# 8053
In their second letter to doctors in a week on H7N9 (dated Dec 6th), Hong Kong’s CHP has broadened the reporting criteria for those with flu-like symptoms or pneumonia for investigation by the health department to include anyone who works in the live poultry industry.
Although there are only two known cases in Hong Kong to date – and both appear to have been imported from the mainland – there is obviously concern that where you find two, there may be others as yet undiscovered.
With the start of cold & flu season upon them, discerning H7N9 from other common respiratory ailments becomes an even greater challenge.
First an excerpt from the latest letter, followed by the new reporting guidelines.
According to the World Health Organization’s risk assessment (as of 7 October), most human cases have reported contact with poultry or live animal markets. Knowledge about the main virus reservoirs and the extent and distribution of the virus in animals remains limited. As avian influenza A(H7N9) virus causes only subclinical infections in poultry, it is possible that the virus continues to circulate among poultry without any warning signals to human. In this connection, we considered poultry workers might be at a higher risk of avian influenza A(H7N9) infection. In fact, a proportion of the cases reported in Mainland China were poultry workers.
In this connection, while other reporting criteria remained unchanged, we would like to enhance the existing surveillance by including workers in live poultry industry as an additional epidemiological criteria. For your ease of reference, the updated reporting criteria for human influenza A (H7N9) infection are attached in Appendix and they are also available on CENO On-line website (http://ceno.chp.gov.hk/).
Please also be reminded that the list of affected areas is regularly uploaded to CHP website (http://www.chp.gov.hk/files/pdf/global_statistics_avian_influenza_e.pdf).
Reporting criteria for Human Influenza A (H7N9) infection
(Last updated on 6 December 2013)
An individual fulfilling both the Clinical Criteria AND Epidemiological Criteria should be reported to CHP for further investigation.
Clinical Criteria
Patient with
influenza-like-illness (fever >38 /C with cough or sore throat); OR
person with severe pneumonia; OR
person died of unexplained acute respiratory illness.
- Epidemiological Criteria
One or more of the following exposures in the 10 days prior to symptom onset:
contact with a human case of influenza A (H7N9); OR
contact with poultry or wild birds or their remains or to environments contaminated by their faeces in countries/areas with documented avian influenza A (H7N9) infection in birds and/or humans in the recent 6 months
(see List of affected areas)
; OR
consumption of raw or undercooked poultry products in countries/areas with documented avian influenza A(H7N9) infection in poultry and/or humans in the recent 6 months
(see List of affected areas)
, OR
close contact with a confirmed influenza A(H7N9) infected animal other than poultry or wild birds; OR
worked in a laboratory that is processing samples from persons or animals that are suspected from avian influenza infection; OR
worked in the live poultry industry
The list of affected areas is regularly uploaded to the Centre for Health Protection (CHP)
website
(http://www.chp.gov.hk/files/pdf/global_statistics_avian_influenza_e.pdf).
While these guidelines aren’t guaranteed to catch every possible H7N9 infection in Hong Kong (assuming there are any), it just isn’t practical to try and test everyone who comes down with a case of the sniffles.
Just as we’ve seen with guidelines issued for MERS-CoV (see CDC HAN Update On MERS-CoV), finite resources must be allocated to investigate those cases which are most likely to prove positive.
