E. coli Blog - Surveillance & analysis on e. coli news & outbreaks

Both the Louisville Zoo, which has a year-round petting zoo, and Huber's Orchard & Winery in Starlight, Indiana, are determined not to let E. coli spoil their patrons' fun.

Huber's petting zoo, which will open for the season on Sunday, has existed for 17 years without incident, spokeswoman Jan Huber told the Courier-Journal:

"We feel confident that it's a clean and safe petting zoo," she said. "Our history speaks for itself." The existing restroom is already "very accessible," Huber said, but the business plans to add some anti-bacterial foam stations so that people have additional places to clean their hands.

The zoo plans to start testing animals once or twice a year for E. coli 0157:H7 -- the strain associated with a recent outbreak in Florida. It already quarantines new animals for at least 30 days. The entire zoo is also subject to periodic inspection by its accrediting organization, the American Zoo and Aquarium Association, and has steered clear of 0157 outbreaks.

Bill E. Wambeke, a writer for American News, reports that Brown County Fair Manager Larry Gerlach told Idaho commissioners Tuesday that after attending a seminar in Wisconsin earlier in the month on how animals can spread E. coli to small children, the fair board considered closing the petting zoo at their Fair.

Gerlach said that it crossed his mind not to have the petting zoo, but the fair board decided to instead adjust the zoo's practices. Now, a hand-washing station will be built next to the petting zoo so that children and adults can wash their hands after their visit.

With young kids, everything goes in their mouths, Gerlach said in reference to children touching animals and then putting their fingers in their mouths.

E. coli causes severe cramps and diarrhea. The symptoms are worse in children and older people, and especially in people who have another illness, and can be fatal. Animals in petting zoos spread it by laying in manure that is infected with E. coli. Children then touch the animals that have been laying in the infected manure.

State agriculture investigators spent the day disinfecting the Central Florida Fairgrounds, making sure there were no traces of E. coli bacteria at the petting zoo that may have made more than two dozen kids sick recently.

"The fair people have gone through and removed all the manure and straw and bedding and then they power-washed and chlorinated and used hot soap and water on the barns. They've asked us to come down and use a general purpose disinfectant to kill any bacteria," said Dr. E.H. Doten, of the Florida Department of Agriculture.

Shannon Smowton was rushed to Arnold Palmer Hospital last month because of the vicious infection she picked up at the petting zoo after a trip to the Central Florida Fair. She was put on dialysis, but the infection had already spread to her brain, paralyzing her left side.

Six weeks later, she has recovered enough to be released from the hospital, but rather than going home, her parents have to take her to a rehab center in Jacksonville, where therapists will work to get the strength back in her legs. If all goes well, she could be home in a few weeks.

At the peak of the outbreak, there were 30 confirmed E. coli cases and another 37 suspected cases. The state determined that petting zoos at the fairgrounds and two other sites, all owned by AgVenture Farm Shows, was the source of the outbreak.

Food safety experts say the war against food pathogens is far from over. Microbes evolve, and produce now comes from all around the world, including countries that have ineffective sanitation.

"We like to think that we're winning the battle to maintain control, but we have to realize that we live in a biological ecosystem where we are constantly changing and where on a microscopic level things are changing, too," said Trent Wakenight, a food safety expert with Michigan State University's National Food Safety and Toxicology Center. "We've still got 76 million incidences of food-borne illnesses a year in this country. There is still a lot to do."

The battle against pathogens has to be taken into home kitchens where most food contamination occurs today. The U.S. Department of Agriculture says the problem with food pathogens could be reduced if cooks prepared meats to temperatures greater than 160 degrees, thoroughly washed vegetables and avoided cross-contamination. Summertime is the peak season for contamination with food-borne pathogens because bacteria multiply faster in warm weather than cold, and people need to remember their thermometers, which are sometimes forgotten in backyard cooking or on summer picnics.

New guidelines set by the Department of Agriculture will now require visitors to reach through fences to pet the animals at petting zoos and animal exhibits, and carefully wash their hands afterward, in response to recent E. coli-related outbreaks.

Under the guidelines, the petting zoos at this year's fair will feature signs warning that contact with animals can spread disease - especially to young children, the elderly, pregnant women and sick people - and encouraging patrons to wash their hands before leaving.

Before, children would sit down in the animal bedding, drop things in the bedding and then put them in their mouths, according to Mary Ann McBride, a department veterinarian who helped develop the new guidelines.

Agriculture officials also will provide the guidelines to anyone operating an animal display or petting zoo and ask that they abide by them, too. That means petting zoos could become less intimate at county fairs, local carnivals and farms, but will be safer for visitors.

The Times Democrat had an editorial today on the many theories why the current E. coli outbreaks in Florida have happened.

Possible explanations include the emergence of new strains of bacteria, and humans' lowered resistance to disease because of increasing urbanization. The Centers for Disease Control and Prevention says that this strain of E. coli - O157:H7 - is responsible for an average of 73,000 cases of infection and 61 deaths in the United States each year.

No matter what the theories, it is a fact that E. coli infection is a more common occurrence and a threat in human association with animals - which should prompt people to examine their own habits more than question the safety of animal exhibits.

The Centers for Disease Control and Prevention stress the importance of something that nearly every person has heard thousands upon thousands of times in their lifetimes: washing your hands. Hand washing is one of the most important things you can do to keep from getting sick and from spreading germs to others. By frequently washing your hands, you wash away germs that you have picked up from other people, or from contaminated surfaces, or from animals and animal waste.

The CDC says when people forget to wash their hands, particularly after petting or handling an animal, or bring food into an area where animals are being housed, they are at risk of becoming ill. Washing your hands regularly can certainly save on medical bills. Because it costs less than a penny to wash your hands, you could say that a penny's worth of prevention can save you a $50 visit to the doctor, and quite possibly a whole lot of pain and suffering.

Unfortunately, it's not always that simple. We have seen cases where kids who never touched an animal or even got out of their strollers got sick.

Ohio State University veterinary researcher Jeff LeJeune has found that the kind of bedding that cows sleep on affects the volume and survival rate of potentially deadly E. coli 0157:H7 in the farm environment.

LeJeune's study found the prevalence of the bacteria in animals from sand-bedded herds was significantly lower than in animals from sawdust-bedded herds. The total number of positive samples in sand-bedded animals was less than half that found in sawdust-bedded animals, 56 out of 1,800.

Sand bedding contains less available organic matter and nutrients, so it isn't as hospitable to reproducing bacteria as sawdust bedding.

"Approximately 17 percent of ground beef comes from dairy cows that go to slaughter," LeJeune said. "One cow contaminated with E. coli 0157:H7 that is sent to the slaughterhouse can contaminate many other cows, and this can result in the contamination of millions of pounds of ground beef."

WFTV.com reports that the number of confirmed E. coli and hemolytic uremic syndrome cases are now at 28, with 45 suspected cases. More lawsuits are being filed against AgVenture, the Plant City-based company that had provided animals to petting zoos at three Central Florida fairs - the Florida State Fair, the Central Florida Fair, and the Florida Strawberry Festival.

The latest lawsuit targets the Central Florida Fairgrounds, saying there are many things the Central Florida Fair could have done to lower the petting zoo risks. The family's attorney says the fair is just as responsible as Ag-Venture.

"The testing (of the animals) should be done by the petting zoos themselves, AgVenture, and it should be required by fair owners or agricultural fairs before they allow these vendors on their property," said attorney Jeffrey Miller. At the very least, he says, the Central Florida Fair should have warned of the danger and had better hand washing available.

"There were no warning signs they saw that advised them that their children could end up in ICU at the hospital simply by going to a petting zoo," said Miller.

As families begin flocking to petting zoos, fairs, and other animal venues this spring, a few people are coming down with serious illnesses. Some of the latest incidents occurred in Florida, where 60 people in 18 counties have confirmed or suspected cases of E. coli-related illness. The sources for the illnesses were petting zoos in three central Florida counties.

Many venues where people come in contact with animals can pose a risk, says the CDC, including county and state fairs, petting zoos, circuses, carnivals, zoos, farm tours, pet stores, animal swap meets, livestock-birthing exhibits, wildlife exhibits, and schools. Diseases other than those caused by certain types of E. coli may also pose a threat, including rabies, tuberculosis, salmonella, ringworm, cryptosporidiosis, and monkeypox.
In addition, physical injuries such as bites, scratches, stepped-on feet, or broken bones are of concern.

Affected animals often show no obvious signs of illness, and testing or antibiotic treatment of animals is of limited value, which makes it nearly impossible for visitors to see if an animal they are playing with is infected.

A list of about two dozen documented incidents in the past decade or so (in IL, MN, OH, NC, NY, OH, OR, PA, TX, WA, WI, the Canadian provinces of British Columbia and Ontario, and a few overseas locations) has been assembled by Seattle law firm Marler Clark. Some of these incidents, which affected a total of more than 1,000 people, are highlighted in a CDC report.

Remedies that can sharply reduce problems are relatively simple, the CDC explains, including:

• hand washing after touching or visiting animals;
• designing, maintaining, and operating animal exhibits carefully to minimize exposures, including full separation of animal areas from any area where people eat or come in contact with human food;
• educating operators, staff, exhibitors, and visitors about risks and appropriate protective measures;
• paying strict attention to those at most risk, including children, the elderly, and those with weakened immune systems; and
• properly cleaning animal areas, especially since harmful microbes have been proven to linger afterward for months.

Due to the E. coli outbreak that caused kidney disease in several people who had played with animals in petting zoos at three fairs in Florida, a children's zoo in Cedar Rapids is taking steps to protect children from similar illnessses.

Backers of the zoo at Bever Park say it's not a petting zoo. But just in case children touch the animals, a hand-sanitizing station has been donated so children and parents can practice good hygiene.

The station, located at a new barn, was donated as part of a 535-thousand project to update the zoo by the Junior League of Cedar Rapids.

In a Special to the Washington Post, E. Fuller Torrey and Robert H. Yolken point out that human infection via bacterial and viral transmission from animals have been around for a long time and does not discriminate. In Angola, about 150 people have died from the largest outbreak of Marburg hemorrhagic virus, also known as green-monkey disease because of its source. There are also international cases of AIDS (which comes from nonhuman primates), Lyme disease (from deer), West Nile virus (spread by birds) and SARS (apparently transmitted by civet cats), and bird flu. In the US, Florida recently had an outbreak of E.coli O157:H7 due to animals in petting zoos.

Experts estimate that at least three-quarters of all infectious diseases originally came from animals, and last year Julie L. Gerberding, director of the Centers for Disease Control and Prevention, noted that "11 of the last 12 emerging infectious diseases that we're aware of in the world, that have had human health consequences, have probably arisen from animal sources."

More than 12,000 years ago, when humans lived in small groups as hunters and gatherers, they were afflicted with relatively few infectious diseases. Early humans acquired a few other infectious diseases, such as anthrax from wild sheep and tularemia from rabbits, as they butchered and ate their kill.

Most diseases come originally from animals, including yellow fever, plague, tuberculosis, measles, typhoid fever, influenza, smallpox and leprosy. At a time when fewer and fewer people engage in agricultural work, more and more people are coming into contact with animal diseases, either through house pets, petting zoos, takeout food or the congested nature of modern life, which allows diseases to spread quickly.

Other human diseases suspected of being the consequence animals include whooping cough from pigs, glanders from horses, typhoid fever from chickens and influenza from ducks. Although the flu virus has existed in water birds for millions of years, when it infects pigs or other mammals it is modified. The modified viruses, if spread to humans, can cause deadly pandemics such as the 1918 influenza outbreak, which killed more than 20 million people worldwide. The current farming system in Southeast Asia, in which ducks, pigs, chickens and humans live, is ideal for fostering such deadly viral strains.

There are estimated to be about 5,000 different species of viruses and up to 1 million species of bacteria, the vast majority of which have not been identified. They presumably infect all of the known 4,500 species of mammals, of which humans are only one.

The most important thing we can do is to educate ourselves about animal pathogens. The continuing transmission of infectious agents from animals to humans, as well as the possibilities of epidemics, are inevitable. Only by educating ourselves, modifying our behavior and using available resources intelligently can we hope to reduce the incidence and severity of such epidemics.

Although the Ag-Venture animals had been certified as healthy by a veterinarian within 30 days of visiting three Central Florida fairs, as required by law, the specific E. coli 0157:H7 strain that have sickened at least 26 visitors to petting zoos in Orlando, Plant City and Tampa was found in six animals from the petting zoo, said state Agriculture Commissioner Charles Bronson.

Many of the people sickened with E. coli infection have gone on to develop hemolytic uremia syndrome (HUS), a life-threatening kidney ailment. Eight of the 26 confirmed victims remain hospitalized, most of them children.

All 37 of the company's animals have been quarantined and are permanently barred from further contact with the public, the Tampa Tribune reports.

Green Meadows Petting Farm has pigs, cows, goats and sheep, in addition to a water buffalo, bison, ostriches and llamas. They also have hay rides, train rides and pony rides - all things that children love to interact with. However, the recent outbreak of E. coli 0157:H7 and hemolytic uremic syndrome in Central Florida has caused business to drop off "tremendously" at Green Meadows.. Typically, they would be welcoming about 150 customers per day. But lately they have been averaging about 50, due to bad publicity from the outbreak.

"All the schools seem to be canceling," Petting Farm manager Linda Langford said. "The school boards are getting involved. Their lawyers are warning them not to go. We have a beautiful place. It's a shame that people are not allowed to come and enjoy it." Langford said she heard from Orange and Seminole county school officials that their lawyers have advised them not to send students to facilities that contain farm animals.

Another company, Phillips Petting Zoos of East Prairie, MO, provided the animals for the Osceola County Fair at Osceola Heritage Park, as part of the Kissimmee Valley Livestock Show. Randy Bateman, livestock extension agent for Osceola County and vice president of KVLS, said:

"We feel like we made a concerted effort to offer a safe environment and we have an ongoing educational program to inform the public about safety practices that need to be followed when visiting the fair."

"Individual families and consumers must make decisions as to whether to attend or not attend," said Dr. John O. Agwunobi, secretary of the Florida Department of Health.. "I'm a parent of three children myself. Every day I look at the risks and make decisions about what's right for my children. My goal is to protect them while exposing them to the wonders of the world. Animals carry diseases. There are precautions that need to be taken as a result."

The Associated Press reports that epidemiologists have matched DNA from E. coli bacteria in six animals -- two goats, two sheep and two cows -- to the DNA in the bacteria contracted by the victims of a recent Central Florida outbreak, thereby definitively linking the outbreak to animals from petting zoos at three fairs.

The six animals were all from the same company, Ag-Venture Farm Shows, which had provided the animals for the petting zoos. Florida Agriculture Commissioner Charles Bronson said Ag-Venture had cooperated fully with the investigation and was voluntarily quarantining the animals permanently. Officials said the farm company hadn't broken any laws and no charges would be filed.

Florida Health Secretary John Agwunobi emphasized that there wasn't any indication that animals at any other petting zoos were carrying the particular strain of E. coli linked to this outbreak.

Twenty-six people were confirmed infected with the E. coli infection, including 23 children, after contracting the bacteria at either the Central Florida Fair in Orlando, the Strawberry Festival in Plant City or the Florida State Fair in Tampa in February and March. More than 20 people were hospitalized.

At this weekend's Lake County Fair, a scheduled petting zoo will be replaced by racing pigs, Local 6 News reports. AgVenture Farm Shows, the petting zoo who was supposed to be providing the animals, is currently under fire as the likely source of an outbreak that has sickened dozens of people throughout Central Florida.

The infections and resulting kidney failure have been linked to petting zoos run by the Plant City-based company at the Central Florida Fair, Tampa's Florida State Fair and the Florida Strawberry Festival in Plant City.

"The whole fair industry just feels for all of the families who are going through this," Fair manager C.E. "Happy" Norris said, who expects tens of thousands of people to attend this year's event. Even without the petting zoo, the Lake County Fair has decided to add four new hand sanitizers since the outbreak. There will also be new signs reminding people to wash their hands while at the fair.

Dr. Bharat Sangani, MD, is a Doctor of Cardiology Disease and Internal Medicine with practices along the Mississippi Gulf Coast who also writes a health column for The Sun Herald. He answered a few questions about travel safety in relation to food and drink, especially a condition known as "traveler's diarrhea":

In the past few months the cruise industry has suffered a lot due to frequent outbreaks. Ten to 50 percent of travelers may develop diarrhea. It is the most common illness of travelers. Men and women are at equal risk for developing travelers' diarrhea. Younger people are at a higher risk. Travelers at risk for diarrhea come from industrialized nations and travel to high-risk areas that are within less industrialized nations of the world, such as Latin America, Africa, Middle East and Asia. Lesser risk areas include China and Caribbean nations.

What causes travelers' diarrhea?
Travelers' diarrhea is contracted by ingestion of contaminated food or water. The single most bacteria causing this problem is E. Coli, which is estimated to cause up to 70 percent of all cases. Travelers' diarrhea does not vary from location to location and with the season of the year. Spices in food and changes in the climate do not cause this.

What are the symptoms of travelers' diarrhea?
Most commonly diarrhea occurs 4 to 14 days after arrival but can occur within a shorter time if the bacteria ingested is high. The patient may pass on average up to 5 loose bowel movements per day and cramping may occur. Nausea, vomiting, fatigue may occur also.

What is the treatment for travelers' diarrhea?
The goal is to prevent dehydration, so fluid replacement is essential. Antibiotics and anti-motility agents may be required. Most cases resolve on their own within 3 to 5 days of treatment with fluid replacement. Antibiotics will shorten the disease duration and anti-motility drugs may decrease the symptoms.

When should someone seek medical attention?
The person with fever, blood in stool, and vomiting should seek treatment. These patients may require fluid in the vein and medications in the vein to relieve the symptoms and treat the dehydration.

How is travelers' diarrhea prevented?
Food is the major source of infection. Foods should be well-cooked and served warm. Avoid raw vegetables, uncooked meat or seafood. Avoid foods maintained at room temperature. Other high-risk foods include dairy products, tap water and ice. Safe foods include carbonated beverages, beer, wine, hot coffee, tea, fruits that can be peeled, and canned products.

The Florida petting zoo E. coli outbreaks brings back memories for Andrea Bourget. Although she has no proof and no other infections were reported locally, Bourget suspects that her son, Matthew, who was 15 months old at the time, had contracted the bacteria from a local petting zoo. Matthew spent six weeks in the hospital, and luckily did not develop hemolytic uremic syndrome, which comes from exposure to E. coli O157:H7.

Kelly Docherty's daughter Averey suffered from HUS in 2001 from exposure to red meat rather than a petting zoo. The experience for me was absolutely life altering, Docherty says. During Averey's nearly five-week hospital stay she experienced renal failure, dialysis, blood transfusions, her bowels shutting down, and a fungal infection in her kidneys. She also required painful bloodwork for weeks after her release.

Although Averey, now 5, has a good bill of health, she still suffers from bowel problems and must be closely monitored during periods of change in the kidneys -- puberty, pregnancy and menopause.

Dr. Julian Midgley, who specializes in kidney disease at Calgary's Alberta Children's Hospital, says that in the 10 years he's been at the hospital he's seen an average of 10 cases of HUS in a year, with only one death. He cautions:

"Clearly, very small children who can't stop putting things in their mouth shouldn't be petting animals. Older children need to make sure they wash their hands and are careful for what they touch."

Manatee County may be adding their name to the list of Florida counties with victims of an E. coli outbreak due to petting zoos at central Florida fairs.

The Manatee County Health Department learned of one suspected case Thursday and two more Friday, spokesman John Burns said. A child and two adults suffered mild to severe or bloody diarrhea after visiting one of the events. He declined to release other details about the patients or their conditions, citing confidentiality laws.

The bacteria, known as E. coli 0157:H7, usually causes diarrhea and abdominal cramps that lasts for five to 10 days. In some cases, especially in children under age 5 and the elderly, it can destroy red blood cells and cause hemolytic uremic syndrome, a potentially fatal kidney condition.

Of the confirmed cases, Orange County has the most at 13, followed by six in Volusia County, state health officials said. There also have been two confirmed cases in Pasco County and one each in Charlotte, Collier and Seminole counties. The 40 suspected cases are spread over 16 counties, including six in Charlotte, four in Pinellas, three in Hillsborough, two in Hardee and one each in DeSoto and Sarasota. They are in 25 children and 15 adults.

With recent E. coli outbreaks nationwide, consumers are become more and more aware that the bacteria can reside in food products other than ground meats. Fruits and vegetables are also at risk - and the University of Minnesota wants to make sure that consumers are informed as to how to properly clean fruits and vegetables:

• Before working with any foods, wash hands with soap and water. Also, make sure preparation areas are sanitary.

• Under clean, running water, rub fruits and vegetables briskly with your hands to remove dirt and surface microorganisms.

• Wash produce just before serving - not before storing, as washing will cause produce to spoil faster.

• Produce with a firm skin or hard rind like carrots, potatoes, melons or squash may be scrubbed with a vegetable brush and water.

• Discard the outer leaves of leafy vegetables such as lettuce and cabbage before washing.

• Always wash squash and melons, even if you don't eat the rind or skin because when cut, dirt or bacteria that is on the outer surface can be transferred to the inner flesh.

• DO NOT wash produce with detergent or bleach solutions. Fruits and vegetables are porous and can absorb the detergent or bleach, which is not intended for use on foods and consuming them on fruits and vegetables have the potential to make you sick.

There are "produce wash" products on the market today, but studies show that washing produce in tap or distilled water is just as effective. In fact, those "produce washes" that recommend soaking produce can actually be harmful, since the water can either add contaminants or remove nutrients from the produce. On the other hand, vinegar and lemon juice, both weak organic acids, have proven to be rather effective anti-microbial and anti-browning agents, especially when combined with water rinsing and agitation.

Cold tempurature storage is also helpful in combating bacterial populations on produce. Salmonella does not grow at 10F, listeria stops growing at 4F, and E. coli O157:H7 stops at 5F.

There are now 24 confirmed cases of E.coli infection and 40 suspected cases statewide in Florida, according to the St. Petersburg Times. Most of those who were infected live in Orange County in central Florida, and that's where three lawsuits have been filed.

Our lawsuits allege AgVenture Farm Shows of Plant City, Florida, should have done a better job protecting visitors from the bacteria and merely cautioning them to wash their hands was not enough.

The reality is, trying to keep their hands washed constantly, not just wiping them down with a handy wipe -- it's a very difficult task.

The following is some basic information on E. coli, as well as helpful tips on how to avoid E. coli infection, provided by the US Department of Agriculture:

What is Escherichia coli O157:H7?
E. coli O157:H7 is one of hundreds of strains of the bacterium Escherichia coli. Although most strains are harmless and live in the intestines of healthy humans and animals, this strain produces a powerful toxin and can cause severe illness. E. coli O157:H7 was first recognized as a cause of illness in 1982 during an outbreak of severe bloody diarrhea; the outbreak was traced to contaminated hamburgers.

How is E. coli O157:H7 spread?
The organism can be found on a small number of cattle farms and can live in the intestines of healthy cattle. Meat can become contaminated during slaughter, and organisms can be thoroughly mixed into beef when it is ground. Bacteria present on the cow's udders or on equipment may get into raw milk. Eating meat, especially ground beef, that has not been cooked sufficiently to kill E. coli O157:H7 can cause infection. Contaminated meat looks and smells normal. Although the number of organisms required to cause disease is not known, it is suspected to be very small.

What illness does E. coli O157:H7 cause?
E. coli O157:H7 infection often causes severe bloody diarrhea and abdominal cramps. Little or no fever is present, and the illness resolves in 5 to 10 days. In some persons, particularly children under 5 years of age and the elderly, the infection can also cause a complication called hemolytic uremic syndrome, in which the red blood cells are destroyed and the kidneys fail. About 2%-7% of infections lead to this complication. In the United States, hemolytic uremic syndrome is the principal cause of acute kidney failure in children.

How is E. coli O157:H7 infection diagnosed?
Infection with E. coli O157:H7 is diagnosed by detecting the bacterium in the stool. Most labs that culture stool do not test for E. coli O157:H7, so it is important to request that the stool specimen be tested on sorbitol-MacConkey (SMAC) agar for this organism.

How is the illness treated?
Most persons recover without antibiotics or other specific treatment in 5-10 days. There is no evidence that antibiotics improve the course of disease, and it is thought that treatment with some antibiotics may precipitate kidney complications. Antidiarrheal agents, such as loperamide (Imodium), should also be avoided. Hemolytic uremic syndrome is a life-threatening condition usually treated in an intensive care unit. Blood transfusions and kidney dialysis are often required. With intensive care, the death rate for hemolytic uremic syndrome is 3%-5%.

What are the long-term consequences of infection?
Persons who only have diarrhea usually recover completely. About one-third of persons with hemolytic uremic syndrome have abnormal kidney function many years later, and a few require long-term dialysis. Another 8% of persons with hemolytic uremic syndrome have other lifelong complications, such as high blood pressure, seizures, blindness, paralysis, and the effects of having part of their bowel removed.

What can be done to prevent the infection?
E. coli O157:H7 will continue to be an important public health concern as long as it contaminates meat. Preventive measures may reduce the number of cattle that carry it and the contamination of meat during slaughter and grinding. Research into such prevention measures is just beginning.

What can you do to prevent E. coli O157:H7 infection?
Cook all ground beef and hamburger thoroughly. Because ground beef can turn brown before disease-causing bacteria are killed, use a digital instant-read meat thermometer to ensure thorough cooking. Ground beef should be cooked until a thermometer inserted into several parts of the patty, including the thickest part, reads at least 160F. Persons who cook ground beef without using a thermometer can decrease their risk of illness by not eating ground beef patties that are still pink in the middle. If you are served an undercooked hamburger or other ground beef product in a restaurant, send it back for further cooking. You may want to ask for a new bun and a clean plate, too.

While over 22 people suffer the effects of E. coli infection due to recent petting zoo visits in Florida, more than a few people are still willing to play with farm animals at recent local events.

Duck Duck Goose Petting Zoo of Bushnell, the company who provided the animals for the Park's petting zoo, is happy that the children are having a good time. The owner, Lynda Lewis, is also grateful that Mount Dora and Lake Eustis Railway, who are sponsoring the event at Wooton Park, has hired her.

The recent E. coli outbreaks have been linked to petting zoos at three separate fairs in Florida, who had all hired AgVenture Farm Tours for their animals. The outbreak has caused cancellations throughout the state for petting zoo owners. Other fairs are cancelling petting zoos altogether, or opting for events with animals that do not involve human contact.

She doesn't know what the long-term effect might be on her 10-year-old business. Duck Duck Goose Petting Zoo has always offered a cleanup area and sanitizer, and their animals are inspected annually by the U.S. Department of Agriculture.

"They get a bath every morning before an event," she said. "We've never had any problems. We have sanitizers, hand wipes -- we always have. And there are bathrooms nearby."

The spread of the illness was surprising to her, she said. "I never even heard of HUS until last week," she said. "And I never heard of an illness spreading like this."

Dr Heather Allison, from the a University of Liverpool's School of Biological Sciences, has discovered how the food poisoning bug E.Coli 0157 became deadly to humans.

Allison's team has determined that twenty-three years ago, a harmless gut bacterium called E. coli developed the ability to kill people through food poisoning, bloody diarrhea and kidney failure by becoming infected with a virus. The virus can infect E. coli by recognizing a newly identified but common receptor on the surface of E. coli cells which allows the viruses to gain entry into the bacteria. Once inside, the virus gives new genetic material to the bacterium, providing it with the ability to produce Shiga toxin.

She explains: "Sometime before 1982, an unknown virus that attacks bacteria passed on a part of genetic coding to E. coli that allows some strains to make Shiga toxin. This lethal poison causes the notorious food-borne infection that results in bloody diarrhoea and sometimes kidney failure in people."

Dr Allison suggests that to reduce E. coli infection to avoid undercooked beef and any other food in general that have come into contact with livestock feces and have not been cooked or properly washed. In addition, untreated water (which might be contaminated with livestock feces) should be avoided, and any cooked food that may have come into contact with contaminated, uncooked meat products.

People attending fairs all across the country look forward to happy memories of carnival rides and cute farm animals. They don't think about sanitation nor the possibility of E. coli infection - which happens at fairs more often than people tend to think.

One of the country's first large fair outbreaks came in the fall of 2000, when E. coli at a suburban Philadelphia petting farm infected 16 children. Health officials suspected an additional 45 probable cases. Outbreaks at county fairs in Ohio and Wisconsin sickened 84 in the summer of 2001. In August 2002, 82 people, mostly children, fell ill after attending a county fair in Oregon, and 108 people got sick after visiting the North Carolina state fair's petting zoos last fall.

The outbreaks are blamed on the bacterium E. coli O157:H7, which typically causes bloody diarrhea. The Centers for Disease Control and Prevention says that this strain of E. coli is responsible for an average of 73,000 cases of infection and 61 deaths in the United States each year. And now, the bacteria have shown up in fairs in Florida - namely the Central Florida Fair in Orlando, the Florida Strawberry Festival in Plant City and the Florida State Fair in Tampa.

At least 22 people, almost all children, fell seriously ill after visiting one of the three fairs in Florida in the past two months. State health officials are investigating 35 more cases. Victims may have had different things to eat and drink, but almost all of them touched the chicks, sheep, goats and calves in the petting zoos, which officials are convinced is the source of the bacteria. About eight per cent of people infected with E. coli O157:H7 are later stricken with the potentially fatal kidney disease known as hemolytic uremic syndrome, or HUS.

People who visit petting zoos must take safety into their own hands - literally. What often happens is that a toddler will pet a sheep or goat, then stick his fingers in his mouth, as children often do. Livestock on farms and at fairs are not regularly tested for E. coli O157:H7 because inspectors are looking only for illnesses that could harm the animals themselves. Infection with the bacteria is not uncommon among livestock, and an animal with E. coli O157:H7 shows no symptoms and does not get sick.

If officials confirm the outbreak began in the zoos, where animals' feces can carry the potentially lethal bacteria, this would be the latest episode in what appears to be a growing threat to public health.

"It's seems to be an increasing phenomenon," said Jeff Bender, an assistant professor of veterinary public health at the University of Minnesota. "As a result, we need to get some recommendations or guidelines out there. The single most important thing in prevention is handwashing," Bender said. He added that only handwashing with soap and water or a sanitizing gel will work.

The Florida State Fair, which ran Feb. 10-21, attracted more than 500,000 visitors. Florida Health Secretary John Agwunobi has now added that fair to the list of fairs that hired a Plant City-based petting zoo company that is the likely source of a bacterial outbreak that has sickened fairgoers across the state. The Strawberry Festival in Plant City and the Central Florida Fair in Orlando are the other two.

The only factor linking the five is that AgVenture Farm Shows provided animals for the petting zoos at fairs that they attended.

"They got it from the same place," Agwunobi said. "We have a very strong suspicion there is an association with this petting zoo."

"We have taken steps to make sure this particular petting zoo is of no further risk," he said. "There will be no further interaction (with the public) as a result of our work with them."

Agwunobi also raised a new concern, saying the suspected cases indicate the bacteria can be spread through human contact. It could be as simple as changing a diaper of a child who had diarrhea, said Agwunobi, himself a father of three young children.

He stressed that "frequent and diligent" hand washing can reduce the chance of infection.

"There are lessons we will learn," he said. "I am of the belief that if you are taking your child to a petting zoo or farm, a very important part of the planning process must contain strict hand washing. Take very serious steps to ensure children aren't putting their hands in their mouths or on their food. Wash their hands vigorously. I know it sounds simple, but at this point, it's what science advises we do."

Florida health officials reported last week that over 20 people there who visited agricultural fairs with petting zoos have developed a kidney condition called hemolytic uremic syndrome, or HUS -- is a rare complication arising from an initial infection most commonly associated with a strain of E. coli known as E. coli O157:H7. E. coli is a bacterium found in undercooked beef and contaminated food. It can live in the guts of cattle, sheep, goats and other ruminants and can be picked up by petting, nuzzling or feeding the animals. The recent Florida outbreak has been linked to petting zoos at local fairs.

Many family members who are braving visits to petting zoos this spring are arming themselves with sanitizing wipes and making doubly sure that they as well as their children are practicing good hygiene. Local petting zoos are also implementing changes to make it easier for visitors to stay healthy.

Last year in Virginia, 40 cases of E. coli O157:H7 were reported, but none could be linked to petting zoos, health officials said.

In response to the scare in Florida, The Maymont Foundation has installed a dispenser of hand sanitizer at the feed machines around their Children's Farm and put up signs reminding visitors to wash their hands after feeding and petting the animals. Traveling petting zoos, like Laughing Place in Chesterfield County, follow similar guidelines, and pass out hand sanitizers at birthday parties and other special events.

Dr. Carl Armstrong, director of the office of epidemiology for the Virginia Department of Health, agrees with Wyatt.

"There are lots of different forms of E. coli out there. We as human beings carry it," he said. "And there are a number of different kinds of pathogenic E. coli that can cause disease. That's what we are concerned about. But illness is easily prevented by good hygiene." The most important thing, Armstrong said, is to wash hands often, especially before eating.

State health officials have now determined that's the number of possible cases of E. coli infection or the related kidney disease, hemoleytic uremic syndrome (HUS), has jumped from 24 to 33, with several new cases being linked to a third Florida fair.

John Agwunobi, Florida Health Secretary, said Thursday that the additional cases appear to have come from the Florida State Fair in Tampa in mid-February. He also said it looks more and more like all the cases are linked to the same petting zoo - AgVenture Farm Shows.

Patients all started with diarrhea and progressively got worse. Conditions can get worse, turning into HUS, a disease that attacks and can destroy the kidneys.

Health officials have not confirmed whether petting zoo animals or a food vendor caused the outbreak, but they said they are leaning more towards the petting zoo as the source of the problem. Although the state Department of Agriculture has said AgVenture's animals might not be the source of the outbreak, and has not ruled out the possibility that the bacteria could also come from the company's equipment or hay.

Meanwhile, families have started to file lawsuits against the petting zoo for failing to maintain sanitary conditions.

Health officials said only those who attended the Central Florida Fair and Strawberry Festival are sick, but petting zoos across Central Florida continue to lose business. The Flagler County Fair has cancelled its petting zoo for next week, and the livestock area of the Brevard Sheriff's Petting Zoo is also closed. At the Lake County Fair, which opens next week, organizers said they will feature a pig-racing event rather than the traditional petting zoo so that fairgoers will not have direct contact with the animals.

Some animal farms, like Barnyard Friends Animal Farm in Samsula, are closing their doors for good. Owner Donna Sue Sanders is shutting Barnyard down after schools and private parties canceled trips to her farm for fear of E. coli, despite the fact that animals at the animal farm are not linked to the E. coli outbreak. Some of the animals at Barnyard will be sold and Mason fears when that happens, she will lose the job she loves.