Notes from the Field: Epidemic Keratoconjunctivitis Outbreak Associated with Human Adenovirus Type 8 — U.S. Virgin Islands, June–November 2016

Killerby, Marie E.; Stuckey, Matthew J.; Guendel, Irene; Sakthivel, Senthilkumar K.; Lu, Xiaoyan; Erdman, Dean D.; Schneider, Eileen; Fagan, Ryan; Davis, Michelle; Watson, John T.; Gerber, Susan I.; Biggs, Holly M.; Ellis, Esther M.

doi:10.15585/mmwr.mm6630a3

Cited by 16 publications

(31 citation statements)

References 2 publications

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“…Further study and systematic testing using molecular epidemiologic techniques to type adenovirus clinical isolates would be needed to better characterize the diversity of circulating strains during any study period. In October 2016, an EKC outbreak occurred in the US Virgin Islands, and NG‐WGS was performed on a sample obtained during that outbreak. Compared with the sequences from our study, the strain from the Virgin Islands was genetically more related to the strain from the Ulster County ophthalmology clinic than to those isolated from the NICU cases (personal communication with the centers for disease control and prevention (CDC), data not shown).…”

Section: Discussionmentioning

confidence: 99%

“…CDS, coding DNA sequence, HAdV, human adenovirus. In October 2016, an EKC outbreak occurred in the US Virgin Islands,24 and NG-WGS was performed on a sample obtained during that outbreak. Compared with the sequences from our study, the strain from the Virgin Islands was genetically more related to the strain from the Ulster County ophthalmology clinic than to those isolated from the NICU cases (personal communication with the centers for disease control and prevention (CDC), data not shown).Throughout this study, limitations were encountered with the Ion Torrent technology and its ability to obtain whole or near whole genome HAdV sequences, particularly the platform's difficulties with sequencing regions of high GC content.…”

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confidence: 99%

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Molecular typing and whole genome next generation sequencing of human adenovirus 8 strains recovered from four 2012 outbreaks of keratoconjunctivitis in New York State

Lamson

Kajon

Shudt

et al. 2018

Journal of Medical Virology

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Ocular infections caused by human adenovirus (HAdV) are highly contagious. The most severe are usually caused by members of species HAdV-D (types HAdV8, 19, 37, 53, 54, and 56) and can manifest as epidemic keratoconjunctivitis (EKC), often resulting in prolonged impairment of vision. During the early months of 2012, EKC outbreaks occurred in neonatal intensive care units (NICUs) in 3 hospitals in New York State (New York and Suffolk Counties). A total of 32 neonates were affected. For 14 of them, HAdV8 was laboratory-confirmed as the causative agent. Nine healthcare workers were also affected with 3 laboratory-confirmed, HAdV-positive EKC. A fourth EKC outbreak was documented among patients attending a private ophthalmology practice in Ulster County involving a total of 35 cases. Epidemiological linkage between the neonatal intensive care unit outbreaks was demonstrated by molecular typing of virus isolates with restriction enzyme analysis and next generation whole genome sequencing. The strain isolated from the ophthalmology clinic was easily distinguishable from the others by restriction enzyme analysis.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Molecular typing and whole genome next generation sequencing of human adenovirus 8 strains recovered from four 2012 outbreaks of keratoconjunctivitis in New York State

Lamson

Kajon

Shudt

et al. 2018

Journal of Medical Virology

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“…Since the 1980s, EKC outbreaks caused by HAdV-8 have been reported in different countries and regions of the world. Most of the outbreaks were caused by iatrogenic ophthalmic transmission in hospitals [25,27,[31][32][33][34][35][36][37]. Two outbreaks of EKC in two schools in the Tibet autonomous region were reported for the first time in mainland China.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, EKC [18][19][20] is caused by enterovirus type 70, human coxsackievirus A24 variant (CVA24v), and HAdV-11. Outbreaks caused by adenovirus types 8, 56, 54 and enteroviruses CVA24v and EV70 have been reported in China and other countries or regions around the world [6,15,[21][22][23][24][25][26][27].…”

Section: Introductionmentioning

confidence: 99%

An Outbreak of Epidemic Keratoconjunctivitis Caused by Human Adenovirus Type 8 in Primary School, Southwest China

Zhou

et al. 2019

Preprint

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Background: Two outbreaks of epidemic keratoconjunctivitis (EKC) occurred successively with an interval of five days in two primary boarding schools in Weixi Lisu Autonomous County, Diqing, and Tibetan Autonomous Prefecture, Yunnan. The aims of this study were to determine the intensity and characteristics of the outbreaks, as well as the clinical manifestations in the patients, the risk factors for infection and the pathogen responsible for the two outbreaks. Methods: An outbreak investigation was conducted in two primary schools, and a case-control study including patients from the Weixi County Ethnic Primary School was performed. Relevant specimens were collected according to the case definition, and next-generation sequencing was employed to identify the pathogen. An epidemiological investigation method was used to analyse the related epidemiological characteristics, such as risk factors. The phylogenetic tree was constructed by MEGA 7.0. Results: A total of 331 acute conjunctivitis cases, including probable cases of EKC, were reported in the two schools, and the attack rates were 30.59% (171/559, 95%CI: 26.76-34.42) and 20.41% (160/784, 95%CI: 17.58-23.24), respectively. Cases occurred in all grades and classes in both schools, and only one staff member in each school presented illness. The epidemics lasted for 54 days and 45 days, respectively. The patients had typical manifestations of EKC, such as acute onset, follicular hyperplasia, pseudomembrane formation, preauricular lymphadenopathy, corneal involvement and blurred vision, and a relatively long disease course (average 9.40 days, longest 23 days and shortest 7 days). The risk factor for infection was close contact with a patient or personal items contaminated by a patient. The pathogen responsible for the outbreaks was HAdV-8. The virus was highly similar to the 2016 HAdV-8 strain from Tibet, China. Conclusions: This study strongly suggests that HAdV-8 could lead to serious consequences. This is the second report of a HAdV-8-associated EKC outbreak in mainland China. Tibetan HAdV-8 might be circulating in southwest China; therefore, it is necessary to monitor the pathogens causing acute conjunctivitis in this area.

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“…Previous studies have demonstrated that adenoviruses can persist on environmental surfaces for several weeks ( 9 ). Enhanced infection prevention practices, including staff member education on eye drop administration and longer slit lamp and tonometer disinfection times were implemented.…”

Section: Discussionmentioning

confidence: 99%

Outbreak of Epidemic Keratoconjunctivitis Caused by Human Adenovirus Type D53 in an Eye Care Clinic — Los Angeles County, 2017

OYong¹,

Killerby²,

Pan³

et al. 2018

MMWR Morb. Mortal. Wkly. Rep.

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On June 22, 2017, the Los Angeles County Department of Public Health (LAC DPH) was notified of seven patients who were seen at an eye care clinic on June 8, 2017, and later developed symptoms of epidemic keratoconjunctivitis (EKC). EKC is a contagious, severe form of viral conjunctivitis that can cause pain and blurred vision for up to 4 weeks (1). LAC DPH conducted an investigation, which identified 17 patients with EKC, including 15 who had visited the optometry clinic and two who were household contacts of clinic patients. Observations in the clinic found deficiencies in disinfection of tonometers (an instrument connected to a slit lamp and used to test for glaucoma by measuring intraocular pressure) and multiuse eye drop administration. Staff member education and revision of disinfection practices interrupted further transmission. Patient specimens tested positive for human adenovirus (HAdV) type D53 (HAdV-53). As the first documented EKC outbreak associated with HAdV-D53 in the United States, this outbreak highlights the need for rigorous implementation of recommended infection prevention practices in eye care settings.

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Notes from the Field: Epidemic Keratoconjunctivitis Outbreak Associated with Human Adenovirus Type 8 — U.S. Virgin Islands, June–November 2016

Cited by 16 publications

References 2 publications

Molecular typing and whole genome next generation sequencing of human adenovirus 8 strains recovered from four 2012 outbreaks of keratoconjunctivitis in New York State

Molecular typing and whole genome next generation sequencing of human adenovirus 8 strains recovered from four 2012 outbreaks of keratoconjunctivitis in New York State

An Outbreak of Epidemic Keratoconjunctivitis Caused by Human Adenovirus Type 8 in Primary School, Southwest China

Outbreak of Epidemic Keratoconjunctivitis Caused by Human Adenovirus Type D53 in an Eye Care Clinic — Los Angeles County, 2017

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