WRAL in Raleigh reports that confirmed cases associated with a pathogenic E. coli outbreak are now at nine. Seven of the ill are children – three of whom required intensive care.Attending the North Carolina State Fair is one common link among the cases – however the source of the outbreak has not yet been pinpointed.

Fairs have lots of somewhat complex foods systems (last weekend the Raleigh News and Observer ran a story of what vendors are required to do – inspection wise) , temporary kitchens and animals.  In 2004, the fair’s petting zoo was the source of a E. coli O157 outbreak that resulted in 108 cases. See a list of petting zoo-linked outbreaks here.

Sue Lynn Ledford, community health director for Wake County was cited as saying  could take several days to pinpoint the source of the outbreak.

"We are working very closely with the known cases to identify common factors," she said. "We’re looking at all large gatherings … sports events, church events, fair events, anywhere."

Five of the nine were hospitalized due to their illness. Three children remain in intensive care.

Ledford said the county is working closely with state health officials to determine whether the cases are related and whether there are more cases in North Carolina. The eighth and ninth confirmed cases were from outside Wake County – an infected adult in Johnston County and an infected child in Cleveland County. 

State Agriculture Commissioner Steve Troxler said his department will do everything they can to assist public health officials with their investigation.

"Our thoughts and prayers are with the patients and their families. We hope they make a full and quick recovery," Troxler said in a statement. "At this time, there is still very little information about the potential source. We hope that as science plays out, investigators will find answers."