A cross-sectional clinical and epidemiological overview of a cohort of acute infectious keratoconjunctivitis among war-displaced populations in Kassala State, Sudan, 2024.

backgroundOutbreaks of acute infectious conjunctivitis can spread rapidly in overcrowded communities and healthcare settings. Sudan's armed conflict has increased displacement, crowding, water insecurity, and barriers to healthcare access.

methodsA facility- and camp-based cross-sectional study included 417 consecutive patients with acute conjunctivitis or keratoconjunctivitis who presented to participating ophthalmic services and internally displaced persons' settings in Kassala State, Sudan, from 15 August 2024 to 15 December 2024. Demographic, environmental, behavioural, clinical, treatment, and follow-up data were collected using a structured form. Diagnosis was clinical; laboratory viral typing was not performed. Descriptive statistics, Spearman correlations, Mann-Whitney U tests, Kruskal-Wallis tests, and multivariable regression models were used as appropriate.

resultsAmong 417 patients, 231 (55.4%) were female, and 353 (84.7%) lived in urban areas. Inadequate water/sanitation access was recorded in 125 (30.0%), a dusty environment in 224 (53.7%), a dirty environment in 317 (76.0%), a crowded environment in 223 (53.5%), and contact with a symptomatic person in 353 (84.7%). The most frequent symptoms were itching or burning (94.2%), redness (89.4%), foreign-body sensation (81.1%), eye pain (63.1%), and lid oedema (60.0%). The most frequent signs were conjunctival injection (38.8%), subconjunctival injection (35.7%), follicles/papillae (31.2%), periauricular lymphadenopathy (18.0%), punctate keratitis (11.0%), and membranes (3.8%). Clinicians recorded suspected bacterial superinfection complicating viral keratoconjunctivitis (43.9%), suspected adenoviral keratoconjunctivitis (29.3%), and suspected bacterial keratoconjunctivitis (21.3%) as the most frequent categories. Recovery data were available for 238/417 patients (57.1%); in this sub-cohort, complete recovery was associated with urban residence (OR 3.51; 95% CI 1.47-8.42), inadequate water/sanitation access (OR 9.87; 95% CI 2.46-39.62), a crowded environment (OR 2.41; 95% CI 1.12-5.14), and a lower symptom score (OR 0.78; 95% CI 0.63-0.97). All estimates are observational and are not interpreted as causal.

conclusionsThis outbreak occurred in a war-affected setting characterized by displacement, overcrowding, and limited access to water and sanitation. The clinical pattern is consistent with acute infectious keratoconjunctivitis, but the lack of laboratory testing prevents definitive classification as adenoviral epidemic keratoconjunctivitis or as enterovirus- or coxsackievirus-associated acute hemorrhagic conjunctivitis. Future outbreak response in similar settings should include laboratory confirmation and viral typing, access to clean water, hand hygiene, separation of cases in eye-care services, and avoidance of shared personal items.