Thursday, January 12, 2017

HK CHP Update On 4th Imported H7N9 Case & Letter To Doctors


Reports of additional H7N9 cases -  both in the Chinese media, and from official sources - continue to trickle in, although the limited information being released from the Mainland makes it difficult to gauge the extent and severity of this month's outbreak.

Rather than blog them individually as the come over the transom, later today I'll try to post a summary. 

For now we have Hong Kong's CHP update on their 4th imported case - confirmed yesterday - and some excepts from a letter the CHP has sent to local doctors which provides more details, and asks for renewed vigilance on their part.

     The Centre for Health Protection (CHP) of the Department of Health today (January 12) reported an update on the fourth human case of avian influenza A(H7N9) in Hong Kong this winter.

     Among the close contacts, three asymptomatic in-patients and visitors to Princess Margaret Hospital (PMH) refused antiviral prophylaxis with oseltamivir (Tamiflu) and will be put under quarantine for 10 days following their last exposure to the patient, according to the recommendations of the CHP's Scientific Committee on Emerging and Zoonotic Diseases from March 2015.

     As for the other contacts, one of the two healthcare workers of Princess Margaret Hospital with mild symptoms reported yesterday (January 11) tested negative for influenza A virus, while the other's test result is pending. The CHP will update the public in due course.

     The CHP is also closely monitoring two additional human H7N9 cases in Jiangxi and Hunan. According to the Health and Family Planning Commission of Jiangxi Province, the female patient aged 50 from Nanchang was hospitalised and in a critical condition. In addition, the Hunan Provincial Center for Disease Control and Prevention reported that the male patient aged 59 from Yiyang with poultry exposure was in a critical condition.   
Ends/Thursday, January 12, 2017

Issued at HKT 19:25

The following letter was sent yesterday from Dr. SK Chaung - Controller, Centre for Health Protection, Department of Health - to local doctors which provides additional detail on this case.  
January 11, 2017
Dear Doctors,

An Imported Case of Human Infection with Avian Influenza A(H7N9) Virus
We would like to draw your attention to the fourth confirmed case of human infection with avian influenza A(H7N9) virus in Hong Kong this winter and solicit your support to remain vigilant against avian influenza.
The case affected a 10-year-old boy with good past health. The patient developed fever, cough and vomiting on January 8. He attended the Accident and Emergency Department of North Lantau Hospital on January 8 and 9, and was referred to Princess Margaret Hospital (PMH) for admission on January 9. He has been in stable condition all along.
His nasopharyngeal aspirate specimen was preliminarily tested positive for influenza A(H7) virus by PMH. Another nasopharyngeal aspirate specimen taken on January 11 was tested positive for influenza A(H7N9) by the Public Health Laboratory Services Branch of the Centre for Health Protection (CHP). He is currently isolated in PMH.
The CHP’s epidemiological investigation revealed that the patient and his family travelled to Foshan, Guangdong between December 31, 2016 and January 3, 2017. During their brief stay in the Mainland, the patient visited a relative’s home where a few live chickens were kept. The family had also visited a market there but denied entry into its poultry section. The patient’s family members have remained asymptomatic so far and have been put under medical surveillance. Tracing of his other contacts is underway. The CHP's investigation is continuing.
We would like to draw your attention that the activity of avian influenza in our neighboring areas has been increasing since the end of 2016. Increasing numbers of human H7N9 cases have been reported in various areas in Mainland China including Guangdong. Since November 2016, at least 132 laboratory-confirmed human H7N9 cases have been reported, including 127 cases in Mainland China (57 cases in Jiangsu, 22 cases in Zhejiang, 15 cases in Guangdong, 14 cases in Anhui, 6 cases in Jiangxi, 4 cases in Shanghai, 3 cases in Fujian, and 2 cases each in Guizhou, Hunan and Shandong), 4 imported cases in Hong Kong and 1 case in Macau. The cases in Guangdong occurred in Guangzhou (3), Jiangmen (3), Jieyang (2), Shenzhen (2), Zhaoqing (2), Dongguan (1), Muizhou (1) and Zhongshan (1). Please also note that avian influenza A(H7N9) has become enzootic among poultry in many parts of Mainland China. The activity of avian influenza is expected to remain high in the winter based on its seasonal pattern.
If you encounter patients who present with fever or influenza-like illness, it is very important to obtain their travel history and relevant exposure history during travel as appropriate. Any patients with acute respiratory illness or pneumonia, and with at-risk exposure (including live poultry workers, history of visiting market with live poultry, contact with poultry, etc.) in affected areas within the incubation period (i.e. 10 days before onset of symptoms) should be managed as suspected cases and immediately reported to the Central Notification Office of the CHP via fax (2477 2770), phone (2477 2772) or CENO On-line (
Private doctors should contact the Medical Control Officer of the Department of Health at pager: 7116 3300 (call 9179) when reporting any suspected case outside office hours. The CHP will make arrangement to send the patient to a public hospital for isolation, testing and treatment. Besides, in order to minimise contact with or exposure to staff and other patients, it is important to isolate the patient and advise the patient to wear a surgical mask while waiting for transfer.
         (Continue . . .)