Outbreak of Shiga toxin producing E. coli (STEC) infections associated with a petting zoo at the North Carolina Sate Fair – Raleigh, North Carolina

On November 1, 2004, the North Carolina Department of Health and Human Services Division of Public Health reported to the Centers for Disease Control and Prevention 15 cases of culture- confirmed E. coli O157:H7 infections, including four patients diagnosed with hemolytic uremic syndrome (HUS).
Many of those reporting illness had a history of attending the NC State Fair. After researching all possibilities it was determined that the area occupied by the Crossroads Farm Petting Zoo had tested positive for E. coli.
There was another petting zoo at the farm, but their zoo only allowed touching through a railing. Crossroads’ petting zoo allowed people to walk among and have extensive direct contact with sheep and goats, and touch various exotic species held in pens. The Crossroads’ petting zoo also had a high number of animals, causing overcrowding in the area, resulting in stressed animals with loose stools in the petting zoo area.
Both petting zoos allowed feeding, and both had hand-sanitizer stations available. The Crossroads’ petting zoo area also had signs recommending hand hygiene, but it is supposed that infection could have occurred from:
• skin contact other than hands (such as face and legs)
• possible exposure sufficient to infection prior to hand-santizer use
• delayed infection from touching shoes and stroller parts (such as wheels) after they had been being exposed to the floor of the petting zoo, which may have had manure contaminated with E. coli.
• possible contaminated hand-sanitizer gel
• lack of sufficient hand-sanitizer gel use
The CDC has recommended the following to assure that E. coli outbreaks are minimized:
• share information about zoonotic disease risks with all potential visitors prior to animal contact
• physical barriers to reduce direct contact with animals
• prohibit or discourage direct or extensive interaction with animals
• prompt removal of contaminated bedding regardless of animal health
• reduce large crowds of people and dense numbers of at any one time
• monitor for and assure removal of any animals ill with diarrhea
• separate animal areas from areas where foods and beverages are prepared, served or consumed
• hand hygiene stations between animal and non-animal areas
• hand-washing stations should be cleaned routinely to reduce cross-contamination, and maintained to assure continued service.
See also: final epidemiology report of the outbreak by U.S. Centers for Disease Control and Prevention