Fair Safety with Bill Marler

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Fair Safety with Bill Marler

  1. 3. E. coli O157:H7 <ul><li>According to the Centers for Disease Control and Prevention: </li></ul><ul><li>73,000 cases occur annually </li></ul><ul><li>2,100 hospitalizations </li></ul><ul><li>61 fatal cases </li></ul>
  2. 4. Disease Process <ul><li>Transmitted by ingesting livestock feces </li></ul><ul><li>Infectious dose – as few as 50 cells </li></ul><ul><li>Incubation period – 3 to 4 days </li></ul>
  3. 5. E. coli O157:H7 Pathology Intestinal cells form pedestals in response to E. coli O157:H7 proteins. The bacteria then can release the shiga-like toxin directly into the blood stream.
  4. 6. Symptoms <ul><li>Severe abdominal pain, cramps, diarrhea, bloody diarrhea, fever, vomiting, painful rectal spasms </li></ul><ul><li>Hemolytic Uremic Syndrome (HUS) may develop </li></ul>
  5. 7. E. coli Illnesses at Fairs <ul><li>Over a dozen E. coli O157:H7 outbreaks associated with petting zoos and fairs reported since 1994 </li></ul><ul><li>Hundreds of illnesses and the development of HUS - Linked to human-animal contact, air, or dust-borne E. coli O157:H7 </li></ul>
  6. 8. Prevalence of E. coli O157:H7 <ul><li>E. coli O157:H7 found: </li></ul><ul><ul><li>13.8% in Beef Cattle </li></ul></ul><ul><ul><li>7.0% in Pest Fly Pools </li></ul></ul><ul><ul><li>5.9% in Dairy Cattle </li></ul></ul><ul><ul><li>5.2% in Sheep </li></ul></ul><ul><ul><li>3.6% in Pigs </li></ul></ul><ul><ul><li>2.8% in Goats </li></ul></ul><ul><li>2003 Ohio Study – 29 County and 3 State Fairs </li></ul>
  7. 9. 1994 – Farm Visitor Center – England <ul><li>Source – Direct Contact with Animals </li></ul><ul><li>Recommendations: </li></ul><ul><ul><li>Provide Information on importance of personal hygiene </li></ul></ul><ul><ul><li>Provide adequate hand washing facilities </li></ul></ul>
  8. 10. 1997 – Farms – Cornwall and West Devon, England <ul><li>Source – Direct Contact with Animals </li></ul><ul><li>Recommendations: </li></ul><ul><ul><li>Provide adequate hand washing facilities </li></ul></ul><ul><ul><li>Segregate eating and drinking areas from animal contact area </li></ul></ul><ul><ul><li>Prohibit visitor exposure to fecal contamination </li></ul></ul><ul><ul><li>Remove fecal contamination from walking trails </li></ul></ul><ul><ul><li>Enforce a “No Touch” policy </li></ul></ul><ul><ul><li>Enhance decontamination in Paddock areas by excluding animals for weeks before visit </li></ul></ul><ul><ul><li>Rigorously clean public access areas </li></ul></ul>
  9. 11. 2000 – Petting Zoo – Washington <ul><li>Source – Petting Zoo Animals </li></ul><ul><li>Recommendations: </li></ul><ul><ul><li>Provide adequate hand washing facilities </li></ul></ul><ul><ul><li>Provide signs instructing visitors to wash after touching animals </li></ul></ul>
  10. 12. 2000 – Dairy Farm – Pennsylvania <ul><li>Source – Animal Touching and Environment </li></ul><ul><li>Recommendations: </li></ul><ul><ul><li>Provide adequate hand washing facilities </li></ul></ul><ul><ul><li>Encourage hand washing </li></ul></ul>
  11. 13. 2001 – Petting Zoo – Pennsylvania <ul><li>Source – Contact with Animals </li></ul><ul><li>Recommendations: </li></ul><ul><ul><li>CDC Guidelines </li></ul></ul><ul><ul><ul><li>Provide information about the risk of animal contact and about strategies to prevent transmission </li></ul></ul></ul><ul><ul><ul><li>Design venues to minimize risk, especially when: </li></ul></ul></ul><ul><ul><ul><ul><li>Food is served </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Infants and school-aged children are present </li></ul></ul></ul></ul><ul><ul><ul><li>Allow animal petting only in specific areas under supervision </li></ul></ul></ul><ul><ul><ul><li>Provide barriers between animals and humans except in supervised interaction areas </li></ul></ul></ul>
  12. 14. 2001 – Petting Zoo – Pennsylvania <ul><ul><li>CDC Guidelines, Cont. </li></ul></ul><ul><ul><ul><li>Provide hand washing areas adequate in all areas </li></ul></ul></ul><ul><ul><ul><ul><li>Running water, soap and towels </li></ul></ul></ul></ul><ul><ul><ul><li>Provide sufficient hand washing facilities for expected attendance </li></ul></ul></ul><ul><ul><ul><li>Supervise children under five </li></ul></ul></ul><ul><ul><ul><li>Post signs </li></ul></ul></ul><ul><ul><ul><li>Provide hand washing training for staff </li></ul></ul></ul><ul><ul><ul><li>Prohibit hand-to-mouth activities </li></ul></ul></ul><ul><ul><ul><li>Exclude high risk individuals </li></ul></ul></ul>
  13. 15. 2001 – County Fair – Wisconsin <ul><li>Source – Animal Contact </li></ul><ul><li>Recommendations: </li></ul><ul><ul><li>Provide adequate hand washing facilities </li></ul></ul><ul><ul><li>Place food and beverage area as far away as possible from livestock areas </li></ul></ul>
  14. 16. 2001 – County Fair – Ohio <ul><li>Source – Cow manure in Sawdust </li></ul><ul><li>Recommendations: </li></ul><ul><ul><li>Disinfect housing facilities for animals </li></ul></ul><ul><ul><li>Provide a non-dusting ground covering </li></ul></ul><ul><ul><li>Provide adequate hand washing facilities </li></ul></ul>
  15. 17. 2001 – County Fair – Ohio <ul><li>Source – Contact with animals </li></ul><ul><li>Recommendations: </li></ul><ul><ul><li>Disinfect areas that house cattle </li></ul></ul><ul><ul><li>Remove fecal contamination from contact surfaces </li></ul></ul>
  16. 18. 2002 – Petting Zoo – Netherlands <ul><li>Source – Animal Contact </li></ul><ul><li>Recommendations: </li></ul><ul><ul><li>Strictly enforce personal hygiene in petting zoos </li></ul></ul>
  17. 19. 2002 – County Fair – Oregon <ul><li>Source - Dust contaminated with fecal matter </li></ul><ul><li>Recommendations: Limit Airborne E. coli by: 1). not moving soiled bedding during exhibit hours, 2). keep stall areas damp with an approved disinfectant </li></ul>
  18. 21. 2003 – County Fair – Texas <ul><li>Source – Rodeo and animal Exhibits </li></ul><ul><li>Recommendations: </li></ul><ul><ul><li>Emphasize personal hygiene and hand washing </li></ul></ul>
  19. 22. Pre-2004 CDC Recommendations <ul><li>Provide Information </li></ul><ul><ul><li>Inform visitors of the risk for transmission of enteric pathogens from animals to humans and strategies for prevention of transmission </li></ul></ul><ul><ul><li>Train facility staff </li></ul></ul><ul><ul><li>Warn visitors that certain animals pose greater risk </li></ul></ul>
  20. 23. Additional Pre-2004 Recommendations <ul><li>Source – Compendium of Measures to Prevent Disease and Injury Associated with Animals in Public Settings, 2004 </li></ul><ul><ul><li>Educate </li></ul></ul><ul><ul><ul><li>Provide educational materials prior to contact </li></ul></ul></ul><ul><ul><ul><li>Train petting zoo staff </li></ul></ul></ul><ul><ul><li>Allow contact with animals in controlled setting only </li></ul></ul><ul><ul><li>Design contact area to minimize risk and maximize hand washing </li></ul></ul>
  21. 24. Additional Pre-2004 Recommendations, Cont. <ul><ul><li>Give consideration to feces removal, waste runoff, and contact with humans </li></ul></ul><ul><ul><li>Take extra precautions to reduce risk of disease transmission in settings where direct animal contact is encouraged </li></ul></ul><ul><ul><li>Do not allow food or drink in animal contact area – no pacifiers, smoking allowed </li></ul></ul><ul><ul><li>Promptly remove feces and animal bedding </li></ul></ul><ul><ul><li>Closely supervise children less than five </li></ul></ul>
  22. 25. <ul><ul><li>Require staff to be in animal contact area to encourage proper hand washing </li></ul></ul><ul><ul><li>Provide transition areas between animal and non-animal areas </li></ul></ul><ul><ul><ul><li>Warn of risk of hand-to-mouth contact on entering </li></ul></ul></ul><ul><ul><ul><li>Warn on the need to wash hands on exiting </li></ul></ul></ul>Additional Pre-2004 Recommendations, Cont.
  23. 26. 2004 N.C. State Fair Outbreak <ul><li>43 confirmed; 108 cases total, E. coli O157:H7 </li></ul><ul><li>>50% under age 5, nearly 80% under 18. </li></ul><ul><li>Confirmed cases with matching PFGE pattern. Matched environmental samples at Crossroads Farm. Matched Crossroads Farm animals. </li></ul>
  24. 27. Recommendation v Reality <ul><li>Inform visitors of the risk for transmission of enteric pathogens from animals to humans and strategies for prevention of transmission. </li></ul><ul><li>“ Petting zoos failed to provide adequate signage. Signs were not sufficiently visible or cautionary: victims families do not remember seeing the signs at all.” </li></ul>
  25. 28. Recommendation v Reality <ul><li>Train petting zoo staff. </li></ul><ul><ul><li>Q. [Prior to the fair] were you aware that it was possible for E. coli to be transmitted to people from animal fecal matter? </li></ul></ul><ul><ul><li>A. No. (Jason Wilkie p. 71) </li></ul></ul><ul><ul><li>Q. Was there any aspect, from your understanding prior to the 2004 fair, of any health concerns to people being some of the reasons for having hand-washing stations on the way out? </li></ul></ul><ul><ul><li>A. No. (Jason Wilkie p. 55) </li></ul></ul><ul><ul><li>Q. Was there any part of that rule [prohibiting outside food in the exhibit] that was there to protect the health of people? </li></ul></ul><ul><ul><li>A. No. (Jason Wilkie p. 66) </li></ul></ul>
  26. 29. Recommendation v Reality <ul><li>Maximize hand washing; “Require staff in animal contact area to encourage hand washing.” </li></ul><ul><ul><li>Q. Did those people [watching the exit from the exhibit] watch to make sure people washed their hands? </li></ul></ul><ul><ul><li>A. No. (Jason Wilkie p. 68) </li></ul></ul><ul><ul><li>Use of hand sanitizer – not running water, no soap. </li></ul></ul>
  27. 30. More Hand Washing Reality <ul><li>Handwashing facilities not located near either petting zoo. </li></ul><ul><li>Fewer hand washing stations than the previous 2 years. </li></ul>
  28. 31. Recommendation v Reality <ul><li>Design contact area to minimize risk; provide transition areas between animal and non-animal areas. </li></ul><ul><li>No barriers; no transition areas. </li></ul><ul><li>100 goat or sheep in a pen 40 x 60. Owner reported overcrowding. </li></ul><ul><li>“ intensive and extensive direct contact with sheep and goats.” </li></ul><ul><li>The other petting zoo had railings between animals and customers. </li></ul>
  29. 32. Recommendation v Reality <ul><li>Allow contact with animals in controlled setting only. </li></ul><ul><li>“ Crossroads Farm permitted full contact between animals and humans. Some of the goats knocked children over…” </li></ul><ul><ul><li>Q. Why a rule against strollers? </li></ul></ul><ul><ul><li>A. Goats like to play king of the mountain, and they’re going to get to the highest spot they can, and it’s no fun when they land on a kid. </li></ul></ul>
  30. 33. Recommendation v Reality <ul><li>Do not allow food or drink in animal contact area. </li></ul><ul><li>A food vendor was positioned near the petting zoo - “a management error.” </li></ul><ul><ul><li>Q. Was there any part of that rule [prohibiting outside food in the exhibit] that was there to protect the health of people? </li></ul></ul><ul><ul><li>A. No. (Jason Wilkie p. 66) </li></ul></ul><ul><ul><li>Coin operated feed vending machines encouraged ‘fecal-oral’ contact. </li></ul></ul>
  31. 34. Recommendation v Reality <ul><li>Closely supervise children less than five. </li></ul><ul><li>Strollers allowed in one later tested positive for E. coli O157:H7. </li></ul><ul><li>Goats knocked down kids. </li></ul><ul><li>Goats jumping on children during feeding. </li></ul>
  32. 35. NCDACS and Crossroads <ul><li>Knew or should have known of risk. </li></ul><ul><li>Knew of should have known of precautions. </li></ul><ul><li>Failed to take precautions across the board. </li></ul>

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