Watch children when they enter a petting zoo. Just about always, their faces light up with joy at seeing the animals as their hands reach out to touch them.

Ask parents why they take children to petting zoos or farm animal exhibits at fairs and most will tell you that they think it’s important for their children to get the chance to see the animals up close. Others say it’s a good way for children to have a connection to agriculture.

At this time of year, live nativity scenes and other holiday presentations offer more chances for interaction between children and animals.

But ask public health officials what they think about such opportunities, and you’ll hear some concerns. You’ll also likely hear why it’s so important that such attractions are operated in ways that protect people of all ages from contracting serious illnesses from contact with the animals and their surroundings.

For the most part, such illnesses are caused by microscopic bacteria, viruses and parasites. Some are potentially fatal and many of them are also known foodborne pathogens. Among them are E. coli O57:H7, Salmonella, Campylobacter and Cryptosporidium.

Veterinarians and public health officials say children, especially, can become infected from doing something as simple as petting the animals or touching fencing or bars separating them from the animals — especially if they don’t wash their hands afterwards. Some pathogens can be found floating in the air around animals and in barns and pens.

Public health officials say it’s important for petting zoo owners and parents to know the health risks involved and how to prevent them. And even though most say that serious illnesses connected to petting zoos are extremely rare, they also warn that they do happen.

How does it happen?
Many people assume that contact with a healthy looking animal isn’t going to make anyone sick, especially if it’s just a matter of petting the animal. After all, how could those adorable calves, lambs, piglets, kid goats and baby chicks typically found in a petting zoo or farm animal exhibit at a fair get anyone sick?

Good question, and one that veterinarians and public health officials are eager answer.

According to the bible on this topic, “Compendium of Measures to Prevent Disease Associated with Animals in Public Settings, 2013,”  put out by National Association of State Public Health Veterinarians, the primary route of transmission of these pathogens is fecal-oral — from poop to mouth.

It’s not an intended route of course, but because animal poop can get on animal fur, hair, feathers, scales, skin and because saliva can harbor fecal organisms, people can become infected when they pet, touch, feed, or are licked by animals. Some bacteria and pathogens can survive on surfaces also, such as when a cow rubs its face on a post to scratch it.

People can also become infected when they come into contact with contaminated animal bedding, flooring, barriers and other environmental surfaces. Contaminated clothing and shoes, and even baby-stroller wheels, can transfer pathogens to other places, including people’s homes. And that means people who didn’t even visit a petting zoo or animal attraction can become infected.

When veterinarians and public health officials talk about “shedding,” they’re usually referring to the fact that the pathogens are expelled in animals’ poop. Animals carrying these pathogens usually have no signs of illness, but when they shed out the pathogens, they contaminate the environment.

Making things more complex yet, an animal can be harboring a pathogen such as E. coli O157:H7 one day and be free of it the next day. Some pathogens are shed by animals intermittently and can live for months, or even years, in the environment.

That’s why testing the animals for the pathogens isn’t a fool-proof prevention strategy for petting zoos or other animal attractions.

The likelihood of  disease transmission at animal exhibits can be attributed to a variety of causes, according to the National Association of Public Health Veterinarians’s report on minimizing risks from animal contact with humans.

Here are some of the reasons cited in the report:

• Animals at attractions are more likely to shed pathogens such as E. coli O157:H7 because of the stress they suffer from prolonged transportation, confinement, crowding and increased handling.
• Co-mingling increases the probability that animals shedding pathogens will infect other animals.
• The presence of certain enteric pathogens, such as E. coli O157:H7, is higher in young animals, which are frequently in petting zoos and educational programs, more so than in mature animals.
• Shedding of these types of pathogens and Salmonella organisms is highest in the summer and fall, when substantial numbers of traveling exhibits, agricultural fairs, and petting zoos are scheduled.

What can be done?
The first solution to preventing these pathogens from infecting people is some good ol’ handwashing with soap and running water after coming into contact with the animals and especially before eating. That way, the pathogens won’t be able to travel from hand to mouth.

Sometimes, especially at fairs, people increase their chances of exposure by wandering through animal barns while eating and drinking. Sometimes they “share” their treats with the animals. Many petting zoos have dispensers where people can buy food to hand-feed the animals. All of these behaviors increase the odds that pathogens will find a route from animals to people.

Pathogens can attach themselves to a barn’s rafters and beams and from there settle down on railings, animal fur, human skin or food people take in the barn. That’s why barns should be thoroughly cleaned after each fair or exhibit.

Protecting the children

The Centers for Disease Control and Prevention have developed a list of steps people can take to keep their children and themselves safe when visiting animal exhibits. These include handwashing, especially before eating, keeping food and drinks out of animal areas, and closely supervising young children.

Additional tips from CDC include:

• Children younger than 5 years always need constant adult supervision in animal areas.
• Never allow children to put their thumbs, fingers, or possessions such as pacifiers in their mouths when they’re around animals or in an animal area, such as an empty livestock barn.
• Encourage and supervise handwashing.
• Do not take or use strollers, bottles, pacifiers, spill-proof cups or toys into animal areas.
• Children younger than 5 years, people older than 65, and people with weakened immune systems should take special care around animal exhibits.

Advice for petting zoos
As for those operating or managing a petting zoo or farm animal exhibit, CDC has these tips to offer:

• Design the exhibit to separate animal areas from places where people eat.
• Use signs to point out the areas where people can eat, and the areas for animals.
• Install handwashing stations at exits of animal exhibits. Make sure that some of the handwashing stations are low enough for young children to reach.
• Use plain language and pictures to show visitors how to stay safe and healthy when visiting animal exhibits.

Veterinarian Russ Daly, chair of the National Association of State Public Health Veterinarians Committee for the Animal Contact in Public Settings, said that the committee has just published some “toolkit” items to go with the organization’s compendium on measures to protect public health.

The organization will be issuing a new compendium in 2017.

The toolkit includes various states’ recommendations for keeping petting zoos, fairs and exhibits safe.

Planning ahead
Now that petting zoo season, which typically runs from summer through the fall, is for the most part over, it’s a good time to look at some statistics and take stock for next year’s season.

According to the veterinarian association’s report, investigators estimated that 445,213 illnesses, 4,933 hospitalizations, and 76 deaths are caused by these microscopic pathogens annually, owing to animal contact in all private and public settings.

The CDC started receiving information on animal contact outbreaks in 2009. However, CDC spokeswoman Brittany Behm said that it’s important to note that the data does not include settings such as  “animal exhibition,” “county fair,” “fair,” or “festival/fair.

Behm also said that CDC has also seen recent outbreaks linked to farms that allow the public to visit and pet the animals, which is known as agritourism.

“These farms may not consider themselves ‘petting zoos,’ but there is a risk for illness any time people visit farms or touch animals without proper handwashing,” she said.

Public health officials say that it’s important to keep in mind that even though the numbers might seem low, each and every one of the statistics represents an actual person, most of them children, who became ill, sometimes painfully ill — or who died.

For example, although there was only one reported outbreak connected to petting zoos in 2015, it included two little boys who had been to a petting zoo at the Oxford County Fair in Tennessee. That outbreak will be remembered for the death of one child and the severe illness to another due to infections with E. coli O111. The common exposure for the two children was the same petting zoo.

In a 2012 outbreak linked to the Circle G. Ranch at the Cleveland County Fair in North North Carolina, 101 known E. coli O157:H7 cases were linked to attendance at the fair. Both state and local health department investigations revealed that animal exposure was the likely source of the E. coli.

In that outbreak, a 2-year-old boy died as a direct result of his E. coli infection. In addition, other children spent weeks in the hospital, some in the ICU with hemolytic uremic syndrome (HUS), a complication of E. coli infection that can lead to kidney failure and even death.

Public health officials say that these statistics aren’t meant to be alarmist, but rather to show how important it is to follow established guidelines when operating or visiting a petting zoo or animal exhibit.

Are there laws about this?
USDA’s Animal Care Program, which falls under the Animal Welfare Act, regulates petting zoos in that it requires the animals’ care and comfort be assured. Passed by Congress in 1966 and amended several times, it protects many animals not raised for food or fiber.

Bottomline, the owner or person in charge of a petting zoo must be licensed or registered with USDA. Failure to do so is a punishable violation of the Animal Welfare Act.

However, anyone arranging or taking part in showing animals at agricultural shows fairs and exhibits is exempt.

USDA inspectors make periodic unannounced visits to places where animals are held to make sure that regulations and standards are being followed.

While the federal animal care standards don’t address the presence of pathogens in the animals or in their housing, they do cover humane handling, housing, space, feeding and watering, sanitation, ventilation, shelter from extremes of weather, adequate veterinary care, separation on incompatible animals, transportation and handling while being transported.

Richard Peck, owner of Peck’s Farm Market in Wisconsin, who has had a petting zoo at his farm stand since the 1960s, said that abiding by those standards goes a long way toward ensuring that your animals are healthy.

“Cleanliness is very important for animal health,” he said.

He also said that he thinks some of the problems linked to outbreaks is that a lot of petting zoos aren’t licensed.

“That’s probably where a lot of the problems with E. coli come in,” he said.

And while he has handwashing stations available — “We go through a lot of paper towels,” he said — he also thinks the parents should bear some of the responsibility for keeping their children safe, such as making sure that they wash their hands after touching the animals, which, of course, applies to adults as well.

Peck’s petting zoo, which is part of his farm business, helps attract customers to his farm stand. It must be a good draw, because Peck said he has from 150,000 to 200,000 visitors each year.

No matter where they come from — the city or the country — he said that people really enjoy seeing the animals.

But for anyone thinking of setting up a petting zoo, he warns that it’s not “all fun and games.”

“You need to check all the rules,” he said. “You might be getting into more than you bargained for.”

As for insurance, Peck said he has umbrella insurance and encourages anyone operating a petting zoo to have some sort of insurance, especially considering how expensive medical care can be when someone gets sick in an outbreak connected to a petting zoo or animal exhibit.

Not surprisingly, lawsuits have been filed in cases such as this.

Aiden’s Law
In North Carolina, legislators in 2005 passed a specific law regulating petting zoos. Known as Aiden’s Law, it was named after 2-year-old AidenAiden Gray who developed HUS in the 2004 state-fair outbreak.

The law was developed around a Duke University study on reducing the transfer of animal-to-human diseases. As such, petting zoo exhibits operating in the state, must have soap-and-water handwashing stations, signs warning visitors about the potential risk of animal contact, and fences separating people from animal pens.

It also bars visitors from bringing in food, drinks, baby bottles or pacifiers.

What about farm kids?
Many people assume that farm kids don’t become infected with pathogens from the animals because they’ve become immune to them. But Veterinarian Russ Daly said is not the case. He said a South Dakota project showed people who live and work on farms are more susceptible to certain infections than is the general public.

On a related note, dairy bull calves from Wisconsin are the suspected culprit of a Salmonella Heidelberg outbreak reported on this month that has sickened 21 people, with eight of them sent to the hospital.

While such calves are often raised for meat, some of them were also purchased for 4-H projects.

Of special concern in these cases is that the salmonella strain identified in the outbreak is showing signs of multi-drug resistance, which makes the infections riskier than normal for the victims.

“We encourage 4-H and FFA programs to increase their understanding of animal contact-related infections, and for their youth to model proper behaviors for visitors to their animal exhibits,” veterinarian Daly said.

Should petting zoos be banned?
While some people might say petting zoos and similar exhibits should be banned, others say they provide an important benefit to society as a whole, especially in this day and age when most people have so little contact with farms and farm animals. Farm and ranch families now make up just 2 percent of the U.S. population.

“It is more critical than ever for children — and adults — to have the chance to observe and interact with farm animals and to understand how they are raised,” said Daly. “With every passing year, the general public on average becomes further and further removed from a direct link to animal agriculture.”

He believes that these opportunities can still be made available while keeping visitors safe.

“Through following recommendations in our compendium and related toolkit items, people who seek to provide these interactions can make sure it’s done in a safe and healthy manner for everyone involved,” he said.

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