The outbreak began with symptoms common to many childhood illnesses: diarrhea, cramps and upset stomach. Soon, youngsters were showing up at hospitals across Florida with their kidneys failing and in urgent need of dialysis.
Before it was over, 30 people, most of them children, were being treated for illnesses that health investigators blame on a potentially deadly strain of E. coli bacteria carried by animals in a petting zoo exhibit that moved from fair to fair in Florida.
Maryland officials, preparing for the carnival and fair season that begins next month, have taken note. They have drafted recommendations that call for additional hand-washing stations at fairs and educational material.
"We will be taking every step possible to prevent the situation in Florida from happening here," said Karen Black, a spokeswoman for the Maryland Department of Health and Mental Hygiene.
The Health Department has joined forces with the state Department of Agriculture, the University of Maryland Cooperative Extension and a fair management group to form a coalition aimed at protecting the health of fair-goers here.
"For a small state, Maryland has a very busy fair, show and festival schedule that gets under way in early May and goes through the fall," attracting millions of visitors, said Becky Brashear. She is president of the Maryland Association of Agricultural Fairs and Shows, a group representing the Maryland State Fair and county fairs across the state.
"This is not a panic situation. There are things that can be done to prevent an outbreak like they had in Florida," she said.
The Maryland State Fair, which opens in late August, will have additional hand-washing facilities as well as a new wall between the Animal World exhibit and the food court at the Cow Palace, said Howard M. Mosner Jr., president and general manager of the fair.
"We don't want to scare people to death, but there will be a lot more signs educating people on the points they need to understand to protect themselves and their children," he said.
"In the past," he said, "we had those waterless cleansers, those alcohol-based cleaning pads, but they were not as effective. Studies show that nothing beats soap and water in preventing this kind of problem."
The federal Centers for Disease Control and Prevention agree.
"Our bottom line recommendation -- our No. 1 tip for fair-goers -- is that people wash their hands after touching the animals," said Jennifer Morcone, a spokeswoman for CDC. "And No. 2 is that fairs have transition areas between the animal exhibits and the food centers where people can wash their hands."
Catching an E. coli infection from animals is extremely rare. Fewer than 25 such outbreaks have occurred between 1990 and 2000, said Morcone.
But the incident in Florida, and an even larger one in North Carolina in December that sickened more than 100 children, has officials urging caution.
Scott M. Miller, a lawyer in Longwood, Fla., said that fairs should be doing more to protect the health of visitors. He has filed suit on behalf of eight victims of the Florida outbreak against the company that provided the petting zoo.
Some fairs in Florida have built barriers around animal exhibits to prevent kids from touching them.
Mosner said such precautions are not planned at the state fair. "But that could change," he said.
Morcone, the CDC spokespersons said: "We don't want to eliminate the public's contact with these animals. It's a wonderful, family-friendly opportunity, but people need to be aware of the possibility of transmitting an infection. They need to be careful."
Black said the Department of Health and Mental Hygiene was not aware of any outbreaks of E. coli at fairs or similar events in Maryland in past years.
All animals exhibited at fairs in Maryland are required to have a certificate signed by a veterinarian stating that they are healthy.
"We also inspect animals at the fair. We are always looking for any signs a health problem," said Dr. Tom Jacobs, assistant state veterinarian.
Morcone said parents should pay close attention to their children when attending fairs. "Make sure the kids don't bring in pacifiers or sippy cups."
In most cases, she said, an infection comes from children touching animal feces and then putting their hand in their mouth.
According to the CDC, the illness may be mild or severe. Young children are more likely to have severe symptoms, including kidney failure, or to die.
Children accounted for 24 of the 30 cases of the infections in Florida this year.
In the vast majority of cases E. coli infection comes from contaminated food such as undercooked ground beef, according to the CDC. With animals, it usually comes from cows, sheep and goats.
Children younger than 5 should be especially cautious around cattle, advises the CDC.
It encourages people with symptoms, including diarrhea, vomiting, abdominal cramps and/or nausea, to contact a physician and to be sure to mention any recent contact with farm animals.
More than 150 million people attended fairs in the United States last year, said Jim Tucker, president of the International Association of Fairs and Expositions in Springfield, Mo. "You probably have a greater likelihood of being hit by lighting" than obtaining an E. coli infection.
E. coli facts
Escherichia coli is a species of bacteria.
Contaminated food, such as undercooked beef, is the most common source of infection.
It can also be contracted from animal manure.
Symptoms: diarrhea, fever, abdominal cramps, nausea and vomiting.
In severe cases, kidney failure can be fatal. Source: Centers for Disease Control and Prevention.