Acute hemorrhagic conjunctivitis in Puerto Rico, 1981-1982

In late 1981, the Western Hemisphere's pandemic of acute hemorrhagic conjunctivitis spread to Puerto Rico. Over 6,000 cases of conjunctivitis were reported to the Puerto Rico Department of Health from November 1981 to March 1982. Enterovirus 70 was isolated from one of 19 eye-swab specimens tested, and 10 of 13 (77%) individuals with acute hemorrhagic conjunctivitis had neutralizing antibody titers to enterovirus 70 of greater than or equal to 1:4. These data suggest that enterovirus 70 was the etiologic agent of the acute hemorrhagic conjunctivitis outbreak in Puerto Rico. In a study of a lower middle socioeconomic sector with relatively intense transmission, 152 of 670 (23%) persons reported illness consistent with acute hemorrhagic conjunctivitis. The highest attack rate was in the 5- to 14-year-old group (30%), and a disproportionate number of household index cases were in the predominantly school age group (5-19 years old). Twelve per cent (3/25) of asymptomatic household contacts of acute hemorrhagic conjunctivitis cases had sera with neutralizing antibody to enterovirus 70. Retrospective surveillance through ophthalmologists and neurologists identified one patient with a neurologic complication, a seventh nerve palsy temporally associated with recent enterovirus 70 infection. Household transmission was significantly associated with crowding and sharing of beds (p less than 0.05). This and other recent studies in Florida suggest that school age children play an important role in the transmission of acute hemorrhagic conjunctivitis. This study also suggests that asymptomatic enterovirus 70 infection is uncommon, and that in Puerto Rico, neurologic complications associated with acute hemorrhagic conjunctivitis were quite rare.