Could Bird Flu Spread at State Fairs? Here’s Why Health Experts Advise Caution

Between July and October, each state holds its annual state fair.

The events are known for things like Ferris wheels and corn dogs, sculptures made entirely of butter and the state’s largest pig. But state fairs can also be places where diseases can spread more easily — bringing people and animals from farms across the state into close contact.

This is particularly worrying this year because last Thursday, H5N1, or bird flu, infections were confirmed in dairy cattle in 14 U.S. states, including California.

Four dairy workers in Michigan, Texas and Colorado also contracted the virus.

But that doesn’t stop many fairgoers from lining up to watch the cattle escape through the barn fences.

Mel Ventimiglia stood with some cows and his grandchildren in a barn at the Indiana State Fair in Indianapolis on a weekday in August. He said bird flu wasn’t even on his radar.

“I haven’t heard anyone mention it, except you,” Side Effects said. “I hope I forget about it pretty quickly.”

Benjamin Thorp / WFYI

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WFYI

At another nearby cattle barn, farmer Randy Mason says he is taking basic precautions to keep his cattle from getting sick while at the fair, but he is not particularly worried.

“I think a lot of this is over the top,” he said. “They get one or two cases and then it becomes — like anything the government does — it becomes over the top and out of proportion.”

However, according to the Centers for Disease Control and Prevention, bird flu infections have been confirmed in nearly 200 flocks nationwide.

That has caused some state fairs to implement stricter rules to stop the spread of the virus.

Minnesota, where cases of bird flu have been detected in dairy cattle, has required all cows to test negative for bird flu before arriving at the state fair.

The situation is different in many other states, such as Indiana, where there have been no confirmed cases of bird flu.

“Because we didn’t have a diagnosis, we didn’t take any extra precautions,” said Bret Marsh, Indiana state veterinarian.

He said the state has ordered farmers to watch for signs of bird flu in their animals. It has also informed farmers about the risk of spreading the disease when coming to the fair and has recommended that animals be quarantined for 30 days after the show. But unless there is a positive test in Indiana, Marsh said, the state does not need to implement stricter restrictions.

Why are state fairs a concern?

However, scientists agree that not enough testing is being done to fully determine which states cows are infected with bird flu.

Amesh Adalja, a senior scientist at the Johns Hopkins University Center for Health Security, said states like Indiana don’t have any positive cases of bird flu in cattle because they don’t look for cases.

“The assumption should be that this virus is in Indiana, we just haven’t found it yet,” he said. “That’s what they should be saying, not, ‘Our cows are free.’ That’s foolish to believe.”

That makes places like state fairs — where people will come into contact with a variety of animals — especially worrisome. Scientists fear that bird flu could mutate to spread more easily among mammals, including humans, if given the chance.

At present, the virus appears to affect only infected people who have direct contact with udders and equipment used to care for infected cows, or farm workers involved in slaughtering infected poultry flocks. The few human cases have had mild symptoms, including conjunctivitis or pink eye in humans. There are wider concerns that the virus could mutate into a respiratory virus that spreads more easily from person to person.

And markets have always been places where transmission from animals to humans occurred.

Benjamin Thorp / WFYI

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WFYI

In 2012, a major outbreak of swine flu led to more than 300 infections in the U.S., most of which were linked to exposure at agricultural shows. Last year, the CDC reported that two people became infected with swine flu after attending pig shows.

Each time a flu virus enters a new host, it has a chance to evolve and potentially become a virus that could begin spreading among humans.

Experts fear that the risk of H5N1 becoming a human virus could increase significantly if the virus reaches pigs in particular, because they are an ideal vessel for mixing viruses from different species. This means different viruses can swap genetic material and learn from each other, potentially mutating and becoming more adept at infecting humans.

“One of the things that people have been bringing up a lot in the context of COVID-19 is the animal fairs in China, where there are so many different animals and species interacting with each other,” Adalja said. “Similar things are happening at state fairs in the United States. This is no different.”

Andrew Bowman, a professor of veterinary preventive medicine at The Ohio State University, agrees that being around animals and people at state fairs has its risks.

“We thought about new pandemic viruses coming from live animal markets in Southeast Asia. And we thought, ‘Oh, we would never do that in the U.S.’ Well, the markets kind of mimic that,” he said.

The risk to public health is still low

But experts like Bowman say that’s no reason not to attend the state fair at all.

“I still go to the fair, and my family still goes to the fair. I had a milkshake while I was there,” Bowman said.

He added that risk groups, such as people with weakened immune systems, should consider avoiding cattle sheds this year.

“You know, be careful and really think about what kind of contact (you) need to have,” Bowman said. “Can I enjoy the animal exhibits, maybe from a little bit more distance, and not get in the middle of it?”

The CDC issued guidelines in June for state fairs to limit the spread of bird flu, including banning milk from being poured on the ground because raw milk from infected cattle likely contains live virus. The guidelines also recommend keeping cows from different herds away from each other and encourage visitors to wash their hands before leaving the barn.

Earlier this year, the U.S. Department of Agriculture introduced a rule requiring cows crossing state lines to test negative for the virus.

Still, the CDC estimates that the risk to humans from the bird flu virus remains low.

This story comes from Side Effects Public Media, a health reporting collaboration based at WFYI in Indianapolis. We work with NPR stations across the Midwest and surrounding areas — including KBIA and KCUR in Missouri, Iowa Public Radio, Ideastream in Ohio and WFPL in Kentucky.

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