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From the Centers for Disease Control and Prevention
October 13, 2010

Notes From the Field: Acute Hemorrhagic Conjunctivitis Outbreaks Caused by Coxsackievirus A24v—Uganda and Southern Sudan, 2010

JAMA. 2010;304(14):1552. doi:

MMWR. 2010;59:1024

CDC was contacted on June 22, 2010, by the Ugandan Ministry of Health (MoH)/Uganda Virus Research Institute and on July 11 by the Government of Southern Sudan (GOSS) via the CDC Global Disease Detection Regional Center in Kenya to perform diagnostic laboratory testing on conjunctival swabs from persons with “red eye syndrome.” Widespread, ongoing outbreaks of acute hemorrhagic conjunctivitis (AHC) have been observed in Uganda and Southern Sudan since spring 2010. AHC becomes a reportable condition in outbreak settings. Case numbers were estimated in Uganda after MoH confirmation of reported cases from district health facilities and, in Southern Sudan, after a medical record review in six health facilities. To date, 6,818 cases from 26 districts in Uganda, and 428 cases in Juba, Southern Sudan, have been counted; however, because most cases are not reported, these totals are considered underestimates.

Conjunctival swabs were tested by reverse transcription—polymerase chain reaction (RT-PCR) for enterovirus RNA. Enterovirus-positive swabs were further characterized and enterovirus-negative swabs were tested by PCR for adenovirus. Of 29 conjunctival swabs tested from Uganda, 13 (45%) were identified as coxsackievirus A24 variant (CA24v), one (3%) as enterovirus 99, and 15 (52%) were negative; of six conjunctival swabs tested from Southern Sudan, three (50%) were identified as CA24v and three (50%) were negative. All 18 enterovirus-negative swabs tested negative for adenovirus.

AHC epidemics, caused predominantly by enterovirus 70, CA24v, or adenovirus, have occurred worldwide in predominantly tropical and subtropical regions, typically last several months, and affect large populations (e.g., >10,000-200,000).1,2 Negative laboratory results are common and can be attributed to multiple factors, including timing of specimen collection. Symptoms (e.g., subconjunctival hemorrhage, foreign-body sensation, photophobia, and discharge) usually resolve within 1-2 weeks. Treatment for AHC is symptomatic; however, if secondary bacterial infection is suspected, patients should seek medical care. AHC is highly contagious and could spread to neighboring areas and countries; prevention (e.g., hand washing and proper hygiene) is essential for control.* Control measures instituted by the Ugandan and GOSS MoHs have included developing investigation and response guidelines and issuing health alerts via media channels to increase awareness concerning symptoms, transmission, treatment, and prevention.

Reported by:

J Wamala, MBChB, I Makumbi, MBChB, M Mugagga, MSc, Ministry of Health (MoH), Uganda; B Bakamutumaho, MBChB, Uganda Virus Research Institute (UVRI) and MoH; S Wasike, R Downing, PhD, UVRI and Div of Global HIV/AIDS-Uganda, Center for Global Health, CDC. A Laku Kirbak, MBBS, T Ugiji, MBBS, J John Hassen, Kenyan Field Epidemiology and Laboratory Training Program and MoH, Government of Southern Sudan (GOSS), A Gordon Abias, MSc, J Lagu, MSc, N Atem, MBBS, MoH, GOSS. KM Yona, DipCM, MoH, Central Equatoria State, Southern Sudan. A Abubakar, MD, World Health Organization-Southern Sudan. MK Njenga, PhD, S Gikundi, MSc, L Nderitu, MSc, Global Disease Detection Regional Center-Kenya, CDC. SL Rogers, MS, MS Oberste, PhD, M Pallansch, PhD, B Whitaker, MS, DD Erdman, DrPH, E Schneider, MD, Div of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC.

*CDC prevention recommendations are available at and

Centers for Disease Control and Prevention (CDC).  Acute hemorrhagic conjunctivitis outbreak caused by Coxsackievirus A24--Puerto Rico, 2003.  MMWR. 2004;53(28):632-634PubMed
Tavares FN, Costa EV, Oliveira SS, Nicolai CC, Baran M, da Silva EE. Acute hemorrhagic conjunctivitis and coxsackievirus A24v, Rio de Janeiro, Brazil, 2004.  Emerg Infect Dis. 2006;12(3):495-497PubMedArticle