Hong Kong: HKU Experts Call For Deploying Prophylactic Tamiflu To Avert Crisis

Flu Express - Severe Flu Week 28

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Hong Kong's out-of-season flu epidemic continues to worsen (see yesterday's Week 28: Hong Kong's Flu Activity Increases To `A Very High Level') with their Centre for Health Protection (CHP) announcing no fewer than 3 new institutional outbreaks, and another severe pediatric case, over night.

• CHP investigates case of severe paediatric influenza A infection
• Cluster of Influenza A cases in Queen Elizabeth Hospital
• Cluster of Influenza A cases in Caritas Medical Centre
• CHP investigates influenza A outbreak in elderly home in To Kwa Wan

Also overnight, and causing quite a stir in the local media, two Hong Kong University infectious disease experts - Yuen Kwok-yung and David Christopher Lung - called upon the government to release 14-day prophylactic courses of  the antiviral drug Tamiflu (tm) - aka oseltamivir - to vulnerable elderly people to avert a crisis.

This from RTHK News:

Use Tamiflu urgently to control flu cases: experts

2017-07-21 HKT 12:00

Two infectious disease experts have called on the government to immediately administer the antiviral drug Tamiflu to vulnerable elderly people to control the current flu outbreak.

The microbiologists from the University of Hong Kong, Yuen Kwok-yung and David Christopher Lung, jointly issued a warning on Friday, saying that the public healthcare system is "on the verge of collapse" due to the summer flu cases.

In a jointly authored article, published in local newspaper Ming Pao, they said the season's peak will probably last at least two more weeks, and the government must act more aggressively to rein in the disease.

         (Continue . . . )

Similar reports appear in the Hong Kong Standard and other English language media outlets. Both of these experts are heavyweights in the world of influenza.

Professor Yuen, Kwok Yung 袁國勇

Title:

Chair of Infectious Diseases

Professor (Clinical)

Henry Fok Professor in Infectious Diseases

Dr LAM Chi Leung David

Clinical Assistant Professor

BSc (BioMedSc) (HK), MBBS (HK), MRCP (UK), FHKCP, FHKAM (Medicine), PhD (HK), FRCP(Edin & Glasgow), FCCP, FACP.

Oseltamivir can be used both for treatment and for prophylaxis, either post or pre-exposure. It is rare, however, to see such a `blanket' recommendation for prophylaxis for at risk individuals across an entire city.

The original article (in Chinese) is available at this link.  In it, these scientists discuss a mutation in the H3N2 virus that may be responsible for this summer's unusual epidemic (translation follows):

(1) viral factors: 2014/15-year-H3N2 influenza A winter peak was due to the emergence of antigenic drift (antigenic drift), but the epidemic of H3N2 influenza is not to drift. According to the recent Danish study showed that 2016/17 H3N2 influenza in a small antigenic variation (N121K), this variation has the potential to influenza vaccine used in the past two years failed.

Hong Kong H3N2 influenza A strains also appeared N121K variation, from July 2016 to March 2017, about 20% of the H3N2 strain appears N121K variation, while in May 2017, more than 35 percent of H3N2 strains N121K variation occurs. This variation may be the peak of the flu this summer one of the reasons.

This N121K variation has previously been linked to diminished vaccine effectiveness with the 3C.2a1 clade of the H3N2 virus, which we looked at in Eurosurveillance: Interim Estimates Of Flu Vaccine Effectiveness Against A(H3N2) - Canada, January 2017 and  Eurosurveillance: Emergence Of A Novel Subclade Of Seasonal A/H3N2 - London.



So far I've not seen any official response by the CHP or Hong Kong authorities.