Hong Kong: Epidemiological Update On H7N9

 

 

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Via Hong Kong’s CHP’s bi-weekly online journal Communicable Diseases Watch, we get an Update on the situation of avian influenza A(H7N9) infection reported by Dr Conan Tsang, Medical and Health Officer, Respiratory Disease Office, Surveillance and Epidemiology Branch, CHP. 

 

This update – dated December 24th - adds 14 new cases since the last update in August of 2013.  I’ve only included a few excerpts, follow the link to read it in its entirety.

 

Geographic spread of cases  - Credit HK CHP

 

Update on the situation of avian influenza A(H7N9) infection

Reported by Dr Conan Tsang, Medical and Health Officer, Respiratory Disease Office, Surveillance
and Epidemiology Branch, CHP.

Since the publication of last issue concerning avian influenza A(H7N9) infection (http://www.chp.gov.hk/files/pdf/cdw_v10_16.pdf), 14 more confirmed cases of human infection with avian influenza A(H7N9) virus were reported (as of December 20, 2013). Among these cases, two of them were likely imported cases from Shenzhen and were confirmed in Hong Kong (HK) on December 2 and 6 respectively, whereas 6 cases were reported from Guangdong Province between August 10 and December 19, 2013.

As of December 20, 2013, the National Health and Family Planning Commission (NHFPC) has reported 144 cases of human infection with avian influenza A(H7N9) virus across 10 provinces and 2 municipalities, including 47 deaths. The health authority of Taiwan also reported one imported case from Jiangsu Province on April 24, 2013. Including the 2 cases confirmed in HK, there are a total of 147 cases. The geographical distribution of the cases is summarized in Figure 1.

Based on the available information, the age of the cases ranged from 2 to 91 years (median: 60 years) and involved 104 males and 43 females. Forty-seven cases died with a case fatality rate of around 32%. The onset dates of the confirmed cases were between February 19 and December 11, 2013 (Figure 2).

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While obviously a huge concern, thus far we’ve not seen any evidence of sustained or efficient human-to-human transmission of the H7N9 virus.The WHO Avian Flu Risk Assessment – December, provides the following risk assessment on this emerging avian flu virus:

 

Overall public health risk assessment for avian influenza A(H7N9) virus: Sporadic human cases and small clusters would not be unexpected in previously affected and possibly neighbouring areas/countries of China. The current likelihood of community-level spread of this virus is considered to be low.

Continued vigilance is needed within China and neighbouring areas to detect infections in animals and humans. WHO advises countries to continue surveillance and other preparedness actions, including ensuring appropriate laboratory capacity. All human infections with non-seasonal influenza viruses such as avian influenza A(H7N9) are reportable to WHO under the IHR (2005). 

 

Similarly, the ECDC recently published an  Epidemiological Update on H7N9, which is current through the last reported case in Shenzhen on Wednesday of last week.

 

After reviewing the data to date, the ECDC’s Risk Assessment at the end of this report illustrates the concern which many scientists and public health officials have regarding this virus.  They warn that public health authorities in the EU should be prepared for the importation of this virus, and close by stating::

 

ECDC’s view is that if this virus persists in poultry, it will represent a significant long-term threat, either as a zoonosis or perhaps a pandemic virus. Both eventualities should be prepared for.

 

So we watch these scattered cases carefully, looking for any signs that this virus is moving closer to becoming a serious public health threat.

Hong Kong CHP: Update On Novel Coronavirus

 

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Hong Kong’s CHP publishes an online "Communicable Diseases Watch" on a bi-weekly basis, that takes a close look at 2 or 3 infectious disease topics that are currently of concern.  

 

Today’s edition, in addition to carrying reports on listeriosis infection in Hong Kong and summary charts select notifiable diseases and outbreaks in Hong Kong, has a review of the novel coronavirus that has emerged on the Arabian peninsula.

 

Given their history with the SARS virus a decade ago (see SARS And Remembrance), outbreaks of a novel coronavirus anywhere in the world is understandably of of great interest to their public health community.

 

Follow the link to read:

 

Update on Severe Respiratory Disease Associated with Novel Coronavirus

Reported by Dr Henry Mou, Medical Officer, Respiratory Disease Office, Surveillance and EpidemiologyBranch, CHP.

Since September 23, 2012 (as of May 15, 2013), a total of 40 patients have been confirmed suffering from Severe Respiratory Disease associated with Novel Coronavirus (NCoV) worldwide, including 30 from the Kingdom of Saudi Arabia (KSA), three from the United Kingdom (UK), two from Qatar, two from Jordan, two from France and one from the United Arab Emirates (UAE). Most patients are male (79%; 30 of 38 cases with sex reported) and aged from 24 to 94 years (median 56 years).The first case had onset of illness in late March or early April 2012; whereas the most recent case reported had onset on May 8, 2013. Most patients presented with severe acute respiratory disease requiring hospitalisation and eventually required mechanical ventilation or other advanced respiratory support.To date, the case fatality rate is around 50%.
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While the H7N9 outbreak on the mainland may be closer to home, Hong Kong’s government website www.info.hk.gov carries almost daily updates on the novel coronavirus as well.

 

Two additional overseas cases of Severe Respiratory Disease associated with Novel Coronavirus closely  Monitored by DH

The Department of Health (DH) is today (May 16) closely monitoring two additional cases of Severe Respiratory Disease associated with Novel Coronavirus reported to the World Health Organization (WHO) by the Kingdom of Saudi Arabia (KSA).

According to the WHO, the two patients are health-care workers who were exposed to patients confirmed with novel coronavirus. The first patient is a 45-year-old man who became ill on May 2 and is currently in critical condition while the second patient is a 43-year-old woman with underlying illness who became ill on May 8 and is now in stable condition.

To date, a total of 21 patients have been reported from the outbreak primarily linked to the same health-care facility in Eastern KSA since the beginning of May. Investigation by the KSA government is ongoing.

This brings the latest global number of confirmed cases of Severe Respiratory Disease associated with Novel Coronavirus to 40.

The WHO noted that this is the first time health-care workers have been diagnosed with Severe Respiratory Disease associated with Novel Coronavirus after exposure to patients. In view of recent clusters reported in health-care facilities, health-care workers and hospitals are reminded to maintain vigilance against novel coronavirus and adhere to strict infection control measures while handling suspected cases in order to reduce the risk of transmission to other patients and health-care workers.

"The Centre for Health Protection (CHP) of the DH will seek more information on the cases from the WHO and the relevant health authority. The CHP will stay vigilant and continue to work closely with the WHO and overseas health authorities to monitor the latest developments of this novel infectious disease," a DH spokesman said.

Locally, the CHP will continue its surveillance mechanism with public and private hospitals, practising doctors and the airport for any suspected case of severe respiratory disease associated with novel coronavirus.

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CHP: Updating The Hong Kong H5N1 Case

 

 

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The Centre For Health Protection (CHP) produces an online bi-weekly Communicable Diseases Watch  report which usually features one or more current infectious disease investigations ongoing in Hong Kong.

 

Today’s issue - Communicable Diseases Watch Volume 9, Number 12, Week 22-23 (May 27, 2012 – Jun 9, 2012) - provides updated details on the condition and investigation into the 2-year old from Guangdong Province who is being treated at the Princess Margaret Hospital for H5N1.

 

 

As I wrote last week in H5N1 And The Hong Kong Public Health Response, the CHP does a remarkably thorough job of surveillance and reporting on H5N1 – along with many other public health threats – in Hong Kong.

 

Would that every public health agency around the globe be as capable, and open.

 

A few excerpts (slightly reparagraphed for readability) from today’s report, but follow the link to read the article in its entirety:

 

An imported human case of influenza A(H5N1) infection in Hong Kong, June 2012

Reported by DR HENRY WONG, Medical Officer, and Dr Alice Wong, Senior Medical Officer, Respiratory Disease Office, Surveillance and Epidemiology Branch, CHP.

The Centre for Health Protection (CHP) confirmed a case of imported human influenza A (H5) infection affecting a 2-year-old boy on June 1, 2012. He lived with his parents and maternal grandmother in Gangzhou, Mainland China. He presented with fever and runny nose since May 23, 2012 while in Guangzhou. He sought medical attention but his symptoms persisted. He was then brought to Hong Kong on May 26 and sought medical attention from a private medical clinic in Mong Kok.

 

Subsequently, he developed febrile seizures and was admitted to Caritas Medical Centre (CMC) Special Care Unit (SCU) on May 28. The clinical diagnosis was encephalitis. His nasopharyngeal aspirate (NPA) collected on May 28 was confirmed to be influenza A virus of subtype H5 by Public Health Laboratory Branch (PHLSB) of CHP on June 1 and later confirmed to be influenza A(H5N1) infection on June 2. The patient was put on Tamiflu and antibiotics. He was transferred to Princess Margaret Hospital (PMH) for isolation and treatment on June 1.

 

Magnetic resonance imaging (MRI) scan for the brain on June 2 was suggestive of obstructive hydrocephalus. Emergency operation was performed on the same day to relieve the hydrocephalus.

Cerebrospinal fluid specimens taken on June 2, 3, 4 and brain tissue specimen taken on June 2 were tested positive for influenza A(H5) by polymerase chain reaction. He is currently under intensive care treatment in PMH and is in serious condition. His parents were asymptomatic and had been quarantined in PMH until June 9. NPAs taken from them were tested negative for influenza A(H5).

 

CHP had traced around 90 people who might have got into contact with the patient in the private medical clinic in Mong Kok, ambulance and CMC. NPAs taken from eight contacts including three healthcare workers from CMC, two patients from CMC, two health care workers of the private clinic and another patient who attended the same clinic, who reported respiratory symptoms were tested negative for Influenza A (H5). They were all put under medical surveillance.

Epidemiological investigation revealed that the patient was brought by his mother to buy a live duck in a wet market near his residence in Guangzhou during the period of May 17-19. From May 20-22, he travelled with his parents by private car to Anhui province but had no direct poultry contact during the trip.

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This edition of the CDW also contains reports on a case of listeriosis in a tourist, a case of Streptococcus suis infection, as well as a 3-year review of institutional scabies outbreaks in Hong Kong.

 

You’ll also find a series of charts showing surveillance data on a variety of infectious diseases.

 

For a listing of weekly, bi-weekly, and other reports from the CHP you can visit their Disease Control Page.

ECDC: Communicable Disease Threats -Week 23

 

 

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With the EUR02012 underway in Poland and the Ukraine, and the London Olympics set to begin in a little over a month, a lot of attention will be paid to public health surveillance and reporting out of Europe this summer.

 

On Friday, in How The ECDC Will Spend Your Summer Vacation, I described some of these monitoring efforts.  One of the products of this surveillance effort is the ECDC’s weekly Communicable Disease Threat Report.

 

We’ve the latest version of this report available this morning, which includes reports on multistate outbreaks of measles in the EU, an update on the Legionnaires outbreak in Scotland (see my blog Legionella Update From NHS Lothian), and a new section on enhanced surveillance for the EURO2012 games ( described below):

 

New! UEFA EURO 2012 - MG enhanced surveillance  (weekly update)

Opening date: 7 June 2012

From 8 June, the CDTR includes a section on threats related to the UEFA Euro 2012. It contains information gathered through epidemic intelligence activities concerning health events or public health measures relevant for the football tournament. The information is classified regarding host countries (Poland and Ukraine), other participating countries (Croatia, Czech Republic, Denmark, England, France, Germany, Greece, Italy, the Netherlands, Portugal, Republic of Ireland, Russian Federation, Spain and Sweden) and other bordering countries (Belarus, Hungary, Lithuania, Moldova, Romania and Slovakia).   

 

 

This report also contains information on non-EU threats, such as H5N1, polio, dengue, malaria, and other diseases around the globe.

 

Surveillance reports - 08 Jun 2012

Available as PDF in the following languages:

 

The World Health Organization today released a 5-page FAQ (Frequently Asked Questions) document providing health information to people traveling to the EURO2012 games.

 

This PDF covers a wide range of topics, including the signs and symptoms of measles and rubella, how to survive a stampede, and how call for emergency services in Poland and the Ukraine on your cell phone. 

 

 

Questions answered: health advice for travellers to EURO 2012

11-06-2012

WHO/Europe has produced detailed health advice for those attending the 2012 UEFA European Football Championship (EURO 2012). It includes information on how to prepare before leaving home, stay safe in crowds, seek emergency health care, and avoid, recognize the symptoms of and treat common travellers’ illnesses.

More information

• Frequently asked questions (FAQ): EURO 2012

 

 

 

While there are some legitimate public health threats involved anytime hundreds of thousands of people from around the world congregate in a small region, the individual risks to one’s health and safety are generally quite small.

 

Perhaps the best advice to anyone planning a holiday, regardless of the destination, is to make sure their immunizations are up-to-date. Many of the health threats one might encounter in their travels are vaccine-preventable.

 

That and being smart about consumption of local food and water, the prevention of tick and mosquito bites, and knowing about specific health threats that may exist along your route, will go a long ways towards making any trip a safe and healthy one.

 

The CDC maintains an extensive Traveler’s Health Website, which includes the 2012 Yellow Book, and travel health information to more than 200 international destinations.

ECDC Launches Weekly Communicable Disease Threat Report (CDTR)

 

 

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Infectious disease geeks and health professionals get a new resource this week with the announcement by the ECDC today of the launching of their new weekly Communicable Disease Threat Report (CDTR).

Here is the announcement from the ECDC, along with a link to the first edition.

 

 

ECDC starts publishing its weekly communicable disease threat report (CDTR)

13 Feb 2012

ECDC

The ECDC communicable disease threat report (CDTR) is a weekly bulletin intended for epidemiologists and health professionals in the area of communicable disease prevention and control. It summarises information gathered through epidemic intelligence by ECDC regarding communicable disease threats of concern to the European Union. It also provides updates on the global situation and changes in the epidemiology of communicable diseases with potential to affect Europe, including diseases that are the focus of eradication efforts. It is prepared by the epidemic intelligence team at ECDC and will be published on a weekly basis from now on.

 

Between 5 and 11 February, three threats affecting the EU were followed. An outbreak of Legionnaires' disease associated with a hotel in Spain was identified by the European Legionnaires' Disease Surveillance Network on 13 January 2012. As of 9 February 2012, 18 cases were confirmed, 15 of them being travel-associated. Cases are from the United Kingdom (12), France (2) and Spain (4).

 

Local measles outbreaks were reported in the media in Spain. There have been 22 cases during the first two weeks of 2012 in Valencia and 77 cases since the beginning of January in Alicante, including 31 reported during the last week. In Romania, a measles outbreak was notified at the Theological Seminary of Arad involving 15 cases, some of whom were hospitalised in a serious condition. Neighbouring countries such as Ukraine, Russia and Belarus also reported measles outbreaks.

 

Influenza activity continued to increase in week 5 in a very varied way across Europe with no clear geographic progression this season. The dominant viruses remain A(H3N2)-type. Medium influenza activity was reported by nine countries and increasing clinical activity in primary care was reported by 18 countries, compared with 12 countries last week.

 

Influenza A(H5N1), poliomyelitis and dengue were also monitored. Even though they don’t present a major risk for the EU at the moment, vigilance remains important.

Communicable Disease Threats Report (CDTR),  05 – 11 February - Week 6