Replies to LegCo questions
LC Urgent Q2: First confirmed case of human infection of avian influenza A(H7N9) in Hong Kong
Following is an urgent question by the Dr Hon Kwok Ka-ki under Rule
24(4) of the Rules of Procedure and a reply by the Secretary for Food
and Health, Dr Ko Wing-man, in the Legislative Council today (December
4):
Question:
The first case of human infection of H7N9 avian influenza in Hong Kong,
which was confirmed on the 2nd of this month, has aroused public
concern. The patient concerned had physical contact with chickens while
she was on the Mainland, where an H7N9 avian influenza epidemic broke
out during the spring season this year, resulting in 139 infected cases
in which 45 people died. In this connection, will the Government inform
this Council whether:
(a) it has assessed the risk of an immediate outbreak of H7N9 avian
influenza epidemic in Hong Kong; if it has, of the assessment results;
if not, the reasons for that;
(b) it has put in place any emergency measures to counter the H7N9 avian
influenza epidemic in case of such an outbreak, including measures to
handle local live poultry, quarantine arrangements for poultry imported
from the Mainland, epidemic prevention measures at boundary control
points (including body temperature checks, health declarations by
arriving and departing travellers, etc.), as well as issuing travel
alerts and setting up an inter-departmental working group for
coordinating efforts and conducting drills; if it has, of the conditions
under which the various measures will be implemented and their details;
if not, how the Government ensures that the epidemic will be under
control; and
(c) it has put in place any medical preparations to counter an H7N9
avian influenza epidemic, including case identification check-ups at
out-patient clinics as well as accident and emergency departments,
infection control and isolation measures in hospitals, as well as
clinical and medication guidelines; if it has, of the implementation
details; if not, the reasons for that?
Reply:
President,
On March 31, 2013, the National Health and Family Planning Commission
(NHFPC) notified the first confirmed human cases of avian influenza A
(H7N9). As at December 2, a total of 139 human cases of avian influenza
A(H7N9) have been confirmed in the Mainland across 10 provinces and 2
municipalities, including 2 cases in Guangdong. In addition, the health
authorities of Taiwan also reported one imported case from Jiangsu.
On December 2, 2013, Hong Kong confirmed the first human infection with
avian influenza A(H7N9) virus. On the day of confirmation, the
Government escalated the response level under the Preparedness Plan for
Influenza Pandemic from "Alert" to "Serious". On December 2 and 3
respectively, I chaired the Serious Response Level Steering Committee to
co-ordinate the response measures by relevant bureaux and departments.
We note that some press reports have alleged a delay in the
identification of the case of avian influenza A(H7N9). I would like to
clarify that the Hospital Authority (HA) took specimens of the patient
on November 28 and 30, 2013 respectively for preliminary rapid tests,
but the results were negative. On December 2, 2013, HA did further tests
on the patient and the results were only confirmed positive at the time.
(a) According to epidemiological and laboratory investigation, contact
with infected poultry or visiting wet markets with live poultry are
important risk factors of human infection caused by the avian influenza
A(H7N9) virus. At present, there is no evidence showing that avian
influenza A(H7N9) virus can cause sustained human-to-human transmission,
and the risk of community outbreaks remains low.
As regards the confirmed case in Hong Kong, according to our preliminary
investigation, we believe it is likely an imported sporadic case. A
number of people who have had close contact with the patient have
received rapid testing and the results so far have been negative.
We will continue to closely monitor the developments and continue to
investigate the source of infection and mode of transmission of the
case, in order to conduct risk assessment in greater detail.
(b) and (c) The Government has been adopting the Preparedness Plan for
Influenza Pandemic in taking measures for preparedness and response in
case of an influenza pandemic. The document defines the response levels,
the corresponding command structures to be set up, and measures to be
taken. To make better preparations for influenza pandemic, on-going
preventive measures adopted by the Government include:
(i) Enhanced surveillance: Influenza A(H7) is a statutorily notifiable
disease and the virus is a scheduled infectious agent under the
Prevention and Control of Disease Ordinance (Cap. 599). Any suspected or
confirmed cases are required to be notified to the Centre for Health
Protection (CHP) of the Department of Health (DH). On the other hand,
CHP works with HA and private hospitals to enhance laboratory testing.
DH also reviews its laboratory diagnostic strategy, enhances diagnostic
service capacity, stockpiles necessary reagents and strengthens liaison
with overseas counterparts on collection of updated information.
(ii) Liaison with other health authorities: All along, CHP maintains
liaison with the World Health Organization (WHO), the Mainland and
overseas health authorities to monitor the latest development, obtain
timely and accurate information from places outside Hong Kong, and will
modify local surveillance activities according to recommendations issued
by the WHO.
(iii) Enhanced port health measures: DH has implemented a series of port
health measures, including the display of posters about the disease at
all boundary control points, delivery of health leaflets to arriving
travellers coming from affected places, regular updates to the tourism
industry through meetings and correspondences, enhanced surveillance of
sick travellers and referral of suspected cases to public hospitals for
further investigation. DH will continue to monitor and follow up on
relevant recommendations on port health measures made by the WHO.
(iv) Prompt control and transparency in dissemination of results: Any
suspected case fulfilling the reporting criteria and notified to CHP
will be immediately isolated in a hospital setting. Specimens from the
patient will be sent to the Public Health Laboratory Services Branch of
CHP for testing. DH will release any positive testing results to the
public as soon as possible.
(v) Infection control in healthcare settings: DH has provided guidelines
on infection control to healthcare professionals, residential care homes
and schools. It has also organised training to provide updated
information to healthcare workers. Moreover, DH has collaborated with HA
to set up a referral mechanism for cases from private sectors. DH has
also urged the management of all private hospitals to be vigilant and to
enhance their preparedness against the disease. They are advised to
review and update the infection control guidelines and contingency plans
in view of the latest development of the disease, and to ensure
sufficient stock of personal protective equipment. Briefings for the
hospital management and the healthcare workers have been arranged to
provide them with the latest information on the disease and training on
the related infection control measures.
(vi) Enhanced risk communication: DH promulgates in press releases and
public announcements that travellers returning from affected places
presenting with respiratory symptoms are advised to wear face masks,
seek medical attention and reveal their travel and contact history to
doctors. DH also provides updates on the disease and health advice to
members of the public.
(vii) Publicity and public education: DH has organised various health
education activities and provided health advice on the prevention of the
disease, personal hygiene and environmental hygiene, targeting the
general public as well as specific sectors of the community. DH has
reminded and will continue to remind members of the public to take heed
of personal hygiene, especially washing hands. A dedicated page has been
set up on the CHP website which carries the latest information on the
disease, guidelines for different sectors of the community and health
advice. There is also a communication plan in the HA which includes
staff forums, designated infectious disease information corners,
establishment of a website etc.
(viii) Contingency plan and drills for concerted interdepartmental
actions: DH will continue to update contingency plans on major outbreaks
of infectious diseases, as well as conduct interdepartmental exercises
and drills with concerned parties and stakeholders in close partnership.
HA's designated contingency plans are in place. Since CHP was
established in 2004, it has organised 13 exercises testing the
preparedness and responsiveness of relevant departments on public health
actions.
In connection with the first confirmed case of human infection of avian
influenza A(H7N9) in Hong Kong, the Serious Response Level Steering
Committee set up under the Preparedness Plan for Influenza Pandemic held
a discussion and decided to, in addition to strengthening various
on-going measures, adopt special measures as follows:
(i) CHP has taken immediate action and successfully located 17 close
contacts and more than 200 other contacts of the first case. Seventeen
close contacts of the patient have been quarantined and prescribed with
Tamiflu prophylaxis. Close contacts without symptoms will be arranged to
stay in non-hospitalised quarantine facilities. The Lady MacLehose
Holiday Village of the Leisure and Cultural Services Department in Sai
Kung has been converted as a quarantine centre and is ready to receive
asymptomatic close contacts.
(ii) HA has also activated the Serious Response Level in public
hospitals since December 3. Frontline hospital staff at accident and
emergency departments and general outpatient clinics are reminded to
stay vigilant to patients seeking consultation at public hospitals.
Enhanced surveillance and patient triage guidelines are in place to
ensure timely reporting and early arrangement of clinical tests. More
stringent infection control measures are enforced in public hospitals,
which include restrictions on visiting. Visitors to public hospitals and
clinics are now required to put on surgical masks and perform hand
hygiene before and after visiting patient areas. An expert working group
under HA has met to discuss the treatment protocol of human infections
of avian influenza A(H7N9).
(iii) With regard to imported live poultry, in this first case of
confirmed human contraction with avian influenza A (H7N9) in Hong Kong,
the patient has reportedly visited a live bird market in Shenzhen,
slaughtered and cooked a live chicken for consumption. However, details
are not available. As a precautionary measure, we have suspended the
import of live poultry from the registered farms in Shenzhen. CHP will
continue to trace the possible source of infection of the patient. Upon
availability of further information, we will discuss with the relevant
Mainland authorities the import suspension arrangement on live poultry.
(iv) The Food and Environmental Hygiene Department (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. FEHD has also disinfected the
patient's residence.
(v) The Agriculture, Fisheries and Conservation Department (AFCD)
conducted visits to 15 local chicken farms and taken specimens for
testing on December 3. No irregularity was detected. It will conduct
visits to the remaining 15 local chicken farms today. At the same time,
AFCD 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. AFCD will continue to take samples from dead birds and
poultry for testing of avian influenza.
(vi) The confirmed case has been notified to the WHO, the NHFPC, the
health authorities of Guangdong and Macau, the General Administration of
Quality Supervision, Inspection and Quarantine of the Mainland as well
as quarantine authorities of Guangdong, Zhuhai and Macau. We have
liaised with the Shenzhen Entry-Exit Inspection and Quarantine Bureau in
paying attention to travellers and cross-boundary students who present
with fever or are symptomatic. Suspected cases will be immediately
referred to public hospitals for follow-up investigation.
(vii) In addition to a dedicated webpage, CHP has also set up a hotline
at 2125 1111 to answer the public's questions. The hotline operates from
9am to 6pm.
Thank you, President.
Ends/Wednesday, December 4, 2013
Issued at HKT 15:26
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