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3 new cases of rare kidney disease found

By Robyn Shelton and Christopher Sherman

Sentinel Staff Writers

Posted March 25 2005

Doctors identified three new victims of a potentially fatal kidney condition Thursday while health investigators focused on a strain of dangerous bacteria as the possible cause of their illnesses.

Two people in Central Florida were diagnosed Thursday with the rare ailment called HUS, or hemolytic uremic syndrome, which attacks and shuts down the kidneys.

The Florida Department of Health also is investigating another case in Wisconsin involving a child who recently visited the Orlando area. The Wisconsin child brought the total number of confirmed illnesses to nine

Eight of those are children.

Health officials fanned out with a renewed sense of urgency, testing farm animals that might have spread the bacteria that often cause the kidney ailment. The animals were at two events from March 3-13: the Central Florida Fair in Orlando and the Florida Strawberry Festival in Plant City.

Investigators are most interested in the calves, goats and other animals that were used in petting zoos, where many of the children visited.

"We're focusing on where there was close contact with children and animals," said Thomas Holt, state veterinarian with the Florida Department of Agriculture and Consumer Services.

Six children remained very ill at hospitals in Orlando -- five in critical condition and one listed as serious. Doctors said four of the children have deteriorated to the point of requiring dialysis to augment their failed kidneys.

One sick child at Florida Hospital Orlando was improving and may be well enough to go home soon.

In other developments Thursday

· The outbreak had its first confirmed case of HUS in an adult, who was in serious condition. Health officials couldn't say whether the person had been to one of the fairs.

· Test results for one of the ill children came back positive for Escherichia coli -- labeled E. coli O157:H7. This bacterium has been linked to the HUS kidney ailment in previous outbreaks in other states.

· The Centers for Disease Control and Prevention released guidelines advising states how to protect the public at petting zoos and other events where farm animals are exhibited.

The recommendations are voluntary, and the CDC said the timing of the advisory had nothing to do with the spate of illnesses in Florida.

The guidelines have been in the works for several years, as health officials noticed an increasing number of disease-related outbreaks linked to farm animals at public events. The CDC counts about 25 such incidents stemming back to 1990 in states from Washington to Pennsylvania and North Carolina.

In Florida, health officials said they are looking at a number of possible causes, including sources beyond the animals.

For example, the state has begun interviewing food vendors from the two fairs to see whether contaminated food or beverages might be involved, said Joann Schulte, a medical epidemiologist with the Florida Department of Health in Tallahassee.

She said tests are ongoing to determine whether other patients also have the dangerous strain of E. coli.

However, Schulte said, it is possible that other patients might test negative for E. coli even if they have been exposed to it. That is because the bacteria might have passed through their systems completely during the first few days of symptoms, which include severe diarrhea.

At the same time, the state also is testing the animals for this strain. Results are expected in two or three days.

As part of their rounds Thursday, state veterinarians visited Ag-Venture Farm Shows in Plant City, which had animals at both the Central Florida Fair and the Florida Strawberry Festival.

"We're cooperating in any way we can," said owner Tom Umiker, whose family has been running its farm-education program for about 10 years. They take cows, sheep and goats to the events.

He said Ag-Venture works about 15 fairs a year across the country, going as far as Detroit, New York and Maine, as well as the Florida State Fair last month in Tampa, he said

News of the illnesses deeply troubled Umiker, who said he hasn't slept well in a couple of nights.

Umiker said the owners of animal exhibits rely on the fairgrounds to provide hand-washing and sanitizing areas, though they also sell hand wipes. Umiker has noticed improvement in recent years in the number of signs urging safe practices and hand-washing stations available at fairs around the country.

"I think you're going to see more of that at public events," he said.

Ag-Venture is licensed by the U.S. Department of Agriculture, which requires record keeping and subjects the company to annual random inspections.

Umiker said his animals have regular tests for tuberculosis and brucellosis, a bacterial infection that can be passed from cattle to people.

Umiker said he has asked veterinarians about regular testing for E. coli but has been told it would be impractical because the bacteria are common in animals. It doesn't make them sick and fluctuates continuously.

It may be in their systems one day, running its course as the animals shed the bacteria in their waste products, and be gone the next day.

Because the bacteria don't make the animals appear sick, it is not possible to weed out the carriers on any given day.

"We're dealing with something that can't be seen," he said.

Florida has no law regulating petting zoos. Some states such as Pennsylvania passed laws after similar outbreaks, said Minnesota veterinarian Jeff Bender, who helped write the CDC guidelines that came out Thursday.

For example, Pennsylvania requires petting zoos and other animal exhibitions to provide hand-washing facilities.

The law, passed in 2002, also requires them to inform the public about the types of diseases that animals can pass on to humans, according the Humane Society of the United States.

Bender said the risks are reduced greatly by such commonsense practices as washing hands thoroughly and not eating food while in close contact with the animals.

"It's in the best interest of these petting zoos to minimize these events, and it's entirely possible with some basic measures and proper supervision," said Bender, a professor in veterinary public health at the University of Minnesota.

The CDC's recommendations include: posting signs that warn visitors they are entering an animal area and advise them to wash their hands before leaving; having enough hand-washing stations available; and making certain they are child-friendly in size and ease of operation; and managing the flow of people through the exhibits.

Physicians in Orlando said they would not be surprised if more cases of HUS showed up in coming days. They're keeping an eye on two patients at Florida Hospital who are displaying symptoms.

They also no longer consider one girl who became ill with the disease weeks ago to be part of the current outbreak because her symptoms appeared much earlier than the others.

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