Wednesday, February 07, 2018

Hong Kong Closes Schools, Calls For Stringent NPIs To Combat Flu



Hong Kong is dealing with a particularly nasty Influenza B epidemic - one which comes at the highest travel time of the year; Chinese New Year's (Jan 16th).  Yesterday, in Hong Kong Considers Early School Closures For Lunar New Year Due To Flu, we looked at the high hospital census and large number of institutional outbreaks, and discussions over closing schools a week early for the holiday.
Today the decision has been made to close schools early, and Hong Kong's CHP is calling upon the public - particularly children - to use NPIs to try to reduce influenza transmission. 
Whenever a severe seasonal flu or worse – a pandemic –  threatens, our first line of defense will be NPIs or Non-Pharmaceutical Interventions.  Vaccines are great, but they can vary in effectiveness, are often in short supply (as in Hong Kong), or may not be available for months (or at all).
The CDC’s Nonpharmaceutical Interventions (NPIs) web page defines NPIs as:
Nonpharmaceutical interventions (NPIs) are actions, apart from getting vaccinated and taking medicine, that people and communities can take to help slow the spread of illnesses like influenza (flu). NPIs are also known as community mitigation strategies.
Measures like social distancing, hand hygiene, staying home when sick, avoiding crowds, wearing a mask if you are sick, even the closure of schools or other public venues are all potential NPIs.
Although there may be other pharmaceutical options - like antivirals - available at the start of an epidemic, those will be in finite supply and are not a panacea for infection.  Prevention is always better than treatment, but never more so than during an epidemic or pandemic, when treatment options may quickly become limited.
In last year's Community Pandemic Mitigation's Primary Goal : Flattening The Curve we looked at the primary goal of the HHS/CDC's 2017 revised Community Mitigation Guidelines to Prevent Pandemic Influenza - which is to slow the spread of any severe outbreak, in hopes of limiting its impact on hospitals, essential workers, infrastructure, and ultimately reducing the death toll.

While Hong Kong is dealing with far less than a pandemic scenario, they are facing similar impacts; overcrowded hospitals, a high number of severe cases (even deaths), a shortage of vaccines, and added concerns over the impact of Chinese New Year's which will see nearly 6 million people entering/leaving the city between Feb 15th to 21st.

In an attempt to mitigate its impact, in the past few hours the CHP has made the following announcements (bolding mine):

     To prevent the spread of influenza in schools, the Education Bureau (EDB), with the advice of the Centre for Health Protection (CHP) announced today (February 7) that all kindergartens, kindergartens-cum-child care centres, primary schools and special schools (excluding Schools for Social Development with secondary section only) will start their Chinese New Year holidays from tomorrow (February 8) till the end of the originally scheduled holidays of the schools.

     The EDB has issued letters to schools to explain the measures and arrangements that should be made during the holidays, including activities within and outside the schools, lunch arrangement and school bus services.
     During the non-scheduled period of school holidays, schools should remain open. If necessary, students can go to school as usual. Schools should arrange for staff to handle school matters and parents' enquiries, and to look after students who might still arrive.
     Parents should take measures to prevent influenza and pay attention to the health condition of their children. Students should avoid visiting crowded places with poor ventilation. They should build up good body immunity by having a proper diet, regular exercise and adequate rest.
     During the holidays, the schools should clean their premises thoroughly to ensure environmental hygiene.
     The EDB will continue to keep close contact with the CHP and provide support to schools when necessary.

Ends/Wednesday, February 7, 2018

Issued at HKT 12:42

While classes have been suspended, schools will apparently remain open for those students whose parents work and who need a supervised place to be during the day.  Probably not the best choice, but for some, the only option.

Another announcement today urges the public to adopt other NPIs, including social distancing, avoiding crowds, stringent hand hygiene, and wearing surgical masks if they have symptoms.
     The Centre for Health Protection (CHP) of the Department of Health (DH) today (February 7) urged the public to continue their vigilance against seasonal influenza and adopt strict personal hygiene as the latest surveillance data showed that the local seasonal influenza activity has increased to a high level in the past few weeks. In particular, social distancing is an effective precautionary measure to reduce the chance of infection for children and others.
     Hosting a press conference to report on the latest situation of the winter influenza season in Hong Kong today, the Controller of the CHP, Dr Wong Ka-hing, said, "Although there was no further increase in a number of surveillance parameters in the past week, we anticipate that the seasonal influenza activity will remain at a high level for some time.
     "The predominating virus of this winter influenza season has been influenza B. Epidemiological experience shows that children are relatively more affected in seasons with predominance of influenza B virus, and this can be reflected by the large number of outbreaks of influenza-like illness (ILI) in schools in this season."
     The CHP recorded a sharp increase in institutional ILI outbreaks in the past three weeks. As at February 6, 398 ILI outbreaks have been recorded in the current season, exceeding the number recorded in the same duration in past influenza seasons. Majority of the outbreaks occurred in primary schools (42.5 per cent) and kindergartens/child care centres (41.7 per cent), followed by secondary schools (5.8 per cent) and residential care homes for the elderly (3.8 per cent).
     Dr Wong said, "The Government this morning held a high-level inter-departmental meeting to review the latest situation of the local influenza activity. Taking into consideration the opinions and recommendations from experts, as well as concerns from parents, the Government has decided to adopt a precautionary approach through social distancing to reduce the transmission of influenza in school settings and that all primary schools, kindergartens and child care centres will take an early break for the Lunar New Year holiday from tomorrow (February 8)."
     Meanwhile, the latest surveillance data showed that the daily number of admission with laboratory confirmation of influenza in public hospitals peaked at 272 per day in the week from January 22 to 28 and steadily decreased to 232 per day in the week from January 31 to February 6. The weekly average rate of the ILI syndrome group in accident and emergency departments has slightly dropped from 247.0 (per 1,000 coded cases) in the previous week to 238.4 last week. The influenza-associated hospitalisation rates reached the peak in the previous week (January 21 to 27). The rate in that week was highest among children aged under 5 (8.65 per 10 000 population), followed by children aged 6 to 11 (3.73 per 10 000 population) and elderly people aged 65 or above (2.75 per 10 000 population). Of note, the influenza-associated hospitalisation rate among children aged 6 to 11 has exceeded the peak levels recorded in the past five years.
     Dr Wong said, "Regarding the severe influenza cases, our data indicated that they mainly affected the elderly. A total of 203 adult cases (115 deaths) of intensive care unit admission/death with laboratory confirmation of influenza were recorded with the Hospital Authority and private hospitals from January 7 to February 6. About 67 per cent of the severe adult cases involved elderly persons aged 65 or above while 74 per cent of the patients had pre-existing chronic diseases."
     As for children (aged under 18), 12 severe cases (two deaths) were reported as at noon today. Among the cases, 11 (92 per cent) did not receive seasonal influenza vaccination for the current season.
     Dr Wong reminded children, the elderly and those with underlying illnesses to get vaccinated against seasonal influenza for better personal protection. People should promptly seek medical advice if influenza-like symptoms develop so that appropriate treatment can be initiated as early as possible to prevent potential complications.
     After the Lunar New Year holiday, children with fever and respiratory symptoms should not attend schools till 48 hours after fever has subsided. Parents and carers are reminded to render assistance in prevention, care and control for vulnerable people.
     Besides receiving seasonal influenza vaccination, the public should maintain good personal and environmental hygiene against influenza and other respiratory illnesses: 

  • Wash hands with liquid soap and water properly whenever possibly contaminated;
  • When hands are not visibly soiled, clean them with 70 to 80 per cent alcohol-based handrub as an effective alternative;
  • Wash or clean hands frequently, especially before touching the mouth, nose or eyes, or after touching public installations such as handrails or door knobs;
  • Cover the nose and mouth when sneezing or coughing, and wash hands thoroughly afterwards;
  • Dispose of soiled tissue paper properly in a lidded rubbish bin;
  • Put on a surgical mask when respiratory symptoms develop;
  • Maintain good indoor ventilation;
  • When influenza is prevalent, avoid going to crowded or poorly ventilated public places; high-risk individuals may consider putting on surgical masks when staying in such places; and
  • Maintain a balanced diet, exercise regularly, take adequate rest, do not smoke and avoid overstress.
     For more information, please visit the CHP's influenza page and weekly Flu Express.

Ends/Wednesday, February 7, 2018

Issued at HKT 17:00

While NPIs won't stop an epidemic, they can help slow it down. And since many of these techniques (like hand washing, staying home while sick, etc.) are only common sense, they don't need to be held in reserve for a severe epidemic.
They should be used by everyone - year round - not just during `flu season'.
For a look as some of the research on NPIs over the past few years, you may wish to revisit:
Study: Effectiveness of NPIs Against ILI's

Michigan NPI Study: A Closer Look

Study: Efficacy Of Hand Hygiene Alone Against Influenza Infection

NPI’s and Influenza

Study: NPI's Can Help Prevent Spread Of Flu-Like Illnesses

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