Surveillance for Acanthamoeba Keratitis after an Outbreak Associated with Use of a Contact Lens Solution

Surveillance for Acanthamoeba Keratitis after an Outbreak Associated with Use of a Contact Lens Solution PowerPoint PPT Presentation


  • 329 Views
  • Uploaded on
  • Presentation posted in: General

Overview. Acanthamoeba keratitis outbreakCase-control study results and discussionOngoing surveillance for Acanthamoeba keratitis casesConsiderations for future surveillance efforts. Acanthamoeba Keratitis (AK). Rare, potentially blinding infection of corneaCaused by free living amoebaUbiquitous in environmentPrimarily affects healthy contact lens users (CLU)Poor hygiene practicesContact w/ non-sterile water while using lensesEstimated incidence in US 1

Download Presentation

Surveillance for Acanthamoeba Keratitis after an Outbreak Associated with Use of a Contact Lens Solution

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


1. Surveillance for Acanthamoeba Keratitis after an Outbreak Associated with Use of a Contact Lens Solution Jonathan S. Yoder, MPH Division of Parasitic Diseases, NCZVED, CDC FDA Microbiological Testing for Contact Lens Care Products Workshop January 22, 2009 Good Morning. Good Morning.

2. Overview Acanthamoeba keratitis outbreak Case-control study results and discussion Ongoing surveillance for Acanthamoeba keratitis cases Considerations for future surveillance efforts A photograph which shows a finger with a soft contact lens as it is about to be inserted onto the eye.A photograph which shows a finger with a soft contact lens as it is about to be inserted onto the eye.

3. Acanthamoeba Keratitis (AK) Rare, potentially blinding infection of cornea Caused by free living amoeba Ubiquitous in environment Primarily affects healthy contact lens users (CLU) Poor hygiene practices Contact w/ non-sterile water while using lenses Estimated incidence in US 1–2 cases per million CLU/year Acanthamoeba keratitis, or AK, is a rare, potentially blinding infection of the cornea caused by a free living amoeba that is ubiquitous in the environment. AK primarily affects otherwise healthy contact lens users. Known risk factors among contact lens users include poor contact lens hygiene practices, such as improper storage or disinfection of lenses, and contact with non-sterile water while using lenses such as swimming or showering with lenses. The estimated incidence in the United States is 1-2 cases per million contact lens users per year. A photograph of an eye infected with acanthamoeba keratitis.Acanthamoeba keratitis, or AK, is a rare, potentially blinding infection of the cornea caused by a free living amoeba that is ubiquitous in the environment. AK primarily affects otherwise healthy contact lens users. Known risk factors among contact lens users include poor contact lens hygiene practices, such as improper storage or disinfection of lenses, and contact with non-sterile water while using lenses such as swimming or showering with lenses. The estimated incidence in the United States is 1-2 cases per million contact lens users per year. A photograph of an eye infected with acanthamoeba keratitis.

4. Increase noted in AK cases. Ophthalmologists surveyed about number of cases. Case control study found that many contact lens wearers were not following instructions for lens care. They were making their own saline solution which were not sterile. Water-related risk factors were identified. Cases begin to decline in 1987 after FDA consumer education and surveillance activities were not maintained. Bar graph with number of cases of acanthamoeba keratitis in the United States from 1973 to 1988. Number of cases on vertical axis and quarter of onset on horizontal axis. Number of cases consistent at one case for 1973, 1974, 1978, 1979,, and 1980. Number of cases increases to 2 during 1981, then continues to increase to 3 in 1982, and to 4 in 1983 and 1984. Number of cases increases to 15 in 1985 and to 16 in 1986 and 1987. Number of cases is 9 in 1988.Increase noted in AK cases. Ophthalmologists surveyed about number of cases. Case control study found that many contact lens wearers were not following instructions for lens care. They were making their own saline solution which were not sterile. Water-related risk factors were identified. Cases begin to decline in 1987 after FDA consumer education and surveillance activities were not maintained. Bar graph with number of cases of acanthamoeba keratitis in the United States from 1973 to 1988. Number of cases on vertical axis and quarter of onset on horizontal axis. Number of cases consistent at one case for 1973, 1974, 1978, 1979,, and 1980. Number of cases increases to 2 during 1981, then continues to increase to 3 in 1982, and to 4 in 1983 and 1984. Number of cases increases to 15 in 1985 and to 16 in 1986 and 1987. Number of cases is 9 in 1988.

5. Outbreak Background May 2006: IL Dept. of Public Health notified CDC of possible increase in AK cases in Chicago area Univ. IL at Chicago conducting case-control study October 2006: CDC informally contacted multiple ophthalmologists in other areas Unclear whether rise in cases nationwide January 2007: CDC surveyed 22 ophthalmology centers nationwide # of cases/yr from 1999-2006 In May, 2006, the Illinois Department of Public Health notified CDC of a possible increase in AK cases in the Chicago area. An ophthalmology group at the University of Illinois at Chicago was conducting a case control study to identify possible risk factors. In October 2006, CDC informally contacted several ophthalmologists across the country to try to ascertain whether cases were on the rise in other areas as well; however the results were inconclusive. So in January 2007, we conducted a retrospective survey of 22 ophthalmology centers nationwide, requesting the numbers of AK cases seen per year for the past eight years. In May, 2006, the Illinois Department of Public Health notified CDC of a possible increase in AK cases in the Chicago area. An ophthalmology group at the University of Illinois at Chicago was conducting a case control study to identify possible risk factors. In October 2006, CDC informally contacted several ophthalmologists across the country to try to ascertain whether cases were on the rise in other areas as well; however the results were inconclusive. So in January 2007, we conducted a retrospective survey of 22 ophthalmology centers nationwide, requesting the numbers of AK cases seen per year for the past eight years.

6. Survey of Ophthalmology Centers for AK Cases 1999–2006 (N=10) The survey results showed an increase in culture-confirmed cases starting in 2004, as shown in this graph with number of cases on the y axis and year on the x axis. Bar graph of non-culture confirmed and culture-confirmed acanthamoeba keratitis cases from 1999 to 2006, based upon a survey of 10 ophthalmology centers. The vertical axis shows the number of cases reported and the horizontal axis shows the year. There were 13 total cases in 1999; one was non-culture confirmed and the others were culture-confirmed cases. There were 12 total cases in 2000; two were non-culture confirmed and the others were culture-confirmed cases. There were 19 total cases in 2001; seven were non-culture confirmed and the others were culture-confirmed cases. There were 25 total cases in 2002; one was non-culture confirmed and the others were culture-confirmed cases. There were 20 total cases in 2003; four were non-culture confirmed and the others were culture-confirmed cases. There were 56 total cases in 2004; twelve were non-culture confirmed and the others were culture-confirmed cases. There were 73 total cases in 2005; eight were non-culture confirmed and the others were culture-confirmed cases. There were 77 total cases in 2006; seven were non-culture confirmed and the others were culture-confirmed cases. The survey results showed an increase in culture-confirmed cases starting in 2004, as shown in this graph with number of cases on the y axis and year on the x axis. Bar graph of non-culture confirmed and culture-confirmed acanthamoeba keratitis cases from 1999 to 2006, based upon a survey of 10 ophthalmology centers. The vertical axis shows the number of cases reported and the horizontal axis shows the year. There were 13 total cases in 1999; one was non-culture confirmed and the others were culture-confirmed cases. There were 12 total cases in 2000; two were non-culture confirmed and the others were culture-confirmed cases. There were 19 total cases in 2001; seven were non-culture confirmed and the others were culture-confirmed cases. There were 25 total cases in 2002; one was non-culture confirmed and the others were culture-confirmed cases. There were 20 total cases in 2003; four were non-culture confirmed and the others were culture-confirmed cases. There were 56 total cases in 2004; twelve were non-culture confirmed and the others were culture-confirmed cases. There were 73 total cases in 2005; eight were non-culture confirmed and the others were culture-confirmed cases. There were 77 total cases in 2006; seven were non-culture confirmed and the others were culture-confirmed cases.

7. Preliminary Results and Public Health Action May 23: 46 case-patients interviewed Significant association of AK with use of Advanced Medical Optics Complete® MoisturePlus™ (AMOCMP) multipurpose solution May 24: communicated preliminary results to FDA May 25: discussed results with state/ local health departments and AMO May 26: MMWR Dispatch released; voluntary recall of AMOCMP By May 23rd, 46 AK case-patients had been interviewed. A preliminary analysis conducted at that time – using the Fusarium controls – found a significant association of AK with use of Advanced Medical Optics Complete® MoisturePlus™ multipurpose contact lens solution. On May 24th those results were communicated to our colleagues in the Division of Ophthalmic and ENT Devices at FDA. On May 25th they were communicated to our collaborators in state and local health departments and to the AMO company. On May 26 an MMWR Dispatch was released and the company undertook a voluntary recall of AMOCMP. A photograph of a container of American Medical Optics AMO Complete MoisturePlus multipurpose solution.By May 23rd, 46 AK case-patients had been interviewed. A preliminary analysis conducted at that time – using the Fusarium controls – found a significant association of AK with use of Advanced Medical Optics Complete® MoisturePlus™ multipurpose contact lens solution. On May 24th those results were communicated to our colleagues in the Division of Ophthalmic and ENT Devices at FDA. On May 25th they were communicated to our collaborators in state and local health departments and to the AMO company. On May 26 an MMWR Dispatch was released and the company undertook a voluntary recall of AMOCMP. A photograph of a container of American Medical Optics AMO Complete MoisturePlus multipurpose solution.

8. Methods: Case-Control Study Case-patients obtained from case series Controls =12 years old with no history of AK Matched by contact lens use Soft, rigid, no use Matched by geographic location Standardized telephone interviews for controls Asked about behaviors and product use during one month prior to symptom onset of corresponding case-patient Following the preliminary analysis and the recall, we conducted a matched case-control study. The case-patients were obtained from the case series. Controls were at least 12 years old with no history of AK. They were matched to cases by contact lens use – either soft contact lenses, rigid contact lenses or no use. They were also matched geographically and a reverse address directory was used to find phone numbers for potential controls. We used standardized telephone interviews, and asked controls about their behaviors and product use during the one month prior to symptom onset of their corresponding case-patient. Following the preliminary analysis and the recall, we conducted a matched case-control study. The case-patients were obtained from the case series. Controls were at least 12 years old with no history of AK. They were matched to cases by contact lens use – either soft contact lenses, rigid contact lenses or no use. They were also matched geographically and a reverse address directory was used to find phone numbers for potential controls. We used standardized telephone interviews, and asked controls about their behaviors and product use during the one month prior to symptom onset of their corresponding case-patient.

9. Case Control Study Conclusions AK case-patients almost 17 times more likely than matched controls to have used AMOCMP Validated preliminary analysis comparing AK cases to Fusarium controls Use of existing comparison data enabled rapid public health action No evidence of solution contamination of AMOCMP Suspect insufficient anti-Acanthamoeba activity Other risk factors “Topping off” solution Contact lens use = 5 years Nonetheless, we found that among soft contact lens users, case-patients were almost 17 times more likely than matched controls to report having used AMOCMP – a finding which validated the results of our preliminary analysis comparing AK cases to fusarium controls. The use of this existing comparison data, which was shared by our colleagues in the Mycotics Diseases Branch at CDC, enabled rapid public health action months before our case-control study was completed. There was no evidence of contamination of AMOCMP and we suspect that insufficient anti-Acanthamoeba activity of the solution may be the underlying cause of the outbreak. Other risk factors included topping off solution, and contact lens use for less than or equal to 5 years. Nonetheless, we found that among soft contact lens users, case-patients were almost 17 times more likely than matched controls to report having used AMOCMP – a finding which validated the results of our preliminary analysis comparing AK cases to fusarium controls. The use of this existing comparison data, which was shared by our colleagues in the Mycotics Diseases Branch at CDC, enabled rapid public health action months before our case-control study was completed. There was no evidence of contamination of AMOCMP and we suspect that insufficient anti-Acanthamoeba activity of the solution may be the underlying cause of the outbreak. Other risk factors included topping off solution, and contact lens use for less than or equal to 5 years.

10. Discussion: AMOCMP Multi-purpose solution Used for disinfecting, rinsing, cleaning and storing lenses Launched in 2003 No evidence of contamination 21 AMOCMP lot numbers None repeated Wide geographic and temporal distribution Suspect insufficient anti-Acanthamoeba activity Primary risk factor in Chicago area case-control study with 55 cases AMOCMP is a multi-purpose contact lens solution used for disinfecting, rinsing, cleaning, and storing lenses. The product was launched in 2003, just preceding the nationwide increase in AK cases. We found no evidence to suggest that the strong association between AMOCMP and AK was a result of contamination. Lot numbers were available for 21 bottles of AMOCMP used by case-patients; no single lot number was repeated. The wide geographic and temporal distribution of cases also argued against contamination as the cause for the outbreak. We suspect that insufficient anti-Acanthamoeba activity of the solution may be to blame. A concurrent case-control study of AK in the Chicago area – which included 55 cases that were not included in our outbreak investigation – also found that AMOCMP was the primary risk factor. A photograph of a container of American Medical Optics AMO Complete MoisturePlus multipurpose solution. AMOCMP is a multi-purpose contact lens solution used for disinfecting, rinsing, cleaning, and storing lenses. The product was launched in 2003, just preceding the nationwide increase in AK cases. We found no evidence to suggest that the strong association between AMOCMP and AK was a result of contamination. Lot numbers were available for 21 bottles of AMOCMP used by case-patients; no single lot number was repeated. The wide geographic and temporal distribution of cases also argued against contamination as the cause for the outbreak. We suspect that insufficient anti-Acanthamoeba activity of the solution may be to blame. A concurrent case-control study of AK in the Chicago area – which included 55 cases that were not included in our outbreak investigation – also found that AMOCMP was the primary risk factor. A photograph of a container of American Medical Optics AMO Complete MoisturePlus multipurpose solution.

11. Parallels with Fusarium Keratitis 2006 Outbreak Concurrent outbreaks of keratitis among CLU Multi-purpose solution implicated Fusarium: Bausch & Lomb ReNu with MoistureLoc No contamination Insufficient anti-microbial efficacy “Topping off” solution in case common risk factor Reduce anti-microbial efficacy Concern about safety of multi-purpose solutions There are there several parallels between this AK outbreak and the Fusarium keratitis outbreak of 2006. Both outbreaks of serious corneal infections occurred primarily among soft contact lens users. The 3-4 year duration of the AK outbreak spanned the 2006 timeframe of the Fusarium outbreak. In both outbreaks, the primary risk factor was a particular multipurpose solution; for fusarium keratitis it was Bauch and Lomb Renu with MoistureLoc, which recalled in April, 2006. Both investigations found no evidence of contamination. Instead, the solutions were thought to have insufficient anti-microbial efficacy. In both outbreaks the practice of “topping off” solution in the case also emerged as an important risk factor. Following the fusarium outbreak, Renu with MoistureLoc was tested under circumstances that simulated the reported practices of the case-patients, including topping off solution, and it was found that this practice reduced the anti-microbial efficacy of the solution. Together, these outbreaks have raised concern about the safety of multi-purpose contact lens solutions. Two photographs of CDC Morbidity and Mortality Weekly Reports. One is entitled Fusarium Keratitis- Multiple States, 2006 and is dated Volume 55, April 10, 2006. The other is entitled Acanthamoeba Keratitis- Multiple States, 2005-2007 and is dated Volume 56, May 26, 2007.There are there several parallels between this AK outbreak and the Fusarium keratitis outbreak of 2006. Both outbreaks of serious corneal infections occurred primarily among soft contact lens users. The 3-4 year duration of the AK outbreak spanned the 2006 timeframe of the Fusarium outbreak. In both outbreaks, the primary risk factor was a particular multipurpose solution; for fusarium keratitis it was Bauch and Lomb Renu with MoistureLoc, which recalled in April, 2006. Both investigations found no evidence of contamination. Instead, the solutions were thought to have insufficient anti-microbial efficacy. In both outbreaks the practice of “topping off” solution in the case also emerged as an important risk factor. Following the fusarium outbreak, Renu with MoistureLoc was tested under circumstances that simulated the reported practices of the case-patients, including topping off solution, and it was found that this practice reduced the anti-microbial efficacy of the solution. Together, these outbreaks have raised concern about the safety of multi-purpose contact lens solutions. Two photographs of CDC Morbidity and Mortality Weekly Reports. One is entitled Fusarium Keratitis- Multiple States, 2006 and is dated Volume 55, April 10, 2006. The other is entitled Acanthamoeba Keratitis- Multiple States, 2005-2007 and is dated Volume 56, May 26, 2007.

12. Efficacy of AMOCMP Recall Product recall in May 2007 Continue to receive anecdotal reports of cases who continue to use AMOCMP Awareness about recall among controls 45% had heard of a solution recall 23% could name AMOCMP Challenges in recalling product with long shelf life The AMOCMP product was recalled in late May, 2007, following the preliminary analysis conducted as part of this outbreak investigation. Although we stopped enrolling cases in July, 2007, we have continued to receive anecdotal reports of cases of AK occurring in patients who continued to use AMOCMP long after the recall, even as late as March of this year. We included a question about awareness of the recall in our control questionnaire and found that less than half of respondents had heard about a solution recall in May, 2007. Of those, less than a quarter could name AMOCMP as the recalled product. This highlights some of the challenges in recalling a product with a long shelf life. While it quickly comes off the pharmacy or grocery store shelf, it may remain on the bathroom shelf in consumers homes for quite some time. A photograph of the NPR web site dated January 6, 2009 which features an article entitled “It’s Easy to Miss the Memo on Product Recalls”. The AMOCMP product was recalled in late May, 2007, following the preliminary analysis conducted as part of this outbreak investigation. Although we stopped enrolling cases in July, 2007, we have continued to receive anecdotal reports of cases of AK occurring in patients who continued to use AMOCMP long after the recall, even as late as March of this year. We included a question about awareness of the recall in our control questionnaire and found that less than half of respondents had heard about a solution recall in May, 2007. Of those, less than a quarter could name AMOCMP as the recalled product. This highlights some of the challenges in recalling a product with a long shelf life. While it quickly comes off the pharmacy or grocery store shelf, it may remain on the bathroom shelf in consumers homes for quite some time. A photograph of the NPR web site dated January 6, 2009 which features an article entitled “It’s Easy to Miss the Memo on Product Recalls”.

13. Ongoing AK Surveillance: Location of Participating Ophthalmology Centers and Laboratories (N=14) The 15 facilities were widely distributed geographically throughout 14 states, as seen on this map. A map of the United States which depicts the location of ongoing acanthamoeba keratitis surveillance at 14 participating ophthalmology centers and laboratories. The centers are located in California (two centers), Oregon, Washington, Utah, Texas, Illinois, Minnesota, Missouri, Florida, Ohio, Pennsylvania, New York, and Massachusetts.The 15 facilities were widely distributed geographically throughout 14 states, as seen on this map. A map of the United States which depicts the location of ongoing acanthamoeba keratitis surveillance at 14 participating ophthalmology centers and laboratories. The centers are located in California (two centers), Oregon, Washington, Utah, Texas, Illinois, Minnesota, Missouri, Florida, Ohio, Pennsylvania, New York, and Massachusetts.

14. In order to assess the impact of the AMOCMP recall, we re-contacted the ophthalmology centers and microbiology laboratories that had provided us with the data that initially detected a nationwide outbreak and we asked them to share the numbers of AK cases diagnosed during 2007 and 2008. It is important to note that these are not incidence rates, since the denominator is unknown; this graph depicts numbers of cases reported by a convenience sample of referral medical centers and laboratories on the y axis and year of diagnosis on the x axis. These centers noticed an increase in cases starting in 2004 and continuing through 2007. These cases have decreased in 2008. Bar graph which is identical to that on slide 6, with the exception that the acanthamoeba keratitis cases are circled for years 2007 and 2008. In order to assess the impact of the AMOCMP recall, we re-contacted the ophthalmology centers and microbiology laboratories that had provided us with the data that initially detected a nationwide outbreak and we asked them to share the numbers of AK cases diagnosed during 2007 and 2008. It is important to note that these are not incidence rates, since the denominator is unknown; this graph depicts numbers of cases reported by a convenience sample of referral medical centers and laboratories on the y axis and year of diagnosis on the x axis. These centers noticed an increase in cases starting in 2004 and continuing through 2007. These cases have decreased in 2008. Bar graph which is identical to that on slide 6, with the exception that the acanthamoeba keratitis cases are circled for years 2007 and 2008.

15. However, if we look more closely at the data from 2007 and 2008, we realize that this finding is not entirely surprising. (click) AMOCMP was on the market for the first five months of the year, (click) and we know that some consumers continued to use the product for much longer. (click) There is often a diagnostic delay, since AK can mimic other types of keratitis; we found that patients were typically started on Acanthamoeba specific treatment nearly 2 months after symptom onset. (click) There also may have been diagnostic artifacts, with peaks in cases diagnosed soon after the recall, (click) and following a series of media reports on the outbreak in late July and early August. In looking at the monthly numbers of cases, there was a decrease in cases during the last half of 2007. During 2008, it does not appear that cases have continued to decrease at these centers. Challenge of monthly numbers: They are small so any change in awareness or testing will dramatically impact these numbers. Bar graph which depicts the number of culture-confirmed cases and cases diagnosed using other methods of acanthamoeba keratitis which were diagnosed at 14 ophthalmology centers by month, from January 2007 to December 2008. The vertical axis shows the number of cases reported and the horizontal axis shows the month and year. There were 12 total cases in January 2007; all except one were culture-confirmed cases. There were 10 total cases in February 2007; all except one were culture-confirmed cases. There were 10 total cases in March 2007; all except two were culture-confirmed cases. There were 11 total cases in April 2007; all except one were culture-confirmed cases. There were 18 total cases in May 2007; all except five were culture-confirmed cases. There were 29 total cases in June 2007; all except ten were culture-confirmed cases. There were 16 total cases in July 2007; all except two were culture-confirmed cases. There were 18 total cases in August 2007; all except four were culture-confirmed cases. There were 12 total cases in September 2007; all except three were culture-confirmed cases. There were 20 total cases in October 2007; all except four were culture-confirmed cases. There were 13 total cases in November 2007; all except two were culture-confirmed cases. There were 11 total cases in December 2007; all except four were culture-confirmed cases. There were 7 total cases in January 2008; all except one were culture-confirmed cases. There were 7 total cases in February 2008; all except three were culture-confirmed cases. There were 12 total cases in March 2008; all were culture-confirmed cases. There were 6 total cases in April 2008; all except four were culture-confirmed cases. There were 5 total cases in May 2008; all were culture-confirmed cases. There were 7 total cases in June 2008; all except one were culture-confirmed cases. There were 7 total cases in July 2008; all except two were culture-confirmed cases. There were 16 total cases in August 2008; all except four were culture-confirmed cases. There were 9 total cases in September 2008; all except three were culture-confirmed cases. There were 12 total cases in October 2008; all except three were culture-confirmed cases. There were 12 total cases in November 2008; all except two were culture-confirmed cases. There were 5 total cases in December 2008; all except one was culture-confirmed cases. However, if we look more closely at the data from 2007 and 2008, we realize that this finding is not entirely surprising. (click) AMOCMP was on the market for the first five months of the year, (click) and we know that some consumers continued to use the product for much longer. (click) There is often a diagnostic delay, since AK can mimic other types of keratitis; we found that patients were typically started on Acanthamoeba specific treatment nearly 2 months after symptom onset. (click) There also may have been diagnostic artifacts, with peaks in cases diagnosed soon after the recall, (click) and following a series of media reports on the outbreak in late July and early August. In looking at the monthly numbers of cases, there was a decrease in cases during the last half of 2007. During 2008, it does not appear that cases have continued to decrease at these centers. Challenge of monthly numbers: They are small so any change in awareness or testing will dramatically impact these numbers. Bar graph which depicts the number of culture-confirmed cases and cases diagnosed using other methods of acanthamoeba keratitis which were diagnosed at 14 ophthalmology centers by month, from January 2007 to December 2008. The vertical axis shows the number of cases reported and the horizontal axis shows the month and year. There were 12 total cases in January 2007; all except one were culture-confirmed cases. There were 10 total cases in February 2007; all except one were culture-confirmed cases. There were 10 total cases in March 2007; all except two were culture-confirmed cases. There were 11 total cases in April 2007; all except one were culture-confirmed cases. There were 18 total cases in May 2007; all except five were culture-confirmed cases. There were 29 total cases in June 2007; all except ten were culture-confirmed cases. There were 16 total cases in July 2007; all except two were culture-confirmed cases. There were 18 total cases in August 2007; all except four were culture-confirmed cases. There were 12 total cases in September 2007; all except three were culture-confirmed cases. There were 20 total cases in October 2007; all except four were culture-confirmed cases. There were 13 total cases in November 2007; all except two were culture-confirmed cases. There were 11 total cases in December 2007; all except four were culture-confirmed cases. There were 7 total cases in January 2008; all except one were culture-confirmed cases. There were 7 total cases in February 2008; all except three were culture-confirmed cases. There were 12 total cases in March 2008; all were culture-confirmed cases. There were 6 total cases in April 2008; all except four were culture-confirmed cases. There were 5 total cases in May 2008; all were culture-confirmed cases. There were 7 total cases in June 2008; all except one were culture-confirmed cases. There were 7 total cases in July 2008; all except two were culture-confirmed cases. There were 16 total cases in August 2008; all except four were culture-confirmed cases. There were 9 total cases in September 2008; all except three were culture-confirmed cases. There were 12 total cases in October 2008; all except three were culture-confirmed cases. There were 12 total cases in November 2008; all except two were culture-confirmed cases. There were 5 total cases in December 2008; all except one was culture-confirmed cases.

16. Bar graph which is identical to that of slide 15, except for arrow which indicates the introduction of AMO Complete MoisturePlus between January 2007 and June 2007.Bar graph which is identical to that of slide 15, except for arrow which indicates the introduction of AMO Complete MoisturePlus between January 2007 and June 2007.

17. Bar graph which is identical to that of slide 16, except for arrow which indicates the continued use of AMO Complete MoisturePlus through February 2008.Bar graph which is identical to that of slide 16, except for arrow which indicates the continued use of AMO Complete MoisturePlus through February 2008.

18. Bar graph which is identical to that of slide 17, except for arrow which indicates the diagnostic delay between July 2007 and December 2007.Bar graph which is identical to that of slide 17, except for arrow which indicates the diagnostic delay between July 2007 and December 2007.

19. Limitations of Surveillance Unknown baseline for comparison How many keratitis patients were tested? Are the facilities surveyed an appropriate sample of AK-treating centers? Increased awareness and testing? Do ophthalmologists have an altered level of suspicion for AK? Changes in testing methods Are facilities using different testing methods? (e.g., confocal microscopy) Have culture methods changed?

20. Considerations for Ongoing Surveillance Possibility of ongoing surveillance at ophthalmology centers and laboratories for newly diagnosed cases in 2009 and beyond Better understanding of the number of patients tested and the method of testing Possible need for expansion of the number of ophthalmology centers and laboratories surveyed To further understand the epidemiology of AK, collect data on patient demographics and practices Seasonality? Geographic differences?

21. Conclusions Challenge of addressing the continued occurrence of AK cases Promote healthy contact lens habits No “topping off” Emphasis on improving hygiene in new contact lens users Improving the anti-Acanthamoeba efficacy of contact lens disinfection products? Regulatory challenge of recalling products with a long “shelf-life” Challenge of ongoing surveillance to monitor AK cases AK cases decreased but continue to occur. Increased education about the importance of hygiene particularly in new CLW. How to communicate recalls effectively. Ongoing surveillance is important. Midwest Eye-Banks, Prevent Blindness America (IPHA Affiliate Member), American Academy of Ophthalmology and Delta Gamma Foundation launched the Contact Lens Safety poster campaign in October. The four organizations have been working together since January on this initiative designed to educate the public about the proper wear and care of soft contact lenses. Picture of medical promotional advertisement entitled “Contact Lenses abd Water Don’t Mix” which states that microscopic organisms found in tap water may cause eye infections in contact lens wearers if proper care is not followed. AK cases decreased but continue to occur. Increased education about the importance of hygiene particularly in new CLW. How to communicate recalls effectively. Ongoing surveillance is important. Midwest Eye-Banks, Prevent Blindness America (IPHA Affiliate Member), American Academy of Ophthalmology and Delta Gamma Foundation launched the Contact Lens Safety poster campaign in October. The four organizations have been working together since January on this initiative designed to educate the public about the proper wear and care of soft contact lenses. Picture of medical promotional advertisement entitled “Contact Lenses abd Water Don’t Mix” which states that microscopic organisms found in tap water may cause eye infections in contact lens wearers if proper care is not followed.

22. Acknowledgments State/Local Health Departments: T Pippin, AL Dept Public Health; K Bryant, J Bugante Los Angeles County Health Dept; T Chang, S Chen, J Rosenberg, CA Dept of Health Svcs; R Hammond, K McConnell, R Sanderson, FL Dept of Health; J Elm, M Nakata, C Wakida, HI Dept of Health; C Austin, J Bestudik, MG Bordson, C Conover, IL Dept of Public Health; L Granzow, IN Dept of Health; A Pelletier, V Rea, ME Dept of Health and Human Svcs; A Chu, E Luckman, MD Dept of Health and Mental Hygiene; K Signs, MI Dept of Community Health; J Harper, MN Dept of Health; T Damrow, E Mosher, MT Dept of Public Health and Human Svcs; K Kruger, ND Dept of Health. E Saheli, OH Dept of Health; M Cassidy, J Hatch, OR Public Health Div, Dept; A Weltman, PA Dept of Health; EJ Garcia Rivera, Y Garcia, PR Dept of Health; MA Kainer, TN Dept of Health; J Archer, WI Dept of Health and Family Svcs EISOs: S Beavers, D Blaney, B Buss, T Chen, K Christian, M Cooper, D Dufficy, M Gershman, M Glenshaw, J Grant, A Hall, S Holzbauer, A Huang, A Langer, G Mirchandani, Z Moore, AS Patel, LR Carpenter, J Schaffzin, S Schumacher, J Su, I Trevino, T Weiser, P Wiersma, D Rentz, L Hausman FDA: M Bonhomme, N Pressly, M Robboy, J Saviola, E Woo  K Warburton, EPA: S Regli, E Burneson, S Shaw, V Blank, YT Guilaran Consultants: C Joslin; J Shaefer, D Jones, A Matoba, K Wilhelmus, MD, Anna Kitzman, Alex Shangraw Joan Hoppe-Bauer Regis P. Kowalski, MS, [M]ASCP Ajit P. Limaye, M.D. Nisha Acharya David Ritterband Durand, Marlene L.,Md Miller, Darlene Bruckner, David ScD William Mathers, M.D. Nancy D. Heidman Emily Vetter Paul Thompson Bennie Jeng Kathryn Colby, MD, PhD Alfonso, Eduardo M.D. CDC/NCZVED/DBMD: D Chang, B Park, K Wannemuehler  CDC/OWCD: S Brim, D Cheek, F Chow, S Cosgrove, AJ Deokar, N Di Meo, R Greco Kone, AS Kusano, P Norwood, S Persaud, B Peterson CDC/NCIRD/ISD: S Lorick CDC/NCZVED/DPD: MJ Beach, C Braden, A daSilva, M Hlavsa, S Johnston, Y  Qvarnstrom, J Roberts, S Roy, R Sriram, G Visvesvara, J Verani Volunteers for control interviews I apologize for the small font here, but this investigation would not have been possible without the efforts of our many collaborators in state and local health departments, FDA, EPA, our academic consultants, and throughout CDC. I apologize for the small font here, but this investigation would not have been possible without the efforts of our many collaborators in state and local health departments, FDA, EPA, our academic consultants, and throughout CDC.

  • Login