Epidemic keratoconjunctivitis: efficacy of outbreak management

Cristina Martin,Ursula Löw,Gesine Schießl,Barbara Gärtner,Albert Heim,Adrien Quintin,Berthold Seitz

doi:10.1007/s00417-021-05344-4

Cristina Martin, Ursula Löw + Show 5 more

Open Access

https://doi.org/10.1007/s00417-021-05344-4

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Abstract

PurposeEpidemic keratoconjunctivitis (EKC) is one of the most severe ocular viral infections. The aim of this interruptive time series study was to quantitatively evaluate the effectiveness of a hygienic EKC outbreak management concept developed in our ophthalmological department.MethodsAll patients with suspected EKC in the period from August to November 2018 were included in the study. Data were retrospectively collected from the patient’s medical documents and records. The disease was diagnosed clinically and confirmed by virus detection through polymerase chain reaction (PCR) from conjunctival swabs. With the beginning of the epidemic, an outbreak management plan was implemented to reduce the nosocomial spread.ResultsThe outbreak lasted 77 days (20th August 2018 to 4th November 2018) and affected a total of 120 patients. This corresponds to a mean of 1.5 patients per outbreak day. The median age was 58 [1–92] years. Of all patients, 61 (50.8%) were female. Conjunctival swabs were collected in 100/120 (83.3%) cases, the adenovirus being detected in all positive smears (63/63, 100%). The implementation of our outbreak management plan reduced significantly the number of EKC cases per outbreak day and resulted in a reduction of the basic reproduction number by a factor of 2.2.ConclusionThe detection of EKC together with the immediate implementation of hygienic outbreak measures can significantly reduce the spread of infection. The implementation of a strict outbreak management concept can significantly reduce the number of EKC cases, thus avoiding possible complications and therefore unnecessary health-related costs.

Highlights

Viruses represent about 80% of all causes of acute conjunctivitis, with epidemic keratoconjunctivitis (EKC) being the most frequent manifestation of an ocular viral infection [1, 2]
EKC is caused by the human adenovirus (HAdV) which belongs to the genus Mastadenovirus of the Adenoviridae family [4]
The serotypes 8, 37, 53, 54, and 64 of species and HAdVD are mainly responsible for EKC, while several other types of species HAdV-B and HAdV-E are associated with less severe conjunctivitis and pharyngoconjunctival fever [5]

Summary

Introduction

Viruses represent about 80% of all causes of acute conjunctivitis, with epidemic keratoconjunctivitis (EKC) being the most frequent manifestation of an ocular viral infection [1, 2]. EKC is a highly contagious infectious disease, affecting in Japan alone approximately one million individuals each year [2]. A considerably higher prevalence can be assumed, because of unreported cases, since only the detection of adenovirus in EKC is notifiable and not every patient with this disease will consult an ophthalmologist or will be tested. EKC is caused by the human adenovirus (HAdV) which belongs to the genus Mastadenovirus of the Adenoviridae family [4]. The serotypes 8, 37, 53, 54, and 64 (previously, 19a) of species and HAdVD are mainly responsible for EKC, while several other types of species HAdV-B and HAdV-E are associated with less severe conjunctivitis and pharyngoconjunctival fever [5]

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