Officials weigh ideas to prevent outbreaks.

Byline: RANDI BJORNSTAD The Register-Guard

Everything's still up in the air at the Lane County Fairgrounds - with the exception, hopefully, of any more E. coli bacteria - as fair officials continue mulling over what to do to prevent a recurrence of the outbreak that sickened up to 82 people in August.

Warren Wong, managing director at the fairgrounds, said options suggested so far have run the gamut, including the extreme of banning animals from the facility altogether.

"But that seems to be a pretty onerous idea that would undermine the entire function of having not only the Lane County Fair but many other events at the facility," Wong said. "No one has supported that idea - the Fair Board is committed to maintaining animal (displays) at the fairgrounds."

The board's response to avoid future problems with E. coli infections more likely will include stronger prohibitions against carrying food or beverages into areas inhabited by animals, more warning signs about the danger of contracting E. coli through physical contact with animals, and providing more hand-washing stations around animal barns and food booths, he said. Increased sterilization of buildings also could be a possibility.

A check of several other county fair operations throughout the country that also have experienced E. coli outbreaks indicates similar responses to the problem. None has banned animals outright, and no subsequent cases of E. coli infection have been reported.

The Lane County outbreak affected mostly young children, causing symptoms ranging from fever to stomach cramps and bloody diarrhea. A dozen ended up in hospitals with a more serious condition, hemolytic uremic syndrome, which can lead to kidney failure or even death. At least one, 2-year-old Carson Walter of Eugene, eventually could need a kidney transplant.

State health officers will meet with local fairgrounds and public health officials early in November to review what's known so far about the local situation. However, William Keene, an epidemiologist with the Oregon Health Service's communicable disease section, said the questions that ultimately need to be answered relate more to public policy than to science.

Lab results, which eventually will pinpoint how many people contracted E. coli directly at the fair as opposed to exposure from others, won't be complete for months, Keene said. However, they probably won't provide the answers most important to the public, such as determining negligence or liability - or even the exact origin - for this particular outbreak.

Most people know that "normal" personal hygiene should include washing hands after touching animals - including family pets - in order to avoid disease, and county officials provided some hand-washing stations for use by fairgoers who visited the barns, he said.

But in this case, investigators found E. coli bacteria on rafters and walls 15 feet above the floor, suggesting that some or all of the infections could have been contracted via airborne particles that settled on food or in some other way got into people's digestive systems. In the past, airborne transmission has not been considered a likely method of contracting the illness.

"We don't really know what to tell people about this," Keene said. "We can tell people how to cook hamburger (to avoid E. coli), but this isn't the same. It's hard to know just how much precaution needs to be taken, how much regulation is appropriate, because the information just isn't that specific. It may be a year before we have all the data, and there's very little more that we expect to learn that we don't already know."

In large part, the issue becomes a policy decision of how far to go in trying to protect the public, Keene said, citing the recent spate of sniper killings in Maryland and Virginia as an example.

"So far, I haven't seen any signs in parking lots saying that people parking there may be in danger from snipers, but now we know even that can happen," he said. "It's difficult to figure out how much risk there really is and how far people want to go to reduce that risk."

In terms of E. coli exposure at the fairgrounds, "the surest way to avoid this problem, to be blunt, is not to have any exposure to animals at all," Keene said. "But that solution may not be acceptable to most people, so somebody has to figure out how far the community is willing to go to avoid more problems, and who's going to pay for it."

Among the fair operations around the country that have experienced similar E. coli incidents in the past, the most common reaction has been a concerted public education campaign with an oft-repeated message: Wash your hands, wash your hands, wash your hands.

In Wyandot County, Ohio, 88 people reported symptoms and health officials confirmed 37 cases of E. coli after the September 2001 fair in Upper Sandusky. The outbreak there apparently came from contact with contaminated cattle, fair secretary Bonnie Miller said.

"This year, we put up an additional 20 to 30 hand-washing stations with colorful signs telling people to wash their hands properly," Miller said. "We've always had hot and cold running water in our restrooms, and we had sanitizing stations at the main doors to the barns, but now we have them at every door."

In addition, county health officials visited schools and talked to students about the importance of hand-washing after contact with animals and distributed fliers throughout the county, she said. At the fairgrounds, buildings used for animal exhibits also undergo cleaning with a chlorine and water solution before each event.

"We didn't have any cases this year - knock on wood," Miller said.

Similar precautions have been undertaken at the Lorain County Fairgrounds in Wellington, Ohio, where 23 confirmed cases of E. coli occurred in August 2001, spokesman Bernie Nirode said.

"We've taken an extremely proactive approach - we've had people from the health department, the Environmental Protection Agency and the Centers for Disease Control working with us on this," Nirode said. "We powerwashed our buildings with the same sanitizing solution used in restaurants, and we removed sawdust and bleachers for cleaning and put up a lot more signs about people washing their hands.

"Apparently we had really clean hands this year - we used six times the amount of soap as usual, plus $3,000 worth of hand-washing solution."

Unlike Wyandot County, where fair attendance actually improved this year, the Lorain County Fair experienced a small drop in visitors, he said.

"But I think it was more because of the weather than anything - we had to cancel three major events because of all the rain we had."

Neither fair operation has been subject to any lawsuits stemming from their E. coli outbreaks, unlike Medina County, Ohio, where fair President Dave Bertram said he couldn't discuss the situation "because we're in the middle of litigation."

Officials familiar with the Lane County situation say they've heard of no legal or insurance claims that have been filed against the fairgrounds so far.

"It's possible that everyone is just waiting for the state (health department) to complete its investigation," said Mark Rauch, claims and litigation manager for City-County Insurance Services, which handles claims for many public agencies statewide. "This certainly would be a first for us to deal with a claim like this - we're much more accustomed to liability claims related to sidewalk (falls), road incidents or police activities. I don't know how something like this would be resolved."

Ron Cramer of Cramer and Giles Insurance, which handles policies for the Lane County Fairgrounds, agrees with epidemiologist Keene that claims related to the local E. coli situation may be more difficult to sort out than foodborne versions of similar outbreaks where responsibility can be more clearly assigned. "In this case, the fair is doing what the public wants, and there has been a tragic deal and some real suffering," Cramer said. "This is more rare - it may not be simple to try to determine where responsibility (lies) in a case like this - it definitely has a different twist to it."