Epidemic Keratoconjunctivitis Caused by Adenovirus Type 8: Epidemiologic and Laboratory Aspects of a Large Outbreak

Abstract

During late 1977 and early 1978, 192 cases of epidemic keratoconjunctivitis occurred in a community in central Georgia. In 86 of these cases, the patient had been exposed to a single ophthalmologist's office (physician A) 3-22 days before onset of illness. Patients considered as cases were more likely to have had invasive ophthalmologic procedures than non-cases (p < 0.001), and a linear relationship existed between the number of procedures performed and the attack rate (r = 0.91, p < 0.05). Adenovirus type 8 (AV8) was identified as the responsible pathogen by culture and/or antibody determination for 20 of these patients. Group-specific AV hexon antigen and type specific dodecon antigen were identified in four of seven ophthalmic solutions obtained from physician A's office. The outbreak stopped after proper control techniques were initiated.

An Outbreak of Epidemic Keratoconjunctivitis at an Outpatient Ophthalmology Clinic

“…Risk factors for EKC transmission identified in healthcare settings include use of inadequately disinfected tonometers to measure intraocular pressure, 8-11 use of multi-dose drops, 10 or exposure to specific care givers. 8-10,12,13 Adenoviruses have been shown to persist in the environment and remain viable in a desiccated state for lengthy periods and to be recoverable from the hands of infected individuals, even following hand washing. 9,14 Guidelines for the disinfection and sterilization of ophthalmology equipment that may contribute to EKC transmission have been published by the Healthcare Infection Control Practices Advisory Committee 15 …”

Epidemic Keratoconjunctivitis in a Chronic Care Facility: Risk Factors and Measures for Control

“…Known historically to cause epidemics in industrial settings (“shipyard eye”), transmission from one person to another through hand‐eye contact, contaminated instruments, and eye solutions has also been frequently reported in nosocomial situations, especially eye‐care clinics, doctors’ offices, and hospitals 6–11 . There is, however, only one report in the literature of an outbreak in a chronic care facility, and this was traced to visits to an eye clinic and contaminated eye solutions 12 .…”

Adenovirus Transmission in a Nursing Home: Analysis of an Epidemic Outbreak of Keratoconjunctivitis

“…Adenovirus serotype 8 is a common cause of EKC outbreaks in different types of closed communities [5,8,9] , and also of large community outbreaks [4,16,17] . The contamination source of the index case was not identified in this outbreak (he had not previously attended an ophthalmological office and no other previous cases were detected).…”