HK SCEZD: Management Of Contacts of Human Avian Flu Cases

 

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With 13 imported H7N9 cases over the past two winters, several brushes with H5N1 over the years, and even an occasional H9N2 infection popping up, Hong Kong has a good deal of experience dealing with avian flu cases.

 

They have also followed up on hundreds of close contacts of these cases, and have even set aside a holiday camp as a quarantine facility (see Hong Kong: Epidemiological Update On Imported H7N9 Case).

 

Yesterday Hong Kong’s SCEZD (Scientific Committee on Emerging and Zoonotic Diseases) released the following guidance on the management of close contacts of avian flu cases.

 

 

20 March 2015

Latest recommendations from SCEZD on management of close contacts of cases of human infection with avian influenza 

The Centre for Health Protection (CHP) of the Department of Health announced today (March 20) the latest recommendations by the Scientific Committee on Emerging and Zoonotic Diseases (SCEZD) on management of close contacts of cases of human infection with avian influenza.

Based on review of the recommendations on contact tracing for human infection with avian influenza cases by the World Health Organization, and experiences and practices of other health authorities, the SCEZD recommends the CHP to continue to conduct contact tracing of contacts of confirmed human cases of avian influenza. Antiviral prophylaxis with oseltamivir (tamiflu) should be given to the close contacts at an appropriate treatment dose for five days.  Medical surveillance is to be undertaken for 10 days after the last exposure, where the close contacts should report to CHP promptly if fever or any respiratory symptom develops.

Moreover, close contacts should wear a face mask for 10 days since last exposure to a confirmed case while the case was infectious. There are no restrictions for work or other daily activities during the surveillance period. If the close contacts are contraindicated / intolerant to or refuse antiviral prophylaxis with oseltamivir, they should be put under quarantine for 10 days since last exposure.

 

"The above recommendations are based on the most current scientific understanding of the risk of human-to-human transmission of avian influenza A (H7N9) virus, which also apply to human infections with other types of avian influenza viruses with low risk of human-to-human transmission, like avian influenza A (H5N1)," a spokesman for CHP explained.

The SCEZD notes that avian influenza viruses may change unpredictably, including its transmissibility and pathogenicity. It advises CHP to closely monitor the latest scientific development on avian influenza viruses and review the above recommendations if in future new scientific evidence suggests changes in the potential of human-to-human transmission and antiviral susceptibility.

The public may visit the CHP's pages about avian influenza below for more information:
* The avian influenza page (www.chp.gov.hk/en/view_content/24244.html);
* The weekly Avian Influenza Report (www.chp.gov.hk/en/view_content/3879.html); and
* Global statistics and affected areas of avian influenza (www.chp.gov.hk/files/pdf/global_statistics_avian_influenza_e.pdf).

Ends/Friday, March 20, 2015

Hong Kong: SCEZD Consensus Statement On MERS-CoV

Coronavirus – Credit CDC PHIL

 

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Hong Kong’s CHP, while far closer to the source of the H7N9 virus, is nevertheless concerned with the emergence of the MERS coronavirus in the Middle East.  They have tested a number of travelers from the Middle East entering the territory with fever, but thus far, no MERS cases have been detected.

 

Today, their SCEZD (Scientific Committee on Emerging and Zoonotic Diseases), chaired by Prof. Yuen Kwok Yung, met to update their members on the MERS threat, and released a consensus statement.

 

The Centre for Health Protection issued a summary, which you can read here.  I’ve reproduced their consensus findings below:

 

 

Consensus Summary on Middle East Respiratory Syndrome

(Updated on 26 August 2013)

As of 26 Aug 2013, more than 100 cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) have been identified in the Middle East (Kingdom of Saudi Arabia (KSA), Jordan, Qatar and the United Arab Emirates), Europe (United Kingdom, France, Italy and Germany) and North Africa (Tunisia) since its first report in September 2012.

 

Over 80% of the cases were reported since April 2013, with the identification of some mild and asymptomatic cases, possibly related to improvement in case finding in recent months.

2.  So far, all cases have either occurred in the Middle East or have had direct links to a primary case infected in the Middle East.

 

3.  People of all age groups were affected although males of middle age or older were  overrepresented.  Majority of the cases had
reported co-morbidities. Patients usually presented with acute  febrile respiratory  symptoms  but immunocompromised individuals may have atypical  presentations. Co-infection is also observed in some cases. The case fatality  ratio  remained high at around 50%. Based on the accumulating information about incubation period, the longest incubation period is about 14 days.

4.  MERS is an emerging  infection whose animal source has yet to be identified.

5.  The currently observed pattern of disease occurrence could be consistent with ongoing transmission in an animal reservoir with sporadic spillover into humans resulting in non-sustained clusters, unrecognized sustained transmission among humans with occasional severe cases cannot be excluded. 

6.  Person-to-person transmission has occurred in many clusters, either in a household, work environment, or health care setting.  With  the
exception of the health facility associated cluster in Eastern KSA, the number of confirmed secondary cases per cluster has remained low.  To date, evidence does not support sustained human-to-human transmission and the pandemic potential of MERS-CoV is considered as low. 

7.  Although the International Health Regulations Emergency Committee  of the World Health Organization (WHO)  has not yet classified MERS as a Public Health Emergency of International Concern, there exists risk of sporadic importation resulting in clusters of infections locally.  The risk may increase during mass pilgrimages. 

8.  People travelling to the Middle East need to be aware of the presence of MERS-CoV in this area and of the risk of infection. They should avoid contact with animals.  People with underlying illnesses should seek medical consultation before travelling.  Travellers who develop symptoms during travel or up to 14 days after their return are encouraged to seek medical attention and to inform their doctors of their travel history.

9.  Surveillance for MERS is crucial. Health care professionals should continue to maintain vigilance for cases of MERS-CoV infection and notify any suspected cases to the Centre for Health protection.  They should look out for atypical presentation in people with underlying medical conditions.  Lower respiratory specimens such as sputum, endotracheal aspirate, or bronchoalveolar lavage should be used whenever possible for diagnosis.

Health care facilities dealing with patients suspected of being infected with MERS-CoV should exercise strict infection control measures.

10.  The Committee recommends:

• Continue intensive surveillance for MERS;
• Strengthen health education for travellers to the Middle East;
• Maintain close liaison with WHO and international health authorities to monitor the latest development; and
• Health care facilities to maintain stringent infection control measures.

 

Hong Kong: SCEZD Risk Assessment On H7N9

Fever Checks At Hong Kong School – Credit HK Govt.

 

 

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Two related stories out of Hong Kong this morning.

 

First, the risk assessment from Hong Kong’s SCEZD (Scientific Committee On Emerging And Zoonotic Diseases) on the emerging H7N9 virus, and then some basic hygiene advice from Dr Leung Ting-hung to the public on preventing the spread of the virus.

 

Although considerably more restrained than the risk assessment recently published in the Chinese Science Bulletin: Early H7N9 Risk Analysis, the SCEZD concedes that additional human infections, and expansion of the this outbreak are both likely, and that while, ` . . .  risk of human-to-human transmission appears to be low, the actual risk is currently unknown . . . ‘

 

One should not be deceived by their seemingly low-keyed approach, as Hong Kong’s CHP has a lot of experience dealing proactively with emerging infectious disease outbreaks. Their bitter experience with SARS in 2003 (see SARS And Remembrance) pretty much ensures that they take this H7N9 threat very seriously.

 

 

30 April 2013

Scientific Committee on Emerging and Zoonotic Diseases meets on risk assessment and local response to human infection of avian influenza A(H7N9) virus 

The Scientific Committee on Emerging and Zoonotic Diseases (SCEZD) of the Centre for Health Protection (CHP) of the Department of Health today (April 30) convened a meeting to assess the risk and local response in view of the recent human cases of avian influenza A(H7N9) in the Mainland.

 

The SCEZD reached a consensus view that the emergence of human infections with the novel avian influenza virus reported in the Mainland since March 31 is of concern as further human sporadic infections and expansion of geographic spread in the Mainland and other countries/areas is anticipated.

 

At the meeting, the members of the SCEZD agreed that the current epidemic strain of the avian influenza A(H7N9) virus is a novel reassortant avian influenza virus which does not cause illnesses in birds, but has gained some abilities to cross species barriers, causing sporadic poultry-to-human transmission which may result in severe disease in infected people. Genetic and epidemiological findings showed that patients are likely to be infected through exposure to infected poultry or its contaminated environment such as wet markets. However, the exact source and mode of spread still require further investigations.

 

While family clusters of infection suggest that limited human-to-human transmission may have occurred in close contacts, exposure to a common source can also be one of the explanations. Hence, the members are of the view that there is no evidence of sustained human-to-human transmission at present but the main concern is whether the virus will further adapt to enable efficient human-to-human transmission, which may result in a pandemic.

 

Turning to the local response, the SCEZD concurred with the view that the enhanced preventive and control measures for human infection with avian influenza should be continued. Surveillance for human avian influenza A(H7N9) infection is crucial. Although the risk of human-to-human transmission appears to be low, the actual risk is currently unknown and control measures, such as appropriate infection control precautions, isolation of suspected cases and quarantine of close contacts of confirmed cases, should be enforced.

 

As for treatment of patients infected with the avian influenza A(H7N9) virus, the members considered that the avian influenza A(H7N9) virus is expected to be sensitive to the neuraminidase inhibitors, oseltamivir (Tamiflu) and zanamivir (Relenza). Confirmed or highly suspected cases should receive antiviral treatment with a neuraminidase inhibitor as early as possible.

 

The SCEZD also recommends to continue intensive surveillance for avian influenza A(H7N9) virus infection in both humans and poultry/birds; maintain a high level of alert, preparedness and response for avian influenza A(H7N9) virus infection; strengthen publicity and public education on the prevention of the disease; and maintain close liaison with international and Mainland health authorities and local academics to monitor the latest developments. In addition, the SCEZD agrees that further studies should be carried out to fill the knowledge gaps and close monitoring of the progress of development of an H7N9 vaccine is required.

Ends/Tuesday, April 30, 2013

 

 

In a related press release, Hong Kong’s Health chief, Dr Leung Ting-hung, upon leaving this meeting called for strict personal and environmental hygiene in the coming months to prevent the spread of the virus.

 

Health chief urges strict hygiene

April 30, 2013

Centre for Health Protection Controller Dr Leung Ting-hung has called for strict personal and environmental hygiene, as the next six months will be critical in the development of the avian influenza A(H7N9) virus.

 

He made the appeal after today's Scientific Committee on Emerging & Zoonotic Diseases meeting, with its Chairman Prof Yuen Kwok-yung.

 

They said while the public should not be overly worried about the situation, the possibility of H7N9 being imported to Hong Kong from the Mainland cannot be ruled out, so people should maintain good personal hygiene by washing hands frequently especially before touching their eyes, nose and month, and to avoid contact with live poultry.

 

Dr Leung said the coming months will be critical in the virus' development, and it cannot be predicted whether and when it will be transmitted among humans, therefore good personal and environmental hygiene must be kept at the highest standard at all times.

 

He said measures are already in place against any possible H7N9 case spreading in Hong Kong, including stringent monitoring of suspected cases and strengthening exchange of information with international and Mainland health organisations and authorities.

 

A working group will formulate medical strategy and make suggestions to frontline doctors on how to treat such cases.

 

More manpower has been deployed to boundary checkpoints to monitor the body temperature of travellers.

 

Prof Yuen said so far the genetic and epidemiological data indicates low efficiency in human to human transmission of the virus. However, as H7N9 does not kill poultry, it has been difficult to monitor, adding public vigilance must be maintained.