A toddler has died after contracting E. coli after coming into contact with animals at the 2019 San Diego County Fair, health officials confirmed.
The County of San Diego Health and Human Services Agency announced Friday night that a 2-year-old boy had been hospitalized and died on June 24 from a complication of the disease.
Three other children ranging from ages 9 to 13 also became ill with E. coli. Those children were not hospitalized. HHSA officials said all four children had visited the San Diego County Fair between June 8 and June 15.
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The source of the E.coli bacteria is under investigation, but all four children had visited the animal enclosures, petting zoo, or had other contact with livestock at the San Diego County Fair.
Officials closed public access to all animal areas, including the petting zoo, at the fairgrounds, effective Friday.
The San Diego County Fair also posted about the incident on Twitter.
At a news briefing Saturday morning, Dr. Eric McDonald, medical director of the San Diego County HHSA’s Epidemiology and Immunization Services Branch, shared details on each pediatric case.
McDonald said the first case involved a 13-year-old girl who visited the San Diego County Fair on June 8, who became ill on June 10. Health officials confirmed that child has E.coli 0157, Shiga toxin-positive.
The second case involved an 11-year-old who visited the fair on June 8 and June 12, and had illness onset on June 12. That child, McDonald said, has a Shiga toxin-positive organism that is still being identified. The third case involved a 9-year-old boy who was at the fair on June 13, who became ill on June 16. That boy also has a Shiga toxin-positive organism that is still being identified.
McDonald said the fourth case reported to health officials was that of the 2-year-old boy who died. The toddler had visited the fair on June 15 and became sick on June 19 with confirmed E.coli 0157, Shiga toxin-positive.
McDonald said the 2-year-old was hospitalized and developed hemolytic uremic syndrome (HUS), and died on June 24. HUS is a severe complication of E.coli infection and can lead to kidney failure.
He said the boy died at a hospital and his death was "somewhat unexpected."
McDonald said each family was interviewed extensively and, in each case, the child had contact with animals and/or the petting zoo at enclosures at the fair. The families are not related to one another and live in different parts of San Diego County.
"The only commonality between the activities of the reported cases is exposure to animals and/or their animal enclosures at the fair," Wilma Wooten, M.D., M.P.H., county public health officer, added at Saturday’s news briefing.
McDonald also said there were no common food items purchased by the families at the fair.
"The is no indication that there is a food connection in any cases," he added.
The San Diego County Department of Environmental Health also re-inspected food facilities at the fairgrounds visited by the ill children and found no link to the cases, officials said.
McDonald said the three other children were not hospitalized and continue to recover at home. One patient, he said, is seeking medical treatment as an outpatient.
Meanwhile, McDonald said 2-year-old boy's case of HUS is the first case of HUS reported to San Diego County health officials this year. He said normally, the county sees two to three cases of HUS annually.
Until 2017, the county had between 30 to 50 cases of STEC reported each year. Since 2017, the county has seen more STEC cases reported largely in part of an outbreak that sickened more than 200 people at Marine Corps Recruit Depot San Diego in the fall of 2017. McDonald said health officials confirmed more than 14 cases of HUS stemming from that 2017 outbreak.
The 2019 San Diego County Fair opened on May 31 and runs through July 4. Fair officials said the event will wrap up its run over the next few days as planned. The San Diego County Fair is the largest annual event in San Diego County, drawing approximately 1.5 million visitors each season.
When asked Saturday by reporters if health officials anticipated more cases of E.coli emerging in people who have visited the fair this season, McDonald said that’s possible.
“We would anticipate we will hear about more cases over time,” he said.
McDonald said that in cases like this, it is likely that more people who are ill with symptoms of Shiga toxin-producing E.coli infection, or STEC, may go visit their doctor. Doctors may also begin to ask patients exhibiting these symptoms if they’ve recently been to the San Diego County Fair.
With more search for these cases and more people possibly seeking treatment, more cases may emerge, McDonald explained.
McDonald also said these types of infections are "on a time delay" because of the time it takes to identify the illness, complete laboratory testing, and diagnose a patient.
He said that's why health officials were not able to share the information publicly until Friday, as there wasn't enough information to share before then.
"Based on the information we have now, we're taking these steps to protect the public," said McDonald.
San Diego County Fair 'Heartbroken' for Impacted Families
San Diego County Fair CEO Tim Fennell said he was heartbroken over the toddler's death and the three other cases linked to E.coli at the fair.
"We are devastated by this news," he said Friday night. "But we are moving forward and taking any precaution, the fair will continue until the Fourth of July."
"As a family-friendly event, when things like this happen, it’s devastating to our staff and the people affected by this event. Our hearts, prayers and thoughts go out to this family," Katie Mueller, deputy general manager of the San Diego County Fair, said Saturday.
Fennell said Saturday that when you have livestock or animals at an event like a county fair, there is always "potential inherent risk."
"Animals do relieve themselves; E.coli is in the feces," Fennell said. "Small children unfortunately can step in it, walk in it, and unfortunately, they don’t always wash their hands. I’m not suggesting that is the case here, but it is a possibility."
Fennell said there are handwashing stations located throughout the San Diego County Fair, particularly in the livestock areas. Signs are placed throughout those areas, too, reminding people to wash their hands.
Until now, an incident like this has never happened at the San Diego County Fair, Fennell said.
"We will look for ways to improve our safety messages, our handwashing messages," Mueller added. "It’s really important when you attend any kind of event that involves animals that you wash your hands and make sure that your children wash their hands as well."
Meanwhile, both McDonald and Wooten said Saturday that "no specific animal activity was implicated" at the fair, but the HHSA recommended the fair restrict all animal activities at the fairgrounds for the remainder of the event’s run, out of an abundance of caution.
"Safety has always been and will continue to be our No. 1 priority here at the fair," Mueller said.
She added that nothing has changed in the fair's ongoing push for "handwashing education."
"Nothing has changed in the way that we operate from previous years," Mueller explained.
"The fair is open, it’s safe and secure, and we would like people to come out," Fennell added.
Mueller said livestock is a longstanding tradition of the fair, and she anticipates animals will return to the fairgrounds in the future, "with safeguards and policies in place." Fair organizers will evaluate the future of the animal exhibits at the end of fair's run.
This weekend is the final weekend of the fair's 2019 run.
Shiga Toxin-Producing E.Coli Infection: The Symptoms
The HHSA said most people with STEC start feeling sick three to four days after eating or drinking something that contains the bacteria. However, illnesses can start anywhere from one to 10 days after exposure.
Symptoms vary from person-to-person and often include:
- Severe abdominal cramps,
- Watery or bloody diarrhea (three or more loose stools in a 24 hour period), and
Symptoms may occur with or without a fever. Most people get better within five to seven days. Some infections are very mild, but others are severe or even life-threatening.
San Diego health officials urge the public to contact their healthcare provider if they have experienced any of these symptoms on or after June 8.
McDonald said these types of infections are more common in the summer.
The HHSA said the most important prevention against a STEC infection is handwashing. Anyone who has contact with animals or their environment -- including at petting zoos, farms, fairs and even one's own backyard. Hands should always be washed before eating or drinking.
McDonald said the temperature of the water used to wash one's hands is not the important part, but rather the amount of time spent washing one's hands.
He said people should wash their hands for the amount of time it takes to sing "Happy Birthday" two times.