# 5066
Yesterday’s announcement that Hong Kong had detected their first human H5N1 infection in 7 years has sparked an immediate response by Hong Kong officials, and a good deal of media coverage.
For now, despite the extent of some of the mainstream news coverage, the disease threat to the residents of Hong Kong appears low.
Not zero, of course.
But the H5N1 virus remains ill suited for efficient human-to-human (H2H) transmission. While H5N1 is primarily an avian virus, the fear is that one day it will mutate into a more humanized form.
So this morning a round up of some of the steps that Hong Kong officials are taking to track, monitor, and contain this H5N1 threat.
One of the first things that Dr. York Chow, Secretary of Food and Health in Hong Kong, announced yesterday was the raising of their pandemic threat to a `Serious’ level.
And that of course sounds . . . well, serious.
So a look at what this declaration really means is in order. The following excerpts are from from Hong Kong’s Framework of Government’s Preparedness Plan for Influenza Pandemic (bolding mine).
Hong Kong Government Response Systems
The Government’s plan includes a three-level response system (Alert Response Level, Serious Response Level and Emergency Response Level).
These levels are based on different risk-graded epidemiological scenarios relevant to Hong Kong, and each of them prescribes a given set of public health actions required. They are designed to match with the World Health Organization (WHO)’s guideline for pandemic influenza planning.
Serious Response Level
4. Serious Response Level depicts two possible scenarios.
The first scenario depicts confirmation of HPAI outbreaks in the environment of or among poultry population in retail markets, wholesale markets or farms in Hong Kong due to a strain with known human health impact. Upon the advice of DAFC or Director of Food and Environmental Hygiene, SFH will activate this Response Level.
5. The second scenario depicts the confirmation of human case(s) of avian influenza in Hong Kong without evidence of efficient human-to- human transmission. Upon the advice of DoH, SFH will activate this Response Level.
The important phrase is, of course, cases without evidence of efficient human-to- human transmission. Should H2H transmission be detected, the alert level would be increased to the EMERGENCY level.
Dr. York Chow held another press conference today, and here is a transcript of his comments in English.
Following is the transcript of remarks (English portion) made by the Secretary for Food and Health, Dr York Chow, on a patient case of Influenza A (H5) infection, at a stand-up media session at the West Wing lobby of Central Government Offices today (November 18):
Reporter: Is there a heightened risk for Mainland poultry and how will the Government step up its monitoring?
Secretary for Food and Health: At the moment we cannot say that there is an increase in risk of the poultry that is imported into Hong Kong because as far as our contact with the Guangdong Entry-Exit Inspection and Quarantine Bureau (GDCIQ) is concerned, there is no report of abnormality in the farms that supply chickens to Hong Kong.
But we have agreed to heighten our vigilance in terms of testing of those chickens. We will be increasing the amount of testing to about 25 percent regarding the PCR (polymerase chain reaction) swabs of all the chickens that cross our border everyday and also testing of the antibodies within those chickens. At the same time, we have also raised the alert on local farms.
In the next few days, our Agriculture, Fisheries and Conservation Department colleagues will be going around those thirty farms in Hong Kong to check on the health status and obtain samples for testing.
Reporter: Can you tell us what was covered in the inter-departmental meeting?
Secretary for Food and Health: This morning we held an inter-departmental steering committee meeting. The participating departments included the Department of Health, the Hospital Authority, the Agriculture, Fisheries and Conservation Department, the Food and Environmental Hygiene Department, the Tourism Commission, the Education Bureau, the Social Welfare Department, the Home Affairs Department, and the Information Services Department.
All these departments participated in the meeting and shared the information we have given them, and each one of them will look at the areas that they might need to heighten the vigilance and also the precautions. In general, we think the risk of avian influenza in Hong Kong is not that significantly higher than before.
But since there is one case, we have to be very careful as it might actually point out its source of infection, which might give rise to another case. Whether this "another case" will be in Hong Kong or outside Hong Kong, we still cannot actually predict. But I think we have to take all precautions so that in case if it is a risk in Hong Kong, we can find out as early as possible.
Reporter: Was this particular patient too late in seeking medical attention or was it too late that the diagnosis came?
Secretary for Food and Health: As I said it is very difficult to judge at this moment because at the time when the patient presented to the Accident and Emergency Department of Tuen Mun Hospital, her condition did not warrant being admitted.
Whether some sort of test should have been done at that stage, I don't think I can comment at this stage. But we will review the history of the medical care there. But what I have said earlier on is, since we understand that there is a risk of avian influenza in this region, we demand and also request the Hospital Authority to step up its vigilance.
Whenever there is a patient who has a high fever and any symptoms or signs of pneumonia, or x-ray evidence of pneumonia, they should do the PCR test as early as possible to rule out any serious avian influenza in those cases. So that will be the practice from now.
(Please also refer to the Chinese portion of the transcript)Ends/Thursday, November 18, 2010
Issued at HKT 15:07
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And finally, from the news.gov.hk site, a round up of the steps being taken by the Hong Kong government to investigate this human H5N1 infection.
Bird flu precautions enhanced
November 18, 2010
Secretary for Food & Health Dr York Chow says the Government will bolster measures to guard against avian flu, although there is no significant increase in the risk of a pandemic in Hong Kong. Government officers will inspect local poultry farms and conduct more checks on live birds. Cleaning work at poultry farms and markets will be strengthened.
Speaking after an inter-departmental meeting on avian influenza today, Dr Chow said the infected 59-year-old woman, whose case was reported yesterday, has been transferred to Princess Margaret Hospital and is still in serious condition. He said preliminary tests show she has a clade 2.3.2 avian virus which is common in Asia.
As the virus can be found in Hong Kong and on the Mainland, it is hard to confirm whether the case is a local or imported one. Experts said the incubation period indicates she likely contracted the virus on the Mainland. The Government has informed the World Health Organisation and the Mainland authorities of the case. It has also asked Guangdong to strengthen surveillance and checks on poultry farms supplying birds to Hong Kong. So far no problems have been found on these farms.
Hospital safeguards
The Hospital Authority has tightened precautionary measures in public hospitals, like shortening visiting hours, and requiring staff and visitors to wear masks. Tests will be conducted on patients with fever and other flu symptoms, and those who have just returned to Hong Kong after visiting markets and being close to poultry.
The Centre for Health Protection has traced the eight people who had close contact with the 59-year-old patient, including three of her family members and five patients who shared her cubical in Tuen Mun Hospital. They have not developed abnormal symptoms so far.
The centre has informed local doctors of the latest situation and will remind institutions and schools to take preventive measures.
Obviously we shall watch the situation in Hong Kong with considerable interest.
But just as importantly, we need to be looking for signs of outbreaks in Mainland China, where this woman likely contracted the virus.
In recent months FluTrackers has carried a number of reports of `Bird Flu drills’ in Chinese cities, something that sometimes happens in response to local poultry infections (see here, here, and here for recent examples – hat tip Sharon Sanders).
Officially, China rarely reports problems with H5N1 in poultry, humans, or wild birds. Unofficially, we hear reports that suggest the problem is larger in China than is generally acknowledged.
For more on these reports out of China, you may wish to revisit some of these blogs:
When Pigs Flu
Not One Of The Usual Suspects
China Reports H5N1 Victim
Hong Kong: Magpie Robin Tests Positive For H5N1
Chinese Vet Warns Of `Grave Threat' From Animal Diseases
Time: Is China Making Its Bird Flu Outbreak Worse?
Hong Kong Continues To Find Infected Birds
China Denies H5N1 Outbreaks In Poultry
All Eyes On Mainland China
