Epidemiology and Infection



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


JOHN A. CRUMP a1a2c1, CHRISTOPHER R. BRADEN a1, MEGHAN E. DEY a1, R. MICHAEL HOEKSTRA a3, JANET M. RICKELMAN-APISA a4, DAVID A. BALDWIN a4, SIETSKE J. DE FIJTER a5, SCOTT F. NOWICKI a5, ELIZABETH M. KOCH a5, TAMMY L. BANNERMAN a5, FORREST W. SMITH a5, JOHN P. SARISKY a6, NATASHA HOCHBERG a1 and PAUL S. MEAD a1
a1 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
a2 Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA
a3 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
a4 Medina County Combined General Health District, Medina, OH, USA
a5 Ohio Department of Health, Columbus, OH, USA
a6 National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA

Article author query
crump j   [PubMed][Google Scholar] 
braden c   [PubMed][Google Scholar] 
dey m   [PubMed][Google Scholar] 
hoekstra r   [PubMed][Google Scholar] 
rickelman-apisa j   [PubMed][Google Scholar] 
baldwin d   [PubMed][Google Scholar] 
de fijter s   [PubMed][Google Scholar] 
nowicki s   [PubMed][Google Scholar] 
koch e   [PubMed][Google Scholar] 
bannerman t   [PubMed][Google Scholar] 
smith f   [PubMed][Google Scholar] 
sarisky j   [PubMed][Google Scholar] 
hochberg n   [PubMed][Google Scholar] 
mead p   [PubMed][Google Scholar] 

Abstract

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.

(Accepted June 24 2003)


Correspondence:
c1 J. A. Crump, Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, MS A-38, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.


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