BACKGROUND: Epidemic keratoconjunctivitis (EKC) is caused by human adenoviruses (HAdV); outbreaks have been linked to eye-care settings. In October 2016, increased cases were reported in St. Thomas, U.S. Virgin Islands. We investigated factors associated with infection and provided infection control recommendations.
METHODS: A case was defined as a clinical diagnosis of acute conjunctivitis by an ophthalmologist or optometrist in a patient in St. Thomas during June 1‒November 10, 2016. Medical records were reviewed and conjunctival swabs from patients and environmental samples from high-contact surfaces and eye-care equipment were tested for HAdV using real-time PCR.
RESULTS: We identified 70 patients who met the case definition; of 12 tested for HAdV, 9 (75%) were positive for HAdV type 8. Median age was 46 years (range, 9 months‒90 years); 27 (39%) were male. Ocular symptoms included redness (66%), watery discharge (44%), and pain (33%). Severe signs included corneal infiltrates (19%) and pseudomembranes (7%). Ten patients (14%) had eye-care clinic exposure within the month preceding symptom onset. A symptomatic household or family contact was documented for 9 (13%) patients. HAdV was detected in 9 (20%) of 44 environmental samples from practices where patients had previous eye-care visits, including eye-care equipment and hand sanitizer dispensers.
CONCLUSIONS: During this community outbreak of HAdV, prior practice visits among patients and positive environmental samples from eye-care clinics suggested healthcare-associated transmission. Recommendations included implementation of strict infection control practices in healthcare settings, advising patients on HAdV infection prevention, and enhanced EKC surveillance to detect additional transmission.