Tuesday, November 05, 2013

Hong Kong: CHP Letter To Doctors On Latest H7N9 Case


Photo credit Hong Kong’s CHP



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Although Guangdong Province has only reported two human H7N9 cases to date (today, and last August see: Hong Kong’s CHP On Guangdong’s Suspected H7N9 Case), the detection of this virus so close to the densely populated, and international travel hub, of Hong Kong has understandably raised public health concerns. 


That city’s experience with SARS in 2003 – when 1750 cases were identified, and  286 died – serves as a constant reminder of how quickly an epidemic can take hold (see SARS and Remembrance).

Today, in concert with today’s announcement of a new case in neighboring Guangdong Province, Hong Kong’s CHP issued the following letter to doctors (and a similar one to hospitals) across the Territory.



5 November, 2013
Dear Doctor,

A Confirmed Case of Human Infection with Avian Influenza A(H7N9) virus in Guangdong Province

Further to our letter to you dated 15 October 2013, we would like to inform you that a confirmed human case of avian influenza A(H7N9) was reported by the Guangdong Province on 5 November, 2013. 

The case involves a 3-year-old boy who is now receiving treatment in hospital. He has mild illness without fever and his current condition is stable. The sample of the patient was tested positive for the avian influenza A(H7N9) virus by relevant health authority of Guangdong Province on 5 November. Three of the seven close contacts developed influenza-like illness  (ILI) but none of them were tested positive for avian influenza A(H7N9).

As of 5 November, there is a total of 137 confirmed cases of human infection with avian influenza A(H7N9) virus in the Mainland China, including 45 deaths. One imported case from Jiangsu Province was also reported by the Centers for Disease Control of Taiwan, making a total of 138 cases. The Centre for Health Protection (CHP) of the Department of Health (DH) has been maintaining close liaison with the World Health Organization and health authorities in the Mainland China to obtain information and monitor the latest development of the disease.

In response to the newly confirmed case in Guangdong Province, we would like to urge you to pay special attention to those who presented with ILI and had history of visiting wet market with live poultry or contact with poultry in the affected areas within the incubation period (i.e. 10 days before onset of symptoms)

Please kindly be reminded that the list of affected areas is regularly updated and is available at the CHP website: 


Any suspected case meeting the reporting criteria (https://ceno.chp.gov.hk/casedef/casedef.pdf) should be immediately reported to he 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 DH at Pager: 7116 3300 call 9179 when reporting any suspected  case. DH will make arrangement to send the patient to regional public hospitals for isolation, testing and treatment. Please kindly isolate patient to minimize contact/exposure to staff and other patients and advise the patient to wear a surgical mask while waiting for transport.

For updates on the latest situation of avian influenza, please visit CHP website at  http://www.chp.gov.hk/en/view_content/24244.html.

Thank you for your ongoing support in combating communicable diseases.


Earlier this summer, in Hong Kong’s Response To Guangdong H7N9 Case, we looked at some of the extensive public health messaging regarding the H7N9 virus threat, posted in shop windows, on billboards, and on the sides of buses across the city.


In 1997  Hong Kong famously destroyed all of their poultry when 18 people contracted a newly emerging avian flu virus called H5N1.  It was a bold response which very well may have averted a pandemic at that time. About a month ago, in Hong Kong: Avian Influenza Drill, we looked at one of their recent H7N9 drills, which simulated an emergency cull of infected poultry. 


Photo Credit Hong Kong Government


While avian H7N9 has shown troubling signs of mammalian adaptation (see Science: H7N9 Transmissibility Study In Ferrets), It is unknown whether this virus will ever adapt well enough to human physiology to pose a genuine pandemic threat.


But with over 7 million residents packed into just 426 sq. miles, sitting adjacent to mainland China, Hong Kong Could expect to be an early battleground against any emerging avian flu epidemic from the mainland.


Which explains the degree of vigilance we are seeing with Hong Kong’s public health sector.