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.

Wrong.

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 https://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.

5 now sick with E. coli from ND fair

A fifth case of E. coli possibly linked to the Red River Valley Fair was confirmed Tuesday by the North Dakota Department of Health.

red.river_The case joins four others that have been confirmed in the last two weeks. All five cases are from eastern North Dakota and four out of the five have been hospitalized, said Michelle Feist, an epidemiologist with the Health Department.

Feist said the investigation into the root causes of the E. coli outbreak is ongoing. She asks anyone who experienced illness after attending the fair, especially gastrointestinal illness like diarrhea or vomiting, to fill out a survey on the Health Department website to determine if their cases are related.

Handwashing is never enough: Rise in infections tied to animal encounters in Kentucky

Northern Kentucky health officials are urging residents to wash their hands if they encounter animals at county fairs after seeing a surge in intestinal infections in the region.

goat.petting.zooThe Northern Kentucky Health Department has received reports of E. coli, campylobacteriosis and Salmonella in local residents in recent weeks.

Of the three illnesses, the Ccmpylobacteriosis infection, causing diarrhea, abdominal pain, nausea and fever, is the most prevalent. Thirty-five cases have been reported from January through the third week of July this year. That compares with 18 cases in the first seven months of 2014, health department records show.

Seven salmonella cases have been reported to the health department in both the first and second quarters of 2015, and fewer than five E. coli cases were reported in each quarter, according to health department records. The department is not seeing increases in the two illnesses but is advising hand-washing to prevent all three diseases, because it’s the best way to prevent getting sick.

Many of the recent cases in the region are still under investigation, said Kelly Giesbrecht, a regional epidemiologist for the health department. “However, animal exposure seems to be common” so far among those who’ve contracted the illnesses.

About half of those with the illnesses are children, she said.

Health officials have seen the diseases associated with several types of animals, Giesbrecht said. Among them: cows, calves, goats, reptiles, chickens, ducks and puppies.

“Areas around the animals can become contaminated as well, so it’s important to keep those as clean as possible, and wash hands if coming into contact with surfaces,” Giesbrecht said

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3 kids sick: E. coli outbreak linked to North Dakota fair

Three children sickened in a recent E. coli outbreak in eastern North Dakota reported attending the Red River Valley Fair earlier this month, prompting state health officials to investigate whether animals there were the source of the infection.

red.riverOfficials said Monday it’s still early in the investigation, but they’re asking anyone who attended the fair, which ran from July 7 to 13, and developed diarrhea or bloody diarrhea for more than 24 hours within 10 days of the fair, to contact them.

The shiga toxin-producing infection from Escherischia coli, or STEC infection, can cause nausea, cramping, diarrhea, vomiting and bloody diarrhea, symptoms that can be severe enough to require hospitalization.

One of the children has developed a complication from the infection which can affect red blood cells and cause kidney damage and kidney failure, said Michelle Feist, a state epidemiologist with the Division of Disease Control.

“Although the cases reported having contact with animals at the fair, we are looking into other possible exposures as well,” said Feist.

Red River Valley Fair General Manager Bryan Schulz expressed shock at the announcement, saying he’d heard no details from health officials other than a call early Monday inquiring from where the fair’s animals had come.

“We haven’t had a petting zoo for three years,” Schulz said. “I’m not sure where they’re getting this from.”

Schulz said while fair officials have been moving away from having petting zoos precisely because of concerns over E.coli, people at the fair could have reached through cage bars in the rabbit display area or petted baby pigs held by workers in the Ag Education Center.

 A table of petting zoo outbreaks is available at https://barfblog.com/wp-content/uploads/2014/04/Petting-Zoo-Outbreaks-Table-4-8-14.xlsx.

 Best practices for planning events encouraging human-animal interactions

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 US 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.

 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]

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.

Aerosolization of pathogens? Petting zoo returns to Minn. fair after 2014 E. coli outbreak

Zerebko Zoo Tran, a traveling petting zoo, is returning to the 2015 Rice County Fair, a year after it was suspected to be the source of an E. coli outbreak.

courtlynn.petting.zooIn 2014, the Minnesota Department of Health identified 13 people from four different events who developed E. coli after visiting the Zerebko Zoo Tran traveling petting zoo.

 But Rice County Fair officials say fair goers shouldn’t be worried. Rice County Fair Executive Director John Dvorak said they were comfortable bringing Zerebko Zoo Tran back.

“The biggest factor is that they were extremely cooperative in working with the department of health, and others with the investigation,” Dvorak said.

Dvorak said the fair has also made changes to the facilities fair goers can use to clean up after visiting the zoo. In the past, the fair supplied hand-washing stations that used a chemical to sanitize hands. This year, the fair is bringing running-water hand washing stations with soap.

“E. coli is best cleaned away by friction, so by bringing the running water hand washing stations, that will help get rid of anything that could be spread,” Dvorak said.

Operational changes have been made in the fairground’s barns, like keeping an extra eye to keep walkways clear of waste and making layout changes within the barns so animals never have to step outside to go to a different part of the barn, he said.

Wally Zerebko, owner of Zerebko Zoo Tran, said after the incident in 2014, he contacted several experts and had all of his animals tested. He also had the company’s vet mention the problem at a conference, which led to them finding a vaccine they could give the animals.