E. coli O157:H7 from Baby Goats at a Tennessee Farm Camp, 2022

At farm A in Tennessee, the summer of 2022 brought three week-long camps that taught children aged 6 to 10 how to raise animals — each camper was assigned a baby goat, a kid, to care for. On June 22 the Tennessee Department of Health learned that a child who had attended the camp was in the hospital with Shiga toxin–producing Escherichia coli (STEC) O157:H7. Three days later came a second hospitalized child, with hemolytic uremic syndrome, whose brother had been at the camp.

STEC lives in the guts of cattle, goats, sheep, deer and other ruminants without making them sick, and outbreaks linked to petting zoos are well documented.

The investigation

• The farm. On June 28 and 29, the health department inspected animal pens, petting areas, the places where children tended the animals, food service, handwashing and sanitizing stations, play areas and toilets, interviewed the owners and staff, gathered camper and goat-assignment records, and took 41 environmental samples.
• The families. Parents or guardians of 53 of the 82 children who attended camp from June 6 to 24 answered an online survey.

The patients were aged 2 to 38.

Onset dates of the 14 cases, June 2022. Credit: CDC, Morbidity and Mortality Weekly Report.

What it pointed to

• Not a food or an activity. Menus and schedules were the same every week, and nothing in the food service contributed.
• The first week. Comparing 12 sick campers with 58 healthy ones, attending the first week of camp was strongly linked to illness (odds ratio 13.1).
• The goats. Six farm samples grew STEC of three types. Only O157:H7 — from a kid's stool swab and a swab of wood inside the kid barn — caused illness, and those two isolates were closely related by whole-genome sequencing to the three from patients.

The camp's operators knew national guidance on animal contact and had handwashing stations, supervision of children with animals, and clean, disinfected animal areas. But children aged 6 to 10 put their hands to their mouths almost three times an hour, making it easy to swallow bacteria from contaminated surfaces. No farm visitors other than campers and their households were found to have been infected, supporting the idea that the campers' prolonged contact with the kids was the cause.

What the farm did

Farm A voluntarily closed the camp, sped up demolition of the kid barn, euthanized two kids that tested positive, and moved the herd off the property. After consulting veterinarians and other petting zoos, it dropped the goat-care part of the camp, added handwashing signs throughout the farm, and posted information online about animal-borne diseases, who is most at risk and how to reduce it. The camp reopened on July 18 without goats.

Farms, petting zoos and other places where young children touch ruminants should be aware of the risk of STEC and make sure hands are washed during and after animal contact.

Sources

Based on "Notes from the Field: An Outbreak of Shiga Toxin–Producing Escherichia coli O157:H7 Associated with a Farming Camp — Tennessee, 2022," by Lindsey Ferraro and colleagues (Tennessee Department of Health; U.S. Department of Agriculture Agricultural Research Service), Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention; a work of the United States government in the public domain.