In October 2004, the North Carolina Division of Public Health received reports of people with hemolytic uremic syndrome amongst residents. All had attended the North Carolina State Fair.

Investigators obtained information about animals exhibited at the fair, areas where persons could have had direct contact with animals, and the layout of animals and pens in each of the animal areas, with specific attention paid to livestock exhibits and petting zoos.

Although some samples taken from other areas of the Fair tested positive for E. coli O157:H7, most of the outbreak illnesses stemmed from animal exposure at Crossroads Farm Petting Zoo. In addition to allowing visitors to walk amongst the animals, there was a high number of animals and people in the petting zoo area at all times, which caused stress-related diarrheal symptoms in the animals.

The final report issued recommended preventative measures to minimize contamination between animals and humans, including:

• prohibiting or discouraging direct contact with farm animals

• providing direct supervision at the exhibits

• removing contaminated bedding promptly and often

• having proper hand-washing facilities for use by petting zoo visitors