Fair Safety with Bill Marler

E. coliE. coli O157:H7O157:H7

According to the According to the Centers for Disease Centers for Disease Control and Control and Prevention:Prevention:

73,000 cases 73,000 cases occur annuallyoccur annually

2,100 2,100 hospitalizationshospitalizations

61 fatal cases61 fatal cases

http://www.about-ecoli.com/

http://www.about-ecoli.com/

Disease ProcessDisease Process

Transmitted by Transmitted by ingesting ingesting livestock feceslivestock feces

Infectious Infectious dose – as few dose – as few as 50 cellsas 50 cells

Incubation Incubation period – period – 3 to 4 days3 to 4 days

E. coliE. coli O157:H7 Pathology O157:H7 Pathology

Intestinal cells form pedestals in response to E. coli Intestinal cells form pedestals in response to E. coli O157:H7 proteins. The bacteria then can release the O157:H7 proteins. The bacteria then can release the shiga-like toxin directly into the blood stream.shiga-like toxin directly into the blood stream.

SymptomsSymptoms

Severe Severe abdominal pain, abdominal pain, cramps, cramps, diarrhea, bloody diarrhea, bloody diarrhea, fever, diarrhea, fever, vomiting, painful vomiting, painful rectal spasmsrectal spasms

Hemolytic Uremic Hemolytic Uremic Syndrome (HUS) Syndrome (HUS) may developmay develop

E. coliE. coli Illnesses at Fairs Illnesses at Fairs

Over a dozen E. coli Over a dozen E. coli O157:H7 outbreaks O157:H7 outbreaks associated with associated with petting zoos and fairs petting zoos and fairs reported since 1994reported since 1994

Hundreds of illnesses Hundreds of illnesses and the development and the development of HUS - Linked to of HUS - Linked to human-animal human-animal contact, air, or dust-contact, air, or dust-borne E. coli O157:H7borne E. coli O157:H7

Prevalence of Prevalence of E. coliE. coli O157:H7 O157:H7

E. coli O157:H7 found:E. coli O157:H7 found:• 13.8% in Beef Cattle13.8% in Beef Cattle• 7.0% in Pest Fly Pools7.0% in Pest Fly Pools• 5.9% in Dairy Cattle5.9% in Dairy Cattle• 5.2% in Sheep5.2% in Sheep• 3.6% in Pigs3.6% in Pigs• 2.8% in Goats2.8% in Goats

2003 Ohio Study – 2003 Ohio Study – 29 County 29 County and 3 State and 3 State FairsFairs

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1994 – Farm Visitor Center – England 1994 – Farm Visitor Center – England

Source – Direct Source – Direct Contact with AnimalsContact with Animals

Recommendations:Recommendations:

• Provide Information Provide Information on importance of on importance of personal hygienepersonal hygiene

• Provide adequate Provide adequate hand washing hand washing facilitiesfacilities

1997 – Farms – Cornwall 1997 – Farms – Cornwall and West Devon, Englandand West Devon, England

Source – Direct Contact with AnimalsSource – Direct Contact with Animals Recommendations:Recommendations:

• Provide adequate hand washing facilitiesProvide adequate hand washing facilities• Segregate eating and drinking areas from Segregate eating and drinking areas from

animal contact areaanimal contact area• Prohibit visitor exposure to fecal contamination Prohibit visitor exposure to fecal contamination • Remove fecal contamination from walking trailsRemove fecal contamination from walking trails• Enforce a “No Touch” policy Enforce a “No Touch” policy • Enhance decontamination in Paddock areas Enhance decontamination in Paddock areas

by excluding animals for weeks before visitby excluding animals for weeks before visit• Rigorously clean public access areasRigorously clean public access areas

2000 – Petting Zoo – Washington2000 – Petting Zoo – Washington

Source – Source – Petting Zoo AnimalsPetting Zoo Animals



• Provide signs Provide signs instructing visitors to instructing visitors to wash after touching wash after touching animalsanimals

2000 – Dairy Farm – Pennsylvania2000 – Dairy Farm – Pennsylvania

Source – Animal Source – Animal Touching and Touching and EnvironmentEnvironment


• Provide adequate Provide adequate

hand washing hand washing facilitiesfacilities

• Encourage hand Encourage hand washingwashing

2001 – Petting Zoo – Pennsylvania 2001 – Petting Zoo – Pennsylvania

Source – Contact with AnimalsSource – Contact with Animals Recommendations:Recommendations:

• CDC GuidelinesCDC Guidelines• Provide information about the riskProvide information about the risk

of animal contact and about of animal contact and about strategies to prevent transmissionstrategies to prevent transmission

• Design venues to minimize risk, Design venues to minimize risk, especially when:especially when:

• Food is servedFood is served

• Infants and school-aged Infants and school-aged children are presentchildren are present

• Allow animal petting only in Allow animal petting only in specific areas under supervisionspecific areas under supervision

• Provide barriers between Provide barriers between animals and humans except in animals and humans except in supervised interaction areassupervised interaction areas

2001 – Petting Zoo – Pennsylvania 2001 – Petting Zoo – Pennsylvania

CDC Guidelines, Cont.CDC Guidelines, Cont.• Provide hand washing areas Provide hand washing areas

adequate in all areasadequate in all areas• Running water, Running water,

soap and towels soap and towels • Provide sufficient hand washing Provide sufficient hand washing

facilities for expected facilities for expected attendanceattendance

• Supervise children under five Supervise children under five • Post signs Post signs • Provide hand washing training Provide hand washing training

for stafffor staff• Prohibit hand-to-mouth activities Prohibit hand-to-mouth activities • Exclude high risk individualsExclude high risk individuals

2001 – 2001 – County Fair County Fair – Wisconsin – Wisconsin

Source – Source – Animal ContactAnimal Contact



• Place food and Place food and beverage area as beverage area as far away as possible far away as possible from livestock areasfrom livestock areas


2001 – 2001 – County Fair County Fair – Ohio– Ohio

Source – Source – Cow manure in Cow manure in SawdustSawdust


• Disinfect housing Disinfect housing facilities for animalsfacilities for animals

• Provide a non-Provide a non-dusting ground dusting ground coveringcovering



2001 – 2001 – County Fair County Fair – Ohio – Ohio

Source – Source – Contact with animalsContact with animals


• Disinfect areas Disinfect areas that house cattlethat house cattle

• Remove fecal Remove fecal contamination contamination from contact from contact surfacessurfaces


2002 – Petting Zoo – Netherlands 2002 – Petting Zoo – Netherlands

Source – Animal ContactSource – Animal Contact

Recommendations:Recommendations:• Strictly enforce personal hygiene in petting zoosStrictly enforce personal hygiene in petting zoos

2002 – 2002 – County Fair County Fair – Oregon – Oregon

Source - Dust Source - Dust contaminated contaminated with fecal matterwith fecal matter

Recommendations: Recommendations: Limit Airborne Limit Airborne E. coli by: E. coli by: 1).1). not moving soiled not moving soiled bedding during bedding during exhibit hours, exhibit hours, 2).2). keep stall areas keep stall areas damp with an damp with an approved approved disinfectantdisinfectant


2003 – 2003 – County Fair County Fair – Texas– Texas

Source – Rodeo Source – Rodeo and animal Exhibitsand animal Exhibits


• Emphasize personal Emphasize personal hygiene and hand hygiene and hand washingwashing


Pre-2004 CDC RecommendationsPre-2004 CDC Recommendations

Provide InformationProvide Information• Inform visitors of the risk Inform visitors of the risk

for transmission of for transmission of enteric pathogens from enteric pathogens from animals to humans and animals to humans and strategies for strategies for prevention of prevention of transmissiontransmission

• Train facility staffTrain facility staff• Warn visitors that Warn visitors that

certain animals pose certain animals pose greater risk greater risk

Additional Pre-2004 RecommendationsAdditional Pre-2004 Recommendations

Source – Compendium of Measures to Prevent Source – Compendium of Measures to Prevent Disease and Injury Associated with Animals in Disease and Injury Associated with Animals in Public Settings, 2004Public Settings, 2004

• EducateEducate

• Provide educational Provide educational materials prior to contactmaterials prior to contact

• Train petting zoo staffTrain petting zoo staff

• Allow contact with animals in controlled Allow contact with animals in controlled setting onlysetting only

• Design contact area to minimize risk Design contact area to minimize risk and maximize hand washing and maximize hand washing

Additional Pre-2004 Additional Pre-2004 Recommendations, Cont.Recommendations, Cont.

Give consideration Give consideration to feces removal, to feces removal, waste runoff, and waste runoff, and contact with humanscontact with humans

Take extra precautions Take extra precautions to reduce risk to reduce risk of disease transmission of disease transmission in settings where in settings where direct animal contact direct animal contact is encouragedis encouraged

Do not allow food or drink in animal contact area – Do not allow food or drink in animal contact area – no pacifiers, smoking allowedno pacifiers, smoking allowed

Promptly remove feces and animal beddingPromptly remove feces and animal bedding Closely supervise children less than fiveClosely supervise children less than five

Require staff to be in Require staff to be in animal contact area to animal contact area to encourage proper hand encourage proper hand washingwashing

Provide transition areas Provide transition areas between animal and between animal and non-animal areas non-animal areas

• Warn of risk of hand-Warn of risk of hand-to-mouth contact on to-mouth contact on entering entering

• Warn on the need to Warn on the need to wash hands on exitingwash hands on exiting

Additional Pre-2004 Additional Pre-2004 Recommendations, Cont.Recommendations, Cont.

2004 N.C. 2004 N.C. State Fair State Fair OutbreakOutbreak

43 confirmed; 108 cases 43 confirmed; 108 cases total, E. coli O157:H7total, E. coli O157:H7

>50% under age 5, >50% under age 5, nearly 80% under 18.nearly 80% under 18.

Confirmed cases Confirmed cases with matching PFGE with matching PFGE pattern. Matched pattern. Matched environmental samples environmental samples at Crossroads Farm. at Crossroads Farm. Matched Crossroads Matched Crossroads Farm animals.Farm animals.


Recommendation v RealityRecommendation v Reality

Inform visitors of Inform visitors of the risk for the risk for transmission of transmission of enteric pathogens enteric pathogens from animals to from animals to humans and humans and strategies for strategies for prevention of prevention of transmission.transmission.

““Petting zoos Petting zoos failed to provide failed to provide adequate adequate signage. Signs signage. Signs were not were not sufficiently visible sufficiently visible or cautionary: or cautionary: victims families victims families do not remember do not remember seeing the signs at seeing the signs at all.”all.”


Train Train petting petting zoo staff.zoo staff.

• Q.Q. [Prior to the fair] were you aware that [Prior to the fair] were you aware that it was possible for it was possible for E. coliE. coli to be transmitted to be transmitted to people from animal fecal matter?to people from animal fecal matter?

• A.A. No. (Jason Wilkie p. 71)No. (Jason Wilkie p. 71)• Q.Q. Was there any aspect, from your Was there any aspect, from your

understanding prior to the 2004 fair, of any understanding prior to the 2004 fair, of any health concerns to people being some of health concerns to people being some of the reasons for having hand-washing the reasons for having hand-washing stations on the way out?stations on the way out?

• A.A. No. (Jason Wilkie p. 55)No. (Jason Wilkie p. 55)• Q.Q. Was there any part of that rule Was there any part of that rule

[prohibiting outside food in the exhibit] [prohibiting outside food in the exhibit] that was there to protect the health of that was there to protect the health of people?people?

• A.A. No. (Jason Wilkie p. 66)No. (Jason Wilkie p. 66)


Maximize hand Maximize hand washing; “Require washing; “Require staff in animal staff in animal contact area to contact area to encourage hand encourage hand washing.”washing.”

• Q.Q. Did those people Did those people [watching the exit from [watching the exit from the exhibit] watch to the exhibit] watch to make sure people make sure people washed their hands?washed their hands?

• A.A. No. No. (Jason Wilkie p. 68)(Jason Wilkie p. 68)

• Use of hand sanitizer – Use of hand sanitizer – not running water, not running water, no soap.no soap.

More Hand Washing RealityMore Hand Washing Reality

Handwashing Handwashing facilities not facilities not located near located near either petting either petting zoo.zoo.

Fewer hand Fewer hand washing stations washing stations than the than the previous previous 2 years.2 years.


Design contact area Design contact area to minimize risk; to minimize risk; provide transition provide transition areas between areas between animal and non-animal and non-animal areas.animal areas.

No barriers; no No barriers; no transition areas.transition areas.

100 goat or sheep 100 goat or sheep in a pen 40 x 60. in a pen 40 x 60. Owner reported Owner reported overcrowding.overcrowding.

“ “ intensive and intensive and extensive direct extensive direct contact with sheep contact with sheep and goats.”and goats.”

The other petting zoo The other petting zoo had railings between had railings between animals and animals and customers.customers.


Allow contact Allow contact with animals in with animals in controlled controlled setting only.setting only.

““Crossroads Farm Crossroads Farm permitted full contact permitted full contact between animals and between animals and humans. Some of the humans. Some of the goats knocked children goats knocked children over…”over…”• Q.Q. Why a rule against Why a rule against

strollers?strollers?

• A.A. Goats like to play king of Goats like to play king of the mountain, and they’re the mountain, and they’re going to get to the highest going to get to the highest spot they can, and it’s no fun spot they can, and it’s no fun when they land on a kid.when they land on a kid.


Do not allow Do not allow food or drink food or drink in animal in animal contact area.contact area.

A food vendor was A food vendor was positioned near the positioned near the petting zoo - petting zoo - “a management error.”“a management error.”• Q.Q. Was there any part of that rule Was there any part of that rule

[prohibiting outside food in the [prohibiting outside food in the exhibit] that was there to protect exhibit] that was there to protect the health of people?the health of people?

A.A. No. (Jason Wilkie p. 66)No. (Jason Wilkie p. 66)

• Coin operated feed vending Coin operated feed vending machines encouraged ‘fecal-oral’ machines encouraged ‘fecal-oral’ contact.contact.


Closely Closely supervise supervise children less children less than five.than five.

Strollers allowed Strollers allowed in one later tested in one later tested positive for E. coli positive for E. coli O157:H7.O157:H7.

Goats knocked Goats knocked down kids.down kids.

Goats jumping on Goats jumping on children during children during feeding.feeding.

NCDACS and CrossroadsNCDACS and Crossroads

Knew or should have known of risk.Knew or should have known of risk.

Knew of should have known of Knew of should have known of precautions.precautions.

Failed to take precautions across the Failed to take precautions across the board.board.

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Fair Safety with Bill Marler