Two more E. coli cases linked to San Diego Fair, more expected

The San Diego County Fair’s E. coli outbreak has now outlasted the event itself.

Though the annual seaside celebration wrapped with a massive fireworks display Thursday night, July 4, the county public health department announced two more probable infections early Friday afternoon, July 5.

They included a 4-year-old girl who is the second child to be hospitalized after touring animal exhibits at the Del Mar Fairgrounds. The child visited the fair on June 21 and got sick on June 29.

Now standing at seven cases, the outbreak could hit double digits this weekend, because the health department is investigating three more cases.

At the moment, it remains unclear whether it was the fair’s petting zoo or its expansive livestock areas where infections occurred. Experts say it will be weeks until the results of DNA-based testing provide any additional clarity.

Meanwhile, the national headline-generating nature of San Diego’s outbreak has already had a tangible effect further north.

Terry Moore, communications director of the Orange County Fair and Event Center, said San Diego’s E. coli experience has definitely informed the organization’s plans for its own 23-day run, which is scheduled to start on July 12.

Though there are no plans to close livestock areas or put a planned animal petting zoo on hiatus, Moore said San Diego’s current travails have spurred installation of even more hand-washing stations than usual and also reconfiguration of some animal exhibits, funneling patrons more directly into washing areas.

There are also plans to employ more roaming attendants wearing big “wash your hands” buttons and on a moment-by-moment mission to intervene in cases where people decide to ignore warning signs and get up close and personal with animals anyway.

“We already have some of the most-stringent E. coli management protocols in the nation in place, but now we’re adding another layer,” Moore said.

Some might wonder: Given the trouble that San Diego has experienced, why not just cancel animal-related events?

Moore said doing so would go against the fair’s core mission which, despite what some might think, is not hocking funnel cakes and midway rides.

“The reason we exist is to educate people about agriculture,” Moore said. “Animals are an important part of our agricultural heritage, and we want to continue to have the animals there to educate the public by the safest means possible.”

Down south in San Diego, epidemiologists continue to track the spread of shiga-toxin-producing E. coli, a variant of the bacteria often referred to by the acronym STEC.

Dr. Eric McDonald, medical director of the county’s epidemiology and immunization services branch, could say little Friday afternoon, July 5, about the medical reasons for the 4-year-old’s current hospitalization. He did indicate that she is not suffering from hemolytic uremic syndrome, the severe kidney complication that contributed to the death of 2-year-old Jedidiah King Cabezuela on June 24.

The second case added to the total Friday involved a 2-year-old girl who visited the fair on June 22 and got sick on June 26. Both new cases are currently classified as “probable” because the bacterial cultures necessary to confirm E. coli’s presence are not yet complete.

Certainly anyone whose child has become infected during the outbreak wants to know where specifically in the fairgrounds the infections occurred, but it’s not likely an answer to that question will be available soon.

Environmental health inspectors took samples from individual animals, and from the surrounding environment, which have been sent to the U.S. Centers for Disease Control and Prevention for analysis. Comparing the genetic fingerprints generated by those tests with similar analyses of the STEC bacteria found in each child will provide the best shot at narrowing the search down to individual areas of the fairgrounds or to individual animals. But fine-grained test results are not expected for at least several more weeks.

In other states where children have died after visiting animal exhibits at fairs, lawsuits have followed. So far, there are no signs that lawsuits are in the offing. As of Friday afternoon, July 5, the fair board had received no claims for E. coli-related damages. Claims generally must be filed before filing suit against a government agency such as the 22nd Agricultural District Association that runs the fair.

The fair board does intend to re-examine its policies around animal activities, said spokeswoman Annie Pierce, but that will wait until test results are in.

“Once we have some conclusions, our team will certainly be meeting to discuss next steps,” Pierce said.

No one understands the legal landscape of food poisoning better than Bill Marler, a Seattle attorney known for representing a long list of children and adults who contracted harmful infections. Marler, who said he is not representing any San Diego fair clients, said these types of cases often come down to whether or not a fair was closely following recommendations included in a compendium of animal-related best practices by the National Association of State Public Health Veterinarians.

“Most of the time, the fair is doing some things, but they don’t necessarily live up to everything that’s in the compendium,” Marler said.

Fair officials have said publicly that they have tried to hold to recognized standards wherever possible, including plenty of warning signs, regular pen cleaning, dozens of hand-washing stations and attendants stationed outside the petting zoo to remind parents and children exiting the attraction that they need to scrub up.

While the death of a 2-year-old boy, and the infections occurring inside a beloved and highly-trafficked venue such as the Del Mar Fairgrounds draws the kind of attention that can make it seem like a contagion is underway, the data does not show that’s the case.

San Diego County updated its STEC infection totals last week and they showed that there were more confirmed cases in June 2018 than there were in the same month this year. And July 2018 eclipsed any other month of either year, showing that E. coli cases are simply more common in the summer whether or not they occur at the fair.
-- Paul Sisson is a reporter for The San Diego Union Tribune