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

Abstract

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.

The COVID-19 pandemic: Important considerations for contact lens practitioners

“…One ocular viral infection to consider is epidemic keratoconjunctivitis (EKC), caused by the non-enveloped DNA virus adenovirus. This disease is highly contagious, spreads rapidly through direct contact, accounts for 65-90% of viral conjunctivitis cases [30,31] and has been implicated in actively transmitted disease in eyecare clinics and other common healthcare settings where there is close contact between healthcare providers and patients [32][33][34][35][36][37][38]. A review of the literature appears to show no increased risk for EKC in those wearing contact lenses versus non-lens wearers, with a reported frequency of 3-15% in contact lens wearers [32,36].…”

Adenoviral Keratoconjunctivitis: Diagnosis, Management, and Prevention

“…It turns out that HAdV-D53 is a highly contagious corneal pathogen and was the first of three recently identified viruses associated with EKC in the last decade or two-HAdV-D53, D54, and D56 [35]. In December 2018, the United States Centers for Disease Control and Prevention (CDC) reported an outbreak of EKC caused by HAdV-D53 at an optometry clinic in Los Angeles due to lax disinfection measures [36]. While this genotype has caused EKC in Japan and Germany, this CDC report described the first EKC outbreak due to HAdV-D53 in the USA.…”

“…The recommended contact time with a pre-moistened wipe containing quaternary ammonium and isopropyl alcohol is 2 min, then allowing to air-dry. These infection control practices were stressed after an investigation of an optometry clinic where an EKC outbreak involving 17 patients occurred [36].…”

Infektionsprävention in der Augenheilkunde

“…Ausbruchsgeschehen über kontaminierte bzw. nicht suffizient aufbereitete Applanationstonometer sind in der Literatur beschrieben [35].…”