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Cleveland County E. Coli Outbreak Looms Over State Fair Prevention Efforts

Dozens of people are now confirmed to have contracted E. coli from the Cleveland County Fair several weeks ago. Organizers of the NC State Fair know what it’s like to have an outbreak – they had one last year, and have made changes in an attempt to prevent another.

This story has been updated with the most recent case count of E. coli cases from the Cleveland County Fair.

By Rose Hoban

In a small dark tent at this year’s N. C. State Fair black lights reveal something truly frightening – just how hard it is to get your hands clean when you wash.

In the Germ City black light tent, "dirt" shows up as white on hands.

In the Germ City black light tent at the State Fair, “dirt” shows up as white on hands.

The Germ City exhibit – tucked between two buildings housing live animal exhibits – aims to teach people about handwashing by having people spread a fluorescent cream on their hands that shows up under ultraviolet light before and after they have a chance to wash their hands.

“We’re using a lot of water,” said Jennifer Godwin, who works for the NC Department of Agriculture and Consumer Services, “but (Agriculture Commissioner Steve Troxler) wanted to make sure we had this out here to teach people.”

The educational effort took on some urgency this week as state public health officials confirmed the death of a 2-year-old Gaston County boy who contracted E. coli at the Cleveland County fair some time in the past three weeks.

Employees at the State Fair remember all too well how a similar outbreak occurred at last year’s fair, when dozens of people were sickened by E. coli.

“We all shudder to think of it,” said spokesman Brian Long. “It is something that none of us would wish on anyone.”

Lessons from Cleveland County

As of Tuesday afternoon, the Cleveland County Fair tally had increased 46 confirmed cases of E. coli from six North Carolina counties and two visitors from South Carolina. Twenty-two are children, and a total of ten people have ended up in the hospital as a result, including the child who died.

Signs discouraging touching animals are all over the animal exhibition areas at the NC State Fair.

Signs discouraging touching animals are all over the animal exhibition areas at the NC State Fair.

Cleveland County Health Director Dorothea Wyant said her infectious disease investigators were still looking for the cause of the outbreak.

“Everyone who’s been sick has been to the fair,” Wyant said. The Cleveland County fair ran from Sept. 26 to Oct. 7.

Wyant said many of the people who have gotten sick answered an eight-page questionnaire, the standard beginning of an outbreak investigation.

“Some of the people who got sick, their families ate the exact same thing, and they didn’t get sick. And some of the people who have gotten sick weren’t around animals,” Wyant said.

She said that the animal exhibits were large, and it rained several times during the week of the fair – that may have helped spread animal feces.

“You get stuff on your feet too, and then you have 2- and 3-year-olds running around” Wyant said. “You put a 2-year-old in their stroller and they’re playing around and touching their shoes, even after they’ve washed their hands.”

Wyant did say that her investigators went out and took photos of what handwashing stations were still in place as the outbreak began.

Henry Claiborne from Norlina, N.C. washes his hands in the Germ City tent.

Henry Claiborne from Norlina, N.C. washes his hands in the Germ City tent.

“There weren’t a lot of shorter ones for children to access easily, most were toward middle school, adult-type heights,” she said, but noted there were signs “everywhere” reminding people to wash up.

“But 176,000 people went through there… how do you police that many people?” Wyant asked.

Changes at this year’s State Fair

After last year’s E. coli outbreak at the State Fair, state Department of Agriculture officials convened a task force to examine ways to reduce the chances of another occurrence.

“We focused our efforts on those main livestock buildings, the Kelley Building the Graham Building and the Expo center where livestock are shown or stabled or housed when they’re not on the grounds,” Long said.

He said one big change is in the way animals are housed and exhibited. There are two sets of railings separating people from animals, instead of railings that allow people to get close enough to touch the animals.

“In the past, we had signs up seeing look, don’t touch, but people were tempted to touch,” Long said. “But if you’re still tempted to touch them you’re (now) gonna have to try real hard to touch one of these show animals.”

An extra layer of barriers separates visitors from animals in the exhibition areas at the State Fair.

An extra layer of barriers separates visitors from animals in the exhibition areas at the State Fair.

The exhibits and areas housing animals have been moved closer together so the critters no longer have to be walked through the same places where people might go.

“If you’re walking in an area where animals are kept, there is more potential to pick up something on your shoe,” Long said. “Keeping people and animals with separate traffic areas as much as possible you reduce the possibility of cross-transmission.”

Long said there are also more hand-washing stations, and stations that have continuous water flow.

“We’re noticing that the children are liking them, they look at little bit like a fountain,” Long said. “Anything we can do to raise awareness is good.”

But some research points to prevention messages not being enough to prevent outbreaks when animals and humans come into close contact.

Scientists studying behavior at petting zoos in Kansas and Missouri found people – children in particular – touching their faces, and eating near animal exhibits, even though signs encouraging hygiene were present. Only about a third of people in the study washed their hands after visiting, that number rose to 6 out of 10 visitors washing their hands when they were reminded by facility staff.

Long said staff at the State Fair had put up many more signs about handwashing and were being more aggressive about reminding people to wash up.

Large signs for handwashing dot the animal exhibits, but people continue to bring food and drinks into areas where animals are being displayed.

Large signs for handwashing dot the animal exhibits, but people continue to bring food and drinks into areas where animals are being displayed.

“We’ve put rope lighting around signs so people can see them better at night,” Long said. “There’s no way you’re not gonna see that sign.”

Germ City

And then there are the tents with black lights.

Since the Germ City exhibit was discontinued five years ago, kids have been asking for its return, said exhibit supervisor Jennifer Godwin. The last time the exhibit was at the fair it was smaller and in a less prominent location; even still, more than 10,000 people walked through.

People visiting the exhibit are given a fluorescent cream to rub on their hands, and then are led into the first dark tent with ultraviolet lights. The cream shows where germs might be on unwashed hands.

“It’s just giving you a good visual. A lot of people are visual,” Godwin said.

Visitors exit the tent and wash hands in a sink with continuously running water. Then it’s back into a second tent to see what kind of job they did at getting the cream off. A pre-recorded message talks visitors through the experience.

“Can you still see some of the glow germ lotion on your hands?,” the recording asks. “This represents locations you may be missing when you are washing your hands.”

After handwashing, residual "dirt" shows up under the black lights as white patches on hands.

After handwashing, residual “dirt” shows up under the black lights as white patches on hands in the Germ City exhibit at the State Fair.

“Sometimes its hard to get all of this lotion off… it’s a great visual. It’s a lot of fun and great for the kids, something for them to take home,” Godwin said. “I’ve already heard the kids walking by saying, ‘Germ City is here.’ “

“We’ve been through an E. coli incident and we don’t want it to happen again, so we’ve made a lot of changes” Long said.

“You don’t want anyone to go home with anything but happy memories.”

The Germ City exhibit will be open at the fair from 10 am – 6 pm between the Graham Building and the Expo Building.

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