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New Rules in Place to Reduce Outbreaks at the NC State Fair

People attending the State Fair in Raleigh next month will see some changes in how animal are displayed, after an E. Coli outbreak last year sickened dozens.

By Saja Hindi

People attending next month’s North Carolina State Fair will still get to pet the animals, but they’ll also see changes in how animals are exhibited, and have more opportunities to wash their hands after being around critters.

Goats are some of the suspected culprits in last year's State Fair E. Coli outbreak. Photo courtesy konomike, Flickr Creative Commons

Goats are some of the suspected culprits in last year’s State Fair E. Coli outbreak. Photo courtesy konomike, Flickr Creative Commons

The changes come after an E. Coli outbreak sickened 25 after last year’s fair, the second major outbreak in a decade.

Fairgoers will see changes ranging from different ways of getting around to bolder signs about hand washing, following recommendations from a commission formed in response to the latest outbreak.

“I think that some of the things that we did will increase the awareness to the public,” said Wake County Public Health Director Sue Lynn Ledford who was part of a study commission formed after the outbreak. “Any time you increase the education level, that’s helpful.”

What will fairgoers see?

In 2004, the same pathogen was responsible for an outbreak that sickened 187 people.

After the 2004 outbreak, North Carolina legislators passed Aedin’s Law, which placed new regulations on petting zoos and animal contact exhibits at agricultural fairs.

But the 2011 outbreak was not associated with petting zoos. Eventually, investigators determined the sick people all had been to competitive animal displays in the Kelley Building, where people are not encouraged to actually touch the farm animals.

Goats on display at the 2011 NC State Fair. Photo courtesy bnhsu, Flickr Creative Commons

Goats on display at the 2011 NC State Fair. Photo courtesy bnhsu, Flickr Creative Commons

Ledford admitted eliminating the risk of E. Coli transmission is impossible any time there is a large crowd coming in contact with animals. But she said the commission recommended changes to reduce the chances of it happening again.

While there already were signs for hand washing stations when leaving animal exhibits, Ledford said the committee recommended making the signs bigger, bolder and more prominent in an attempt to get people to the stations and use them. She also said there will be more and larger reminders not to take food or strollers into animal exhibits.

State Fair spokesman Brian Long said there will also be lighting at night near handwashing stations.

“We’ve had signs in the past alerting people that there are risks to interacting with animals. We have signs that advised people at certain parts of the fairgrounds, that it’s good to leave the food and drink somewhere else,” Long said.

“When you’re walking through a livestock barn, you don’t want to necessarily be eating or drinking,” he said.

The most noticeable changes will be the traffic patterns that discourage people from touching or petting competition animals in the livestock buildings.

“We still want the visitors to the fair to see those animals and watch those shows,” Long said. “But if they want to pet an animal, then the petting zoo is the place to do that, not the competition areas.”

During opening weekend, only swine will be housed in the Kelley Building. For the rest of the State Fair, there will be more barriers between humans and the stabling areas for all animals in the Graham and Kelley buildings.

Ben Chapman, an assistant professor at N.C. State and food safety specialist for the N.C. Cooperative Extension, researches outbreaks and has been blogging about last year’s incident.

He said he liked the way the commission looked at the fair as a whole as a way of reducing potential risks.

“They’re all policy and risk management changes that if implemented, can go a long way for reducing the risk [of E. Coli transmission],” Chapman said.

CSI State Fair

According to Ledford, last year’s outbreak was found quickly because of a statewide disease surveillance system called NC DETECT that’s hooked to every emergency department in the state.

Highly magnified image of Escherichia Coli, Image courtesy CDC/Janice Haney Carr

Highly magnified image of Escherichia Coli, Image courtesy CDC/Janice Haney Carr

Data related to disease patterns is tracked and authorized public health officials can access information on the system.

“We monitor it for certain communicable diseases,” she said.

Ledford said the system is updated daily, so it was easy to spot an uptick in people heading to doctors complaining of bloody diarrhea, who eventually tested positive for E. Coli. The incubation period to get sick from the bacteria is 2-10 days, so the 25 people who had contracted it were interviewed to see what they had done in the 10 days before they got sick.

“We found that all of them had reported attending the State Fair,” said David Sweat, an epidemiologist with the N.C. Division of Public Health. “That was the only thing they had in common.”

To narrow down where people might have come in contact with the bacteria, Sweat said his department conducted a case control study.

In the 2004 incident, epidemiologists were able to collect samples on site because the outbreak started early in the fair. But last year, by the time the connection with the Kelley building was established, everything had been removed and the building was already cleaned.

Sweat’s department developed a questionnaire, contacted people who had attended the State Fair and asked them to answer the survey. More than a thousand healthy fairgoers volunteered and 75 were interviewed to compare answers from those who had contracted the E. Coli.

According to Sweat, those who contracted the E. Coli reported visiting the Kelley Building and a nearby sheep and goat tent four to five times more frequently than those who were healthy.

Many of the sick people had also visited during the first weekend of the fair.

Why don’t farmers get E. Coli?

Chapman said some people may wonder why farmers who handle animals all the time don’t get sick from E. Coli. He said sometimes they do, but research specifically relating to E. Coli O157:H7 shows there’s an increased resistance in antibodies for that bacteria in people who live in rural areas or on farms.

NCHN Editor Rose Hoban feeds camels at the 2010 NC State Fair. Photo courtesy Steve Tell

NCHN Editor Rose Hoban feeds camels at the 2010 NC State Fair. She washed her hands afterwards. Photo courtesy Steve Tell

“It’s kind of a biology situation,” he said. “They do face the same risks, except the people who are handling those animals are around those animals a lot. They may have been exposed to the pathogen or one similar to it at a young age, been ill, recovered, and have antibodies.”

But in a situation where a few thousand people are cutting through a building over an 11-day period and they have never been exposed to the pathogen, there is a risk of illness, Chapman said.

Times are also different.

“People didn’t use to leave their environment as much. Rural people lived in rural areas and got their food from those areas. Now, we get food that may carry pathogens our bodies may have never seen before,” Chapman said.

Chapman says this doesn’t mean people who have never been around animals shouldn’t go to the fair, but that they should take precautions, especially with younger children.

“As my children get older, I’m more confident their immune systems are developing, but I wouldn’t take my newborn child to touch an animal,” he said.

 

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