Translating Outbreak Advisories in Real-Time to Meet the Language Needs of the People Affected

Theoretical Background and research questions/hypothesis: Zoonotic salmonellosis is a bacterial infection transmitted to humans from animals. Outbreaks of zoonotic salmonellosis in the United States (US) have been linked to small pet turtles (shell length <4 inches).  Therefore, sale of small turtles was banned in the U.S. by the Food and Drug Administration (FDA) in 1975. However, outbreaks of zoonotic salmonellosis linked to small turtles continue to occur because they continue to be sold illegally in flea markets, swap meets, and by transient vendors. Because of the nature of turtle sales, public health messaging concerning this risk is essential in preventing illness. In 2015, CDC investigated Salmonella outbreaks linked to small turtles. We aimed to provide targeted and translated messaging to affected populations to prevent additional illnesses.

Methods: Ill people were interviewed with supplemental questionnaires to gather additional information regarding their demographic characteristics, illness duration, and turtle exposures such as the type of turtle, location of purchase, and handling behaviors. The results of these questionnaires were used to target public health messaging toward populations at highest risk for illness. The type of messaging and need to communicate were discussed throughout the investigation. Because evidence strongly demonstrated that the source of these illnesses was contact with small turtles, we communicated to the public about this outbreak and the risk of Salmonella infection from contact with small turtles through a posting on the CDC website with accompanying social media posts in both English and Spanish. Webpage and social media interaction metrics were used to evaluate the effectiveness of this communication.

Results: During the first two weeks the outbreak announcement was posted on the CDC website, there were 4,128 page views by 3,144 unique viewers. Seventy-five percent of infected people identified as Hispanic. To reach this at-risk population, the outbreak announcement was translated to Spanish. Both postings were promoted using the English and Spanish CDC Facebook and Twitter accounts. During the first two weeks the Spanish posting obtained 287 page views by 249 unique visitors, with a peak in visits on the same day as social media posts.

Conclusions: Small turtles continue to be a source of human Salmonella infections. The high percentage of illnesses among people of Hispanic ethnicity in the 2015 outbreaks informed the decision to translate the outbreak postings into Spanish. Identification of the demographic characteristics of people involved in zoonotic Salmonella outbreaks is essential to ensure public health messages reach impacted populations through tailored communication to prevent future recurring outbreaks from small pet turtles.

Implications for research and/or practice: Enteric zoonotic outbreaks often impact specific sub-populations. Therefore, public health messages should be developed and delivered with these audiences in mind. Educational messages intended to prevent illness and outbreaks should reflect the epidemiologic data and be considered for translation into appropriate languages, especially if people primarily affected are of ethnicities whose primary language is not English.