Acute haemorrhagic conjunctivitis outbreak attributed to coxsackievirus A24 in Ratanakiri, Cambodia, 2023

Authors

  • Kimhour Lay Preah Ang Duong Hospital, Phnom Penh, Cambodia; Cambodian Ophthalmological Society, Phnom Penh, Cambodia
  • Kossama Chukmol Preah Ang Duong Hospital, Phnom Penh, Cambodia; Cambodian Ophthalmological Society, Phnom Penh, Cambodia
  • Guechlaing Chea Preah Ang Duong Hospital, Phnom Penh, Cambodia
  • Leng Un Preah Ang Duong Hospital, Phnom Penh, Cambodia
  • Kimhong Moch Provincial Referral Hospital of Ratanakiri, Ratanakiri, Cambodia
  • Seiha Do National Program for Eye Health, Phnom Penh, Cambodia; Khmer–Soviet Friendship Hospital, Phnom Penh, Cambodia
  • Lykheang Lou Preah Ang Duong Hospital, Phnom Penh, Cambodia
  • Meng Ngy National Program for Eye Health, Phnom Penh, Cambodia; Khmer–Soviet Friendship Hospital, Phnom Penh, Cambodia
  • Piseth Kong Preah Ang Duong Hospital, Phnom Penh, Cambodia

DOI:

https://doi.org/10.5365/wpsar.2026.17.1.1226

Keywords:

acute hemorrhagic conjunctivitis, human coxsackievirus A24, enterovirus, RNA sequencing, outbreaks, Cambodia

Abstract

Objective: To determine the causative agent, clinical manifestations and risk factors for infection during a September 2023 outbreak of acute haemorrhagic conjunctivitis (AHC) in Pak Touch village, Ratanakiri province, Cambodia.

Methods: A retrospective case-control study was conducted. Cases were age-matched to controls (1:1), who were randomly selected from the village population. Twenty-one conjunctival samples were analysed using real-time reverse transcription–polymerase chain reaction (RT–PCR). RNA sequencing was additionally performed to identify the causative agent of the outbreak. Logistic regression models were used to identify significant risk factors.

Results: A total of 73 cases and 73 controls were included in the analysis. Cases had a median age of 20 years (range: 1–70, mean and standard deviation: 27.7 ± 20.0), and 46.6% (34/73) were male. The overall attack rate was 12.3% (73 cases/594 residents). Clinical presentations included conjunctival hyperaemia (100%), subconjunctival haemorrhage (82.2%, 60), pain and discharge (64.4%, 47 each), eyelid swelling (57.5%, 42) and tearing (54.8%, 40). RT–PCR identified enterovirus in 52.4% (11/21) of conjunctival swabs, with RNA sequencing confirming the coxsackievirus A24 variant as the causative agent in five swabs. Statistical analysis identified significant risk factors, including physical contact with patients with acute haemorrhagic conjunctivitis (adjusted odds ratio [aOR]: 4.42, 95% confidence interval [CI]: 1.90–10.10), frequent eye rubbing (aOR: 4.56, 95% CI: 2.00–10.37) and poor hand hygiene (aOR: 3.70, 95% CI: 1.64–8.43).

Discussion: The outbreak of acute haemorrhagic conjunctivitis in Pak Touch village was primarily caused by coxsackievirus A24. Significant risk factors included physical contact with infected individuals, frequent eye rubbing and poor hand hygiene. Effective hygiene measures are crucial to prevent the spread of AHC.

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Published

23-02-2026

How to Cite

1.
Lay K, Chukmol K, Chea G, Un L, Moch K, Do S, Lou L, Ngy M, Kong P. Acute haemorrhagic conjunctivitis outbreak attributed to coxsackievirus A24 in Ratanakiri, Cambodia, 2023. Western Pac Surveill Response J [Internet]. 2026 Feb. 23 [cited 2026 Apr. 9];17(1). Available from: https://ojs.wpro.who.int/ojs/index.php/wpsar/article/view/1226

Issue

Vol. 17 No. 1 (2026): January – March

Section

Original Research

Categories

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Copyright (c) 2026 Kimhour Lay, Kossama Chukmol, Guechlaing Chea, Leng Un, Kimhong Moch, Seiha Do, Lykheang Lou, Meng Ngy, Piseth Kong

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