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 ot Health from November 1981 to March 1982. Enterovirus 70 was isolated from one of 19 eyeswab specimens tested, and 10 of 13 (77%) individuals wlth acute hemorrhagic conjunctivitis had neutralizlng antibody tlters to enterovirus 70 of ij1:4. These data suggest that enterovlrus 70 was the etiologic agent ot the acute hemorrhaglc conjunctivitis outbreak in Puerto Rico. In a study of a lower middle socioeconomic sector with relatively intense transmission, 152 ot 670 (23%) persons reported illness consistent wlth 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 antibdy to enterovlrus 70. Retrospectlve surveillance through ophthalmologists and neurologists identified one patient wlth a neurologic complication, a seventh nerve palsy temporally associated with recent enterovirus 70 infection. Household transmission was significantly associated wtth crowding and sharing of beds (p < 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 infectlon is uncommon, and that in Puerto Rico, neurologic complications associated with acute hemorrhagic conjunctivitis were quite rare.