EPIDEMIC GONOCOCCAL CONJUNCTIVITIS IN CENTRAL AUSTRALIA

Objectives: To describe an epidemic of gonococcal conjunctivitis in ce ntral Australian Aboriginal children, the responsible phenotypes of Ne isseria gonorrhoeae, factors facilitating spread and treatment efficac y. Design: Prospective study of patients with laboratory confirmed or clinical gonococcal conjunctivitis diagnosed from January to July 1991 . Setting: The Alice Springs and Barkty Tablelands Health Districts of the Northern Territory, the Anangu Pitjantjatjara Lands of South Aust ralia and the Ngaanyatjarra Homelands of Western Australia. Methods: C ases were identified from surveillance data and laboratory notificatio ns, and by active case finding. A community survey explored risk facto rs. Main outcome measures: Age-specific attack rates, auxotype/ serova r characterisation of isolates, and clinical response to single dose t reatment. Results: We identified 432 cases. The highest attack rate wa s in the 0-4 year age group (86 per 1000), and the risk of conjunctivi tis decreased with age. The odds ratio of secondary infection in house hold compared with community contacts was 14.5 (P < 0.002; 95% CI, 1.8 -120.0). Disease was less common in children with clean faces and hand s. The outbreak occurred after unseasonable rains and large community gatherings. Isolates were predominantly IA serovars, less common among central Australian serovars. Conclusions: The trigger for non-sexuall y transmitted gonococcal conjunctivitis epidemics remains obscure. Age is a significant risk factor and social and ecological factors may al so contribute. Active case finding within affected households and trea tment with a suitable penicillin is effective in stopping transmission .