An outbreak of epidemic keratoconjunctivtis in a pediatric unit due to adenovirus type 8.
OBJECTIVE
To investigate and control an outbreak of epidemic keratoconjunctivitis (EKC) occurring in a neonatal intensive care unit (NICU) and to determine signs specific for EKC in newborns.


METHODS
Outbreak investigation and case-control study.


METHODS
NICU of a 1,600-bed university hospital in Heidelberg, Germany.


METHODS
Case-patients were defined as individuals who had adenoviral antigen detected by ELISA or by PCR from conjunctival swabs or who had clinical signs of conjunctivitis. Twelve newborns from the NICU who had EKC between October and November 1998 were compared with 11 who had bacterial conjunctivitis.


METHODS
Control measures included cohorting patients in contact isolation, using gloves and gowns for patient care, and using a hand rub and disinfectants with virucidal activity.


RESULTS
Thirteen patients, 6 healthcare and 11workers, relatives of the patients had EKC, according to our case definition. Case-patients were more likely than control-patients to develop lacrimal swelling (P < .001), eye redness (P = .004), and lacrimation (P = .037) involving both eyes (P = .002). Prior examination by an ophthalmologist was a significant risk factor for EKC (P = .004). For diagnosis or treatment of retinopathy, premature newborns were seen by an ophthalmologist from a nearby eye care center where an EKC outbreak was ongong. No new cases were diagnosed more than 10 days after the implementation of control measures.


CONCLUSIONS
In newborns, lacrimal swelling, eye redness, and lacrimation in both eyes should evoke suspicion of EKC. Ophthalmologists who have had contact with known EKC cases should use antiseptics and disinfectants with virucidal activity before contact with newborns or abstain from examining newborns.
Chaberny
Iris E
IE
Department of Medical Microbiology and Hygiene, Institute of Hygiene, University of Heidelberg, Germany.
Schnitzler
Paul
P
Geiss
Heinrich Konrad
HK
Wendt
Constanze
C
D000256:Adenoviridae / Q000235:genetics / Q000276:immunology; D000257:Adenoviridae Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D000956:Antigens, Viral / Q000032:analysis; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D004196:Disease Outbreaks; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005858:Germany / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007637:Keratoconjunctivitis / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D008297:Male
D000956:Antigens, Viral; D004279:DNA, Viral