{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T16:24:21Z","timestamp":1788279861341,"version":"build-2803163510"},"reference-count":25,"publisher":"Wiley","license":[{"start":{"date-parts":[[2024,6,10]],"date-time":"2024-06-10T00:00:00Z","timestamp":1717977600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Zoonoses and Public Health"],"abstract":"Abstract<\/jats:title>Aims<\/jats:title>In October 2023, the Tennessee Department of Health identified an outbreak of Shiga toxin\u2010producing Escherichia coli<\/jats:italic> (STEC) O157:H7 infections among elementary school students who attended school field trips to the same farm animal exhibit. Our aim was to determine STEC source and prevent additional illnesses by initiating epidemiologic, laboratory and environmental investigations.<\/jats:p><\/jats:sec>Methods and Results<\/jats:title>We identified cases using laboratory\u2010based surveillance and by surveying caregivers of children who attended the exhibit. Probable cases were defined as illness with abdominal cramps or diarrhoea after attendance; confirmed cases were laboratory\u2010confirmed STEC infection in an attendee or household contact. A site visit was conducted, and event organizers were interviewed. Human stool, animal faeces and environmental samples were tested for STEC O157:H7 by real\u2010time polymerase chain reaction (PCR), culture and whole\u2010genome sequencing (WGS). Approximately 2300 elementary school students attended the animal exhibit during 2\u2009days. Field trip activities included contact with different farm animal species, drinking pasteurized milk outside animal enclosures and eating lunch in a separate building onsite. We received survey responses from 399 caregivers for 443 (19%) animal exhibit attendees. We identified 9 confirmed and 55 probable cases with illness onset dates during 26 September to 12 October. Seven children aged 1\u20137\u2009years were hospitalized. Four children aged 1\u20136\u2009years experienced haemolytic uraemic syndrome; none died. Laboratory testing identified STEC O157:H7 by culture from eight human stool samples with 0\u20131 allele difference by WGS. Three environmental samples had Shiga toxin (stx 2) genes detected by PCR, but no STEC isolates were recovered by culture.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>This is the largest reported STEC O157:H7 outbreak associated with an animal exhibit in Tennessee. We identified opportunities for educating school staff, event organizers and families about zoonotic disease risks associated with animal contact and published prevention measures.<\/jats:p><\/jats:sec>","DOI":"10.1111\/zph.13161","type":"journal-article","created":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T04:46:19Z","timestamp":1718081179000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Shiga toxin\u2010producing Escherichia coli<\/i> O157:H7 outbreak associated with school field trips at a farm animal exhibit\u2014Tennessee, September\u2013October 2023"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2610-6797","authenticated-orcid":false,"given":"Christine M.","family":"Thomas","sequence":"first","affiliation":[{"name":"Tennessee Department of Health Nashville Tennessee USA"},{"name":"Epidemic Intelligence Service, Centers for Disease Control and Prevention Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Foster","sequence":"additional","affiliation":[{"name":"Tennessee Department of Health Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Boop","sequence":"additional","affiliation":[{"name":"Tennessee Department of Health, Northeast Tennessee Regional Health Office Johnson City Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Kirschke","sequence":"additional","affiliation":[{"name":"Tennessee Department of Health, Northeast Tennessee Regional Health Office Johnson City Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hopelyn","family":"Mooney","sequence":"additional","affiliation":[{"name":"Tennessee Department of Health, Northeast Tennessee Regional Health Office Johnson City Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella","family":"Reid","sequence":"additional","affiliation":[{"name":"Tennessee Department of Health, Northeast Tennessee Regional Health Office Johnson City Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew S.","family":"May","sequence":"additional","affiliation":[{"name":"Sullivan County Regional Health Department Blountville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Mullins","sequence":"additional","affiliation":[{"name":"Sullivan County Regional Health Department Blountville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie N.","family":"Garman","sequence":"additional","affiliation":[{"name":"Tennessee Department of Health Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mugdha","family":"Golwalkar","sequence":"additional","affiliation":[{"name":"Tennessee Department of Health Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack H.","family":"Marr","sequence":"additional","affiliation":[{"name":"Tennessee Department of Health Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Orejuela","sequence":"additional","affiliation":[{"name":"Tennessee Department of Health Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danny","family":"Ripley","sequence":"additional","affiliation":[{"name":"Tennessee Department of Health Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Rasnic","sequence":"additional","affiliation":[{"name":"Tennessee Department of Health Division of Laboratory Services Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica","family":"Terrell","sequence":"additional","affiliation":[{"name":"Tennessee Department of Health Division of Laboratory Services Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa M.","family":"Durso","sequence":"additional","affiliation":[{"name":"Agricultural Research Service, United States Department of Agriculture Lincoln Nebraska USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Schaffner","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy F.","family":"Jones","sequence":"additional","affiliation":[{"name":"Tennessee Department of Health Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary\u2010Margaret A.","family":"Fill","sequence":"additional","affiliation":[{"name":"Tennessee Department of Health Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John R.","family":"Dunn","sequence":"additional","affiliation":[{"name":"Tennessee Department of Health Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,6,10]]},"reference":[{"issue":"50","key":"e_1_2_11_2_1","first-page":"1277","article-title":"Outbreaks of Escherichia coli O157:H7 associated with petting zoos\u2014North Carolina, Florida, and Arizona, 2004 and 2005","volume":"54","author":"Centers for Disease Control and Prevention","year":"2005","journal-title":"MMWR. Morbidity and Mortality Weekly Report"},{"key":"e_1_2_11_3_1","volume-title":"National Shiga toxin\u2010producing Escherichia coli (STEC) surveillance overview","author":"Centers for Disease Control and Prevention","year":"2012"},{"key":"e_1_2_11_4_1","unstructured":"Centers for Disease Control and Prevention. (2019).E. Coliinfection. Healthy pets healthy people.https:\/\/www.cdc.gov\/healthypets\/diseases\/ecoli.html"},{"key":"e_1_2_11_5_1","unstructured":"Centers for Disease Control and Prevention. (2021).National Shiga toxin\u2010producingEscherichia coli(STEC) surveillance annual report 2017. US Department of Health and Human Services.https:\/\/www.cdc.gov\/ecoli\/surv2017\/index.html"},{"key":"e_1_2_11_6_1","unstructured":"Centers for Disease Control and Prevention. (2022a).Stay Healthy at Animal Exhibits. Healthy Pets Healthy People.https:\/\/www.cdc.gov\/healthypets\/specific\u2010groups\/stay\u2010healthy\u2010animal\u2010exhibits.html"},{"key":"e_1_2_11_7_1","unstructured":"Centers for Disease Control and Prevention. (2022b).E. coli(Escherichia coli).E. Coli.https:\/\/www.cdc.gov\/ecoli\/index.html"},{"issue":"16","key":"e_1_2_11_8_1","first-page":"426","article-title":"Outbreak of Shiga toxin\u2010producing Escherichia coli O157 infection associated with a day camp petting zoo\u2014Pinellas County, Florida, may\u2010June 2007","volume":"58","author":"Centers for Disease Control and Prevention (CDC)","year":"2009","journal-title":"MMWR. Morbidity and Mortality Weekly Report"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prevetmed.2009.07.004"},{"key":"e_1_2_11_10_1","unstructured":"Daly R. F. Mathewson A. A. Pride K. R. Ireland M. J. &Bailey S. J.(2023).Compendium of measures to prevent disease associated with animals in public settings.https:\/\/www.nasphv.org\/Documents\/AnimalsInPublicSettings2023.pdf"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1089\/vbz.2005.5.193"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7229a6"},{"key":"e_1_2_11_13_1","unstructured":"Food Safety News. (2022).Visitors at petting zoo exposed toE. coli. Food Safety News.https:\/\/www.foodsafetynews.com\/2022\/04\/visitors\u2010at\u2010petting\u2010zoo\u2010exposed\u2010to\u2010e\u2010coli\/"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2108739"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpediatrics.2008.525"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm655051"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.3389\/fvets.2021.744055"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2012.00138"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268816001229"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmm.2018.06.008"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms9071529"},{"key":"e_1_2_11_24_1","unstructured":"Tennessee Department of Health. (2024).Shiga toxin\u2010producingEscherichia coliSTEC.https:\/\/www.tn.gov\/health\/cedep\/reportable\u2010diseases\/shiga\u2010toxin\u2010producing\u2010escherichia\u2010coli\u2010stec.html"},{"key":"e_1_2_11_25_1","unstructured":"University of Tennessee \u2013 Extension. (2024).Preventing Disease Associated with Animals in Public Settings.https:\/\/tennessee.csod.com\/LMS\/LoDetails\/DetailsLo.aspx?loid=11e9698c\u20108e56\u20104d61\u20108d42\u2010ad530c99f592#t=1"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1128\/AEM.00829\u201016"}],"container-title":["Zoonoses and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/zph.13161","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T04:46:29Z","timestamp":1718081189000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/zph.13161"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,10]]},"references-count":25,"alternative-id":["10.1111\/zph.13161"],"URL":"https:\/\/doi.org\/10.1111\/zph.13161","archive":["Portico"],"relation":{},"ISSN":["1863-1959","1863-2378"],"issn-type":[{"value":"1863-1959","type":"print"},{"value":"1863-2378","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,10]]},"assertion":[{"value":"2024-04-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-06-01","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-06-10","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"zph.13161"}}