osteomyelitis in people with sickle-cell, it is not the most common cause, which is Staphylococcus infection. Those infected may become asymptomatic carriers, but this is relatively uncommon, with shedding observed in only 0.2 to 0.6% of cases after a year. Causes Contaminated food, often having no unusual look or smell Poor kitchen hygiene, especially problematic in institutional kitchens and restaurants because this can lead to a significant outbreak Excretions from either sick or infected but apparently clinically healthy people and animals (especially dangerous are caregivers and animals) Polluted surface water and standing water (such as in shower hoses or unused water dispensers) Unhygienically thawed poultry (the meltwater contains many bacteria) An association with reptiles (pet tortoises, snakes, iguanas, and aquatic turtles) is well described. Amphibians such as frogs Salmonella bacteria can survive for some time without a host; they are frequently found in polluted water, with contamination from the excrement of carrier animals being particularly important. The European Food Safety Authority highly recommends that when handling raw turkey meat, consumers and people involved in the food supply chain should pay attention to personal and food hygiene. An estimated 142,000 Americans are infected each year with Salmonella Enteritidis from chicken eggs, and about 30 die. The shell of the egg may be contaminated with Salmonella by feces or environment, or its interior (yolk) may be contaminated by penetration of the bacteria through the porous shell or from a hen whose infected ovaries contaminate the egg during egg formation. Nevertheless, such interior egg yolk contamination is theoretically unlikely. Even under natural conditions, the rate of infection was very small (0.6% in a study of naturally contaminated eggs and 3.0% among artificially and heavily infected hens). Prevention The US Food and Drug Administration (FDA) has published guidelines to help reduce the chance of food-borne salmonellosis. Food must be cooked to , and liquids such as soups or gravies should be boiled when reheating. Freezing kills some Salmonella, but it is not sufficient to reliably reduce them below infectious levels. While Salmonella is usually heat-sensitive, it acquires heat-resistance in high-fat environments such as peanut butter. Vaccine Antibodies against nontyphoidal Salmonella were first found in Malawi children in research published in 2008. The Malawian researchers identified an antibody that protects children against bacterial infections of the blood caused by nontyphoidal Salmonella. A study at Queen Elizabeth Hospital in Blantyre found that children up to two