Sorenne’s school is doing the hatching-chicks-thing in anticipation of Easter (which is a surprisingly big deal in Australia) and I’ve been doing my best Dougie-Downer about handwashing, Salmonella, pestilence and death.

In the northern Hemisphere, this is apparently the start of the petting farm season (didn’t have that one penciled in), so the UK Health Protection Agency is reminding people, especially those with responsibility for young children, to enjoy their farm visits safely by ensuring good hand hygiene after touching farm animals or their surroundings.

Outbreaks of gastrointestinal illness associated with contact with farm animals peak in the spring and summer as this coincides with schools holidays when visits to petting farms tend to be more popular, although outbreaks can occur at other times.

The route of transmission in these illnesses, which include the infections E. coli O157 and Cryptosporidium, is direct contact with animals in petting and feeding areas as well as contact with the droppings of animals on contaminated surfaces around farms.

Dr Bob Adak, head of the gastrointestinal diseases department at the HPA, said, “… hand gels or wipes have their uses in areas that are generally clean, such as offices or hospitals, but they are not effective in completely removing from soiled hands bugs such as E. coli or Cryptosporidium that are commonly found in animal droppings and on contaminated surfaces around farms. This is why washing the hands thoroughly with soap and water is so important - it is the only way to effectively remove the bacteria and reduce the risk of becoming unwell.”

Figures from the HPA’s national surveillance system show that there were 61 outbreaks of gastrointestinal illness associated with farms visits between 1992 and 2011. Twenty two of these outbreaks (36 per cent) occurred in the last three years (2009-11).

Around half were caused by E. coli O157 and around half were caused by Cryptosporidium. A handful were caused by Salmonella. Overall 1,238 people were affected in these outbreaks – 1,003 people with Cryptosporidium and 235 with E. coli O157.

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

We’ll have more to say about this once our research paper, led by Gonzalo, completes the peer review process and gets published.

Notable finding: illness was associated with visit to a building in which sheep, goats, and pigs were housed for livestock competitions. Fair attendees were not intended to have physical contact with animals in the building; however, 25% of case-patients (three of 12) and 24% of control subjects (five of 21) who visited the building reported direct contact with animals.

The U.S. Centers for Disease Control and Prevention reports that on October 24, 2011, the North Carolina Division of Public Health (NCDPH) was notified of four Shiga toxin–producing Escherichia coli (STEC) infections among persons who had attended the 2011 North Carolina State Fair, held October 13–23 in Raleigh. Approximately 1 million visitors had attended the fair.

NCDPH conducted a case-control study to identify the source of transmission. A case was defined as laboratory evidence of STEC, hemolytic uremic syndrome (HUS), or acute bloody diarrhea with no other identified etiology in a person who attended the fair 1–10 days before illness onset. Active case finding was performed by using a network of hospital-based public health epidemiologists..

Passive surveillance was enhanced through notifications to public health officials, health-care providers, laboratory directors, and the public. Control subjects were recruited by contacting 11,000 randomly selected advanced ticket purchasers by e-mail with a request to participate in the investigation. Three control subjects were matched to each case by age (<18 years or ≥18 years) and date of fair attendance. A stool specimen was requested of all case-patients for laboratory confirmation of E. coli. Pulsed-field gel electrophoresis (PFGE) patterns were compared with known strains in the national PulseNet database. Case-patients' exposures to food, animals, and fair activities were assessed by using a scripted questionnaire administered to case-patients and control subjects.

Twenty-five cases were identified with case-patients' illness onsets during October 16–25; median age was 26 years (range: 1–77 years). Eight case-patients (32%) were hospitalized; four (16%) experienced HUS. Nineteen case-patients provided stool specimens, and 11 (44%) had laboratory confirmation of E. coli O157:H7 with matching PFGE patterns. This PFGE pattern is the eighth most common pattern in the PulseNet database and has been associated with previous foodborne outbreaks (CDC, unpublished data, 2011).

The only exposure associated with illness was having visited one of the permanent structures in which sheep, goats, and pigs were housed for livestock competitions (matched odds ratio: 5.6; 95% confidence interval: 1.6–19.2). Fair attendees were not intended to have physical contact with animals in the building; however, 25% of case-patients (three of 12) and 24% of control subjects (five of 21) who visited the building reported direct contact with animals.

A previous STEC outbreak linked to a petting zoo at the 2004 North Carolina State Fair resulted in 187 illnesses, 15 of which were complicated by HUS (1). The 2004 outbreak led to the passage of Aedin's Law in North Carolina, which created regulations for exhibitions housing animals intended for physical contact with the public. These regulations include requirements for permitting, education, and signage to inform the public of health and safety concerns, enhanced maintenance of animal facilities, transitional entrances and exits, and easily accessible hand-washing stations. The 2011 outbreak was associated with an animal exhibit not subject to Aedin's Law. Preventive measures such as educational signs and hand-washing facilities were in place, based on national guidelines compiled in the 2011 Compendium of Measures to Prevent Disease Associated with Animals in Public Settings. As a result of this outbreak, a multiagency task force is being created in North Carolina to evaluate the preventive measures that were in place during the 2011 state fair and to identify additional interventions that could be applied to prevent disease transmission in livestock exhibitions where physical contact with the public might occur.

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

NBC17 reports state health officials have determined that the source of the E. coli O157:H7 outbreak came from the Kelley Building at the North Carolina State Fair.

The Kelley Building is one of the permanent buildings where sheep, goats, and pigs were housed and competed in livestock show.

NBC-17 was the first to report a direct link to goats at the State Fair and the E. coli outbreak. A family of six in Sampson County who was diagnosed with E. coli reported they visited the goats while attending the State Fair.

The N.C. Division of Public Health says 27 individuals were identified as having contracted E. coli after attending the State Fair in October.

State Epidemiologist Megan Davies said the illness is likely related to animal contact, however the study did not implicate any specific animal or breed. Health officials say no other exhibits, foods or activities were linked to the E. coli infections.

In 2004, 108 cases of E. coli were reported, all linked to the petting zoo at the State Fair. After the 2004 outbreak, Fair officials installed handwashing stations with sinks, soap and water around the petting zoo and near animal exhibits.

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

After numerous outbreaks, U.K. health watchdogs are getting somewhat more serious about the risks posed by petting zoos and have banned a zoo from allowing the public contact with animals after its lack of hand-washing facilities posed a potential risk to the public.

Unfortunately, a child in Lancashire was already stricken with E. coli O157 after visiting the Dalton zoo in the summer.

South Lakes Wild Animal Park was served with a prohibition notice under the Health and Safety at Work Act after failing an inspection carried out by the Health Protection Agency (HPA) and Barrow Borough Council’s environmental health on August 18.

The North West Evening Mail reports inspectors found the zoo had failed to comply with new hygiene guidelines.

Prohibition notices can only be served when an inspector believes activities on at a premises involve or will involve a risk of serious personal injury.

The tourist attraction was ordered to stop letting people have contact with its animals until it had cleaned areas of the park and could provide handwashing facilities.

Zoo owner David Gill said he had taken immediate action after the notice was issued by installing 30 new handwashing areas.

Dr Nigel Calvert, NHS Cumbria’s associate director of public health, said: “The case of E coli was not definitely linked to the facility.

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