# 8034
One of the reason’s Hong Kong’s CHP is so well regarded among bloggers is they proactively release information to the public that other public health agencies might try hide, or at least gloss over. Such was the case yesterday with the rapid confirmation of Hong Kong’s first (likely, imported) case of H7N9 (see Video: HK Officials Seeking Traveling Companion Of H7N9 Patient).
Today, HK’s CHP openly published a letter to local doctors and hospitals with additional details on this case, which provides us with the most detailed timeline of this patient’s illness and diagnosis to date.
Our Ref. : (102) in DH SEB CD/8/6/1 Pt.27 3 December, 2013
Dear Doctors,
A Confirmed case of Human Infection with Avian Influenza A(H7N9) virus and Activation of Serious Response Level of Government’s Preparedness Plan I would like to draw your attention to a confirmed case of human infection with avian influenza A(H7N9) virus in Hong Kong. The patient is a 36-year-old Indonesian maid. She lives with her employer's family (six family members) in Tuen Mun in Hong Kong.
She had onset of cough on 21 November 2013 and developed fever on 22 November. She sought medical attention from two general practitioners on 25 and 26 November. She developed shortness of breath on 27 November and attended Accident and Emergency Department of Tuen Mun hospital (TMH) and chest X-ray on admission showed right lower lobe consolidation. She was admitted to TMH and was transferred to intensive care unit for treatment on 29 November. Her condition deteriorated and she was transferred to Queen Mary Hospital for extracorporeal membrane oxygenation on 30 November by ambulance.
Her nasopharyngeal swabs and aspirates were tested positive by polymerase chain reaction (PCR) for influenza A and H7 and N9 on 2 December, confirming the diagnosis of influenza A (H7N9) by Public Health Laboratory Services Branch (PHLSB) of the Centre for Health Protection (CHP). Her current condition is critical.
Preliminary epidemiological investigation revealed that the patient went to Shenzhen of Guangdong Province on 17 November for a day trip. She bought a live chicken in a market and ate after cooking with a friend in Shenzhen. CHP of the Department of Health (DH) is communicating with the Guangdong Health Department to investigate the source of her infection. According to available information, this is likely to be an imported infection. CHP is tracing the exposed close contacts of the patients and will provide them with chemoprophylaxis and put them under quarantine. So far, four of the close contact had symptoms including cough, runny nose or sore throat and have been isolated in hospital. Investigation is on-going.
The Government has raised the influenza response level from “Alert” Response Level to “Serious” Response Level under the Framework of Government’s Preparedness Plan for Influenza Pandemic. Prior to this case, no human infections with avian influenza A(H7N9) virus were recorded in Hong Kong. According to the latest update from the National Health and Family Planning Commission of the People's Republic of China (28 November 2013), a total of 140 cases of human infection with avian influenza A(H7N9) virus have been reported.
In response to the newly confirmed imported case in Hong Kong, we have enhanced surveillance by activating zero reporting with both public and private hospitals. We would like to urge you to pay special attention to those who presented with influenza-like illnesses and had history of visiting wet market with live poultry or contact with poultry in Guangdong Province and other affected areas within the incubation period (i.e. 10 days before onset of symptoms). Please kindly be reminded that the list of affected areas is regularly updated and is available at the CHP website:(http://www.chp.gov.hk/files/pdf/global_statistics_avian_influenza_e.pdf).
Any suspected case meeting the reporting criteria (https://ceno.chp.gov.hk/casedef/casedef.pdf) should be immediately reported to the Central Notification Office of CHP via fax (2477 2770), phone (2477 2772) or CENO On-line (www.chp.gov.hk/ceno). Please also contact the Medical Control Officer (MCO) of DH at Pager: 7116 3300 call 9179 when reporting any suspected case. DH will make arrangement to send the patient to regional public hospitals for isolation, testing and treatment. Please isolate patient to minimize contact/exposure to staff and other patients and advise the patient to wear a surgical mask while waiting for transport.
For updates on the latest situation of avian influenza, please visit CHP website at http://www.chp.gov.hk/en/view_content/24244.html. Thank you for your ongoing support in combating communicable diseases.
Yours sincerely,
(Dr. SK CHUANG)
for Controller, Centre for Health Protection
Department of Health
