2004 E. coli Outbreak Associated with the North Carolina State Fair in Raleigh
In late October 2004 the North Carolina Department of Health and Human Services (NCDHHS) conducted an E. coli O157:H7 outbreak investigation among attendees at the 2004 State Fair. 108 cases were identified with 15 who experienced HUS. The majority of cases occurred in children. This is one of the largest outbreaks attributed to a petting zoo. Illness was associated with animal contact and hand-to-mouth activities. One interesting finding was that the use of alcohol-based hand sanitizers was not protective in preventing illness. There was widespread environmental contamination of the grounds where the animals were housed (Arch Pediatr Adolesc Med. 2009;163(1):42-48).