A recent Morbidity and Mortality Weekly Report (MMWR) Notes from the Field, issued by the Center for Disease Control and Prevention (CDC), took a look back at a 2022 outbreak that resulted in the death of 1 child and illness in 14 others.
The Shiga toxin-producing Escherichia coli (STEC) bacterial infection was linked to goats at the Lucky Ladd Farms in Eagleville, a small town outside of Nashville, Tennessee.
In June of 2022, local news covered the story, but the specifics were only officially confirmed with new details in the weekly report published July, 21, 2023. Local outlets reported that the infection was spread to the two-year-old child from his brother who attended the camp. The toddler ultimately succumbed to the illness after developing a rare type of kidney infection associated with STEC infections.
The Camp
Lucky Ladd Farms is a petting zoo farm located in Eagleville, Tennessee. A town just outside of Nashville. During the summer, the farm held three week-long summer camps for children aged 6 to 10 years old where they would learn about animal husbandry and other farm knowledge.
Campers were each assigned a baby goat to care for during their stay at the camp.
The Outbreak Investigation
A series of events lead to the investigation and ultimate discovery of the source of the STEC outbreak. The following is a timeline of those events.
June 22, 2022
On June 22, 2022, the Tennessee Department of Health (TDH) was notified that a child was hospitalized with a reportable bacterial infection. He was sick from the Shiga toxin-producing Escherichia coli O157:H7 bacteria. Patient data indicated that the child had attended a farming camp.
June 25, 2022
Three days later, June 25, 2022, TDH was notified that a second child was hospitalized with the same infection and presenting symptoms of hemolytic uremic syndrome. This child’s brother had attended the same camp as the first hospitalized child.
Two children. From different households. Sickened with the same bacterial illness.
This prompts an investigation.
June 28 and 29, 2022
On June 28 and 29, 2022, TDH visited the farm that linked the two sick children. An environmental assessment was performed. Onsite interviews with the farm owners and employees were conducted and aspects of the farm were observed.
The investigators looked at the animal pens, public petting areas, areas where the children cared for the animals, food service facilities, handwashing and sanitizing facilities, as well as play areas and bathroom facilities.
Camp attendee registration information and goat assignment records were collected and 41 environmental samples from animals, animal feces, animal pens, water sources, and toilets were obtained.
Additionally, an online survey was sent to the parents and guardians of all 82 children who attended the camp between June 6 and 24, 2022. The survey included dates of attendance, illnesses and outcomes, foods consumed, and camp activities participated. About 65% of the surveys were completed.
Test Results
STEC bacteria was identified in six samples collected from the farm. These samples were further subtyped, and three different strains were discovered.
STEC O157:H14 was found in two samples (one rectal swab from a goat kid and one stool swab from a goat kid).
STEC O157:H7 was found in two samples (one stool swab from a goat kid and one wood swab from inside the goat kid barn).
STEC O26:H11 was found in two samples (two stool samples from goat kids).
Only the STEC O157:H7 was associated with clinical illnesses associated with the outbreak. Those farm isolates were analyzed with whole genome sequencing. This genetic testing resulted in data indicating that the farm samples were closely related to the available outbreak STEC O157:H7 patient samples.
The remaining 35 samples tested negative for E. coli. These samples included swabs from three other goats, well water (including goat drinking water, pond, and water pipes), barn environmental samples (including goat feed), portable restrooms, goat feces, lamb feces, and a stool specimen from an unknown animal source.
Farm Temporarily Closed
In response to the outbreak, the farm voluntarily closed the camp and initiated mitigating activities.
July 18, 2022
The farm reopened their summer camp on July 18, 2023, without the goat husbandry component. In fact, the animal husbandry component of the camp was completely discontinued.
Lucky Ladd Farms Response
The farm fully cooperated with the outbreak investigation and consulted with experts to help them through the aftermath of the outbreak.
The goat kid barn was demolished and the two goat kids that tested positive for STEC bacteria were euthanized. The remaining kid herd was moved off the property.
During the closure, the farm worked with veterinarians and other petting zoos to determine additional methods to reduce the risk of disease transmission. As a result, the facility discontinued the animal husbandry aspect of the camp.
Additionally, increased signage was displayed to encourage handwashing after touching animals and other objects around the farm. The website was updated to increase messages about zoonotic diseases and warning about populations that are at higher risk for infection.
CDC Response
According to the report, the CDC indicates that it is possible that the goats ingested STEC from contaminated surfaces. “TDH concluded that this outbreak was associated with STEC O157:H7-infected [goat] kids and involved secondary transmission.” Secondary transmission is when those originally sickened individuals spread the illness to other members of their household.
The children also may have become infected after touching those surfaces and touching their faces without washing their hands. According to the CDC, “hand-to-mouth contact has been observed to occur almost three times per hour among children aged 6-10 years,” which supports the hypothesis that the outbreak was spread from contaminated environmental surfaces.
Additionally, the “prolonged contact” factor between the campers and the goat kids resulted in a higher risk of illness transmission. This is supported by the reports finding that patrons of the farm, apart from the actual camp attendees and members of their households, did not become infected with the outbreak bacteria.
STEC Symptoms and Complications
Certain strains of E. coli bacteria can cause illness. Sometimes very serious illness. There are several different strains of harmful E. coli, but the one that makes the most news due to its association with foodborne outbreaks is STEC.
Symptoms
Symptoms may vary from person to person, and usually begin around 3 to 4 days after exposure. But this is not concrete. People have reported falling ill as early as 1 day after exposure to as late as 10 days or more after exposure.
The most common symptoms include severe stomach cramps, diarrhea (often bloody), and vomiting. Some people may experience a low-grade fever (less than 101 °F).
Symptoms often resolve within 5 to 7 days. Illnesses range from very mild to severe and even life-threatening. Particularly in the case of hemolytic uremic syndrome.
Hemolytic Uremic Syndrome
About 5 to 10% of those diagnosed with STEC infection develop a type of kidney failure known as hemolytic uremic syndrome (HUS).
This syndrome usually begins just as diarrheal symptoms begin to improve.
Early indicators include:
Significant illness associated with HUS involves the bacteria’s role in the destruction of blood platelets and red blood cells. These damaged cells clog the kidney’s filtering system resulting in kidney failure.
Those with HUS should be hospitalized due to this potential kidney failure and other serious complications. Most people with HUS can recover within a few weeks with prompt medical care, though others may suffer more permanent damage or death.
When to Contact Your Healthcare Provider
Most people can recover from STEC infection without medical intervention. Those can often get by with treating symptoms, staying hydrated, and taking precautions to prevent the spread of illness. However, certain indicators should prompt seeking medical attention.
Petting Zoos and Animal Farm Risks
Environments such as petting zoos and animal farms as well as other places that small children might have direct contact with ruminant animals should be aware of the risk for STEC transmission. While detrimental to humans, STEC infection in these ruminants (cattle, goats, sheep, deer, etc.) generally does not cause illness to the animal. As a result, outbreaks among humans associated with petting zoos and similar facilities are well documented.
These types of facilities should be aware of those risks and make efforts to help prevent the spread of infection. Efforts such as availability of handwashing and sanitizing facilities and promoting proper handwashing during and after animal contact are very important to reduce the risk of infection.
These facilities have an obligation to protect patrons and promote risk management practices to help prevent the spread of illness.
If you have questions about an illness following exposure at a petting zoo or animal farm, an experienced consultant at The Lange Law Firm, PLLC can help answer your questions. Reach out by phone at (833) 330-3663 or by emailing here for a free consultation.
By: Heather Van Tassell
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