108 sickened; court rules no negligence in E. coli outbreak at NC state fair

The North Carolina State Fair is not, according to Courthouse News Service, liable after more than 100 people became sick after an E. coli outbreak at its petting zoo in 2004, the state appeals court ruled.

The state’s health department and the U.S. Centers for Disease Control and Prevention traced the infection of 108 people to the petting zoo at the state fair in 2004. Jeff Rolan and dozens of others then sued the fair’s sponsor, the North Carolina Department of Agriculture and Consumer Services.

amy_s_lamb_aug_121-300x225The North Carolina Industrial Commission ruled in favor of the state, noting that veterinarians prepared for the fair by checking the animals’ health and removing those that were sick. Also, a veterinarian posted additional signs warning patients to wash their hands and also added hand sanitizers to the petting zoo area.


In light of these facts, the commission determined that the state had taken precautions to protect the health of the patrons.
 The plaintiffs argued on appeal that the state should have taken additional cautionary measures, such as providing better supervision, erecting a fence between the children and the animals, and providing information on the risk of E. coli infection. A three-judge panel with the North Carolina Court of Appeals affirmed the commission’s ruling on April 1.
”While it was certainly possible for defendant to take the additional precautions suggested by plaintiffs, we agree with the Commission’s conclusion that Defendant did not fail to act with due care in October of 2004 to minimize the risk of exposure to E. coli,” Judge Linda Stephens wrote for the court. “Sources cited by the Commission note that it is impossible to eliminate the risk of enteric pathogens, like E. coli, in human-to-animal contact settings without eliminating petting zoos altogether.” 

Then maybe they should be eliminated, or at least much better controlled.

Best practices for planning events encouraging human-animal interactions

03.Apr.14

Zoonoses and Public Health

G. Erdozain , K. KuKanich , B. Chapman  and D. Powell

http://onlinelibrary.wiley.com/doi/10.1111/zph.12117/abstract?deniedAccess

Educational events encouraging human–animal interaction include the risk of zoonotic disease transmission. ‘It is estimated that 14% of all disease in the USA caused by Campylobacter spp., Cryptosporidium spp., Shiga toxin-producing Escherichia coli (STEC) O157, non-O157 STECs, Listeria monocytogenes, nontyphoidal Salmonella enterica and Yersinia enterocolitica were attributable to animal contact. This article reviews best practices for organizing events where human–animal interactions are encouraged, with the objective of lowering the risk of zoonotic disease transmission.

No one wants their kid to get sick from animals: best practices paper published

From North Carolina, U.S. to Brisbane, Australia, outbreaks of E. coli, Salmonella and other pathogens related to petting zoos or animal exhibits have been devastating to the families involved.

We wanted to provide a checklist for parents, and the teachers who book these events.

Two veterinarians from Kansas State University – Gonzalo Erdozain who completed his Masters of Public Heath with me and is about to graduate as a vet, and Kate KuKanich, an assistant prof with whom I’ve had the pleasure gonzalo.pic_.may13-300x300of writing several papers with – joined with me and my BFF Chapman (until we have a fight over hockey) and we tried to produce some guidelines.

The uniting factor was – we all have kids.

We’ve all seen microbiologically terrible practices, and read about them from around the world, and thought, maybe we should try and provide some guidance.

And now it’s been published.

Gonzalo did the bulk of the work for his MPH, but we all contributed our experiences.

For me, it was going to the Ekka in Brisbane, something like the Texas State Fair. The petting zoo was absolute madness, and after living in Brisbane and hanging out with micro-types who told me, don’t go to the Ekka, you’ll get sick, we didn’t go last year.

Fourty-nine people got sick from E. coli O157.

North Carolina has had repeated and terrible outbreaks.

As a father of five daughters, I’ve had many requests over 20 years to go on a school trip to see the animals. As a food safety type, I’ve been kate.jackroutinely concerned about best practices. The other parents may dislike microbiology, but I’m concerned with the health and safety of the children involved.

I am extremely proud of this paper, with the hope that maybe there will be fewer sick kids. I’m also extremely proud to be associated with my co-authors.

Best practices for planning events encouraging human-animal interactions

03.Apr.14

Zoonoses and Public Health DOI: 10.1111/zph.12117

doug.ben.familyG. Erdozain , K. KuKanich , B. Chapman  and D. Powell

http://onlinelibrary.wiley.com/doi/10.1111/zph.12117/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false

03.Apr.14

Zoonoses and Public Health

G. Erdozain , K. KuKanich , B. Chapman  and D. Powell

http://onlinelibrary.wiley.com/doi/10.1111/zph.12117/abstract?deniedAccess

Educational events encouraging human–animal interaction include the risk of zoonotic disease transmission. ‘It is estimated that 14% of all disease in the USA caused by Campylobacter spp., Cryptosporidium spp., Shiga toxin-producing Escherichia coli (STEC) O157, non-O157 STECs, Listeria monocytogenes, nontyphoidal Salmonella enterica and Yersinia enterocolitica were attributable to animal contact. This article reviews best practices for organizing events where human–animal interactions are encouraged, with the objective of lowering the risk of zoonotic disease transmission.

(And it was Amy that noticed the thing had been published; always ahead by a century.)

petting.zoo.guidelines

80 crypto cases a year; handwashing is never enough: UK health chief warns over risk of infection from region’s petting farms

We have a paper coming out shortly about best practices at petting zoos and farm visits and state fairs and just hanging out with animals.

I’ll follow my own best practice and wait until it’s published to talk about it, but Dr Ken Lamden, the health chief of Cumbria and north Lancashire in handwashing.ekka.jpgthe UK is urging parents to be aware of potential infections that can be caught at farm attractions.

Over the past 20 years, an average of around 80 cases of cryptosporidium infection linked to visits to petting farms have been reported to Public Health England each year. This is out of a total of around two million visits to the 1,000 plus farm attractions in the UK, with peak visitor times during school and public holidays.

Dr Lamden, of PHE’s Cumbria and Lancashire Centre, said: “Visiting a farm is a very enjoyable experience for both children and adults alike but it’s important to remember that contact with farm animals carries a risk of infection because of the micro-organisms – or germs – they carry.

 “Anyone visiting a petting farm should be aware of the need to wash their hands thoroughly using soap and water after they have handled animals or been in their surroundings. Children are more at risk of serious illness and should be closely supervised to make sure that they wash their hands thoroughly.

“It is also very important not to rely on hand gels and wipes for protection because these are not suitable against the sort of germs found on farms.” 

Community rallies behind Oklahoma boy battling E. coli infection

Residents in a small town in northwest Oklahoma are rallying behind a young boy, who is fighting for his life after being infected with E. coli.

State health officials in Oklahoma are investigating a spike in a deadly strain of E. coli. Eight-year-old Connor Sneary of Alva, Oklahoma, is one of oklahoma.e.coliat least a dozen people who became hospitalized.

Connor has been in the intensive care unit at OU Children’s Hospital where he remains in critical condition. As part of the treatment, he is undergoing dialysis and blood transfusions.

Connor has a form of E. coli that the family believes may have been contracted at an agricultural event at the Oklahoma State Fair Grounds. Investigators say that is a possibility.

Several organizations are hosting events benefiting Connor’s family. The Oklahoma Blood Institute will have a special blood drive in Alva on Tuesday, April 8, from noon to 6 p.m., at the First Christian Church. All donations will be credited to Connor for his use.

7-year-old sickened by E. coli at Minnesota petting zoo returns to school

Days after visiting a petting zoo at a pumpkin patch before Halloween, Emma Heidish was in the hospital. Almost a month later, her family is grateful she will spend Thanksgiving at home.

Heidish was one of 3 people who got sick after visiting Dehn’s Pumpkins in Dayton, Minn., but while the others were able to recover at home, her case was severe.

Like many 7-year-olds, Heidish loves animals, but after what she’s endured, her opinions about her favorite farm animals have goat.petting.zoo_changed.

“They are the ones that made me sick!” she explained.

Within days of visiting the pumpkin patch in mid-October, stomach cramps and diarrhea landed Heidish in the intensive care unit.

For a month, the little girl fought through a form of kidney failure that required her to undergo surgery and near-constant dialysis because her digestive system basically shut down.

The family is also bracing for the bill. Even though they have health insurance, they’re not sure what a month-long stay in the ICU will cost them. Friends have organized two fundraisers to offset the coasts and have established a fund for the family.

For more information on the benefit’s and more ways that you can help visit: www.emmasfund.com

As for Dehn’s farm, the owners still aren’t sure what they’ll do with the livestock next year because E. coli can simply be in an animal’s fur or the pen they’re kept in, but the Heidish family says they just want to stress the importance of hand washing.

Handwashing is never enough when it comes to human-animal interactions. My colleagues and I have a paper on best practices that will hopefully be published soon.
KMSP-TV

3 sick, more suspected; E. coli O157 at Minn. petting zoo

Three Minnesota residents have become ill with confirmed E. coli O157:H7 infections after contact with animals at Dehn’s Pumpkins in Dayton, MN, the Minnesota Department of Health reported today.

The three cases were all children, ranging in age from 15 months to 7 years and are residents of the Twin Cities metro area. One child is hospitalized with hemolytic uremic syndrome (HUS), a serious goat.petting.zoocomplication of an E. coli infection characterized by kidney failure. The others were not hospitalized and are recovering. Routine monitoring by the health department identified the E. coli O157:H7 cases, which all have bacterial isolates with the same DNA fingerprint. These cases visited the farm on October 12 or 13, and became ill on October 16 or 18.

The Minnesota Department of Health is in the process of following up with any groups that visited the farm in order to help determine if more people have become ill. At this time, two additional people have reported symptoms consistent with E. coli O157:H7 infection and are currently being tested. These people visited Dehn’s on October 18, raising concern that exposures also could have occurred after the weekend of October 12-13.

All of the cases reported having contact with cattle and/or goats at Dehn’s. The farm owners have been cooperating fully with the investigation and public access to the cattle and goat areas is being prohibited. The rest of the farm, including the pumpkin patch, remains open for business.

A table of petting zoo related outbreaks is available at http://bites.ksu.edu/petting-zoos-outbreaks.

‘We love Hubers’ Kentucky E. coli cases linked

The three cases of E. coli on the Indiana-Kentucky border are genetically linked and they all visited Huber’s Orchard and Winery.

Two are Louisville residents, one is from Indiana.  Some parents believe their children got sick from the Huber’s petting zoo, but the health huber'sdepartment won’t confirm that.

Last week, Huber’s released a statement saying an inspection by the Clark County Health department found no link to Huber’s.  But that inspection only focused on food.

The Health Department says the three who got sick each visited Huber’s between September 20th and September 28th.

A parent named Kirby, who doesn’t want his last name used, says his five-year-old daughter Peyton contracted E. coli after touching the animals and had scraped her arm at the petting zoo.  She washed her hands, but still became sick and was at Kosair Children’s Hospital for six days.

When asked how he felt knowing that the three cases were linked to Huber’s Orchard and Winery, Kirby replied, ”That’s something we knew from the beginning even though people were saying we were wrong for saying that.  We knew in the hospital from the other cases that were there at the same time.  Does it change my mind about them?  No, we love Huber’s.”

Another petting zoo outbreak? Maybe

Families, according to WDRB, are claiming their children got sick after going to the Huber’s Petting Zoo in Indiana.

The Clark County Health Department confirms one E. coli case, but says at this point, Huber’s Orchard, Winery and Vineyards and its petting zoo courtlynn.petting.zooare not connected.

A mother tells WDRB that her 2-year-old daughter is at Kosair Children’s Hospital after her kidneys failed after contracting E.coli.

She says she believes she got it from going to Huber’s petting zoo and claims there are two other sick children at the hospital dealing with the same thing who also pet the animals there.

Huber’s says it has received numerous calls and has issued its own statement on Facebook.

Dana Huber with Huber’s Marketing and Public Relations says, “To be completely honest the Facebook posts, what was being posted as of yesterday was very concerning to us. Our family didn’t want to release information until it was the most accurate information. Again, we handled it the best that we could.”

Huber says the family wanted to set the record straight and let people know there is no link between E. coli and their facility. Huber’s says their thoughts are with the family who has been affected.

A table of petting zoo related outbreaks is available at http://bites.ksu.edu/petting-zoos-outbreaks.

Handwashing is never enough: a parent’s story about sickness at state fairs

Arinn Dixon Widmayer of Raleigh, North Carolina, writes in the Charlotte Observer:

As I sat in a darkened room in the middle of the night watching a nurse hook up a dialysis machine to my pale and shivering 7-year-old son, I wondered how in the world we ended up here.

It was October 2011, and my husband and I had been watching our son’s health all week. He stood motionless on the soccer field on Tuesday night, white handwash.UK.petting.zoo.09as a sheet, as the ball rolled by. By Thursday, he was nauseated and feverish. Our pediatrician told us to keep him hydrated, reduce the fever, that it was a bug and he’d get past it. By the weekend, he was eating little, sleeping most of the day.

This is a tale any parent can tell. We see it all the time – children with a virus, a cold, the flu. Parents worry, give them medicine, juice and too much TV, and in a few days they perk up and get back to their normal selves.

Except when they don’t.

During that weekend, the pediatrician thought maybe our son had eaten something that made him sick. She treated his symptoms and started running some tests for infection. It was at that visit I first heard a suggestion of salmonella, of listeria, of E. coli.

By Monday, he was in bad shape. I helped him to the bathroom that morning and hugged him while he sat there crying that his tummy hurt. Once I got him standing back up, I turned to flush the toilet and froze. It was full of blood. Only blood. Within three hours, an ER doctor was explaining test results. It was E. coli.

I closed my eyes, just relieved to have a name for this suffering, so I wasn’t looking at the doctor’s face when she uttered the words “double kidney failure.” handwashing.ekka.jpgAnd then I was in that dark room with the doctors and nurses and the dialysis machine. How did we get here?

Our son was infected with E. coli at the N.C. State Fair. Public health officials narrowed the site of his infection to the Kelley Building, one of the animal exhibit areas. It was a no-contact exhibit where the animals were fenced in. My family walked up and down the rows of pigs, sheep and goats. Our kids pointed and giggled at the jumping goats and fuzzy sheep. When we left the building, we stopped at the hand-washing station at the door and cleaned up. We did everything right. We avoided the petting zoo. We didn’t eat near the animals. We used the hand-washing stations when we left the exhibit and before we ate. None of us ever touched an animal. And our son still ended up enduring six dialysis treatments, four blood transfusions, 15 days in the hospital and a brush with death because of our decision to walk into that building.

Our son was just one of 27 people infected with E. coli at the State Fair in 2011. Add that to 108 people infected at the fair in 2004 and another three in 2006, and we end up with a serious public health issue. State health officials have recently made changes to the fair to reduce the risk of infection. They changed traffic patterns in the animal exhibits, increased the number of hand-washing stations, added signage warning fairgoers against touching animals and other measures.

Those are great steps toward protecting the public, but are they enough to protect fairgoers this year? I’m not advocating keeping animals and fairgoers separated by a glass wall, and I don’t pretend to know what else the fair can do to eliminate the risk of infection. But I do have to wonder whether large crowds and animals that carry deadly bacteria can coexist without the risk of E. coli? And at what point do those risks outweigh the benefits?

Handwashing is never enough. 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 royal.petting.zooagents may be aerosolized and inhaled. Handwashing tool selection may also contribute to the success of hand hygiene as a preventive measure, as some outbreak investigations have reported alcohol-based hand sanitizer was not protective against illness, especially when hands are soiled.

All the refs can be found in our 2012 paper, a sorta secret petting zoo shopper, Observation of public health risk behaviors, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011.

I’m fine with animal interactions; but people, and organizers, should be a lot more careful than they thought. That’s what I told my 3-year-old’s daycare as they prepared for a chicken coop. I’m not sure people like that message.

Further, sanitizers have limited effectiveness, and in a petting zoo situation, so does handwashing; it’s only one component of an overall strategy to reduce risk. But it’s easy to say handwashing because that blames the patrons, not something else.

A table of petting zoo outbreaks is available at http://bites.ksu.edu/petting-zoos-outbreaks.

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. 2012 Jul 30. doi: 10.1111/j.1863-2378.2012.01531.x. [Epub ahead of print]

Abstract below:

Observation of public health risk behaviors, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011Outbreaks of human illness have been linked to visiting settings with animal contact throughout developed countries. This paper details an observational study of hand hygiene tool availability and recommendations; frequency of risky behavior; and, handwashing attempts by visitors in Kansas (9) and Missouri (4), U.S., petting zoos. Handwashing signs and hand hygiene stations were available at the exit of animal-contact areas in 10/13 and 8/13 petting zoos respectively. Risky behaviors were observed being performed at all petting zoos by at least one visitor. Frequently observed behaviors were: children (10/13 petting zoos) and adults (9/13 petting zoos) touching hands to face within animal-contact areas; animals licking children’s and adults’ hands (7/13 and 4/13 petting zoos, respectively); and children and adults drinking within animal-contact areas (5/13 petting zoos each). Of 574 visitors observed for hand hygiene when exiting animal-contact areas, 37% (n=214) of individuals attempted some type of hand hygiene, with male adults, female adults, and children attempting at similar rates (32%, 40%, and 37% respectively). Visitors were 4.8x more likely to wash their hands when a staff member was present within or at the exit to the animal-contact area (136/231, 59%) than when no staff member was present (78/343, 23%; p<0.001, OR=4.863, 95% C.I.=3.380-6.998). Visitors at zoos with a fence as a partial barrier to human-animal contact were 2.3x more likely to wash their hands (188/460, 40.9%) than visitors allowed to enter the animals’ yard for contact (26/114, 22.8%; p<0.001, OR= 2.339, 95% CI= 1.454-3.763). Inconsistencies existed in tool availability, signage, and supervision of animal-contact. Risk communication was poor, with few petting zoos outlining risks associated with animal-contact, or providing recommendations for precautions to be taken to reduce these risks.

Hand sanitizers didn’t protect Iowa kids against crypto after petting cows

This is why the UK says, handwashing with soap and water only at any petting farm or zoo.

A recent cluster of cryptosporidium cases cropped up after a Iowa preschool class visited a farm, Dr. Patricia Quinlisk, the Iowa Department of Public Health’s medical director, reported this morning. “While on the farm, the children petted cows and cow_hug_cumberlandate snacks,” Quinlisk wrote in a weekly email to public-health officials statewide. “The children did use hand sanitizer before eating; however, hand sanitizers are not particularly effective against crypto. Please continue to encourage handwashing with soap and water whenever possible.”

The Des Moines Register reports the parasite sickened hundreds of Iowans this summer, mainly via tainted swimming-pool water. Many of the patients suffered severe diarrhea. The outbreak has slowed now that most public pools have closed for the season. But infections also can happen in other ways, including contact with infected animals.

Quinlisk did not identify the preschool or say how many children became ill.

On Sept. 12, the state health department reported that there had been 861 confirmed or probable cases in Iowa so far in 2013. In all of 2012, there were 328 such cases.