Conjunctivitis outbreak associated with Enterovirus Type C in Luzira Prisons, Uganda, February-April 2024

On March 7, 2024, the Ministry of Health was notified of a rising number of inmates with suspected conjunctivitis in Luzira Prisons in Uganda. We investigated this outbreak to determine its cause and extent, identify risk factors, and recommend evidence-based control measures.

We investigated the outbreak in four prisons: Kampala Remand Prison, Murchison Bay Prison, Luzira Upper Prison, and Luzira Women Prison. A suspected case was defined as the onset of redness in one or both eyes with more than or equal to one of the following: tearing, discharge, grainy sensation, itching, pain, or swelling, in any Luzira Prison resident from February 1 to April 3, 2024. We identified cases using medical records and active case searches among prisoners. We administered structured questionnaires and collected conjunctival swabs for polymerase chain reaction testing. We assessed prisoner movement, handwashing, isolation practices, and administration of eye medications. We compared exposures of 200 randomly selected cases and 200 controls in a case-control study. Using logistic regression, we conducted multivariable analysis to identify risk factors.

We recorded 1935 cases; the overall attack rate was 23% (1935/8518), varying by prison: Murchison Bay Prison (41%; 1229/3000), Kampala Remand Prison (33%; 610/1835), Luzira Women Prison (12%; 83/670), and Luzira Upper Prison (0.4%; 13/3013). With no associated deaths, most cases resolved within 4-5 days. Of the 10 samples tested, 4 (40%) were positive for Enterovirus Type C. Sharing of eye medication (adjusted odds ratio: 5.2, 95% confidence interval: 2.0-6.6), and infrequent handwashing increased the odds of infection (adjusted odds ratio: 5.8, 95% confidence interval: 3.5-9.6). Prisoner mixing took place during a plea-bargain session amid the outbreak. Symptomatic patients were isolated for 3 days.

The outbreak was associated with Enterovirus Type C and was facilitated by prisoner mixing, sharing of eye medications, short isolation periods, and inadequate hand hygiene practices. Improving infection prevention and control measures, including strict isolation, individualized eye medication, and enhanced hand hygiene practices, could prevent future outbreaks in similar settings.