A team of state and federal public health experts is heading to Whatcom County, WA, to help with an ongoing investigation into the recent E. coli outbreak there. The outbreak, with a case count of 45 people (23 lab-confirmed, 22 probable, and 8 who were hospitalized), has been linked to a dairy festival held late last month in Lynden, WA, and attended by more than 1,300 first-graders. The serotype involved is Shiga toxin-producing E. coli O157:H7. Team members — from the U.S. Centers for Disease Control and Prevention (CDC) and the Washington State Department of Health — will be looking at case definitions, data collection, testing processes, and any unanswered questions that need to be addressed, said Marcus Deyerin, emergency response specialist for the Whatcom County Health Department in Bellingham, in an interview Friday with Food Safety News. “As they come to some specifics about the source, what are some best practices that need to be evaluated and acted upon?” he said, adding, “Obviously, the goal is to keep this from happening.” Washington State Epidemiologist Scott Lindquist, M.D., Ph.D., said Friday that the state, which requested CDC’s help, would send a veterinarian, an environmental health specialist, or someone with expertise in foodborne epidemiology. He told Food Safety News that he planned to meet first thing Monday morning with the CDC team to review what is currently known about the outbreak. “Usually they will send one to four people, and it will be a mix of a vet, environmental health, or epidemiology,” Lindquist explained. Deyerin said he would characterize the E. coli outbreak there as “stabilized,” although it’s possible that some secondary cases could still crop up. The county asks for state and federal assistance with outbreaks and other situations when it can’t keep up with the caseload, he said, although county staff has been able to do interviews with adults and children who attended the festival and handle a variety of other duties related to the investigation. “In terms of bringing in the CDC, that’s a good thing to leverage the expertise that they have,” Deyerin said. He noted that the state has already been responsive to assisting the county with the outbreak. No specific source of the E. coli bacteria has yet been identified, although Lindquist indicated that the source of the illnesses was the Milk Makers Fest held April 21-23 at the fairgrounds in Lynden, WA. Among the activities there was a farm animal petting zoo. “… [We] haven’t identified a specific source such as a specific cow or a specific bale of hay, but this occurred at the Milk Makers Fest and within a specific barn at the fairgrounds because that is where 90 percent of the activities were, so I know that our staff knows that the source was within that facility,” Deyerin said. The county health department has no regulatory authority over such events unless food is being sold, he added. Chocolate milk was offered to children at the event, but it was pasteurized and officials said there was no indication that it was the source of the bacteria. Lindquist said Friday that it’s very clear from PFGE (Pulsed-field Gel Electrophoresis) fingerprinting that nine samples match each other. “We know we have a common source, and we know the common exposure for these folks. That’s what I’m comfortable saying,” he said, adding, “The interesting piece is, where did this come from?” The Whatcom County Dairy Women, which sponsored the Milk Makers Fest, has been posting regular updates on the outbreak here. The most recent one, posted Friday, announced that the county health department had informed the group that CDC staff would be coming to town. “We welcome the CDC’s participation and will fully cooperate with the continuing investigation,” the group stated. The update also noted that, as of Thursday, one of the eight people hospitalized in connection with the outbreak was still at St. Joseph Hospital in Bellingham. “We are very grateful for the outpouring of support for the organizers of the Milk Makers Fest as well as for the community-wide support for those who have become ill and their families. Our hearts and prayers continue to go out to all those involved and we are grateful to hear that at least some of those who were ill have recovered or are recovering,” the group stated. E. coli infections are typically transmitted via contact with contaminated food, water or animal feces. Symptoms of infection are stomach cramps, diarrhea (often bloody) and vomiting. Some people, especially children, can develop a severe complication from E. coli infection known as hemolytic uremic syndrome (HUS), a type of kidney failure which can be fatal.