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, Lorain County, with bacterial diarrhea. The environmental and site investigation indicated that visible manure was present on the ground in at least one area of the barn floor. Out of 54 environmental samples, 23 tested positive for Shiga toxin producing E. coli O157:H7.  Samples from the doorways, rails, bleachers, and sawdust exhibited an identical fingerprint pattern when analyzed by PFGE. Environmental samples of water obtained by the Health Department in the week before and during the fair tested positive for total coliforms for two spigots.

The CDC memorandum clearly associated the Lorain County Fair with the E. coli O157:H7 outbreak in the county. The possible mechanisms proposed for disease transmission included contamination of human hands with residual cow manure and/or aerosolized dispersion of E. coli O157:H7 in the sawdust. The memorandum also hypothesized that the patients became contaminated at the cow palace and were subsequently infected while eating or drinking at the various vendors. The case control study of this memorandum did not support an alternative hypothesis, that the fairground water was related with the outbreak. This investigation strongly supported the previous incidences of E. coli O157:H7 outbreaks associated with the county fair attendance. This memorandum also stressed the need for collaborative efforts between various public agencies to develop clear guidelines for ensuring the disinfection of the temporary facilities housing the animals.  The recommendations provided in this memorandum included considering the banning of large dusty events,  and the development of guidelines for disinfecting surfaces in the Cow Palace prior to events or to replace sawdust with non particulate ground covering. They also suggested that the fairgrounds should be provided with adequate hand washing facilities with hand sanitizers. Measures should be provided to prevent intermixing of water.