I have been doing this for more than thirty years, and every fall feels the same. The leaves turn, the pumpkin patches open, the state fairs roll into town, and a few weeks later the phone rings. A child is in the ICU. Her kidneys are failing. The family went to a petting zoo.
This fall it is happening again, in three states at once. And CDC just put a number on the problem that ought to stop everyone in their tracks.
The Number: About One Million
A new study in CDC’s journal Emerging Infectious Diseases, Estimated Illness Linked to Animal Contact for 7 Pathogens, United States, 2019, updates the government’s estimate of how many Americans get sick from touching animals or the places they live. The answer: roughly one million illnesses a year, an estimated 9,592 hospitalizations and 236 deaths.
The researchers looked at Campylobacter, Cryptosporidium, Shiga toxin-producing E. coli (STEC), Listeria, nontyphoidal Salmonella and Yersinia, plus Toxoplasma for hospitalizations and deaths. They adjusted for the fact that most sick people never see a doctor and most who do never get a stool test. Those six bacterial and parasitic pathogens alone caused an estimated 995,022 illnesses linked to animal contact around 2019.
Campylobacter led in illnesses and hospitalizations, with an estimated 3,601 hospitalizations a year, followed by Salmonella at 2,415. Campylobacter also passed Salmonella in deaths. The biggest killer was Toxoplasma, the parasite spread through cat feces, at an estimated 91 deaths a year.
Now the number that matters at a petting zoo. STEC, the E. coli that causes hemolytic uremic syndrome, accounted for an estimated 134,738 animal-contact illnesses, 960 hospitalizations and 19 deaths a year. Most of that was non-O157 E. coli: an estimated 117,477 illnesses, more than ten times the 10,097 CDC estimated in 2012. E. coli O157 went from 5,960 illnesses to 17,261.
The study’s tables show how big a slice of the problem animals are. Based on a structured survey of experts, CDC attributes about 12 percent of domestically acquired E. coli O157 illnesses and 22 percent of non-O157 STEC illnesses to animal contact. And O157 is not a stomach bug you sleep off: in FoodNet surveillance, 43 percent of lab-confirmed O157 patients were hospitalized.
The 2012 estimate, published by Hale and colleagues, put all animal-contact illness at about 450,000 cases, 5,000 hospitalizations and roughly 70 deaths a year. Hospitalizations nearly doubled. Deaths more than tripled, although Toxoplasma was not counted last time. Take it out and deaths still roughly doubled. The authors are careful to say the methods differ, so the two studies are not a straight comparison.
They are also honest about why the numbers jumped. Since 2013, labs have moved to PCR-based gastrointestinal panels that catch infections old culture methods missed, especially non-O157 STEC and Campylobacter. The authors think much of the increase reflects better detection. I do not find that comforting. It means these kids and adults were getting sick all along, and we were not counting them.
For some perspective, CDC’s 2019 foodborne illness burden estimates put STEC from food at about 357,000 illnesses, 3,150 hospitalizations and 66 deaths a year. So for every three Americans who get STEC from food, more than one more gets it from an animal or its environment. Animal contact is not a footnote to food safety. It is food safety’s next-door neighbor, and it is sharing the same fairgrounds.
Three Outbreaks, One Month
The timing of the CDC paper could not be more on point.
In Illinois, health officials are investigating five confirmed E. coli cases tied to Bengtson’s Pumpkin Farm in Homer Glen. As I reported last week, the patients range from four to thirty-eight years old, and four were hospitalized.
In California, Brookshire Farms in San Luis Obispo has closed after five lab-confirmed E. coli O157 infections and eight more people with matching symptoms who visited between October 16 and 26. Three of the confirmed cases have hemolytic uremic syndrome, the kidney failure complication that keeps me up at night.
And in Texas, Dallas County is looking at nine suspected cases in children and families who had been to the State Fair of Texas. According to local reporting, the common thread is a visit to the livestock and petting zoo areas at Fair Park. Doctors noticed it first. Kids kept showing up sick, and parents kept mentioning the fair.
I wrote about all three when they broke. Here is what I said then and what I will say again: none of this is new, and none of it is a mystery.
We Have Seen This Movie Before
Just one year ago, the Arizona State Fair. The Maricopa County outbreak report found 18 people sick, 11 hospitalized and six with HUS, most of them children. Thirteen of the 18 had been at the fair on October 26, 2025, the last day. Here is the detail that matters: of the sick people who visited the animal areas, only five of eleven said there were handwashing stations. Eight said there was hand sanitizer.
Hand sanitizer is not handwashing. A study in the Journal of the American Veterinary Medical Associationfound that alcohol-based sanitizer was not protective against STEC in a fair outbreak. Manure on little hands does not care about your Purell.
Go back further. The 2004 North Carolina State Fair: about 108 people sick, 15 with HUS, traced to two commercial petting zoos. Investigators found the outbreak strain in shavings from a baby stroller and on visitors’ shoes.
2005: three separate outbreaks at fairs, festivals and petting zoos in North Carolina, Florida and Arizona, written up together by CDC.
2019: the San Diego County Fair, where a two-year-old boy died and other children were sickened after visiting the animal areas.
2022: a farm summer camp in Tennessee, written up in MMWR, where the camp operators said they knew the national guidance and had handwashing stations. Kids still got sick.
2023: the Appalachian Fairgrounds in Tennessee, where more than 64 elementary school children on field trips were infected with E. coli O157:H7. Five children, ages 15 months to 7 years, went into kidney failure and needed dialysis.
I could keep going. CDC’s own Animal Contact Outbreak Surveillance System counted 557 animal-contact outbreaks from 2009 to 2021, with 14,377 illnesses, 2,656 hospitalizations and 22 deaths. Fairs and festivals accounted for 36 of the single-location outbreaks, petting zoos 28, and farms and dairies 89. And those are just the outbreaks somebody found and reported.
Outbreaks are the tip of it. A Minnesota study I cited in my earlier post found that 28 percent of STEC patients not tied to any outbreak had visited a fair, petting zoo, agritourism farm or similar venue. The million-a-year number from CDC is mostly made of those quiet, unconnected cases.
Why the Animals, Why the Kids
Cattle, goats and sheep carry STEC in their guts and look perfectly healthy doing it. They shed it in manure. It ends up on their coats, the bedding, the fence rails, the dirt and the stroller wheels. A new analysis of CDC outbreak data found that when outbreaks were tied to sheep or goats, nearly half were caused by STEC.
Then you add small children. They touch everything. They put their hands in their mouths. They sit on the ground. The JAVMA review noted that in one outbreak, illness in kids under six was tied to touching manure, falling or sitting on the ground, and thumb-sucking or pacifiers. Another fair study found the risk of illness went up 51 percent for every extra day a child attended.
And then, too often, we put a corn dog stand at the exit. In the 2004 North Carolina outbreak, investigators flagged a food vendor positioned right next to the petting zoo exit. You could not design a better fecal-oral pipeline if you tried.
The Fix Has Been Written Down for Years
This is the part that makes me crazy. We know how to prevent this. CDC and the National Association of State Public Health Veterinarians publish the Animal Contact Compendium, and CDC has a plain-language page on staying healthy at animal exhibits. The recommendations are not complicated:
Put real handwashing stations, with soap and running water, at every exit. Not sanitizer alone. Real sinks.
Keep food and drink out of animal areas, and keep animal areas away from food. Separate entrances and exits.
Keep strollers, sippy cups, pacifiers and toys out of the pens.
Supervise. Put a person at the exit making sure kids wash.
Keep sick animals, especially those with diarrhea, away from the public. And clean the place.
The problem is that almost none of this is required. There is no federal law addressing disease risk at animal exhibits. It is a patchwork of state rules, county permits and voluntary guidance.
After Arizona, a bill was introduced to require handwashing stations, warning signs and a monitor at animal exhibits. It died in the legislature. To their credit, the Maricopa County Fair dropped its petting zoo, and the Arizona State Fair dropped direct animal contact on its own. That is something. But it should not take a cluster of kids on dialysis for each fair board to figure it out one at a time.
Groups like Parker’s Promise, started after a child developed HUS from an agricultural summer camp, are pushing for exactly the kind of mandatory rules that should already exist. They are right.
What I Want to See
Here is my ask, and it is not radical. Every state should require a permit for any public animal exhibit. No permit without soap, running water and a monitor at every exit. No food sales within a set distance of an animal area. No sanitizer-only setups. Mandatory signage that tells parents, in plain words, that children under five are at the highest risk of HUS. And when an outbreak happens, health departments should name the venue right away, not weeks later.
To parents: you do not have to skip the pumpkin patch. Just wash your kids’ hands with soap and water every single time they leave the animals, keep the snacks away from the pens, and if your child gets bloody diarrhea in the week after a visit, call the doctor and tell them about the animals. Do not give antidiarrheals, and do not push for antibiotics. Both can make HUS more likely.
CDC just told us a million Americans a year get sick from animal contact. Ten thousand end up in the hospital. Some of them die. A lot of them are kids who went to the fair.
We have the playbook. We have had it for twenty years. What we do not have is the will to make it the law.
Sources
Medford R, et al. Estimated Illness Linked to Animal Contact for 7 Pathogens, United States, 2019. Emerging Infectious Diseases 32(12), Dec. 2026 (early release, Oct. 27, 2026). https://wwwnc.cdc.gov/eid/article/32/12/26-0787_article
Hale CR, et al. Estimates of Enteric Illness Attributable to Contact With Animals and Their Environments in the United States. Clinical Infectious Diseases, 2012. https://academic.oup.com/cid/article-abstract/54/suppl_5/S472/432063
CDC. Enteric Disease Outbreaks Associated with Animal Contact — ACOSS, United States, 2009–2021. MMWR Surveillance Summaries 74(3). https://www.cdc.gov/mmwr/volumes/74/ss/ss7403a1.htm
CDC. Estimates: Burden of Foodborne Illness in the United States (circa 2019). https://www.cdc.gov/food-safety/php/data-research/foodborne-illness-burden/index.html
Comparison of zoonotic enteric disease outbreaks associated with ruminant and non-ruminant animal contact — United States, 2013–2021. Frontiers in Public Health, 2026. https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2026.1845080/full
KWBU. Investigations underway for potential E. coli outbreak from State Fair petting zoo. Oct. 30, 2026. https://www.kwbu.org/news-from-across-texas/2026-10-30/investigations-underway-for-potential-e-coli-outbreak-from-state-fair-petting-zoo
KSST Radio. Health Officials Investigate Potential E. Coli Outbreak Linked to State Fair of Texas Petting Zoo. Oct. 29, 2026. https://www.ksstradio.com/2026/10/health-officials-investigate-potential-e-coli-outbreak-linked-to-state-fair-of-texas-petting-zoo/
Food Poisoning News. Five E. Coli Cases Possibly Linked to Bengtson’s Pumpkin Farm in Illinois. Oct. 26, 2026. https://www.foodpoisoningnews.com/five-e-coli-cases-possibly-linked-to-bengtsons-pumpkin-farm-in-illinois/
Marler Blog. Weekend Wrap-Up: Twenty-Seven Children and Adults Sick After Two Pumpkin Patches and a State Fair Petting Zoo. https://marlerblog.com/case-news/weekend-wrap-up-twenty-seven-children-and-adults-sick-after-two-pumpkin-patches-and-a-state-fair-petting-zoo-three-of-them-with-kidney-failure-the-justice-department-told-fda-in-writing-that-its-ow
Marler Blog. Pumpkin Patches, Petting Zoos and State Fairs: Three New E. coli Investigations. https://www.marlerblog.com/case-news/pumpkin-patches-petting-zoos-and-state-fairs-three-new-e-coli-investigations-twenty-five-years-of-outbreaks-just-like-them-and-the-prevention-playbook-everyone-already-has/
Maricopa County Department of Public Health. 2025 STEC Outbreak Report (Arizona State Fair). https://media.ronsimonassociates.com/reports/maricopa-county-2025-stec-outbreak-report.pdf
Food Poisoning News. Arizona State Fair Petting Zoo Linked to 2025 E. coli Outbreak That Sickened 18, Hospitalized 11 Children. Oct. 14, 2026. https://www.foodpoisoningnews.com/arizona-state-fair-petting-zoo-linked-to-2025-e-coli-outbreak-that-sickened-18-hospitalized-11-children/
Arizona Legislature. SB 1082 (2026). https://legiscan.com/AZ/text/SB1082/2026
Arizona Republic. Maricopa County Fair: no petting zoos following E. coli outbreak. Apr. 4, 2026. https://www.azcentral.com/story/news/local/arizona-health/2026/04/04/maricopa-county-fair-no-petting-zoos-following-e-coli-outbreak-arizona-state-fair/89461033007/
CIDRAP. North Carolina E. coli outbreak traced to petting zoo (2004). https://www.cidrap.umn.edu/e-coli/north-carolina-e-coli-outbreak-traced-petting-zoo
CDC. Outbreaks of E. coli O157:H7 Associated with Petting Zoos — North Carolina, Florida, and Arizona, 2004 and 2005. MMWR 54(50). https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5450a1.htm
San Diego Union-Tribune. E. coli death, infections spark claims against San Diego fair board. July 30, 2019. https://www.sandiegouniontribune.com/2019/07/30/e-coli-death-infections-spark-claims-against-san-diego-fair-board-2/
Tennessee Department of Health. STEC O157:H7 outbreak, Appalachian Fairgrounds (2023). https://healthdata.tn.gov/Infectious-Disease/Shiga-toxin-producing-Escherichia-coli-O157-H7-out/8crc-mqrk/about_data
Notes from the Field: An Outbreak of STEC O157:H7 Associated with a Farming Camp — Tennessee, 2022. MMWR. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10360649/
Direct and indirect zoonotic transmission of Shiga toxin–producing E. coli. JAVMA 232(6), 2008. https://avmajournals.avma.org/view/journals/javma/232/6/javma.232.6.848.xml
CDC and NASPHV. Compendium of Measures to Prevent Disease Associated with Animals in Public Settings. https://stacks.cdc.gov/view/cdc/133062
CDC. Staying Healthy at Animal Exhibits. https://www.cdc.gov/healthy-pets/about/staying-healthy-at-animal-exhibits.html
Parker’s Promise. https://parkers-promise.com/
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