Monday, November 20, 2017

HK CHP Notified Of Human H5N6 Infection In Guangxi Province


While human infections with HPAI H5N6 have always been sporadic, it has been a year since the last two cases (see WHO Update On 2 Recent H5N6 Cases In China) were reported from China. Those two cases brought 2016's total to 9 cases. 
Despite seeing this avian virus turn up (in poultry and wild birds) over the past 3 years in Vietnam, Laos, South Korea, Japan, Taiwan, and the Philippines - China is the only country to have reported human infections.
The reasons behind this disparity - and the recent lull in human cases - are unknown, although we do know that there are numerous genotypes of this virus in circulation (see Cell Host Microbe: Genesis, Evolution and Prevalence of HPAI H5N6 In China) and it is likely than some of these (dozens) of variants are less well adapted to human physiology than others (see Differences In Virulence Between Closely Related H5N1 Strains).

With H5N6 just confirmed in South Korean poultry after an absence of 6 months, and the virus confirmed in wild birds collected in Japan last week, the news from Hong Kong this morning - while not unexpected - is far from welcome.

CHP notified of human case of avian influenza A(H5N6) in Guangxi

The Centre for Health Protection (CHP) of the Department of Health (DH) today (November 20) received notification of an additional human case of avian influenza A(H5N6) in Guangxi from the National Health and Family Planning Commission, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

The case involved a 33-year-old man from Guigang. He developed symptoms on November 7 and was hospitalised on November 12. He is now in a critical condition. The patient had contact with live poultry and exposure to live poultry markets before the onset of symptoms.

"Based on the seasonal pattern of avian influenza viruses, their activity in the Mainland is expected to increase in winter. The public should avoid contact with poultry, birds and their droppings and should not visit live poultry markets and farms to prevent avian influenza," a spokesman for the CHP said.

From 2014 to date, 17 human cases of avian influenza A(H5N6) have been reported by the Mainland health authorities.

"All novel influenza A infections, including H5N6, are notifiable infectious diseases in Hong Kong," the spokesman said.

Travellers to the Mainland or other affected areas must avoid visiting wet markets, live poultry markets or farms. They should be alert to the presence of backyard poultry when visiting relatives and friends. They should also avoid purchasing live or freshly slaughtered poultry, and avoid touching poultry/birds or their droppings. They should strictly observe personal and hand hygiene when visiting any place with live poultry.

Travellers returning from affected areas should consult a doctor promptly if symptoms develop, and inform the doctor of their travel history for prompt diagnosis and treatment of potential diseases. It is essential to tell the doctor if they have seen any live poultry during travel, which may imply possible exposure to contaminated environments. This will enable the doctor to assess the possibility of avian influenza and arrange necessary investigations and appropriate treatment in a timely manner.

While local surveillance, prevention and control measures are in place, the CHP will remain vigilant and work closely with the World Health Organization and relevant health authorities to monitor the latest developments.

The CHP's Port Health Office conducts health surveillance measures at all boundary control points. Thermal imaging systems are in place for body temperature checks on inbound travellers. Suspected cases will be immediately referred to public hospitals for follow-up.

The display of posters and broadcasting of health messages in departure and arrival halls as health education for travellers is under way. The travel industry and other stakeholders are regularly updated on the latest information.

The public should maintain strict personal, hand, food and environmental hygiene and take heed of the advice below if handling poultry:

  • Avoid touching poultry, birds, animals or their droppings;
  • When buying live chickens, do not touch them and their droppings. Do not blow at their bottoms. Wash eggs with detergent if soiled with faecal matter and cook and consume the eggs immediately. Always wash hands thoroughly with soap and water after handling chickens and eggs;
  • Eggs should be cooked well until the white and yolk become firm. Do not eat raw eggs or dip cooked food into any sauce with raw eggs. Poultry should be cooked thoroughly. If there is pinkish juice running from the cooked poultry or the middle part of its bone is still red, the poultry should be cooked again until fully done;
  • Wash hands frequently, especially before touching the mouth, nose or eyes, before handling food or eating, and after going to the toilet, touching public installations or equipment such as escalator handrails, elevator control panels or door knobs, or when hands are dirtied by respiratory secretions after coughing or sneezing; and
  • Wear a mask if fever or respiratory symptoms develop, when going to a hospital or clinic, or while taking care of patients with fever or respiratory symptoms
The public may visit the CHP's pages for more information: the avian influenza page, the weekly Avian Influenza Report, global statistics and affected areas of avian influenza, the Facebook Page and the YouTube Channel.
Ends/Monday, November 20, 2017
Issued at HKT 18:05 
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Like with H5N1 and H7N9, human infection with H5N6 is associated with high morbidity and mortality. Although the sampling size is small (n=18), and some details are lacking, roughly half of reported H5N6 cases have died.
Hospitalized cases - which represent the `sickest of the sick'  - are most likely to be tested and reported, which means we don't have a very good handle on how many `mild' cases might fly under the surveillance radar.
While reports of human avian flu infections out of China have been absent for the past couple of months, this is the time of year - as winter sets in - we normally expect to start seeing cases.   

Although H7N9 is expected to be the big story out of China this winter, H5N6 continues to spread and evolve, making it a virus very much worth keeping our eyes on. 


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