Conjunctivitis outbreak caused by Enterovirus Type C in Luzira prisons, Uganda, February - April 2024

BackgroundOn March 7, 2024 the Ministry of Health (MoH) 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. MethodsWe investigated the outbreak in four prisons: Kampala Remand Prison (KRP), Murchison Bay Prison (MBP), Luzira Upper Prison (LUP) and Luzira Women Prison (LWP). A suspected case was onset of redness in one or both eyes with [≥]1 of 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 search among prisoners. We administered structured questionnaires and collected conjunctival swabs for PCR testing. We assessed movement of prisoners, handwashing, isolation practices, and administration of eye medications. We compared exposures of 200 randomly-selected cases 200 controls for the case control study. Using logistic regression, we conducted multivariable analysis to identify risk factors. ResultsWe recorded 1,935 cases; overall attack rate was 23% (1,935/8,518), varying by prison: MBP (41%; 1,229/3,000), KRP (33%; 610/1,835), LUP (12%; 83/670), and LWP (0.4%; 13/3,013). 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 (aOR: 5.3, 95%CI: 2.8-9.9), and non-frequent handwashing increased odds of infection (aOR: 5.8, CI: 3.5-9.6). Prisoner mixing took place during a plea-bargain session amidst the outbreak. Symptomatic case-persons were isolated for 3 days. ConclusionsThe outbreak was caused by Enterovirus Type C, facilitated by prisoner mixing, sharing 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.