Known Cases of Zoonotic Pathogen Outbreaks Associated with State and County Fairs, Petting Zoos, and Community Activities Involving Human-Animal Contact

• Petting Zoo,  E. coli O157:H7 outbreak, Pinellas County, FL 2007

  In May and June 2007, seven Florida children were infected with E. coli O157:H7.  Six of the children had visited a Day Camp petting zoo, and the seventh was another victim’s sibling.  Two of the children were hospitalized, all seven recovered.  The petting zoo was closed on the recommendation of the health department.  The CDC’s report on the incident can be found here.…

• Campylobacteriosis Outbreak Associated with a Camping Trip to a Farm

  In June 2005, King County Public Health was notified that a several children on a school trip had been ill with diarrhea, abdominal pain, and fever following the trip. Campylobacter was isolated from the stool of the ill individual, and later in the week, two more cases of campylobacteriosis were reported in persons who had been on the same camping trip, held at a private…

• Florida State Fair, Central Florida Fair, Florida Strawberry Festival

  The AgVenture Farms E. coli O157:H7 outbreak was first recognized after two separate HUS case reports were posted on the Florida Department of Health EpiCom on March 18 and March 21, 2005. The two cases (a 5-yr-old girl and a 7-yr-old boy) both reported having visited a fair with a petting zoo (AgVenture) a few days prior to becoming ill. The two children visited the same fair and did not have any other risk factors in common. The fair (the Central Florida Fair) was held from March 3-13, 2005.

  The Orange County Health Department was contacted on March 20 by a local hospital administrator, who reported a cluster of pediatric HUS cases in her hospital. Interviews with the parents of the hospitalized children revealed that all had attended the AgVenture Farms petting zoo at the Central Florida Fair or the Florida Strawberry Festival, also held March 3-1. E. coli O157:H7 isolates from the initial cases were sent to the Bureau of Laboratory in Jacksonville for PFGE typing.

  A total of 22 confirmed, 45 suspect and 6 secondary cases from 20 Florida counties were identified as victims of this outbreak. All but one culture-confirmed case had isolates with matching PFGE patterns. Most cases were infected at either the Central Florida Fair or the Florida Strawberry Festival. Three cases were associated with the Florida State Fair, where AgVenture’s petting zoo was present in February. Twelve cases developed HUS. There were no fatalities.

  A summary of the outbreak report can be found on the Florida Department of Health Web site.

  E. coli O157:H7 with PFGE patterns matching those isolated from victims were recovered from the animal exhibit areas of the Central Florida Fair and the Florida Strawberry Festival. E. coli O157:H7 with matching PFGE patterns were also recovered from 6 animals from the Agventure petting zoo.

  The December 23, 2005 MMWR discussed the Florida petting zoo outbreak, along with those associated with North Carolina and Arizona fairs in 2004 and 2005 in its report, “Outbreaks of Escherichia coli O157:H7 Associated with Petting Zoos—- North Carolina, Florida, and Arizona, 2004 and 2005.”

• State fair, Raleigh, North Carolina

  In late October 2004 the North Carolina Department of Health and Human Services (NCDHHS) conducted an E. coli O157:H7 outbreak investigation among attendees at the 2004 State Fair. The health department received over 180 reports of illness; the majority of cases occurring in children five years old and younger. Fifteen children developed hemolytic uremic syndrome.

  A preliminary report issued by the NCDHHS in December 2004…

• County fair, Fort Bend County, Texas

  In 2003 twenty-five people - fair visitors and animal exhibitors - became ill with E. coli O157:H7 after attending the Fort Bend County Fair in Rosenberg, Texas. There were four cases of Hemolytic Uremic Syndrome and one case of Thrombotic Thrombocytopenic Purpura. All seven laboratory-confirmed cases had an indistinguishable PFGE pattern which matched with ten isolates obtained from environmental samples taken at four animal husbandry…

• Petting Zoo, Zutphen, The Netherlands

  Heuvelink et al (2002) reported that a young child developed a Shiga toxin 2 producing strain of Escherichia coli ( STEC) O157 infection after visiting a petting zoo in Zutphen, The Netherlands.  The STEC strains were isolated from the fecal samples from goats and sheep on the farm. Molecular sub-typing proved that the human and animal isolates were identical.

• County fair, Lane County, Oregon

  A news release from the Oregon Department of Human Services ( Oregon, 2002) reported on hemorrhagic colitis from the Lane County Fair held during August, 2002, in Oregon. The report indicated that 56 primary and 14 presumptive secondary cases were identified. This is believed to be the largest E. coli O157:H7 outbreak in Oregon history.  Two-thirds (66%) of the confirmed cases were <6 years old,…

• Farm, Wellington, New Zealand

  An outbreak of Cryptosporidiosis was linked to a two-day farm educational event in the Wellington region of New Zealand. The total number of cases is unknown, but 23 cases were laboratory-confirmed. The most likely route of infection was determined to be from an infected animal. The outbreak was discussed in a report released in 2001 (Stefanogiannis et al, 2001).

• County fair, Wyandot County, Ohio

  The Ohio Wyandot County Health Department received a report of an E. coli O157 outbreak in September, 2001 (CDC memorandum, February, 2002). A total of 92 cases were identified, including 27 laboratory-confirmed E. coli O157 infections. Two cases were diagnosed with hemolytic uremic syndrome. Eighty-eight cases reported attending Wyandot County Fair before becoming ill. The source of the outbreak was not fully identified; however, the…

• County fair, Lorain County, Ohio

  The Department of Health and Human Services, Public Health Services (CDC memorandum, February, 2002) reported that 23 cases of E. coli O157:H7 infection were identified associated with the attendance at the Lorain County Fair, Ohio, in September, 2001. A number of additional cases of diarrhea were identified as likely due to secondary transmission from primary cases. The memorandum strongly associated presence at the Cow Palace,…

• County Fair, Ozaukee County, Wisconsin

  The Ozaukee County Public Health Department and Wisconsin Department of Health and Family Services (2001) investigated an outbreak of E. coli O157:H7 associated with animals at the Ozaukee County Fair in August, 2001. A total of 59 E. coli O157:H7 cases were identified in this outbreak, with 25 laboratory confirmed cases (25 “primary cases” and 34 probable cases). Bacteriological testing of water at the Ozaukee County fairgrounds and the Fireman’s park did not indicate presence of E. coli O157:H7, though 10 of the 36 samples collected from the Ozaukee County Property showed elevated levels of total coliforms. The environmental investigation focused primarily on testing water samples from the livestock buildings, livestock washing stations, runoffs from settling basin, grass filter strip, manure storage area, fishing pond, and streams. A total of 19 surface water samples, and 8 sediment samples, were collected from the pond and stream on the fairgrounds property. All tested negative for E. coli O157:H7.  Public health officials attributed the outbreak to animal contact in the petting zoo at the county fair (Cole et al, 2001).

  As a consequence of this outbreak, the Wisconsin Division of Public Health, Wisconsin Department of Agriculture, Trade and Consumer Protection, and the Dane County Division of Public Health developed a list of voluntary guidelines for animal exhibitions at Wisconsin. The general precautions for livestock on public displays included providing hand-washing stations at strategic places around livestock barns, and posting signs encouraging their use. Actions included developing and implementing manure collection, handling, and storage procedures. It was recommended that runoffs into places where water was pulled be avoided.  A written policy should be developed on handling animal bites and should be discussed with the corresponding county fair health authorities. Visitors should be prohibited from being in contact with baby animals, including newborns, if an animal birthing display is available. The recommendations regarding the food and hygiene practices included keeping food and beverage service away from the livestock, providing adequate hand washing facilities, and encouraging their usage. The guidelines also recommended keeping of records of all the vendors, vendor locations, and schedule of events.

• Petting Zoo, Worcester, Pennsylvania

  An article published by WebMD Medical News on April 23, 2001 (Bloomquist, 2001), reported an outbreak of E. coli O157:H7 among visitors to the Merrymead Farm petting zoo in Worcester, Pennsylvania. In all, 16 children who had visited the zoo contracted E .coli, and it was suspected that another 45 people became ill from the bacteria.  The report indicated that one week after visiting the…

• Dairy farm, Pennsylvania

  Crump et al (2002) discussed an outbreak of E. coli O157:H7 among visitors to a dairy farm in Pennsylvania in September, 2000. A case control study among the visitors was conducted to identify the risk factors of infection, along with a household survey to determine the rates of diarrheal illness. The total number of confirmed or suspected E. coli O157:H7 cases were determined to be fifty-one. The median age among the patients was four. Eight of the cases developed hemolytic uremic syndrome (HUS). The environmental investigation indicated that 28 of 216 cattle (13%) on the farm were carrying E. coli O157:H7 that yielded an identical pattern when analyzed by pulsed field gel electrophoresis to that observed for the isolates of the patients. The organism was also recovered from various surfaces in public access areas of the farm.

  MMWR Weekly (April, 2001) reported that a case control study among the farm visitors was conducted jointly by the CDC, Pennsylvania Department of Health, and Montgomery County Health Department to identify the risk factors. A “confirmed case” was defined as diarrhea in a person within 10 days of visiting the farm on or after September 1, with either E. coli O157 isolated from stool or HUS. A “probable case” was defined as diarrhea in a person within 10 days of visiting the farm on or after September 1. A “control” was defined as a person visiting the farm after September 1 who did not develop diarrhea within 10 days of the visit. Fifty one case patients and ninety two controls were interviewed for this case control study.  The research concluded that this large outbreak of E. coli O157:H7 was most likely a result of contamination of both animal hides and the environment. This study also reported that the data showed hand washing as providing protection against transmission of the pathogen.

• County Fair, Medina County, Ohio

  Crump et al (2000) discussed county fairs as risk factors for E. coli O157:H7 infections. The researchers investigated a cluster of E. coli O157:H7 isolates observed in Medina County, Ohio, in August of 2000. In this case control study 43 culture confirmed E. coli O157:H7 cases were identified. The environmental investigation suggested that contamination of a section of the water distribution system supplying various vendors…

• Petting zoo, Snohomish County, Washington

  A press release by the Snohomish Health District, Communicable Disease Control (June, 2000) reported five cases of bacterial diarrhea caused by E. coli O157:H7 in children in Snohomish County in May 2000. Three of the children visited a petting zoo several days before they became sick. The fourth child did not visit the petting zoo, but was found to live on another farm where cattle…

• Social event in cow pasture, Petersburg, Illinois

  An outbreak of E. coli bacteria was reported in Petersburg, Illinois, in 1999 (Nando Times, 1999). The outbreak took place among 1,800 people who attended a party called “Cornstalk” held in a cow pasture.  State health officials reported that 202 individuals became ill, and that 20 were hospitalized. However, none of the reported illnesses were considered serious.  The source of contamination was not found.

• Agricultural Fair, Ontario, Canada

  Warshawsky et al (2002) investigated an outbreak of E. coli O157:H7 associated with a large agricultural fair conducted between September 10 and 19, 1999, in Ontario, Canada. This study indicated that 7 cases of E. coli O157:H7 infections were associated with animal contact at the agricultural pavilion of the regional fair. Sub-typing revealed that five of the seven cases were extremely uncommon E. coli O157:H7…

• County Fair, Washington County, New York

  The New York State Department of Health investigated what is believed to be the largest outbreak of waterborne E. coli O157:H7 illness in United States history. The outbreak occurred at a fair in Washington County, New York, in August of 1999 (New York State Department of Health, March, 2000).  A total of 781 persons were identified with suspected infections of E. coli O157:H7 and/or Campylobacter…

• Farm, North Wales, London

  Payne et al (2003) reported an outbreak of Vero toxin producing E. coli O157:H7 (VTEC O157:H7) causing gastroenteritis among people visiting an open farm in North Wales, London in June 1999. A case-control study was designed which included 16 primary case patients and 36 controls. The preliminary investigation indicated a significant association between attendance on the second day of the festival, eating…

• County Fair, Puyallup, Washington

  An outbreak of hemorrhagic colitis due to E. coli O157:H7 was identified among visitors to the Puyallup Fair in Puyallup, Washington, during September of 1998 (CDC Memorandum, March 1999). Two children were initially confirmed as being ill from E. coli O157:H7.  The Communicable Disease State Epidemiologist at the Washington State Department of Health mentioned in a news release immediately after the detection of two confirmed cases at the Puyallup fair that health officials were looking for food borne exposure as well as possible contamination at the animal petting areas and on water rides (Kobayashi, 1998).

  The CDC conducted an investigation, and concluded that out of 80 ill people reporting, there were three confirmed and five probable cases of E. coli O157:H7 illness.  Of these eight cases, seven reported consuming hamburgers, though purchased from multiple vendors. The environmental investigation suggested that exposure could have resulted from consuming food without washing hands after petting the animals in the petting zoo. The internal temperature of the cooked hamburgers tested ranged between 155 to 195° F although a number of situations of potential cross contamination were observed among the food handlers.

  The CDC memorandum stated that compelling circumstantial, but not conclusive, evidence was found that the outbreak was a result of consumption of contaminated hamburgers. The memorandum also recommended enforcing proper food handling practices among food vendors, installing a large number of hand washing facilities at the animal petting zoo, and also throughout the fair. It also recommended performing a hazard evaluation of all the food sold at the fair for potential risk of foodborne illnesses.

• Agricultural Fair, British Columbia

  During August and September of 1998 the British Columbia Center for Disease Control sent all E. coli O157:H7 isolates to an outside laboratory for molecular sub-typing (BC Center for Disease Control, March, 1999).  On September 17 it was reported that nine of the 69 referred isolates had a common genotype.  Three individuals were hospitalized, though none developed hemolytic-uremic syndrome (HUS).  Seven of the nine had…

• Zoo water fountain, Minnesota

  In July 1997, the Minnesota Department of Health (MDH) reported an outbreak of Cryptosporidiosis among children who visited the Minnesota Zoo (MMWR Weekly, October, 1998). A total of 369 cases were reported, of which 73 were subsequently confirmed by means of laboratory cultures. The report by MDH indicated case onset of vomiting or diarrhea 3 to 15 days after exposure…

• Farms in Cornwall and West Devon, United Kingdom

  Milne et al (1999) investigated an E. coli O157:H7 outbreak associated with a farm in the United Kingdom during the period of June to July, 1997. A Vero cytotoxin producing Escherichia coli O157:H7 infection was observed in three children, one who lived on an open farm and two who visited the farm during school parties. Two of the three children developed HUS and one suffered from severe neurological impairment.  Isolates collected from the three children and from all environmental samples were indistinguishable by molecular typing, providing evidence of the link between the human contact with the farm and the outbreak.

  The farm was closed voluntarily for six weeks, while recommendations to reduce the risk of transmission were implemented. These recommendations included reassessing provisions made for general hygiene, including making sure adequate hand washing facilities were available; strict segregation of eating and drinking areas from the animal contact area; reinforcement of precautions to be taken by visitors; reassessment of the species type and age of animals kept in the touching barn; prohibition of visitor exposure to fecal contamination (e.g. manure heaps, etc.); elimination of visitor use of cattle trails unless devoid of fecal contamination; implementing a “no touch” policy in various parts of the farm trail, like the calf pen area; enhancing decontamination of the goat paddock by putting it out of use a few weeks before the visits and keeping the grass short; performing rigorous detergent cleaning in areas of public access and appropriate use of disinfectants; and prohibiting public asses to the milking parlors, and calving barns.

• Farm visit, Dublin

  Sayers et al (1996) reported a Cryptosporidium outbreak during the summer of 1995, involving 13 children identified as cases. The children had been to a summer project and visited an open farm in Dublin, Ireland. The second part of this study also included a case control study of 52 out 55 people who had visited the open farm.

  The researchers concluded that…

• Farm visit, Wales

  In April 1995, an outbreak of Cryptosporidiosis was reported among 43 children and four staff after visiting a rural farm (Evans and Gardner, 1996). Out of the 43 cases reported, 7 were confirmed by laboratory cultures. The investigation indicated that the highest likelihood of source of contamination was contact with calves.

• Farm Visitor Center, Leicestershire, United Kingdom

  Shukla et al (1995) investigated an outbreak of seven cases of E. coli O157:H7 infection associated with a visit to a farm in Leicestershire, United Kingdom, during the summer of 1994.  A joint study was conducted between environmental health officers and the local veterinary investigation center of the Ministry of Agriculture, Fisheries and Food.  A questionnaire was sent to all cases.  Samples were collected from…

• County Fair, Wisconsin

  MMWR Weekly (November, 1988) reported that in September, 1988, a human was fatally infected with swine influenza virus in Wisconsin.  A subsequent investigation found that the victim, a woman, had attended a county fair and visited the display area of the pig barn. Statements from the veterinarians at the fair indicated that pigs in the display area were found to show an illness consistent with…