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Outbreaks of Escherichia coli O157 infections at multiple county agricultural fairs: a hazard of mixing cattle, concession stands and children

Published online by Cambridge University Press:  23 December 2003

JOHN A. CRUMP
Affiliation:
Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA
CHRISTOPHER R. BRADEN
Affiliation:
Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
MEGHAN E. DEY
Affiliation:
Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
R. MICHAEL HOEKSTRA
Affiliation:
Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
JANET M. RICKELMAN-APISA
Affiliation:
Medina County Combined General Health District, Medina, OH, USA
DAVID A. BALDWIN
Affiliation:
Medina County Combined General Health District, Medina, OH, USA
SIETSKE J. DE FIJTER
Affiliation:
Ohio Department of Health, Columbus, OH, USA
SCOTT F. NOWICKI
Affiliation:
Ohio Department of Health, Columbus, OH, USA
ELIZABETH M. KOCH
Affiliation:
Ohio Department of Health, Columbus, OH, USA
TAMMY L. BANNERMAN
Affiliation:
Ohio Department of Health, Columbus, OH, USA
FORREST W. SMITH
Affiliation:
Ohio Department of Health, Columbus, OH, USA
JOHN P. SARISKY
Affiliation:
National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
NATASHA HOCHBERG
Affiliation:
Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
PAUL S. MEAD
Affiliation:
Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Abstract

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Escherichia coli O157 infections cause an estimated 60 deaths and 73000 illnesses annually in the United States. A marked summer peak in incidence is largely unexplained. We investigated an outbreak of E. coli O157 infections at an agricultural fair in Ohio and implicated consumption of beverages made with fairground water and sold by a geographically localized group of vendors who were all on the same branch of the fairground water distribution system. To examine county fair attendance as a risk factor for infection, we conducted two further epidemiological studies. In the first, we enhanced surveillance for E. coli O157 infections in 15 Northeast Ohio counties during the 2000 agricultural fair season and showed increased risk of E. coli O157 infection among fair attendees. In the second study, we examined Ohio Public Health Laboratory Information Service (PHLIS) data for 1999 using a time-varying covariate proportional hazards model and demonstrated an association between agricultural fairs and E. coli O157 infections, by county. Agricultural fair attendance is a risk factor for E. coli O157 infection in the United States and may contribute to the summer peak in incidence. Measures are needed to reduce transmission of enteric pathogens at agricultural fairs.

Type
Research Article
Copyright
2003 Cambridge University Press