title: National outbreak of Acanthamoeba keratitis associated with use of a contact lens solution, United States.
abstract: An outbreak of Acanthamoeba keratitis, a rare, potentially blinding, corneal infection, was detected in the United States in 2007; cases had been increasing since 2004. A case-control study was conducted to investigate the outbreak. We interviewed 105 case-patients from 30 states and 184 controls matched geographically and by contact lens use. Available contact lenses, cases, solutions, and corneal specimens from case-patients were cultured and tested by molecular methods. In multivariate analyses, case-patients had significantly greater odds of having used Advanced Medical Optics Complete Moisture Plus (AMOCMP) solution (odds ratio 16.9, 95% confidence interval 4.8-59.5). AMOCMP manufacturing lot information was available for 22 case-patients, but none of the lots were identical. Three unopened bottles of AMOCMP tested negative for Acanthamoeba spp. Our findings suggest that the solution was not intrinsically contaminated and that its anti-Acanthamoeba efficacy was likely insufficient. Premarket standardized testing of contact lens solutions for activity against Acanthamoeba spp. is warranted.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. jverani@cdc.gov
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Verani
authors.forename: Suchita A
authors.initials: SA
authors.lastname: Lorick
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Yoder
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Beach
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Braden
authors.forename: Jacquelin M
authors.initials: JM
authors.lastname: Roberts
authors.forename: Craig S
authors.initials: CS
authors.lastname: Conover
authors.forename: Sue
authors.initials: S
authors.lastname: Chen
authors.forename: Kateesha A
authors.initials: KA
authors.lastname: McConnell
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Chang
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Park
authors.forename: Dan B
authors.initials: DB
authors.lastname: Jones
authors.forename: Govinda S
authors.initials: GS
authors.lastname: Visvesvara
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Roy
mesh_terms: D000048:Acanthamoeba / Q000302:isolation & purification; D015823:Acanthamoeba Keratitis / Q000453:epidemiology* / Q000469:parasitology / Q000635:transmission; D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D016022:Case-Control Studies; D002648:Child; D021821:Communicable Diseases, Emerging / Q000453:epidemiology* / Q000469:parasitology / Q000635:transmission; D018639:Contact Lens Solutions / Q000009:adverse effects* / Q000032:analysis; D004196:Disease Outbreaks; D004340:Drug Contamination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D018639:Contact Lens Solutions