Marler Clark Retained in Maine Petting Zoo E. coli Outbreak

The 2015 Oxford County Fair that was held in mid-September will be remembered for the death of one child and the severe illness to another due to infections with E. coli O111. The common exposure to the two children was the same petting zoo.

The investigation is ongoing, but what has appeared thus far indicates a venue that followed few of the warnings and recommendations from decades of prior outbreaks that had sickened thousands. As more information comes out over the next week on what the Fair did and did not do to prevent these families’ tragedies, the fair should be judged from health official recommended since 2001.

“Reducing the Risk for Transmission of Enteric Pathogens at Petting Zoos, Open Farms, Animal Exhibits, and Other Venues Where the Public Has Contact With Farm Animals” – 2001 CDC Recommendations:

• Information should be provided. Persons providing public access to farm animals should inform visitors about the risk for transmission of enteric pathogens from farm animals to humans, and strategies for prevention of such transmission. This should include public information and training of facility staff. Visitors should be made aware that certain farm animals pose greater risk for transmitting enteric infections to humans than others. Such animals include calves and other young ruminant animals, young poultry, and ill animals. When possible, information should be provided before the visit.
• Venues should be designed to minimize risk. Farm animal contact is not appropriate at food service establishments and infant care settings, and special care should be taken with school-aged children. At venues where farm animal contact is desired, layout should provide a separate area where humans and animals interact and an area where animals are not allowed. Food and beverages should be prepared, served, and consumed only in animal-free areas. Animal petting should occur only in the interaction area to facilitate close supervision and coaching of visitors. Clear separation methods such as double barriers should be present to prevent contact with animals and their environment other than in the interaction area.
• Hand washing facilities should be adequate. Hand washing stations should be available to both the animal-free area and the interaction area. Running water, soap, and disposable towels should be available so that visitors can wash their hands immediately after contact with the animals. Hand washing facilities should be accessible, sufficient for the maximum anticipated attendance, and configured for use by children and adults. Children aged <5 years should wash their hands with adult supervision. Staff training and posted signs should emphasize the need to wash hands after touching animals or their environment, before eating, and on leaving the interaction area. Communal basins do not constitute adequate hand washing facilities. Where running water is not available, hand sanitizers may be better than using nothing. However, CDC makes no recommendations about the use of hand sanitizers because of a lack of independently verified studies of efficacy in this setting.
• Hand-mouth activities (e.g., eating and drinking, smoking, and carrying toys and pacifiers) should not be permitted in interaction areas.
• Persons at high risk for serious infections should observe heightened precaution. Everyone should handle farm animals as if the animals are colonized with human enteric pathogens. However, children aged <5 years, the elderly, pregnant women, and immunocompromised persons (e.g., those with HIV/AIDS) are at higher risk for serious infections. Such persons should weigh the risks for contact with farm animals. If allowed to have contact, children aged <5 years should be supervised closely by adults, with precautions strictly enforced.

“Compendium of Measures to Prevent Disease Associated with Animals in Public Settings, 2013” – National Association of State Public Health Veterinarians Animal Contact Compendium Committee 2013:

Venue operators should take the following steps:

• Become familiar with and implement the recommendations in this compendium.
• Consult with veterinarians, state and local agencies, and cooperative extension personnel on implementation of the recommendations.
• Become knowledgeable about the risks for disease and injury associated with animals and be able to explain risk-reduction measures to staff members and visitors.
• Be aware that direct contact with some animals is inappropriate in public settings, and this should be evaluated separately for different audiences.
• Develop or obtain training and educational materials and train staff members.
• Ensure that visitors receive educational messages before they enter the exhibit, including information that animals can cause injuries or carry organ- isms that can cause serious illness.
• Provide information in a simple and easy-to-under- stand format that is age and language appropriate.
• Provide information in multiple formats (e.g., signs, stickers, handouts, and verbal information) and languages.
• Provide information to persons arranging school field trips or classroom exhibits so that they can educate participants and parents before the visit.

Venue staff members should take the following steps:

• Become knowledgeable about the risks for dis- ease and injury associated with animals and be able to explain risk-reduction recommendations to visitors.
• Ensure that visitors receive educational messages regarding risks and prevention measures.
• Encourage compliance by the public with risk- reduction recommendations, especially compliance with hand-washing procedures as visitors exit animal areas.

Recommendations for nonanimal areas are as follows:

• Do not permit animals, except for service animals, in nonanimal areas.
• Store, prepare, serve, or consume food and beverages only in nonanimal areas.
• Provide hand-washing facilities and display hand- washing signs where food or beverages are served.
• Entrance transition areas should be designed to facilitate education.
• Post signs or otherwise notify visitors that they are entering an animal area and that there are risks associated with animal contact.
• Instruct visitors not to eat, drink, smoke, and place their hands in their mouth, or use bottles or pacifiers while in the animal area.
• Establish storage or holding areas for strollers and related items (e.g., wagons and diaper bags).
• Control visitor traffic to prevent overcrowding.
• Exit transition areas should be designed to facilitate hand washing.
• Post signs or otherwise instruct visitors to wash their hands when leaving the animal area.
• Provide accessible hand-washing stations for all visitors, including children and persons with disabilities. Position venue staff members near exits to encourage compliance with proper hand washing.

Recommendations for animal areas are as follows:

• Do not allow consumption of food and beverages in these areas.
• Do not allow toys, pacifiers, spill-proof cups, baby bottles, strollers, or similar items to enter the area.
• Prohibit smoking and other tobacco product use.
• Supervise children closely to discourage hand-to- mouth activities (e.g., nail biting and thumb sucking), contact with manure, and contact with soiled bedding. Children should not be allowed to sit or play on the ground in animal areas. If hands become soiled, supervise hand washing immediately.
• Ensure that regular animal feed and water are not accessible to the public.
• Allow the public to feed animals only if contact with animals is controlled (e.g., with barriers).
• Do not provide animal feed in containers that can be eaten by humans (e.g., ice cream cones) to decrease the risk of children eating food that has come into contact with animals.
• Promptly remove manure and soiled animal bedding from these areas.
• Assign trained staff members to encourage appropriate human-animal interactions, identify and reduce potential risks for patrons, and process reports of injuries and exposures.
• Store animal waste and specific tools for waste removal (e.g., shovels and pitchforks) in designated areas that are restricted from public access.
• Avoid transporting manure and soiled bedding through nonanimal areas or transition areas. If this is unavoidable, take precautions to prevent spillage.
• Where feasible, disinfect the area (e.g., flooring and railings) at least once daily.
• Provide adequate ventilation both for animals and humans.
• Minimize the use of animal areas for public activities (e.g., weddings and dances).
• If areas previously used for animals must be used for public events, they should be cleaned and disinfected, particularly if food and beverages are served.

A view from the Courtroom:

Under premises liability law, the entity or entities responsible for managing an animal exhibition have a duty of care to those it invites onto the premises. This duty includes the responsibility to adequately reduce risks the entity is or should be aware of. The duty also carries a responsibility to warn fairgoers of risks present at the exhibition.

The principles of negligence also revolve around the risks to fairgoers that animal exhibitors know of or reasonably should know of. To successfully bring a negligence claim, a sickened person would need to show that the actions of an animal exhibitor fell below a reasonable standard of care in the operation of the exhibit. Failing to implement the well-established recommendations of the CDC and NASPHV constitutes falling below that standard of care.

Both bases for liability on the part of animal exhibitors-premises liability and negligence-carry with them a burden of education on the part of the exhibitor. Because the law holds people to a standard of what they reasonably should know, ignorance of the risks involved is not an effective defense. The law thus provides no impetus to stray from the course of action that is best for both customers and exhibitors in the first place-recognizing the risk and taking steps to reduce it.