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August 1, 1977

Self-Induced Epidemic Keratoconjunctivitis

JAMA. 1977;238(5):396-397. doi:10.1001/jama.1977.03280050036005

To the Editor.—  Self-induced illnesses, including self-mutilation, drug overdoses, and suicidal behavior, have been reported among prisoners, mental retardates, patients with Lesch-Nyhan and DeLange's syndromes, psychotic and neurotic persons, and those intoxicated with LSD. To our knowledge, no outbreak of a self-induced infectious disease has previously been reported. The following account describes such an outbreak.From October through December 1976, an outbreak of keratoconjunctivitis occurred at a northern California correctional facility for boys. The institution houses some 1,000 youths, aged 16 to 23 years, in residence halls of around 40 boys each. Fifteen out of the total 20 cases of keratoconjunctivitis occurred among residents of one hall.The index case was a 19-year-old in whom left-sided conjunctivitis developed on Oct 7, a few days after returning from a one-day visit home. By Nov 13 another ten boys had keratoconjunctivitis, and by Dec 30 a total of 20 boys and three