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

 

Dr. Ko Wing-man  SFH

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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: Dr. Ko Wing-man On H7N9 Threat

 

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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.

Hong Kong: SFH On H7N9 Biosecurity & Surveillance

 

The Secretary for Food and Health, Dr Ko Wing-man (right), visits the Cheung Sha Wan Temporary Wholesale Poultry Market this morning (April 8) to inspect the implementaion of enhanced surveillance and control measures in view of confirmed human cases of Influenza A (H7N9) on the Mainland. – Credit HK Govt.

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As the surveillance and epidemiological investigations continue in Easter China for the H7N9 virus, Hong Kong officials continue to monitor the situation, and work on possible counter measures.

 

One indication of the seriousness with which this virus is being taken are the masks being worn by just about everyone in the photo above, even though the virus has yet to be detected in Hong Kong.

 

Hong Kong’s SFH (Secretary of Food & Health) Dr. Ko Wing-man made the following comments after inspecting a local poultry market on the morning of April 8th.

 

SFH on preventive and surveillance measures Against human cases of Influenza A (H7N9) (with photos)

Following is the transcript of remarks made by the Secretary for Food and Health, Dr Ko Wing-man, after inspecting Cheung Sha Wan Temporary Wholesale Poultry Market this morning (April 8):

Secretary for Food and Health: The experts from the Agriculture, Fisheries and Conservation Department, as well as the Food and Environmental Hygiene Department, met with experts from the Mainland authorities yesterday. The meeting agreed that starting from Thursday both sides would enhance the surveillance work on poultry, particularly the live poultry imported into Hong Kong. We will take samples from poultry imported into Hong Kong upon their entry at the Man Kam To Control Point for rapid tests of H5 avian influenza (AI) and H7 AI. When these live poultry arrive at Cheung Sha Wan Temporary Wholesale Poultry Market, they will be held here until the results of the rapid tests demonstrate that they are negative for H5 AI and H7 AI. They will then be released to the market for sale.

Reporter: (On when the Government will upgrade our preparedness to serious response level.)

Secretary for Food and Health: According to our contingency plan for influenza outbreaks (the Government Preparedness Plan for Influenza Pandemic) including avian influenza outbreaks, when we detect any poultry in Hong Kong positive for H7N9 avian flu, or any human infection of H7N9 is established in Hong Kong, we will escalate the contingency plan to a serious response level. At the same time, we will also carry out partial or total culling of live poultry in Hong Kong as well as suspending the import of live poultry into Hong Kong.

Reporter: Are there any measures to stop wild birds from infecting poultry here?

Secretary for Food and Health: You can see that the storage place for live poultry overnight (in the Cheung Sha Wan Temporary Wholesale Poultry Market) is protected by nets. There are adequate biosecurity measures in this wholesale market to guard against the wild birds spreading the H7N9 virus to our poultry.

 

 

Meanwhile, Xinhua News has a report on the meeting between Hong Kong and the Mainland Authorities held on Sunday.

 

HK, Mainland step up surveillance against H7N9 virus

2013-04-08 16:58:04

HONG KONG, April 8 (Xinhua) -- Chinese Mainland, Hong Kong and Macao officials decided at a meeting in the southern coast city of Zhuhai to step up surveillance of live poultry and poultry products bound for Hong Kong, by increasing the sample size and frequency of farm inspections, according to a Monday's release by the city's Information Service Department.

 

Representatives of concerned departments from Hong Kong and Macao met with representatives of the Chinese General Administration of Quality Supervision, Inspection & Quarantine, and those in charge of inspection and quarantine for Guangdong, Shenzhen, Zhuhai, Hainan, and Macao on Sunday.

 

The meeting was called in response to the H7N9 avian influenza outbreak affecting people in the eastern region of the Mainland, and to ensure the safety of live poultry and poultry products supplied to Hong Kong.

 

To strengthen prevention and control measures against the virus, testing methods will be developed, testing standards and results will be validated, and technical training will be provided, the meeting decided.

 

Since 2010, all live poultry and poultry products bound for Hong Kong have been tested for H5 and H7 avian influenza, and all 570,000 specimens have tested negative.

 

Hong Kong will soon begin conducting tests for H7 avian influenza in imported live poultry. Over 18,000 dead birds and 15,000 other specimens have been tested in the past three years, and no cases of the virus have been found.

 

The city's government will continue to work closely with Mainland authorities and keep them informed of any infected birds, in which case poultry will be culled and Mainland poultry imports suspended to minimize the risk of an outbreak in Hong Kong.

Hong Kong: H2H Transmission Risk `Low’ – SFH

SFH Briefing On H7N9 April 5th – Credit HK Govt

 

 

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Although no one is taking the outbreak of H7N9 in China lightly, and there remains much about this virus we obviously do not know, for now the number of reported cases remains low (n=16) and there are no obvious signs of sustained human-to-human transmission.

 

That is not to say that H2H transmission has not occurred (officials are investigating of a couple of `suspected clusters’), and there may well be undiagnosed cases circulating in the community.

 

Events, or at least our knowledge of them, are apt to change quickly and often over the next few days and weeks. 

 

For now, while we know very little about the sensitivity or specificity of the H7N9 tests being used, the lack of reports of secondary infections among close contacts of those known to be infected have been reassuring. 

 

That said, influenza viruses are constantly evolving.

 

If this virus isn’t transmitting well between humans today, that happy state of affairs may not hold true tomorrow, next week, or next month. The sudden appearance of H7N9  in humans (see chart below) is ample proof of how quickly a flu virus can change behavior.

 

Dr. Ian MacKay’s Terrific Timeline of Human Cases - VDU

 

Which helps explain why the ECDC, CDC, World Health Organization, and Hong Kong’ Centre for Health Protection are viewing these events so seriously.

 

While getting accurate and timely reports out of China can sometimes be difficult, I believe we can get our best idea of the current threat level based on how Hong Kong officials react each day.

 

Arguably, no city was hit harder during the 2003 SARS outbreak (see SARS And Remembrance) – and their Centre for Health Protection (which was created as a result of that epidemic) - has a reputation for taking an open and proactive stance against communicable disease threats.

 

This report on statements this morning from Hong Kong’s Secretary of Food & Health – Dr. Ko Wing-man – are from news.gov.hk.

 

 

Human-to-human bird flu spread risk 'low'

April 06, 2013

Secretary for Food & Health Dr Ko Wing-man says the Government has assessed the risk of human-to-human transmission of the new H7N9 avian influenza virus to be low since most infected patients have had contact with poultry.

 

Speaking to the media after attending a radio programme this morning, Dr Ko said the Department of Health, the Centre for Health Protection, the Hospital Authority, the Food & Environmental Hygiene Department and the Agriculture, Fisheries & Conservation Department conducted an internal risk assessment yesterday.

 

He said their assessment is that the risk of human-to-human transmission of the virus is still low.

 

Most of the infected patients have a history of contact with poultry and therefore a prevention strategy will focus on poultry control, he said.

 

“That is why we have arranged a meeting with the Mainland authorities to introduce an H7 [avian influenza] rapid test on poultry imported from the Mainland as well as those within Hong Kong,” Dr Ko said.

 

He said the Government will also strengthen control at immigration checkpoints, and additional staff will be deployed to reinforce the body temperature checks for incoming passengers.

 

After the SARS outbreak in 2003, public hospitals have enhanced their isolation facilities capacity, he said.

 

The authority has 1,400 isolation beds, he said, adding this is in line with a strategy to identify and isolate suspected cases early and carry out rapid testing as soon as possible.

Hong Kong: Statement By SFH On H7N9 Surveillance Efforts

 

The Secretary for Food and Health, Dr Ko Wing-man (10th right) briefs the Chief Secretary, Mrs Carrie Lam (centre), and representatives from various bureaux and departments this afternoon (April 5) on the latest development of the human cases of Influenza A (H7N9) in the Mainland and the enhanced surveillance and control measures in Hong Kong. – Credit HK Govt.

 

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A lengthy statement this morning from Hong Kong’s Secretary for Food and Health (SFH), Dr. Ko Wing-man, on their ongoing efforts at preventing introduction of the H7N9 virus to their region.

 

 

 

SFH on preventive and surveillance measures against human cases of Influenza A (H7N9)

 

Secretary for Food and Health: This morning, I convened a meeting with staff of the Department of Health, the Hospital Authority (HA), the Agriculture, Fisheries and Conservation Department, as well as the Food and Environmental Hygiene Department to discuss the spread of the H7N9 virus in the eastern part of the Mainland and to review our corresponding preventive and surveillance measures. This afternoon, I briefed the Chief Secretary and representatives from various bureaux and departments on the latest development and our preparedness and response plan. The Chief Secretary has requested all bureaux and departments to work closely together and reiterated that the Government will provide all necessary resources and manpower to support the work.

 

Hong Kong currently remains at the alert level according to the risk assessment having regard to the development of the latest situation in the eastern part of the Mainland. However, we would take the following additional measures to further enhance Hong Kong's preparedness.

 

The Administration has been conducting H7 avian influenza (AI) testing for wild bird carcasses and samples taken from local chicken farms, poultry wholesale and retail markets. In the past three years, we have not detected any H7 AI virus in these specimens.

 

At present, all live poultry from the Mainland comes from registered poultry farms in Guangdong Province, Shenzhen, Zhuhai and Hainan Province. Provinces and cities in the eastern part of the Mainland where H7N9 human cases were found do not export any live poultry or poultry products to Hong Kong. Should any poultry be found to be infected with H7 or, for that matter, H5 AI, we will put in place additional measures according to the recommendation of the World Organisation for Animal Health. This will include the suspension of import of Mainland poultry as well as culling of local poultry.

 

The Department of Health will also step up the temperature checking and surveillance at the immigration control points. Starting from tomorrow, extra manpower from the Auxiliary Medical Services and the Civil Aid Service, as well as the Health Surveillance Assistants, will be deployed to all immigration control points to conduct random temperature checking on travellers by using handheld temperature devices, in addition to the whole-body infrared temperature scanners.

 

The HA has also stepped up the infection control measures in hospitals. A team of experts from the HA arrived in Shanghai yesterday to have exchanges with the experts there on the treatment and surveillance of Influenza A (H7N9). The delegation will return to Hong Kong this evening. Once they have returned to Hong Kong, they will be ready to give a briefing on the result of the study.

 

Reporter: Do you see any sign of widespread outbreaks in the Mainland, in particular in the eastern part?

Secretary for Food and Health: Up to this moment, we know that the Mainland authority has been very active in investigating the source of the outbreak. So far, it was reported that the virus was found in pigeons and therefore the Municipal Government of Shanghai city has taken corresponding measures. In the coming days, it will be expected that more cases might be reported.

 

Reporter: The Government is stepping up a series of measures to protect Hong Kong from the new virus. Does it mean that Hong Kong is under a very serious level of attack?

Secretary for Food and Health: We ought to be prepared mainly because of the fact that, firstly, the Influenza A (H7N9) has caused a relatively high mortality among the infected patients up to this moment. Secondly, the outbreak has been extending or worsening in these two or three days in the eastern part of the Mainland. That is why there is every reason for us to step up the infection control preparedness. Thank you.