Published Date: 2009-09-21 14:00:02
Subject: PRO/AH/EDR> E. coli O157 - UK (05): England, children's farm
Archive Number: 20090921.3316
E. COLI O157 - UK (05): ENGLAND, CHILDREN'S FARM
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Sun 20 Sep 2009
Source: The Telegraph [edited]
Last weekend [12-13 Sep 2009], 36 cases were linked to the center of
the outbreak in Surrey, with 13 children treated in hospital. The
latest figures released by the HealthProtection Agency (HPA) show that
64 people have the _E. coli_ O157 strain of the infection, with 9
children remaining in hospital.
Parents have been warned that 40 per cent of cattle herds carry the
potentially harmful infection and experts have told of the possible
dangers of allowing children under 5 to touch animals. Professor Hugh
Pennington, emeritus professor of bacteriology at the University of
Aberdeen, said the strain was present in cows, sheep, and goats. The
Department of Health [DOH] has asked the Advisory Committee of
Dangerous Pathogens to see if the current guidelines about contact with
animals are satisfactory.
The committee is due to meet in October 2009 and is expected to discuss
how the outbreak has been handled. A DOH spokesman said: "It will
review whether there is a need to change the current guidance or a need
for additional precautions. The risk of infection from _E. coli_ O157
through petting farm animals can be prevented by following everyday
good hand hygiene measures.
Ill health following a visit to an open farm is unusual even among
children and these risks need to be balanced against the benefits for a
child's education and development that arise from contact with animals."
The HPA has already announced an investigation into the outbreaks of
infection. An HPA spokeswoman said the number of cases at Godstone,
which closed its gates on 12 Sep 2009 and traced its 1st link of
infection back to 8 Aug 2009, rose from 57 to 64 over the weekend.
2 medical experts have voiced concern about the existing guidelines
regarding contact with animals, calling either for them to be reviewed
or for greater controls to be introduced.
Prof Pennington said youngsters were "the most difficult part of the
population to get to wash their hands" while also "most likely to touch
"We have to look very, very seriously at the guidelines that we have
been running for many years and see if they need changing," he said.
"There is an issue here and I think the public expects that we have a
really good look at the guidelines and also at the way the guidelines
are being implemented, it is all very well having guidelines if people
are not following them."
Professor Ron Cutler, deputy director of Biomedical Science at Queen
Mary, University of London, said: "The trouble with today is often they
(children) don't get to touch live animals and when they do, maybe the
actual conditions in which they touch them aren't as good as they ought
to be." He said zoos should think about giving people nail brushes to
make sure their hands were clean after a visit.
Godstone Farm's sister farm, Horton Park Children's Farm in Epsom,
White Post Farm in Nottinghamshire and The World of Country Life farm,
in Exmouth, Devon, have all been closed.
[Byline: Caroline Gammell]
In 2000, the CDC (CDC: Outbreaks of _Escherichia coli_ O157:H7
infections among children associated with farm visits -- Pennsylvania
and Washington, 2000. MMWR 2001; 50: 293-7) offered the following in an
effort to reduce the risk for transmission of enteric pathogens at
petting zoos, open farms, animal exhibits, and other venues where the
public has contact with farm animals:
- Information should be provided. Persons providing public access to
farm animals should inform visitors about the risk for transmission of
enteric pathogens from farm animals to humans, and strategies for
prevention of such transmission. This should include public information
and training of facility staff. Visitors should be made aware that
certain farm animals pose greater risk for transmitting enteric
infections to humans than others. Such animals include calves and other
young ruminant animals, young poultry, and ill animals. When possible,
information should be provided before the visit.
- Venues should be designed to minimize risk. Farm animal contact is
not appropriate at food service establishments and infant care
settings, and special care should be taken with school-aged children.
At venues where farm animal contact is desired,layout should provide a
separate area where humans and animals interact and an area where
animals are not allowed. Food and beverages should be prepared, served,
and consumed only in animal-free areas.
- Animal petting should occur only in the interaction area to
facilitate close supervision and coaching of visitors. Clear separation
methods such as double barriers should be present to prevent contact
with animals and their environment other than in the interaction area.
- Handwashing facilities should be adequate. Handwashing stations
should be available to both the animal-free area and the interaction
area. Running water, soap, and disposable towels should be available so
that visitors can wash their hands immediately after contact with the
animals. Handwashing facilities should be accessible, sufficient for
the maximum anticipated attendance, and configured for use by children
and adults. Children aged less than 5 years should wash their hands
with adult supervision. Staff training and posted signs should
emphasize the need to wash hands after touching animals or their
environment, before eating, and on leaving the interaction area.
- Communal basins do not constitute adequate handwashing facilities.
Where running water is not available, hand sanitizers may be better
than using nothing. However, CDC makes no recommendations about the use
of hand sanitizers because of a lack of independently verified studies
of efficacy in this setting.
- Hand-mouth activities (such as, eating and drinking, smoking, and
carrying toys and pacifiers) should not be permitted in interaction
- Persons at high risk for serious infections should observe heightened
precaution. Farm animals should be handled by everyone as if the
animals are colonized with human enteric pathogens. However, children
aged less than 5 years, the elderly, pregnant women, and
immunocompromised persons (such as, those with HIV/AIDS) are at higher
risk for serious infections. Such persons should weigh the risks for
contact with farm animals. If allowed to have contact, children aged
less than 5 years should be supervised closely by adults, with
precautions strictly enforced.
Raw milk should not be served. - Mod.LL]