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Nosocomial adenovirus keratoconjunctivitis
  1. Erik Letko
  1. Dr Eric Letko, 10240 NW Village Heights Drive, Portland, OR 97229, USA; erikletko{at}

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The first report of adenovirus epidemic affecting the eyes was made by Fuchs in Austria.1 Since then, several major epidemics have been described in the literature. One of the most severe occurred during Word War II in the USA.24 It involved many military shipyards that had to be closed, and as a consequence affected the military plans in the Pacific Rim. According to one report, as many as 600 personnel in one of the shipyards were affected.

Adenovirus keratoconjunctivitis represents a public health problem with short-term and long-term significance because of its epidemic nature and its potential for prolonged ocular morbidity. The reported incidence of acute adenovirus eye involvement in the general population is between 0.03% and 1.1%, but in groups with close contact such as in camps, homes or prisons, the reported rate is between 10% and 32%. It is believed, however, that the true incidence is higher, since much adenoviral conjunctivitis remains undiagnosed, thus making this pathogen very likely the most common cause of ocular viral infection in the world.

At least 19 different serotypes of adenovirus have been associated with epidemic conjunctivitis or keratoconjunctivitis,5 with seroptypes 8, 19 and 37 being the most common in patients with epidemic keratoconjunctivitis. The most severe ocular disease is typically seen with serotype 8. Adenovirus serotypes 3 and 7 have been associated with pharyngeal conjunctival fever, and serotypes 1, 2, 4, 5 and 6 with non-specific follicular conjunctivitis.1 Adenovirus is a highly resistant pathogen that may survive for hours on objects such as furniture and magazines shared by patients.1 69 The ophthalmology office or hospital presents a unique opportunity for the start of epidemic through the use of tonometers, contaminated hands and waiting room contact.

In this issue (see page 18) the authors report on the rate of nosocomial adenovirus conjunctivitis prior to and after introducing a new infection control policy.10 They observed a dramatic decrease in the rate of adenovirus keratoconjunctivitis after segregating suspected patients with epidemic keratoconjunctivitis in a separate waiting area and examination room, and by expediting their examination, to reduce their exposure to both staff and patients in the common waiting areas. This study demonstrates how relatively simple measures may result in major reduction in the spread of infection. The measures that they proposed might be applicable and beneficial not only to big institutions with a large number of patients and personnel but also to smaller practices.


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  • Competing interests: None.

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