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Biological Health Hazard – MDR Campylobacteriosis: Public Warning (Canine-Human Infection), USA


Multistate Outbreak of Multidrug-Resistant Campylobacter Infections Linked to Contact with Pet Store Puppies (CDC Final Update)

Published Date: 2018-02-03 11:30:55
Subject: PRO/AH/EDR> Campylobacteriosis – USA (02): canine, human, CDC advisory
Archive Number: 20180203.5602125

Date: Tue 30 Jan 2018
Source: CDC [edited]

Multistate Outbreak of Multidrug-Resistant Campylobacter Infections Linked to Contact with Pet Store Puppies (Final Update)
CDC, several states, and the U.S. Department of Agriculture’s Animal and Plant Health Inspection Service (USDA-APHIS) investigated a multistate outbreak of multidrug-resistant _Campylobacter_ infections. Epidemiologic and laboratory evidence indicated that contact with puppies sold through Petland stores were a likely source of this outbreak. This outbreak investigation is over. Illnesses could continue to occur because people may be unaware of the risk of _Campylobacter_ infections from puppies and dogs.

A total of 113 people with laboratory-confirmed infections or symptoms consistent with campylobacteriosis were linked to this outbreak. Illnesses were reported from 17 states. Illnesses started on dates ranging from 12 Jan 2016 to 7 Jan 2018. Ill people ranged in age from less than one year to 86, with a median age of 27. 63 percent of ill people were female. Of 103 people with available information, 23 (22%) were hospitalized. No deaths were reported. Whole genome sequencing (WGS) showed that isolates from people infected with _Campylobacter_ were closely related genetically. This close genetic relationship means that people in this outbreak were more likely to share a common source of infection.

_Campylobacter_ bacteria isolated from clinical samples from people sickened in this outbreak were resistant to commonly recommended, 1st-line anti-bacterials. This means it may be difficult to treat these infections with the drugs usually prescribed for _Campylobacter_ infections. Antibacterial resistance may be associated with increased risk of hospitalization, development of a bloodstream infection, or treatment failure in patients. Using WGS, we identified multiple antimicrobial resistance genes and mutations in most isolates from 38 ill people and 10 puppies in this outbreak. This finding matched results from standard antibiotic susceptibility testing methods used by CDC’s National Antimicrobial Resistance Monitoring System laboratory on isolates from 5 ill people and 7 puppies in this outbreak. The 12 isolates tested by standard methods were resistant to azithromycin, ciprofloxacin, clindamycin, erythromycin, nalidixic acid, telithromycin, and tetracycline. In addition, 10 were resistant to gentamicin, and 2 were resistant to florfenicol.

In interviews, ill people answered questions about the foods they ate and any animal contact in the week before they became ill. 99 percent of people reported contact with a puppy in the week before illness started, and 87% reported they had contact with a puppy from Petland stores, or had contact with a person who became sick after contact with a puppy from a Petland store. 25 ill people worked at Petland stores.

During the investigation, officials collected samples from pet store puppies for laboratory testing and identified the outbreak strain of _Campylobacter_ in the samples. WGS showed that the isolates from sick people in this outbreak and isolates from pet store puppies were closely related genetically, providing additional evidence that people got sick from contact with pet store puppies.

Ill people reported contact with different breeds of puppies at different store locations in several states. The investigation did not identify a common breeder where puppies infected with the outbreak strain originated. Puppies in this outbreak may have become infected at various points along the distribution chain when they had contact with infected puppies from other breeders or distributors during transport to pet store locations. Enhanced infection prevention measures throughout the distribution chain may help reduce the spread of _Campylobacter_ infections among puppies.

This multidrug-resistant outbreak highlights the need for responsible use of antimicrobials in pets. Education about best practices for _Campylobacter_ disease prevention, diarrhea management in puppies, and responsible antibacterial use is essential throughout the distribution chain to help prevent the emergence and spread of resistance. Pet owners should be aware that any puppy or dog, regardless of where it is purchased or adopted, may carry germs like _Campylobacter_ that can make people sick. Always wash your hands thoroughly with soap and water right after touching puppies and dogs or after picking up their poop. Work with your veterinarian to keep your animal healthy to prevent disease. More information about how to prevent illness when handling puppies and dogs is available for pet owners.

Communicated by:

[Pet-associated campylobacteriosis is underappreciated in human _Campylobacter_ infection. The following is a recent review of the topic:

Campagnolo ER, Philipp LM, Long JM, and Hanshaw NL: Pet-associated campylobacteriosis: A persisting public health concern. Zoonoses Public Health. 2017 Aug 21. doi: 10.1111/zph.12389. [Epub ahead of print]

Campylobacter is regarded as a leading cause of human bacterial gastroenteritis in the USA. We report on a case of laboratory-confirmed _Campylobacter jejuni_ infection in the Commonwealth of Pennsylvania among members of a household living with a laboratory-confirmed but non-speciated _Campylobacter_-infected puppy. We describe an outbreak of likely dog-associated campylobacteriosis, the risk factors, potential routes of exposure, and the clinical features in the exposed family members, which began shortly after exposure to the recently purchased dog. We also provide public health recommendations to prevent _Campylobacter_ infections in veterinary care providers, pet owners, and those planning to adopt pets in the future. Finally, this report underscores the importance of the One Health approach when public health responders, human and animal healthcare providers and clinical diagnostic laboratories are tasked with developing effective strategies when investigating, detecting, and responding to zoonoses (diseases shared between animals and humans).” – Mod.LL

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See Also

Campylobacteriosis – USA: canine, human, CDC advisory 20180127.5588815

Campylobacteriosis – USA (04): canine, human, CDC advisory 20171031.5415984
Campylobacteriosis – USA (03): canine, human, CDC advisory 20171005.5362283
Campylobacteriosis – USA (02): (WA) chicken liver pate, 2016 20170928.5347818
Campylobacteriosis – USA: canine, human, alert 20170913.5312884

Campylobacteriosis – USA: (UT) unpasteurized milk, 2014 20160401.4131443

Campylobacteriosis, E. coli EHEC – USA (02): (ID) unpasteurized milk 20151030.3755260
Campylobacteriosis, E. coli EHEC – USA: (ID) unpasteurized milk, recall 20151022.3735320
Campylobacteriosis – USA (02): (CA) raw goat milk 20150606.3415757
Campylobacteriosis – USA: (CA) unpasteurized milk 20150327.3258683

Campylobacteriosis – USA (07): (SD) raw milk 20141124.2986579
Campylobacteriosis – USA (06): (WI) raw milk 20141025.2901058
Campylobacteriosis – USA (05): (WI) 20141001.2817542
Campylobacteriosis – USA (04): (WI) 20140926.2805165
Campylobacteriosis – USA (03): (UT) unpasteurized milk 20140827.2727937
Campylobacteriosis – USA (02): (NV) race participants, 2012 20140501.2443247


Antibiotic resistance (02): WHO, priority pathogens, 20170301.4871299

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