Key messages

  • Notification requirements for acute bacterial conjunctivitis depend on the bacteria causing the infection. Notifications for Neisseria meningitidis, and N. gonorrhoeae are required.
  • Conjunctivitis is sometimes referred to as 'pink eye'.
  • School exclusions apply for infections from all pathogens, as the infection is highly contagious.

Notification requirement for acute bacterial conjunctivitis

Neisseria meningitides infection is an ‘urgent’ notifiable condition and must be notified by medical practitioners and pathology services immediately by telephone upon initial diagnosis (presumptive or confirmed). Pathology services must follow up with written notification within 5 days.

N. gonorrhoeae infection is a ‘routine’ notifiable condition and must be notified by medical practitioners and pathology services in writing within 5 days of diagnosis. 

Other pathogens are not notifiable.

These are Victorian statutory requirements.

Primary school and children’s services centre exclusion for acute bacterial conjunctivitis

Exclude until discharge from the eyes has ceased.

Infectious agent of acute bacterial conjunctivitis

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

Identification of acute bacterial conjunctivitis

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. The disease may last from 2 days to 2–3 weeks. Most people have only hyperaemia (engorgement of the conjunctival blood vessels) and slight exudate for a few days. Trachoma should be suspected in the presence of lymphoid follicles and diffuse conjunctival inflammation or scarring of the tarsal conjunctiva or trichiasis (inturned eyelash/es). While pain or loss of vision is not common, patients with significant eye pain, orbital cellulitis, loss of vision or photophobia require immediate referral to an ophthalmologist.

Diagnosis

Mild conjunctivitis is rarely investigated and is usually treated empirically. Microscopic examination of a stained smear, polymerase chain reaction (PCR) or culture of the discharge is useful to differentiate bacterial from viral or allergic conjunctivitis.

Incubation period of acute bacterial conjunctivitis

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

Public health significance and occurrence of acute bacterial conjunctivitis

Acute bacterial conjunctivitis is widespread throughout the world. Outbreaks of gonococcal conjunctivitis have occurred in northern and central Australia. Infection due to C. 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 of acute bacterial conjunctivitis

Humans are the reservoir.

Mode of transmission of acute bacterial conjunctivitis

Infection is transmitted via contact with the discharge from the conjunctivae or upper respiratory tract of infected people (direct hand-to-eye contact) or by touching or using something that has been contaminated by a person with the infection. Neonates may acquire infection during vaginal delivery. In some areas, flies have been suggested as possible vectors.

Period of communicability of acute bacterial conjunctivitis

Acute bacterial conjunctivitis is infectious while there is discharge.

Susceptibility and resistance to acute bacterial conjunctivitis

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 for acute bacterial conjunctivitis

Preventive measures

Preventative measures include careful treatment of affected eyes and personal hygiene, particularly handwashing.

Prevention of trachoma in Australia follow the Guidelines for the public health management of trachoma in Australia.

Control of case

Conjunctivitis due to bacterial infection may be difficult to distinguish clinically from allergic or viral conjunctivitis or conjunctivitis due to physical irritation. Therefore, empirical antibiotic therapy is often used. In mild cases, antiseptic eyedrops (propamidine) are the usual treatment.

In moderate and severe cases, a combination of treatments (antibiotic eye-drops/ointments or intramuscular/intravenous antibiotics) may be used. Consult the current version of Therapeutic guidelines: antibiotic.

Contaminated articles/items should be discarded or disinfected.

Rigorous hand hygiene is important in preventing further transmission. Wash your hands often and after contact with an infected person or items he or she uses. Wash your hands after applying eyedrops or ointment or cleaning an infected individual’s eyes.

Avoid touching or rubbing your eyes and do not share items used by an infected person, such as washcloths, towels, eye or face make-up and eyeglasses.

Children should not attend primary school and childcare settings until discharge from the eyes has ceased.

Control of contacts

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

Control of environment

Dispose of contaminated articles, such as cotton balls or tissues used to cleanse the eye area.

Wash linen, such as pillowcases, sheets, washcloths and towels, in hot water and detergent; hands should be washed after handling such items.

Outbreak measures for acute bacterial conjunctivitis

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

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