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