State health officials continued through the weekend to investigate 24 cases of suspected E. coli infections with links to the North Carolina State Fair.

Officials have confirmed that eight of the cases are the O157:H7 strain of E. coli; five people have been hospitalized, three with kidney failure.

Health officials are continuing their detective work to pinpoint the source of the bacteria, by interviewing the affected people as well as fairgoers who did not get sick, according to Julie Henry, a spokeswoman for the Department of Health and Human Services.

We’ve been immersing ourselves in Brisbane culture. Saturday it was an Aussie rules football game – my second favorite sport because of the speed and violence aggressiveness after ice hockey. Basketball and baseball would be far more interesting if there was full body contact.

Today was a state holiday in Queensland so we joined 70,000 others for People’s Day at the Ekka – the Royal Queensland Show, originally called the Brisbane Exhibition and usually shortened to Ekka.

Ekka runs over 10 days and is similar to American-style state fairs or the Canadian National Exhibition in Toronto: bad food, hucksters of various wares, a large midway, and the best livestock from across the state.

There was a petting zoo, a short of controlled-chaos the like of which I’d never seen (right, exactly as shown) where hundreds of parents and their kids roamed in a large pit with goats, sheep, cattle, and shelled out some cash to feed the animals from a cup. Kids were crying and falling in poop, animals were scarfing down food, parents were interested in the free hat upon departure from the enclosed area.

Both hand sanitation and handwashing stations were available at the departure point, which was good, although reminders could have been more graphic: the compliance rate appeared low.

Other areas of the livestock pens included cattle and goats, where contact was encouraged but no handwashing signs or facilities were available. One budding entrepreneur – the dude in the black hat -- offered cuddle-a-goat for $1.

“You two go in and I’ll give him $1 and take your picture.”

“That will be $2 for two.”

No handwashing. Bad.

A table of petting zoo related outbreaks is available at http://bites.ksu.edu/petting-zoos-outbreaks.

The Scarecrow Fest in Akron, Iowa, has one of the better names for the various fall festivals.

Michelle Clausen Rosendahl, of the Siouxland District Health told

Le Mars Daily Sentinel, "In Iowa for the most part, if you're selling food, you have to have a license to do that.”

For short events like the Akron Scarecrow Festival, vendors can purchase a temporary food license. Vendors buy the licenses the day of the event if a district health representative is present to sell them.

They cost $33.50.

Rosendahl said the district health office doesn't always know when food vendors are going to be at an event, and health officials request that event organizers notify them.

Glenn Eckert, an environmental specialist with Siouxland District Health said, "If we know there is a festival going on, we'll stop in and check the vendors. There's lots of things that go on during weekends in smaller towns we don't even know about."

Things going on in small towns like in a David Lynch movie?

One of the biggest things district health officials see is food vendors that don't have a place to wash hands right where they are working.

"If they have any kind of food or beverages that are not prepackaged, they would have to have a handwashing station," Rosendahl said. "It doesn't have to be a sink with actual running water."

Using hand sanitizer is not enough to take the place of washing hands, Eckert said.

The district health website gives instructions as to how to set up a temporary handwashing station.

The health inspectors also will want to know where the food being sold came from.

"It has to come from a licensed or approved source. If they have meat we would look at if it's inspected meat," Rosendahl said.

Inspectors also want to know where food was prepared.

"In this situation, it's not allowed for food to be prepared at home and brought to a temporary food stand and sold, with a couple exception of some non-potentially-hazardous baked goods," Rosendahl said. "We don't know what issues may be in the home. It's not an inspected kitchen."

A non-profit organization can serve food one day per week on its premises without a temporary license.

That means, for example, at a church potluck, people can bring food prepared at home, and no temporary food license is needed.
 

Traverse City, Michigan, is sorta famous in food safety circles because a 1982 outbreak of E. coli O157:H7 was the first time the bug was identified as a cause of human disease, after 47 people in and Traverse City and White City, Oregon, developed severe stomach disorders after eating hamburgers at McDonald’s outlets.

Reporting on E. coli O157:H7 in the New York Times began on 8 October 1982 with prompt coverage of this first known outbreak. Researchers at the U.S. Centres for Disease Control and Prevention (CDC) said the bacterium associated with the outbreaks was normally killed by cooking. The next day, federal epidemiologists characterized the disease as an intestinal ailment that had not proven fatal and was not a major public health hazard ; yet by Nov. 5, 1982 another 29 cases were reported.

In 1983, CDC issued a report on the Oregon and Michigan outbreaks and by 1984, the first report on the behavior of the organism and possible control measures appeared.

Today, the Grand Traverse County Health Department reported it had received reports of three probable cases of shigatoxin-producing E. coli in the past week.

All cases were in children and all three attended the Northwestern Michigan Fair in Grand Traverse County between August 9 and August 13.

The onset of symptoms, including bloody diarrhea, were between August 15 and August 17.

Dr. Michael Collins, Medical Director for the Grand Traverse County Health Department said,

"Considering the number of animals in close proximity to people at that venue, it seems likely that their infections were contracted there. Though we will probably never know exactly which animal or animals were involved as sources.”

The water supply at the Fairgrounds was tested prior to the event and will be re-tested for possible contamination. Area physicians were also notified and encouraged to obtain stool cultures for individuals with severe or bloody diarrhea.