The Texas Department of State Health Services has not reported an outbreak.  

Cook Children’s pediatricians Devona Martin, M.D., and Jenica Rose-Stine, D.O., say they have seen a surge in cases at their primary care clinic in Willow Park, Texas.  

“Over the past few months, we have noticed a big increase in the number of cases of salmonella,” Dr. Martin said. “This usually presents as diarrhea that has blood or mucus and fever. Each case is reported to the Health Department to try to track down a cause, but a common source has not been identified.”  

Since July, the Emergency Department at Cook Children’s Medical Center – Fort Worth has also reported increased numbers of patients with salmonella.  

“In the ED, we usually see less than 20 patients per month with a diarrheal illness caused by salmonella,” said Stephanie Felton, D.O., associate medical director of the Cook Children’s Emergency Department. “In the month of July, we had 43 positive cases. We had 59 in August, 71 in September, and 74 in October.”  

Last week at Cook Children’s, 11 out of 229 patients tested for Salmonella were positive, resulting in a 5% positivity rate.  

Dr. Felton, Dr. Martin, and Dr. Rose-Stine provide answers to commonly asked questions about Salmonella.  

What is salmonella?  

Salmonella is a bacteria that can cause gastrointestinal illness and fever called salmonellosis. It is one of the most common causes of foodborne illness in the United States.  

What is the difference between salmonella and E. coli?  

Although salmonella and E. coli cause similar illnesses, they are different kinds of bacteria. E. coli more commonly produces a toxin that can lead to kidney damage, a condition called hemolytic uremic syndrome. This isn’t seen as often with salmonella.  

What are the symptoms of a salmonella infection?  

Symptoms of salmonellosis are diarrhea with blood and/or mucus, vomiting, abdominal cramps, and fever. 

How do children contract salmonellosis?  

Salmonella infection can be contracted by consuming contaminated food products, including poultry, eggs, produce, infant formula, and water. It can also be spread through contact with infected animals, like reptiles and birds, or other people who are infected if strict hand hygiene isn’t followed.  

Is salmonella contagious?  

Yes, salmonella is contagious and can be spread by person-to-person contact or by touching contaminated surfaces. The incubation period usually is between eight and 72 hours following exposure. You may be asymptomatic during this time.  

Salmonella is not as contagious as the viral stomach bugs we often see.  

How can parents and caregivers prevent infection?  

We can prevent infection with proper hand washing, especially before eating and after touching animals. Make sure that your counter spaces and sinks are clear of any bottles, sippy cups, or dishware before washing any fruits or vegetables. Cook and prepare all poultry and meat products appropriately. 

Only use FDA-approved formulas for your infants. Thoroughly clean all bottles, pacifiers, and toys before handing them to your children.  

How are salmonella infections treated?  

Treatment primarily involves rehydration and rest. Infants less than three months old or children with moderate to severe illness may receive antibiotics. These infections usually clear on their own.  

What should parents do if they think their child has a salmonella infection?  

If you are worried about your child having salmonella, please contact your primary care physician. He or she can run stool studies to confirm the diagnosis.  

Unless your child has blood, mucus, or fever with their diarrheal illness, it’s likely a stomach virus and not salmonella. Keep your child at home and make sure they hydrate!  

If your child is acutely ill or if you are concerned about dehydration or prolonged fevers (100.4 degrees Fahrenheit for five days or greater) please bring your child to the Emergency Department for an evaluation.  

JBS Tolleson Inc. is recalling the “raw, non-intact beef products,” including ground beef, packaged on various dates from July 26, 2018 to Sept. 7, 2018. This is the third time the company has recalled beef since October and the salmonella outbreak is associated with almost 250 people getting sick in 25 states.

Consumers are asked to check their homes for the recalled ground beef and other “non-intact” raw beef. 

The following products are subject to recall: [Products List (PDF) | Product Labels (PDF only)|.

FSIS says it is “concerned that some product may be frozen and in consumers’ freezers. Consumers who have purchased these products are urged not to consume them. These products should be thrown away or returned to the place of purchase.”

Symptoms of salmonellosis are diarrhea, abdominal cramps, and fever within 12 to 72 hours after eating the contaminated product. The illness usually lasts 4 to 7 days. Most people recover without treatment. In some persons, however, the diarrhea may be so severe that the patient needs to be hospitalized. Older adults, infants, and persons with weakened immune systems are more likely to develop a severe illness. Individuals concerned about an illness should contact their health care provider.

Justin Smith, a pediatrician at Cook Children’s Trophy Club office, said salmonella is one of the most common bacterial causes of infections he sees in his office and it is a “fairly frequent cause” of severe diarrhea and abdominal pain in children.

Parents should call a doctor if they see the following symptoms:

1. Severe vomiting with decreased urine frequency or other signs of dehydration.
2. Fever of more than 102.
3. Blood or mucous in the stool.
4. Severe belly pain.
5. Diarrhea that lasts more than one week.

If you are concerned your child has one of these symptoms, Dr. Smith said parents should consult with their doctor and keep them out of daycare until the pediatrician is sure they will not put other children at risk.

“If you suspect your child has salmonella, your pediatrician can run stool studies to confirm the diagnosis,” Dr. Smith said. “This may not be necessary if there are known cases that the child has been exposed to. The infection will typically go away on its own in seven days or less. Most healthy children do not require antibiotics. I do not routinely recommend anti-diarrheal medications in children because they can prolong symptoms with some infections.”

For more on this outbreak, read the following:

• USDA's Food Safety and Inspection Service Report
• Product List for Recall
• Product Label List of Recall
• Food Safety Alert from CDC
• What Is Salmonella?

NOT ‘THE SNACK THAT SMILES BACK’?!?!

Unfortunately it is true. Specifically the:

• Flavor Blasted Xtra Cheddar
• Flavor Blasted Sour Cream & Onion
• Goldfish Baked with Whole Grain Xtra Cheddar
• Goldfish Mix Xtra Cheddar + Pretzel

These have been added to a growing list of other foods already recalled including: Ritz Bits cheese cracker sandwiches and mixed cookie and cracker variety packs, Swiss rolls, and Hungry Man Chipotle BBQ Sauced Boneless Chicken Wyngz with a “best by” date of 9/6/19.

All of these snacks and foods contain whey powder which is the specific ingredient that is being recalled. Not everything that contains whey powder is being recalled at this time, but stay tuned because the list may keep growing.

"So how do I know if my child has a Salmonella infection?"

If someone gets Salmonella, symptoms may begin 12-72 hours after a person is infected. Symptoms typically include diarrhea, fever and abdominal cramping; which can last 4-7 days in most individuals who will recover without treatment other than drinking plenty of fluids. However, young children are most at risk for developing complications from severe illness.

One of the best ways to avoid contracting the illness is frequent hand-washing (seems like this is the best way to avoid A LOT of things

The CDC recommends people not eat this cereal and retailers not sell any Kellogg’s Honey Smacks cereal at this time because it might be contaminated with salmonella and could make people sick.

Justin Smith, M.D., a pediatrician at Cook Children’s Trophy Club office, said that salmonella is one of the most common bacterial causes of infections he sees in his office and it is a “fairly frequent cause” of severe diarrhea and abdominal pain in children.

Symptoms that might alert parents they should call a doctor include:

1. Severe vomiting with decreased urine frequency or other signs of dehydration.
2. Fever of more than 102.
3. Blood or mucous in the stool.
4. Severe belly pain.
5. Diarrhea that lasts more than one week.

“If you suspect your child has salmonella, your pediatrician can run stool studies to confirm the diagnosis,” Dr. Smith said. “This may not be necessary if there are known cases that the child has been exposed to. The infection will typically go away on its own in seven days or less. Most healthy children do not require antibiotics. I do not routinely recommend anti-diarrheal medications in children because they can prolong symptoms with some infections.”

If you suspect your child has one of these infections, Dr. Smith said parents should consult with their doctor and keep them out of daycare until the pediatrician is sure they will not put other children are risk.

The Kellogg Company recalled all Honey Smacks products that were on the market within the cereal’s one-year shelf-life on June 14, 2018. The CDC stated that even products with earlier dates could also potentially be contaminated.

In its press release, Kellogg Company states that none of their other products are impacted by the recall. “Kellogg launched an investigation with the third-party manufacturer who produces Honey Smacks immediately after being contacted by the Food & Drug Administration (FDA) and Centers for Disease Control (CDC) regarding reported illnesses,” Kellogg wrote in its release.

The CDC has this advice for consumers and retailers:

• Do not eat any Kellogg’s Honey Smacks cereal, regardless of package size or best-by date. Check your home for it and throw it away, or return it to the place of purchase for a refund. The Kellogg Company recalled the cereal on June 14, 2018.

• Retailers should not sell or serve Kellogg’s Honey Smacks cereal.

• Even if some of the cereal has been eaten and no one got sick, throw the rest of it away or return it for a refund.

• If you store cereal that looks like Kellogg’s Honey Smacks in a container without the packaging and don’t remember the brand or type, throw it away.

• Thoroughly wash the container with warm, soapy water before using it again, to remove harmful germs that could contaminate other food.

Illnesses due to the outbreak have been reported from March 3, 2018 to July 2, 2018. Ill people range in age from less than 1 year to 94. No deaths have been reported.

Here's why:

There has been an outbreak of severe flu among dogs in the Midwest. Cases of the H3N2 strain have now been seen in dogs in Texas.

Most dogs have cough, runny nose and fever, but it has been severe and resulted in death in some.

So you may be wondering, “Is my child at risk if our dog has this flu?”

The answer, according to the CDC:

“To date, there is no evidence of transmission of canine influenza viruses from dogs to people and there has not been a single reported case of human infection with a canine influenza virus.”

That’s fortunate, but what are some health dangers associated with pets?

Bites

I’ve seen too many severe dog bites in my training to not mention bites first. The most common statement I hear about the dogs who bite is, “We just never thought he/she would do that.”

Dogs can be a great addition to a family but use caution:

• Be careful of rough play. Even a playful snip can be dangerous if it happens near the eye or a fingertip.

• Stay away from dogs when they are likely to be defensive: when they are eating, sleeping or taking care of puppies.

• Stay away from unfamiliar dogs or dogs that seems scared or anxious.

Here are some more tips from the ASPCA on how to avoid dog bites.

Allergies/Asthma

This is actually one of the most common questions I get regarding animals. It’s very intuitive. People can be allergic to dogs and cats, so wouldn’t owning one increase my child’s risk for allergies?

I have seen several studies that suggest the exact opposite. Often by having animals in the house early, kids may have slightly decreased risk of developing allergies. That said, if your child has frequent allergy and asthma symptoms, it may be reasonable to attempt to isolate the animal from the child for a bit to see if symptoms improve.

Infections

Infectious diseases are transmitted through animals frequently; think about the number of diseases that tics and mosquitoes can carry. Although it can happen, they are less frequently transmitted from pets.

Here is a list of pets and some of the diseases they can transmit:

Cats

Cat-scratch fever:

This disease is caused by bacterial infection (Bartonella) of an open wound or a bite that results in the breaking of skin. It is more commonly transmitted by kittens than older cats. Symptoms of the infection in humans are fever, headache and fatigue. There is often a large and tender lymph node near the site of the bite.

Toxoplasma:

Toxoplasma is usually a foodborne illness, but can be transmitted from cat feces. In people with normal immune systems, there are often no symptoms of toxoplasmosis. Pregnant women (and fetuses) are especially susceptible and, for that reason, should not handle cat litter boxes.

Dogs

Hookworms:

Dogs infected with hookworms can have bloody stools; which in severe cases can lead to anemia. Humans are infected by walking barefoot on contaminated soil and develop an interesting rash which consists of red, squiggly lines where the larvae have migrated under the skin.

Reptiles

Salmonella:

Salmonella is one of the most common pet-associated infections. It is estimated that 70,000 people will contract salmonella from pet reptiles. Salmonella generally causes bloody stools but in children and in people with weakened immune systems can be serious. The CDC recommends that houses with children less than 5 and with any household members with weakened immune systems not own reptiles as pets.

Many Animals

Campylobacter:

Ingesting food contaminated with the bacteria transmits most infections of campylobacter, but cases can occur from the handling of dog or cat feces. The main symptom of campylobacter infections is diarrhea (which can be bloody) and usually lasts about one week.

Ringworm:

The fungus that causes can be transmitted from many different animals but most commonly occurs from puppies and kittens. The appearance of the rash on human skin is a circular rash with a raised edge. It can be difficult to distinguish from eczema which sometimes causes circular patches as well.

Pets can be great additions to your family and, in most cases, will not cause any harm to your children. Be aware of the specific risks associated with certain types of pets and take caution to protect your children when appropriate.

How do you know when it is something else or when it could be more dangerous?

A report last week from the CDC described a cluster of infections caused by shigella, a bacteria that can cause severe diarrhea.

Shigella is common, causing an estimated 500,000 cases of diarrhea in the United States annually. But this group of infections is unique because it has been found to be resistant to the most common type of antibiotic used in adults used for shigella. Most cases have been located on the East and West coast and many have been associated with travel outside the United States.

Fortunately, there were no cases of this more severe form of shigella reported in Texas so I feel that we are pretty low risk at this point. I did want to take a second to tell you about warning signs that might alert you that diarrhea might be more than a stomach bug.

Here are some symptoms that might alert you that should trigger a call to your doctor:

1. Severe vomiting with decreased urine frequency or other signs of dehydration.
2. Fever more than 102.
3. Blood or mucous in the stool.
4. Severe belly pain.
5. Diarrhea that last more than one week.
6. Let your doctor know if your child has traveled recently.

What are Salmonella and Shigella?

Two of the most common bacterial causes of infection are salmonella and shigella. They are both fairly frequent causes of severe diarrhea in children.

They can both be transmitted by contaminated food or water but can also be spread from person to person. Salmonella is more frequently caused by transmission from contaminated food, but also can be contracted from infected reptiles. Shigella is more frequently acquired from other children and is much more contagious than salmonella.

(Just to give you an idea, stool of a child infected with shigella contains 100,000,000 bacteria per gram of stool. Ingesting just 200 bacterial cells is enough to cause infection. Because of this, outbreaks of Shigella are common in child-care settings.)

The most common symptoms with both infections are diarrhea, abdominal pain and fever. With shigella, fever is often higher and children are more likely to have blood or mucous in their stools.

For either infection, your doctor can run stool studies to confirm the diagnosis. This may not be necessary if there are known cases that the child has been exposed to.

Both infections will typically go away on their own in seven days or less. Most healthy children do not require antibiotics. I do not routinely recommend anti-diarrheal medications in children because they can prolong symptoms with some infections.

If you suspect your child has one of these infections, consult with your doctor and keep them out of day care until we are sure they will not put other children are risk.

"Salmonella infection can cause bloody diarrhea, severe stomach pain, cramping, vomiting and fever," said Mark M. Shelton, M.D., board certified physician with Cook Children's specializing in infectious disease. "It can be very dangerous in infants and toddlers whose immune systems are still developing, and salmonella requires hospitalization once symptoms become life-threatening."

Many parents are unaware of the harm associated with giving live animals as pets for Easter. Watching your child kiss, cuddle or hold an adorable baby chick or bunny makes for a picture-perfect moment, but it can be dangerous to the child and incredibly stressful for the animal, too. It's easy to forget these delightful, tiny creatures will mature in fewer than 90 days and require long-term care and attention.

Once Easter is over, thousands of rabbits are surrendered to animal shelters or rescues, while chickens and ducks are often turned into backyards or fields to tend for themselves. The Humane Society of the United States recommends buying children a toy stuffed animal or chocolate bunny in place of a live animal.

"Holidays such as Easter - along with petting zoos and farm-yard exhibits - expose children to a whole host of dangerous bacteria," Dr. Shelton said. "Children pet the animals then put their hands in their mouths, rub their nose and eyes, and can become infected on contact. There are hundreds of E. coli (Escherichia coli) strains and even potentially deadly bacteria and germs that can cause children severe illness or even permanent damage to the brain or kidneys."

Dr. Shelton recommends parents ensure children wash their hands thoroughly after touching and playing with any animal.

"We don't want to prevent children from enjoying and learning about animals," Dr. Shelton said. "But it is important they stay healthy by taking the proper hygienic measures."