A dangerous E. coli outbreak tied to the annual Milk Makers Fest in Lynden has sickened at least 45 people and sent eight to hospitals, prompting state officials to request federal help in tracking the problem.

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Two weeks after a dangerous strain of E. coli bacteria ripped through the annual Milk Makers Fest agricultural fair in Lynden, Whatcom County., the state is asking for federal help in figuring out the outbreak that has sickened at least 45 and sent eight to regional hospitals.

Dr. Scott Lindquist, Washington’s epidemiologist for communicable diseases, said he’s requested that the Centers for Disease Control and Prevention assist county and state officials in tracking the spread of what’s known as Shiga toxin-producing E. coli O157:H7 at the event attended by more than 1,300 first-graders.

“I’m not calling them because I think it’s a large outbreak and it’s unmanageable,” Lindquist said. “I think it would be great; it would be helpful.”

E. coli facts

Escherichia coli, known as E. coli, are a large and variable group of bacteria.

Most strains are harmless, but a few can make people very sick.

Shiga toxin-producing E. coli, or STEC, bacteria make a toxin that can cause serious illness.

The most common STEC in the U.S. is E. coli O157:H7. The bacteria are often associated with eating undercooked ground beef.

Infections are typically caused by contact with animal feces in contaminated food, water or surfaces.

Symptoms can include stomach cramps, bloody diarrhea and vomiting.

In some cases, people develop a life-threatening complication called hemolytic uremic syndrome or HUS, which can cause kidney failure and/or death.

Source: Centers for Disease Control and Prevention

Lindquist said he’s looking for more boots on the ground to back up local officials as they conduct interviews and perform analysis to help identify the problem.

“No one knows what the source is yet,” Lindquist said.

Local health officials haven’t been able to say how the outbreak started, whether food, livestock, a petting zoo — or something else — may have spread the potentially deadly bacteria.

Results are pending for tests that may show whether the bacteria that made people sick also were found in the environment or on surfaces at the Northwest Washington Fair & Event Center, Lindquist said. Ditto for additional tests that can tell whether the genetic fingerprint of the bugs indicates one source — or several.

Such information can’t come too soon for victims of the outbreak, including the mom of a teen who was hospitalized for 10 days with an E. coli O157:H7 infection after he helped set up a hay maze at the festival.

“I don’t want people to think it’s just from a petting zoo when it might be much bigger than that,” said Amy Hayes-Shaw, 46, who works at a local Safeway store. “I wouldn’t want this to happen to anybody. This is a horrible, horrible thing.”

Her 15-year-old son, Toby Hager, fell ill within days of joining his Lynden High School classmates on a field trip to help set up the maze with hay from a local farm. Two other high-school kids are among those who also got sick, Hayes-Shaw said.

Toby was eventually diagnosed with a life-threatening kidney complication known as hemolytic uremic syndrome, or HUS, and sent by ambulance to Seattle Children’s for treatment, hospital officials confirmed.

“He’s not out of the woods yet,” Hayes-Shaw said, noting that her son had just returned home Wednesday. “Toby will have kidney problems. He’ll have to watch this his whole life.”

HUS is a potentially deadly side effect of E. coli infections that produce dangerous Shiga toxins, which can cause serious illness in people.

E. coli O157:H7 bacteria are found in the guts of many mammals and cause infections usually linked to contact with animal feces.

The Whatcom County Dairy Women, the group that organized the festival April 21-23, said it followed petting-zoo guidelines issued by the Centers for Disease Control and Prevention, which call for hand-washing stations monitored by volunteers to prevent illness in children. Hand sanitizer was also available, they noted.

“We are deeply saddened by this outbreak and its association with our event, which we have held for 22 years without incident,” Debbie VanderVeen, president of the group, said in an email. “We are eager to identify the cause or cases and continue to pray for the recovery of both children and adults who have become ill.”

Health officials haven’t released details about the victims, except to say they range in age from young children to adults.

Toby Hager is represented by Bill Marler, a Seattle food-safety lawyer who has tracked dozens of county-fair and petting-zoo outbreaks in the past decade. He also represents families of three other children who fell ill.

Information about the outbreak has been lacking so far, Marler said. Normally, consumers by now could expect results of environmental sampling tests and so-called pulsed-field gel electrophoresis, or PFGE tests, which identify the genetic fingerprint of the bacteria.

“I just think in the normal course of an outbreak, whether it’s foodborne or environmental, the lack of basic information about PFGE, about environmental testing, is a bit odd.”

Dr. Greg Stern, the Whatcom County health officer, said county and state health officials are working hard to find answers. They’re interviewing the adults and children who are included in the outbreak and comparing them with people who attended the fair and didn’t get sick. They’re waiting for test results and hope to know about PFGE links soon.

“It’s going to take weeks to correlate the interviews,” he said. “It takes time.”

Lindquist said test results could come as early as next week.

There’s no question that the Milk Makers Fest was the source of the illnesses, Lindquist added. But there has been a lot of speculation in the community about when and where the bugs might have originated.

Toby got sick after being exposed on just one day, April 20, before the fair began, his mother notes. That means the bacteria had to be present before the hundreds of first-graders, plus teachers and parents, ever showed up.

“To me, it seems like they aren’t looking at the right thing,” she said. “To me, Toby is like Patient Zero. Why wouldn’t you be looking at that?”

More E. coli infections tied to the outbreak could still be reported, particularly in people who didn’t attend the fair but were exposed to those who did. So-called “secondary cases” could create a new wave of illness as serious as the first, Stern noted. “The good news is, the case count is increasing slowly,” Stern said.

It’s not yet clear who might be legally responsible for the illnesses tied to the annual dairy festival, Marler said.

“If you’re going to have animal contact, especially for small kids, you’ve got to make sure that the environment is safe for them,” he said. “These kinds of cases swirl around the idea of negligence. Did people provide reasonable care in protecting these kids from harm?”