291 Case Study Exercise 34 E pidemiology of Gastrointestinal liness: Differentia

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291 Case Study Exercise 34 E pidemiology of Gastrointestinal liness: Differentiation of Enterobacteriacese CASE STUDY ne microorganisms can spoil even the best laid outbreaks of disease have been foodborne, zoonotic trans- ruin a perfectly good day at the fair. Study the mission has been implicated in a small but growing num- ber of cases involving petting zoos, animal shows, and farm work. The most serious symptoms associated with HUS tend case below and then answer the questions that follow Outbreaks of Escherichio col 0157 H7 Associated with a to occur in young children and the elderly. This outbreak was very similar to an E. coli outbreak that had also occurred at the North Carolina State Fair in 2004, toxin-producing resulted in 187 ilnesses, and was traced to one of two pet among persons who ting zoos at the fair. In response to that outbreak, North ate Fair. In addiCarollina enacted Aedin's Law, which created regulations for petting zoos, pony rides, and other exhibitions where petting zoos. Based on the people could have direct contact with animals. The law pro- State Fair--North Carolina, 201n In October 2010, four cases of Shiga E. coi (STEC) infection were discovered had attended the 2010 North Carolina In addi numerous food and beverage concessions, the fair t had various animal exhibits and nitial outbreak, the North Carolina Division of Public Health vided for signage informing the public of health concerns (NCDPH) notified loc that occurred during or after the fair and had no other known cause. This intensified surveil- ed an additional 21 persons who fit the criteria Stool samples were obtained from samples con- al health departments to report cases at petting zoos, mandated maintenance of animal facilities and required that handwashing stations be made available Patients identified by the NCDPH as part of the 2011 outbreak were questioned with regard to their behavior dur- outlined by the NCDPH. 19 patients, and DNA analysis revealed that 11 tained E coll O157:H7 with the ing their time at the fair. The only exposure associated with illness was having visited one of the permanent structures in which sheep, goats, and pigs were housed for livestock com- same DNA profile. This strain were not intended to have physical contact with animals in these areas but 25% of people who visited these buildings-and were later interviewed as part of the investigation -reported direct contact with animals. As a result of this outbreak, a multiagency task force was created in North Carolina to evaluate the preventive measures that were in place during the 2011 state fair and to identify addi- tional interventions that could be applied to prevent disease physical contact petitions. Fair visitors of E coli had been linked with a number of previous food borne outbreaks. A total of eight patients were hos and pitalized, four experienced hemolytic uremic syndrome (HUS) HUS is a severe form of hemolytic anemia that can lead to acute renal failure and, in about596 of cases, death. Four of every five cases of HUS can be traced to infection with E. coli strain 0157:H7, resulting in 26S,000 illnesses and 2,000 hospitalizations a year in the United States. This strain is found in goat, sheep, cattle, llamas, and other ruminants, transmission in livestock exthibitions where which are colonized but show no symptoms. Although most with the public might occur over CASE STUDY QUESTIONS 1. How are gastrointestinal infections of the type seen in this case commonly spread?

Explanation / Answer

1. The gastrointestinal infection of E. coli O157:H7 is a food-borne infection. However, in the above-mentioned case, the cause of the spread was predicted to be the exposure to the animal shelters and/or contact with the infected animals.

2. In 2005, there were no laws in place to avoid direct contact with the animals. Thus, the activities like pony riding, which are more attractive children were prevalent. After the implementation of the laws, these activities were restricted and thus, children were not exposed during the later epidemic of 2011.

3. The laws to avoid direct animal-human contact were in place, still, 25% of the respondents reported direct contact. If I were a part of the North California taskforce, I would have informed the authorities of the laxity in the procedures, so that the laxity shall not be repeated in future.

4. The five-year-olds are very restless and do not understand the importance of the instructions of the authorities, therefore, they are more prone to the infections.

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