HK’s Dr. Ko Wing-man On Flu Reassortment Concerns

Reassortment is the mechanism where two different flu viruses infect the same cell simultaneously, and swap genetic material, producing a new, hybrid virus. -  Credit AFD

 

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At the same time that mainland China is experiencing their third winter wave of H7N9 infections, Hong Kong and the rest of southern China are embroiled in a particularly nasty H3N2 seasonal flu epidemic. 

 

Today’s flu update from Hong Kong’s CHP acknowledges:

 

Regarding severe cases, from noon yesterday (February 7) to noon today, four additional cases of influenza-associated admission to intensive care units or death (including two deaths) among adults aged 18 or above have been recorded under the enhanced surveillance in collaboration with public and private hospitals reactivated since January 2.

This brings the total number to 218 ( 142 deaths) so far. Among them, 207 were A(H3N2), five were B and six were A pending subtype. In the last winter season in early 2014, 266 (133 deaths) were filed.

Meanwhile, no additional cases of severe paediatric influenza-associated complication or death among children aged under 18 have been reported since yesterday via the ongoing reporting system. The total this year hence remains at 11 (no deaths) and all were A(H3N2). In 2014, 27 (four deaths) were filed.

 

Things are so bad - that while located in the Northern Hemisphere - Hong Kong is making arrangements to purchase a quantity of the recently revised Southern Hemisphere vaccine, as announced yesterday in New flu vaccine ready by April.

A couple of weeks ago, in Hong Kong CHP Update On Imported H7N9 Case, we looked at published reports saying that HK CHP director Dr. Ko Wing-man had publically expressed concerns over the possibility that this year’s seasonal flu, and the H7N9 virus, could cross paths and create a new, reassorted virus.

 

Today, based on reports in the South China Morning Post and Sputniknews, Dr. Ko Wing-man has apparently once again voiced those concerns.

 

Hong Kong Health Minister Warns of Possible New Deadly Virus Outbreak

© AFP 2015/ ISAAC LAWRENCE

 16:18 08.02.2015 (updated 16:54 08.02.2015)

Hong Kong's health minister stated that rampant seasonal flu in Hong Kong and the recent strain of bird flu detected in poultry could together give rise to a deadly new virus.

MOSCOW, (Sputnik) – The rampant seasonal flu in Hong Kong and the recent strain of bird flu detected in poultry could together give rise to a deadly new virus, Hong Kong's health minister said Sunday.

“If a person contracts two viruses, a gene recombination is likely to happen,” Ko Wing-man was quoted as saying by the South China Morning Post, adding that the mutation could lead to a more contagious virus.

(Continue . . . )

 

A novel/seasonal flu reassortment is not a new concern, nor is this scenario limited to H7N9, or the H3N2 virus. Anytime two different flu viruses inhabit the same host (human, avian, porcine, etc.) at the same time, the potential for seeing a reassortant virus exists. 

Most of the time, however, the resultant hybrid virus fails to thrive and spread, and it is never even noticed.

But when you have an abundance of seasonal flu co-circulating with a novel flu virus like H7N9, the odds of seeing a someone infected with both subtypes – admittedly a rare event – go up.  And the more opportunities these viruses have to get together, the better the chances are they will produce an offspring.

 

Last month, in EID Journal: Timing of Influenza A(H5N1) in Poultry and Humans Worldwide, 2004–2013, we looked exactly these concerns, albeit focusing on H5N1 and seasonal flu interactions.   The author’s wrote:

Abstract

Co-circulation of influenza A(H5N1) and seasonal influenza viruses among humans and animals could lead to co-infections, reassortment, and emergence of novel viruses with pandemic potential.

 

Previously, in the Lancet: Coinfection With H7N9 & H3N2, we saw the first evidence of co-infection with the newly emerged H7N9 virus and a seasonal flu virus in a human. While last October, in EID Journal: Human Co-Infection with Avian and Seasonal Influenza Viruses, China, we looked at co-infections in 2 patients in Hangzhou, in January 2014.

 

In all of three of these cases, no reassortant virus was detected.

But In 2011,  an influenza co-infection in Canada led to the creation of a unique hybrid reassorted virus (see Webinar: pH1N1 – H3N2 A Novel Influenza Reassortment), although it was not passed on to anyone else.

 

And in 2010, in EID Journal: Co-Infection By Influenza Strains, I wrote about a study in New Zealand during the opening months of the 2009 pandemic that discovered at least 11 co-infections (out of 1,044 samples tested) with the older seasonal H1N1 virus and the newly emergent pandemic H1N1 virus.

While rarely detected, influenza A coinfections are probably more common than we realize.  Luckily, most do not result in the production of a hybrid strain, else we’d be hip deep in novel viruses all the time.

 

Over the past few years we’ve seen a growing list of novel (avian, swine, canine) flu viruses emerge (H5N3, H5N2, H5N5, H5N6, H5N8, H7N9, H10N8, H3N8, H6N1, H1N1v, H1N2v, H3N2v, etc. . .), and each carries some risk of reassortment. 

With other novels viruses, or with human viruses. Or conceivably both.

 

How big that risk really is, in terms of producing a pandemic virus, is unknown.  Most of these reassortant hybrids will fail and fade away unnoticed, either being biologically `flawed’ in some way, or simply not as competitive as existing strains.

 

The odds of any one viral assignation producing a viable, humanized virus is probably fairly remote.

The concern is, if these viruses get enough rolls of the genetic dice, they will eventually roll a natural.  Which is why we watch Hong Kong, mainland China, and Egypt so carefully this time of year.

Hong Kong CHP Update On Imported H7N9 Case

 

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We’ve an update on the epidemiological investigation into Hong Kong’s second imported H7N9 case of the season, and some comments from CHP Director Dr. Ko Wing-man over concerns that the H7N9 virus could evolve into a more dangerous virus..

Update of imported human case of avian influenza A(H7N9)

The Centre for Health Protection (CHP) of the Department of Health (DH) today (January 24) reported the latest updates of the second imported 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.

So far, seven close contacts and 62 other contacts have been identified.

(A) Close contacts

The close contacts have been put under quarantine and prescribed with antiviral presumptive treatment until the completion of the five-day treatment or 10 days after last exposure to the patient, whichever is earlier. They include:

• Two family members who remained asymptomatic;
• An in-patient admitted to the same cubicle as the patient in the Accident and Emergency Department of Alice Ho Miu Ling Nethersole Hospital (AHNH), who was symptomatic and tested positive for Influenza A (H3) virus; and
• Four asymptomatic patients who had attended the private clinic in Tai Po with the patient.
  

(B) Other contacts

The other contacts have been put under medical surveillance and they include:

• 34 asymptomatic healthcare workers who took care of the patient in AHNH;
• 24 clinic contacts (including patients and staff of the clinic in Tai Po) in which one was symptomatic and tested positive for Influenza A (H3) virus while the rest being asymptomatic;
• An immigration officer involved upon patient's arrival in Hong Kong, who was symptomatic and tested negative for Influenza A; and
• Three asymptomatic ambulance officers involved in patient transfer.

The Lady MacLehose Holiday Village in Sai Kung under the Leisure and Cultural Services Department is being converted as a quarantine centre. Asymptomatic close contacts will be quarantined there.

Investigations are ongoing.

The CHP's hotline (2125 1111) for public enquiries will operate from 9am to 6pm today and tomorrow (January 25).

Ends/Saturday, January 24, 2015
Issued at HKT 19:48

 

With China’s winter epidemic of H7N9 ramping up, and seasonal H3N2 in full swing, Hong Kong’s CHP Director Dr. Ko Wing-man has publicly expressed concerns over the possibility that this emerging avian flu could evolve into a more dangerous virus. 

 

First a couple of brief media reports on his concerns, then I’ll return with a bit more.

 

Ko Wing-man worried about the bird flu virus variants

Secretary for Food and Health, Ko Wing-man, said the second case of human infection appeared in Hong Kong H7N9 bird flu cases, patients have no contact with live poultry, only to over-selling live poultry markets, the citation to these places, there will be the risk of infection, subject to appeal to the public if the visiting birds flu-affected areas, in addition to not touch live poultry, also not to the sale of live poultry locations.

Ko Wing-man said, scientists fear the high incidence of seasonal flu, plus the H7N9, may lead to two viruses in animals or humans cross-infection, the virus appears to make genetic changes, the authorities are very concerned that if a new virus appears, it will immediately for research. Ko Wing-man said, did not receive notice Mainland authorities, resumption of live chickens to Hong Kong, in Hong Kong and mainland cities to Hong Kong chickens and quarantine departments to maintain close liaison.

 

Hong Kong suffered a bird flu fear flu virus genetic changes
2015-01-24 United Daily News reporter Li Chun ╱ immediate reports

Hong Kong suffered a bird flu seasonal influenza, Hong Kong Secretary for Food and Health Ko admitted that fear there will be changes in the viral genes.

<SNIP>

With the same time, a time when the peak of the flu in Hong Kong, 27 people have died in the past week, the new flu, the occupancy rate increased intensive care unit of public and private hospitals. Ko means worrying situation, appealing for influenza vaccination.

  
Change and adaptation are the hallmarks of all influenza A viruses, but we worry most about novel viruses (like H7N9, H5N1, H10N8) because of their ability to cause severe, often fatal illness in humans. 

 

Of the novel  viruses currently on our radar, H7N9 seems to be furthest along the path towards mammalian adaptation, and research shows continued evolution over the first two epidemic waves. 

 

Last summer, in Eurosurveillance: Genetic Tuning Of Avian H7N9 During Interspecies Transmission, we saw a study that identified at least 26 different genotypes of the virus in circulation.  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.

 

While there have been fewer than 500 H7N9 cases recorded to date, there are some estimates that put the real number of symptomatic cases in the tens of thousands (see Clinical severity of human infections with avian influenza A(H7N9) virus, China, 2013/14).

Assuming there really are a sizable number of mild cases going undetected, that would increase the chances of seeing a reassortment during this heavy seasonal flu season, with unpredictable results.

 

Reassortment is the mechanism where two different flu viruses infect the same cell simultaneously, and swap genetic material, producing a new, hybrid virus. -  Credit AFD

 

Admittedly, no one knows how likely this is to happen – or even if an H7N9/H3N2 reassortant would be viable. But since this process has the potential to produce a dangerous hybrid without warning, it remains a genuine concern. 

 

This isn’t the only evolutionary path that H7N9 could take towards becoming a pandemic virus. It could simply pick up host adaptations as it passages through humans, it could reassort with other influenza viruses in a non-human host, or it could accrue the requisite mutations through antigenic drift. 

 

Alternatively, there could be some unknown species barrier that prevents avian flu viruses from ever posing a pandemic threat to humans (see Are Influenza Pandemic Viruses Members Of An Exclusive Club?).

While that would certainly be welcome news, few researchers at this point are willing to bet the farm on our being that lucky.

Hong Kong: Update On Investigation Into H7 Infected Poultry

Credit FAO

 

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This time last year Hong Kong’s SFH (Secretary of Food & Health), Dr. Ko Wing-man was taking a lot of heat from mainland Chinese officials over his insistence on performing both serological and PCR spot checks on shipments of imported poultry from neighboring provinces (see Dr. Ko Wing-man On H7N9 Testing Of Poultry).

 

While serological tests can determine if a bird has ever been exposed to and infected by a specific virus (very handy for viruses like H7N9 that produce no symptoms in birds), PCR testing must be used to determine if a bird is actively infected, and able to spread the virus.

Mainland officials have lobbied extensively against serological testing, feeling that a positive result would unfairly malign their poultry industry, and cause unnecessary culling of their product.

 

In the past 24 hours, a new batch of poultry arrived in Hong Kong and a handful of tested samples showed a positive result via serology, but negative by PCR.  The positive serological results were viewed (rightfully so) as a red flag, which led Hong Kong to perform PRC testing on a larger number of birds, and last night the results were announced (see Imported Poultry PCR Positive For H7 Avian Flu).

Today Hong Kong is busy culling birds, and doing contact tracing and surveillance on those people who may have been exposed to infected birds. Two reports,  first a statement by Dr. Ko Wing-man on the situation, followed by a progress report on local contact tracing efforts.

 

SFH on result of H7 PCR tests of imported live chickens

Following is the transcript of remarks made by the Secretary for Food and Health, Dr Ko Wing-man, at a media session on result of H7 Polymerase Chain Reaction (PCR) tests (genetic testing) of imported live chickens at the lobby of West Wing, Central Government Offices, this morning (December 31):

Reporter: (On the testing result of samples from a consignment of imported live chickens)

Secretary for Food and Health: On December 30, the Government found in a consignment of imported live chickens a number of samples tested positive in H7 avian influenza (AI) serology tests, whilst all swab samples collected from the same consignment of live chickens were tested negative in H7 Polymerase Chain Reaction tests. According to our risk management mechanism, we collected 120 additional swab samples from the same consignment of live chickens to conduct PCR tests. Shortly before now, the results were back. A number of samples were tested positive for H7 AI. Accordingly, we kicked off a number of public health measures to prevent the risk of spreading of H7N9 virus.

Firstly, the Agriculture, Fisheries and Conservation Department (AFCD) has declared the Cheung Sha Wan Temporary Wholesale Poultry Market as an infected place. It will be closed for 21 days. This will mean that supply of live poultry from the Mainland will also have to be suspended for the same period of time. After the 21-day suspension period, the index registered farm of this particular consignment of poultry has to be verified that it is safe in terms of bio-security measures before resuming supply of live chicken to Hong Kong.

AFCD will also arrange to cull all the live poultry, around 15 000 in total, in the Cheung Sha Wan Temporary Wholesale Poultry Market, starting this morning.

AFCD will then conduct inspections and collect additional samples for testing from all of the 29 registered live poultry farms in Hong Kong to ensure that they are not affected by H7 AI. We will then channel the local live chickens to the Ta Kwu Ling Checkpoint before they could be dispatched to the retail points.  

Reporter: (On whether the Mainland authorities could step up their inspections at poultry farms)

Secretary for Food and Health: Hong Kong Government is always in very close collaboration with the relevant Mainland authorities. Our Mainland counterparts have been doing a lot in terms of safeguarding the health of live poultry to be supplied to Hong Kong. In fact, the supply chain of live poultry for Hong Kong is entirely segregated from other live poultry on the Mainland. You are right that this is not the first time that we have detected a positive H7 AI specimen from the live poultry supplied from the Mainland. This time is special. It is the first time that we have utilised the serology tests which helped us in detecting a batch of live poultry affected by H7 virus.    
(Please also refer to the Chinese portion of the transcript.) 

Ends/Wednesday, December 31, 2014
Issued at HKT 09:23

 

Update on contact tracing for imported live chickens positive for avian influenza A(H7)

The Centre for Health Protection (CHP) of the Department of Health today (December 31) reported the latest updates on contact tracing after samples of live chickens imported from the Mainland tested positive for avian influenza A(H7) virus, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

In collaboration with the Food and Environmental Hygiene Department and the Agriculture, Fisheries and Conservation Department, the CHP's epidemiological investigations have so far identified one close contact who is a poultry worker at Cheung Sha Wan Temporary Wholesale Poultry Market (CSWTWPM), and 77 other contacts including a lorry driver who transported the involved consignment of live chickens, poultry workers and staff at CSWTWPM and Man Kam To Animal Inspection Station, and workers involved in the poultry culling operation.

The CHP is tracing these contacts and will monitor their health conditions. Among them, a member of staff at CSWTWPM developed sore throat and his specimen tested negative for influenza A virus.

"Enhanced surveillance of suspected human cases in public and private hospitals is ongoing," a spokesman for the CHP remarked.

"Poultry workers, who have prolonged exposure to live poultry, might have higher risks of contracting the virus from infected poultry and hence increased risks of genetic reassortment of the virus. Poultry workers have been recommended by the CHP's Scientific Committee on Vaccine Preventable Diseases as one of the priority groups and have been covered in the Government Vaccination Programme under which they are eligible for free influenza vaccination. We advise them to get vaccinated early as it is one of the effective means to prevent influenza-associated complications and hospitalisations," the spokesman added.

Letters to doctors and hospitals will be issued to alert them to the latest situation.

The National Health and Family Planning Commission and the health authorities of Guangdong and Macau have been informed.

Poultry workers and cullers in doubt may call the CHP's avian influenza hotline (2125 1111) for enquiries and it operates from 9am to 6pm.

Ends/Wednesday, December 31, 2014
Issued at HKT 18:11

Hong Kong: SFH On H7N9 & Vaccine Timetable

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Tomorrow, March 31st, will be the one-year anniversary of the world’s notification from the Chinese MOH that a new avian flu virus – H7N9 – was spreading and infecting people in China (see  China: Two Deaths From H7N9 Avian Flu). In these past 12 months more than 400 human infections have been recorded – a milestone that took the H5N1 virus roughly 6 years to reach (2003-2008).

 

While the closure of live-markets in many of the larger towns and cities in China seems to have reduced the rate of human infection over the past couple of months, we continue to see scattered cases reported from several provinces in Eastern China. 

 

As avian flu spreads best in cold temperatures, public health officials in China are anxiously awaiting the arrival of summer, which they hope will provide a respite in transmission of the virus.  They are very aware, however, that the virus could easily return next fall.

This morning, we’ve some comments from Hong Kong’s Secretary of Food & Health Dr. Ko Wing-man, on this expected reduction in the H7N9 threat, and on prospects on when a vaccine for humans would be available.

 

You may recall that earlier this month, in Parsing China’s H7N9 Vaccine Headlines, we looked at some dubious Chinese media claims, suggesting that a vaccine was only a couple of months away.  Given that only phase I (animal) trials had been conducted on the vaccine, some of the promises (see Xinhua News H7N9 vaccine may hit market in May) seemed more than a little ambitious.

 

Dr. Ko Wing-man provides a far more plausible timetable, in his remarks which are carried in the following item published overnight by the Hong Kong Government.

 

H7N9 cases to decline: Health chief

March 30, 2014

Secretary for Food & Health Dr Ko Wing-man says the threat from H7N9 will decrease as temperatures rise, but the Government will stay vigilant.

Briefing reporters today, Dr Ko said H7N9 cases have decreased since Mainland authorities adopted preventive measures, and added he hoped the contingency plan for local chicken sales would not have to be activated after Mainland live chicken imports resume in June.

Noting concerns from Ta Kwu Ling residents on the plan, he said the Government will continue to communicate with them and will minimise environmental impacts.

Dr Ko also said the Government will conduct a study in May to formulate a contingency plan for the coming winter, including the use of a new vaccine against H7N9.

"According to our experts, the experts in the Mainland have already obtained the licence for experiment. The earliest possible available time frame would be around the end of the year or early next year. However, as to the application of this new vaccine, it remains to be discussed among the scientists and the authorities."

 

 

While work is being done on an H7N9 vaccine in China, Taiwan, Japan, and the United States - and there are hopes that a suitable one can be created – we’ve seen evidence in the past that effective H7 (and H5) flu vaccines are harder to make than their seasonal cousins.

 

Last May we saw an analysis of some of the problems inherent in creating and deploying an  H7N9 vaccine published in JAMA, penned by CIDRAP’s Michael T. Osterholm, PhD, MPH; Katie S. Ballering, PhD; and Nicholas S. Kelley, PhD.

Major Challenges in Providing an Effective and Timely Pandemic Vaccine for Influenza A(H7N9)

Michael T. Osterholm, PhD, MPH; Katie S. Ballering, PhD; Nicholas S. Kelley, PhD

JAMA. 2013;():1-2. doi:10.1001/jama.2013.6589.

Published online May 9, 2013

Issues such as the correct amount of antigen per shot, the timing or need for a booster shot, the incidence and severity of side effects, and even the need for an adjuvant are usually sorted out during several rounds of clinical (human) testing, something that can take months or even years.

 

Last September (see NIH Begins Phase II Clinical Trials On H7N9 Vaccine Candidates) the NIH released a detailed summary of their plans to test a variety of H7N9 vaccine formulations across two clinical trials - involving as many as 1700 volunteers - who will receive various strength H7N9 vaccines (adjuvanted and non-adjuvanted).

 

When complete, we should have a much better idea of what will be involved in creating a pandemic H7N9 vaccine. Full results, however, are not expected until December of 2014.

 

And assuming no major obstacles are encountered during these clinical trials, there’s several months of vaccine production, fill and finish, shipping, and local distribution to take into account. But the reality is - In a world of 7 billion people- our ability to manufacture and (just as importantly) distribute a pandemic vaccine in  a short amount of time remains severely limited.

 

Realistically, all of this means we are still a long way from having adequate amounts of commercial H7N9 vaccine available to the general public. 

 

Should H7N9 (or any other novel virus) spark a major epidemic or worse – a pandemic – then our first line of defense will be NPIs or Non-Pharmaceutical Interventions.   The CDC’s Nonpharmaceutical Interventions (NPIs) webpage defines NPIs as:

 

Nonpharmaceutical interventions (NPIs) are actions, apart from getting vaccinated and taking medicine, that people and communities can take to help slow the spread of illnesses like influenza (flu). NPIs are also known as community mitigation strategies.

NPIs are geared to the virulence and spread of the virus, and may range from simple advice to `wash your hands and cover your coughs’ to mandatory school and business closings.

 

Vaccines would eventually play an important role in the containment of any pandemic, but likely not until the second or third wave of infection. And even then, they would initially only be available to a fraction of the world’s population.

 

Despite having been depicted in movies and TV shows as the panacea for any pandemic, the rapid global rollout of an experimental (and untested) vaccine is something that only really happens in in the minds of Hollywood screenwriters.

Video: Dr. Ko Wing-man On Hong Kong’s H7N9 Response

 

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We’ve a little more on Hong Kong’s immediate response to the discovery of avian H7N9 in imported poultry in the following report and (1 minute) video clip of a statement by Dr. Ko Wing-man, SFH of Hong Kong (h/t Pathfinder on FluTrackers).

 

 

Bird flu shuts wholesale market

January 27, 2014

Cheung Sha Wan Poultry Wholesale Market will be shut for 21 days until February 18 after a batch of live chickens from Foshan, Guangdong was confirmed to have H7N9 avian influenza virus today, Secretary for Food & Health Dr Ko Wing-man says.

 

Briefing the media on the Government's measures to prevent the virus spread, Dr Ko said that all live poultry in the wholesale market at Cheung Sha Wan - about 20,000 birds - will be destroyed tomorrow.

Video 1 of 1
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Live poultry imports from the Mainland will be suspended during the market closure, and there will be no imports from Foshan's affected farm until it has been cleared of infection, he added.

 

Dr Ko said local farms will stop sending chickens to the wholesale market for three weeks and the Agriculture, Fisheries & Conservation Department will collect more samples from the farms to monitor whether local poultry have been infected.

 

Centre for Health Protection officers will follow up on poultry wholesalers' and poultry market workers' health conditions.

Hong Kong: Dr. Ko Wing-man On H7N9 Testing Of Poultry

 

Photo Credit – FAO

 

 

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With increasing, albeit incomplete evidence of the H7N9 virus circulating in poultry in Mainland China, it is understandable that Hong Kong would like to prevent the virus from entering their territory, and infecting their poultry – or worse – people.

 

As the 7 million+ residents of Hong Kong consume more poultry than can be produced locally, every week a large quantity of live poultry is imported from neighboring Guangdong Province.  The same province that has reported 5 human H7N9 infections in the past few weeks.

 

Negotiations over virus testing procedures have been underway for several weeks between mainland authorities and Hong Kong’s SFH (Secretary for Food & Health) Dr. Ko Wing-man.  At issue is expanding the use of serum –or serological – testing for the virus. 

 

Unlike PCR testing, which can detect the virus if the bird is shedding virus when the samples are taken, serology tests can tell us if the bird has ever been exposed to the virus.  And that could tell us a great deal about how widespread the virus is in the poultry population.  It does not, however, tell us whether the tested subject is currently infectious (it may, or may not be).

 

And therein lies the rub.  

 

The powerful Chinese Ministry of Agriculture – which in the past has taken every opportunity to deny they have a `bird flu problem’  - would take a dim view of culling (or banning)  `possibly not currently infected’  poultry based on a test only indicative of  prior exposure.

 

Today, Dr. Ko Wing-man made the following comments regarding the negotiations with the mainland.

 

SFH on avian influenza A(H7N9)

Following is the transcript of remarks made by the Secretary for Food and Health, Dr Ko Wing-man, before attending a public function this afternoon (December 21):

Secretary for Food and Health: We are still discussing with the Mainland authorities regarding the introduction of serological test for avian influenza A(H7N9) among the imported poultry. I hope that it is at the final stage. But there are implications of introducing such a test which we have to deal with before the implementation.

For example, I have repeatedly explained that although the rapid PCR test for avian influenza A(H7N9), which is currently in use, is already quite a big improvement in terms of our overall risk management, some experts feel that it is not 100% safe. The serological test will perhaps give us a clearer picture of how widespread the avian influenza A(H7N9) virus is among the poultry population, but the test itself cannot directly imply that the batch of poultry concerned is infectious. (A positive result) from a serological test does not strictly mean that the poultry batch (concerned) is infectious.

 

Therefore, how to dispose of the particular batch of imported poultry which is tested positive in serology investigation is a question, and it is something that we really need to have an agreement beforehand. I believe the Mainland authorities are now considering this aspect. I will give it a little bit more time.

(Please also refer to the Chinese portion of the transcript.)

Ends/Saturday, December 21, 2013
Issued at HKT 19:01

 

 

In China, food insecurity breeds unrest, and so anything that threatens the national food supply is treated as a serious national security risk.  For many Chinese, poultry is their only affordable source of meat protein.

 

With the H5N1 virus, the choice to cull was relatively easy.  It killed a high percentage of the birds it infected.   If you didn’t cull your flock, the virus would do it for you.  And continue to spread, to boot.

 

But with H7N9, the virus produces little or no discernable illness in poultry. To the poultry farmer, culling means killing  – by all outward appearances – perfectly healthy birds. 

 

While the small number of human infections with the H7N9 virus would seem ample incentive to eradicate infected birds, to date, the evidence implicating poultry as the primary vector of the disease is pretty much circumstantial.  We’ve no `smoking chicken’.

And so an agreement between Hong Kong and Mainland China on poultry testing has yet to be agreed upon.

 

Leaving us with more questions than answers regarding  the rate of infection, and geographic spread, of the H7N9 virus in Chinese poultry.

H7N9: Roundup of Reports From Hong Kong & Shenzhen

 

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While follow up reports from Hong Kong’s CHP continue to indicate no additional cases of H7N9 infection have been detected (see 12 December 2013 update Epidemiological investigation and follow-up actions by CHP on two confirmed human cases of avian influenza A(H7N9)), experts remain concerned over the possibility of seeing more human cases in neighboring Guangdong Province, particularly since the trade in live birds continues (see SCMP report below), at least at some of the markets in Shenzhen.

 

A tour then of recent comments by Hong Kong’s SFH, Dr. Ko Wing-man, virologist Dr. Guan Yi from the University of Hong Kong, and infectious disease specialist  Ho Pak-leung – also of the University of Hong Kong, and a curious change in China’s 2014 Holiday Schedule. 

 

First, this exchange between reporters and Dr. Ko Wing-man on the importation of chickens from Guangdong Province.

SFH on avian influenza A(H7N9)

Following is the transcript of remarks made by the Secretary for Food and Health, Dr Ko Wing-man, after attending a public function this morning (December 12):

Secretary for Food and Health: The Centre for Health Protection has received notification that (three) specimens from two live poultry markets in Shenzhen were tested positive for the avian influenza A(H7N9) virus. I think this is an evidence further supporting experts' opinion that part of the live poultry in Shenzhen has already been infected with the virus. But up to this stage, there is no concrete evidence to substantiate the direct relationship between these positive specimens and the source of infection of the two human cases of avian influenza A(H7N9) in Hong Kong. Therefore, we will maintain the arrangement to suspend live poultry import from Shenzhen farms for the time being.

Serology test is a more sensitive test (used to) detect the antibodies of the poultry, which gives us an idea of how wide the virus is spreading among the poultry population. The test, however, has its own limitation as well. Because even there are specimens tested positive (for the virus) in the serology (test), we cannot draw a direct conclusion that the live poultry (in question) would be infectious.

Reporter: (On avian influenza A(H7N9).)

Secretary for Food and Health: I think experts have pointed out that the positive finding of the (avian influenza A)H7N9 virus in the environmental specimens from two Shenzhen markets actually highlighted the possibility that sporadic human cases (of infection) after contacting poultry will continue. However, up to this moment, there is no evidence showing that the virus is being transformed into a shape that it can be sustainably transmitted among humans.

 

Dr. Guan Yi, who played a huge role in the identification of the SARS virus a decade ago, is featured in The Hong Kong Standard report entitled (H7N9 found in Shenzhen markets by Eddie Luk and Mary Ann Benitez), where he warns:

 

Hong Kong bird flu experts warned that H7N9 remains "the biggest threat to public health" as it has a high chance of becoming endemic if not eradicated early.

"The virus is suddenly spreading out [in parts of the mainland]," said professor Guan Yi, director of the State Key Laboratory of Emerging Infectious Diseases at the University of Hong Kong.

"There is a high chance that the virus will become endemic. It must have been circulating for a long time in this region."

Guan said the discovery of samples of H7N9 in chicken markets in Shenzhen is "not surprising because we have human cases."

 

Also in the same article, Dr. Ho Pak-leung urged the Hong Kong government to consider asking   `local poultry stalls to suspend business until after the Lunar New Year’.   Ho warned they could see a `second wave’  of cases this winter sometime around the Lunar New Year.

Whether these concerns will translate into the closure of live markets in Shenzhen remains to be seen.

You may recall that earlier this month we saw reports (see Shanghai To Close Poultry Markets Over Lunar New Years To Curtail H7N9) that the sale of live poultry would be suspended from the end of January until the end of April.

 

In what could turn out to be a related story, Reuters is reporting this morning on a controversial change in China’s 2014 official holiday schedule which will impact next year’s Lunar New Year’s celebrations, which involves the largest single migration of humans on the planet each year.

 

Chunyun, or the Spring Festival travel season, begins about 15 days before the Lunar New Year and runs for about 40 days total, during which time more than 2 billion passenger journeys will be made (mostly via crowded rail and bus) across Asia.

 

This year’s revised schedule (released only yesterday)  makes the Lunar New Year’s Eve a workday, putting a major crimp in the travel plans of millions of people who plan to return home for their traditional New Year’s Dinner. 

 

China's revised 2014 holiday schedule sparks public ire

SHANGHAI Thu Dec 12, 2013 2:30pm IST

(Reuters) - China has designated the eve of Lunar New Year as a working day in 2014, triggering an outcry over the disruption of plans to celebrate the year's most important traditional holiday.

Each year in mid-December, the government announces public holidays for the following year.

They often follow a similar pattern, but next year's schedule, announced late on Wednesday, has surprised and angered many, as the Spring Festival holiday is when millions travel home to be reunited with families, many for the only time in the year.

(Continue . . . )

 

I’ve no idea if this abrupt decision has anything to do with China’s concerns over the spread of H7N9, but it has the potential to affect the amount of travel during a perennial period of elevated concern by infectious disease specialists (see The Impact Of Mass Gatherings & Travel On Flu Epidemics).

 

Unfortunately, what may seem like reasonable preventative steps to us - like the closing live bird markets - carries with it tremendous societal, political, and economic costs in China. 

 

So we may continue to see reluctance on the part of local officials to act decisively as long as human infections remain sporadic and under control.

Hong Kong: Dr. Ko Wing-man On H7N9 Cases

Dr. Ko Wing-man receiving briefing from Hospital Personnel – Credit HK Gov

 

# 8051

 

Today,  Hong Kong’s Secretary of Food & Health (SFH) – Dr. Ko Wing-man, answered reporter’s questions regarding the two recent H7N9 cases detected in Hong Kong.   This from News.gov.hk.

 

 

SFH on confirmed human case of avian influenza A(H7N9) (with photos)

Following is the transcript of remarks made by the Secretary for Food and Health, Dr Ko Wing-man, after attending a public function this afternoon (December 7):

Reporter: (On the second confirmed human case of avian influenza A(H7N9) in Hong Kong.)

Secretary for Food and Health: We confirmed a second patient with avian influenza A(H7N9) infection yesterday evening. This patient is an elderly man (80-year-old), who has been living in Shenzhen for quite a long time. He attended Tuen Mun Hospital by taking a taxi directly from the border (upon his arrival in Hong Kong). He should not have any history of exposure in Hong Kong, and therefore the Centre for Health Protection classified this second case as an imported case at this stage. There are now a total of 19 contacts of the second patient and they are all isolated in the hospitals. Only one or two of the contacts have mild upper respiratory track symptoms.

Reporter: (On follow-up action to trace the source of infection.)

Secretary for Food and Health: The Centre for Health Protection is maintaining a very close liaison with the relevant authorities on the Mainland. We hope that with such collaboration, it could enable the Mainland authority to isolate and identify the source of infection as soon as possible.

Reporter: (On the condition of the patient of the first confirmed human case of avian influenza A(H7N9) in Hong Kong.)

Secretary for Food and Health: The condition of the first patient with avian influenza A(H7N9) has been improved. She has been taken off the connection to the ECMO (Extracorporeal Membrane Oxygenation) machine. Since she still requires a relatively high concentration of oxygen, she is still being kept in the intensive care unit of the hospital for safety sake.  

(Please also refer to the Chinese portion of the transcript.)

Ends/Saturday, December 7, 2013
Issued at HKT 19:26

Hong Kong: Dr. Ko Wing-man On H7N9 Investigation

 

Dr. Ko Wing-man  SFH

# 8044

 

 

While Hong Kong’s CHP has been working feverishly to contain any further spread of the H7N9 virus, media reports indicate that such is not the case in Shenzhen,  where Hong Kong’s first patient is suspected of having been infected.  According to the following report in the the South China Morning Post, the trade in live poultry continues in that city’s markets.

 

Travellers to Hong Kong tested for bird flu but it's business as usual in Shenzhen

Health Department sends 40 staff to borders as temperature checks beefed up in wake of H7N9 infection, but Shenzhen wet markets still open

UPDATED : Thursday, 05 December, 2013, 11:50am Emily Tsang and He Huifeng in Shenzhen

(Continue . . . )

 

Since there is no actual proof that the virus was acquired in Shenzhen, this report indicates that `attitudes towards the virus were more relaxed in the government and media. Sterilisation measures were little used at Shenzhen's markets.’

 

Another controversy exists over the delay in testing this patient for the H7N9 virus when she first appeared at Tuen Mun Hospital.  In a letter sent to local hospitals on December 3rd, the CHP reminded:

In response to the newly confirmed imported case in Hong Kong, we have enhanced surveillance by activating zero reporting with both public and private hospitals. We would like to urge you to pay special attention to those who presented with influenza-like illnesses and had history of visiting wet market with live poultry or contact with poultry in Guangdong Provinceand other affected areas within the incubation period (i.e. 10 days before onset of symptoms).

 

Today, in brief remarks, Hong Kong’s Secretary of Food & Health (SFH) – Dr. Ko Wing-man – touched on both of these issues.

SFH on confirmed human case of avian influenza A(H7N9)

Following is the transcript of remarks made by the Secretary for Food and Health, Dr Ko Wing-man, after attending the 12th Joint Meeting of Senior Health Officials of the Mainland, Hong Kong and Macao today (December 5):

Reporter: (On the source of infection of the first confirmed human case of avian influenza A(H7N9) in Hong Kong, and the accusation that Tuen Mun Hospital has delayed in detecting the virus)

Secretary for Food and Health: Regarding the first patient diagnosed as having avian influenza A(H7N9), investigation relating to the epidemiological aspect, especially the source of infection, is still continuing. The Controller of the Centre for Health Protection, Dr Leung Ting-hung, will give an update later. On the clinical testing of the infection, although there are guidelines for the clinical staff, doctors still have to make clinical judgement considering the individual condition of every patient. In this particular incident, a particular factor which might have affected the judgement of the doctor-in-charge would be the fact that the patient has not disclosed earlier that she went to Shenzhen and had a contact history with poultry.
(Please also refer to the Chinese portion of the transcript.)

Ends/Thursday, December 5, 2013
Issued at HKT 20:30

Hong Kong: Steering Committee Reconvenes On H7N9

Dr. Ko Wing-man  SFH

 

 

 

# 8039

 

The nimble-fingered typists at Hong Kong’s Centre for Health Protection are getting a workout today, as we’ve another update on their H7N9 response just posted on their website (see earlier reports HK CHP: Epidemiological Investigation & Response To H7N9 Case, HK: Hospitals Increase Infection Control Efforts Due To H7N9 Concerns, HK CHP: Notification Letter To Doctors On H7N9 Case).

 

Today, Dr. Ko Wing-man - Secretary for Food & Health (SFH) - reconvened the Steering Committee on Serious Response Level under the Preparedness Plan for Influenza Pandemic, which also met yesterday.  First we have some remarks made by the SFH to reporters after this meeting, and then  a summary of the meeting from the CHP.

 

 

SFH on update of the confirmed human case of avian influenza A(H7N9)

Following is the transcript of remarks made by the Secretary for Food and Health, Dr Ko Wing-man, after chairing a meeting of the Steering Committee on Serious Response Level under the Preparedness Plan for Influenza Pandemic this afternoon (December 3):

Secretary for Food and Health: We have convened again a meeting of the Steering Committee on Serious Response Level under the Preparedness Plan for Influenza Pandemic this afternoon. In addition to departments under the Food and Health Bureau, other relevant bureaux and departments also took part in the meeting. At today's meeting, the Hospital Authority provided an update on the clinical condition of the patient who is the first confirmed human case of avian influenza A(H7N9). The patient is still receiving treatment in the Intensive Care Unit of Queen Mary Hospital. Her condition remains critical. The Centre for Health Protection has also updated the meeting on its work on contact tracing.

      
Reporter: (On how long the work on contact tracing will be continued)

Secretary for Food and Health: We would certainly continue the work on contact tracing until all persons, whom we have reasons to suspect that they had contacts with the first confirmed patient of avian influenza A(H7N9) in Hong Kong, have been traced. In this regard, the incubation period of the disease is up to 10 days. In this particular incident, (the incubation period) would be sort of a reference indicator.    
(Please also refer to the Chinese portion of the transcript.)

Ends/Tuesday, December 3, 2013
Issued at HKT 21:24
NNNN

 

Additional details on Hong Kong’s Pandemic Preparedness response comes from the following press release:

 

SFH chairs meeting of steering committee on preparedness plan for influenza pandemic

The Secretary for Food and Health, Dr Ko Wing-man, today (December 3) again convened a meeting of the Steering Committee on Serious Response Level under the Preparedness Plan for Influenza Pandemic to follow up on the latest development of the first confirmed human case of avian influenza A (H7N9) in Hong Kong and relevant contingency measures.

The meeting comprises representatives from the Centre for Health Protection (CHP) of the Department of Health, Hospital Authority (HA), the Food and Environmental Hygiene Department (FEHD), the Agriculture, Fisheries and Conservation Department (AFCD), the Education Bureau (EDB), the Commerce and Economic Development Bureau, Tourism Commission, the Home Affairs Department (HAD), the Information Services Department, the Social Welfare Department and the Leisure and Cultural Services Department (LCSD).

At the meeting, the HA reported on the latest condition of the index patient and other related persons, while the CHP reported on the source of contracting the disease and the tracing of contacts with the patient.

The patient is in critical condition at the Intensive Care Unit of Queen Mary Hospital. The CHP has so far successfully contacted over 200 persons who had contacts with the patient, including 17 persons with close contacts.  Of which, 10 home contacts of the patient were tested negative for the H7N9 virus after rapid test at this stage. Close contacts without any symptoms will be arranged to stay in non-hospitalised quarantine facilities. It is expected that five close contacts without any symptoms will be sent to Lady MacLehose Holiday Village of the LCSD in Sai Kung for quarantine tonight.

The HA has also taken measures in preparation for activation of Serious Response Level in public hospitals and the conduct of rapid test, while its expert group has met to discuss the clinical issues relating to the treatment protocol on H7N9.

The DH would strengthen the port health measures.  Relevant departments will help disseminate information on preventive measures for H7N9 to enhance public awareness.

With regard to imported live poultry, the patient has reportedly visited a live bird market in Shenzhen, slaughtered and cooked a live chicken for consumption.  But details are not available.  As a precautionary measure, we have suspended the import of live poultry from the registered farms in Shenzhen starting from today.  The supply of live poultry in Hong Kong was not affected today.

The FEHD has stepped up cleansing and disinfection of retail outlets for live poultry, as well as enhanced inspection to ensure strict compliance with the rule against overnight stocking of live poultry.  The Department has also disinfected the patient’s residence.

The AFCD has conducted visits to 15 local chicken farms and taken specimens for testing.  No irregularity was detected.  It will conduct visits to the remaining 15 local chicken farms tomorrow.  At the same time, the Department will continue to inspect the poultry wholesale market, Yuen Po Street Bird Garden and pet bird shops etc. to ensure that the birds are in healthy and normal condition.  It has also issued letters to the trade reminding them to stay alert and strictly follow the biosecurity and hygiene measures.  The Department will continue to take samples from dead birds and poultry for testing of avian influenza.

The Government will continue to monitor the situation and maintain transparency in release of information. The CHP has set up a designated website and issued letters to inform the relevant trades the latest information and precautionary measures against the disease through the network of the EDB, the HAD and the Tourism Commission.

The public are reminded to maintain good personal hygiene, wash hands frequently and avoid contacts with birds and poultry, while travelling the public should avoid visit to any poultry markets.  For enquiries, the public can visit the website of CHP or call its hotline (2125 1111) which operates from 9am to 6pm.

Ends/Tuesday, December 3, 2013
Issued at HKT 22:43

Transcript Of Remarks By Dr. Ko Wing-Man On Hong Kong’s H7N9 Case

 

 

# 8031

 

http://www.info.gov.hk has posted the following transcript of remarks made by Dr. Ko Wing-man to reporters after chairing a meeting of the Steering Committee in discussions over the detection of an imported case of H7N9 in Hong Kong.

 

 

SFH on confirmed human case of avian influenza A(H7N9)

Following is the transcript of remarks made by the Secretary for Food and Health, Dr Ko Wing-man, after chairing a meeting of the Steering Committee on Serious Response Level under the Preparedness Plan for Influenza Pandemic last night (December 2):

Secretary for Food and Health: We have just confirmed the first human case of avian influenza A(H7N9) in Hong Kong. The victim is a 36-year-old Indonesian domestic helper. She has a history of travelling to Shenzhen, buying a chicken, slaughtering and eating the chicken. She is now in critical condition at Queen Mary Hospital. Her home contacts will be admitted to Princess Margaret Hospital for isolation and testing.

We have also escalated the response level of our Preparedness Plan for Influenza Pandemic to "Serious". The Hospital Authority will strengthen its infectious control measures, including limiting the visiting hours as well as other measures. The Centre for Health Protection will continue its work on contact tracing. The Food and Environmental Hygiene Department will ensure strict adherence to biosafety measures and cleansing arrangement by the live chicken stalls in the markets.

The Agriculture, Fisheries and Conservation Department will conduct visits to all local chicken farms and ensure the infection control measures in the poultry wholesale market (are in place).

We have notified the Mainland authority and will notify the World Health Organization according to the established procedures. We have an understanding with the relevant department of the Central People's Government that we will suspend the import of live chickens from the three registered chicken farms in Shenzhen.

Reporter: (On assessment on human-to-human transmission of avian influenza A(H7N9))

Secretary for Food and Health: It depends very much on the investigation or testing results of the close contacts of this particular patient, who is the first patient so far in Hong Kong. I am sure that this part of the investigation results will be available very soon, the earliest by tomorrow.  

(Please also refer to the Chinese portion of the transcript.)

Ends/Tuesday, December 3, 2013
Issued at HKT 01:43

 

You’ll find earlier posts on this newly announced case below:

 

HK Gov Confirmation Of H7N9 Case

Dr. Ko Wing-man On Hong Kong H7N9 Case

HK Gov Confirmation Of H7N9 Case

 

# 8030

 

Although we’ve been following this story for a couple of hours now (see here & here), we finally have an English language announcement on an official Hong Kong government website:

 

 

 

Human H7N9 case confirmed

December 02, 2013

Secretary for Food & Health Dr Ko Wing-man has confirmed the first human case of avian influenza H7N9 in Hong Kong, affecting a 36-year-old Indonesian domestic helper. She is in critical condition.

Speaking to the media after chairing the Steering Committee on Avian Influenza meeting tonight, he said the patient was in Shenzhen last month, and had been in contact with poultry there.

She fell ill on November 21 and was admitted to Tuen Mun Hospital on November 27. She was transferred to Queen Mary Hospital on November 30. Her close contacts have minor symptoms and are being isolated in Princess Margaret Hospital.

Dr Ko said the Government has raised the response level from 'alert' to 'serious' under its preparedness plan for influenza pandemic, and the Centre for Health Protection is looking for the patient’s friend who travelled with her to Shenzhen.
The Government has suspended the import of live chickens from three Shenzhen farms, and has notified Mainland authorities and the World Health Organisation about the case.

The Hospital Authority will strengthen anti-infection measures, and will limit hospital visiting hours.

The Food & Environmental Hygiene Department will ensure safety and cleaning measures at local markets, and the Agriculture, Fisheries & Conservation Department will inspect local chicken farms to tighten infection control.

 

 

Note: This report indicates Hong Kong’s Pandemic Response level has been raised to SERIOUS, not ALERT as was indicated earlier today on the CHP website.

Dr. Ko Wing-man On Hong Kong H7N9 Case

Photo credit Hong Kong’s CHP

 

# 8028

 

Another translated story, this time from Xinhua News on remarks made by Hong Kong’s SFH (Secretary of Food & Health), Dr. Ko Wing-man

 

Hong Kong confirmed the first case of human infection of H7N9 avian local flu cases

2013-12-03 00:39:19 Source: Xinhua

 

Xinhua HONG KONG, Dec. 2 (Xinhua) Hong Kong SAR Government Secretary for Food and Health Ko Wing Man 2 evening confirmed that Hong Kong confirmed the first case of human infection of H7N9 avian influenza cases, patients being treated in hospital, of the influenza pandemic contingency plans have been alert level to a serious level.

 

Ko Wing-man said that the patient is an Indian commission, November 17 went to Shenzhen slaughter chickens for cooking, which is currently in critical condition. Ko Wing-man, said the patient's close contacts have been taken to hospital, four of which famous people have mild symptoms, as soon as they will quickly test. In his view, only one case due to a temporary, but patients also have a clear history, so initially classified as imported cases.

 

HKU Infectious Disease Center Director Ho Pak-leung said, I believe this is an imported cases, found that H7N9 is not yet changed hands successor, but urged the public to be vigilant.

 

Ko Wing Man also said it would suspend the registration of Shenzhen three farms for chickens to Hong Kong.

(Original title: Hong Kong confirmed the first case of human infection with H7N9 local avian flu)

Dr. Ko Wing-man: Joint Measures To Control H7N9

Photo credit Hong Kong’s CHP

 

# 7946

 

Winter is coming, and along with that comes enhanced transmission of many respiratory viruses.   Some are perennial visitors like seasonal influenza (currently H3N2, H1N1, & Victoria and Yamagata B strains), RSV, myriad strains of Rhinovirus, multiple adenoviruses, etc. 

Others are more exotic, but thankfully - so far - very rare.  They include the MERS coronavirus, the H5N1 virus (and all its permutations/clades), and the recently emerged H7N9 virus in Mainland China.

 

Last August, we also saw a warning on a new strain of H7N7, found to have emerged in Chinese poultry at roughly the same time as H7N9 (see Nature: Genesis Of The H7N9 Virus).  It is unknown, right now, just how much of a player this virus will be down the road. And to this list, we can add in the variant swine flu viruses (H3N2v, H1N2v, H1N1v), which while not making as much of a impact this year in humans, continue to circulate in swine.

 

Trying to identify a rare virus, against the backdrop of our yearly winter flu epidemic, is always a challenge.  This year, with so many emerging viruses in the mix, that job has become far more complex.  Nowhere is that task more appreciated than in Hong Kong, which receives frequent travelers from both the Middle East and Mainland China.

 

The following press release from http://www.info.gov.hk describes meetings ongoing between Hong Kong’s Secretary of Food & Health (SFH) – Dr. Ko Wing-man – and Mainland Chinese officials on joint measures to prevent the spread of the H7N9 virus.  AQSIQ mentioned in the report is Administration of Quality Supervision, Inspection and Quarantine of the People's Republic of China.

 

 

Hong Kong and Mainland study measures to further enhance prevention and control of avian influenza H7

Hong Kong will continue to communicate with the State General Administration of Quality Supervision, Inspection and Quarantine (AQSIQ) and experts of Guangdong, Macao, Shenzhen and Zhuhai to study enhanced monitoring measures against avian influenza H7N9, as the risk of the disease has not yet been eliminated and should not be treated lightly. Continuous assessment of the risk and close surveillance of the disease are necessary.

The above remarks were made by the Secretary for Food and Health, Dr Ko Wing-man, when addressing the opening ceremony of the 2013 Guangdong, Hong Kong, Macao, Shenzhen, Zhuhai Health, Animal and Plant Quarantine and Food Safety Control Meeting in Shenzhen today (November 7).

"Since the confirmation of human cases of avian influenza H7N9 on the Mainland early this year, we have been maintaining close contact with the AQSIQ. The AQSIQ has kept us abreast of the latest development of the disease and the corresponding preventive and control measures adopted with regard to health inspection and quarantine as well as safety of live poultry and poultry products supplied to Hong Kong.

"As regards live poultry and poultry products supplied to Hong Kong, the relevant Mainland authorities have already taken a series of measures, including enhancing the surveillance measures, increasing the sampling ratio and the frequency of farm inspections, and introducing rapid test for avian influenza H7 antigen and antibodies. These measures help ensure the safety of live poultry and poultry products supplied to Hong Kong, fortify the public's confidence in consuming imported live chickens, and safeguard public and animal health," Dr Ko said.

Dr Ko added that experts from Guangdong, Hong Kong, Macao, Shenzhen and Zhuhai will discuss and study other measures to strengthen the monitoring of avian influenza H7 at the meeting. He hoped the experts could reach a consensus soon.

After the opening ceremony, Dr Ko witnessed the signing of an action plan on facilitation of inspection and quarantine clearance by representatives of the five places. The action plan reaffirms and strengthens exchange and co-operation in areas including health inspection and quarantine issues, animal and plant quarantine, food safety control and clearance facilitation.

The 2013 Guangdong, Hong Kong, Macao, Shenzhen, Zhuhai Health, Animal and Plant Quarantine and Food Safety Control Meeting is held today and tomorrow, covering topics including health inspection and quarantine; animals, foods of animal origin, plants and foods of plant origin supplied to Hong Kong and Macao from the Mainland; and food safety.

Other representatives of the Hong Kong delegation attending the meeting include the Permanent Secretary for Food and Health (Food), Mrs Marion Lai; the Director of Agriculture, Fisheries and Conservation, Mr Alan Wong; and the Director of Food and Environmental Hygiene, Mr Clement Leung.

Ends/Thursday, November 7, 2013
Issued at HKT 20:35

 

While no one knows if the H7N9 virus will ever pose a genuine pandemic threat, the level of concern in Hong Kong and Mainland China as winter approaches is palpable. 

Hong Kong: Dr. Ko Wing-man On H7N9 Threat

 

# 7941

 

 

In recent weeks we’ve looked at some of Hong Kong’s preparations for the possible introduction of the H7N9 virus into their region (see Hong Kong: SFH Outlines Measures Against H7N9 & Hong Kong: Avian Influenza Drill). Today we’ve some remarks  from Hong Kong’s SFH (Secretary of Food & Health), Dr. Ko Wing-man, on the two ways in which H7N9 might make its way into Hong Kong, and the steps they are taking to prevent it. 

 

SFH on human case of avian influenza A(H7N9)

Following is the transcript of remarks made by the Secretary for Food and Health, Dr Ko Wing-man, after inspecting the implementation progress of the Government Vaccination Programme 2013/14 at Ngau Tau Kok Jockey Club General Out-patient Clinic this afternoon (November 6):

Reporter: (On whether there is a high risk for avian influenza A(H7N9) coming into Hong Kong)

Secretary for Food and Health: There will be two possible channels that avian influenza A(H7N9) would be brought into Hong Kong. The first channel is through an infected human case and the second is through chickens. For a human infected case, the assessment has all along been that a person might possibly be infected on the Mainland and without the relevant symptoms when he or she travelled to Hong Kong. This possibility is always present. That is why we have to strengthen all the risk and infection control measures, including body temperature surveillance at the border. The more important end is at the frontline of our medical facilities. Early identification of such cases will lead to early isolation of patients and this will help us bring down the possibility of the spread of avian influenza A(H7N9) infection among the population of Hong Kong.

(Please also refer to the Chinese portion of the transcript.)

Ends/Wednesday, November 6, 2013
Issued at HKT 20:09

 

 

Another report, via this slightly syntax-challenged machine translation, gives us a look at some of the anti-H7N9 steps being taken by Hong Kong Authorities.

 

 

Ko Wing Man: Anti-H7N9 measures up to high standards

November 6, 2013

Secretary for Food and Health Ko Wing-man said that influenza will start at 20 degrees or less active, Mainland twelve weeks prior to the emergence H7N9 cases. Hong Kong's existing supply of live poultry for the H7N9 risk management measures has reached a very high level, some experts believe that is enough, some experts have proposed to do more to follow up with the Mainland authorities.

Ko Wing Man today (November 6) Inspection "2013-14 Annual Government Vaccination Programme" implementation after meeting with the media, said that since last year, East outbreak H7N9 avian flu, the Hong Kong health care system and food safety authorities have taken a series of measures, there has been no let up, and today there are meeting risk assessment.

He said that the current H7N9 virus genes have not found major changes, so to maintain the level of risk assessment. The Government will strengthen the temperature probe in the port of entry, and strengthen education, improve cross-boundary students and other health conscious. Hospitals, in addition to the prevention of various diseases with high morbidity winter and seasonal flu, we will also strengthen against H7N9 in "Early diagnosis and isolation", and other infection control measures.

Speaking recently, Dongguan City, a year-old boy diagnosed with avian influenza A H7N9 infection, he said that the mainland still had for the boy to be inspected poultry markets, has introduced a series of poultry wholesale and retail markets for the control of measures, including cleaning, suspension and "clear day" and other similar policies in Hong Kong. He attended the annual event tomorrow to Shenzhen inspection and quarantine seminar will follow up with the Mainland authorities prevention and control measures.

Ko Wing Man said Hong Kong has two annual seasonal influenza season, mainly between winter to spring. Government has embarked on influenza vaccination and subsidy schemes were hospitalized chronic high-risk groups of people vaccinated, children and the elderly and funding to private clinics vaccinated.

He said that the flu itself is not a serious illness, but there are few people, especially low resistance and chronic diseases, seasonal flu might arise from the more dangerous complications. If large-scale outbreak of influenza in Hong Kong, while avian invasion, there may make two kinds of influenza virus in the same recombinant human body, when flu may be more severe or high pathogenicity, so I hope the public will receive the seasonal flu vaccine.

 

 

His last point  – urging seasonal flu vaccination because of the possibility of a seeing a reassortment between the H7N9 virus, and an already humanized influenza A strain (H1N1, H3N2) - is something we’ve discussed before.

 

While rare, a reassortant or hybrid flu can emerge when a host (human, swine, avian, etc.) is simultaneously infected with two different flu strains.

 

 

In 2011 we saw an influenza co-infection in Canada that led to the creation of a unique hybrid reassorted virus (see Webinar: pH1N1 – H3N2 A Novel Influenza Reassortment). While in 2010, in EID Journal: Co-Infection By Influenza Strains, I wrote about a study in New Zealand during the opening months of the 2009 pandemic that discovered at least 11 co-infections (out of 1,044 samples tested) with the older seasonal H1N1 virus and the newly emergent pandemic H1N1 virus.

 

Admittedly, most reassortments do not result in a biologically `fit’ and competitive virus.  Most are evolutionary failures, or brief flashes in the pan, only to be drowned out by more robust strains. 

 

Were it otherwise,  we’d be hip-deep in emerging viruses all the time.

 

But in the rare event that one does emerge, it can have the potential of sparking an epidemic or even a pandemic.

 

The good news here is that Hong Kong provides some of the best influenza surveillance in the world, and should H7N9 begin to spread readily, or a new hybrid (reassortant) virus emerge in that part of the world, they will likely know very quickly and will alert the world.