Outbreak of adenovirus serotype 8 conjunctivitis in preterm infants in a neonatal intensive care unit

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Summary

Background

Adenovirus keratoconjunctivitis outbreaks have rarely been reported in preterm infants. An outbreak of adenovirus conjunctivitis occurred between 15 January and 25 February at a neonatal intensive care unit of a university hospital in Turkey.

Aim

To describe the evolution, investigation and management of the outbreak.

Methods

Adenovirus type 8 was identified in 14 samples by polymerase chain reaction analysis. A case–control study was performed to determine the risk factors.

Findings

Fifteen preterm neonates, five healthcare workers (HCWs) and four parents suffered from conjunctivitis signs such as lacrimation, swelling and redness of the eye. A retinopathy of prematurity (ROP) examination was found to be the most important risk factor for adenovirus conjunctivitis (odds ratio: 17.5; 95% confidence interval: 1.9–163.0; P = 0.012). The eyelid speculum (blepharostat) used during the ROP examination was not sterilized between each patient and was found to be the cause of contamination.

Conclusion

The outbreak was controlled by measures such as barrier precautions, hand hygiene, sterilization of the blepharostat, suspending patient transfer to other units, and excluding infected HCWs for at least 15 days.

Introduction

Epidemic keratoconjunctivitis caused by adenovirus is an acute eye infection usually seen as epidemics in the community. It presents with lacrimation, photophobia and pain. It is a highly contagious and serious disease involving the cornea and conjunctiva. Serotypes 4, 8, 19, and 37 have usually been reported as causes of epidemic keratoconjunctivitis in adult patients.1, 2, 3, 4

Nosocomial adenovirus eye infection outbreaks have previously been reported in adults.5, 6, 7, 8, 9 Most outbreaks have been in ophthalmology departments, and caused by inadequate disinfection of instruments and the environment; reports from neonatal intensive care units (NICUs) are rare.6, 10, 11, 12, 13 We describe the evolution, investigation and successful control of an outbreak of conjunctivitis caused by adenovirus type 8 in a university hospital NICU.

Section snippets

Setting

The outbreak occurred in an 891-bed university hospital in eastern Turkey. The NICU has 16 beds where only preterm neonates are hospitalized. Prospective active infection sur-veillance is undertaken, and the NICU is visited by an infection control nurse each day (except weekends). Once an outbreak was suspected, prospective and retrospective analysis was undertaken to determine whether an outbreak was indeed occurring. After a nurse on the NICU was diagnosed with adenovirus conjunctivitis, the

Results

A total of 15 preterm neonates, four NICU nurses, four parents, and one ophthalmology resident had conjunctivitis between 15 January and 25 February. The timings of the onset of illness among all affected individuals are shown in Figure 1. The first neonatal case presented on 15 January with lacrimation, purulent discharge and swelling. None of the neonates had fever or systemic complications during the attack, and none developed keratitis. Six patients were initially treated with topical

Discussion

Epidemic keratoconjunctivitis attack rates have been reported as high as 25% in medical facilities during outbreaks.16 Most reported outbreaks have been in ophthalmology units and nursing homes.1, 16 However, our experience demonstrates that adenovirus should be kept in mind when investigating outbreaks of conjunctivitis in NICUs.

Guidelines recommend that infants with a birth weight of <1500 g or gestational age of ≤30 weeks and selected infants with a birth weight of 1500–2000 g or gestational

Acknowledgements

We thank Prof. Dr A. Selimoglu, head of the Department of Pediatrics, and A.A. Demir, nurse manager of the NICU, for their efforts in controlling the outbreak.

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