The Associated Press reports that North Carolina has confirmed more cases of infection with the E. coli bacteria, raising the total to 24 victims and 14 suspected cases Thursday.
Health officials are awaiting genetic tests on some of the bacteria to see whether the cases are related. So far, the most common link among victims is that some visited the State Fair last month.
Of the 38 cases being examined, at least 15 have some link to the State Fair and one person attended the Cleveland County fair. Seven people did not go to the fair, and investigators are awaiting information from others.
“If it does turn out to be a petting zoo, there are thousands of people who were exposed, and they are widespread,” said Dr. Jeffrey Engel, state epidemiologist. “People came to visit from other states.”

The highly contagious E. coli bacterium commonly lives inside of animals and can be passed to humans by eating contaminated meat or through contact with manure, animals or contaminated surfaces.
“Ten percent of farm animals will be harboring e. coli in their intestine at any one time,” Engel said.
There’s been no attempt to quarantine or otherwise confine the animals that were on display at the fair, which had seven or eight animal attractions including two petting zoos and a pony ride. Each included numerous hand-washing stations.
The problem was not the presence of animals, but the difficulty of quickly and thoroughly cleaning children who might have come in contact with e. coli – or any germ, Engel said.
Half the cases under investigation involve children younger than five, who are more susceptible to infection, as well as to complications of that infection.
“We’re dealing with toddlers that fall face-first into animal poop or whatever,” he said. “They touch things and their hand goes into their mouth and it’s impossible to make sure they stay clean.”
Engel said Thursday that three or four victims have developed a severe complication known as hemolytic-uremic syndrome, in which the number of blood platelets suddenly drops, red blood cells are destroyed and the kidneys shut down. The syndrome can be life-threatening or cause permanent kidney damage.
He did not know how many were still hospitalized Thursday.
Once the germ is contracted, there’s no way to stop the illness, “and that’s been frustrating, because we can’t tell people who’ve been to the fair and are concerned to do anything,” Engel said.
But he noted the incubation period would now be over for anyone who attended the fair, “so we’re hoping we’ve seen the worst of it.”
State officials have sent the affected families a 14-page survey, asking where the victims had been, what they ate and with whom they came in contact in the days before becoming sick.
The outbreak is North Carolina’s largest E. coli infection since 2001, when schoolchildren in Robeson County were offered unpasteurized butter during a demonstration. More than 200 became sick.
Ordinarily, North Carolina sees about four or five cases of e. coli infection per month.
“They’re sporadic – one here, two there, with no connection,” Engel said. “Some have a connection to farm animals or wild animals, since deer can carry it, but generally it’s not related to large public gatherings.”