Healthy fairsHealthy fairs

Gail R. Hansen, DVM, MPHGail R. Hansen, DVM, MPHKansas Department of Health and EnvironmentKansas Department of Health and Environment

Ghansen@kdhe.state.ks.us Ghansen@kdhe.state.ks.us

KD

HEShort versionShort version

(If you have to leave now)(If you have to leave now)

Website: Website: http://www.cdc.gov/mmwr/preview/mmwrhtml

/rr5404a1.htm

KD

HE

Zoonoses and fairs Zoonoses and fairs

Historical perspectiveHistorical perspective Why you are glad you aren’t in FL,NC, AZ

CompendiumCompendium Prevent disease from animals in public settings

Specific diseasesSpecific diseases What does this mean for youWhat does this mean for you

Practical tips Q&A and DiscussionQ&A and Discussion

KD

HE

Definition Definition

ZoonosisZoonosis Disease of animals transmissible to

humans

KD

HE

Basic tenet Basic tenet

Animals at fairs are a GOOD ideaAnimals at fairs are a GOOD idea Entertainment Education

KD

HE

When bad things happen to When bad things happen to good exhibitsgood exhibits

KD

HE

25+ outbreaks from 1990-200025+ outbreaks from 1990-2000 E. coli 2000 E. coli 2000

PA 51 ill 51 ill

WA 5 ill5 ill

Salmonella 1996Salmonella 1996 Denver zoo “Dragon days”

>75 ill>75 ill Many never touched the reptileMany never touched the reptile

directlydirectly

KD

HE

E. coli, NC E. coli, NC

Oct. 2004Oct. 2004State fairState fair108 ill108 ill13 hospitalized13 hospitalizedE. coli found months laterE. coli found months laterParent awareness of potential more likely to Parent awareness of potential more likely to

help than using a hand sanitizerhelp than using a hand sanitizer

Credit: John R. Dunn, DVM, PhD

Sheep and goats

E. coliE. coli O157 positive O157 positive

E. coliE. coli O157 negative O157 negative

Systematic sample of Systematic sample of Petting Zoo BPetting Zoo B

•Soil / shavings Soil / shavings sampled 16 days sampled 16 days after fairafter fair

Results: sheep / goat Results: sheep / goat area uniformly area uniformly contaminated with contaminated with E. E. colicoli O157 O157

Credit: John R. Dunn, DVM, PhDCredit: John R. Dunn, DVM, PhD

Sheep and goats

E. coliE. coli O157 positive O157 positive

E. coliE. coli O157 negative O157 negative

Systematically re-Systematically re-sampled Petting Zoo sampled Petting Zoo B: 100 days after fairB: 100 days after fair

•Results: Results:

Sheep and goat area Sheep and goat area remained uniformly remained uniformly contaminatedcontaminated

Credit: John R. Dunn, DVM, PhDCredit: John R. Dunn, DVM, PhD

KD

HE

E. coli, FLE. coli, FL Local fairs, petting zoos

26 confirmed, 68 total26 confirmed, 68 total22 hospitalized22 hospitalized

KD

HE

E. coli, AZE. coli, AZ July 2005July 2005

Petting zoo (in a zoo) 2 children hospitalized

Only 1 with direct contactOnly 1 with direct contact E. coli found in petting zoo area and play

area downhill from petting zooPetting zoo and play area closedPetting zoo and play area closed

KD

HE

Increased chance of illnessIncreased chance of illness

Populations at higher riskPopulations at higher risk Infants Children <5 Pregnant women People undergoing chemotherapy People with organ transplants People with HIV/AIDS Elderly

KD

HE

Increased chance of diseaseIncreased chance of disease

Riskier animalsRiskier animals Reptiles Chicks/ducklings Puppies, kittens < 6 months Animals with diarrhea Exotic and wild animals

KD

HECompendiumCompendium

Measures to Prevent Disease Associated Measures to Prevent Disease Associated with Animals in Public Settings 2005with Animals in Public Settings 2005 Not eliminate Minimize risks

NASPHV/CDCNASPHV/CDC Document on CD-ROMDocument on CD-ROM

KD

HE

Specific diseasesSpecific diseases Enteric diseases Enteric diseases

Salmonella E. coli O157:H7 Campylobacter

RabiesRabies Other pathogensOther pathogens Bites/injuries Bites/injuries

KD

HE

Salmonella Salmonella

BacteriaBacteria Contamination of bedding, fur, skin,

saliva Fecal/oral transmissionFecal/oral transmission Diarrhea/vomitingDiarrhea/vomiting

May be bloody diarrhea

Illness 6-72 hours after exposureIllness 6-72 hours after exposure

KD

HE

SalmonellaSalmonella

All are animal originAll are animal origin ReptilesReptiles

Intermittent shedding No treatment

PoultryPoultry Eggs Chicks, ducklings

Swine, cattle, sheep, goatsSwine, cattle, sheep, goats

KD

HEE. coli O157:H7E. coli O157:H7

BacteriaBacteria Diarrhea/vomitingDiarrhea/vomiting

Bloody diarrhea Kidney failure (HUS)

Illness 3-8 days after exposureIllness 3-8 days after exposure Unpasteurized juice, undercooked Unpasteurized juice, undercooked

hamburgerhamburger

KD

HEE. coli O157:H7E. coli O157:H7

AnimalsAnimals Cattle Deer

Infected animals rarely look illInfected animals rarely look ill Shed when stressedShed when stressed Summer and fall Summer and fall

Peak shedding

KD

HECampylobacterCampylobacter

BacteriaBacteria Diarrhea/vomitingDiarrhea/vomiting

GBS can occur later Illness 1-10 days after exposureIllness 1-10 days after exposure

KD

HECampylobacterCampylobacter

Raw milk Raw milk 2 outbreaks in KS in past 3 years

Kittens, puppiesKittens, puppies Usually with diarrhea

PoultryPoultry Horses Horses

KD

HE

Rabies Rabies

VirusVirus FatalFatal All mammals potentialAll mammals potential

Carnivores most likely Calf at local KS fair

Discovered before fair openedDiscovered before fair opened ““ADR”, sent homeADR”, sent home

KD

HE

Parasites and moreParasites and more

RingwormRingworm GA, show lambs

CryptosporidiosisCryptosporidiosis OrfOrf LeptospirosisLeptospirosis

KD

HEBites/injuries Bites/injuries

Dis-easeDis-ease

AvoidableAvoidable Bites, scratchesBites, scratches KicksKicks Falls from animals, crushingFalls from animals, crushing

KD

HE

Laws and RegulationsLaws and Regulations

Regulations in KSRegulations in KS KAHD regs on inspection

No federal lawsNo federal laws GuidelinesGuidelines

Federal State

This meetingThis meeting

KD

HE

RecommendationsRecommendations

EducationEducation Handwashing Handwashing Food away from animalsFood away from animals SignsSigns Cleaning/disinfectionCleaning/disinfection EnvironmentEnvironment

KD

HE

EducationEducation

Operator Operator StaffStaff

Able to explain to visitors Authority to enforce Encourage animal/human interaction Available fo injury/bite reports

KD

HE

EducationEducation

ExhibitorExhibitor Specifics on their animal(s) Instructions if animal gets sick

VisitorVisitor Field trips/group trips Individuals/families

KD

HEHandwashing Handwashing

THE most effective preventionTHE most effective prevention Most zoonoses transmitted fecal-oral

Thorough and oftenThorough and often Plain soap and water bestPlain soap and water best Waterless gels okWaterless gels ok Stations available Stations available

KD

HEHandwashingHandwashing

Have stations available outside animal Have stations available outside animal areasareas

Keep clean and suppliedKeep clean and supplied Shoe scrapers?Shoe scrapers?

KD

HE

Food away from animalsFood away from animals

No food or beverages allowed in No food or beverages allowed in animal areasanimal areas

Discourage:Discourage: Smoking Pacifiers Bottles/”sippy cups” Carrying toys

KD

HEMore on FoodMore on Food

If visitors allowed to feed If visitors allowed to feed animalsanimals Only “approved” foods Not in containers that can be eaten by

people (e.g., ice cream cones)

KD

HE

SignsSigns

Different formatsDifferent formats Know your audience Literacy Poster contests?

Post at entrance and exitsPost at entrance and exits Handwashing signs near food concession Handwashing signs near food concession

areasareas Included in CD-ROMIncluded in CD-ROM

Wash Hands

After Leaving

Animal

Exhibit Area

Please supervise children in animal areas

Please leave toys and pacifiers outside

This way to

Handwashing area

No Food or Drink in Animal Exhibit Area

www.kdhe.state.ks.us/fofs/handouts/did_you_wash_em_color_sign.pdfwww.kdhe.state.ks.us/fofs/handouts/did_you_wash_em_color_sign.pdf

Available in English and SpanishAvailable in English and Spanish

KD

HE

CleaningCleaning

Manure and soiled bedding removed as Manure and soiled bedding removed as neededneeded Scheduled “Unscheduled” Avoid trucking through food areas

At least avoid spillageAt least avoid spillage

KD

HE

CleaningCleaning

Disinfect after after removing bedding, Disinfect after after removing bedding, other organic matterother organic matter 1-5% Bleach solution works well

Make fresh dailyMake fresh daily Other disinfectants—see CD-ROM

KD

HEEnvironmentEnvironment

Flow throughFlow through Animal and non-animal areas

Food prepared/served in non-animal areas onlyFood prepared/served in non-animal areas only Restrict uncontrolled access to animals

BarriersBarriers

KD

HEEnvironmentEnvironment

Drinking water separate from waste Drinking water separate from waste waterwater Don’t duct tape together

If both leak….If both leak…. Back flow prevention devices “Not for human consumption” on hoses

KD

HE

Keep fairs fun for everyoneKeep fairs fun for everyone

No unwelcome souvenirs!No unwelcome souvenirs!

KDHE hotline:KDHE hotline: 877-427-7317877-427-7317www.kdhe.state.ks.uswww.kdhe.state.ks.us

Questions? Questions?

Insert picture here