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 identified multiple risk factors for infection with E. coli O157:H7 among visitors to four animal exhibits. Direct contact with goats and sheep was strongly associated with illness. Ill children age three years or less were seven times more likely to have contact with manure than children who were not ill. Ill children were also five times more likely to fall or sit on the ground than children who were not ill.

Cultures from 33 ill fair attendees had the same PFGE patterns. Environmental samples obtained from four fairground areas grew E. coli O157:H7. Nineteen of thirty specimens obtained from a particular petting zoo grew E. coli O157:H7 and were a PFGE match to ill patients.

The NCDHHS report recommends restricting direct contact with animals, reducing fecal contamination, and reducing crowding in petting zoos. The report concludes by saying that these recommendations are particularly pertinent to young children and others with reduced immunity to infection.

A copy of the report can be found at http://www.dhhs.state.nc.us/docs/ecoli.htm.

The December 23, 2005 MMWR discussed the North Carolina petting zoo outbreak, along with those associated with Florida and Arizona petting zoos 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.”