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International Notes Acute Hemorrhagic Conjunctivitis -- Mexico

In September 1987, an outbreak of conjunctivitis occurred among residents of several towns in the Yucatan Peninsula of Mexico (Figure 1). Illness was characterized by conjunctival injection, palpebral edema, lacrimation, and foreign-body sensation. Subconjunctival hemorrhages were observed less frequently than expected, occurring in 13% of patients. The Mexico Field Epidemiology Training Program surveyed a 10-block area of Cozumel, a resort island reporting many cases, and found an overall attack rate of 25% among local residents. The secondary attack rate among family members of affected households was 37%. Cultures of conjunctival swabs obtained from eight of 13 patients were positive for coxsackie virus A24 variant (CA24v).

In July 1988, a second outbreak of conjunctivitis occurred in Delicias in the state of Oaxaca in south central Mexico. CA24v was isolated from eight of 16 affected persons. In October 1988, a third outbreak was reported in Tampico, a town in northern Mexico along the gulf coast and about 250 miles south of Brownsville, Texas. Three of nine specimens from this outbreak sent to CDC for virus isolation were positive for CA24v. In all three outbreaks, attack rates appeared to be highest among school-aged children (i.e., 5-14 years of age).

The outbreak in Mexico subsided during the winter. The Texas Department of Health was notified of the outbreak and increased its surveillance for conjunctivitis in the Brownsville area. No cases in Texas have been reported. Reported by: M Gonzalez, MD, F Meneses, MD, L Camacho, MD, A Moreno, DD, C Ruiz, MD, Field Epidemiology Training Program, General Directorate of Epidemiology, Secretariat of Health, Mexico. Div of Global EIS, International Health Program Office; Respiratory and Enterovirus Br and Epidemiology Office, Div of Viral Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Acute hemorrhagic conjunctivitis (AHC) is a clinical entity characterized by the rapid onset of conjunctival injection, lacrimation, foreign-body sensation, and in many cases, subconjunctival hemorrhages. The illness is caused by enterovirus 70, CA24v, or adenovirus 11. Epidemiologically, AHC is characterized by its high communicability; the incubation period is short (24-48 hours), secondary attack rates in households are high, and transmission is enhanced by crowding and poor sanitation. Illness is self-limited, lasting 3-7 days, and serious sequelae are rare. The proportion of patients with subconjunctival hemorrhage in the Mexico outbreak was lower than previously observed; this might be explained by the simultaneous presence in the community of other, unidentified bacterial or viral agents that cause conjunctivitis. Based on the epidemiologic observations and laboratory data, the outbreak in Mexico is consistent with AHC caused by CA24v.

In 1981, an epidemic of AHC occurred in south Florida after enterovirus 70 was introduced from the Bahamas. In the Florida epidemic, illness was spread throughout the community largely by schoolchildren. Closing affected schools helped to control the epidemic (1,2).


  1. Malison MD, Gunn RA, Hatch MH, Bernard KW, White MC. Acute hemorrhagic conjunctivitis, Key West, Florida: an assessment of risk factors for introduction of illness into households and secondary spread during the 1981 epidemic. Am J Epidemiol 1984;120:717-26. 2.Patriarca PA, Onorato IM, Sklar VEF, et al. Acute hemorrhagic conjunctivitis: investigation of a large-scale community outbreak in Dade County, Florida. JAMA 1983;249:1283-9.

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