An outbreak of epidemic keratoconjunctivitis in a pediatric unit due to adenovirus type 8

OBJECTIVES: 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. DESIGN: Outbreak investigation and case-control study. SETTING: NICU of a 1,600-bed university hospital in Heidelberg, Germany. PATIENTS: 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. INTERVENTION: 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 workers, and 11 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 ongoing. No new cases were diagnosed more than 10 days after the implementation of control measures. CONCLUSION: 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.