Avian Flu Diary: Hong Kong CHP Notified Of A Human H5N6 Case In Beijing

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In the 2 years since China launched their aggressive nationwide H5+H7 poultry vaccination program, avian influenza reports (in poultry, and in humans) have been greatly suppressed across China.

China reported their only human H7N9 infection of 2019 - after a gap of more than a year - last April (see Taiwan CDC: Travel Alert Level Raised (Level 2) for Inner Mongolia Due to Recent H7N9 Case), while H5N6 cases - which saw a small uptick in the 2nd half of 2018 (n=4) - have been absent since November.

Although greatly suppressed, we've seen a few poultry outbreaks over the past year, and studies (see OFID: Avian H5, H7 & H9 Contamination Before & After China's Massive Poultry Vaccination Campaign), indicate H5 and H7 avian viruses still circulate at low levels in Chinese livestock.

How long this welcome reduction in avian flu activity will last is anyone's guess, but today we have the first reported H5N6 case in 10 months. It is also the first case reported from China's capital; Beijing, and the first to be reported outside of Southern China.

Other than her age (59), gender, and location we are told very little about the case. While most cases have been linked to live poultry, there is no mention of recent poultry exposure in today's announcement.

First the statement from Hong Kong's CHP, then I'll return with a postscript.

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

The Centre for Health Protection (CHP) of the Department of Health (DH) today (August 19) received notification of an additional human case of avian influenza A(H5N6) in Beijing from the National Health Commission, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

The case involved a 59-year-old female from Beijing. She was hospitalised on August 11. She is now in a critical condition.

From 2014 to date, 24 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, August 19, 2019
Issued at HKT 17:00

(Continue . . . )

It should be noted that surveillance and testing for novel flu is still limited in China - and while H5 and H7 activity undoubtedly remains greatly suppressed - it is still likely that some cases fly under the radar.

Additionally, a number of research studies have suggested the H5N6 virus is becoming better adapted to mammalian hosts, including: