Should they have animals? 13 sickened including several hospitalized after E. coli outbreak linked to California pumpkin farm last year

Drew Bollea of CBS Sacremento reports a California pumpkin farm south of Marysville is set to open for the season after making changes to its petting zoo following an E. coli outbreak last year.

Roughly 180,000 people will come through the gates of Bishop’s Pumpkin Farm during the seven weeks they’re open this fall.

“We spent a lot of time last winter thinking about whether we should even have animals,” said Wayne Bishop, the Co-Owner of Bishop’s Pumpkin Farm.

Bishop says the decision was difficult after an E. coli outbreak last year was linked to their farm.

“Five to 10 people who were seriously ill,” said Bishop.

According to a report by the California Department of Health, E. coli was detected in fecal matter found in more than a dozen samples from the petting zoo. Thirteen people reported an illness and exposure to the petting zoo. Several children ended up in the hospital for observation.

“With all that rain, it’s very possible that bacteria was washed out of the pens out into areas that people were walking,” said Bishop describing one theory of how people may have contracted the bacteria.

So what changes were made to the petting zoo at Bishop’s Pumpkin Farm this year?

  • The animals are now vaccinated
  • Guests are required to watch a health and safety video
  • The pens are redesigned to keep waste and water away from guests.
  • Bishop added more hand washing stations near the entrance and exit making it nearly impossible to leave the petting zoo without washing your hands.

“If you want to be able to pet animals, this is the safest place in the world to do it,” said Bishop.

Erdozain GKukanich KChapman BPowell D. 2012. Observation of public health risk behaviours, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011. Zoonoses Public Health. 2012 Jul 30. doi: 10.1111/j.1863-2378.2012.01531.x. [Epub ahead of print]

Abstract below:

Observation of public health risk behaviors, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011Outbreaks of human illness have been linked to visiting settings with animal contact throughout developed countries. This paper details an observational study of hand hygiene tool availability and recommendations; frequency of risky behavior; and, handwashing attempts by visitors in Kansas (9) and Missouri (4), U.S., petting zoos. Handwashing signs and hand hygiene stations were available at the exit of animal-contact areas in 10/13 and 8/13 petting zoos respectively. Risky behaviors were observed being performed at all petting zoos by at least one visitor. Frequently observed behaviors were: children (10/13 petting zoos) and adults (9/13 petting zoos) touching hands to face within animal-contact areas; animals licking children’s and adults’ hands (7/13 and 4/13 petting zoos, respectively); and children and adults drinking within animal-contact areas (5/13 petting zoos each). Of 574 visitors observed for hand hygiene when exiting animal-contact areas, 37% (n=214) of individuals attempted some type of hand hygiene, with male adults, female adults, and children attempting at similar rates (32%, 40%, and 37% respectively). Visitors were 4.8x more likely to wash their hands when a staff member was present within or at the exit to the animal-contact area (136/231, 59%) than when no staff member was present (78/343, 23%; p<0.001, OR=4.863, 95% C.I.=3.380-6.998). Visitors at zoos with a fence as a partial barrier to human-animal contact were 2.3x more likely to wash their hands (188/460, 40.9%) than visitors allowed to enter the animals’ yard for contact (26/114, 22.8%; p<0.001, OR= 2.339, 95% CI= 1.454-3.763). Inconsistencies existed in tool availability, signage, and supervision of animal-contact. Risk communication was poor, with few petting zoos outlining risks associated with animal-contact, or providing recommendations for precautions to be taken to reduce these risks.

Handwashing is never enough, bureaucrats have no spine: E. coli O157 from animals at Ekka edition

The EKKA, Queensland’s agricultural showpiece, concluded last week in Brisbane, about the same time an uncomfortable memory was finally published in the peer-reviewed cyber-sphere.

In Aug. 2013, 56 people became sick with E. coli O157 after contact with animals, or hanging out in the animal facility at the EKKA.

No child, or family, should have to go through grief and anguish because they took the kids to a petting zoo at the local fair.

Being repeatedly told they failed because they didn’t wash their hands is condescending. And ignores the science.

Handwashing is never enough.

At the time, a Biosecurity Australia dude said, “This highlights the importance of people practising sound hygiene measures following all contact with animals, their body fluids and excretions.”

How many want bureaucrats talking about body secretions?

As Anderson and Weese found in 2011 at a temporary petting zoo in Guelph (that’s in Canada) using video observation, 58 per cent of visitors performed some form of hand hygiene (either using water, soap and water, or hand sanitizer), and two interventions (improved signage while offering hand sanitizer, and verbal hand hygiene reminders by venue staff) were associated with increased hand hygiene compliance. U.K. health officials currently recommend handwashing stations with soap and water only (no wipes or sanitizers).

And while some studies suggest inadequate handwashing facilities may have contributed to enteric disease outbreaks or washing hands was protective against illness, others suggest relevant infectious agents may be aerosolized and inhaled.

In the fall of 2009, an E. coli O157:H7 outbreak at Godstone Petting Farm in the U.K resulted in 93 illnesses – primarily little kids.

The investigation into the Godstone outbreak identified evidence of environmental contamination outside the main barn, indicating acquisition of illness through both direct animal or fecal contact, and indirect environmental contact (e.g. contacting railings or soiled footwear).

Aerosolization of potential pathogens is also possible, as suggested in an E. coli O157:H7 outbreak at a county fair in Oregon, in which 60 people fell ill.

As part of the response to the Godstone outbreak, U.K. health types recommended handwashing stations with soap and water only (no wipes or sanitizers, because they don’t work that well under certain conditions).

Ihekweazu et al. subsequently concluded that in the Godstone outbreak, “handwashing conferred no demonstrable protective effect. …

“Moreover, from the findings of many previous published studies, it must be assumed that all petting or open farms are potentially high-risk environments for the acquisition of VTEC O157 infection (an STEC).”

This is what the Ekka folks had to say about the 2013 outbreak (which no one in Brisbane seems to know about).

The 2013 Ekka agricultural show displayed >10,000 animals and included sections where direct contact between visitors and animals could occur. The animal boulevard included a large animal nursery where visitors could pat and feed farm animals, including goats, lambs, calves, piglets, chicks, ducklings, donkeys, and turkeys. A milking demonstration took place in an area adjacent to the animal nursery and visitors were invited to milk a cow. Unpasteurized milk was not served. Visitors could also view the birth of lambs that took place in an enclosed booth. The birthed lambs were available for supervised petting after >24 h after veterinary clearance. Other animals displayed in the animal boulevard and other pavilions were less accessible to the public for direct contact. 

The number of visitors in the animal nursery was not restricted. Limited unsupervised handwashing facilities were available opposite the exit of the animal nursery. Hand sanitizers were available in other areas. Signs in animal contact areas encouraged visitors to wash their hands. Staff at the agricultural show regularly removed animal waste from animal contact areas. 

Stool samples from 56 of 57 case-patients showed identical virulence gene profiles, consisting of stx1, stx2, eaeA, and ehxA . The virulence gene profile of the remaining probable primary case-patient was only stx2 and ehxA. Twenty bovine, 4 ovine, and 2 caprine fecal samples were tested from animals traced to other properties after the show had ended. Serotype O157:H- was confirmed from 51 of the human cases, and also from ovine, caprine, and bovine feces, and the animal bedding sample. All O157:H- isolated from animal and environmental sources displayed the same MLVA profiles (6_8_2_9_4_7_8_2_3_8 and 11–7-13–4-5–6-4–9) (Technical Appendix Table 2), stx1a and stx2c subtypes, and sequence type ST11, and 2/51 of human isolates differed by 1 allele in 1 of the MLVA profiles. Although E. coli O157 has frequently been reported to belong to sequence type 11 (13), the MLVA profiles were novel to the Queensland collection of previously typed STEC isolates (n = 112). 

A table of petting zoo outbreaks is available at http://www.barfblog.com/wp-content/uploads/2017/08/Petting-Zoo-Outbreaks-Table-7-26-17.xlsx

Mild illness during outbreak of shiga toxin-producing Escherichia coli O157 infections associated with agricultural show, Australia

Emerging Infectious Diseases, vol. 23, no 10, October 2017, Bhakti R. Vasant, Russell J. Stafford, Amy V. Jennison, Sonya M. Bennett, Robert J. Bell, Christine J. Doyle, Jeannette R. Young, Susan A. Vlack, Paul Titmus, Debra El Saadi, Kari A.J. Jarvinen, Patricia Coward, Janine Barrett, Megan Staples, Rikki M.A. Graham, Helen V. Smith, and Stephen B. Lambert

https://wwwnc.cdc.gov/eid/article/23/10/16-1836_article

During a large outbreak of Shiga toxin−producing Escherichia coli illness associated with an agricultural show in Australia, we used whole-genome sequencing to detect an IS1203v insertion in the Shiga toxin 2c subunit A gene of Shiga toxin−producing E. coli. Our study showed that clinical illness was mild, and hemolytic uremic syndrome was not detected.

Erdozain G, Kukanich K, Chapman B, Powell D. 2012. Observation of public health risk behaviours, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011. Zoonoses Public Health. 2012

Outbreaks of human illness have been linked to visiting settings with animal contact throughout developed countries. This paper details an observational study of hand hygiene tool availability and recommendations; frequency of risky behavior; and, handwashing attempts by visitors in Kansas (9) and Missouri (4), U.S., petting zoos. Handwashing signs and hand hygiene stations were available at the exit of animal-contact areas in 10/13 and 8/13 petting zoos respectively. Risky behaviors were observed being performed at all petting zoos by at least one visitor. Frequently observed behaviors were: children (10/13 petting zoos) and adults (9/13 petting zoos) touching hands to face within animal-contact areas; animals licking children’s and adults’ hands (7/13 and 4/13 petting zoos, respectively); and children and adults drinking within animal-contact areas (5/13 petting zoos each). Of 574 visitors observed for hand hygiene when exiting animal-contact areas, 37% (n=214) of individuals attempted some type of hand hygiene, with male adults, female adults, and children attempting at similar rates (32%, 40%, and 37% respectively). Visitors were 4.8x more likely to wash their hands when a staff member was present within or at the exit to the animal-contact area (136/231, 59%) than when no staff member was present (78/343, 23%; p<0.001, OR=4.863, 95% C.I.=3.380-6.998). Visitors at zoos with a fence as a partial barrier to human-animal contact were 2.3x more likely to wash their hands (188/460, 40.9%) than visitors allowed to enter the animals’ yard for contact (26/114, 22.8%; p<0.001, OR= 2.339, 95% CI= 1.454-3.763). Inconsistencies existed in tool availability, signage, and supervision of animal-contact. Risk communication was poor, with few petting zoos outlining risks associated with animal-contact, or providing recommendations for precautions to be taken to reduce these risks.

8 sick with E. coli from Colorado fair

At least eight people are sick with Shiga toxin-producing E. coli after spending time at the Mesa County Fair, which ran from July 25-29 in Grand Junction.

The Post Independent reports Mesa County Public Health officials have been working with representatives from the fair and those who became sick to find the source of the illness.

Shiga toxin-producing E. coli is common in cattle, sheep and goats. It can be contracted through direct contact with these animals or contact with things in close proximity to the animals that may have been cross contaminated.

Mesa County Public Health officials have also been in close communication with child-care providers and health-care providers to determine the magnitude of the outbreak, and to prevent further spread of the illness.

People can become sick between two and 10 days after being infected with Shiga toxin-producing E. coli.

E. coli O157 claims sister; brother remains critical in Minn.

Two siblings, Kade and Kallan Maresh from Maple Lake, Minnesota, were stricken with E. coli O157, possibly after visiting a petting zoo.

The family’s Caring Bridge site broke the sad news on Sunday when it reported that Kallan lost her battle with the deadly strain.

Bill Hudson of CBS Minnesota reports she died one week after shiga toxin-producing E. coli O157 raced through her young body.

“It’s very serious, potentially fatal,” says George Canas, M.D., with Kidney Specialists of Minnesota.’

The state Health Department is investigating where the E. coli exposure was. Possibly, something as simple as a trip to a petting zoo and transferring the bacteria onto the child’s hands and their mouth. It’s also common to acquire an exposure by eating unsanitary meat, produce or dairy.

The severe case eventually claimed Kallan’s life just a week after she was rushed to Masonic Children’s Hospital. Fortunately, her older brother, Kade, continues his fight, although his situation remains extremely serious.

Handwashing is never enough: Texas family says sons infected with E. coli at petting zoo

An Azle family wants to warn others after both their young boys were hospitalized with E. coli earlier this year.

“It’s awful. You can’t do anything but just sit there and watch your child hurt,” Emily Miller told WFAA.

Miller’s sons Brayden, 7, and Dylan, 5, were both diagnosed with an E. coli infection, and Dylan’s case impacted his kidneys. Miller said he required dialysis, and he was hospitalized for 27 days, including several nights in the ICU.

“It’s such a crazy thought that this could happen,” Miller said.

She was surprised by the intensity of the illness, but also by where her boys may have come into contact with E. coli. She said doctors believe they were likely contaminated while the family was visiting a petting zoo.

“I wasn’t aware that you could get it from animals and livestock,” Miller said.

She took the boys to the petting zoo back in January, and four days later her oldest was in the hospital.

Both brothers are now doing well, though Dylan is still on blood pressure medicine due to the illness, Miller said.

The Centers for Disease Control says petting zoos do pose risks, as livestock can carry E. coli bacteria. The CDC’s advice is to wash hands with soap and water immediately after being near animals, whether you touch them or not.

The CDC also says that soap and water is more effective than instant hand sanitizers, and if sanitizers are the only option, go ahead and use them but follow up with soap and water as soon as possible.

A table of petting zoo outbreaks is available at http://barfblog.com/wp-content/uploads/2014/04/Petting-Zoo-Outbreaks-Table-4-8-14.xlsx.

Erdozain G, Kukanich K, Chapman B, Powell D. 2012. Observation of public health risk behaviours, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011. Zoonoses Public Health. 2012 Jul 30. doi: 10.1111/j.1863-2378.2012.01531.x. [Epub ahead of print]

Abstract below:

Observation of public health risk behaviors, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011Outbreaks of human illness have been linked to visiting settings with animal contact throughout developed countries. This paper details an observational study of hand hygiene tool availability and recommendations; frequency of risky behavior; and, handwashing attempts by visitors in Kansas (9) and Missouri (4), U.S., petting zoos. Handwashing signs and hand hygiene stations were available at the exit of animal-contact areas in 10/13 and 8/13 petting zoos respectively. Risky behaviors were observed being performed at all petting zoos by at least one visitor. Frequently observed behaviors were: children (10/13 petting zoos) and adults (9/13 petting zoos) touching hands to face within animal-contact areas; animals licking children’s and adults’ hands (7/13 and 4/13 petting zoos, respectively); and children and adults drinking within animal-contact areas (5/13 petting zoos each). Of 574 visitors observed for hand hygiene when exiting animal-contact areas, 37% (n=214) of individuals attempted some type of hand hygiene, with male adults, female adults, and children attempting at similar rates (32%, 40%, and 37% respectively). Visitors were 4.8x more likely to wash their hands when a staff member was present within or at the exit to the animal-contact area (136/231, 59%) than when no staff member was present (78/343, 23%; p<0.001, OR=4.863, 95% C.I.=3.380-6.998). Visitors at zoos with a fence as a partial barrier to human-animal contact were 2.3x more likely to wash their hands (188/460, 40.9%) than visitors allowed to enter the animals’ yard for contact (26/114, 22.8%; p<0.001, OR= 2.339, 95% CI= 1.454-3.763). Inconsistencies existed in tool availability, signage, and supervision of animal-contact. Risk communication was poor, with few petting zoos outlining risks associated with animal-contact, or providing recommendations for precautions to be taken to reduce these risks.

Best practices for planning events encouraging human-animal interactions

Zoonoses and Public Health 62:90-99, 2015

G. Erdozain , K. KuKanich , B. Chapman  and D. Powell

http://onlinelibrary.wiley.com/doi/10.1111/zph.12117/abstract?deniedAccess

Educational events encouraging human–animal interaction include the risk of zoonotic disease transmission. It is estimated that 14% of all disease in the US caused by Campylobacter spp., Cryptosporidium spp., Shiga toxin-producing Escherichia coli (STEC) O157, non-O157 STECs, Listeria monocytogenes, nontyphoidal Salmonella enterica and Yersinia enterocolitica were attributable to animal contact. This article reviews best practices for organizing events where human–animal interactions are encouraged, with the objective of lowering the risk of zoonotic disease transmission.

petting1-791x1024

petting2-791x1024 

Heaven on Earth rescue farm linked to crypto outbreak

Farm sanctuaries sound nice, former Daily Show host Jon Stewart and his partner run several.

But does Jon Stewart know microbiology?

Visitors to the popular Heaven on Earth animal rescue farm in Bethlehem Township, Pennsylvania (which Stewart is not affiliated with, that I know of), have come down with a variety of stomach illnesses linked to the farm, state health officials said Friday.

“At least five laboratory-confirmed cryptosporidium infections and at least six compatible illnesses have been associated with this farm,” the state Department of Health said Friday in a health advisory.

Hundreds of people may have been exposed to infected young goats and calves in the last four or five weeks since the public was invited to help feed the animals at the 3868 Bethman Road farm just east of Route 33, the advisory noted.

The Health Department is asking that all those who became ill after visiting the farm contact the department at 877-PA-HEALTH and consult their personal doctors.

Meanwhile, Heaven on Earth Farm owner Jahjah Melhem announced Friday the farm is no longer open to the public.

“In the past four years, Heaven on Earth Farm has had the pleasure of meeting so many of you. There has been a ton of love and support that visited the property at any given time,” Melhem says on the farm’s Facebook page. “We have decided that it is in our best interest to close the farm to the public so that we can focus on the well-being of the animals.”

He said he is working with the Health Department to determine the origin of the reported sicknesses. He said he isn’t sure anyone was infected at the farm, but it is possible.

“People come every day with their kids and we never had a problem,” Melhem said. “I’m fine. I’m here every day. Three or four women are here every day and none of them are sick.”

The farm has attracted 600 people since mid-February to help Melhem with 30 baby goats he rescued to avoid their slaughter. He asked for volunteers, he said, because the goats needed bottle-feeding four times a day.

On Thursday, a Health Department researcher told him she had three or four cases of people who visited the farm becoming sick later. Since then, the department has associated additional illnesses with the farm.

A table of petting zoo outbreaks is available at http://barfblog.com/wp-content/uploads/2014/04/Petting-Zoo-Outbreaks-Table-4-8-14.xlsx.

Best practices for planning events encouraging human-animal interactions

Zoonoses and Public Health 62:90-99, 2015

G. Erdozain , K. KuKanich , B. Chapman  and D. Powell

http://onlinelibrary.wiley.com/doi/10.1111/zph.12117/abstract?deniedAccess

Educational events encouraging human–animal interaction include the risk of zoonotic disease transmission. It is estimated that 14% of all disease in the US caused by Campylobacter spp., Cryptosporidium spp., Shiga toxin-producing Escherichia coli (STEC) O157, non-O157 STECs, Listeria monocytogenes, nontyphoidal Salmonella enterica and Yersinia enterocolitica were attributable to animal contact. This article reviews best practices for organizing events where human–animal interactions are encouraged, with the objective of lowering the risk of zoonotic disease transmission.

 

First we take Manhattan, then Berlin: Zoonoses in the food chain

I may have spoken at this in 1998.

quote-first-we-take-manhattan-then-we-take-berlin-leonard-cohen-87-88-65Or something else.

My parents warned me Germans would not get my sense of humor, and I hobbled around Berlin with my first affliction of what I later understood to be familial-associated gout.

The beer probably didn’t help.

Regardless, the occurrence of zoonotic pathogens and toxigenic bacteria in the food chain and the associated risk for humans were the focus of the4th Symposium for Zoonoses and Food Safety” at the Federal Institute for Risk Assessment (BfR) in Berlin.

Around 250 participants were discussing strategies to combat zoonotic pathogens in livestock, their occurrence in foods of animal origin and the role of toxigenic bacteria for food safety.

“The sharp decline of salmonellosis in humans in recent years can be seen as a success of the measures taken to combat this pathogen in poultry flocks,” says BfR President Professor Dr. Dr. Andreas Hensel. “Accordingly, there is now more focus on other sources of human infection”. This includes the occurrence of Salmonella in pig farming and in reptiles kept as pets.

For this reason, the symposium also focused on how to reduce the spread of salmonella in pig herds and pork meat. To do so, the food chain was examined from feedstuffs all the way through to food retail. New goals and initiatives of the federal states were presented too. The possible role of household pets as a source of infection for humans was also thematised using the example of reptiles.

The risk posed to humans by other zoonotic pathogens was also looked at. New laboratory methods play an important role in estimating these risks and assessing possible infection chains. This was illustrated by describing the investigation of a listeriosis outbreak. Another current example is the appraisal of the gut bacteria Clostridium difficile as a zoonotic pathogen.

one-healthA second main focus of the symposium was toxigenic bacteria. These are bacteria whose metabolites can trigger illnesses known as food intoxications (poisonings) that can sometimes be severe. It is not the bacterium but rather the toxin produced by it that is the cause of the health impairment.

The number of cases of foodborne diseases through toxigenic bacteria reported on EU level is increasing continuously. With approx. 16%, overall food intoxications took third place in reported cases of foodborne disease outbreaks after viruses and salmonella in 2014.

The main focus of the symposium was on the significance, occurrence and detection of toxigenic Staphylococci, Bacilli and Clostridia. The results of outbreak investigations in Germany were presented among other things, along with suitable examination methods for detecting toxigenic bacteria in prepared foods. The experts also picked up on the question of whether more efforts have to be made to better estimate and minimise the risk posed by toxigenic bacteria in the future.

 

Petting zoo: Minnesota 10-year-old awarded $7.55 million in E. coli settlement

Maury Glover of Fo 9 reports a jury awarded $7.5 million to a Rosemount, Minnesota family after a young girl contracted E. coli from a petting zoo at Dehn’s Pumpkins in Dayton.

emma-rosemount-girl-e-coli_1479962267763_2325612_ver1-0_640_360In 2013, Emma Heidish spent a month overcoming a potentially deadly form of kidney disease which cause her kidneys to shut down and required surgery and near constant dialysis.

On Tuesday, a Hennepin County jury found the owners of the farm where she got E. coli, Dehn’s Pumpkins in Dayton, negligent for not taking steps to prevent their animals from transmitting diseases and awarded Emma $7.5 million.

Emma was one of seven people sickened in an October 2013 E. coli O157:H7 outbreak linked by the Minnesota Department of Health to cows in the animal attraction  at Dehn’s Pumpkins, LLC, a business located in Dayton, MN.

The bulk of the money is for future medical bills and pain and suffering.

“It is one of the largest verdicts in the country for an E. coli outbreak for a condition like this one and its one of the largest involving a petting zoo case,” Emma’s attorney, Fred Pritzker, said. “The people who run the pumpkin patch are decent people. It’s not that they were mean spirited. But, what they didn’t know caused a great deal of pain and suffering for my clients.”

Since the outbreak, the popular pumpkin patch no longer operates a petting zoo, but Pritzker sais animal attractions like it are not regulated or inspected.

His firm will push for a new law, named after Emma, requiring petting zoos to follow safety precautions, like having hand washing stations nearby to help prevent the spread of the disease.

“There have been 150 to 200 cases of outbreaks involving animals in public settings in the last 15 years, Pritzker said

Pritzker says Emma probably won’t see all the money because the farm’s insurance doesn’t have that much coverage.

A table of petting zoo outbreaks (which needs to be updatd) is available at http://barfblog.com/wp-content/uploads/2014/04/Petting-Zoo-Outbreaks-Table-4-8-14.xlsx

UK farm still owes £100k over E. coli outbreak at petting zoo

In April 2014, at least 15 people, primarily children, who visited a petting farm in Lancashire were stricken with E. coli O157.

lambing-live-prestonWhen the outbreak was first reported, the UK National Farmer’s Union reassured people that petting farms are safe as long as hygiene rules are followed and that they should continue to go despite the E. coli outbreak.

Not quite.

You people are assholes.

There have been outbreaks where pathogens have been aerosolized and that handwashing was not a significant control factor.

In 2014, a UK court heard that four children suffered potentially life-threatening kidney failure after an E. coli outbreak at a Lancashire farm shop.

Huntley’s Country Stores, near Preston, admitted health and safety breaches at a lambing event in April 2014.

The four children needed life-saving kidney dialysis with one needing three operations and blood transfusions.

The farming attraction was fined £60,000 and told to pay £60,000 costs at Preston Crown Court on Monday.

In total, 15 people were struck down by the bug – 13 of them children – with nine needing hospital treatment. A further 15 possible cases were also recorded.

The court heard the tragically typical litany of errors:

  • visitors allowed uncontrolled access to lambs – children could enter animal pens and roll in feces-covered straw;
  • during bottle-feeding, lambs were allowed to climb onto seats, leaving them soiled with feces;
  • pens had open bar gates allowing contaminated bedding to spill onto main visitor area;
  • animals were densely packed, allowing bacteria build-up; and,
  • hand washing basins meant for visitors were used to clean animal feeding dishes.

Juliette Martin, of Clitheroe, took her daughter Annabelle, 7, to the ‘Lambing Live’ event at Easter in 2014.

The youngster, who had bottle-fed a lamb, suffered kidney failure and needed three operations, three blood transfusions and 11 days of dialysis.

Mrs Martin said: “If we ever thought that by feeding lambs that our daughter would be fighting for her life we would never have visited Huntley’s.”

Now, while the company has “accepted responsibility in court for failings in the assessment of risks” it hasn’t paid up.

The latest count is more than 20 children ill from the 2014 visit, and the owners of Huntley’s Country Stores still owe more than £100,000 after being convicted of health and safety offences in December 2015.

Managing director Harry Wilson appeared before Blackburn magistrates to ask for more time to pay the financial penalties.

Magistrates were told that the outfit had repaid £14,800 of the court costs, leaving £45,120 outstanding. But the £60,000 fine was still owed, the court was told.

Mr Wilson told magistrates that the after effects of the publicity surrounding the E.coli case, which was brought by South Ribble Council, were still being felt by the business.

Questioned by magistrates about how the outstanding sums could be met, he said: “At the present moment we cannot afford any more because we are just starting to get the business going. It might be two years before we recover.”

Huntley’s had been previously ordered to pay £5,000 every three months.

Magistrates ordered that they should be required to find £1,000 every month instead, up to and including May 2017. The penalty would then resume at its previous rate.

A table of petting zoo outbreaks is available at http://barfblog.com/wp-content/uploads/2014/04/Petting-Zoo-Outbreaks-Table-4-8-14.xlsx.

Crypto is all around us

This report outlines the evidence and main conclusions presented at an expert workshop on Cryptosporidium genotyping held on 16 and 17 June 2016, hosted by the Robert Koch Institute, Berlin, and funded by EU COST Action FA1408 “A European Network for Foodborne Parasites: Euro-FBP” (http://www.euro-fbp.org).

erddig-hall-wales-lamb-cryptosproidiumThe consultation brought together 23 scientists and experts in public and animal health from 12 European countries and the United States (US) to discuss how Cryptosporidium spp. surveillance and outbreak investigations could benefit from a harmonised approach to intra-species differentiation of the two main human pathogens, C. parvum and C. hominis. These are major zoonotic and anthroponotic causes of gastroenteritis, respectively. There is currently no standardised genotyping scheme for these protozoan parasites.

The workshop was organised in two parts: firstly, specialists described the current state of knowledge and need, and secondly, four working groups considered different aspects of the development, implementation and maintenance of Cryptosporidium genotyping schemes.

An overview of genotyping Cryptosporidium for public health purposes

Laetitia Kortbeek (National Institute for Public Health and the Environment, the Netherlands) described the diagnosis of Cryptosporidium and the usefulness of genotyping for epidemiology. Although cryptosporidiosis cases are notifiable in some European Union (EU) countries, testing and diagnostic practices are variable. Improved understanding of the epidemiology, sources and transmission of cryptosporidiosis is needed, but surveillance is also highly variable and the quality of the data provided to the European Centre for Disease Prevention and Control (ECDC) hinders comparisons between countries [1]. Improved diagnosis and basic surveillance across the EU would provide the means to estimate and compare the prevalence of cryptosporidiosis and detect changing trends in transmission.

The complexity of Cryptosporidium transmission was highlighted using data from the Netherlands, where a proportion of Cryptosporidium-positive stools are genotyped to identify species. In the second half of 2012, an excess of cases, mainly due to C. hominis, triggered an alert to other EU countries via ECDC’s Epidemic Intelligence Information System for Food and Waterborne Diseases (EPIS); the United Kingdom (UK) and Germany also reported an increase [2]. An ongoing case–control study in the Netherlands failed to reveal an endemic source. In the following year, C. parvum predominated and risk factors for infection included the use of inland bathing waters and animal contact (not unexpected for C. parvum). More discriminatory genotyping of isolates could contribute to the identification of parasite sources and routes of transmission. As a first step, partial sequencing of a gene encoding a highly variable surface antigen (gp60) has shown that C. hominis allele IbA10G2 is highly prevalent throughout Europe, whereas C. parvum has greater diversity at this locus [3]. There is no specific licensed treatment in the EU for cryptosporidiosis, so understanding the epidemiology and improving the ability to identify sources through genotyping are important for the interruption of transmission routes and subsequent disease reduction.

The confusing world of Cryptosporidium typing

Giovanni Widmer (Tufts University, US) described how consideration of the reproductive biology and genetics of the parasite and analysis of metadata from studies that used the same genotyping markers have provided further clarification of Cryptosporidium diversity, especially within C. parvum. The lifecycle involves asexual and sexual reproductive stages, requiring a multilocus scheme to account for sexual recombination within genetically diverse populations. Therefore, it is important to select markers that are sufficiently distant or located on different chromosomes, to ensure they are not in linkage. Excluding markers that provide redundant information reduces wastage and increases efficiency. As part of the marker selection process, ordination methods such as principal coordinates analysis and rank abundance plots can be used to estimate objectively how informative individual genetic markers and their combinations are. Because of the multivariate nature of multilocus data, ordination methods are ideal to visualise genetic similarity among isolates [4] and infer the likely source of an outbreak. In silico analysis of existing data can be used to improve and harmonise current genotyping approaches for surveillance and outbreak investigations.

Human epidemiology and food-borne outbreaks

Rachel Chalmers (National Cryptosporidium Reference Unit, UK) showed how supplementing epidemiological and environmental data with Cryptosporidium species and gp60 allele identification has strengthened the statistical evidence of association with food exposures in outbreaks. In May 2012, an excess of 300 cases of C. parvum was linked to the consumption of pre-cut mixed salad leaves, spinach and tomatoes [5]. The odds of association with eating pre-cut mixed salad leaves were increased when the case definition was restricted to those infected with gp60 allele IIaA15G2R1. In 2015, C. hominis infections exceeded expected numbers by more than 900 cases in late summer/early autumn, triggering an EPIS alert, with a similar increase reported by the Netherlands. Hypothesis-generating questionnaires revealed no sufficiently common exposures or risk factors to allow a case–control study. Isolates with the gp60 allele IbA10G2 predominated. Not only is this allele highly prevalent among C. hominis isolates from northern Europe, but there is also limited heterogeneity at other loci, highlighting the limitation of multilocus genotyping as an epidemiological tool for this species [3]. Suitable samples [6] with the IbA10G2 allele were further analysed by whole genome sequencing. Very few differences were seen in pairwise comparisons, with at most 50 single nucleotide polymorphisms (SNPs) observed in the ca 9.2 Mbp genome; the significance of these extremely small differences is currently unknown. In contrast, a C. parvum outbreak of more than 300 cases at the end of 2015 was defined by an unusual gp60 allele, IIdA24G1, recognised initially by the Scottish Parasite Diagnostic and Reference Laboratory, highlighting the value of genotyping routinely and including the data in national surveillance. A case–control study revealed food-linked exposures and the outbreak remains under investigation at the time of writing, demonstrating the difficulties in food chain investigations.

Zoonotic transmission

Karin Troell (National Veterinary Institute, Sweden) illustrated the importance of applying One Health approaches to the investigation of Cryptosporidium as a zoonosis. In Sweden, samples are tested from any likely host animal that is linked to a human cryptosporidiosis case, for example from household cats when C. felis has been detected in a patient [7]. This has led to collaborative studies on other, less common, species causing human infections. These findings reinforce the need for clinical diagnostics to detect not only C. parvum and C. hominis.

The most common zoonotic species in humans, C. parvum, has an unusual epidemiology in cattle in Sweden, where some studies have shown low prevalence even in young calves. This is in contrast to other countries where C. parvum is the main cause of cryptosporidiosis in pre-weaned calves [8]. Despite this, one of the most common C. parvum gp60 alleles in cattle, IIaA16G1R1, is also frequent in humans in Sweden. To support epidemiological investigations, a multilocus sequencing tool based on nine SNP markers across five chromosomes has been evaluated in a multiplex PCR on numerous samples; high discriminatory power and evidence of transmission between calves and humans in Sweden was shown.However, further studies of the population structure of C. parvum are needed across Europe to assess the broader applicability of this scheme.

How diversity relates to transmission to humans

Simone Cacciò (National Institute of Health, Italy) described the apparent geographic diversity of C. parvum in Ireland, Italy, and Scotland, as revealed by multilocus analyses. Studies so far indicate that in those countries, C. parvum populations from humans and livestock may have become isolated from each other, to the extent that the opportunity for genetic interchange appears limited [9]. To investigate the degree of genetic isolation, further studies are needed across Europe that include the major hosts for C. parvum. One study showed that in the UK, a high proportion of C. hominis isolates were indistinguishable at multiple loci, contrasting with those from Uganda, where a more diverse population structure was found [10]. Therefore, conclusions from one location may not be widely applicable and information is specific to host populations, whether these are defined geographically or demographically. A European-wide project (COMPARE; http://www.compare-europe.eu/) aims to increase the number of whole genome sequences for Cryptosporidium and to develop bioinformatic pipelines that would further the understanding of the population biology and determinants of virulence of the parasite. Information from COMPARE will undoubtedly benefit typing scheme development.

Four working groups considered how the evidence presented could be used to develop, implement and maintain suitable genotyping resources for Cryptosporidium.

Are the genetic and population structures of Cryptosporidium amenable to developing a genotyping scheme?

One working group considered whether reliable predictions of transmission can be made by combining genotyping with epidemiological and clinical data, considering that genetic diversity and population structures differ for C. parvum and C. hominis. It concluded that data are currently unavailable for much of Europe and are often not comparable because of lack of standardisation, indicating the need for further studies. Sampling frames need to follow the One Health concept, including both human and animal samples. Comparative analysis of increasingly available genome sequence data can provide a solid basis for marker selection. An evaluation process should be defined and applied to those markers already used.

What needs to be done to develop a standardised, multilocus genotyping scheme?

Another working group considered the development of separate multilocus schemes for C. parvum and C. hominis to provide robust, cost-effective assays, suitable for specialist and reference laboratories. Fragment sizing of regions containing tandem nucleotide repeats was considered alongside in-house sequencing. The decision whether to choose fragment sizing or sequencing will depend on the best workflow for individual laboratories, but markers that provide the same results with either method would be desirable. Sequence data from gp60 remains important. The most suitable markers need to be identified through a structured and objective process, ideally starting from whole-genome comparisons. Well-defined panels of samples are needed for biological and statistical evaluation of individual markers and their combinations, before progressing to inter-laboratory trials. DNA standards should be available. A web-based database needs be developed to contextualise metadata and genetic identification of isolates.

A multilocus genotyping scheme as a component of epidemic preparedness and response

A third working group considered multilocus genotyping as a component of a resilient response for health protection, highlighting that any scheme should be informative for epidemiological investigations and the detection and management of outbreaks, and that genotyping results should be incorporated into the collection of high quality epidemiological data. Differentiating between what is ‘nice to know’ and ‘essential to know’ is important: at present, there is more to be gained from genotyping C. parvum, as a high proportion of C. hominis cases in Europe have the gp60 allele IbA10G2, which is associated with low diversity at other markers. If genotyping all cases cannot be justified, selection will depend on outbreak size and available information and is probably best delivered as a test done in specialist or reference laboratories. Simulated outbreak exercises should be undertaken.

Sustainability of a standardised, multilocus genotyping scheme

The final working group discussed the elements needed to sustain a standardised scheme, including validation, external quality control (EQA), and inclusion of future developments, for example identification of new informative markers. A good mechanism for EQA should be established using an independent provider, also providing training modules and DNA standards. Central, ongoing collection of a minimum set of metadata are needed to facilitate surveillance of genotypes and meaningful comparisons and interpretation; this may be possible through the Cryptosporidium database at http://CryptoDB.org. Nomenclature for multilocus genotypes needs to be adopted for effective interdisciplinary communication.

Conclusions

Increased standardisation of diagnostic practices for Cryptosporidium is fundamental to the meaningful interpretation of surveillance data and distribution of species and genotypes. A robust, standardised, multilocus genotyping scheme should be developed, using a defined process to replace or supplement the multitude of genotyping methods used. Although further genotyping of C. parvum would be highly informative, this procedure may not always be warranted for the genetically more conserved C. hominis in Europe. A web-based database, enabling interpretation of genotype occurrence and distribution trends in an epidemiological context, is required. Genotype data should be incorporated into national surveillance programmes, and a standardised nomenclature provided for effective communication with public health professionals.

Towards a consensus on genotyping schemes for surveillance and outbreak investigations of Cryptosporidium, Berlin, June 2016

Eurosurveillance, Volume 21, Issue 37, 15 September 2016, DOI: http://dx.doi.org/10.2807/1560-7917.ES.2016.21.37.30338

R Chalmers, S Cacciò

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22578