Although there are many benefits related to human-animal interactions, it is important to consider health risks associated with these encounters. Zoonotic disease transmission is of concern to public health practitioners, especially when large groups of people and animals come together within a small setting. This study examined the disease prevention strategies employed at selected agricultural fairs in the Northeastern United States and health protective behaviors exhibited by fair visitors. An observational study was conducted using a multiple case study design. Data collected were compared to a similar study conducted in 2006 to evaluate changes in the level of adherence to the National Association of State Public Health Veterinarians' recommendations. Results showed an increase in public service announcements, but few changes in fair visitor health-protective behaviors. As was noted in similar investigations throughout the United States, improved health promotion strategies are still greatly needed at agricultural fairs.