Friday, December 30, 2016

A Bit More Detail On the Hong Kong H7N9 Case


Although we've already seen this morning's CHP update on their second H7N9 case of the season, we often can get more detail on the patient's condition and medical history via the letters the CHP sends out to local physicians.  

This letter's primary thrust is to remind local physicians to ask patients with acute flu-like symptoms or pneumonia about their recent travel history and/or `at risk' exposures (including live poultry workers, history of visiting market with live poultry, contact with poultry, etc.) and to report suspect cases promptly.

Whether this latest case turns out to be imported, or locally acquired, the expectation is that this won't be the last case to turn up in Hong Kong this winter.

December 30, 2016
Dear Doctors,

A Confirmed Case of Human Infection with Avian Influenza A(H7N9) Virus

We would like to draw your attention to the second confirmed case of human infection with avian influenza A(H7N9) virus in Hong Kong this winter and solicit your support to remain vigilant against avian influenza.

The case involved a 70-year-old man who had history of carcinoma of bladder, stroke and hyperlipidaemia. According to information provided by the patient and his wife, he developed fever, cough with sputum, shortness of breath, vomiting and diarrhoea on December 26, 2016. He attended the Accident and Emergency Department of United Christian Hospital on December 27 and was admitted to an isolation ward on December 28 for management of pneumonia. His sputum specimen was tested positive for influenza A(H7N9) virus by the Public Health Laboratory Services Branch of the Centre for Health Protection (CHP). 

The patient has been transferred to Princess Margaret Hospital for further management and is now in serious condition. According to the assessment by the attending physicians, the onset date of the patient was likely before December 26 based on pneumonic changes detected in the chest X-ray taken upon admission and clinical findings.

The CHP’s investigation revealed that the patient had travelled to Shenzhen and Zhongshan of Guangdong since December 13 and returned to Hong Kong on December 16. He claimed that he came across mobile stalls selling live poultry in Zhongshan. In Hong Kong, the patient recalled having purchased a chilled chicken from a shop near a wet market in Kwun Tong on December 22 but there was no sale of live poultry in the shop. According to the patient, he did not enter the wet market in Kwun Tong. The source of infection is still under investigation. 

His close contacts have remained asymptomatic so far and have been put under medical surveillance. Tracing of his other contacts is underway. The CHP's investigation is continuing.

Prior to this case, 17 imported human H7N9 cases have been recorded in Hong Kong. Cumulatively, a total of 818 human H7N9 cases have been reported globally since March 2013.

We would like to draw your attention that there has been increase in the activity of avian influenza viruses in neighboring areas and overseas countries since November 2016. The avian influenza activity is expected to remain high in the winter based on its seasonal pattern. In this regard, please pay special attention to patients who present with fever or influenza-like illness. It is essential to obtain their travel history and relevant exposure history during travel as appropriate.
Any patients with acute respiratory illness or pneumonia, and with at-risk exposure (including live poultry workers, history of visiting market with live poultry, contact with poultry, etc.) in affected areas within the incubation period (i.e. 10 days before onset of symptoms) should be managed as suspected cases and immediately reported to the Central Notification Office of the CHP via fax (2477 2770), phone (2477 2772) or CENO On-line (

Private doctors should contact the Medical Control Officer of the Department of Health at pager: 7116 3300 (call 9179) when reporting any suspected case outside office hours. The CHP will make arrangement to send the patient to a public hospital for isolation, testing and treatment. Besides, in order to minimise contact with or exposure to staff and other patients, it is important to isolate the patient and advise the patient to wear a surgical mask while waiting for transfer.

For updates on the latest situation of avian influenza and the affected areas, please visit the CHP’s designated website at Please draw the attention of the healthcare professionals and supporting staff in your institution/ working with you to the above. Thank you for your ongoing support in combating communicable diseases.

Yours faithfully,
for Controller, Centre for Health Protection
Department of Health

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