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Epidemiologic Notes and Reports Acute Bacterial Conjunctivitis -- Southeastern Georgia, 1981

In September and October 1981, an outbreak of conjunctivitis involving primarily grade-school-aged children occurred in southeastern Georgia. Between September 5 and October 16, the Office of Epidemiology, Georgia Department of Human Resources, received both passive and active surveillance reports of over 2,000 conjunctivitis cases in 20 counties. Reports suggested that the outbreak peaked in the week ending September 19. The patients' ages ranged from 6 months to 84 years (median age = 7 years).

Between September 24 and October 4, a telephone survey of households with children in three randomly selected first grade classes (the age group most affected) was conducted in one community. Of the 72 selected households, 44 (61%) were contacted. Twenty-two of 44 (50%) reported one or more persons with conjunctivitis since September 1. Eighteen of 44 first graders (41%) had conjunctivitis. There was no difference in attack rates between males and females, blacks and whites, and residents within and beyond city limits. Symptoms reported from the index case in affected households were: conjunctival injection (86%), lid swelling (73%), watering (73%), purulent drainage (73%), eye pain (60%), itching (55%), headache (36%), and discomfort on exposure to bright light (32%). Fever, as well as respiratory and gastrointestinal symptoms were present in 10% of cases. Thirty-eight percent of cases involved one eye; 62% were bilateral. The median duration of illness was 6.5 days (range 2 days-2-1/2 weeks). In nine of the 22 case households (41%), more than one person was affected. In three households, multiple cases appeared simultaneously. In households with multiple cases, age-specific attack rates were: less than or equal to 4 years, four of five (80%); 5-9 years, 29 of 35 (83%); 10-14, six of 14 (43%); 15-19, zero of nine; 20-29, one of 11 (9%); greater than or equal to 30, zero of 31.

Microscopic examination of purulent material obtained from the eyes of eight acutely ill children in one community revealed small, pleomorphic intracellular gram-negative rods morphologically compatible with the presence of Haemophilus organisms. A possible Haemophilus species was isolated from seven of the eight specimens but could not be further identified. A similar organism was isolated from 17 persons with conjunctivitis in another community. Viral cultures from nine patients were negative.

Health authorities considered the possibility that gnats (Hippelates pusio) were responsible for mechanical transmission of this disease. These insects derive nourishment from eye secretions and were unusually prevalent during the outbreak period. Attempts to isolate Haemophilis from gnats trapped in a first-grade classroom were unsuccessful. Reported by R Poblete, MD, Baxley, DC Schwekendiek, Tift General Hospital, Tifton, I Eunice, RN, C Matthews, JT Holloway, MD, Health District 9, Unit 2, Waycross, J Franklin, Bacteriology Laboratory, RK Sikes, DVM, State Epidemiologist, Georgia Dept of Human Resources; Field Svcs Div, Epidemiology Program Office, CDC.

Editorial Note

Editorial Note: Outbreaks of seasonal conjunctivitis in the southern states and southern California were described as early as 1929 (1-5); they occurred during the summer or early fall and primarily affected young children. The etiologic agent was Haemophilus aegyptius (known as the Kochs-Weeks bacillus and now as H. influenza biotype III), and mechanical vector transmission by gnats has long been suggested. In many areas of the southern United States, these insects are prevalent during the warm months. Gnat-borne transmission has been documented in animal studies (6).

In this outbreak, transmission by gnats was suggested. It was hypothesized that such transmission may have been facilitated when children congregated in school yards. It was not possible, however, to discern the relative importance of vector or direct person-to-person spread.


  1. Bengston IA. Seasonal acute conjunctivitis occurring in the Southern states. Public Health Rep 1933;48:917-26.

  2. Davis DJ, Pittman M. Acute conjunctivitis caused by hemophilus. Am J Dis Child 1950;79:211-22.

  3. The California eye gnat. Science 1929;69:14.

  4. Dawson CR. Epidemic Koch-Weeks conjunctivitis and trachoma in the Coachella Valley of California. Am J Ophthalmol 1960;49:801-8.

  5. Dow RP, Hines VD. Conjunctivitis in Southwest Georgia. Public Health Rep 1957;72:441-8.

  6. Payne WJ Jr, Cole JR Jr, Snoddy EL, Seibold HR. The eye gnat Hippelates pusio as a vector of bacterial conjunctivitis using rabbits as an animal model. J Med Entomol 1977;13:599-603.

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