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E. coli outbreak finds eerie echo in N. Carolina

Aedin Gray tries to live like every other 2-year-old, but it's not easy scooting around with an insulin pump attached to your waist, or having your toe punctured by a needle several times a day.

The toddler spent more than a month at the University of North Carolina's Children's Hospital, including 15 days in the pediatric intensive-care unit as a dangerous kidney ailment ravaged her body.

Today, she forges ahead with typical childlike spunk and resilience. But she is far from healthy.

Every three days, the catheter for her insulin pump is moved. It's painful, but she's a good sport. She pouts but hardly complains.

Her kidneys function at 35 percent -- enough to keep her off dialysis but still a major concern.

She has diabetes.

And some day she might need a kidney transplant.

That prospect tortures Kyle and Liz Gray, who had no idea that a trip to a petting zoo -- a rite of passage for millions of American children -- would expose their little girl to life-threatening bacteria.

Though most victims fully recover, Aedin is a troubling reminder of the long-term struggle that likely awaits critically ill children in Central Florida who are battling the same kidney condition that nearly killed her a few months ago.

The ailment is caused by the Escherichia coli O157:H7 bacteria, which Florida health officials think is responsible for an outbreak of two dozen cases in the Orlando area that are eerily similar to one that sickened Aedin and 107 others last year.

By Monday, state health investigators were zeroing in on the suspected cause of the outbreak in Florida -- petting zoos run by a company called Ag-Venture Farm Shows.

A perilous visit

Five months ago, Aedin and her family walked into the Crossroads Farm Petting Zoo at the North Carolina State Fair.

Goats, sheep and llamas jostled for the food pellets in her outstretched hands -- even knocking her over.

She loved every minute.

Within a couple of weeks, Aedin was fighting for her life. It started with severe diarrhea, then progressed to the more serious kidney disease.

She spent 36 days in the hospital, as hemolytic uremic syndrome, or HUS, thrashed its way from her kidneys to her pancreas.

A buildup of fluid swelled Aedin's body to the point that she couldn't open her eyes. She didn't urinate for 14 days.

Dialysis, blood transfusions and intravenous fluids are the treatments for HUS.

For days, her parents would watch in horror as Aedin's blood looped out of her body through a tube in her neck, and back in through another tube. Each session would take three hours as the machine performed the vital life-sustaining functions that her kidneys could not.

There was the constant fear the machine would clog.

At least twice her blood pressure dropped, she began to pass out and her eyes rolled back in her head. Days later, another form of dialysis continuously pumped a solution into and out of her abdominal cavity.

E. coli O157:H7 is a strain particularly dangerous to humans. It can be passed through contact with farm animals' manure, contaminated food or beverages. About 8 percent of those infected get HUS, in which a toxin created by the bacteria causes microscopic clots in the vessels that feed the kidneys.

Complications can include renal failure, intestinal perforations and an inflammation of blood vessels called vasculitis in the brain and stomach, said Dr. Mehul Dixit, a pediatric nephrologist at Florida Hospital Orlando. It also can cause a potentially lethal condition called pancreatitis that can throw off insulin levels.

Dixit is treating two children with HUS, both of whom are in critical condition and on dialysis. The long-term effects may not be known for months, he said.

Aedin got pancreatitis, which led to what her parents and doctors hope is a temporary case of diabetes.

"Not every 2-year-old has an insulin pump attached to her body," her father said.

In other ways, though, Aedin acts like a typical 2-year-old. Her mom calls her "feisty" because she bosses everyone around.

But her parents can't help but wonder what she would be like if HUS hadn't attacked her.

"She can run around, but would she be faster? Would her muscle tone be better? We don't know," Kyle Gray said.

For now, she goes in for blood draws every other month to test whether her kidney function is improving. Every other week she visits her doctor and has her blood pressure checked.

Several times a day her mom pricks her toe to check her blood sugar. Aedin practices on her stuffed animals.

The fact that she jokes with her 5-year-old brother, Hunter, makes her parents feel better. Her favorite thing in the world is to tackle Hunter in a game they call wipeout.

Aedin was the last of 108 confirmed cases in the North Carolina E. coli outbreak. She was one of 15 children to develop HUS.

She left the hospital Dec. 15, one day before North Carolina health officials released a report tying the outbreak to the state fair's petting zoo.

Uncovering a mystery

Florida health investigators have confirmed 24 cases of people who became sick after attending Orange County's Central Florida Fair, the Florida Strawberry Festival in Plant City or the state fair in Tampa.

All victims have suffered diarrhea and either have tested positive for E. coli O157:H7 or have been diagnosed with the related kidney disease called HUS. Many visited petting zoos at the fairs.

So far, DNA tests have come back on 20 victims in Florida. They all have tested positive for a specific strain of the bacteria after visiting petting zoos run by Ag-Venture at one of the three fairs, state investigators said.

Florida's investigation seems to parallel the one summarized in a report from the North Carolina Department of Health and Human Services.

Like health officials in Florida, North Carolina investigators cast a wide net in the early days of the outbreak, initially identifying 180 cases before common links led them to focus on the state fair and refine the outbreak to 108 people.

The fair ended Oct. 24, and by early November health officials began to see the number of new cases fall. Investigators developed a study in which they compared those who became ill at the fair with those who didn't become ill in an attempt to isolate more links.

Meanwhile, they tested various locations on the fairgrounds for E. coli O157:H7. Their hypothesis focused on the petting zoos, but their questionnaires were extensive, covering petting zoos, other animal exhibits, food and drink, and even possible sources at home.

At first glance, the data tied the illness to four animal exhibits. But the dominant ties were with the Crossroads Farm Petting Zoo.

The petting zoo had signs and hand-sanitizing stations, but investigators think exposure to the bacteria may have occurred before people could even get their kids' hands washed.

Genetic "fingerprinting" finally identified unique strains of E. coli O157:H7 in a group of patients. Four areas at the fairgrounds came back positive for E. coli O157:H7, with the highest number of hits from Crossroads Farm Petting Zoo.

All 19 positive cultures from the Crossroads area matched the "fingerprint" of the patients' E. coli strain.

Investigators concluded that they had found their culprit.

While there may have been E. coli O157:H7 exposure in other parts of the fair, they said, most patients picked up the bacteria at Crossroads.

Too late

The Grays spent about 30 minutes at Crossroads that Saturday morning in October. They had not been allowed to take Aedin's stroller into the petting zoo, so the child was walking around.

She loves animals. They all used the hand sanitizer before leaving, as signs recommended. But the damage was done.

"I think they should keep kids under 5 out," Liz Gray said. "They couldn't make a sign with print big enough" to warn parents.

"It sounds harsh, but it's a cost-benefit analysis," her husband said.

A possible compromise could be setting up a separate animal exhibit for the younger children that would greatly limit the contact and more closely monitor the sanitation, said the Grays, who live in Carrboro, near Chapel Hill.

"States and the federal government need to get serious and clamp down on how they run these things," said Kyle Gray, who recently met with North Carolina's agriculture commissioner to urge changes at this year's fair. "I think there's a real benefit for kids to be exposed to animals."

As word spreads about such outbreaks, regulation could be good for business.

"If you adopt [Centers for Disease Control and Prevention] guidelines, I'm going to your petting zoo," Gray said. "Regulation can be good for business if you're the only one doing it."

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