HealthDay News — Poor infection control measures played a role in six unrelated outbreaks of keratoconjunctivitis linked to human adenovirus, according to the CDC.

The six outbreaks affected 411 people in Florida, Illinois, Minnesota and New Jersey in 2008, 2009 and 2010, the agency reported in in the Aug. 16 issue of the CDC’s Morbidity and Mortality Weekly Report.

Each appeared to have been associated with healthcare transmission in the setting of ophthalmologic examination, and involved a symptomatic practitioner in several cases; however, community transmission was noted as well.

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The outbreaks resulted in significant morbidity and cost, and also the temporary closing of a neonatal intensive care units and several clinics.

“In settings where ophthalmologic care is provided, routine adherence to basic infection control measures and early implementation of enhanced outbreak control measures are essential to prevent HAdV transmission,” Eileen Schneider, MD, of the CDC in Atlanta, and colleagues wrote.

These should include:

  • Strict adherence to hand hygiene
  • Using disposable gloves if there is any potential contact with eye secretions
  • Either disinfection of ophthalmic instruments after each use or use of disposable equipment
  • Instituting isolation precautions for suspected conjunctivitis patients by keeping them separate from other patients, such as in separate waiting rooms, sign-in areas and examination rooms
  • Encouraging time off for staff members who appear to have epidemic keratoconjunctivitis.

In each of the outbreaks, one or more of these precautions were omitted, according to the researchers.

The largest outbreak involved 245 people who visited either the main clinic or one of four satellite offices at a New Jersey opthalmologic practice — one of three outbreaks that occured in that state. More than half of the cases were associated with the facility.

In the single Florida outbreak, 62% of the 37 people who developed epidemic keratoconjunctivitis had visited one of two ophthalmologic clinics that were part of the same practice. The practice’s only staff physician worked despite being symptomatic, the CDC reported.

The Illinois outbreak was the smallest, involving 18 people, but 12 were babies in a neonatal intensive care unit, which was closed to new admissions for 23 days due to the outbreak. All of the infected infants had retinopathy of prematurity and had been examined with reusable scleral depressors and ocular specula that were soaked in isopropyl alcohol between uses, despite it not being a reliable disinfectant for ophthalmic instruments. Members of the ophthalmologic team in that outbreak also worked while symptomatic.

The Minnesota outbreak involved 70 cases, including eight healthcare staff members from three ophthalmology and optometry outpatient clinics, and was linked to poor hand hygiene and lack of disinfection of medical equipment shared between patients.

The other two smaller outbreaks occurred in New Jersey and involved a total of 41 people, including a staff optometrist.


  1. Centers for Disease Control and Prevention “Adenovirus-associated epidemic keratoconjunctivitis outbreaks — four states, 2008-2010” MMWR 2013; 62: 627-631.