The North Carolina Department of Health and Human Services announced the death of a child Saturday.  So far fourteen children and six adults who attended the Cleveland County Fair have gotten sick with the E. coli O157:H7 bacteria. I penned the following op-ed in January of this year. I am sure I have missed several other outbreaks that have happened in the United States and around the world, but I think you will see my point. For more information on outbreaks and prevention measures, visit Ban Petting Zoos? I can hear the wailing and gnashing of teeth over such an un-American suggestion. The Centers for Disease Control and Prevention (CDC) reports the creation of yet another multiagency task force in North Carolina “to evaluate the preventive measures that were in place during the 2011 state fair and to identify additional interventions that could be applied to prevent disease transmission in livestock exhibitions where physical contact with the public might occur.” Hmm, didn’t that happen after the 2004 North Carolina State Fair E. coli outbreak, which resulted in 187 illnesses, including 15 complicated by hemolytic uremic syndrome (HUS)? This latest task force is looking into what happened at the 2011 North Carolina State Fair, held October 13-23 in Raleigh. According to the CDC, 25 cases of E. coli O157:H7 infection were identified with case-patients’ illness onsets during October 16-25; median age was 26 years (range: 1-77 years). Eight case-patients (32 percent) were hospitalized; four (16 percent) experienced HUS. Once again, the only exposure associated with illness was having visited one of the permanent structures in which sheep, goats, and pigs were housed for livestock competitions. After decades of outbreaks, the CDC and a collection of state veterinarians have issued these stern warnings and suggestions about animal exhibits and petting zoos: – Wash hands after contact with animals to reduce the risk of zoonotic disease transmission. – Do not allow food, drink, or pacifiers in animal areas. – Include transition areas between animal areas and non-animal areas. – Educate visitors about disease risk and prevention procedures. – Properly care for and manage animals. But, if history is any guide, guidelines are not working very well.  Here is a sample of zoonotic outbreaks over the last decade: 2011 English Animal Farm Outbreak – Cruckley Animal Farm in Foston-on-the-Wolds, England is closing its gates permanently following an outbreak of E. coli O157:H7.  The family-run farm was linked to at least six cases of the life-threatening infection as of August 2011.  The owners, John and Sue Johnston, expressed sorrow at the illness and stated that “the health and safety of our visitors has always been our top priority,” thus with the news the farm was the likely source of illnesses, they decided to close. 2011 Snohomish County Petting Zoo – At least 6 people who visited the Forest Park Petting Zoo in Everett, Washington, in June 2011 became ill with E. coli O157:H7 infections. The Snohomish County Health Department investigated the E. coli outbreak and determined that there was a “clear association between disease and being in the open animal interaction area of the forest Park Animal Farm.” 2009 Utah Rodeos Outbreak – Utah state and local health officials and the CDC noted a cluster of E. coli O157:H7 cases in the summer of 2009.  The illnesses were associated with attendance to rodeos, but not all the same one.  The vast majority of the 14 cases (93 percent) had food histories containing ground beef, unsurprising for rodeo visitors.  However, a traceback on the meat products provided at the rodeos found no contamination. 2009 Godstone Park Farm and Plan Barn E. coli Outbreak in Surrey, England – A final report of the Outbreak Control Committee of the Surrey and Sussex Health Protection Unit describes an outbreak of E. coli O157 (VTEC O157 PT21/28) occurring in August and September 2009. This was the largest documented outbreak of VTEC O157 associated with farms in the UK. Individuals became infected either through direct or indirect contact with farm livestock. 2009 “Feed the Animals” Exhibit E. coli Outbreak at the Western Stock Show – In January 2009, the Communicable Disease and Consumer Protection Divisions of the Colorado Department of Public Health noticed an increase is in the number of laboratory confirmed cases of E. coli O157.  Thirty cases were identified–including nine hospitalizations and 2 cases of HUS.  All the children had visited the National Western Stock Show in Denver, Colorado. 2007 Petting Zoo E. coli O157:H7 Outbreak in Pinellas County, FL – In May and June 2007, seven Florida children were infected with E. coli O157:H7. Six of the children had visited a Day Camp petting zoo, and the seventh was a sibling. Two of the children were hospitalized, all seven recovered.  The petting zoo was closed on the recommendation of the health department. 2005 Big Fresno Fair Petting Zoo E. coli Outbreak – At least six children were infected with E. coli O157:H7 – one gravely – visiting the petting zoo at the 2005 Big Fresno Fair. One child was 2 years old at the time of her visit to the petting zoo. She developed HUS and was hospitalized for months. Her kidneys were severely damaged and a series of strokes left her with impaired movement and vision. 2005 Campylobacteriosis Outbreak Associated with a Camping Trip to a Farm – In June 2005, King County Public Health was notified that a several children on a school trip had been ill with diarrhea, abdominal pain and fever following the trip. Campylobacter was isolated from the stool of one ill individual, and later in the week, two more cases of campylobacteriosis were reported in persons who had been on the same camping trip, held at a private farm. 2005 Florida State Fair, Central Florida Fair, and Florida Strawberry Festival E. coli Outbreak – The AgVenture Farms E. coli O157:H7 outbreak was first recognized after two separate HUS case reports were reported to the Florida Department of Health in mid-March.  The two cases (a 5-year-old girl and a 7-year-old boy) both reported having visited a fair with a petting zoo (AgVenture) a few days prior to becoming ill. The two children did not have any other common risk factors. A total of 22 confirmed, 45 suspect and 6 secondary cases were reported. 2003 Fort Bend County Fair E. coli Outbreak – Rosenberg, TX – In 2003, 25 people (fair visitors and animal exhibitors) became ill with HUS and one case of a related disease, thrombotic thrombocytopenic purpura. All seven laboratory-confirmed cases had an indistinguishable PFGE pattern, which matched 10 isolates obtained from environmental samples taken from animal housing areas. 2002 E. coli Outbreak at a Petting Zoo in Zutphen, The Netherlands  – A young child developed a Shiga toxin 2 producing strain of Escherichia coli (STEC) O157 infection after visiting a petting zoo in Zutphen, The Netherlands. The STEC strains were isolated from the fecal samples from goats and sheep on the farm and were indistinguishable from the human patient isolate. 2002 Lane County, Oregon, Fair E. coli Outbreak – The Oregon Department of Human Services (Oregon, 2002) initially documented a patient with bloody diarrhea, who attended the Lane County Fair held during August 2002. Epidemiologists identified 82 ill persons, 22 who were hospitalized, and 12 with HUS. This is the largest E. coli O157:H7 outbreak recorded in Oregon. 2002 Wyandot County, OH, Fair E. coli Outbreak – The Ohio Wyandot County Health Department received a report of an E. coli O157 outbreak in September 2001 (CDC memorandum, February, 2002). A total of 92 cases were identified, including 27 laboratory-confirmed E. coli O157 infections. Two cases were diagnosed with hemolytic uremic syndrome. Eighty-eight cases reported attending Wyandot County Fair before becoming ill. 2001 Lorain County, OH, Fair E. coli Outbreak – The Department of Health and Human Services, Public Health Services (CDC memorandum, February, 2002) reported that 23 cases of E. coli O157:H7 infection were associated with the attendance at the Lorain County Fairgrounds in September 2001. Additional cases were identified as likely due to secondary transmission from attendees at the fairgrounds. An investigation associated illness with environmental contamination at the Cow Palace. 2001 Ozaukee County, WI, Fair E. coli Outbreak – The Ozaukee County Public Health Department and Wisconsin Department of Health and Family Services (2001) investigated an outbreak of E. coli O157:H7 associated with animals at the Ozaukee County Fair in August 2001. A total of 59 E. coli O157:H7 cases were identified in this outbreak, with 25 laboratory confirmed cases (25 “primary cases” and 34 probable cases). 2001 E. coli Outbreak at a Petting Zoo in Worcester, PA – An article published by WebMD Medical News on April 23, 2001 (Bloomquist, 2001), reported an outbreak of E. coli O157:H7 among visitors to the Merrymead Farm petting zoo in Worcester, Pennsylvania. In all, 16 children who had visited the zoo contracted E. coli, and it was suspected that another 45 people became ill from the bacteria. The report indicated that one week after visiting the zoo, one of the children came down with violent stomach cramps and was hospitalized. 2000 Cryptosporidiosis Outbreak at a Farm in Wellington, New Zealand – An outbreak of Cryptosporidiosis was linked to a two-day farm educational event in the Wellington region of New Zealand. Twenty-three cases were laboratory-confirmed. The route of infection was most likely from an infected animal.

2000 E. coli Outbreak at a Dairy Farm – Crump et al (2002) discussed an outbreak of E. coli O157:H7 among visitors to a dairy farm in Pennsylvania in September 2000. A case control study among the visitors was conducted to identify the risk factors of infection, along with a household survey to determine the rates of diarrheal illness. The total number of confirmed or suspected E. coli O157:H7 cases was 51. The median age among the patients was four. Eight of the cases developed hemolytic uremic syndrome (HUS). 2000 Snohomish County, WA, Petting Zoo E. coli Outbreak – The Snohomish Health District, Communicable Disease Department (June, 2000) reported five cases of bacterial diarrhea caused by E. coli O157:H7 in children in Snohomish County in May 2000. Three of the children visited a petting zoo several days before they became sick. The fourth child did not visit the petting zoo, but lived on another farm where cattle were raised. 2000 Medina County, OH, Fair E. coli Outbreak – A cluster of E. coli O157:H7 isolates was observed in Medina County, Ohio, in August of 2000. In the case-control investigation, 43 culture confirmed E. coli O157:H7 cases were identified. The environmental investigation suggested that contamination of a section of the water distribution system supplying various vendors was the likely exposure. So, what do you think should be done?
See the original op-ed, published January 8, 2012, here.

  • Jim Mann

    Simple parental hand cleansing behaviors could help keep petting zoos safe.

    SaniTwice® is a protocol made for this situation, following its development for, and approval by, the US military. It solved situations with restricted access to traditional handwashing facilities.

    For over six years we have sought FDA support for this handwash-equivalent method but have found resistance. They fail to recognize that if the SaniTwice method were in The Model Food Code, the local health departments would help see that the protocol would be available in locations without running water. SaniTwice is a generic solution, not brand specific and lab documentation is available. The FDA is in effect, blocking the solution from reaching this critical at-risk situation.

    Bill, Can Food Safety News help raise awareness for this solution and help ask the FDA for an answer as to why it has resisted codification for the last thee sessions of the Conference for Food Protection?

    Your readers may also be interested in this unusual perspective from the University of Minnesota’s National Center for Food Protection:

    • There’s actually an institute for handwashing? 

      I find that a little depressing. 

      • Jim Mann

        Lowering risk. Saving lives. Yes, depressing.

  • Since parents/guardians have shown a dismal record of following basic safety procedures, such as washing with soap and water after being with the pets (which is all that’s needed), I think it is time to end the petting zoos. 

    These petting zoos are actually, for the most part, not that well run anyway. The animals are stressed, clean up facilities lacking, and as noted, the dangers associated with lack of proper hygiene carry a very steep price. 

    I’d rather programs be created to allow kids to visit actual working farms. Then adult supervisors can make sure all precautions are taken, and the kids will get a more realistic look at farm animals in their habitats. 

  • pawpaw

    Have been at a petting zoo at a county fair, where the handwashing station was situated for maximum effect, and the people working there made sure the vast majority of those moving through sanitized their hands.  You could see those ahead of you doing so ahead of us, so we got the message.  At another fair, there was no handwashing station nearby, so few if any were doing so after touching the animals or their enclosures.

    My daughter worked at a petting zoo in Sept, and the animals there and their stalls were kept very clean.  That helps.  Also, some calves were sent back home at the first sign of sickness.

    As for much else in life, awareness of the routes of transmission, and working to minimize those goes a long way.

    Are the insurance companies who cover these fairs putting pressure on the petting zoos, to minimize zoonotic transmission, and therefore liability?  If I understand correctly, some private farms have eliminated petting zoos to minimize disease risk and therefore liability.  

  • Richard Moyer

    What should be done?
    County fairs compete for awards at the state level.  A number of criteria must be met.  
    What if counties, in considerations for such awards, need to demonstrate (diagrams, etc) where handwashing stations will be located in livestock barns (especially petting zoos), and how such use will be encouraged.  Also, plans in writing for cleaning all surfaces touched by fair visitors, and how such cleaning is monitored.

    So, a county fair could choose not to implement these ‘best practices’, but to qualify for awards at the state level then need to do so.  This also raises the question of agreement on best practices, to limit zoonotic transfer of pathogens.