I wrote this one year ago today:
Here we go again.
Last Friday the Division of Public Health of the N.C. Department of Health and Human Services in collaboration with Local Health Departments is investigating an outbreak of E. coli infection in 101 people who attended the Cleveland County Fair. Preliminary findings suggest animal exposure may be the source of this outbreak. As of 1 p.m. Friday, 62 children and 39 adults are known to be/have been affected by this outbreak. Thirteen individuals have been or are currently hospitalized. One child died.
Now Cowlitz County Health and Human Services is investigating one confirmed case and one probable case (laboratory confirmation pending) of illness caused by E. coli O157:H7 bacteria in children that visited the Willow Grove Gardens Pumpkin Patch and petting zoo. The two children became ill after visiting the farm earlier this month. One of the children was hospitalized for several days but is now recovering.
As I have said before – is it time to ban petting zoos?
I can hear the wailing and gnashing of teeth over such an un-American suggestion.
The North Carolina Department of Health and Human Services announced last week that a two-year-old boy who became ill with an E. coli infection after attending the Cleveland County Fair had died. So far 101 people who attended the fair—mostly children—have gotten sick with E. coli O157:H7 infections. Over a dozen are still hospitalized. Attendance at the fair is the common link among E. coli cases.
This is not the first, or even the second, time an E. coli outbreak has been traced to a North Carolina fair. The coming months will likely bring the announcement that public health agencies are joining forces to learn from the Cleveland County Fair E. coli outbreak and prevent future outbreaks from happening.
In 2004, 187 people who attended the North Carolina State Fair became ill with E. coli infections; 15 with hemolytic uremic syndrome (HUS), a complication of E. coli infection that can lead to kidney failure, central nervous system impairment, and death. In response to the E. coli outbreak, Duke University’s Terry Sanford Institute of Public Policy issued an analysis report regarding government regulation of petting zoos. The authors stated:
In response to the largest outbreak of Escherichia coli (E. coli) in North Carolina history, we recommend that the North Carolina Department of Health and Human Services (DHHS) issue guidelines and pursue legislation that will control public contact with animals, inform the public of risks related to animal contact, provide transition areas, regulate animal care, and license petting zoos.
In 2005, North Carolina adopted new legislation on petting zoo sanitation. The bill, called “Aieden’s Law,” was named after a boy who suffered a severe, life-threatening case of HUS. It stipulated that petting zoos must obtain a permit following a physical inspection in order to operate in the state.
Last year, at least 25 cases of E. coli infection were traced to the N.C. State Fair. The only exposure associated with illness was having visited one of the permanent structures in which sheep, goats, and pigs were housed for livestock competitions.
In response to the 2011 N.C. State Fair E. coli outbreak, the North Carolina Department of Health and Human Services and the Centers for Disease Control and Prevention (CDC) created a multiagency task force in North Carolina “to evaluate the preventive measures that were in place during the 2011 state fair and to identify additional interventions that could be applied to prevent disease transmission in livestock exhibitions where physical contact with the public might occur.” The recommendations were released on July 23, 2012, with plenty of time for Cleveland County Fair operators to take note and implement similar interventions.
I am sure there will be yet another task force following the Cleveland County Fair outbreak. But at what point will North Carolina health officials decide that preventing E. coli outbreaks at their fairs and petting zoos is better for public health than responding to them?
In 2009, the CDC and a collection of state veterinarians issued an update to what were already stern guidelines for preventing illness associated with animal exhibits and petting zoos, including:
– Wash hands after contact with animals to reduce the risk of zoonotic disease transmission.
– Do not allow food, drink, or pacifiers in animal areas.
– Include transition areas between animal areas and non-animal areas.
– Educate visitors about disease risk and prevention procedures.
– Properly care for and manage animals.
But, if history is any guide, guidelines are not working very well. The bottom line is that what fairs and petting zoos are doing – or not doing – is not working.
Perhaps blaming the victims for not washing their hands is wearing thin. Perhaps, animals should be vaccinated to reduce how much pathogenic E. coli that they carry. Perhaps, animals could be tested before they arrive at the fair and excluded if they are shedding pathogens.
Something needs to be done. State and county fairs and petting zoos will get the same results if they continue to do the same thing. Continued E. coli outbreaks linked to these settings are unacceptable. Other solutions need to be tried.
Or is it simply time to ban petting zoos?
For more on past petting zoo and fair outbreaks, see www.fair-safety.com.