With new reports coming in daily, state health officials said Wednesday they believe they have connected 11 cases of E. coli bacterial infection to contact with animals at the N.C. State Fair.
Health officials have investigated reports of 33 E. coli infections since last week. Of those, 24 have been confirmed, and 11 of those people reported visiting last month's fair in Raleigh, according to state health department spokesman Bill Furney.
Of the 24 confirmed E. coli infections, four are from Mecklenburg County, two from Union County and one from Cleveland County. Only one of those victims, a 21-month-old Mecklenburg girl who is recovering and was never hospitalized, attended the fair and visited a petting zoo, health officials said.
Six other counties have cases connected to the fair: five in Wake County and one each in Wilson, Lee, Chatham, Durham and Forsyth counties.
Most of the victims are children, and several are hospitalized with hemolytic uremic syndrome, a serious complication that can cause kidney failure, seizures and death, said N.C. state epidemiologist Dr. Jeffrey Engel. One of the children suffered kidney shutdown and is on dialysis, he said.
Four animal exhibits at the fair, including two petting zoos, a 4-H and farm animal exhibit and a pony ride, are possible sources of the E. coli infection, Engel said. "We're also looking at food sources. There's a lot of possible exposure sources at a fair."
More than 800,000 people attended the N.C. State Fair from Oct. 15 to 24.
E. coli is found in feces, and humans become ill if they drink or eat anything containing the bacteria. The most common way to contract the infection is from improperly cooked or handled food, but it can be passed on from animals.
Engel said E. coli infection "is an emerging problem of petting zoos," and some states have passed laws requiring signs and handwashing stations at petting zoos. North Carolina has no such law.
"There's absolutely no negligence here whatsoever," Engel said. "It's just a fact of life."
State agriculture officials said petting zoo operators at the state fair had posted signs reminding people to wash their hands after touching the animals and provided hand sanitizing stations. But Engel said one of the petting zoos was selling towelettes for 25 cents. He said soap and water are needed to be effective. "It's always a matter of degree and how adequate it was."
He recalled that, in 2001, Robeson County had an outbreak of E. coli infection in about 200 people. The cases were linked to cattle at a butter-making demonstration at an elementary school, Engel said.
Investigators are taking stool samples from those who have reported symptoms that could be caused by E. coli, Engel said. They have also sent letters to physicians asking them to be on the lookout for symptoms associated with E. coli.
Symptoms include diarrhea, vomiting, severe abdominal cramps and dehydration. Patients may have low-grade fever. The illness can be serious if left untreated, especially in children.
Engel urged people to prevent the spread of infection, especially in schools and day-care centers.
"If you know a child (with E. coli infection), wash your hands real well after changing diapers, wash hands before preparing meals, and to the extent possible, keep that infected child away from others."
He said teachers and school officials should have plenty of soap and paper towels for students and make sure they use them. "This is a very contagious organism."
Mecklenburg health officials said the county averages about 10 cases of E. coli per year in a five-year period. So far this year, there have been four.