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Epidemic Keratoconjunctivitis Outbreak Investigation

Introduction: In June 2019, an epidemic keratoconjunctivitis (EKC) outbreak occurred in the ophthalmology clinic at St. Michael’s Hospital. This infection is caused by human adenovirus which has an incubation period of 2-14 days, and symptoms include redness and itchiness in the eyes, swelling of the eyes, and/or discharge from the eyes. An immediate cause or an index case was not determined, hence, a formal outbreak investigation was conducted in the form of a case-control study. 
Methods: The case-control study focused on 9 outbreak cases all from the same ophthalmologist’s clinic; 18 controls were randomly picked from the same clinic, and were matched to the cases on the date of visit to the clinic. Data was collected on all 27 participants on their gender, age, date and time of visit, details of staff that saw them during their visit, and the procedures done during their visit. Data analysis was then conducted to identify exposures that could have been associated with the cause of the outbreak. 
Results: It was found that all cases visited the eye clinic on two specific dates – four cases on May 29 and five on June 5 – and that having a non-contact laser procedure done on May 29 was associated with higher odds of being a case [OR=42; 95% CI = 1.016-1622; p-value<0.05]. Two cases seen on May 29 also returned on June 5, and they could have possibly propagated the transmission on the second day. 
Conclusion: A clear cause of the outbreak was not determined; however, the case-control study helped narrow down the cause of the outbreak and route of transmission. This outbreak also helped highlight the importance of proper hand hygiene and cleanliness of the patient environment to prevent similar outbreaks in the future.