It's been 3 years since deadly E.coli hit San Diego County Fair. What's being done to control infection risk?

San Diego Union-Tribune - 6/18/2022

As her family approached the exit of the livestock barn at the San Diego County Fair, Raeven Cox used her voice as she does working with local Marine Corps recruits.

"Wash your hands, wash your hands, wash your hands," she yelled, her voice penetrating through the background noise that filled the cavernous space. "You've got to wash your hands, all of you."

That perspective was not universal Wednesday afternoon at the Del Mar Fairgrounds, which experienced a deadly E. coli bacterial outbreak among nearly a dozen who visited animal exhibits in 2019, the last time the fair ran full bore.

An hour of continuous observation showed that about half of those walking through the main livestock barn paused to wash their hands on the way out while the rest breezed past numerous hand-washing stations despite the urging of signs directing them to lather up.

The ratio was much better for those exiting the small petting zoo stationed just outside the barn's entrance, with the majority — say, 80 percent or 90 percent — of families heading straight to the large cluster of nine gray washing stations as directed by an audio recording playing on a continuous loop in Spanish and English.

Visitors seemed to adhere quite closely to one of the main provisions designed to prevent infections, generally refraining from eating and drinking in spaces where animals were present.

Carlene Moore, the fair's chief executive officer, said that the approach is designed to offer visitors what they need to stay safe.

"From signage to reminders to information that we send out and have available on our website, (we are) just really trying to do that for the entire community and all of the visitors that come here," Moore said.

The fair was taking similar precautions in 2019 when kids, and a few adults, began arriving at local medical offices exhibiting the symptoms of shiga toxin-producing E. coli infection and one boy, two-year-old Jedidiah Cabezuela, died after suffering severe kidney damage. Another young boy suffered similar effects of infection but survived.

Extensive environmental testing never determined exactly where exposures occurred, though all were said to have visited animal areas while at the fair, and testing of food preparation areas was all negative as was testing of animals in that year's petting zoo.

The 22nd District Agricultural Board, which runs the Del Mar Fairgrounds, found itself facing claims for damages alleging that it did not do enough to warn its visitors of infection risk in animal areas and, according to court records and one of the attorneys representing families, recently settled for more than $4 million.

Though it was significant news when the outbreak occurred in 2019, the E. coli outbreak seems to have faded in the public consciousness, no doubt subsumed by the ongoing COVID-19 pandemic, which shut the fair down in 2020 and forced it into a much more minor event in 2021.

Potential infection was clearly not on the minds of those who thrust hands, arms and sometimes entire torsos into animal enclosures this week.

For a few hours early Wednesday afternoon, kids and their families were able to walk up to a long line of cows tethered to a rail in the main barn, standing on straw bedding to pet the animals. A volunteer eventually pulled a set of metal rails around the animals, fretting that some young children were getting very close without being accompanied by an adult.

Fair rules require straw spread on the ground to control droppings be removed regularly, and there were plenty of signs that was happening. However, there were few efforts visible to intervene if visitors wanted to get close to animals.

Moore said that the fair does not employ workers to observe the goings on in animal areas and intervene in situations where hands are not being washed, food is being consumed or very close contact with animals is occurring, though she said that general orders are in place for all employees to address what they see.

"All of our employees are, in essence, employed to remind people," Moore said.

That did not seem to be the case Wednesday afternoon, with many blue-shirted fair workers walking past close animal contact.

Russell Daly, a professor of veterinary medicine at South Dakota State University, is co-author of the Compendium of Measures to Prevent Disease Associated with Animals in Public Settings, essentially the Bible of best practices for such gatherings last updated by a group of experts from the National Association of State Public Health Veterinarians.

The peer-reviewed treatise recommends all of the precautions that the fair is currently taking, including ubiquitous hand-washing stations, signs prohibiting eating where animals are housed and having "transition areas" where people have space to wash up when they are ready to leave.

There is also a bullet item that encourages operators to "position venue staff members near exits to encourage compliance with proper hand washing." That provision, Daly said, is far from common at fairs and other events with animals, held nationwide.

"My opinion is it is not as common as it should be," Daly said in an email. "I think some of this is staffing-related, and some is not wanting to 'get in the face' of visitors they are wanting to accommodate.

"The best example of intervention I saw years ago at a county fair in South Dakota was a dedicated volunteer at the exhibit exit asking and encouraging every visitor to wash their hands. I think this happens, but possibly not as much as it could."

Generally, though, the expert said the emphasis is on trying to help families learn what they need to know to keep themselves and their children safe.

Nobody should lose sight, he added, of the value that livestock and other such animal-focused exhibits provide to participants and visitors, especially in largely urban areas.

"Generally, we recognize the importance of having animal exhibits accessible to the public, particularly as generations get farther removed from farm animals," Daly said. "It's more important than ever for people to know how those animals are raised and taken care of."

The amount of contact with animals on display at the fair this week did not bother Robin Dishman of San Carlos, who came to the fair with her grandkids. A registered nurse, she insisted that everybody in her party wear masks to keep the ever-evolving coronavirus threat at bay. But she said she was comfortable with her grandkids petting cows.

"They could touch, I was encouraging them to touch, just as long as they wash their hands, use the facilities that are available," Dishman said.

"If we had a 2-year-old, no, we wouldn't be touching the animals because their hands immediately go in their mouth."

Angelina Hicks contributed to this report.

This story originally appeared in San Diego Union-Tribune.