Hepatitis C Virus in Blood Donors, Brazil

tivitis during July–September 2007. Reported treatment included home remedies and a nonprescription, locally available, cream containing a sulfa drug. Review of municipal hospital records during June 1–September 30, 2007, identifi ed no additional cases of conjunctivitis. After the last case-patient died, 17 other persons were identifi ed with purulent conjunctivitis: 4 at the municipal hospital and 13 during active case-fi nding in schools and the community. All were treated with oral amoxicillin and chloramphenicol optic solution, and 76 contacts were treated prophylactically with oral rifampin. No further suspected BPF cases were detected. Test results for acute arbovirus infection and PCR were negative for all patients (Table). This outbreak of highly fatal illness is clinically compatible with BPF. Compatible features included young age, antecedent purulent conjunctivitis, signs and symptoms (i.e., antecedent conjunctivitis, fever 39.5Co–41.0Co, abdominal pain, nausea, vomiting, petechiae or ecchymoses), and high case-fatality rate. Epstein-Barr infection has reportedly produced similar symptoms (4) but with an illness lasting >7 days in contrast to the <24 hours for our case-patients. We did not detect H. aegyptius in peripheral blood by culture or in serum or CSF by PCR in the 2 surviving children and in contacts of casepatients. One reason could be the remoteness of the investigation site, which resulted in improper sample collection, storage, and processing in the fi eld before samples reached reference laboratories. Hemagglutination tests for arboviruses have low specifi city. Therefore, another known or novel pathogen could have caused these cases. Timely treatment with antimicrobial drugs for patients with suspected disease, prophylaxis of contacts, and treatment of children with conjunctivitis resulted in no additional cases. Intensive surveillance for febrile illness preceded by conjunctivitis, immediate treatment, contact prophylaxis, and appropriate prompt laboratory testing are essential for continued control of BPF in this region.