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A Summer Fair, a Deadly Germ, and One Child's Life Taken

On Saturday, Aug. 28, Rachel Aldrich was a vibrant, intelligent 3-year-old, relishing the delights of the Washington County Fair in Greenwich, N.Y. On Saturday, Sept. 4, Rachel Aldrich was virtually brain-dead, spending the day that had been set aside for her fourth-birthday party in the Albany Medical Center, bathed in the prayers of family and friends to whom she was increasingly oblivious.

In between came the savaging of her body and brain by a virulent strain of E. coli bacteria, which health officials believe she and more than 150 other people -- including her 2-year-old sister, Kaylea -- ingested at the fair. Kaylea was listed in fair condition Monday at the hospital.

That Saturday at the fair was Rachel's "last day of fun in the world," her father, Wayne Aldrich, said Monday. Officials believe the outbreak may have been caused by surface runoff passing a barn that housed cattle and then contaminating the fair's water supply. Saturday afternoon, when Rachel's family made the decision to disconnect her life support system, Rachel became the first, and so far only, fatality attributed to the E. coli outbreak, which officials are calling the largest in the state's history.

On Monday, Wayne Aldrich, 32, accompanied by his wife, Lori, 26, recounted his daughter's last devastating days at a news conference at the medical center. Health officials issued warnings of their own, saying that they had identified two cases of secondary infection -- people who were not at the fair, but who share a household with someone who was.

To prevent further spread of the disease, they urged anyone with even mild diarrhea, one of the symptoms of infection, to take precautions like washing their hands and avoiding activities like food preparation. The authorities also advised them to avoid settings like day care or health care centers where the bacteria could easily spread.

In addition to Rachel, health officials have identified 155 confirmed or suspected E. coli cases. Almost all of the victims, who include at least 5 people from Vermont and Massachusetts, visited the fair the weekend of Aug. 28 and 29. Forty-five people are hospitalized. The incubation period for E. coli is one to nine days.

Many of the victims are children, who are particularly vulnerable to the bacteria's toxic effects. Kaylea, while faring far better than her sister, is not out of danger yet. Although she was in fair condition, she suffered a few setbacks Sunday night, her father said Monday.

At least some of the patients have E. coli O157:H7, a particularly toxic strain. Health officials have identified "massive E. coli contamination" at one well point at the fairgrounds, which has its own water system, said a spokeswoman for the state Health Department, Kristine Smith.

Ms. Smith said that a "terrible convergence of circumstances" -- first the drought, then a downpour, and the fair -- seemed likely to blame for the outbreak.

The working hypothesis is that after a major downpour on Aug. 26, the water probably swept surface runoff from a nearby barn, which was housing 700 head of cattle for an agricultural exhibit at the fair, into the soil. From there, the water likely leached into the aquifer, which was at a very low level because of the drought. The low level meant that instead of deeper, cleaner water, being drawn up, the contaminated surface water made its way into the well.

Contaminated water can expose people to bacteria in innumerable ways, especially at a county fair playing host to tens of thousands of people. It goes into ice, lemonade, even soda mixes. It can also be used to wash lettuce.

For the Aldrich girls who are from nearby Clifton Park, the fair was pure joy, their parents recalled. They looked at animals and rode the merry-go-round. They bounced in the big balloon castle and ate hot dogs and french fries and fried dough. By Sunday, the girls, usually the best of friends, were being unusually aggressive toward each other. By Monday, they were scratching each other and trying to fight. Kaylea came down with a fever, then Rachel did too. A pediatrician diagnosed the flu. The girls began sleeping excessively and developed bad cases of diarrhea. Rachel's was so bad, Aldrich said, that she was going to the bathroom every five minutes. She stopped sleeping, and was so tired that she would fall asleep as she sat on the toilet. When the parents saw blood in the girls' stools, they took them back to the doctor, who diagnosed salmonella, and had them admitted to Ellis Hospital in Schenectady. "Kaylea recovered quite well," Aldrich said.

"Rachel started to fall apart." She could no longer walk. She was lethargic. Her speech was slurred. Early Friday morning she was transferred to Albany Medical Center. At one point, her heart failed, and the supply of oxygen to her brain was cut off for seven minutes. She had kidney failure. The family ended life support the next day.

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