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Nitrate News -- September, 1999 -- SPECIAL: Toxic E. coli in Water at Fair Kills Two in New York

E. coli outbreak in New York sickens 290 kills one (Copyright © 1999 Nando Media Copyright © 1999 Associated Press By ANNY KUO ALBANY, N.Y. September 9, 1999 6:54 a.m. EDT http://www.nandotimes.com) - The largest E. coli outbreak in state history - and possibly one of the worst nationally - has sickened nearly 300 people who believe they were infected after attending a county fair. The outbreak at the Washington County Fair about 35 miles north of Albany has led to one fatality, 3-year old Rachel Aldrich of Clifton Park. By Wednesday, the number of patients seeking hospital treatment rose to 291, said Kristine Smith of the state Department of Health. Of those, 49 have been confirmed to have the potentially deadly 0157:H7 strain of bacteria, she said. In the Albany area, eight children have developed hemolytic uremic syndrome, or HUS, as a result of the contamination and were listed in serious condition, Smith said. HUS attacks the blood cells and can result in kidney failure. Five of the children were on kidney dialysis. Health officials were still investigating the outbreak's cause, but suspected the fair's water supply may have been contaminated when rainwater runoff washed cow feces from a nearby farm into an underground aquifer. If the number of people who have sought treatment turn out to have E. coli poisoning, as is strongly suspected, it would make the outbreak one of the largest in the country, health officials said. In 1993, four children died and more that 500 others became ill from eating undercooked hamburgers at a Jack in the Box fast-food restaurant in the Pacific Northwest. In 1996, contaminated apple juice produced by Odwalla Inc. caused 70 people in several western states and Canada to become sick, and a 16-month-old child to die. E. coli bacteria normally live in the intestines of humans and other warm-blooded animals. Most strains are harmless but some, including 0157:H7, can be deadly. Symptoms of the infection include abdominal cramps, diarrhea and fever.

2 Deaths Blamed on E. Coli Outbreak (NY Times, By The Associated Press, September 11, 1999) MALTA, N.Y. (AP) -- A massive E. coli outbreak at a county fair claimed its second life as state health officials said the outbreak could become the worst such contamination in U.S. history. On Friday, the same day that 3-year-old Rachel Aldrich, the first victim of the outbreak, was buried, Ernest Wester of Gansevoort, N.Y., died at the Stratton Veterans Administration Medical Center Hospital in Albany. Tests confirmed that Wester died of E. coli contamination. He attended the Washington County Fair Aug. 28 and 29 and had been hospitalized since Sunday, hospital spokeswoman Linda Blumenstock said. Wester, 79, was believed to have become sick after drinking contaminated coffee. Earlier Friday, Wayne and Lori Aldrich held a graveside memorial for their 3-year-old daughter, then headed back to the hospital where their younger daughter, 2-year-old Kaylea, also is still struggling with kidney failure. Kaylea shared a glass of contaminated water with her sister Aug. 28 at the county fair. More than 600 suspected cases of contamination have been reported from the fair, held 30 miles north of Albany, making it New York state's largest E. coli outbreak ever and one of the largest in U.S. history. Dr. Antonia Novello, the state health commissioner, said Friday the number of cases could exceed 1,000 once the outbreak runs its course. That would make it worse than the 1993 E. coli outbreak that sickened 700 patrons of Jack in the Box restaurants in Washington state and killed four. Meanwhile, in Illinois, state health officials were trying to reach about 1,800 people who attended a party in a cow pasture that now is linked to an E. coli outbreak there. Seven people had been hospitalized by Friday evening, and 15 others were ill from the bacterial infection. The party was held Sept. 4 in a cow pasture near Petersburg, about 25 miles northwest of Springfield. In New York, rain runoff is believed to have washed the potentially deadly E. coli bacteria from cow manure at a nearby cattle barn into the fair's underground water supply. After a memorial service underneath a thick canopy of pine trees at a cemetery in Malta, Ms. Aldrich described Rachel as ``happy, vivacious, full of fun and compassion.'' Almost two weeks earlier, the family had spent a carefree day at the fair. It was a day of merry-go-rounds, games and petting zoo animals. ``When we were at the fair, there were balloons released,'' the girl's father said. ``Rachel asked why and at the time I didn't know, but today I was inspired. Sometimes things you love just slip away from you.'' The girls became sick a day later. A week later, Rachel was dead because of hemolytic uremic syndrome, which can result in kidney failure. On Friday, the Aldriches learned Kaylea wouldn't need to be on dialysis, the first time in three days, and that it appeared she was recovering. Eight other children from the fair remained on dialysis Friday at Albany Medical Center Hospital as doctors tried to filter toxins from their blood. Two other children and one adult also remained hospitalized.

Contaminated water source believed cause of E. coli outbreak (Nando Times. Com, CRISTINA C. BREEN, 6Sep ’99) ALBANY, N.Y. (September 6, 1999 7:23 a.m. EDT http://www.nandotimes.com) - A contaminated underground water source is believed to be the source of an E. coli outbreak at a county fair that killed a 3-year-old girl and sickened 112 others, state Health Department officials said Sunday. Tests on water in an aquifer supplying the Washington County fairgrounds turned up high levels of the E. coli bacteria. It remained unclear how the water became contaminated, but officials said runoff from animals or another contaminant may have been to blame. A total of 112 people - mostly children - were treated at hospitals in five counties and Vermont since Friday and at least 38 remained hospitalized Sunday evening, according to state Health Department spokeswoman Kristine A. Smith. All had visited the Washington County Fair about 35 miles north of Albany on either Aug. 28 or 29. Rachel Aldrich, 3, of Clifton Park, died Saturday at Albany Medical Center Hospital. She had been in critical condition with E. coli contamination since Friday, according to hospital spokesman Richard Puff. Aldrich died after developing hemolytic uremic syndrome, or HUS, as a result of the E. coli contamination, Smith said. HUS attacks the blood cells and can result in kidney failure. By Sunday evening, one other small child had developed HUS, but Smith would not say where the child was being treated or the child's age. E. coli bacteria normally live in the intestines of humans and other warm-blooded animals. Most strains are harmless but some - like this one identified as O157:H7 - can be deadly. Symptoms of the infection include abdominal cramps, diarrhea and fever. E. coli bacteria must be ingested to cause infection. Illness can be caused by exposure to an infected person, or by ingesting tainted food or liquids. Copyright © 1999 Nando Media Copyright © 1999 Associated Press

A Summer Fair a Deadly Germ and One Childs Life Taken (NY Times, By AMY WALDMAN, September 7, 1999) On Saturday, Aug. 28, Rachel Aldrich was a vibrant, intelligent 3-year-old, relishing the delights of the Washington County Fair in Greenwich, N.Y. On Saturday, Sept. 4, Rachel Aldrich was virtually brain-dead, spending the day that had been set aside for her fourth-birthday party in the Albany Medical Center, bathed in the prayers of family and friends to whom she was increasingly oblivious. In between came the savaging of her body and brain by a virulent strain of E. coli bacteria, which health officials believe she and more than 150 other people -- including her 2-year-old sister, Kaylea -- ingested at the fair. Kaylea was listed in fair condition Monday at the hospital. That Saturday at the fair was Rachel's "last day of fun in the world," her father, Wayne Aldrich, said Monday. Officials believe the outbreak may have been caused by surface runoff passing a barn that housed cattle and then contaminating the fair's water supply. Saturday afternoon, when Rachel's family made the decision to disconnect her life support system, Rachel became the first, and so far only, fatality attributed to the E. coli outbreak, which officials are calling the largest in the state's history. On Monday, Wayne Aldrich, 32, accompanied by his wife, Lori, 26, recounted his daughter's last devastating days at a news conference at the medical center. Health officials issued warnings of their own, saying that they had identified two cases of secondary infection -- people who were not at the fair, but who share a household with someone who was. To prevent further spread of the disease, they urged anyone with even mild diarrhea, one of the symptoms of infection, to take precautions like washing their hands and avoiding activities like food preparation. The authorities also advised them to avoid settings like day care or health care centers where the bacteria could easily spread. In addition to Rachel, health officials have identified 155 confirmed or suspected E. coli cases. Almost all of the victims, who include at least 5 people from Vermont and Massachusetts, visited the fair the weekend of Aug. 28 and 29. Forty-five people are hospitalized. The incubation period for E. coli is one to nine days. Many of the victims are children, who are particularly vulnerable to the bacteria's toxic effects. Kaylea, while faring far better than her sister, is not out of danger yet. Although she was in fair condition, she suffered a few setbacks Sunday night, her father said Monday. At least some of the patients have E. coli 0157:H7, a particularly toxic strain. Health officials have identified "massive E. coli contamination" at one well point at the fairgrounds, which has its own water system, said a spokeswoman for the state Health Department, Kristine Smith. Ms. Smith said that a "terrible convergence of circumstances" -- first the drought, then a downpour, and the fair -- seemed likely to blame for the outbreak. The working hypothesis is that after a major downpour on Aug. 26, the water probably swept surface runoff from a nearby barn, which was housing 700 head of cattle for an agricultural exhibit at the fair, into the soil. From there, the water likely leached into the aquifer, which was at a very low level because of the drought. The low level meant that instead of deeper, cleaner water, being drawn up, the contaminated surface water made its way into the well. Contaminated water can expose people to bacteria in innumerable ways, especially at a county fair playing host to tens of thousands of people. It goes into ice, lemonade, even soda mixes. It can also be used to wash lettuce. For the Aldrich girls who are from nearby Clifton Park, the fair was pure joy, their parents recalled. They looked at animals and rode the merry-go-round. They bounced in the big balloon castle and ate hot dogs and french fries and fried dough. By Sunday, the girls, usually the best of friends, were being unusually aggressive toward each other. By Monday, they were scratching each other and trying to fight. Kaylea came down with a fever, then Rachel did too. A pediatrician diagnosed the flu. The girls began sleeping excessively and developed bad cases of diarrhea. Rachel's was so bad, Aldrich said, that she was going to the bathroom every five minutes. She stopped sleeping, and was so tired that she would fall asleep as she sat on the toilet. When the parents saw blood in the girls' stools, they took them back to the doctor, who diagnosed salmonella, and had them admitted to Ellis Hospital in Schenectady. "Kaylea recovered quite well," Aldrich said. "Rachel started to fall apart." She could no longer walk. She was lethargic. Her speech was slurred. Early Friday morning she was transferred to Albany Medical Center. At one point, her heart failed, and the supply of oxygen to her brain was cut off for seven minutes. She had kidney failure. The family ended life support the next day.

Fears Growing at Site of Fair and Outbreak (NY Times, By RAYMOND HERNANDEZ, September 10, 1999) GREENWICH, N.Y. -- Barbara Jones's 6-year-old son recently came down with a fever and diarrhea. A week ago, she said, she might have responded the way she always has: Take his temperature regularly and give him plenty of fluids. But this time she panicked. "I was worried that this was life or death," she said. "It terrified me." As it turned out, her son was fine, but her response was simple enough to understand. A few days ago, a child who came to the Washington County fair here on the weekend of Aug. 28 and Aug. 29 died in one of the nation's worst outbreaks of E. coli bacteria, and parents in this small town have not been the same since. Like many of her neighbors, Mrs. Jones and her family spent that weekend here at the fair and are now suddenly realizing that they could be facing a health hazard. The number of people suspected to have been infected by E. coli bacteria has grown to 497 cases, the State Health Department said. And health officials said that two vendors at the fair might have spread the bacterium to another fair, in Rensselaer County, although no cases had yet been reported there. The outbreak has claimed the life of a 3-year-old child, Rachel Aldrich. The strain involved, known as O157:H7, is typically found in undercooked ground beef, unpasteurized milk or contaminated water. With adults, it usually causes only stomach problems, but it can be fatal in children or older people. Health officials think the bacteria might have come from water in a well at the fair that had been contaminated by rain runoff from cow manure. News of the outbreak has led to widespread concern among the people of this town of 4,000. It is evident in places like the Country Kitchen, where the talk has been about the state of the food and drinking water. "People who come in here have been very worried," said Barbara Smith, a waitress. "My mom called me when she heard about this because she knew that we liked to go to the fair each year." Peter Kuzmich, who owns a construction firm, said he and his wife had gone to the fair, as they had in previous years, mostly for the food. He said they had not given it a second thought until a couple of days ago, when they watched the local television news describing the outbreak. "I ran to the calendar and asked my wife, 'What day were we there?' " he said. "It turned out that we were fine." "We kept asking each other, 'How are you doing?' " he said. Kristine A. Smith, a spokeswoman for the Health Department, said that the outbreak peaked last week and that the spike in cases represented a lag time in reporting. "What we believe we are seeing is the influence of people who suffered mild symptoms earlier on and waited to see their doctor. Only now are their cases being reported by their doctors." Of those who have come down with E. coli infections, 51 have been hospitalized, she said, and 8 of those are on kidney dialysis. Most of those infected were in Albany, Saratoga, Washington and Warren Counties. Joan Robertson, who took her two, 7-year-old grandchildren to the fair, said she panicked when she heard about the outbreak, even though she had packed a lunch of juice, sandwiches and fruit. A few days later, she said, she called her son, the father of the girls, to tell him to keep an eye on them. But she felt a great sense of guilt about the episode. "I was terrified that something happened to them," she said. In the end, she said, "they were fine. But it was very scary. I felt responsible that I had done harm to my two grandchildren."

E. Coli Takes Terrible Toll (NY Times, By DAVID BARSTOW, 20Sep99) EASTON, N.Y. -- In this rolling dairy country between the Hudson River and Vermont, the farmers are fiercely protective of the Washington County Fair. Their fair has never lost its "agricultural integrity," they like to boast, which is a polite way of saying that it has not been allowed to degenerate into another boozy tractor pull. The organizers -- third-generation farmers, prominent businessmen, a few key politicians -- have zealously guarded the fair's status as the region's social event of the year, where farmers can caress the latest John Deere, skinny 4-H teen-agers can still dream of glory for prized heifers, and the local volunteer fire departments can raise money for new boots and hoses by selling fabulously greasy barbecue chicken. No alcohol or bare feet allowed. This year's fair seemed no different, only bigger and better with the addition of a new milking parlor. And then the children started getting sick. One after another, then by the dozens, they went to local hospitals and doctor's offices, howling with stomach cramps, weakened by diarrhea and nausea, some near death. Parents and grandparents got sick, too, baffled that something that had seemed so wholesome could turn out this badly. The authorities suspect that about 1,000 people -- roughly a third of them children -- were infected at the fair with a particularly vicious strain of the E. coli bacteria that can swiftly escalate from diarrhea to dementia to brain death. With a little girl and an elderly man already dead, and with several children still in serious condition, the E. coli outbreak at the Washington County Fair now ranks among the nation's worst. As health officials and personal-injury lawyers circle about in the inevitable search for blame, the lingering question here is whether this beloved fair, with roots more than a century deep, will be the final casualty of an outbreak that in all likelihood, state officials now say, seeped into the fair's water from the manure of a single cow. Wayne Aldrich was one who cherished the tradition. He was raised in Greenwich, one town over from Easton, population 2,100, and the Washington County Fair was a big part of his childhood. Now a graphic artist for The Daily Gazette of Schenectady, Aldrich, 32, wanted to share his memories with his wife, Lori, and their daughters: Rachel, 3, and Kaylea, 2. "I thought it would be great to have them see the same fair that I went to as a kid," he said. They went on Saturday, Aug. 28, the fair's second to last day, and it was just as Aldrich remembered it, only much bigger. Over the week, about 100,000 people streamed into the fairgrounds, a sprawling complex of grandstands, stables and vending booths. The girls saw the farm animals and tried a few kiddie rides. Their parents bought them a hot dog at the Argyle Volunteer Fire Department booth, and then french fries, and then fried dough. The girls were thirsty, so Aldrich, trying to stretch his fair money, bought them each a 25-cent cup of water. It tasted great. After a final romp in the balloon castle, the family drove home to Clifton Park, just north of Albany. Ernest Wester, a 79-year-old retired truck mechanic from Gansevoort, a hamlet about seven miles north of the fairgrounds, was there on Saturday, too. He went with his daughter, stubbornly brushing aside his wife's concerns that it might be too much walking for him. He wanted to see the tractor pull, so highly regarded that it routinely wins the "Pull of the Year" award from the state's tractor pull association. Wester returned with his daughter's boyfriend on Sunday for the much-anticipated Big Rigs competition. They drank coffee and Pepsi, and ate barbecue chicken from the Argyle Volunteer Fire Department booth. "He loved the fair," said his daughter, Trina M. Hamm. The Symptoms: Doctors Suspect Salmonella, at First The first symptoms were innocuous. On Sunday, the Aldrich girls were a little cranky. On Monday, Kaylea had a slight fever and a headache. That night, both girls crawled into their parents' bed. On Tuesday, between her first bouts of diarrhea, Rachel took five naps, at one point spreading her blanket on the kitchen floor to be close to her mom. Their pediatrician suspected a virus and suggested plenty of fluids, but after a checkup on Wednesday, doctors suspected salmonella poisoning and the girls were admitted to Ellis Hospital in Schenectady. "They said three or four days and it will be all right," Mrs. Aldrich recalled. Kaylea seemed to improve, but Rachel was falling apart. She spent much of Wednesday night and Thursday morning on the toilet, now so exhausted that her parents took turns propping her up so she wouldn't collapse on the bathroom floor. Her speech began to slur. She imagined scary things under her hospital bed. She became too weak to walk. Aldrich felt the first edge of panic when, on Thursday night, he saw unmistakable concern in his doctor's eyes. "I was so scared that I could vomit," he said. Tests had revealed E. coli in Kaylea, and the decision was made to transfer first Rachel and then Kaylea to Albany Medical Center, which has the region's only pediatric intensive care unit. A doctor at Ellis led a prayer at Rachel's bedside. Pale and listless, Rachel summoned the strength to whisper, "In the name of Jesus Christ, Amen." That same day, Wester began to experience the first twinges of an upset stomach. "Could be anything," he told his family. Albany Medical Center has a first-rate reputation, and when Rachel Aldrich arrived there about 1 A.M. on Friday, her parents mostly felt relief. Surely here modern medicine would reverse their daughter's slide. Aldrich relaxed enough to take a nap. The Treatment: Easing Symptoms Only Real Option In truth, doctors can do very little about this type of E. coli, called O157:H7, which releases toxins into the blood, toxins that were destroying Rachel's kidneys. Antibiotics are thought to trigger a stronger release of toxins; diarrhea medicine only makes it tougher for the body to rid itself of infection. All doctors can really do is treat the symptoms. In mild cases, plenty of fluids and time do the trick as the body fights off the infection itself. In serious cases, physicians reinforce the body's defenses by cleansing the blood with transfusions and dialysis. The elderly and the young are especially vulnerable. Over the next few hours, nurses tried to draw blood from Rachel. They stuck needles into her arms, hands, legs and feet. But her blood pressure was low, her veins were shriveled. A doctor had to be called to draw blood from her thigh. With her mother by her side, Rachel drifted in and out of lucidity. She talked about honey bees, and she asked about her sister. She sang "Take Me Out to the Ball Game." Then she stopped breathing. She was revived within a few minutes, and a test revealed no brain damage. Her parents hoped they had seen the worst. Dr. Martha Lepow, head of the pediatric infectious diseases unit at the hospital, went on morning rounds at 7 A.M. that Friday. The residents told her about a 12-year-old boy who had been brought in the night before with cramps and bloody diarrhea. He had been at the Washington County Fair. An hour later, an associate got a call from a pediatrician who wanted to talk about a 10-year-old patient with bloody diarrhea. The pediatrician mentioned the Washington County Fair. Then Dr. Lepow heard about the Aldrich girls, and Kaylea's infection. Dr. Lepow arranged for the families to be questioned about what they ate and drank at the fair. Research in other E. coli cases had pointed to undercooked hamburger -- the source of the 1993 Jack in the Box outbreak that killed four children and infected hundreds of people across the Pacific Northwest. Dr. Lepow's four pediatric patients had one thing in common. They had all eaten fried dough. Later patients, she learned, had not. But armed with that early link, the hospital notified the State Health Department, which had been getting similar reports on Friday from other hospitals. That afternoon, the state's new Health Commissioner, Dr. Antonia C. Novello, was on a conference call with her executive staff, discussing the outbreak of St. Louis encephalitis in New York City. An aide broke in: "By the way, do you know we have 12 cases of E. coli?" Within hours, they began to warn the public while starting an investigation. The same afternoon, the Aldrich family faced an agonizing decision. The doctors said Rachel would die without immediate dialysis. But because her blood pressure was so low, dialysis might kill her. Joined by relatives and by friends from their Mormon church, the Aldriches gathered in a waiting room to consider the options. They went to Rachel's bed and prayed. Despite days of diarrhea, her body was bloated, because she could not produce urine. Blood trickled from her nose. Wayne and Lori Aldrich knew they had to try the dialysis, and their hopes soared when Rachel's blood pressure somehow increased just before the procedure began. They cheered for her to make it through dialysis, literally. "Go, Rachel, fight!" they chanted. "Punch those germs in the nose!" She survived dialysis, but through Friday night the E. coli ravaged her brain, causing it to liquefy and swell and slowly cease functioning. Late Friday night, her eyes would blink reflexively when blown on. By Saturday, no amount of blowing caused even a flutter. Doctors flashed a light into her pupils. Nothing happened. They scratched her foot with a key. Nothing. Rachel, who only 30 hours before had been singing and talking to her mother, was brain dead. By then, Ernest Wester had begun to vomit and suffer from diarrhea. His wife, alarmed by the news alerts of a possible E. coli outbreak from the fair, suggested that maybe he should go to the hospital. "Don't be silly," Wester said. He pointed out that the experts on television had said there was not much to be done besides drinking plenty of fluids. "He was a stubborn man," said his daughter, Ms. Hamm. Saturday afternoon, as more and more parents were taking children to local hospitals, Wayne and Lori Aldrich prepared for Rachel's death. With her sister's help, Mrs. Aldrich carefully washed Rachel one last time, and then they shampooed and conditioned her hair, and then they put her hair up with purple clips. They took prints of her palms and her feet for a memory book, and they cut one lock of her dark curls, and they carried Kaylea in to say goodbye to Rachel. Then they asked their friends and family to come in, and sang "I Am a Child of God," one of Rachel's favorite songs. Lori Aldrich sat in a rocking chair. Rachel was placed in her arms. The life support machines were turned off. Mrs. Aldrich gently rocked back and forth. Word of Rachel's death spread through the 17-bed pediatric intensive care unit, and the nurses could see the deepening dread in the other parents. They gathered in the hallways to discuss the fine points of dialysis, and to parse platelet counts. In Gansevoort, Saturday night was terrible for Wester. Once a robust, tough man -- he was 6 feet 2 inches tall -- Wester was frightened and worn by hours of bloody diarrhea. At 5 A.M. on Sunday, he finally asked his daughter to take him to the local veterans hospital. By noon, Wester was getting fluids intravenously and telling his daughter he needed some rest. Ms. Hamm said she would take a nap, too, and check back on him that night. No need, he said. Don't come back until morning. "O.K.," she said, kissing him goodbye. Eight hours later the doctors called. "He didn't even know his name," Ms. Hamm said. The Aftermath: Strained Hospitals, Cries for Reform On Monday, Aug. 30, three days after learning of the E. coli outbreak, Dr. Novello swept into the pediatric intensive care unit at Albany Medical Center with several top aides. An energetic woman, Dr. Novello said she went because she imagined how she would have felt if it were her child. Trained as a pediatrician, Dr. Novello has returned to the I.C.U. every day since, often staying late into the night. From the start, she promised answers about what had caused the outbreak. While her investigation continues -- Dr. Novello said she hoped to meet with the fair board this week -- the outlines of what happened are known. The fair organizers had planned to supply most or all of the water from a chlorinated 120,000-gallon storage tank that is fed by a network of wells. But the dry summer made it hard to fill the tank. So they decided to supplement it with water from a 20-foot well, Well No. 6, which is 83 feet from the youth cattle shed. About 100 cows were kept there during the fair. Although Well No. 6 is not chlorinated, several previous tests, including one in June, showed that its water met state standards. On Thursday, Aug. 26, two days before Wester and the Aldrich family visited the fair, there was a heavy rain. It washed through piles of manure left outside the cattle shed. After water tests and genetic testing, Dr. Novello said that E. coli from one cow's waste apparently seeped into Well No. 6, which in turn supplied water to several vendors, including the Argyle Volunteer Fire Department, at whose booth Wayne Aldrich bought water for his daughters. "I paid 25 cents to put my daughter to death," Aldrich said bitterly. The second week after the fair was the scariest for the local hospitals. New cases were streaming in, and no one knew how many people would eventually get sick. Albany Medical Center, which started with four children, had 45 cases a week later, including nine children in serious condition. One was Kaylea Aldrich, whose condition worsened after her sister's death. Kaylea would curl up, her stomach cramped and hardened with infection, and cry out for relief. Her parents thought they might go insane. All that week, doctors worked to save Wester's life with transfusions and dialysis, but his brain function continued to deteriorate. His family took hope when he squeezed the hand of his wife of 58 years. But by Thursday, he was brain dead. His eyes, closed for days, suddenly opened when he was taken off life support on Friday. "It was really beautiful," his daughter, Ms. Hamm, said. "I looked into his eyes and told him everyone was here with him." The first lawsuit was filed against the Washington County Fair last Thursday. Lawyers are suggesting that the fair organizers were negligent in serving untreated water drawn near a cattle barn. "It's not rocket science to say, 'Gee, maybe we should test the water,'" said William Marler, a Seattle lawyer who has represented families in other outbreaks. Fair officials declined to comment, but so far state health officials have found no evidence that organizers violated what few regulations apply to county fairs. Dr. Novello described the outbreak as "an act of God," albeit one that revealed huge holes in the state's oversight of such events. Last week, she ordered that all fairgrounds serve only disinfected water. But if there are health reforms, the people of Washington County fear a more immediate impact. Even if the fair survives the lawsuits and a tarnished reputation, the normal rhythms of life here have been altered. Jean M. Wilbur, president of the Greater Greenwich Chamber of Commerce, described the change: Her husband is a dairy farmer, and they have always taken their milk straight from the cows, before it is sent off to be pasteurized. No more, she said. For now, the Aldriches are putting their energies into Kaylea, who appears to be headed toward recovery. Aldrich said that he often dreams of Rachel, of that Saturday morning when they left for the fair. He always decides at the last minute not to go. Determined that her death not be in vain, the Aldriches have established a fund for their daughter, who one day had announced that she was saving all her allowance for medical school. Her parents said donations to the Rachel Gene Aldrich Foundation Fund, accepted at Key Bank branches, will be used to help other children go to medical school, and perhaps one day solve the terrible enigma of E. coli.

E. coli tainted water may have been taken to 2nd New York fair Copyright © 1999 Nando Media Copyright © 1999 Associated Press By JESSE J. HOLLAND ALBANY, N.Y. (September 10, 1999 2:04 p.m. EDT http://www.nandotimes.com) - The deadly E. coli bacteria that killed a 3-year-old girl and sickened nearly 500 others may have found its way into the water at a second county fair, health officials warned. A fair worker at F & W Concessions, which sold food at the Washington County Fair, might have taken three gallons of tainted water with her to use for coffee, lemonade and frozen treats at the Rensselaer County Fair on Sept. 1-6. One of the wells at the Washington County Fair was infected with E. coli bacteria, state Health Commissioner Antonia Novello said. Health officials also think that a deadly strain of E. coli, O157:H7, also came from that well although they have yet to find any traces of that E. coli bacteria. Three-year-old Rachel Aldrich, who died Sept. 4 and was to be buried Friday, was the only reported fatality. While 497 people had been treated at hospitals for E. coli symptoms, 85 cases, including that of Rachel and her 2-year-old sister, Kaylea, are confirmed to be E. coli poisoning, Novello said. Kaylea was in serious condition. All of those sickened visited the Washington County Fair, which was about 35 miles north of Albany, on Aug. 28-29. The suspected well was not even supposed to be used for the fair, but the state's recent drought forced the auxiliary well into use, Novello said. The fair worker who transported the water, whom state officials refused to identify, has reported the symptoms of E. coli infection although it has yet to be confirmed she was infected, Novello said. The water that was used by the worker may have been drawn from a well not suspected to carry the infection, Novello said. Health officials said Thursday they are concentrating their search for the deadly E. coli bacteria on a 3-year-old well at the Washington County Fair. The 20-foot well was only 83 feet from a cattle barn and the ground around it had been dug up for the installation of two new wells, Novello said. A strong rainstorm Aug. 26 might have driven some E. coli-laced cattle manure straight into the well, she said. Many of the nation's worst E. coli outbreak come from undercooked meat. In 1993, four children died and more than 700 others became ill from eating undercooked hamburgers at a fast-food restaurant in the Pacific Northwest.

E. Coli Leads to Tougher Water Rules for Fairs (NY Times, By THE ASSOCIATED PRESS September 14, 1999) ALBANY -- Acting amid the worst E. coli outbreak in state history, Health Department officials on Monday ordered all fairgrounds without public water supply systems to disinfect and monitor their water. The emergency order, signed by Dr. Antonia Novello, the health commissioner, will affect fairgrounds in six counties. Dr. Novello also announced that health researchers had confirmed that the E. coli bacteria that have killed two people and sickened more than 750 who attended the Washington County Fair on Aug. 28 or Aug. 29 came from a well contaminated by cow feces. Researchers matched 12 samples of E. coli taken from the well and from a pipe connection to vendors at the fair with samples taken from 25 infected people. "We have absolutely conclusive documentation," the commissioner said. Health officials said 771 people had complained of E. coli symptoms by this afternoon. Of those, 108 were confirmed to have been affected by one of the most serious strains of the bacteria, O157:H7. Sixty-two people were hospitalized -- including 13 children, one of whom remained in critical condition, Dr. Novello said. Officials were still waiting to determine if nine people, including a 3-week-old boy, who attended the Rensselaer County Fair in Schaghticoke and now have symptoms of E. coli are also infected. Officials suspect that a vendor who worked at both fairs may have transmitted the bacteria. The Washington County outbreak, at a fair about 30 miles north of Albany, claimed the lives of a 3-year-old girl and a 79-year-old man. The order requires the fairgrounds to check their water systems, disinfect them and monitor the supply before the start of any public event and during the event.

NY Tracing Fatal E. coli Bacteria (NY Times, By The Associated Press, September 9, 1999) ALBANY, N.Y. (AP) -- The largest E. coli outbreak in state history -- and possibly one of the worst nationally -- has sickened nearly 300 people who believe they were infected after attending a county fair. The outbreak at the Washington County Fair about 35 miles north of Albany has led to one fatality, 3-year old Rachel Aldrich of Clifton Park. By Wednesday, the number of patients seeking hospital treatment rose to 291, said Kristine Smith of the state Department of Health. Of those, 49 have been confirmed to have the potentially deadly 0157:H7 strain of bacteria, she said. In the Albany area, eight children have developed hemolytic uremic syndrome, or HUS, as a result of the contamination and were listed in serious condition, Smith said. HUS attacks the blood cells and can result in kidney failure. Five of the children were on kidney dialysis. Health officials were still investigating the outbreak's cause, but suspected the fair's water supply may have been contaminated when rainwater runoff washed cow feces from a nearby farm into an underground aquifer. If the number of people who have sought treatment turn out to have E. coli poisoning, as is strongly suspected, it would make the outbreak one of the largest in the country, health officials said. In 1993, four children died and more that 500 others became ill from eating undercooked hamburgers at a Jack in the Box fast-food restaurant in the Pacific Northwest. In 1996, contaminated apple juice produced by Odwalla Inc. caused 70 people in several western states and Canada to become sick, and a 16-month-old child to die. E. coli bacteria normally live in the intestines of humans and other warm-blooded animals. Most strains are harmless but some, including 0157:H7, can be deadly. Symptoms of the infection include abdominal cramps, diarrhea and fever.

E. coli Outbreak Sickens 281 (NY Times, By The Associated Press, September 14, 1999) SPRINGFIELD, Ill. (AP) -- What did you eat? Where did you sit? Did you wash your hands? Did you wade in the pond? Who was with you? Health investigators have been interviewing hundreds of people who attended a Sept. 4 concert and cookout, hoping some pattern will emerge to explain an E. coli outbreak that has now sickened at least 281 people. While they work the phones, other health workers were performing lab tests or gathering samples. All they know for sure is that the people who fell ill were among the 1,800 people at the event in a cow pasture near Petersburg. Twenty were sick enough that they had to be hospitalized. Maybe the E. coli bacteria lurked in the beef served at the event. Maybe bacteria was in the water, or on the hands of a food server, or hiding someplace else entirely. ``We're no different from detectives on a crime scene. We kind of tear apart everything we can to come up with the clues that may give us an answer,'' Thomas Schafer, spokesman for the Illinois Department of Public Health, said Monday. ``We still are going to have to be a little lucky.'' E. coli is a bacteria usually found in the intestines or manure of cattle. People who ingest it can suffer severe cramps, bloody diarrhea and, in extreme cases, kidney failure. The biggest job for investigators is interviewing people who attended the concert, dubbed Cornstock '99. Schafer said investigators have the names of about 900 partygoers and have spoken to 551 -- asking what they ate and drank, where they sat, whether they washed their hands, what they did. All the answers -- from sick people and healthy alike -- are fed into a computer that will search for patterns. If most of the sick people ate the same things or did the same things, it narrows the field, Schafer said. Other investigators were working in the field -- literally. They visited the farm near Petersburg, about 25 miles northwest of Springfield, where Cornstock was held to gather water and manure samples. The crowd at the free concert ate and drank in a field that had been used as a cow pasture. Owner Tom Baird had raked and cleaned the field of manure, although some traces probably remained. But Schafer said those traces were unlikely to be the source of contamination, since E. coli will not survive long outside a host animal. Still, investigators have taken manure samples from Baird's herd. If they were carrying E. coli, it suggests the contamination probably came from the cow Baird donated to be cooked at the event, Schafer said. Results of the first tests won't be available until later this week, Schafer said. It could be weeks, or even months, before the health department finishes its investigation, he said.

More sick in central Illinois E. coli outbreak (Nando Times. Com, Copyright © 1999 Nando Media; Copyright © 1999 Associated Press) SPRINGFIELD, Ill. (September 13, 1999 6:57 a.m. EDT http://www.nandotimes.com) - The number of reported illnesses from an outbreak of E. coli bacteria in central Illinois has topped 200 and state health officials say it will likely rise even further. Officials are trying to track down the estimated 1,800 people who attended a party called "Cornstock" in Petersburg, about 25 miles northwest of Springfield. They are seeking the source of the potentially fatal strain of E. coli that Illinois Department of Public Health spokesman Thomas Schafer says sickened 202 and sent 20 to area hospitals. He believes the numbers will rise because the bacteria has an incubation period of three to eight days, and sometimes longer. Schafer said his department has conducted 365 interviews of people who were at the Sept. 4 event, held in a cow pasture. He said none of the reported illnesses was considered serious. Health Department officials have used a logbook people signed at the event to track down some of the guests, according to John Lumpkin, the public health department's director. Investigators are sending out a three-page questionnaire to those they can reach, asking them what they ate and drank, where they sat, whether they washed their hands and if they touched any animals. Schafer said investigators have collected and will analyze meat that people brought home from the event and put in their freezers. He said it is likely those who got sick either ate or drank something contaminated by E. coli bacteria, but he said it may never be known where the bacteria originated. The party was a free gathering for family and friends of members of eight bands, and guests may have come from 15 Illinois counties as well as Florida, Hawaii, Kentucky, Michigan, Missouri and Ohio. Tom Baird, who has hosted the event for years, said he donated a steer for the party, which was slaughtered and prepared off-site beforehand. Other farmers donated a hog and an ostrich. Baird said the pasture was cleaned of manure before the party. He said he has decided not to host future parties. The strain of bacteria responsible for the outbreak - found in the feces and intestines of cattle - is the same strain blamed for an outbreak in New York late last month. That outbreak, believed to have been caused when rain runoff washed the bacteria from cow manure into a well at a county fair, sickened more than 600 people and killed one child and one adult.

2d Death Confirmed in E. Coli Outbreak Near Albany; 60 Are Hospitalized (NY Times, THOMAS J. LUECK, September 12, 1999) New York state and local health officials confirmed on Saturday that a 79-year-old Gansevoort man was the second person to die in an outbreak of E. coli bacteria infections in the Albany area. The authorities also raised the number of people hospitalized with the illness Saturday to 60, two more than on Friday, according to the state Health Department. Although almost all of the cases have been linked to the contamination of a well at the Washington County Fair in Greenwich. The authorities said that four people had become ill since Friday after attending the Schaghticoke Fair in Rensselaer County, and E. coli infections were suspected. John Signor, a spokesman for the State Health Department, said investigators had determined that two food vendors had moved their booths from the fair in Washington County to the one in Rensselaer County, and may have carried contaminated well water with them. "If you have not had symptoms of the infection yet, you probably are not going to get them," Signor said. "The peak has passed." He said the main threat of infection had been from well water drawn at the Washington County Fair on Sept. 1, and since the strain of E. coli involved, O157:H7, has an incubation period of nine days, few more infections were expected. With health officials on high alert in much of upstate New York, residents of Phoenix, an Oswego County village 135 miles east of Albany, were advised Saturday to boil drinking water after inspectors found E. coli in a test of school water fountains. No illness was reported. Signor said state officials believed that the contamination in Phoenix was unrelated to the outbreak around Albany because the two were separated by great distances, and because isolated cases of E. coli contamination are common across the nation, with about 20,000 reported annually. Still, state health officials, assisted by several local agencies, continued to monitor the outbreak near Albany Saturday and to warn people of the symptoms of E. coli infection, which include diarrhea and abdominal pains. Signor said the initial cause had been identified as a combination of heavy rain on Aug. 26 and the proximity of the Washington County well to a farmyard containing cows, manure and an area being excavated. He said the well, which had been tested by health inspectors as recently as June, had been contaminated by runoff from the rain, which carried bacteria from the manure into the well water. He said the two vendors who may have transported some of the contaminated water to the Schaghticoke Fair "would not have done so intentionally." Nonetheless, he said people who suffer symptoms of E. coli after having attended the fair in Rensselaer County should consult their doctors, particularly if they consumed food or drinks from either of the two vendors -- O'Sullivan Crows Enterprise Taco Stand or S&W Caterers, which sells lemonade, coffee and ice cream. But Signor said the four people in Rensselaer County might not have contacted E. coli infections at all, but "just happened to get diarrhea."

Number of E. Coli Cases in New York State Rises to 291 (NY Times, JENNIFER STEINHAUER, September 9, 1999) The number of people suspected to have been infected in a severe outbreak of E. coli poisoning in New York State almost doubled on Wednesday, making the outbreak one of the most serious to have occurred in the United States, state health officials said on Wednesday. The virulent E. coli bacterium, which health workers said they believed could be traced to contaminated water at the Washington County Fair in upstate New York late last month, is thought to have infected 291 people, said Kristine A. Smith, a spokeswoman for the State Department of Health. Of those, 49 have been hospitalized, including 10 children, 8 of whom are on kidney dialysis and in serious condition. The outbreak is the worst to have occurred in the state, officials said, and some of the suspected cases have been reported in parts of Vermont adjacent to Washington County, where the outbreak began. Health care workers around the state moved to contain public fears while informing parents with children who have symptoms of E. coli poisoning what to do. Other state officials worked to ascertain just how the outbreak became so severe. A 3-year-old child, Rachel Aldrich, died on Saturday from the disease, and her 2-year-old sister Kaylea, who was also infected, was among those in serious condition on Wednesday. The strain involved in the Washington County outbreak, known as 0157:H7, is usually spread in under-cooked ground beef, unpasteurized milk and contaminated water. In healthy adults, it often just causes a mild gastrointestinal ailment. But 0157:H7 can be especially deadly to children, elderly people and those who have compromised immune systems. The affected children have developed hemolytic uremic syndrome, which attacks blood cells and damages the kidneys. "We are doing everything we can for these children," said Richard Puff, a spokesman for the Albany Medical Center Hospital, where the children are being treated. "As parents, we think it is an awful thing that happened," said Debi Conti, who lives in Clifton Park, where the dead girl lived. "When you go to a fair you expect to drink the water there." Heavy rain may have caused water contaminated with cow feces from a farm near the fairgrounds to run into an aquifer, and from there into a well supplying water to the fair. "This seems to be the most credible theory," Ms. Smith said, "because we know E. coli is present in a certain amount of healthy cattle that can excrete it." As health care workers moved yesterday to prevent secondary infections -- infections transmitted from one person to another -- the state continued to test the water supply at the fairgrounds, in Greenwich, N.Y. Health officials have detected water "grossly contaminated with E. coli" from a well at the fair, Ms. Smith said, and are now checking that water for the 0157:H7 strain. The process can be a lengthy one, Ms. Smith said. She added that the number of suspected cases jumped from 159 to 291 overnight, as people with mild symptoms who thought they had the flu were told yesterday that they probably had been infected with E. coli. Of the 291 suspected cases, 69 had been confirmed as E. coli by Wednesday. All eight of the children on dialysis were listed in serious condition. Two other children are in fair condition at the hospital, Mr. Puff said. Most of those infected were in Albany County and three counties north of there -- Saratoga, Washington and Warren. If the number of people who have sought treatment turn out to have E. coli poisoning, as is strongly suspected, "it would be accurate to say that this is one of the largest outbreaks ever in the country," said Tom Skinner, a spokesman for the Centers for Disease Control and Prevention. In 1993, four children died and more that 500 others became ill from eating undercooked hamburgers at a Jack in the Box fast-food restaurant in the Pacific Northwest. In 1996, contaminated apple juice produced by Odwalla Inc. caused 70 people in several western states and Canada to become sick, and a 16-month-old child to die. Scores of health care workers were working overtime on Wednesday, analyzing water samples, examining the area where the fair took place and working to contain the illness by urging schools, day care centers and institutions that serve food to send home anyone with diarrhea. Health care workers in the region said that there was little panic because of the efforts of local health departments and other municipal organizations. "We are getting a large number of phone calls, most of which come from people who have symptoms or are exposed to people with symptoms," said Dr. Max Crossman of the Granville Family Health Center in Granville, N.Y. "We are not seeing panic. Most of the health care community is being consistent with its message." However, Dr. Carl Beckler, in West Pawlet, Vt., less than a mile from Granville, said more than a dozen panicky patients had come to his office in the last few days, concerned that stomach pain or diarrhea might be symptoms of exposure to E. coli bacteria. Beckler said his office found no E. coli cases in those patients. "People up here are pretty concerned," said James King, who lives in Fort Miller, near Greenwich. "My son, Philip, parked cars at the fair and so I was concerned," but he has shown no symptoms since the fair ended 11 days ago. The 0157:H7 strain has an incubation period of one to nine days, and its symptoms include severe diarrhea, cramping and occasional kidney failure.

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