# 6365
There is little change to the news this morning regarding the 2 year-old boy from Guangdong Province who is being treated at the Princess Margaret Hospital in Hong Kong for H5N1 (see Progress Reports On H5N1 Investigation).
The boy remains in serious condition, and despite aggressive contact tracing, no additional cases have been identified. Authorities appear hopeful that this will remain an isolated case.
The Hong Kong response to H5N1 stands as a impressive example for the rest of the world on how to deal with a budding public health crisis. Not only do they have world class diagnostics and surveillance in place, they continue to do an admirable job in keeping the public informed on the details and progress of their investigation.
Since crisis and risk communications is part and parcel to any emergency response, today I thought we’d take a look at some of the communications coming out of the Centre For Health Protection on this case.
I’ve already covered several of the press releases from the CHP, including a Q&A with Dr. York Chow on Saturday, in earlier blogs (see here, here, and here).
But in addition to these, the CHP has sent out letters to Hospitals, Doctors, Schools, Child Care Facilities, and Nursing Homes with details on the threat, and specialized instructions for these facilities.
You can view these letters by clicking this link, or the graphic below.
As an example, on June the 2nd, the CHP sent out this remarkably clear and detailed letter to doctors in their jurisdiction. They then posted this letter to their website.
Our Ref. : (49) in DH SEB CD/8/6/1 Pt. 27
2 June 2012
Dear Doctors,
Confirmation of a Human Case H5 avian Influenza Infection and Activation of Serious Response Level of Government’s Preparedness Plan
I would like to draw your attention to a confirmed case of human influenza A H5 infection in Hong Kong. The patient is a 2-year-old boy with good past health. He lives with his parents and maternal grandmother in Guangzhou, Mainland China.
He developed fever since 23 May 2012 while in Guangzhou. He sought medical attention there but his symptoms persisted. He was then brought to Hong Kong on 26 May 2012 and was admitted to Caritas Medical Centre (CMC) Special Care Unit (SCU) on 28 May 2012 for febrile seizures. The clinical diagnosis was encephalitis.
His nasopharyngeal aspirate (NPA) collected on 28 May 2012 confirmed to be of subtype H5 by Public Health Laboratory Branch (PHLSB) of the Centre for Health Protection (CHP) on 1 June 2012. The patient, along with his parents, was transferred to Princess Margaret PMH for single isolation on 1 June 2012 evening. Latest radiological imaging was suggestive of obstructive hydrocephalus. Investigation is underway to exclude underlying cause. His current condition is serious.
Epidemiological investigation revealed that during the period of 17-19 of May, he was brought by mother to buy a live duck in a wet market near his residence. He travelled to Anhui province with his parents from 20 May to 22 May 2012 but had not contacted any live poultry there. CHP is communicating with the Guangdong Health Department to investigate the source of his infection. His close contacts are all
asymptomatic and his parents are put under quarantine in Hong Kong.
The Government has raised the influenza response level from “Alert” Response Level to “Serious” Response Level under the Framework of Government’s Preparedness Plan for Influenza Pandemic.
So far, 22 human cases of H5N1 infections were recorded in Hong Kong. Apart from the case confirmed yesterday, there was one outbreak of influenza A (H5N1) in 1997 with 18 people affected, of whom six died. In February 2003, two imported cases were detected and one of them died. According to the latest update from the World Health Organization (29 May 2012), worldwide there were so far a total of 604 confirmed cases (including 357 deaths) of human infection with the H5N1 avian influenza virus.
Please be reminded that Influenza A (H2, H5, H7, and H9) is a notifiable disease. Apart from the statutory notification system, CHP will further strengthen surveillance for suspected human case of influenza A(H5N1) infection. I attach again (Annex) for your attention the Reporting Criteria for Human Influenza A(H5N1). In addition, I would like to urge you to pay special attention to those who presented with influenza like illness and had history of visiting wet market or contacting poultry in Guangzhou within the incubation period (i.e. 7 days before onset of symptoms).
Any suspected case meeting the reporting criteria
(https://ceno.chp.gov.hk/casedef/casedef.pdf) should be reported to the Central Notification Office of CHP via fax (2477 2770), phone (2477 2772) or CENO On-line (www.chp.gov.hk/ceno). Please also contact the Medical Control Officer (MCO) of the Department of Health at Pager: 7116 3300 call 9179 when reporting any suspected case.Yours sincerely,
(Dr. SK CHUANG)
for Controller, Centre for Health Protection
Department of Health
While most health departments maintain a static, rarely updated avian influenza information page, Hong Kong proactively produces a detailed Avian Influenza Report every week. Not only can you always read the latest report, you can go back through the archives of hundreds of reports beginning in 2005 on this archive page.
Today’s report can be accessed by clicking the graphic below.
A few excerpts include:
Cambodia: A 10-year-old girl from Kampong Speu was confirmed positive for H5N1 avian influenza infection. She died on May 27, 2012. Investigations indicated recent deaths among poultry in her village and the patient had also prepared sick chicken as food prior to becoming sick. (WHO, May 29, 2012)
Hong Kong: A 2-year-old boy was confirmed with H5 avian influenza infection. He lived in Guangdong with his parents and maternal grandmother. He had visited a wet market with live poultry near his residence in Guangzhou in mid-May. The boy’s subsequent laboratory results confirmed H5N1 avian influenza infection. He is in serious condition. (Department of Health, Hong Kong, China, June 1, 2012)
You’ll also find updated tables and charts, including this one on the CFR (Case Fatality Rate) over the past 9 years.
Unfortunately, Hong Kong is the exception, not the rule when it comes to quality reporting on bird flu. Many countries either ignore the threat, or if they find they must address it, release as little information as they feel they can get away with.
While you can never know what you don’t know, the impression that Hong Kong’s CHP gives is one of remarkable openness about disease threats, and of a willingness to trust that the public will be able to handle the truth.
A refreshing, if all too rare, risk communications policy that ought to be emulated more widely around the globe.
