CHP: Zhejiang, Jiangsu & Fujian (Belatedly) Report 4 H7N9 Cases

 

# 10,032

 

Reporting on H7N9 cases out of Mainland China during this third winter wave has been frustratingly slow, and often devoid of useful details.  In early March, after a winter of intermittent and inconsistent reporting, daily reports all but dried up (see H7N9: No News Is . . . . Curious). 

 

Since then we’ve seen a few `bulk’ announcements of older cases, often buried in EOM epidemiological reports, and almost always with little or no epidemiological information.

 

Hong Kong’s CHP today reports they’ve been informed of 4 additional H7N9 cases – all apparently from between 4 and 6 weeks ago – from three mainland provinces. The fact that they are only now sharing this information with Hong Kong’s Centre For Health Protection underscores how lax reporting from the mainland has become. 

 

First their statement, then I’ll be back with a bit more.

 

CHP notified of additional human cases of avian influenza A(H7N9) in Mainland

The Centre for Health Protection (CHP) of the Department of Health (DH) today (May 10) received notification of four additional human cases of avian influenza A(H7N9) with onset of symptoms between March 27 and April 12 from the National Health and Family Planning Commission, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

The patients comprise two men and two women aged 5 to 67 and two of them (one man and one woman) died. Two cases are from Zhejiang, one is from Fujian and one is from Jiangsu.

From 2013 to date, 640 human cases of avian influenza A(H7N9) have been reported by the Mainland health authorities. Regarding the third wave in the Mainland since November 2014, a total of 200 cases have been reported, including 72 in Guangdong, 40 in Fujian, 40 in Zhejiang, 18 in Jiangsu, eight in Anhui, seven in Xinjiang, six in Shanghai, three in Jiangxi, two in Hunan, two in Shandong, one in Guizhou and one in Hubei.

 

 

Today’s announcement brings this year’s `official’ total to 200 cases – considerably more than the 1st wave of 2013 (n=133), but less than the 2nd wave (n=303).

 

While seemingly an improvement over last year, the continual foot dragging in reporting from the mainland and the dearth of data provided, make it a lot harder to compare this year’s wave to the first two.

Even the best disease surveillance system in the world won’t pick up all of the cases of a disease outbreak. Some cases will have mild symptoms, and never seek medical care. Some may die, untested or misdiagnosed, and never be counted.

 

The `official’ number is always going to be a subset of the total burden of an outbreak.  The `tip of the iceberg’.

 

When you have good, consistent, and honest surveillance you can deal without having exact numbers. You can follow trends (increasing or decreasing case loads), geographic spread, or changes in the behavior of the virus (CFR, age or gender shifts, etc.).  

 

Radically change the way you report cases – as we’ve seen from China during this third wave  - and data comparisons become far more difficult.

 

It is possible (perhaps even likely) that this 3rd winter wave of H7N9 was less severe than the previous year, perhaps due to the closing of some live bird markets, the weather, or other factors.

 

But to make that call, you have to be comfortable with the accuracy and completeness of the data. And this year, that’s an open question.

Hong Kong CHP Notified Of 19 H7N9 Cases From Mainland China

 

# 9797

 

One of the frustrations with this year’s wave of H7N9 in China over the past two years has been the delays in reporting of cases by a number of Mainland provinces.  We’ve looked at this issue several times, including in Jiangsu Province’s Uncertain H7N9 Count, and as a result  the size and scope of this year’s outbreak is difficult to quantify.

 

Today Hong Kong’s CHP published their notification of 19 H7N9 cases, from 6 different provinces, going back more than six weeks.  Individual case details, however, are not included.

 

Although we have seen several of these `bulk’ announcements this winter, there are still several provinces that have reported cases in previous years, but that we’ve not heard from this year (including Henan, Jilin, and Hebei).

 

 

CHP notified of additional human cases of avian influenza A(H7N9) in Mainland

The Centre for Health Protection (CHP) of the Department of Health (DH) today (March 9) received notification of 19 additional human cases of avian influenza A(H7N9) with the onset dates in the past five weeks prior to February 25 from the National Health and Family Planning Commission, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

The patients comprise 13 males and six females aged from 3 to 76. Three of them (one man and two women) died and two (one man and one woman) were in critical condition. Eleven cases are from Zhejiang, three are from Jiangsu, two are from Hunan, one is from Fujian, one is from Guizhou and one is from Jiangxi.

To date, 618 human cases of avian influenza A(H7N9) have been reported by the Mainland health authorities in Guangdong (181 cases), Zhejiang (167 cases), Jiangsu (73 cases), Fujian (59 cases), Shanghai (45 cases), Hunan (26 cases), Anhui (24 cases), Xinjiang (10 cases), Jiangxi (10 cases), Shandong (six cases), Beijing (five cases), Henan (four cases), Guangxi (three cases), Jilin (two cases), Guizhou (two cases) and Hebei (one case).

(Continue. . . .)

Guangdong & Anhui Provinces Report H7N9 Cases

 

 

 

# 9765

 

Unlike last winter, day-to-day reporting of H7N9 cases from much of Mainland China has been slow, although it isn’t entirely clear how much of this is due to an actual reduction in cases and how much is due to a change in the way some provinces are reporting. 

 

We’ve seen some case announcements turn up belatedly in Provincial EOM epidemiological reports.

Earlier this week the World Health Organization, in their most recent Antigenic and genetic characteristics of zoonotic influenza viruses and candidate vaccine viruses developed for potential use in human vaccines, described this year’s H7N9 activity and virus evolution as:

 

Influenza A(H7N9) activity from 24 September 2014 to 23 February 2015

During this period, 148 human cases of avian influenza A(H7N9) virus infection were reported to WHO, bringing the total number of cases to 602 with 227 deaths reported4. All human cases were detected in China, or in travelers who visited China (2 in Canada). Increased genetic heterogeneity of HA and NA gene sequences was observed among recent viruses from humans, poultry and environmental samples. Comparison of these viruses using haemagglutination inhibition (HI) assays showed that the majority remained antigenically similar to the CVVs derived from A/Anhui/1/2013-like viruses.

 

`Increased genetic heterogeneity of HA and NA gene sequences’  is evidence  that the H7N9 virus continues to evolve, something we’ve looked at previously in Eurosurveillance: Genetic Tuning Of Avian H7N9 During Interspecies Transmission &  EID Journal: H7N9 As A Work In Progress.

 

Two reports this morning courtesy of Hong Kong’s CHP.

 

HP notified of additional human case of avian influenza A(H7N9) in Guangdong

The Centre for Health Protection (CHP) of the Department of Health (DH) is today (February 27) closely monitoring an additional human case of avian influenza A(H7N9) in Guangdong notified by the Health and Family Planning Commission of Guangdong Province (GDHFPC), and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

According to the GDHFPC, a male patient aged 80 in Shantou was hospitalised for treatment in critical condition.

To date, 589 human cases of avian influenza A(H7N9) have been reported by the Mainland health authorities in Guangdong (176 cases), Zhejiang (156 cases), Jiangsu (70 cases), Fujian (58 cases), Shanghai (45 cases), Hunan (24 cases), Anhui (19 cases), Xinjiang (10 cases), Jiangxi (nine cases), Shandong (six cases), Beijing (five cases), Henan (four cases), Guangxi (three cases), Jilin (two cases), Guizhou (one case) and Hebei (one case).

 

After not having reported any H7N9 cases this winter, Anhui Province – which reported two cases on February 25th (see CHP closely monitors three additional human cases of avian influenza A(H7N9) in Mainland) – has apparently notified Hong Kong’s Centre for Health Protection of two more cases (1 from Anqing City and the other from Tongling).

 

 

HP closely monitors two additional human cases of avian influenza A(H7N9) in Mainland

The Centre for Health Protection (CHP) of the Department of Health (DH)is today (February 28) closely monitoring two additional human cases of avian influenza A(H7N9) in the Mainland, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

According to the Health and Family Planning Commission of Anhui Province, a male patient and a female patient, both aged 58 with poultry exposure before onset, were hospitalised for management. They were in critical condition.

To date, 591 human cases of avian influenza A(H7N9) have been reported by the Mainland health authorities in Guangdong (176 cases), Zhejiang (156 cases), Jiangsu (70 cases), Fujian (58 cases), Shanghai (45 cases), Hunan (24 cases), Anhui (21 cases), Xinjiang (10 cases), Jiangxi (nine cases), Shandong (six cases), Beijing (five cases), Henan (four cases), Guangxi (three cases), Jilin (two cases), Guizhou (one case) and Hebei (one case).

Guangdong Notifies HK Of 1 New H7N9 Case

 

# 9710

 

 

Although their Ministry of Health Website hasn’t updated with any cases since the 12th, Guangdong Province continues to notify Hong Kong’s CHP of new H7N9 cases, with their 53rd case of this 3rd wave announced today.

 

Other provinces are being far more circumspect in their reporting of cases, usually doing so only in batches -  every few weeks – instead of daily.

 

Meanwhile, the largest annual human migration on the planet is well underway as hundreds of millions of Asians travel to their hometowns to celebrate the Lunar New Year (aka The Spring Festival) with family and friends (see Health Vigilance Urged For China’s Spring Festival). 

 

The Year of the Goat kicks off on February 19th, but this heavy `travel season’ will continue for several more weeks.

 

 

CHP notified of additional human case of avian influenza A(H7N9) in Guangdong

The Centre for Health Protection (CHP) of the Department of Health (DH) is today (February 14) closely monitoring an additional human case of avian influenza A(H7N9) notified by the Health and Family Planning Commission of Guangdong Province (GDHFPC), and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

According to the GDHFPC, the patient is a 45-year-old man who lives in Meizhou. He is currently hospitalised for treatment and in a critical condition.

To date, 573 human cases of avian influenza A(H7N9) have been reported by the Mainland health authorities, respectively in Guangdong (162 cases), Zhejiang (156 cases), Jiangsu (70 cases), Fujian (58 cases), Shanghai (45 cases), Hunan (24 cases), Anhui (17 cases), Xinjiang (10 cases), Jiangxi (nine cases), Shandong (six cases), Beijing (five cases), Henan (four cases), Guangxi (three cases), Jilin (two cases), Guizhou (one case) and Hebei (one case).

(Continue . .. )

Hong Kong CHP Notified Of 1 H7N9 Case In Shenzhen

 

 

# 9615

 

We’re having a much tougher time figuring out what’s going on with the H7N9 virus in China this winter, as reporting of cases has become increasingly haphazard, and those reports we do get have very little information in them. 

 

It is possible that closure of some live poultry markets has reduced the number of human infections this year, but the inconsistent reporting of cases and conspicuous lack of detail are less than reassuring. 

 

This from Hong Kong’s CHP.

 

CHP notified of human case of avian influenza A(H7N9) in Shenzhen

The Centre for Health Protection (CHP) of the Department of Health (DH) is today (January 22) closely monitoring an additional human case of avian influenza A(H7N9) in Shenzhen notified by the Health and Family Planning Commission of Guangdong Province (GDHFPC), and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

According to the GDHFPC, the male patient aged 58 with underlying illnesses was hospitalised for treatment in serious condition.

To date, 485 human cases of avian influenza A(H7N9) have been reported by the Mainland health authorities, respectively in Zhejiang (145 cases), Guangdong (125 cases), Jiangsu (63 cases), Shanghai (43 cases), Fujian (28 cases), Hunan (24 cases), Anhui (17 cases), Jiangxi (nine cases), Xinjiang (nine cases), Shandong (six cases), Beijing (five cases), Henan (four cases), Guangxi (three cases), Jilin (two cases), Guizhou (one case) and Hebei (one case).

(Continue . . .)

 

Curiously, we’ve seen cases reported from some of China’s provinces that have yet to be added to Hong Kong’s list, such as the announcement by Xinhua News yesterday that Zhejiang province has seen 14 cases this winter.

 

The list above only reflects 7 cases this year in Zhejiang.

 

So, while we continue to get scattered reports of H7N9 out of China, how well that represents the level of activity in this year’s wave remains to be seen.

Hong Kong: CHP Update On Latest Imported H7N9 Case

 

 

# 9505

 

 

The epidemiological investigation – including contact tracing – on Hong Kong’s 11th imported case of H7N9 continues, and today we learn that her two traveling companions, and one of the doctors she initially consulted, have now been located and are asymptomatic.

 

Two reports from Hong Kong’s CHP.  First an investigation status update, followed by excerpts from the letter sent to local doctors informing them of the case, alerting them of the possibility of seeing additional cases, and providing additional details on the patient’s presentation and course of treatment. 

 

 

Update of human case of avian influenza A(H7N9)

The Department of Health (DH) today (December 29) reported the latest updates on the first confirmed human case of avian influenza A(H7N9) in Hong Kong this winter, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

Further epidemiological investigations by the Centre for Health Protection (CHP) of the DH have so far located two travel collaterals who travelled with the patient to Shenzhen on December 13. According to them, the trio visited a wet market in Niulanqian, Bao'an, Shenzhen, bought vegetables, and did not purchase or have contact with live chickens sold there. Both travel collaterals have remained asymptomatic for more than 10 days (incubation period) since their last contact with the patient and have been put under medical surveillance.

Investigations also revealed that the patient had consulted two private doctors practising in the same clinic on December 19 and 23 respectively. While the CHP has reached one of the duo thus far, the other private doctor is now out of town and follow-up is under way.

According to the private doctor whom the CHP has reached, the patient did not reveal her travel history to the Mainland during consultation. The clinic staff have remained asymptomatic and have been put under medical surveillance. Tracing of the relevant clients who attended the clinic at the same time with the patient is under way.

In addition, the patient underwent a chest X-ray examination in a medical laboratory centre on December 23, and the CHP's follow-up is under way.

Investigations are ongoing.

Ends/Monday, December 29, 2014
Issued at HKT 18:56

 

 

And this letter sent to local doctors (similar ones were sent to hospitals):

 

Surveillance And Epidemiology Branch            December 28, 2014

Dear Doctors,

A Confirmed Case of Human Infection with Avian Influenza A(H7N9) virus and Activation of Serious Response Level of Government’s Preparedness Plan

I would like to draw your attention to a confirmed case of human infection with avian influenza A(H7N9) virus in Hong Kong. The patient is a 68-year-old Chinese woman who has hypertension. She lives with her husband in Tuen Mun in Hong Kong.

According to the patient's family, she developed fever and symptoms of influenza-like illness (ILI) on December 19 and consulted two private doctors on December 19 and 23. She subsequently developed shortness of breath on December 25 and attended Accident and Emergency Department (AED) of Tuen Mun Hospital (TMH). Chest X-ray taken at AED showed extensive right side pneumonia and she was admitted to TMH. She developed desaturation soon after admission. She was intubated and was transferred to intensive care unit for treatment on the same day. She is now in critical condition.

Her endotracheal aspirate, nasopharyngeal aspirate and nasopharyngeal swab were all tested positive for influenza A(H7N9) virus by polymerase chain reaction by the Centre for Health Protection (CHP)'s Public Health Laboratory Services Branch on December 27, 2014.

Preliminary epidemiological investigation revealed that the patient travelled to Longgang, Shenzhen on December 13 for a day trip and returned to Hong Kong on the same day. During the trip, she ate cooked chicken at her friend's residence in Longgang. The CHP is communicating with the Health and Family Planning Commission of Guangdong to investigate the source of her infection. The patient did not visit any wet market in Hong Kong during the incubation period. According to available information, this is likely to be an imported infection. The CHP is tracing the exposed close contacts of the patient and will provide them with antiviral presumptive treatment and put them under quarantine. CHP’s investigation is on-going.

In view of this confirmed case, 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. Prior to this case, ten imported cases of human infection with avian influenza A(H7N9) virus were recorded in Hong Kong since December 2013.

Cumulatively, a total of 470 confirmed human H7N9 cases have been reported since March 2013, including at least 184 deaths (as of December 27, 2014). These included 454 cases in Mainland China and 16 cases exported from Mainland China to Hong Kong (11), Taiwan (4) and Malaysia (1).

As the winter months approached, there has been increase in number of sporadic human cases of avian influenza A (H7N9) infection occurring in Mainland China. There have been 16 human H7N9 cases reported (as of December 27) with onset dates since the beginning of September. These 16 cases occurred in Xinjiang (6), Jiangsu (3), Guangdong (2), Zhejiang (2), Beijing (1), Fujian (1) and Shanghai (1). Based on the seasonal pattern of avian influenza viruses, it is likely that the disease activity of H7N9 in Mainland China may further increase in the winter and heightened vigilance is warranted.

In response to the newly confirmed case in Hong Kong, we have enhanced surveillance by activating zero reporting with both public and private hospitals. Private hospitals are obliged to report the number of suspected cases on a daily basis and a nil return is required (Appendix 1 and 2). We would like to urge you to pay special attention to those who presented with ILI or fever and had history of visiting wet market with live poultry or contact with poultry in Guangdong or other affected areas within the incubation period (i.e., 10 days before onset of symptoms). The list of affected areas is regularly updated and is available at the following webpage of the CHP website:

http://www.chp.gov.hk/files/pdf/global_statistics_avian_influenza_e.pdf

 
Any suspected case meeting the reporting criteria (available from: https://ceno.chp.gov.hk/casedef/casedef.pdf ) should be immediately reported to the Central Notification Office (CENO) of CHP via fax (2477 2770), phone (24772772) 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 - 3 - 9179) when reporting any suspected case. CHP will make  arrangement to send the patient to regional public hospitals for isolation, testing and treatment. Besides, it is important to isolate the 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 the CHP’s designated website at http://www.chp.gov.hk/en/view_content/24244.html.

Thank you for your ongoing support in combating communicable diseases.

Yours faithfully,
(Dr. SK CHUANG)
for Controller, Centre for Health Protection
Department of Health
 

CHP CDW: Avian Influenza (H7N9 & H5N8) Update

Two waves of H7N9 – Credit CHP CDW

# 9482

 

Hong Kong’s CHP publishes their Communicable Diseases Watch every two weeks, and today it includes an excellent overview of the H7N9 avian flu virus, and some notes on the recently emerged H5N8 virus as well. Being in close proximity to the source, and the recipient of 10 exported H7N9 cases during the first two waves, Hong Kong keeps close track of the developments with these viruses.

I’ve only included some excerpts, so follow the link to read:

 

An Update on Avian Influenza

Reported by Miss Amy Li, Scientific Officer, Respiratory Disease Office, Surveillance and
Epidemiology Branch, CHP.

According to the World Health Organization (WHO), avian influenza viruses have demonstrated a seasonal pattern in temperate zones in which animal outbreaks and human cases have been less frequent in summer months and more frequent in winter months. As the winter months approached, there has been an increase in sporadic human cases of avian influenza A (H7N9) infection in Mainland China. Two sporadic human infections due to a newly emerged highly pathogenic avian influenza H5N6 have also been detected in Mainland China in recent months. Besides, there were widespread outbreaks of avian influenza A(H5N8) among poultry in several Asian and European countries, as well as detection of H5N8 in birds recently in Washington and Oregon, United States.

Avian influenza A(H7N9)

The activity of avian influenza A(H7N9) remained at a relatively low level during the summer months in 2014. From July to August 2014, only two human H7N9 cases occurred in Mainland China (by onset date). Subsequent to these two cases, there have been 16 human H7N9 cases reported with onset dates since the beginning of September (as of December 23, 2014). These 16 cases occurred in Xinjiang (6), Jiangsu (3), Guangdong (2), Zhejiang (2), Beijing (1), Fujian (1) and Shanghai (1). Their ages ranged from seven to 81 years (median = 49.5 years) and the male-to-female ratio was 1 : 1. Of note, Xinjiang Uyghur Autonomous Region, which was not affected in both the first wave in 2013 and the second wave in 2014 and also not adjacent to previously affected areas, is a newly affected region in Mainland China, with a total of eight cases since July this year. WHO commented that this indicated that the virus continues to circulate and is potentially widespread.

Cumulatively, a total of 469 confirmed human H7N9 cases have been reported since March 2013, including at least 184 deaths (as of December 23, 2014).These included 454 cases in Mainland China and 15 cases exported from Mainland China to Hong Kong (10), Taiwan (4) and Malaysia (1). Figure 1 shows the epidemic curve of human cases. There were two distinct waves of human infections, one occurring from March to June in 2013 and another occurring from October 2013 to June 2014. A total of 318 cases were reported in the second wave, which greatly exceeded the total of 133 cases reported in the first wave. The age and sex distribution of the cases reported in the second wave remained largely comparable to that of the first wave.

Nonetheless, Guangdong, which was not affected in the first wave, had its first case detected in July 2013 and subsequently became the most affected province in the second wave. Thirty-four percent of the cases recorded in the second wave occurred in Guangdong. Moreover, all the 10 cases notified in Hong Kong were imported from Guangdong during the second wave.

<SNIP>

Regarding H7N9 in poultry and birds, the World Organisation for Animal Health (OIE) reported detection of positive H7 samples in a market in Henan on July 9, 2014. Separately, the Ministry of Agriculture in Mainland China conducts regular testing to monitor the presence of H7N9 in poultry and birds. In November 2014, a total of 151 583 samples (103 050 serum samples and 48 533 virological samples) were collected from 5 326 locations*. Among these samples, 12 serum samples from Henan and seven serum samples from Guangdong were tested positive for H7 by serological test, and two samples from Fujian as well as one sample from Qinghai were tested positive for H7N9 by virological test.

Based on the seasonal pattern of avian influenza viruses, it is likely that the disease activity of H7N9 in the Mainland may further increase this winter and heightened vigilance is warranted.

(Continue . . . )

Hong Kong’s CHP Updates Ebola Response – Travel Warning

Credit Hong Kong CHP

 

# 8907

 

Earlier this week, in Hong Kong’s Ebola Response, we looked at their Centre for Health Protection’s plans to test anyone with a fever, and recent (within 3 wks) travel history to the West African nations of Guinea, Liberia, and Sierra Leone for the Ebola Virus, and the letter sent to doctors to alert them to report any suspected cases.

 

Today, Hong Kong’s government has posted a warning to `avoid unnecessary travel’ to these affected regions, and has provided an update to their local response plan.

 

Additionally, today airline passengers arriving from these African nations will receive information sheets on the Ebola virus, and what to do if they develop symptoms in the 21 days following their arrival.

 

 

DH update on measures against overseas outbreaks of Ebola virus disease

The Centre for Health Protection (CHP) of the Department of Health (DH) today (August 2) provides an update on local response in view of the overseas outbreaks of Ebola virus disease (EVD).

"As additional EVD cases and deaths have been continually reported in the Western African region since March 2014, we have been closely monitoring the latest developments. According to the World Health Organization (WHO), as of July 27, there have been 1 323 EVD cases including 729 deaths reported in the Western African region. We also call on the public to stay alert and maintain good personal, food and environmental hygiene during travel," a spokesman for the DH remarked.

"In view of the latest situation in the related area, we advised travellers to avoid unnecessary travel to the affected area including Guinea, Liberia and Sierra Leone. This travel alert message has been posted on the website of the CHP," the spokesman said.

Besides, the CHP has provided guidelines for health professional on infection control for EVD in healthcare settings. The CHP will issue letters to doctors and hospitals to remind them the importance of infection control measures. The guidelines are now available on the CHP's EVD page at (www.chp.gov.hk/files/pdf/ic_recommendations_for_evd.pdf)

Meanwhile, a new measure will be initiated later today that immigration officers will assist in identifying arrival passengers holding travel documents issued by the three affected countries and provide them information sheets of EVD. The information sheets will remind the sick travellers to approach port health personnel immediately if they are already sick upon arrival. If travellers have symptoms during visit in Hong Kong, they should seek medical treatment promptly in nearest Accident and Emergency Department of public hospitals as provided in the information sheet and tell the doctors about their travel history.

"Viral haemorrhagic fever, including EVD, has been a statutorily notifiable infectious disease since July 2008. No cases have been recorded in Hong Kong so far. The CHP's Public Health Laboratory Services Branch is capable of detecting the virus," the spokesman stressed.

• There is currently no vaccine for EVD. The DH appealed to the public to take heed of the following preventive measures:
• Observe good personal and environmental hygiene. Wash hands with soap frequently;
• Avoid close contact with feverish or ill persons, and avoid contact with blood or bodily fluids of patients, including items which may have come in contact with an infected person's blood or bodily fluids;
• Avoid contact with animals; and
• Cook food thoroughly before consumption.

The public may visit the CHP's EVD page (www.chp.gov.hk/en/view_content/34199.html), the Travel Health News in the DH's Travel Health Service website (www.travelhealth.gov.hk/english/outbreaknews/outbreaknews.html) or the WHO's EVD page (www.who.int/csr/disease/ebola/en/) for more information and travel advice.

Ends/Saturday, August 2, 2014
Issued at HKT 18:26
NNNN

CHP Ebola Fact Sheet

CHP Notified Of Additional H7N9 Case In Hunan Province

Two Waves of H7N9  - Credit Hong Kong’s CHP

 

# 8810

 

As the graph above indicates, summer is the `off season’ for avian flu, although sporadic cases occasionally crop up, reminding us that theses viruses continue to circulate in wild birds and poultry.   Today, for the first time in more than a week,  we’ve a report from Hong Kong’s CHP indicating that they’ve been notified of an addition H7N9 case, this time in Hunan Province. 

 

 

CHP notified of additional human case of avian influenza A(H7N9) in Mainland

The Centre for Health Protection (CHP) of the Department of Health (DH) received notification from the National Health and Family Planning Commission of an additional human case of avian influenza A(H7N9) affecting a man aged 55 hospitalised in Hunan as of yesterday (July 7).

A total of 436 cases were confirmed in the Mainland, including Zhejiang (139 cases), Guangdong (109 cases), Jiangsu (56 cases), Shanghai (41 cases), Hunan (24 cases), Fujian (22 cases), Anhui (17 cases), Jiangxi (eight cases), Shandong (five cases), Beijing (four cases), Henan (four cases), Guangxi (three cases), Jilin (two cases), Guizhou (one case) and Hebei (one case).

"Locally, we will remain vigilant and maintain liaison with the World Health Organization (WHO) and relevant health authorities. Local surveillance activities are ongoing according to the WHO's recommendations," a spokesman for the DH said.

"In view of cases confirmed in the Mainland, further sporadic cases are expected in affected and possibly neighbouring areas. Those planning to travel outside Hong Kong should maintain good personal, environmental and food hygiene at all times," the spokesman urged.

"All boundary control points have implemented disease prevention and control measures. Thermal imaging systems are in place for body temperature checks of inbound travellers. Suspected cases will be immediately referred to public hospitals for follow-up investigation," the spokesman added.

(Continue. . . )

Hong Kong has also published their weekly Avian Influenza Report that adds today’s case to the previous totals.

 

 

 

While it is easy to be lulled by the apparent inactivity of H7N9 in Mainland China right now, the virus continues to spread stealthily among poultry and wild birds, and as it does, it finds new opportunities to mutate and evolve. 

 

Last May, in  EID Journal: H7N9 As A Work In Progress, we looked at a study that found the H7N9 avian virus continues to reassort with local H9N2 viruses, making the H7N9 viruses that circulated in wave 2 genetically distinct from those that were seen during the 1st wave.

 

While late last month, in Eurosurveillance: Genetic Tuning Of Avian H7N9 During Interspecies Transmission, we saw even more evidence of the genetic diversity, and continual evolution, of the H7N9 virus in Mainland China.  Researchers found that at least 26 separate genotypes had emerged, mostly during the first wave, through a process they called `genetic tuning’.

 

As this process appears to be ongoing, with unpredictable results, the authors warned:

 

Overall, due to the genetic tuning procedure, the potential pandemic risk posed by the novel avian influenza A(H7N9) viruses is greater than that of any other known avian influenza viruses.

 

Which means that as welcome as this respite in cases may be this summer, come the fall and winter, all eyes will be on the H7N9 virus once again looking for any signs that this avian flu has better adapted to humans.

Hong Kong Unveils Their MERS-CoV Preparedness Plan

 

 

# 8732

 

Hong Kong’s CHP (Centre for Health Protection) was created after the shellacking that city took from the SARS outbreak of 2003 (see SARS and Remembrance).  Since then, the CHP has become the very model of a modern, proactive and diligent public health system.

 

Over the years we’ve watched Hong Kong deal effectively with intrusions from  H7N9, H9N2, H5N1 and a variety of other imported infectious diseases, all whilst keeping the public – and outside public health interests – well informed along the way. 

 

With more than 7 million residents crammed into just 426 sq miles, the CHP takes infectious disease threats very seriously. Today, Hong Kong’s CHP unveiled their MERS-CoV Preparedness Plan – one that is based in large measure on their Preparedness Plan for Influenza Pandemic launched in 2012 (see Hong Kong Updates Their Pandemic Preparedness Plan).

 

As with their pandemic plan, this MERS plan has three response levels;  Alert, Serious, and Emergency.   Descriptions of each below come from the new plan:

 

Alert Response Level 

Alert  Response  Level  corresponds  to  a  situation  where  the  risk  of MERS  causing  new  and  serious  health  impact  in  Hong  Kong  is  low.  Generally,  it  depicts  the  existence  of  MERS  coronavirus  capable  of causing serious health outcome in humans  in  places outside Hong Kong and  the  transmissibility  to  human  has  not  been  sufficient  to  sustain community  level  outbreaks.   An  example  of  scenario  under  this  level includes the following –

• confirmation of sporadic or clusters of human case(s) caused by MERS  coronavirus  in  areas  outside  Hong  Kong,  which  the transmissibility  to  human  has  not  been  sufficient  to  sustain community level outbreaks.

Serious Response Level

Serious Response Level corresponds to a situation where the risk of MERS causing new and serious impact to human health in Hong Kong is moderate.   Generally, it depicts a moderate risk of  local spread of the disease in Hong Kong.  Examples of scenarios under this level include the following –

• confirmation of sporadic or a few small clusters of human case(s) caused  by  a  MERS  coronavirus  in  Hong  Kong  but  without sustained human-to-human transmission;

Emergency Response Level

Emergency Response Level corresponds to a situation where the risk of MERS causing new and serious impact to human health in Hong Kong is  high  and  imminent.   Generally,  it  depicts  a  high  risk  of community-wide transmission of the virus in Hong Kong.  An example of a scenario under this level is MERS infection locally acquired in Hong Kong or in a place with considerable level of trade and travel relationship
with  Hong  Kong  and  with  evidence  of  human-to-human  transmission sufficient to cause sustained community level outbreaks.

 

This 23 page PDF document outlines in detail the individual response steps mandated for each of these three scenarios. 

 

The CHP has also released a press statement, explaining this new plan, and reiterating their health advice - and admonitions to avoid camels - for anyone traveling to the Arabian peninsula (Excerpts follow):

 

12 June 2014

Preparedness Plan for Middle East Respiratory Syndrome launched 

The Government today (June 12) announced the launch of the Preparedness Plan for Middle East Respiratory Syndrome (MERS Plan). The Plan sets out the Hong Kong Special Administrative Region Government's preparedness and response plan in case of an outbreak of MERS, and is mainly based on the framework of the Preparedness Plan for Influenza Pandemic launched in 2012 (Influenza Plan 2012).

<SNIP>

In the MERS Plan, a three-tier response level, namely, Alert, Serious and Emergency, is used, which is in line with the Influenza Plan 2012. The MERS Plan also includes comprehensive response measures, clear command structures, and mechanisms for the activation and standing down of response levels.

In accordance with the MERS Plan, the Alert Response Level is activated with reference to the current epidemiological situation. The MERS Plan has been uploaded to the CHP's MERS page (www.chp.gov.hk/en/view_content/26511.html).

<SNIP>

Recent scientific studies supported the premise that camels served as the primary source of MERS Coronavirus (MERS-CoV) infecting humans. The virus appears to pass from an infected person to another in close contact as observed among family members, patients and health-care workers (HCWs). However, so far there is no evidence of sustained human-to-human transmission in the community. Currently, there is no vaccine against MERS available. Treatment is mainly supportive and there is no effective antiviral treatment recommended for MERS at the moment.

"As the summer vacation is just round the corner, we strongly advise travel agents organising tours to the Middle East not to arrange camel rides and activities involving camel contact, which may increase the risk of infection. Furthermore, travellers are reminded to avoid going to farms, barns or markets with camels, and avoid contact with animals (especially camels), birds, poultry or sick people during travel," the spokesman added.

Travellers returning from the Middle East who develop respiratory symptoms should wear face masks, seek medical attention and report their travel history to the doctor. HCWs should arrange MERS-CoV testing for them. Patients' lower respiratory tract specimens should be tested when possible and repeat testing should be undertaken when clinical and epidemiological clues strongly suggest MERS.

Travellers are reminded to take heed of personal, food and environmental hygiene:

• Avoid going to farms, barns or markets with camels;
• Avoid contact with animals (especially camels), birds, poultry or sick people during travel;
• Wash hands regularly before and after touching animals in case of visits to farms or barns;
• Do not consume raw or undercooked animal products, including milk and meat, or foods which may be contaminated by animal secretions, excretions (such as urine) or products, unless they have been properly cooked, washed or peeled;
• Seek medical consultation immediately if feeling unwell;
• Avoid visits to health-care settings with MERS patients;
• Wash hands before touching the eyes, nose and mouth, and after sneezing, coughing or cleaning the nose; and
• Wash hands before eating or handling food, and after using the toilet.

The public may visit the DH's Travel Health Service

(www.travelhealth.gov.hk/english/popup/popup.html) or the WHO's latest news (www.who.int/csr/don/archive/disease/coronavirus_infections/en/) for more information and health advice.

Tour leaders and tour guides operating overseas tours are advised to refer to the CHP's health advice against MERS (www.chp.gov.hk/en/view_content/26551.html).

Ends/Thursday, June 12, 2014

Jiangsu & Shandong Provinces Report 4 New H7N9 Cases

Credit Hong Kong Centre For Health Protection 

 

 

#8703

 

Having only emerged in the spring of 2013, H7N9 is only just barely in its second year of circulation, and so we only have one summer season under our belts when it comes to defining its behavior.  Last year, as the chart below illustrates, case reports in China all but disappeared after the first week of May, with only three cases reported between mid-May and late September.

Credit ECDC Epidemiological Report Feb 7th, 2014

 

The return of warm weather, and the closing of live-markets, was credited with this remarkable drop in cases.

 

This year, while the number of cases being reported remains fairly low (at least compared to the two large winter/spring outbreaks we’ve seen), we haven’t seen the sharp cutoff in cases yet.  We continue to see a few human infections – particularly from the more northern provinces (Anhui, Shandong, Jiangsu)  trickle in - despite the calendar now reading early June. 

 

Last week, in Shandong Province: Two Related H7N9 Cases, we saw reports of a father-son family cluster, with the father dying from the virus, while the WHO reported on 3 cases from Anhui province from earlier in the month.

 

Today Hong Kong’s CHP is reporting on 4 new cases from the Mainland; 2 from Shandong province, and 2 from Jiangsu.  Today’s update doesn’t provide us with much in the way of epidemiological information on these cases, other than one fatal case had poultry exposure.

 

CHP notified of four additional human cases of avian influenza A(H7N9) in Mainland

The Centre for Health Protection (CHP) of the Department of Health (DH) today (June 4) received notification of four additional human cases of avian influenza A(H7N9) in Jiangsu (two cases) and Shandong (two cases) from the National Health and Family Planning Commission.

The two patients in Jiangsu are a man and a woman, both aged 51, who are now hospitalised for treatment. The two cases in Shandong involve a man aged 61 who had poultry exposure and died and a man aged 33 who is hospitalised for management.

A total of 433 human cases of avian influenza A(H7N9) have been confirmed in the Mainland, including Zhejiang (138 cases), Guangdong (108 cases), Jiangsu (56 cases), Shanghai (41 cases), Hunan (23 cases), Fujian (22 cases), Anhui (17 cases), Jiangxi (eight cases), Shandong (five cases), Beijing (four cases), Henan (four cases), Guangxi (three cases), Jilin (two cases), Guizhou (one imported case from Zhejiang) and Hebei (one case).

"Locally, enhanced disease surveillance, port health measures and health education against avian influenza are ongoing. We will remain vigilant and maintain liaison with the World Health Organization (WHO) and relevant health authorities. Local surveillance activities will be modified upon the WHO's recommendations," a spokesman for the DH said.

"In view of human cases of avian influenza A(H7N9) confirmed locally and in the Mainland, further sporadic cases are expected in affected and possibly neighbouring areas. Those planning to travel outside Hong Kong should maintain good personal, environmental and food hygiene at all times," the spokesman urged.

"All boundary control points have implemented disease prevention and control measures. Thermal imaging systems are in place for body temperature checks of inbound travellers. Random temperature checks by handheld devices have also been arranged. Suspected cases will be immediately referred to public hospitals for follow-up investigation," the spokesman added.

Regarding health education for travellers, display of posters in departure and arrival halls, in-flight public announcements, environmental health inspection and provision of regular updates to the travel industry via meetings and correspondence are proceeding.

     The spokesman advised travellers, especially those returning from avian influenza-affected areas and provinces with fever or respiratory symptoms, to immediately wear masks, seek medical attention and reveal their travel history to doctors. Health-care professionals should pay special attention to patients who might have had contact with poultry, birds or their droppings in affected areas and provinces.

• Members of the public should remain vigilant and take heed of the preventive advice against avian influenza below:
• Do not visit live poultry markets and farms. Avoid contact with poultry, birds and their droppings;
• If contact has been made, thoroughly wash hands with soap;
• Avoid entering areas where poultry may be slaughtered and contact with surfaces which might be contaminated by droppings of poultry or other animals;
• Poultry and eggs should be thoroughly cooked before eating;
• Wash hands frequently with soap, especially before touching the mouth, nose or eyes, handling food or eating; after going to the toilet or touching public installations or equipment (including escalator handrails, elevator control panels and door knobs); or when hands are dirtied by respiratory secretions after coughing or sneezing;
• Cover the nose and mouth while sneezing or coughing, hold the spit with a tissue and put it into a covered dustbin;
• Avoid crowded places and contact with fever patients; and
• Wear masks when respiratory symptoms develop or when taking care of fever patients.
  

The public may visit the CHP's avian influenza page (www.chp.gov.hk/en/view_content/24244.html) and website (www.chp.gov.hk/files/pdf/global_statistics_avian_influenza_e.pdf) for more information on avian influenza-affected areas and provinces.

Ends/Wednesday, June 4, 2014
Issued at HKT 12:12
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While it is always worrisome whenever a novel flu jumps to humans, the good news is that H7N9 remains primarily an avian-adapted virus. The vast majority of cases appear to have contracted the virus from direct exposure to infected poultry, and only a handful of cases are even suspected as due to human-to-human transmission. 

The concern, of course, is that these viruses are constantly changing (see EID Journal: H7N9 As A Work In Progress) and that what we say about their behavior today may not hold true tomorrow.

Meanwhile, In Eastern China . . . .

 

 

# 8645

 

While MERS has garnered most of our attention these past few weeks, it is important to note that we continue to see sporadic, and widely scattered, cases of H7N9 infection popping up in Eastern China as well.

 

 Hong Kong’s CHP has released their latest Avian Influenza report (Avian Influenza Report (Volume 10, Number 20 (Week 20)), which cites 5 new cases reported over the past reporting week.

 

During this reporting period, 5 confirmed human cases of avian influenza A(H7N9) were reported by the National Health and Family Planning Commission (NHFPC). The cases were from Guangdong (3), Hunan (1) and Jiangsu (1). Since March 2013 (as of May 17, 2014), there were a total of 441 cases reported.

 

 

By this time last year (week 20, 2013), cases had all but vanished (see ECDC chart below), and did not pick up again until the fall.   We’ll be watching to see if this summer is a repeat of that pattern, or if we continue to see scattered cases.

In comparison, this year’s H7N9 outbreaks started earlier, and peaked sooner than in 2013.   Early closure of wet markets last January and February no doubt limited the spread.  

H7N9, H5N1, and the new upstart avian viruses like H10N8, H5N6, and H6N1 are all potential public health threats.  They may very well simmer quietly for years or even decades, only occasionally bubbling up with a human infection here or there, or at some point one of them may further adapt to humans, and spark an epidemic.

 

Likewise, two years ago all eyes were on an array of variant swine influenza viruses (see A Variant Swine Flu Review) that were spreading from county and state fairs into the population. They failed to return in any serious way last year, but once again, the summer fair season lies ahead, and they could once again be players.

 

While none of these emerging viruses may ever rise to the level of a global public health concern, and we may well be blindsided someday by a pathogen not currently on our radar, these threats are a reminder that nature’s lab is open 24/7, and is not constrained by budget cuts, politics, or a social conscience .

 

Given enough time – the odds favor seeing another pandemic. The only real  question is when.

Hong Kong Detects Their 10th Imported H7N9 Case

H7N9 Awareness Campaign Summer 2013 - Photo credit Hong Kong’s CHP

 

 

 

# 8470

 

 

 

 

 

While our attentions are understandably focused these past few days on the MERS-CoV outbreaks in the Middle East,  the H7N9 virus continues to circulate in Eastern China, occasionally infecting humans.  

Today, for the third time in the past 9 days, Hong Kong’s CHP is reporting an imported case – their 10th to date.

 

 

Imported human case of avian influenza A(H7N9) under CHP Investigation

Sunday, April 13, 2014
Issued at HKT 22:39

 

The Centre for Health Protection (CHP) of the Department of Health (DH) is today (April 13) investigating an imported human case of avian influenza A(H7N9) affecting a woman aged 85.

The patient, with underlying medical conditions, travelled to Dongguan from April 4 to 5 with her husband and younger brother. They lived at their relatives' home where their relatives have reared chickens. The patient also visited a wet market near their home there and helped in slaughtering chickens at home on April 4. She returned to Hong Kong on April 5, and developed fever, cough with blood-stained sputum and shortness of breath since April 11. She was sent to the Accident and Emergency Department of Tseung Kwan O Hospital (TKOH) by ambulance today and was subsequently admitted. She is currently managed under isolation and her condition is critical.

 

Her respiratory specimen was positive for avian influenza A(H7N9) virus upon preliminary laboratory testing by the CHP's Public Health Laboratory Services Branch today.

 

Initial investigation revealed that the patient had visited her husband at Haven of Hope Hospital (HHH) on April 10 who was admitted due to other illness. Her husband has remained asymptomatic so far and is currently under observation at HHH.

 

Apart from her husband, seven other family members of the patient are also considered as close contacts. One of them had sore throat since April 12 and his condition is stable. The other close contacts have remained asymptomatic so far.  These close contacts will be admitted to hospital for observation and their respiratory specimens will be taken for preliminary laboratory testing.

 

The CHP's investigations and tracing of other contacts are ongoing. The patient's brother who travelled to Dongguan with the patient, relevant healthcare workers, ambulance staff and patients who had stayed in the same cubicle with the patient’s husband at HHH are being traced for exposure assessment and medical surveillance.

 

The CHP will liaise with the relevant Mainland health authority to follow up on the patient's contacts during her stay in the Mainland.

 

"The Serious Response Level under the Government's Preparedness Plan for Influenza Pandemic remains activated and the CHP's follow-up actions are in full swing," a spokesman for the CHP remarked.

 

This is the tenth confirmed human case of avian influenza A(H7N9) in Hong Kong. The CHP will notify the World Health Organization (WHO), the National Health and Family Planning Commission as well as health and quarantine authorities of Guangdong and Macau.

(Continue . . . )

HK CHP: Follow Up Epidemiological Investigation Into Imported H7N9 Case

 

H7N9 Awareness Campaign Summer 2013 - Photo credit Hong Kong’s CHP

 

# 8385

 

Yesterday, in HK CHP Investigating Imported H7N9 Case, we learned of the arrival in that city of a 5-month-old girl from neighboring Guangdong Province, who was infected with the H7N9 avian flu virus.

 

Today, we’ve an update from Hong Kong’s Centre for Health Protection  that focuses on aggressive patient contact surveillance (all asymptomatic and/or negative for Influenza A so far), and reminders to the public on appropriate precautions to avoid infection.

 

To date, Hong Kong has identified 7 imported cases of the H7N9 virus, but none that have been acquired locally.

 

Epidemiological investigation and follow-up actions by CHP on confirmed human case of avian influenza A(H7N9)

The Centre for Health Protection (CHP) of the Department of Health (DH) today (March 18) provided an update on the seventh confirmed human case of avian influenza A(H7N9), which is affecting a 5-month-old girl.

"The epidemiological investigations, enhanced disease surveillance, port health measures and health education against avian influenza are all ongoing," a spokesman for the DH said.

As of 4pm today, five close contacts and 44 other contacts have been identified.

The close contacts included the patient's parents and two patients and a visitor who had stayed in the same cubicle with the index patient in Alice Ho Miu Ling Nethersole Hospital. All of them have remained asymptomatic so far and their respiratory specimens all tested negative for Influenza A virus. They are now under quarantine.

Other contacts included relevant healthcare workers, ambulance staff, visitors of patients and staff at Lo Wu Control Point. All of them have remained asymptomatic so far. They are all under medical surveillance.

"In view of human cases of avian influenza A(H7N9) confirmed locally and multiple cases notified by the Mainland, further cases are expected in affected and possibly neighbouring areas. Those planning to travel outside Hong Kong should maintain good personal, environmental and food hygiene at all times," the spokesman said.

"All boundary control points have implemented disease prevention and control measures. Thermal imaging systems are in place for body temperature checks on inbound travellers. Random temperature checks by handheld devices have also been arranged. Suspected cases will be immediately referred to public hospitals for follow-up investigation," the spokesman added.

Health education for travellers, the display of posters in departure and arrival halls, in-flight public announcements, environmental health inspection and provision of regular updates to the travel industry via meetings and correspondence are all proceeding.

The spokesman advised travellers, especially those returning from avian influenza-affected areas and provinces with fever or respiratory symptoms, to immediately wear masks, seek medical attention and reveal their travel history to a doctor. Health-care professionals should pay special attention to patients who might have had contact with poultry, birds or their droppings in affected areas and provinces.

"We have enhanced publicity and health education to reinforce health advice on the prevention of avian influenza," the spokesman said.

(Continue . . . )

HK CHP Investigating Imported H7N9 Case

 

# 8382

 

Although we are seeing fewer H7N9 cases being reported out of China over the past couple of weeks we continue to see occasional cases - such as one announced today (h/t Ironorehopper on FluTrackers) from Hong Kong’s CHP – that of a 5 month-old baby girl brought to Hong Kong from Shenzhen last night by her parents, and subsequently taken to a local hospital for symptoms of fever and vomiting.

 

Unknown, of course, are how many mild or asymptomatic cases that might be occurring, but are not detected because they do not seek medical care or get tested.

 

See today’s Lancet: Community Burden & Severity Of Seasonal And Pandemic Influenza for an extended discussion of asymptomatic cases and low rates of clinical consultation for influenza and last summers’ Lancet: Clinical Severity Of Human H7N9 Infection for an estimate from researchers at the University of Hong Kong on the number of possible `undetected’ cases during the first wave.

 

Here is the statement from Hong Kong’s Centre for Health Protection.

 

 

Imported human case of avian influenza A(H7N9) in Hong Kong under CHP investigation

The Centre for Health Protection (CHP) of the Department of Health (DH) is today (March 17) investigating an imported human case of avian influenza A(H7N9) in Hong Kong affecting a five-month-old baby girl.

The patient, who lives in Foshan, Guangdong but has been staying in Shenzhen in the past week, developed fever and vomiting yesterday (March 16). She came to Hong Kong with her parents last night and was taken to the Accident and Emergency Department of North District Hospital (NDH) by taxi for consultation. She was subsequently transferred to Alice Ho Miu Ling Nethersole Hospital (AHNH) by ambulance and was admitted for further management in the small hours of today.

Her nasopharyngeal aspirate tested positive for avian influenza A(H7N9) virus upon laboratory testing by the CHP's Public Health Laboratory Services Branch today.

The patient has been sent to Princess Margaret Hospital for isolation. Her current condition is stable.

The CHP's initial investigation revealed that the patient had been taken to a wet market in Shenzhen by her grandparents four to five days ago where live poultry was sold, but the patient had no direct contact with the poultry.

"The CHP's epidemiological investigations and contact tracing are on-going. Close contacts including the patient's parents and the patients who had stayed in the same cubicle with the index patient in AHNH will be admitted for testing and observation, while other contacts including relevant healthcare workers, ambulance staff, visitors, staff at Lo Wu Control Point and the taxi driver who took the patient to NDH, will also be traced for exposure assessment and medical surveillance," a spokesman for the CHP explained.

The CHP will liaise with relevant Mainland health authority to follow-up on the patient's contacts in the Mainland.

(Continue . . . )

Ends/Monday, March 17, 2014
Issued at HKT 23:52

HK CHP: Three `Close Contacts’ Of H7N9 Case Leave Quarantine Without Permission

 

 

# 8352

 

Hong Kong’s CHP, along with their local hospital Authority, has issued a statement indicating that 3 of the `close contacts’ of their latest H7N9 case (see Epidemiological Follow-up On HK Imported Case)  – who were placed in precautionary quarantine at Queen Elizabeth Hospital – left the premises Wednesday evening without permission.

 

While the chances that they are infected – or will transmit the virus on to others – is likely low, the CHP is nevertheless `very concerned’  over this biosecurity breach,  and has notified local police.

 

 

Joint statement by the Department of Health and the Hospital Authority

 

The following is a joint statement issued by the Department of Health and the Hospital Authority:

A spokesman for the Centre for Health Protection (CHP) of the Department of Health (DH) today (March 6) said that the Government is very concerned that three close contacts of a confirmed human case of avian influenza A(H7N9) who have been put under quarantine in isolation ward of Queen Elizabeth Hospital (QEH) left the ward without prior permission from a health officer last night (March 5).

 

The three persons was put under quarantine in accordance with section 22 of Cap 599A of the Prevention and Control of Disease Regulation until March 13.

 

"We are taking the case very seriously and the CHP has reported this incident to the Police," the spokesman stressed.

 

"Under the Prevention and Control of Disease Ordinance, a person escapes or attempts to escape from a place of quarantine commits an offence and is liable on conviction to a fine of $5,000 and to imprisonment for six months," he added.

 

The Hospital Authority (HA) spokesman said that following the quarantine order issued by the DH, QEH admitted the three close contacts in the early morning yesterday (March 5).

 

The parents were arranged to stay with their son once their negative laboratory results were available at 2.45pm yesterday. Choices on place to continue their quarantine were offered, including Hospital Authority Infectious Disease Centre and a recreational camp. Eventually, the parents preferred to stay in QEH and indicated the wish to stay together.

 

At around 7pm last night, without informing the ward staff, the family of three left their isolation wards, to which they should be confined to stay according to the quarantine order. Understanding their concern towards the isolation arrangement, two neighbouring isolation rooms have now been arranged for the family of three on the same floor.

 

"HA and QEH would continue to provide necessary assistance and support to the family during their stay, while appeal for their co-operation and understanding that the arrangement has been made to safeguard public health and in the interests of the community at large," the spokesman added.

Ends/Thursday, March 6, 2014
Issued at HKT 00:21
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Hong Kong Broadens Statutorily Notifiable Flu Definitions

 

# 8306

 

 

Amid the ever-expanding alphabet soup of novel flu combinations showing up in Asia, and around the world (think H5N1, H7N9, H10N8, H9N2, H7N7, H6N1 . . . the list goes on . . .) Hong Kong today has broadened their definition of what constitutes a `statutorily notifiable’ influenza.

In addition to scheduling the recently emerged H10N8 virus as a notifiable infection, the new regulation adds a generic "Novel influenza A infection" to include all subtypes of novel influenza infections in humans, regardless of whether it has been previously placed on the schedule.

According to well respected anthropologist and researcher George Armelagos of Emory University, we are entering the age of emerging and re-emerging infectious diseases, something he calls The Third Epidemiological Transition. As we saw yesterday, in The Global Reach Of Infectious Disease, this is a trend that public health agencies around the globe take very seriously.

 

As a result, public health agencies, and the regulations they work under, must become more nimble and proactive if these threats are to be contained. The following announcement comes from Hong Kong’s CHP.

 

Statutory notification of Novel influenza A infection

A spokesman for the Centre for Health Protection (CHP) of the Department of Health said today (February 17) that the Government will amend the Prevention and Control of Disease Ordinance (Cap 599) (the Ordinance) and its subsidiary legislation, the Prevention and Control of Disease Regulation (Cap 599A) (the Regulation), to include Novel influenza A infection as one of the statutorily notifiable diseases and specified diseases, and add influenza virus type A (subtype H10) as one of the scheduled infectious agents.

"Apart from the influenza viruses which can circulate among humans and cause seasonal influenza, many other influenza A viruses are found in birds and other animal species. Some of these animal viruses may, however, occasionally infect humans, causing disease ranging from mild conjunctivitis to severe pneumonia and even death. These are known as novel influenza viruses, against which the human population has low or no immunity," the spokesman explained.

Given the potentially unpredictable behaviour of novel influenza viruses and the fact that the majority of the population has no immunity against these viruses, vigilance and close monitoring is needed for Novel influenza A infection.

It is also foreseen that with frequent international travel, more imported human cases of Novel influenza A infections, such as influenza A (H6N1) or influenza A (H10N8) or other subtypes, may occur in Hong Kong, besides the five imported sporadic influenza A (H7N9) human infections detected so far locally.

Against this background, the Government has used the name "Novel influenza A infection" to include all subtypes of novel influenza infections in humans as a notifiable disease. The Government has also added subtype H10 to the various influenza virus type A as one of the scheduled infection agents, as human cases of influenza A (H10) infection detected so far have resulted in severe infection.

According to the amendments, "Influenza A (H2), Variant Influenza A (H3N2), Influenza A (H5), Influenza A (H7), Influenza A (H9)" will be repealed from the list of infectious diseases and replaced by "Novel influenza A infection" in Schedule 1 to the Ordinance; whereas "Influenza virus type A (subtype H2, H5 and H7)" will be repealed from the list of infectious agents and replaced by "Influenza virus type A (subtype H2, H5, H7 and H10)" in Schedule 2 to the Ordinance. Additionally, "Influenza A (H2), Influenza A (H5), Influenza A (H7), Influenza A (H9) or Swine Influenza" will be repealed from the list of specified diseases and replaced by "Novel influenza A infection" in Section 56 of the Regulation.

"The legislative amendments will be gazetted on February 21 with immediate effect. The amendments will make Hong Kong better prepared against the disease by facilitating early disease detection and implementation of appropriate public health measures if they are called for, depending on public health risk assessment," the spokesman said.

Medical practitioners are reminded to stay alert on cases of Novel influenza A infection and are required by law to notify the Director of Health of any suspected cases. Persons in charge of a laboratory are required to notify leakage of these viruses in the laboratory that may pose a public health risk.

"The CHP will issue letters to doctors and the medical laboratory sector to inform them of the relevant legislative amendments and the revised reporting criteria,"the spokesman said.

"In Hong Kong, the CHP has a sensitive laboratory surveillance system for influenza virus. The CHP conducts characterisation of all influenza virus isolates including antigenic and genetic analysis. Upon detection of any such cases, the CHP will conduct epidemiological investigation, contact tracing and other necessary control measures, to ascertain and contain the extent of transmission of infection," he said.

The spokesman reminded members of the public to observe good personal and environmental hygiene at all times to prevent influenza.

Ends/Monday, February 17, 2014
Issued at HKT 19:29
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