Adenovirus Outbreaks — The Eyes Have It

Epidemic keratoconjunctivitis (EKC) is one of the most common eye infections. Usually self-limited, it lasts weeks to months and may result in considerable morbidity and loss of time at work or school. In the past, it was common in shipyard workers who experienced eye trauma, and it was often spread by such fomites as roller towels; now, however, transmission is usually through contaminated ophthalmologic equipment or solutions. Human adenovirus (HAdV) types 8, 19, and 37 are frequently to blame.

Six unrelated outbreaks of EKC were reported to the CDC between August 2008 and July 2010. The first outbreak, with symptom onset between June and September 2008, involved 70 cases (including 8 in healthcare staff) at three ophthalmology or optometry facilities in Minnesota. It was probably caused by HAdV-8, which was identified in three cases; no source was identified. Between November 2008 and March 2009, EKC was diagnosed in 37 individuals in Florida. The outbreak was traced to an outpatient ophthalmology practice at two sites at which the sole staff physician continued to work after developing an eye infection. HAdV-8 was also identified in this outbreak. In March 2009, an outbreak caused by HAdV-19 occurred in 12 infants in a neonatal intensive care unit in Illinois. Eye examination for retinopathy of prematurity had been carried out by a team that reused equipment after sterilization with isopropyl alcohol. Four staff members — including one who continued to work while symptomatic — and two patient family members were also infected. Finally, between December 2009 and July 2010, three separate EKC outbreaks occurred in New Jersey. Three ophthalmologic practices and 286 patients were involved. HAdV-8 was identified in two of the outbreaks, and HAdV-3 in the other.