62 sickened with E. coli at North Dakota fair, no cause found

The North Dakota Department of Health says an investigation yielded no cause of an E. coli outbreak centered on the Red River Valley Fair earlier this year.

fargo.margThe final report says 62 people were sickened over the course of the Fair this summer. State health officials are unsure if the cause came from one of the food vendors or rather close contact with farm animals.

The report also says no investigation was conducted at the fairgrounds in West Fargo because the first symptoms came to health officials after the fair’s conclusion. Therefore, there were no food vendors or animal attractions still there to be looked at. However, all food vendors are inspected prior to the Fair’s opening.

Handwashing is never enough: 60 sickened in E. coli outbreak at Washington fairgrounds

A total of 60 people likely were sickened during an E. coli outbreak at the Milk Makers Fest in April, according to a report issued Friday, Oct. 30, by the Centers for Disease Control and Prevention.

Fair E coli 1About 1,325 Whatcom County first-grade students, plus the teachers and parents who accompanied them, from all school districts in Whatcom County went to the annual event April 21-23 at the Northwest Washington Fairgrounds in Lynden.

The event was designed to introduce young students to farming. It also gave them a chance to pet farm animals, including small horses, sheep, rabbits, chickens and a calf. There was a hay maze and scavenger hunt as well.

People who helped set up and take down the event — on April 20 and April 24 — also were among those who were sickened.

The new report provided additional details about the incident.

preliminary report was put out in June by health officials investigating the outbreak, and the findings were similar. Whatcom County and state health departments as well as the CDC were the investigators.

The CDC’s Oct. 30 report found that:

▪ Of the total number of people who were ill, 25 were confirmed through tests and 35 were probable. Eleven were hospitalized. Six developed hemolytic uremic syndrome, a life-threatening complication. There were no deaths.

In the earlier stages of the investigation, health officials identified cases that were confirmed or probable. Then they switched to confirmed cases only. The latest report returned to tracking both types of cases.

▪ Forty people who attended the event were sickened — 35 first-graders, three high school students, one parent and one teacher.

Twenty secondary cases — people who had contact with someone who went to the Milk Makers Fest — were identified in 14 siblings, four caretakers and two cousins of those who went to the event, the CDC wrote.

▪ The strain of Shiga toxin-producing E. coli O157: H7 that caused an outbreak was found in the north end of the dairy barn where the Milk Makers Fest was held, which was reported previously.

“Animals, including cattle, had been exhibited in the barn during previous events. Before the dairy education event, tractors, scrapers, and leaf blowers were used to move manure to a bunker at the north end of the barn,” the CDC reported stated.

▪ While it wasn’t possible to disinfect the barn, steps could have been taken to minimize risk, including hand-washing.

“Students attending the setup and breakdown might have had higher rates of illness because they consumed food in the barn and might not have washed their hands before eating,” the CDC stated. “Facility cleaning procedures and location of the manure bunker (inside the barn) might have contributed to an increased risk for infection among the attendees.”

What jumps out is leaf blowers used to move manure. That’s going to aerosolize and E. coli in the cow poop and no amount of handwashing will remove it.

Be the bug, think where these things are going to go and how they are going to make people barf.

Keep food out of animal education events

Next week I’m tagging along on a field trip with Jack’s first grade class. They’ve been studying the solar system and we’re headed to the planetarium to view the stars and learn about space missions.

No animal exhibits involved in this trip, but I’m sure those are in the future.

I plan on chaperoning any school trips the boys take to the farm, the fair or the petting zoo to help with the onsite risk management.070414.T.FF_.AGEDCENTER1

But, as today’s MMWR highlights, a lot of the disease risk stuff needs to be taken care of before with good planning and procedures.

Yeah, hand washing matters, but so does not letting kids bring lunch/snacks into a contaminated environment.

Or serving food directly in the barn to a 1,000 kids.

Or as Curran et al. say,  ‘These environments should be considered contaminated and should not be located in areas where food and beverages are served’
During April 20–June 1, 2015, 60 cases (25 confirmed and 35 probable) were identified (Figure). Eleven (18%) patients were hospitalized, and six (10%) developed hemolytic uremic syndrome. No deaths occurred. Forty primary cases were identified in 35 first-graders, three high school students, one parent, and one teacher who attended the event. Twenty secondary cases were identified in 14 siblings, four caretakers, and two cousins of attendees.

Food was served inside the barn to adolescents who set up and broke down the event on April 20 and April 24. During April 21–23 approximately 1,000 first-grade students attended the event, which included various activities related to farming. Crude attack rates were higher among those who assisted with setup on April 20 or breakdown on April 24 (three of 14 high school students; 21%) and among attendees on April 21 (22 of 254 students; 9%), than among attendees on April 22 (six of 377 students; 2%) and April 23 (seven of 436 students; 2%).

Animals, including cattle, had been exhibited in the barn during previous events. Before the dairy education event, tractors, scrapers, and leaf blowers were used to move manure to a bunker at the north end of the barn. Environmental samples collected in this area yielded E. coli O157:H7 PFGE patterns indistinguishable from the outbreak strains.

Although it might not be possible to completely disinfect barns and areas where animals have been kept, standard procedures for cleaning, disinfection, and facility design should be adopted to minimize the risk for exposure to pathogens (1). These environments should be considered contaminated and should not be located in areas where food and beverages are served. Hands should always be washed with soap and clean running water, and dried with clean towels immediately upon exiting areas containing animals or where animals have been kept previously, after removing soiled clothing or shoes, and before eating or drinking. Event organizers can refer to published recommendations for preventing disease associated with animals in public settings.

Here’s a set of guidelines we came up with for folks to use when choosing whether to take a trip to these animal events.




The kids are not alright: STEC in England

Between 1 January 2009 and 31 December 2012 in England, a total of 3717 cases were reported with evidence of Shiga toxin-producing E. coli (STEC) infection, and the crude incidence of STEC infection was 1·80/100 000 person-years.

kids.are.alrightIncidence was highest in children aged 1–4 years (7·63/100 000 person-years). Females had a higher incidence of STEC than males [rate ratio (RR) 1·24, P < 0·001], and white ethnic groups had a higher incidence than non-white ethnic groups (RR 1·43, P < 0·001). Progression to haemolytic uraemic syndrome (HUS) was more frequent in females and children. Non-O157 STEC strains were associated with higher hospitalization and HUS rates than O157 STEC strains.

In STEC O157 cases, phage type (PT) 21/28, predominantly indigenously acquired, was also associated with more severe disease than other PTs, as were strains encoding stx2 genes.

Incidence of STEC was over four times higher in people residing in rural areas than urban areas (RR 4·39, P < 0·001). Exposure to livestock and/or their faeces was reported twice as often in cases living in rural areas than urban areas (P < 0·001). Environmental/animal contact remains an important risk factor for STEC transmission and is a significant driver in the burden of sporadic STEC infection.

The most commonly detected STEC serogroup in England was O157. However, a bias in testing methods results in an unquantifiable under-ascertainment of non-O157 STEC infections. Implementation of PCR-based diagnostic methods designed to detect all STEC, to address this diagnostic deficit, is therefore important.

 The epidemiology, microbiology and clinical impact of Shiga toxin-producing Escherichia coli in England, 2009–2012

Epidemiology and Infection / Volume 143 / Issue 16 / December 2015, pp 3475-3487


Keeping animal event goers safe takes vigilance

Two weeks ago 20-month old Colton James-Brian Guay tragically died from an E. coli O111 illness he picked up from a Maine fair petting zoo. Another child who visited the same event, Myles Herschaft, is still recovering from HUS.

Reading about these illnesses and thinking about my kids creates a pit in my stomach. The seriousness of the tragedy and how something like this might happen shouldn’t be a surprise to anyone who works with food – farmers, processors, food handlers (commercial or domestic) – or the folks who run petting zoos and animal events.ekka_petting_zoo(3)

These tragedies happen often, but it’s not enough to just understand why; the science of pathogen transfer in animal contact events is out there. We’ve published on behaviors and best practices. Petting zoo operators should be watching this case closely and evaluating whether their current strategies would have avoided the outbreak. Changes might mean adjusting a process, increased training, testing and better communication of risks to patrons.

According to Time Warner Cable News, the NC State Fair organizers are focused on controlling zoonotic diseases at animal events.

“For many people, the fair is the only opportunity they may have to come see a cow or a pig or a mule, and so we want to make sure they get that experience. But we want everybody to understand that things like washing your hands and keeping your distance are great little steps that you can take and keep everybody healthy,” said N.C. State Fair spokesman Brian Long.

An E. coli outbreak at the 2011 State Fair caused 25 people to get sick and a year later, officials added barriers between livestock and fairgoers.

“Just to create more separation between humans and animals, you know animals are capable of transmitting bacteria to humans, and vice-versa. We want to keep the animals healthy. We want to keep the people healthy,” said Long.

Keeping folks and food separate from animals is a good strategy. Handwashing matters, but so does cleaning/sanitation of rails, floors and hand-contact surfaces.

At the root of a good food safety culture is recognition by everyone that it’s really important that things go right all the time. The stakes are too high if they don’t: kids end up in hospital or worse.

E. coli O111 felled two toddlers at Maine fair

State health officials said this afternoon that two toddlers who fell ill with an E. coli infection had the same strain of the dangerous bacteria.

Colton-Guay“The strain and molecular typing from each patient was identical, making it highly likely that the cases acquired the illness from same source,” said Dr. Siiri Bennett, the state epidemiologist for the Maine Center for Disease Control and Prevention. “We cannot say with certainty what that common exposure might have been.”

The strain, known as O111, is one of many strains that can be responsible for an illness” such hemolytic uremic syndrome, or HUS, a particular strain of E. coli.

One of the toddlers, 20-month-old Colton James-Brian Guay, died this week, while another, Myles Herschaft, remained in fair condition this afternoon at Maine Medical Center. Myles, 17 months, of Auburn, also suffered from hemolytic uremic syndrome.

The state is still investigating the source of the E. coli infection, although the families of the toddlers have publicly said that they both visited the petting zoo at the Oxford County Fair in late September.

Handwashing is never enough: Maine man says 20-month-old son died of E. coli linked to petting fair

A man from the town of Poland says his 20-month-old son died of an illness caused by E. coli and that the child may have come in contact with it while visiting a petting zoo at the Oxford County Fair in mid-September.

Colton-GuayThe toddler is believed to be one of two young children who visited the fair’s petting zoo around the same time and were hospitalized with symptoms of E. coli. The father made the announcement on Facebook, saying he was doing so to warn other parents about the dangers of letting small children pet farm animals.

State health officials have confirmed they are investigating two E. coli cases, but they have not confirmed that anyone has died or named either of the people affected.

However, Victor Herschaft of Auburn posted a message on his Facebook page Tuesday asking that friends and family share the message about his son, Myles, who was at Maine Medical Center undergoing treatment for E. coli.

A nursing supervisor said Myles was in fair condition Tuesday night.

“This (E. coli) is what Myles contracted and I hope no one else is sick or gets sick. If your child has symptoms of an illness please don’t take it lightly and please get your children checked out,” Herschaft wrote. “Myles is still battling this HUS (hemolytic uremic syndrome).”

Herschaft said his son and the other boy went to the same petting zoo around the same time. They were admitted to the hospital within 6 hours of each other, he said.

ekka.petting.zoo.aug.12State health officials say there is only one way of preventing the spread of E. coli after touching farm animals: washing hands throughly with soap and water or using some type of hand sanitizer.


Handwashing is never enough, and we have documented numerous cases of shiga-toxin producing E. coli linked to animal exhibits that involve aerosolization of E. coli or cross-contamination.

Maine sucks at going public: Two toddlers contracted E. coli at fair

It’s fair season in the U.S. and elsewhere, and that means, reports of children stricken with various forms of deadly E. coli.

Tcourtlynn.petting.zoohe Maine CDC confirms two children contracted E. coli last month at the Oxford County Fair.

The CDC has not released the names or the conditions of the children due to confidentiality laws.

It’s not unusual: UK spike in Salmonella cases linked to snakes

Public Health England have linked a spike in Salmonella cases to an unlikely source – snakes.

It’s not unusual.

You see a reptile, I see a Salmonella factory.

In the UK, 70 cases have been reported so far in 2015 involving people handling reptiles.

Professor Jeremy Hawker said the bug was primarily contracted from handling raw and frozen mice which are then fed to snakes.

He also warned that it could be caught from furniture, clothes and household surfaces contaminated by infected droppings.

But Welsh crooner Tom Jones has a simpler message that snake owners should take to heart.

Handwashing is never enough: NW Washington Fair organizers emphasize safety after E. coli outbreak

I applaud the event coordinators for the Northwest Washington Fair for making health and safety a priority following an outbreak of shiga toxin-producing E. coli in April that sickened at least 25.Second Opinions: Necessary or Not?

claudia.e.coli.petting.zoo.may.14Whatcom County Health Department (WCHD) inspectors confirmed in June the outbreak originated in a barn at the fairgrounds. In light of this, Steve VanderYacht, president of the fair’s board of directors, said the fair organizers aren’t taking any chances.

“This year’s focus at the fair is health and safety,” he said. “Through our close consultations with the health department and outside groups, we’ve learned that the surest way to prevent the spread of E. coli is through proper, thorough and frequent handwashing, so we’re doing everything we can to make sure our visitors have the access and tools necessary to do so.”

Event staff were trained as “hand washing ambassadors” during a special training session on August 12. Hand washing ambassadors will man three of the hand-washing stations to teach proper technique to families and kids. As an extra incentive, kids who visit all three stations earn the chance to win prizes.

But handwashing is never enough.

In 2013, 49 were sickened with shiga toxin-producing E. coli at the Ekka, Queensland’s state fair in Brisbane. STEC genes were detected in the bedding of animals in the Ekka’s nursery.

Go hang out at petting zoos or the exhibits at county and state fairs and watch what little kids do; we have. So have others.

And while some studies suggest inadequate handwashing facilities may have contributed to enteric disease outbreaks or washing hands was protective against illness, others suggest relevant infectious agents may be aerosolized and inhaled.

In the fall of 2009, an E. coli O157:H7 outbreak at Godstone Petting Farm in the U.K resulted in 93 illnesses – primarily little kids.

ekka.petting.zooThe investigation into the Godstone outbreak identified evidence of environmental contamination outside the main barn, indicating acquisition of illness through both direct animal or fecal contact, and indirect environmental contact (e.g. contacting railings or soiled footwear).

Aerosolization of potential pathogens is also possible, as suggested in an E. coli O157:H7 outbreak at a county fair in Oregon, in which 60 people fell ill.

Ihekweazu et al. subsequently concluded that in the Godstone outbreak,

“handwashing conferred no demonstrable protective effect. …

“Moreover, from the findings of many previous published studies, it must be assumed that all petting or open farms are potentially high-risk environments for the acquisition of VTEC O157 infection (an STEC).”

A table of petting zoo outbreaks is available at http://barfblog.com/wp-content/uploads/2014/04/Petting-Zoo-Outbreaks-Table-4-8-14.xlsx., and a list of risk factors at petting zoos and animal contact events at fairs can be found in: Erdozain G, Kukanich K, Chapman B, Powell D. 2012. Observation of public health risk behaviours, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011. Zoonoses Public Health.