Fairassociated E' coli O157 Outbreaks and Risk Reduction

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Fair-associated E. coli O157 Outbreaks and Risk
Reduction

• James F. Howell, D.V.M., M.P.H.
• Diplomate, ACVPH
• Deputy for Operations
• Public Health Preparedness and Emergency Response
• Indiana State Department of Health

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Zoonotic InfectionsTransmission Routes

• Zoonoses Diseases shared by animals and humans
• Animal-to-human transmission
• Human-to-animal
• Human-to-human by the same pathogens
• Transmission routes
• Direct contact
• Indirect contact
• Food
• Water
• Air
• Other environmental media and routes

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Some Zoonotic Viral Pathogens
Viruses Animals?_____ Hepatitis E virus
swine, rats, etc. Reoviruses mice, others
(type 3) Rotaviruses probably
(bovine) Adenoviruses maybe? Caliciviruses p
robably (bovine swine) Orthomyxoviruses
(influenza) yes (swine, avian,
etc.) Coronavirus SARS yes (civets,
others) __________________________________________
____________________ Prions - spongiform
encephalopathogens Yes (bovine,
others) __________________________________________
____________________ An international
problem Avian (or other animal) swine ? human
pandemic influenza Bird flu avian ? human
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Some Zoonotic Parasitic Pathogens

• Parasite________________________________________
• Protozoan
• Cryptosporidium parvum yes
• Giardia lamblia yes
• Entamoeba histolytica rare
• Balantidium coli yes (pigs)
• Toxoplasma gondii yes
• Helminths
• Trichuris trichiura pigs
• Ascaris suum yes (pigs)
• Strongyloides stercoralis yes (dogs others)
• Taenia spp. cattle pigs
• Echinococcus spp. Dogs others

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Some Zoonotic Bacterial Pathogens

• Bacterium/Group Animal Other sources
• Salmonella spp. yes no
• (except S. typhi) no no
• Campylobacter spp. yes yes
• Escherichia coli yes no
• Aeromonas hydrophila yes yes
• Yersinia enterocolitica yes yes
• Vibrio cholerae other Vibrio spp. yes yes
• Brucella yes no
• Leptospira yes no
• Mycobacteria spp. (non-tubercular)rare
  (rising?) yes

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State and county fairs

• Millions of visitors
• Children
• Farm animal contact
• Outbreaks of E. coli O157

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How common is E. coli O157 at US fairs?

• Summer 02
• USDA State and county fair survey
• Goal Estimate the prevalence of enteric
  pathogens in livestock at fairs

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Various species sampled
Cattle
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Prevalence at US agricultural fairs

• E. coli O157
• 32 (100) of 32 fairs
• 233/2914 8.0 of livestock
• Persistence gt 9 months

Keen JE et al, VTEC 2003, Edinburgh, Scotland
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Recent outbreaks- E. coli O157

• Fair Year Ill
• Medina county (OH) 2000 27
• Lorain county (OH) 2001 111
• Ozaukee county (WI) 2001 59
• Wyandot county (OH) 2001 88
• Lane county (OR) 2002 60
• Calaveras county (CA) 2002 4
• Fort Bend county (TX) 2003 25
• North Carolina State Fair 2004 108
• Florida (multiple fairs) 2005 gt30
• Indiana (county fair) 2006 5

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Transmission routes
Waterborne Direct contact with animals Indirect
contact
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Direct animal contact
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Indirect contact
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• gt800,000 visitors between October 15-24, 2004
• Confirmed and probable E. coli O157H7
  infections
• 108 cases, 15 HUS
• Median age 5 years (range 1-61)
• 43 culture-confirmed or HUS
• Predominant PFGE pattern (Pattern A)

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• Case-control study risk factors
• Attending Petting Zoo B
• Contact with feces and bedding

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Animals and farm environment

• Fecal samples
• Sheep, goats, and large animal species
• Hide swabs from sheep and goats
• Environmental samples

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Culture results

• Fecal samples
• 12 (60) of 20 sheep and goats
• Camel
• 0 of 20 hide swabs
• 10 (63) of 16 environmental samples
• All 22 isolates indistinguishable from
  predominant outbreak subtype

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Mitigation Steps

• Hand washing facilities
• Increased emphasis on keeping barns clean
• Signage to indicate risk
• Control visitor flow thru petting zoos

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Petting Zoos
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Observational Study ConnecticutSeptember,
2006Yale Emerging Infections Program

• 10 fairs with animal contact areas
• 28 had risk info signage (but 93 dealt with
  rabies)
• 52 had hand hygiene instruction signs
• 60 had hand hygiene facilities
• 5.6 of visitors per hour performed some sort of
  hand hygiene

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Resources

• http//www.nasphv.org/documentsCompendiaAnimals.ht
  ml
• Outbreak of Escherichia coli 0157H7 and
  Campylobacter Among Attendees of the Washington
  County Fair New York, 1999 - Brief Article,
  Morbidity and Mortality Weekly Report, Sept 17,
  1999
• WWW.cdc.gov/healthypets

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Contact Information
James F. Howell, D.V.M., M.P.H. Indiana State
Department of Health [phone] jhowell_at_isdh
.in.gov