Replies to LegCo questions

LCQ10: Influenza vaccination

Following is a question by the Hon Law Chi-kwong and a written reply by the Secretary for Health, Welfare and Food, Dr Yeoh Eng-kiong, in the Legislative Council today (October 8):

Question :

The World Health Organization ("WHO") has advised that vaccination is the primary means to prevent influenza and recommended that governments should provide such vaccinations for the elderly and other high risk groups. In this connection, will the Government inform this Council:

(a) of the number of elderly persons (i.e. those aged 60 or above) who were given influenza vaccinations by the Department of Health last year, and its percentage in the elderly population; whether it will provide influenza vaccination for all elderly persons and other high risk groups as recommended by WHO; if so, of the costs required; if not, the reasons for that;

(b) whether it has statistics on the amount of public health care expenditure incurred in treating influenza and its complications and the number of deaths caused by such diseases each year and assessed, on the basis of these figures, the cost-effectiveness of providing vaccinations for all elderly persons and other high risk groups; if so, of the assessment results; and

(c) whether it knows the percentage in the total population of those persons who have received influenza vaccination this year; whether it has formulated specific guidelines and programmes to be implemented by public and private medical institutions, for increasing the vaccination coverage and taking measures to ensure an adequate supply of vaccine?

Reply :

(a) As institutions are more prone to outbreak of infectious diseases, and frail elders are more susceptible to complications if they become infected with influenza, the Department of Health (DH) has since 1998 implemented an annual influenza vaccination programme for residents in residential care homes for the elderly (RCHEs). This is in accordance with the recommendations of the Advisory Committee on Immunization (Advisory Committee), which comprises infectious disease experts in paediatrics, medicine, immunology and public health from the public, private and academic sectors. The Committee reviews the current strategy on immunization and makes recommendations to the Director of Health on future directions of the immunization programmes in Hong Kong based on the best available evidence and local epidemiology of vaccine-preventable infectious diseases. In 2002, over 49,000 elders residing in RCHEs were vaccinated by DH.

In view of a possible seasonal return of the Severe Acute Respiratory Syndrome (SARS) which may coincide with the influenza peak season and the absence of a rapid and reliable diagnostic test to rule out SARS early in the course of illness, and in the light of the WHO's recommendations which were made with a risk-stratification approach and the local epidemiological situation, the Advisory Committee proposes an extension of this year's influenza vaccination programme to cover long-term residents in residential institutions for persons with disabilities. The aim is to reduce the chance of an outbreak in these institutions, the risk of post-influenza complications in the residents and subsequent admission to hospitals. It is anticipated that this year's influenza vaccination programme by DH covering institutions will achieve a coverage of about 70 000 recipients. The Hospital Authority (HA) will also provide influenza vaccination to certain groups of public hospitals in-patients who are elderly or who have certain chronic illnesses.

In addition, the Government will offer free vaccination to eligible high-risk elders outside the institutional setting who lack the means and require assistance in arranging for vaccination. These include elders aged 65 and above on Comprehensive Social Security Assistance or medical waivers granted by HA or the Social Welfare Department, and are being followed up at public clinics with chronic heart and lung diseases and assessed to be at higher risk of developing complications from influenza. Other elderly persons and persons with chronic diseases are encouraged to seek medical advice from their doctors to receive influenza vaccination for individual protection. There are also non-governmental organizations offering influenza vaccination at affordable prices.

The Advisory Committee has also advised that health workers who are occupationally exposed to a higher risk of influenza and SARS infection should receive influenza vaccination to be arranged by themselves or their employers as early as possible. In line with the Advisory Committee's recommendations, the Department of Health and the Hospital Authority will arrange influenza vaccination in the coming months for their health care staff. Employers of health care staff in the private sector and other settings should encourage their staff to receive influenza vaccination.

The costs for the above immunization programmes include vaccine cost, and staff cost and administrative backup cost of the parties concerned including DH, HA and the RCHEs. Breakdown of these costs is not available.

(b) Influenza is a type of common infectious respiratory disease. The number of deaths caused by influenza in Hong Kong is between zero and six each year. Most patients will recover in several days without medication and the severity varies among people. Not all patients will seek medical advice when falling sick with flu-like symptoms. There is no available statistics on the amount of public health care expenditure incurred in treating influenza. We are therefore unable to quantify the cost-effectiveness of providing vaccinations to elders and other high-risk groups.

However, senior citizens and the disabled living in residential institutions have a relatively higher risk of being infected by an influenza outbreak and developing complications that require hospitalized treatment. Therefore, it should be relatively more cost-effective to organise influenza vaccination programmes for this group of people.

(c) DH's vaccination programme in 2002 covered over 49,000 elders residing in RCHEs. Comprehensive figures on the number of persons who have influenza vaccination are however not available because, apart from DH and HA, the private sector also provides such vaccination services.

To better prepare the community against influenza, DH is liaising with the Hong Kong Medical Association to organise a seminar for private health care providers, and issue notices and circulars to enhance their knowledge and awareness of influenza vaccination with a view to increasing the vaccination rate among high-risk groups. DH has ordered adequate supply of vaccine for use in its free vaccination programme as outlined in part (a) above. We have been liaising with the private sector and with suppliers and understand that a substantial supply of vaccine has been procured.

End/Wednesday, October 8, 2003
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