Genetic testing showed that Myles Herschaft and Colton Guay were infected with an indistinguishable strain of E. coli O111 identified as PulseNet Pattern Identification Numbers XDX01.1540/EXDA26.1144. There were no other patients infected with this genetic strain occurring temporally in the United States. Given the rarity of strain XDX01.1540/EXDA26.1144, it stands to reason that Myles Herschaft and Colton Guay shared a common exposure to this specific strain. Public health investigators identified two potential exposures, consumption of green grapes and attending the Oxford County Fair. Investigators ruled out green grapes as a source of infection after learning the grapes were prepackaged and distributed nationally. E. coli O111 was not found when samples were collected 18 days after the fair had ended and the grounds had been cleaned. It is noteworthy, however, that a different Shiga toxin E. coli, E. coli O100:nonmotile was found in an environmental sample. There was no testing of animals that were exhibited at the Oxford County Fair.
Transmission of STEC from animal areas of fairgrounds is a well-known risk factor and multiple outbreaks have occurred in the US over the past 10 years. Exposure to petting zoo animals and the petting zoo environment at the Oxford County Fair is the only plausible exposure to explain how Colton Guay and Myles Herschaft acquired their genetically indistinguishable E. coli O111 infections.
Drs. John Dunn and Kirk Smith are uniquely qualified to assess the facts of this case. Co-authors of the “Compendium of Measures to Prevent Disease Associated with Animals in Public Settings, 2013” published by the National Association of State Public Health Veterinarians and the CDC, Dr. Dunn and Dr. Smith reviewed ME CDC outbreak investigation documents. Independently they reached the same conclusion that Colton Quay and Myles Herschaft became ill with STEC O111 as a result of attending the Oxford County Fair.
Dr. Smith opines that the source of the E. coli O111 infections experienced by Myles Herschaft and Colton Quay was more likely than not the Oxford County Fair. Dr. Smith also opines that the Fair did not implement at least several critical prevention measures recommended in long-standing, widely available, national recommendations to prevent illness in visitors to public animal contact venues. He asserts that had these critical recommendations been implemented at the Fair, more likely than not the boys’ infections would have been avoided.
Dr. Dunn concurs stating that with regard to the outbreak of STEC O111 and subsequent HUS affecting Colton Guay and Myles Herschaft, “…with a reasonable degree of epidemiological certainty it is more likely than not that transmission occurred at the Oxford County Fair petting zoo.” He notes that information about measures taken to prevent disease transmission to fairgoers was limited but writes that “applicable recommendations from the Compendium were not implemented or implementation was not clearly evident in the materials” he reviewed. He states that in his opinion “to a reasonable degree of epidemiologic certainty, had the recommendations from the Compendium been implemented, it is more likely than not that the risk of STEC O111 infection for Colton Guay and Myles Herschaft would have been minimized and potentially prevented.”
Marler Clark represented both of the children affected by the outbreak, achieving settlements for both families.