Suspected cases of E. coli infection have tripled since last week, as N.C. health officials narrowed their search for the source of bacteria to last month’s State Fair.
Health officials are now investigating 112 cases of possible E. coli infection, with 35 cases confirmed so far. Of the 35, 32 visited the Raleigh fair, which ran from Oct. 15-24, and half are children under age 5.
“We’re investigating all areas where people have contact with animals,” including the fair’s two petting zoos and other livestock exhibits, state epidemiologist Dr. Jeffrey Engel said Monday at a Raleigh news conference. “But there are other avenues of infection from E. coli. Contaminated food is also under investigation.”
If the N.C. outbreak turns out to be related to petting zoos or fairs, it will be one in a string of such outbreaks from Oregon and Washington to Ohio and Pennsylvania since 1998.
After the Pennsylvania outbreak in 2000, when about 50 people got sick after visiting a dairy farm, the U.S. Centers for Disease Control and Prevention issued guidelines for fairs and petting zoos to post signs warning of the risk and to make handwashing stations available.
But families, health officials and a lawyer familiar with those events say the public has not been adequately informed.
“This is not new, and people are not learning from the mistakes of other people that run these fair venues,” said Kevin Closson of Portland, Ore. His 3-year-old daughter was hospitalized for 16 days and nearly died of kidney failure after visiting the petting zoo at a county fair in August 2002.
About 75 people got sick in that outbreak, and health officials eventually said the bacteria may have been airborne, in dust. For that reason, Closson said the CDC’s advice about handwashing would not have helped. “The building was rife with E. coli. Tell me what washing your hands is going to do,” he said.
North Carolina’s Engel said public health officials need to do a better job of telling people how to prevent E. coli infection. “It’s going to be our job in public health to educate people,” he said. “… Should we ban petting zoos? I don’t think so … But people may decide they want to keep their younger kids out of these things.”
Engel said he thinks the outbreak has peaked, “based on what we know about incubation periods.” Those who would have gotten sick from an E. coli exposure at the State Fair would already be sick, he said. “If you don’t have it now, you’re not going to get it.”
One fair-related victim is a 21-month-old Mecklenburg County girl, who is recovering. Of the other confirmed victims, 17 are from Wake County, three from Chatham and Durham counties, two from Orange and Wilson counties, one each from Forsyth, Harnett, Johnston, Lee, Moore, Person and Union counties.
Several children have been hospitalized with hemolytic uremic syndrome, a serious complication that can cause kidney failure, seizures and death. All appear to be recovering, Engel said.
William Marler, a Seattle lawyer who represented Closson and other families affected by the Oregon outbreak and who has filed some of the nation’s biggest food safety lawsuits, said most people do not realize the danger, especially for children.
“We the public have not kept up with the virulence of E. coli O157:h7 … If you talk to every one of the parents from the Oregon case, they had no idea that this could happen,” Marler said.
“When I used to take animals to the county fair, when I was a kid, no one ever heard of E. coli.”
The strain of E. coli making people sick, called O157:h7, was first identified in 1982 in Oregon and is best known from the 1992 Jack in the Box hamburger outbreak in Washington state.
E. coli is usually spread through undercooked meat contaminated with animal feces or in contaminated water. But it can be spread by contact with animals. E. coli sickens 73,000 Americans each year, killing about 60, according to the CDC.
Britt Cobb, commissioner of the N.C. Department of Agriculture, said signs, in English and Spanish, were posted in State Fair petting zoos and livestock buildings advising visitors to wash their hands after contact with animals. Restrooms in the buildings had hot water and soap, he said. The zoos, run by Commerford & Sons of Goshen, Conn., and Crossroads Farms of Bear Creek, had stations with hand sanitizing products, but not soap and water.
Dr. Chobi DebRoy, director of the Gastroenteric Disease Center at Penn State University, said antibacterial handwashing products are not as good as washing with soap and water.
Testing animals before they’re exhibited to make sure they don’t carry E. coli bacteria would be “pretty useless,” said Dr. David Marshall, state veterinarian. He said cows, goats and sheep sometimes shed the bacteria sporadically, and it doesn’t make them ill.
“If you went and tested an animal and found it to be negative, you really haven’t proven that it didn’t have it,” he said.
As a dairy farmer in the 1980s, Marshall said, he “spent a large portion of my time covered in cow manure” without getting sick. “I always made sure I washed my hands before I ate.”
He said there’s some belief that farmers and people who live in rural areas can develop immunity to the bacteria not shared by urban dwellers.
“Certainly, we want to prevent or minimize any future incidents, but where do you balance it without legislating … agriculture right out of the fair?” he said. “I think it’s way too early to speculate as to what measures, if any, the department will take.”