Epidemic Kerato-conjunctivitis. Report of an Outbreak Which Resulted in Ward Cross-infection.

IN April 1961 it became apparent that an increasing number of patients was attending the out-patients department of the Birmingham and Midland Eye Hospital with a follicular conjunctivitis, and an associated pre-auricular adenitis, which often proceeded to a keratitis. This was soon recognized as an outbreak of epidemic keratoconjunctivitis and therefore precautionary measures were immediately taken to prevent iatrogenic spread, e.g. cessation of tonometry, tonography, and gonioscopy. Altogether about 500 patients were affected but the unusual feature of this outbreak was the spread of the disease to involve the in-patients of the hospital, a serious degree of cross-infection occurring in the wards. The main purpose of this paper is to report this unusual feature of the outbreak of epidemic kerato-conjunctivitis but mention will be made of how the disease affected the out-patients. Epidemic kerato-conjunctivitis has long been recognized as a clinical entity since the early descriptions of outbreaks (Stellwag von Carion, 1889; von Reuss, 1889; Fuchs, 1889; Adler, 1889; and others). An adequate historical review has been provided by Hogan and Crawford (1942), who designated the disease "epidemic keratoconjunctivitis" (EKC) and thus allowed differentiation from the many other causes of superficial punctate keratitis. EKC is a severe viral kerato-conjunctivitis which is widespread in sporadic and epidemic form throughout the world, the greatest incidence being in the Far East. The evidence for incrimination of adenovirus type 8 as the causal agent has been outlined by Jawetz (1962) and includes: Growth of the virus in cell culture (Jawetz, Thygeson, Hanna, Nicholas, and Kimura, 1956; Hanna, Jawetz, Mitsui, Thygeson, Kimura, and Nicholas, 1957; Bennett, Law, Hamilton, and Macdonald, 1957); Demonstration in convalescents of neutralizing antibody to adenovirus type 8 (Jawetz, Thygeson, Hanna, Nicholas, and Kimura, 1956; Sommerville, 1958); Experimental inoculation of volunteers (Mitsui, Hanna, Minoda, Ogata, Kurihara. Okamura, and Miura, 1959); Accidental laboratory infections (Jawetz, Hanna, Sonne, and Thygeson, 1959); Vaccination (Ogata, Kurihara, Okamura, Tanaka, and Wakae, 1960).