CDC’s new resource, Prevent EKC, provides guidance on how to disinfect surfaces and equipment to help prevent and control outbreaks of epidemic keratoconjunctivitis (EKC) in eye clinics. EKC is a severe and highly contagious form of viral conjunctivitis (pink eye). EKC is caused by adenoviruses, which are often resistant to many disinfectants.
Adenoviruses usually cause respiratory illnesses or conjunctivitis, and outbreaks can occur throughout the year. There is no specific time of year when adenovirus infections and outbreaks are more common.
Adenoviruses is not a nationally notifiable disease in the United States, meaning clinicians are not required to test for or report cases to health departments or CDC. Therefore, many outbreaks of adenovirus likely go either undetected or unreported.
Adenovirus types that can cause outbreaks
Reported sporadic cases and outbreaks of adenovirus have included:
- Adenovirus types 3, 4 and 7 are most commonly associated with acute respiratory illness.
- Adenovirus type 7 has been associated with more severe outcomes than other adenovirus types, particularly in people with weakened immune systems. In the last 10 years, instances of severe illness and death from adenovirus type 7 infection have been reported in the United States.
- Adenovirus type 14, which since 2007 has been associated with outbreaks of acute respiratory illness among U.S. military recruits and the general public
- Adenovirus types 8, 19, 37, 53, and 54, which can cause epidemic keratoconjunctivitis
- Enteric adenovirus types 40 and 41, which cause gastroenteritis, usually in children
- Some adenoviruses (e.g., 4 and 7) that spread in bodies of water such as small lakes or swimming pools without adequate chlorine and can cause outbreaks of febrile disease with conjunctivitis
Health Professionals should
- Consider adenoviruses as possible causes of upper respiratory illness, and lower respiratory illness such as pneumonia
- Report unusual clusters of illness (e.g., respiratory, conjunctivitis) potentially caused by adenoviruses to the state or local health department
- Take appropriate infection control measures specific to adenovirus to help prevent or control outbreaks. This can include active surveillance, isolating ill patients when possible, restricting visitors and new admissions, monitoring staff for illness and sending them home when sick, environmental cleaning, using personal protective equipment, and frequent handwashing or sanitizing.
- Clinical Overview of Adenoviruses
- Biggs HM, Lu X, Dettinger L, Sakthivel S, Watson JT, Boktor SW. Adenovirus-Associated Influenza-Like Illness among College Students, Pennsylvania, USA. Emerg Infect Dis. 2018 Nov;24(11):2117-9. http://dx.doi.org/10.3201/eid2411.180488external icon
- Killerby ME, Rozwadowski F, Lu X, et al. Respiratory Illness Associated With Emergent Human Adenovirus Genome Type 7dexternal icon, New Jersey, 2016–2017, Open Forum Infectious Diseases, Volume 6, Issue 2, 1 February 2019, ofz017.
- CDC. Notes from the Field: Fatalities Associated with Human Adenovirus Type 7 at a Substance Abuse Rehabilitation Facility — New Jersey, 2017. MMWR. 2018;67:371–372.
- CDC. Adenovirus-associated epidemic keratoconjunctivitis outbreaks — four states, 2008–2010. MMWR. 2013;62(32);637-41.
- James L, Vernon M, Jones R, et al. Outbreak of Human Adenovirus Type 3 Infection in a Pediatric Long-Term Care Facility—Illinois, 2005external icon. Clinical Infectious Diseases. Volume 45, Issue 4, 15 August 2007, Pages 416–420.