Page content: Victorian statutory requirement | Infectious agent | Identification | Incubation period | Public health significance & occurrence | Reservoir | Mode of transmission | Period of communicability | Susceptibility & resistance | Control measures | Outbreak measures

Victorian statutory requirement

Infections with Neisseria meningitidis (Group A disease) must be notified immediately by telephone or fax followed by written notification within five days.

Infections with Chlamydia trachomatis (Group C disease) must be notified in writing within five days of diagnosis.

Infections with Neisseria gonorrhoeae (Group C disease) must be notified in writing within five days of diagnosis.

Other pathogens are not notifiable.

School exclusion: exclude until discharge from the eyes has ceased.

Infectious agent

Haemophilus influenzae and Streptococcus pneumoniae are the most common causes but Staphylococcus aureus, Pseudomonas aeruginosa, Neisseria gonorrhoeae, Neisseria meningitidis and Chlamydia trachomatis (trachoma serovars A-C) can occasionally be implicated.

Identification

Clinical features
The clinical syndrome ranges from mild redness of the conjunctivae to corneal infiltration and visual disturbances in neglected cases. A purulent exudate is almost always present. Trachoma should be suspected in the presence of lymphoid follicles and diffuse conjunctival inflammation or trichiasis (inturned eyelashes). Specialist ophthalmological advice should be sought in this case.

Method of diagnosis
Mild conjunctivitis is rarely investigated and is usually treated empirically. Microscopic examination of a stained smear or culture of the discharge is required to differentiate bacterial from viral or allergic conjunctivitis.

Incubation period

The incubation period is usually 24–72 hours. In the case of trachoma incubation is 5–12 days.

Public health significance & occurrence

Acute bacterial conjunctivitis is widespread throughout the world. Outbreaks of gonococcal conjunctivitis have occurred in northern and central Australia. Infection due to Chlamydia trachomatis (trachoma) continues to be a significant public health concern in Aboriginal communities and is a major cause of preventable blindness worldwide.

The epidemiology of acute bacterial conjunctivitis in Australia due to causes other than trachoma and gonococcal infection is not well documented. Infections are most common in children under five years of age and incidence decreases with age.

Reservoir

Humans.

Mode of transmission

Infection is transmitted via contact with the discharge from the conjunctivae or upper respiratory tract of infected persons. Neonates may acquire infection during vaginal delivery. In some areas flies have been suggested as possible vectors.

Period of communicability

It is infectious while there is discharge.

Susceptibility & resistance

Everyone is susceptible to infection and repeated attacks due to the same or different bacteria are possible. Maternal infection does not confer immunity to the child.

Control measures

Preventive measures
Preventative measures include careful treatment of affected eyes and personal hygiene, particularly hand washing.

Control of case
Conjunctivitis due to bacterial infection may be difficult to distinguish clinically from allergic or viral conjunctivitis or that due to physical irritation. Therefore, empirical antibiotic therapy is often used. Patients with significant eye pain, loss of vision or photophobia require immediate referral to an ophthalmologist.

In mild cases propamidine eye drops are the usual treatment.

In moderate and severe cases a combination of treatments may be used. Consult the current version of Therapeutic guidelines: antibiotic (Therapeutic Guidelines Limited). An eye ointment may be used at bedtime. Soiled articles should be discarded or disinfected. Rigorous hand washing before and after eye examinations and toilets is important in preventing further transmission. Children should not attend school and child care settings until discharge from the eyes has ceased.

Control of contacts
With the exception of gonococcal or meningococcal conjunctivitis, contact tracing is not applicable in most situations in Victoria. Refer to the relevant sections for the management of persons in contact with these infections.

Control of environment
Dispose of contaminated articles carefully.

Outbreak measures

Public health action in an outbreak is dependent on the type of infection and the setting in which it has occurred.