The 21-page case questionnaire used by the North Carolina Division of Public Health to crack an outbreak of E. coli helped investigators to quickly focus on the Kelley livestock building on the State Fair grounds.  

They have concluded that the Kelley livestock building, a permanent round-roofed structure where sheep, goats and pigs were exhibited, was the source of the E. coli O157:H7 outbreak at the North Carolina State Fair, which attracted more than one million attendees during its Oct. 13-23 run.

State Epidemiologist Megan Davies said animal contact at the Kelley building was the likely cause of the E. coli infections suffered by 27 fairgoers. She did not name any specific breed as the source.

No other fair exhibits, foods, or activities were found responsible for the illnesses.

Two of the 27 victims of the state fair outbreak remained in the hospital Thursday.

The 2011 E. coli outbreak at the North Carolina State Fair is at least the third to occur in recent years. In 2004 the petting zoo was responsible for infecting 108 fairgoers with the pathogen. Two years later in 2006, three others were stricken with the O157:H7 strain from contamination thought to have occurred at the pita stand.

After its 2004 run, the state fair installed its first public hand-washing stands around the petting zoo and other animal exhibits. It also double-fenced bedding areas to help keep people out.

In its case questionnaire this year, North Carolina public health officials asked fairgoers to recall if they or their children touched sheep, goats or pigs; allowed animals to nuzzle, nibble, or lick them; or whether they stepped in or touched “manure or poop” during their visit to the Kelley livestock building.

Investigators also asked  whether children going through the building were carrying toys or blankets, sucking their thumbs or Sippy cups, or riding in strollers.

North Carolina public health investigators interviewed 114 fairgoers, including the 27 who got sick.

The Children’s Barnyard, the Graham Building, the State Fair Ark, the Rabbit Barn, the Amazing Animals Petting Zoo, the Hog way Speedway, and the Gov. Kerr Scott building were other fair locations that investigators asked specific questions about.

In addition, they required victims to answer questions about the foods they ate. Foods checked out included hamburgers and cheeseburgers, barbeques, hot dogs, turkey legs, ham, sausage, game meat, raw vegetables, salads, finger foods like popcorn and peanuts, ice cream, cotton candy, candy and caramel apples. The investigators also asked about beverages, including fresh squeezed lemonade.

Steve Troxler, North Carolina’s Agricultural Commissioner since 2005, is ultimately responsible for the state fair. With the Kelley livestock building named as the source of the latest outbreak, Troxler is promising to put additional safeguards in place.  

“Our goal is to put on the safest fair we can,” he said.

Troxler said visitors are not supposed to touch animals in the Kelley building, and it is cleaned and disinfected after each livestock event. He said it “is not a petting zoo.”

But the Kelley livestock building was suspected from the beginning of the outbreak when a Sampson County, NC family named it as the fair location they’d visited before becoming ill.

Troxler acknowledged visitors attend the fair based on a “certain amount of trust.”

“We certainly want to keep that trust with the public and be proactive in doing anything we can do,” the commissioner said.

That the Kelley livestock building was the source of the outbreak came as no surprise to Davies, the state epidemiologist. She noted that pathogenic E. coli bacteria are shed in the feces of ruminant animals such as cows, goats, and sheep.