Salmonella

Dear Lisa,

My baby is due this April. My 15 yr old son has a ball python. I've read that reptiles carry Salmonella and that this can be deadly to a newborn and children up to age 5. Would you recommend I remove the pet from my household or are there things I can do to limit any exposure to the baby. Also, am I at risk during my pregnancy? We have had the snake for 4 years.

“Salmonella Concerns”

Dear “Salmonella Concerns”,

Yes, it is true that reptiles can become infected with and carry Salmonella. Other pets such as dogs and cats can also become carriers.(1) The interesting thing is that when animals are infected with Salmonella they usually are asymptomatic or have no visible symptoms. Therefore an owner would never know that their pet is harboring the germ.(1)

Salmonella is responsible for a broad spectrum of illnesses. Salmonella infection can cause Gastroenteritis, Enteric fever, Bacteremia(blood infection), Meningitis, Osteomyelitis(bone infection) and Abscesses. The way that the disease manifests itself depends upon the serotype or type of Salmonella exposure and the health condition and age of the person exposed.

Gastroenteritis is the most common condition caused by Salmonella. The symptoms of Gastroenteritis caused by Salmonella develop abruptly and include nausea, vomiting and crampy abdominal pain followed by loose watery stools. Diarrhea caused by Salmonella may contain mucus and visible blood. (1,2) Fever is a common symptom that is noted in 70% of patients.(1)

In normal healthy adults, the symptoms subside within 2 to 5 days. Those at risk for systemic disease or complications include children under 5 years old, the elderly, those with Sickle Cell Disease, patients taking antibiotics or steroids and those with compromised immune systems. (1,2) Infants in particular have a higher risk of developing Septicemia(overwhelming infection), Bacteremia(blood infection), Meningitis and Osteomyelitis (bone infection). Salmonella can be fatal in infants , especially in those under 3 months old, and in the elderly. (2)

The good thing is that there are measures that can be taken to prevent the transmission of the disease. Salmonella is transmitted via the fecal oral route. This means you can catch Salmonella from contact with an infected person’s stool. Microscopic amounts of stool can become caught underneath the fingernails or left on the hands from inadequate cleansing. The germ can be spread if an infected person handles food that other people eat.

Transmission can become an issue because Salmonella can be shed from a patient’s stool for weeks and sometimes months after the infection has resolved. Surprisingly 1% of patients continue to excrete Salmonella for more than one year after their acute infection!(2) The problem with such a long transmission period is that a patient can unknowingly spread the disease not realizing that they still harbor the germ.

Another mode of transmission is through undercooked food. Poultry, cattle and livestock are common reservoirs for Salmonella. Thoroughly cooking meat and eggs kills Salmonella and prevents people from becoming infected. The problem is that other items that come into contact with the raw meat or eggs during food preparation can become contaminated with the microorganism. Fruits and vegetables can also transmit the disease because once contaminated they are typically not cooked but eaten raw allowing the germ to infect the host.

Other sources of transmission include ingestion of contaminated water or unpasteurized milk and contact with contaminated medications, dyes and medical instruments. Contact with infected animals, especially pets is a common source of infection. Animals such as turtles, iguanas and other reptiles are known carriers of Salmonella. (2)

In order to prevent yourself from becoming infected during your pregnancy you should avoid handling your son’s snake, feeding it or cleaning its cage. It also would be a good idea to have your older son clean his own bedroom, washing his hands carefully afterwards. Whenever preparing food, careful cleansing of food surfaces and diligent hand washing is necessary in order to prevent the transmission of Salmonella. A person that is known to have a Salmonella infection should not handle or prepare food.(2)

From my experience, the infants that contracted Salmonella did so when their parents touched their pacifier or bottle with infected hands. In many of the cases, a caretaker touched an infant’s pacifier or bottle while they were preparing a meal made from chicken or eggs. Many of these parents reported that they put the pacifier in the baby’s mouth out of habit, forgetting to wash their hands first.

In order to keep a newborn baby from catching Salmonella it is necessary that each family member washes their hands before feeding the baby, touching the pacifier, touching the baby’s hands or cleaning the baby's belly button. When preparing meals remember to clean all cooking surfaces before putting the baby's food on them and to wash your hands before touching the baby or any baby items.

The addition of a new baby into the home will affect the dynamics of your whole family. This adjustment may be more difficult for some family members because of change in routine, change in family dynamics and shift of responsibilities. These changes can be difficult for a teenage sibling, especially if they affect his lifestyle. Removing your son’s pet from the home during this time may cause him a lot of grief.

It would be a good idea to sit down and talk with your son about where he stands. If the initial novelty of the snake has worn off and your son is no longer interested in caring for his pet it may be easier to find the snake a new home. I would not be surprised though, if your son is resistant to giving the snake away. Most people are unwilling to remove their pet from the home.(3) Many people view pets as part of the family and refuse to move a pet out of their bedroom, not to mention out of the home .(3)

There are a lot of positive aspects to pet ownership. Studies on the elderly have shown that interacting with animals causes a decrease in blood pressure.(4) Having a pet is a very good learning experience for a child too. Taking care of a pet teaches a child the value of life and the responsibility of taking care of someone other than themselves. Pet ownership has also been shown to have positive psychological effects. So there will be some benefits if the snake remains in the home.

Whether or not you keep the snake or not is your decision. You know your son the best, how mature and responsible he is and how likely it is that he will follow measures to prevent the spread of infection. If you decide to keep the snake it is important that your son understands the steps that he needs to take in order to keep your family free from infection.

You should explain to him that after he handles his ball python, feeds it or cleans its cage that he needs to thoroughly wash his hands with warm soapy water. Before handling the new baby’s food or pacifier he also needs to wash his hands. If your son lets the snake out of the cage and onto the floor it would be a good idea to keep the snake confined to his bedroom and to keep the new baby out of his bedroom when she learns to crawl.

Congratulations on your pregnancy. I wish you and your family well and you a happy and healthy pregnancy.

References:
(1)Behrman R, Kliegman R. Nelson Essentials of Pediatrics. Philadelphia ,PA: W.B.Saunders Company. 1990:330.
(2)American Academy of Pediatrics. Salmonella Infections. In: Peter G, ed. 1997. Red Book: Report of the Committee on Infectious Disease. 24th ed. Elk Grove Village, IL: American Academy of Pediatrics; 1997:462-465.
(3)Phipatanakul, W. Environmental Indoor Allergens. Pediatric Annals. 2003. 32(1):40-48.
(4)Stephenson M. Spreading disease from pets to people. Infectious Diseases in Children. 2006. September:101-102.


Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice About Infectious Diseases In Children