Part I: E. coli Status/Outbreak Report

E.Coli O157:H7, H3N2v Swine Flu and ?????

© Copyright 2012, Technical Solutions International, Inc.

It started with food…

And then went to fairs…

Recently it has turned tragic…

• 2007 – Clackamas County Fair

• Environmental Sampling

• 2009 – National Western Stock Show – Pacific National Exhibition – Western Fair ~ Ontario

• 2011 – North Carolina State Fair – Pacific National Exhibition ~

Vancouver • 2012

– Cleveland County Fair ~ NC

• Pre-2000 – 20+ Outbreaks on Fair Properties

• 2002 – Lane County Fair ~ OR

• 2004 – North Carolina State Fair

• 2005 – Florida State Fair – Central Florida Fair – Florida Strawberry Festival – County Fair in Wisconsin – Clarke County Fair ~ OR – Fresno County Fair ~ CA

E. coli at Fairs & Expositions

Litigation… Past, Present & Future?

• North Carolina State Fair* • Florida Strawberry Festival* • Central Florida Fair • Florida State Fair • The Big Fresno Fair* • Cleveland County Fair

North Carolina State Fair 2011 Outbreak

• 25 visitors became ill • Likely source non-contact animal exhibits (stalling

areas) • State Agriculture Commissioner convened Study

Commission • Primary recommendation: restrict public access

to animal exhibit stalling areas. • http://www.ncstatefair.org/StudyCommission/ • http://www.ncstatefair.org/StudyCommission/Re

commendations.pdf

North Carolina State Fair 2012 Restricted Public Access to Stalling Areas

North Carolina State Fair 2012 Restricted Public Access to Stalling Areas

Cleveland County Fair (NC) E.coli O157:H7 Outbreak 2012

Key Facts All agricultural fairs in NC with animal contact exhibits must be approved, inspected and in compliance with

Aedin’s Law (NCAC 52K, 9/1/2006)

– Signage message – Signage lettering size – Fencing – Age requirements – Feeding of animals – Staffing

– Surface areas – Health certificates &

vaccinations of animals

– Daily monitoring – Types of animals – Record keeping

http://www.ncga.state.nc.us/sessions/2005/bills/senate/pdf/s268v4.pdf

Timeline

• Cleveland County Fair Sept. 27-Oct. 6 • Health Department investigation begins 10/8 • Two Year Old Boy Dies, 10/12 • DHHS Case Count 10/15

– 22 children, 16 adults – 8 hospitalizations, including 1 death

• LA Times article, “Should Petting Zoos Be Banned?” 10/16

S M T W T F S

1 2 3 4 5 6

7 8 9 10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30 31

Timeline

• November 12 – News-Observer editorial, “Petting Zoos: Closing Time”

• November 16 – “The Petting Zoo Problem”, article from attorney Bill Marler’s, Food Safety News blog.

• November 20 – Local TV reports first lawsuit filed against fair

Confirmation of Source DHHS releases findings on 11/9/12

• 106 illnesses, additional 160 (fairgoers not ill) in case control study

• Two specific strains of E.coli O157:H7 identified from environmental samples at fairgrounds – Petting Zoo Area – Parking lot “downhill” from petting zoo

• Heavy rains 6 of 11 days at fair noted

Cleveland County Fairgrounds, Shelby, NC

What’s Next? • Final report from DHHS released 1/8/13

– “The requirements set forth in Aedin’s Law have done a great deal to protect the public in venues such as the CCF. Nonetheless, Aedin’s Law cannot guard against all possibilities. Ruminant animals are a known reservoir for STEC; environmental contamination in outbreak settings is not uncommon; and the provisions of the NASPHV animal contact compendium may not be adequate to prevent illness in certain situations.”

• DHHS expects to convene task force of experts and interested parties to review findings and discuss future

Part II - Other Zoonotic Disease Concerns for Agricultural Fairs

H3N2v Influenza

• Novel influenza A viruses are different than current circulating human H1 and H3 viruses

• Since 2007, novel influenza A infections in humans are nationally reportable to National Notifiable Diseases Surveillance System

• When swine influenza infects humans, they are referred to as “variant” viruses (denoted as “v” at end of subtype designation)

Source: CDC Influenza Division, October 2012

Variant Influenza Virus Case history

• Before 2005, 1 to 2 cases per year of swine flu viruses infecting people

• 2005-2011, variant viruses H1N1 and H3N2 identified more frequently, 3 – 5 cases per year.

• Aug. – Dec, 2011 there were 12 human cases

Source: CDC Influenza Division, October 2012

H3N2v Infections, July-Sept. 2012 306 cases

• 10 states • 29 fairs associated with human cases • 16 hospitalizations • 1 death • 14 cases of “human-to-human” transmission • Mean age = 8 years (range of 4 months-74 yrs) • Incubation = 2-3 days • Duration of illness = 3 -4 days

Source: CDC Influenza Division, October 2012

203 cases at fairs

• 98% had contact at fair – Direct = 77% (many exhibited hogs) – Indirect = 16%

• Of direct/indirect exposure, 66% had exposure to pigs for 2 – 7 days of 7 days prior to clinical onset

– “Attended Fair” = 5%

Source: CDC Influenza Division, October 2012

High Risk Individuals = Top Concern

• Younger than 5 years • Older than 65 years • Pre-existing conditions such as asthma,

diabetes, lung or heart diseases, other long-term health conditions

• Pregnant women

Source: CDC Influenza Division, October 2012

What Did Fairs Do? • Temp check pigs before unloading • Stepped up monitoring of pigs in barns by vets • Additional signage

– Caution to hi-risk – Wash hands

• Additional hand wash stations (and sanitizers) • Those with prior CPP workshop training were

better prepared to answer media inquiries

What Did Fairs Do?

• Release pigs early • Special

communication with exhibitors

• Step up cleaning protocol

• Barriers to prevent guest access to pigs

• Elimination of all pigs at fair

Expectations for Future Ideas circulating

• Shorten length of time pigs are on grounds to less than 72 hours

• Vaccination of pigs prior to fair exhibition • Daily monitoring of pigs in barns • Increase emphasis on good hygiene (exhibitors

and guests) • Encourage sick exhibitors to stay home • Increase communication with exhibitors

(awareness, last minute changes, etc.)

Expectations for Future Ideas circulating

• CDC Compendium will probably recommend increased awareness (signage) for high-risk populations (including avoidance of pig exhibits) as well as exhibitors wearing personal protective equipment (PPE such as masks, gloves, clothing) if pigs are ill.

• The “Swine Influenza Working Group” (representatives from CDC, USDA, NPB, various state public health and animal health agencies) invited IAFE to be represented. Measures to minimize influenza at exhibitions are in draft, to be published in next two months.

• It is expected the National Pork Board will issue recommendations.

Other Concerns

• Salmonella – No handling of baby poultry by anyone <5 years – No handling of reptiles, turtles, etc. by anyone <5 – CDC will recommend no reptiles, turtles, etc. be used as

prizes in carnival/fair games

Source:NASPHV Compendium

Other Concerns

• Cryptosporidium – No handling of baby ruminants unless strict hand

hygiene protocol implemented

Source: CDC Influenza Division, October 2012

Other Concerns

• Q Fever – Primarily from exposure to birthing by-products – Can be airborne

Source: CDC Influenza Division, October 2012

The “Compendium”

*Current version (2011) is available on-line *Expect 2013 version to be released in spring *Every fair will be sent notice of 2013 edition

http://www.omafra.gov.on.ca/english/food/foodsafety/producers/pettingfarms.htm

What IAFE Does for Members • Constant monitoring of news reports, issuance

of PAS (Personalize Alert System) news items. • Consults with fairs, their lawyers and

insurance companies involved in litigation • Created Members Only H3N2v information

page – Tip Sheets – Resources for more detail and signage examples – Latest news

• Special E-Announcement to fairs occurring in remainder of 3rdQ and 4thQ (H3N2v outbreak and the Cleveland County Fair E.coli outbreak)

• Constant communication with CDC Influenza Division

• Participation in study groups organized by NASPHV to review zoonotic disease from contact with animals in public settings

• One-on-one consulting for actions, media response

What Does IAFE Do for Members?

• Continue to make available the Consumer Protection Program workshop – a 7 hour session designed to enhance awareness and understanding of enteric pathogens (E.coli O157:H7) and risk management procedures.

What Does IAFE Do for Members?