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While the source of the recent introduction of the H7N9 virus remains undetermined, and Hong Kong’s CHP prepares to send investigators to neighboring Shenzhen where both of Hong Kong’s avian flu patients were likely exposed, the daily updates from the Centre for Health Protection reassuringly have shown no signs of a wider outbreak in the city.
Out of more than 3 dozen close contacts, and more than 300 other contacts, none have tested positive for the virus. While the incubation period still has some time to go, the news so far remains good.
The big question mark comes comes from Shenzhen - just an hour away from Hong Kong by either train or ferry - where live poultry markets remain open, and authorities deny finding the virus in any of the birds they’ve tested.
This from (machine translated) report from Metroradio HK.
The experts had not been able to meet the source of infection in patients diagnosed two H7N9
09/12/2013 7:45 PMH7N9 avian influenza infection diagnosed two patients remained in hospital medicine, were in serious and stable condition. CHP and HA sent to Shenzhen, Guangdong Province and Shenzhen City Health Planning and CDC experts meetings, yet able to determine the source of infection of two patients.
Director, Centre for Health Protection Leung Ting-hung means, after investigation I believe the first 36 years were diagnosed with Indian commission, had to deal with chickens Shenzhen residential South Bay Street, Longgang District, but the patient failed to explain the source of live chickens. Diagnosed eighty second man, his family was in the vicinity of downtown Shenzhen Fu Yong Town, buying chickens have been slaughtered cooking, but the man had no contact with live poultry markets and The mainland authorities have collected samples for testing for H7N9 virus was not found positive, Leung Ting-hung means, will continue to investigate whether patients come into contact with virus-contaminated environments.
Unlike its more famous cousin H5N1 which causes significant illness and mortality in poultry, the H7N9 virus is a LPAI (Low pathogenic Avian Influenza) virus in birds. Poultry generally show no symptoms, making the virus both hard to detect, and difficult to eradicate (see FAO H7N9 Homepage).
Although exposure to infected birds is considered the most likely route of infection with this virus, the evidence in these two cases thus far is purely circumstantial. Here then is the latest update from Hong Kong’s CHP on the epidemiological investigation into both of these (presumably) imported cases.
9 December 2013
The Centre for Health Protection (CHP) of the Department of Health (DH) today (December 9) provided an update on the two confirmed human cases of avian influenza A(H7N9) in Hong Kong.
"The epidemiological investigations, enhanced disease surveillance, port health measures and health education are proceeding," a spokesman for the DH remarked.
The male patient aged 80 living in Fu Yong Xin He District in Shenzhen. As of 4pm today, no additional close contacts have been identified. The number of close contacts remains at 19 while there are over 140 other contacts. Details are as follows:
(A) The 19 close contacts remain under quarantine for ten days since their last contact with the patient. Their specimens all tested negative for the avian influenza A(H7N9) virus upon preliminary laboratory testing by the Public Health Laboratory Services Branch (PHLSB) of the CHP. They were prescribed with the antiviral Tamiflu for prophylaxis. During isolation, if their health conditions change, further testing and surveillance will be conducted. They include:
1. Thirteen patients who had stayed in the same cubicle with the confirmed patient in Tuen Mun Hospital (TMH);
2. His five family members; and
3. The taxi driver who had taken the patient and his family members from Shenzhen Bay Port Border Control Point (SBP BCP) to TMH on December 3.
(B) Over 140 other contacts, including other relatives of the patient, healthcare workers (HCWs) of TMH and the ambulance service, relevant hospital visitors as well as an immigration control officer at SBP BCP, have been put under medical surveillance and offered Tamiflu prophylaxis. Among them, one HCW of TMH newly developed non-specific symptoms whose specimen collected today has been tested negative for the avian influenza A(H7N9) virus by the PHLSB.
Regarding the first confirmed case affecting a female patient aged 36, as of 4pm today, no additional close contacts have been identified. The number of close contacts remains at 17 while there are now 230 other contacts under medical surveillance. Of the 17 close contacts, 12 have completed quarantine and will be continued to be put under medical surveillance for ten more days. The remaining five close contacts remain under quarantine for ten days since their last contact with the patient. During isolation, if their health conditions change, further testing and surveillance will be conducted. Among the 230 other contacts, one HCW of the Queen Mary Hospital newly developed non-specific symptoms whose specimen collected today has been tested negative for the avian influenza A(H7N9) virus by the PHLSB. In addition, a client of Dr Wong Chun-yan whom the patient consulted on November 26 presented with non-specific symptoms today and has been referred to Princess Margaret Hospital (PMH) for isolation treatment. Specimen will be collected and sent for testing.
Lady MacLehose Holiday Village in Sai Kung under the Leisure and Cultural Services Department has been converted as a quarantine centre. Currently, six asymptomatic close contacts of the second case are under quarantine. An asymptomatic close contact of the same case who has been under quarantine in the centre has been transferred to PMH for isolation due to other health problems.
The epidemiological investigations into the two cases by the CHP, including contact tracing, are ongoing.
Locally, enhanced surveillance over suspected cases in public and private hospitals is underway. The CHP will continue to maintain liaison with the World Health Organization (WHO), the Mainland and overseas health authorities to monitor the latest developments and obtain timely and accurate information. Local surveillance activities will be modified according to the WHO's recommendations.
"We have enhanced our publicity and health education on the prevention of avian influenza. The CHP has also sent letters to government departments and related organisations to reinforce our health advice on the prevention of avian influenza," the spokesman added.
The CHP hotline (2125 1111) has been set up for public enquiries. As of 4pm today, 77 calls had been received.
"Travellers, especially those returning from avian influenza A(H7N9)-affected areas and provinces, with fever or respiratory symptoms are reminded to immediately wear facial masks, seek medical attention and reveal their travel history to doctors. Healthcare professionals should also pay special attention to patients who might have had contact with birds, poultry or their droppings in affected areas and provinces," the spokesman advised.
The spokesman also urged travellers not to visit live poultry markets in the affected areas and provinces and avoid direct contact with poultry, birds and their droppings. If contact has been made, they should thoroughly wash their hands with soap and water.
