have separate cutting boards designated for raw meat and for produce as cleaning may not remove all of the bacteria.
• Don't work with raw poultry or meat and handle an infant (e.g., feed, change diaper) at the same time.

Cook

• Cook poultry, ground beef, and eggs thoroughly before eating. Do not eat or drink foods containing raw eggs or raw unpasteurized milk. Raw eggs may be unrecognized in some foods such as homemade hollandaise sauce, homemade salad dressings, tiramisu, homemade ice cream, homemade mayonnaise, cookie dough, eggnog, and frostings.
• If you are served undercooked meat, poultry or eggs in a restaurant, don't hesitate to send it back to the kitchen for further cooking. Poultry and meat, including hamburgers, should be well-cooked, not pink in the middle.

Chill

• Keep refrigerators clean and cold (40 F or below for refrigerators).
• Cover and refrigerate produce you have cut.
• Read and follow label instructions such as "Keep Refrigerated" or "Use By" (a certain date).
• Keep prepared fruit salads or other cut produce items in the refrigerator until just before serving. Discard cut produce items if they have been out of the refrigerator for more than four hours.

General

• Mother's milk is the safest food for young infants. Breastfeeding prevents salmonellosis and many other health problems. Wash your hands before breastfeeding your child.
• Don't drink untreated water that could be contaminated by animal waste.

Animal and Pet Contact

While animals may transmit salmonella to anyone, there are groups who are at higher risk and should avoid any contact with animals that commonly carry the bacteria. These groups include infants, children age 5 and younger, adults over age 65, and people with decreased immune function (HIV/AIDS, chemotherapy, organ transplant recipients).

The highest-risk animals are reptiles (turtles, iguanas, other lizards, snakes), amphibians (frogs, salamanders), and live poultry (chickens, ducks, geese, turkeys).

Other animals that may transmit salmonella include pet birds, rodents (hamsters, guinea pigs, rats, mice), hedgehogs, farm animals, dogs, cats, and horses. The bacteria are primarily found in their feces, but their fur, feathers, bedding, toys, food, feeders, cages, or enclosures will also harbor the germs. These animals can be completely healthy and still carry the bacteria.

Use these tips to reduce your risk and protect people in higher-risk groups:  

• Wash your hands with soap and water after any contact with animals, their enclosures, or their feces. While this applies to any animal or pet, it is especially a concern with reptiles, amphibians, or birds.
• People in high-risk groups should avoid direct or even indirect contact with reptiles, amphibians, and live poultry. These animals should not be kept as pets in households that have members in the high-risk groups, or at daycare facilities, elder care facilities, or medical facilities.
• Don't allow high-risk animals into areas where you commonly eat or drink. Don't eat, drink, or smoke while around those animals.
• Petting zoos or farm visits are best reserved for children over age 5, with supervision.
• Adults in high-risk groups should not clean any pet items or animal waste without wearing disposable gloves. Children age 5 and under should not be given such tasks.
• When washing pets or their items, try to do so outdoors. Do not discard the water in a sink that is used for food preparation. Use bleach to disinfect any sink, tub, or toilet afterward.
• If your child is age 5 or younger, supervise the child around animals. Don't allow contact with your child's face or kissing. Assist your child in handwashing after handling an animal.

Backyard Farming

As keeping chickens and enjoying homegrown eggs is popular, it is important to understand the risks of salmonella from these activities. You should only buy live poultry or chicks from hatcheries certified by the USDA National Poultry Improvement Plan (USDA NPIP).   It's best not to get your poultry from show breeders or other backyard farmers.

Use these tips to avoid getting salmonella:

• Clean your coop regularly, wearing gloves and shoe protectors or shoes you only use in the coop.
• Change the food and water daily.
• Wash your hands after handling a chicken or collecting eggs and do so either outdoors or using a sink that isn't used for food preparation.
• Clean feeding bowls and other items outdoors or in a sink not used for food preparation, disinfecting it with bleach.
• Don't eat, drink, or smoke around your birds.
• Keep your birds out of the house and away from areas, including outdoor patios, where you prepare or eat food.
• Don't allow children under age 5 around your birds and supervise other children and adults so they handle the birds safely.
• If any bird is sick, separate it from the rest of the birds and contact your veterinarian.
• Ensure your birds get all recommended vaccines.
• If you use chicken manure as garden compost, it must be cured for at least 45 days before use.
• Don’t kiss backyard poultry, or snuggle them and then touch your face or mouth.  

Use these tips for homegrown egg safety:

• Collect the eggs each morning and afternoon.
• Washing eggs after collection isn't recommended as the Center for Disease Control (CDC) says that washing in cold water can pull bacteria into the eggs.   Clean them outdoors with a brush or cloth.
• Discard cracked or dirty eggs.
• Refrigerate eggs in two hours or less.
• If you are selling your eggs, follow all local regulations and licensing requirements.
• When eating homegrown eggs, cook them thoroughly and don't consume raw eggs.

Identifying Outbreaks

Public health departments and the CDC require medical facilities to report cases of salmonellosis so they can identify and track outbreaks.   Clinical laboratories send isolates of Salmonella to public health laboratories so the specific type can be determined and compared with other Salmonella in the community. If many cases occur at the same time, it may mean that a restaurant, food, or water supply has a problem which needs correction by the public health department. While many people don't seek medical care for a bout of salmonellosis that runs a typical course, those who do will help with this monitoring for outbreaks.

Information on outbreaks can be seen on the CDC site.

Examples of recent outbreaks include those due to shell eggs, coconut, chicken salad, raw sprouts, kratom, pet guinea pigs, and pet turtles. You can drill down to see the specifics for outbreaks.

If you hear any news reports of recalls of food due to concern for salmonella or foodborne illnesses, check to see whether you have bought the recalled products. Do not consume them.

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