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by manufacturer A at plant A in Pennsylvania and sold under several brand names caused human illness during 20062007. Although previous reports in North America have associated Salmonella infection with certain pet treats, this report is the first to associate Salmonella with contaminated dry dog food. The case-control study found an association between infections in households and use of dry dog food or dry cat food produced by manufacturer A. In addition, the outbreak strain was isolated from 1) opened bags of dry dog food (brands A and B) that were produced in plant A by manufacturer A, 2) stool specimens from dogs in casepatient households that ate dry dog food produced in plant A, 3) an environmental sample from plant A, and 4) two bags (brands E and F) of previously unopened dry dog food produced in plant A.

A voluntary recall of specific-sized bags of two brands of dry dog food issued by the manufacturer in August 2007 was based only on lot-specific testing of finished unopened bags found to be positive for Salmonella by official FDA testing. Other sizes of bags of the two brands of dry dog food, although produced at plant A, were not recalled. Other brands of dry dog or cat food produced at plant A, including brands associated epidemiologically and microbiologically with illness, also were not included in the recall.

Plant A ceased operations during July-November 2007 to allow for cleaning and disinfection. However, because dry pet food has a 1-year shelf life and all contaminated products were not recalled, contaminated dry pet food might still be found in homes and could provide the potential for causing illness. Only an estimated 3% of Salmonella infections are laboratory-confirmed and reported to surveillance systems (2); therefore, this outbreak likely was larger than the 70 laboratory-confirmed cases identified.

Most Salmonella infections are acquired by handling or consuming contaminated food products, particularly foods

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ises (n = 59) for which month of S. Schwarzengrund isolation was ailable.

ound bags of brand F dry dog food. On July 26, 2007, nufacturer A suspended operations at plant A for clean

and disinfection. In mid-November 2007, plant A umed normal operations. ported by: A Ferraro, PhD, M Deasy, V Dato, MD, M Moll, MD, andt, PhD, J Tait, B Perry, MS, L Lind, MPH, N Rea, PhD, R Rickert, 'H, C Marriott, MPH, C Teacher, MSN, P Fox, MS, K Bluhm, rdaneta, MD, S Ostroff, MD, Pennsylvania Dept of Health. E Villamil

, H, P Smith, MD, Regional Epidemiology Program, New York State ot of Health. Ohio Dept of Health. JL Austin, PulseNet; T Ayers, MS, lexander, DVM, RM Hoekstra, PhD, I Williams, PhD, Div of Foodborne, terial, and Mycotic Diseases, National Center for Zoonotic, Vectorne, and Enteric Diseases; C Barton Behravesh, DVM, EIS Officer, CDC. itorial Note: The laboratory and epidemiologic evidence this investigation indicates that dry dog food produced

BLE. Number and percentage of persons in case-patient and control households reporting pet-related exposures in study of break of Salmonella serotype Schwarzengrund infections, by type of exposure - United States, January 1, 2006-August 30, 2007

Case-patient

Control
households

households
(n = 43*)
(n = 144*)

Matched osure

No. (%)

No.
(%)
odds ratio

(95% Cit) tact with any animal that might eat dry pet food 37/42 (88) 108/143 (76)

2.0

(0.7-7.0) contact

34/43 (79)
86/143 (60)

2.7

(1.0–7.7) 2ps in bed with dog

13/41 (32)
36/143 (25)

1.5

(0.6–3.6) sehold purchases pet food

34/43 (79)
93/142 (65)

2.4

(1.0–7.0) sehold purchases dry pet food

32/42 (76)
91/142 (64)

2.1

(0.9–5.9) ufacturer A product typically used

19/43 (44)
14/144 (10)

(2.6–27.8) iufacturer A product used recently

17/43 (40)
14/144 (10)

7.9

(2.4-33.9) nd A (from manufacturer A) typically used

11/43 (26)
6/144 (4)

(3.3–>999.9)
se-patient and control households were excluded from analysis where questions were not answered.
nfidence interval.
se-patient households: within 2 weeks of illness onset; control households: within 2 weeks of interview.

23.7

7.8

a stool sample. Illness typically lasts 4-7 days, and c: persons recover without treatment. Infants, elderly pers. and persons with impaired immune systems are more liks than others to develop severe illness. To prevent Salo nella infections, persons should wash their hands for at lez 20 seconds with warm water and soap immediately afte handling dry per foods, pet treats, and pet supplemens and before preparing food and eating. Infants should b: kept away from pet feeding areas. Children aged <3 year should not be allowed to touch or eat pet food, treats. O supplements. S

of animal origin. Infections also are acquired by direct and indirect contact with farm animals, reptiles, and occasionally pets. Investigations are ongoing to determine how persons might acquire Salmonella infections from dry pet food. Factors under review include the handling and storage of dry pet food, hand-washing practices, exposure of children to dry pet food, and location in the home where pets are fed. Although a specific source of contamination for the pet food from plant A was not identified, the plant equipment might have been contaminated, or contaminated ingredients might have been delivered to plant A. Dry pet foods typically are extruded, and production includes heat treatment, but the extruded food also is spray-coated with a taste enhancer, usually an animal fat.

Outbreaks of human illness associated with animalderived pet treats have been described previously in North America (3-6). These include outbreaks of Salmonella Infantis infection caused by contaminated pig ear pet treats (3,4), Salmonella Newport infection caused by contaminated pet treats containing dried beef (5), and Salmonella Thompson infections associated with contact with contaminated pet treats made from of beef or seafood (6). Followup investigations of these outbreaks demonstrated that pet treats were frequently contaminated with Salmonella organisms. After a 1999 outbreak in Canada, Salmonella organisms were isolated from 48 (51%) of 94 samples of pig ear pet treats purchased from local retail stores (5). During 1999-2000 in the United States, Salmonella strains were isolated from 65 (41%) of 158 samples of pig ear and other animal-derived pet treats purchased from retail stores (7).

FDA regulates pet foods, treats, and supplements. If Salmonella is present, these products are considered adulterated under the Federal Food, Drug, and Cosmetic (FDC) Act. During January 1-July 27, 2007, at least 15 pet food products were recalled because of Salmonella contamination (8). On November 2, 2007, a single brand of pet vitamin was recalled voluntarily by the manufacturer because of possible Salmonella contamination (9). Salmonella contamination has not been identified in canned pet food, probably because the manufacturing process eliminates contamination. However, Salmonella contamination has been associated with raw pet food diets (10).

Persons who suspect that contact with dry dog food has caused illness should consult their health-care providers. Most persons infected with Salmonella develop diarrhea, fever, and abdominal cramps 12–72 hours after infection, and Salmonella infection usually is diagnosed by culture of

Acknowledgments This report is based, in part, on contributions by LS Kidoguch MPH, LM Gross, Bur of Communicable Disease; L Kornstein, Pha B Tha, MS, Public Health Laboratory, New York City Dept of Hear and Mental Hygiene. G Johnson, M Fage, Regional Epidemioce Program; D Nicholas, MPH, A Mears, MS, Food Protection; T Quicki Y Khachadourian, D Schoonmaker-Bopp, MS, L Armstrong, T Rat T Passaretti, K Musser, PhD, Wadsworth Center Laboratory, No York State Dept of Health. Food and Drug Admin. References 1. CDC. Salmonella annual summary 2005. Atlanta, GA: U'S Deper

ment of Health and Human Services, CDC; 2007. Available at http www.cdc.gov/ncidod/dbmd/phlisdata/salmtab/2005/salmore':

annualsummary 2005.pdf. 2. Voetsch AC, Van Gilder TJ, Angulo FJ, et al. FoodNet estimate of tr:

burden of illness caused by nontyphoidal Salmonella infections in

United States. Clin Infect Dis 2004;38:S127-34. 3. Laboratory Centre for Disease Control, Public Health Agency 3

Canada. Human health risk from exposure to natural dog treats. Cz"

Commun Dis Rep 2000;26:41-2. 4. Clark C, Cunningham J, Ahmed R, et al. Characterizar.o.

Salmonella associated with pig ear dog treats in Canada. J Clin Micrant

2001;39:3962-8. 5. Pitout JD, Reisbig MD, Mulvey M, et al. Association between 12

pet
treats

and infection with Salmonella enterica serotypeport expressing the AmpC B-Lactamase, CMY-2. J Clin Microb

2003;41:4578-82. 6. CDC. Human salmonellosis associated with animal-derived pet treatr

United States and Canada, 2005. MMWR 2006;55:702-5. 7. White DG, Datta A, McDermott P, et al. Antimicrobial susceptibürs I.

genetic relatedness of Salmonella serovars isolated from animal-cerita

dog treats in the USA. J Antimicrob Chemother 2003:52:860_3. 8. Food and Drug Administration. CVM update: FDA tips for preven:

foodborne illness associated with pet food and pet treats. Rockefe MD: Food and Drug Administration; 2007. Available at http://w** ! fda.gov/cvm/cvm_updates/foodbornetips.htm.

! 9. Food and Drug Administration. The Hartz Mountain Corporat. Ja

recalls Vitamin Care for Cats because of possible health risk. Rockida MD: Food and Drug Administration; 2007. Available at http://

fda.gov/oc/po/firmrecalls/hartz10_07.html. 10. Finley R, Reid-Smith R, Weese JS. Human health implications of

Salmonella-contaminated natural pet treats and raw pet food. (.. Infect Dis 2006;42:686–91.

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Available at http://www.fda.gov/opacom/laws/fdcact/fdcact4.htm.

Additional information available at http://www.cdc.gov/salmon. schwarzengrund.html.

Paddle Sports Fatalities

Maine, 2000-2007 In 2006, approximately 70 million persons in the United ates participated in recreational boating (1), and paddle orts vessels (i.e., canoes, kayaks, and inflatable rafts) made

the fastest-growing segment of the boating market. From 05 to 2006, canoe sales in the United States increased

23%, and kayak sales increased by 11%, while werboat sales decreased by 5% (1). To analyze the trends d characteristics of deaths associated with paddle sports, - Maine Department of Health and Human Services imined data on fatalities that occurred during 200007. The results of this analysis determined that paddle orts deaths were associated with inexperience, alcohol use, d not using a personal flotation device (PFD). To reduce z risk for paddle sports fatalities, boating organizations d water-sport enforcement agencies should encourage ater safety education, use of PFDs, and avoidance of cohol before and during boating. si case was defined as a fatality occurring in Maine dur

} 2000–2007 that was associated with use of a canoe, vak, or raft in a natural water source (i.e., lake, pond, er, stream, or ocean). Cases were identified by reviewing ath certificates with International Classification of Dises, Tenth Revision codes V90 and V92 and reports from e: Maine Department of Inland Fisheries and Wildlife,

Maine Office of Chief Medical Examiner, and the U.S. vast Guard. Supplemental information, including addinal witness statements, was obtained from newspaper counts. Level of experience was defined as the total hours :nt in a particular paddle sport vessel during the lifetime

the decedent and was ascertained through interviews by e investigating warden with friends and family members the decedent. The following case reports illustrate comin scenarios and risk factors. Case 1. In May 2004, three persons aged 19 years idled in a canoe to an island on a lake. On the return ), the wind picked up, and a wave swamped their canoe. ne of the three persons was wearing a PFD. Two persons im back to the island, but the third, a man with a blood ohol concentration (BAC) of 0.16 g/dL, drowned; his ly was found 50 yards from the island. The water temature was 45.0°F (7.2°C). ase 2. In April 2005, an inexperienced kayaker aged 48 rs, wearing a PFD in a newly purchased kayak, paddled into Team that had been swollen by rain and had overflowed its ks in a small town. Minutes after leaving the shore, the man ame trapped in standing trees and was forcefully submerged. drowned in front of a crowd of onlookers.

Case 3. In June 2001, a tour group of six persons went on a commercial river rafting trip. All wore helmets and PFDs; a guide accompanied them in the raft. The raft hit a rock and capsized while going over some rapids. Five passengers and the guide were able to hold onto the raft, but a male aged 44 years was not; the current swept him downstream, where he was entrapped in an eddy. His body was found 20 minutes later; cause of death was drowning.

During 2000–2007, a total of 38 paddle sports fatalities in 37 incidents were identified in Maine. Twenty-nine (76%) of the decedents were Maine residents; eight were residents of other states, and one was a resident of another country. Paddle sports fatalities amounted to 46% of the 82 total boating deaths during this period in Maine (Figure). Twenty-two (58%) of the 38 deaths were associated with canoes, 12 (32%) with kayaks, and four (10%) with rafts (Table). Primary cause of death for 23 (61%) decedents was drowning after capsizing. Eight deaths (21%) resulted from drowning after falling overboard, two (5%) from drowning after entrapment, two (5%) from drowning in persons who had a history of seizure, two (5%) from cardiac arrest while boating, and one (3%) from hypothermia. No deaths were attributed to trauma.

Twenty-six (68%) of the decedents were not wearing PFDs. Among canoeists, 21 (95%) of 22 decedents did not wear a PFD, although eight (38%) had PFDs in their canoes. Of the 31 fatalities for which BAC was tested, five (16%) decedents had BACs 20.08 g/dL (the legal limit for driving and boating in Maine), with a median among the five of 0.17 g/dL (range 0.12–0.24 g/dL).

Twenty-one (55%) of the fatalities occurred on lakes or ponds, 13 (34%) on rivers or streams, and four (11%) on the Atlantic Ocean. Nineteen (50%) paddle sports-related fatalities occurred during May or June. Fifteen (39%) deaths occurred on Saturday or Sunday; 21 (55%) deaths occurred

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TABLE. Number and percentage of paddle sports fatalities, by selected characteristics — Maine, 2000–2007 Characteristic

No. (%)* Total

38 (100) Sex Male

35 (92) Female

3 (8) Age group (yrs) <18

3 (8) 18-29

8 (21) 30-39

2 (5) 40-49

7 (18) 50-59

11 (29) 260

7 (18) Day of week Monday

4 (11) Tuesday

7 (18) Wednesday

5 (13) Thursday

3 (8) Friday

4 (11) Saturday

(26) Sunday

5 (13) Vessel type Canoe

22 (58) Kayak

12 (32) Raft

4 (10) Water temperature (°F) 30-39

3 40-49

6 (16) 50-59

12 (32) 60-69

3 (8) 70-79

4 (11) Unknown

10 (26) Site Lake/Pond

(55) River/Stream

(34) Ocean

4 (11) Experience (hrs) <20

10 (26) 20-500

10 (26) >500

2 (5) Unknown

16 (42) Cause of death Drowning after capsizing

23 (61) Drowning after falling overboard

8 (21) Drowning after entrapment

2 (5) Cardiac arrest

2 (5) Seizure

2 (5) Hypothermia

1 (3) Personal flotation device use Yes

(32) No

26

(68) Blood alcohol concentration None

24 (63) <0.08 g/dL

2 (5) »0.08 g/dL

(13) Unknown

7 Subtotals might not add to 100 because of rounding.

between noon and 6:00 p.m. The median water tempera ture at the time of the fatal incidents was 54°F (12°C) (rang 31°F-78°F (0.6°C-26°C]); 75% of the fatalities occurre. in water with a temperature <60°F (<16°C).

Among the 38 fatalities, 35 (92%) decedents were mai median age was 48 years (range: 16–77 years). Two deco dents were aged 17 years, and one was aged 16 years, the other 35 were adults. Among the 22 fatalities for which such information was available, 10 decedents had <20 hour of experience in their vessels. Reported by: T Mangione, PhD, John Snow, Inc., Boston, Massachuss A Johnson, US Coast Guard. M Sawyer, Maine Dept of Inland Fisheri and Wildlife; B Greenwald, MD, Maine Office of Chief Medical Ex

Pelletier, MD, Maine Dept of Health and Human Sves. ) Gilchrist, ML Div of Unintentional Injury Prevention, National Center for Indian Prevention and Control; JE Tongren, PhD, EIS Officer, CDC. Editorial Note: During 2000–2006,* the percentage o! boating fatalities associated with paddle sports

vessels Maine (49%) was three times the national percentage (13%) recorded in the U.S. Coast Guard Boating Accider: Report database for the same period (2). However, other findings in this report were similar to national data. In this analysis, factors associated with paddle sports

death included being male, not using PFDs, using alcohol, incrperience, and capsizing the vessel. On the national leve during 2000–2006, males accounted for 91% of all boating fatalities (2), a percentage similar to that observed in this analysis. In the United States, during 1999–2006, th: percentage of adults using PFDs was estimated at 9% for all vessels, 23% for canoes, and 85% for kayaks (3), ( Maine, PFD use in paddle sports is mandated only for chil dren aged <10 years, and noncompliance results in a $ fine (4). Increased use of PFDs might be encouraged by education, enforcement, and incentives, such as programa that loan PFDs to paddle sports participants at a minimi charge or for free (5).

Approximately 16% of paddle sports decedents in Main: who were tested had BACs 20.08 g/dL, the legal limit të: driving or boating in the state. Education and enforcemen: might reduce alcohol use among persons operating padd. sports vessels. Some states have prohibited alcohol sales near parks and water sources to reduce the risk for alcoho. related incidents and deaths (6).

Education aimed at paddle sports participants might hep offset inexperience and reduce capsizing incidents. Five states require registration of paddle sports vessels, but none ma?date boating safety education specifically for paddle sports

21 13

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2007 data on national boating fatalities are not yet available. Maine Revised Statutes Title 12 913068-A. Operating watercraft; prohibitiss Available at http://janus.state.me.us/legis/statutes/12/titlel 2 sec13068-2.1 7. Moore C, Sarver R, eds. Reference guide to state boating laws. 6th ed.

Lexington, KY: National Association of State Boating Law Administrators; 2000. Available at http://uscgboating.org/regulations/nasbla_ref_

guide_6.pdf. 8. Brooks CJ. Survival in cold waters. Ottawa, Canada: Transport Canada;

2007. Available at http://www.tc.gc.ca/marinesafety/tp/tp13822/menu.htm. 9. United States Power Squadrons. Paddle smart boating seminar.

Raleigh, NC: United States Power Squadrons; 2008. Available at http://www.usps.org/e_stuff/seminars/paddlesmart_sem.htm.

Notice to Readers

:-). Registration offers an opportunity to determine the umber of paddle sports participants and require boating fety education that might encourage PFD use, discoure alcohol use, and underscore the dangers of cold water cock and immersion (8). In Maine, paddle sports vessels o not require registration or boating education, although zislation mandating boating safety education was proused in 2007. : The findings in this report are subject to at least two nitations. First, data for certain variables (e.g., paddle orts experience, BAC, and water temperature) were not ailable for all decedents and incidents. Second, no data :re available for the number of paddle sports vessels in aine or the frequency of their use; therefore fatality rates sed on these denominators could not be calculated. United States Power Squadrons, a nonprofit educational ganization dedicated to promoting boating safety, offers Paddle Smart seminar with safety information specific

paddle sports (9). This seminar and other prevention · ategies that promote PFD use, discourage alcohol use fore and during boating, and support boating safety eduion, might help reduce paddle sports fatalities in Maine. -aluations of boating safety education programs should

conducted to determine which are most effective at preating fatalities.

TM

Acknowledgments The findings in this report are based, in part, on contributions by Corkum, A Sites, MPH, Maine Dept of Health and Human Sves. Chaplin, Maine Dept of Inland Fisheries and Wildlife. K Bisgard, M, Office of Workforce Development, CDC. ferences National Marine Manufacturers Association. 2006 recreational boating tatistical abstract. Chicago, IL: National Marine Manufacturers Issociation; 2007. Available at http://www.nmma.org/facts/boatingstats/ !006/files/abstract.pdf. 'S Coast Guard. Boating statistics 2006. Washington, DC: US Department of Homeland Security; 2007. Available at http://www.uscg voating.org/statistics/boating_statistics_2006.pdf. Mangione T. Observational study of PFD wear rates in adults in the JS, 1996–2006. Boston, MA: John Snow, Inc.; 2007. tate of Maine Department of Inland Fisheries and Wildlife. State of Aaine boating: 2007 laws and rules. Augusta, ME: State of Maine Department of Inland Fisheries and Wildlife. Available at http://www. naine.gov/ifw/laws_rules/pdf/boatinglaws2007.pdf. joatUS Foundation. Life jacket loaner program. Annapolis

, MD: BoatUS oundation; 2007. Available at http://www.boatus.com/foundation/lilp/ idex.htm. awrence B, Miller T. Recent research on recreational boating accients and the contribution of boating under the influence. Calverton, 1D: Pacific Institute of Research and Evaluation; 2006. Available at ttp://uscgboating.org/statistics/bui_study_final.pdf.

Click It or Ticket Campaign

May 19-June 1, 2008 During 2006, motor-vehicle crashes resulted in 32,092 deaths to motor-vehicle occupants (excluding motorcyclists), and 2.7 million occupants were treated for injuries in emergency departments in the United States (1,2). Safety belts are an effective means of preventing serious injury and death in the event of a crash. However, millions of persons continue to travel unrestrained, and some groups, including men and young adults (ages 18–34 years), are less likely to be restrained than others (3). Consequently, young adult males have high rates of crash fatalities (2).

Click It or Ticket, May 19-June 1, 2008, is a national campaign, coordinated by the National Highway Traffic Safety Administration, to increase the proper use of safety belts. Law enforcement agencies across the nation participate in the campaign by conducting intensive, highvisibility enforcement of safety belt laws. This year, the campaign will focus on young adult males and will include daytime and nighttime enforcement activities. Additional information regarding Click It or Ticket activities is available from the National Highway Traffic Safety Administration website at http://www.nhtsa.gov. Additional information on preventing motor vehicle crash injuries is available at http://www.cdc.gov/ncipc/duip/mvsafety.htm. References 1. National Highway Traffic Safety Administration. Traffic safety facts:

2006 data. Washington, DC: US Department of Transportation; 2008

(publication no. DOT-HS-810-809). 2. CDC. WISQARS (Web-based Injury Statistics Query and Reporting

System). Atlanta, GA: US Department of Health and Human Services,

CDC. Available at http://www.cdc.gov/ncipc/wisqars. 3. Beck LF, Shults RA, Mack KA, Ryan GW. Associations between

sociodemographics and safety belt use in states with and without primary enforcement laws. Am J Public Health 2007;97:1619–24.

act to require boating safety education, LD 2067. Available at http://www. inelegislature.org/legis/bills/billtexts/ld206701.asp.

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