Replies to LegCo questions

LCQ8: Ebola virus disease

Following is a question by the Dr Hon Elizabeth Quat and a written reply by the Secretary for Food and Health, Dr Ko Wing-man, in the Legislative Council today (October 29):

Question:

It has been reported that the outbreak of Ebola virus disease (EVD) has not yet been brought under control since it erupted in West African countries in March this year, and there is a crisis of the outbreak spreading to other regions. The World Health Organization declared on August 8 this year the EVD outbreak a Public Health Emergency of International Concern. Meanwhile, Hong Kong, being an international aviation hub, is frequented by travellers from all around the world. In addition, contacts between the nationals of China and those of African countries are increasingly frequent in recent years as a result of the robust trade development between the two places, while quite a number of people of African descent are residing in the nearby Guangdong province. Thus, the risk of EVD being imported into Hong Kong should not be overlooked. In this connection, will the Government inform this Council whether:

(1) it has assessed the current risk of EVD being imported into Hong Kong; if it has assessed, of the outcome; if not, the reasons for that;

(2) it has taken appropriate measures to prevent EVD from being imported into Hong Kong in light of the latest development of the outbreak abroad; if it has, of the details, including the contingency measures to be taken by the authorities when the first confirmed case of EVD is found in Hong Kong; if not, the reasons for that;

(3) the Government has currently put in place a reciprocal notification mechanism with Guangdong authorities on the developments of EVD; if it has, of the details; if not, the reasons for that;

(4) it has assessed if Hong Kong's healthcare system is capable of coping with a local outbreak of EVD; if it has assessed, of the outcome; if not, the reasons for that; and

(5) it has conducted any inter-departmental drill to counter a local outbreak of EVD; if it has, of the details; if not, the reasons for that?

Reply:

President,

The Ebola virus disease (EVD) is caused by infection with Ebola virus. It is a severe acute viral illness, often characterised by the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding.

Ebola virus is introduced into the human population through close contact with the blood, secretions, organs or other body fluids of infected animals. It then spreads in the community through human-to-human transmission, with infection resulting from direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other body fluids of infected people, and indirect contact with environments contaminated with such fluids.

We have been closely monitoring the latest EVD outbreak in West Africa. The World Health Organization (WHO) announced on October 25, 2014 that there have been 10 141 cases, including 4 922 deaths, in Guinea, Liberia, Sierra Leone, Nigeria, Senegal, Mali, Spain and the United States. The latest case fatality rate is about 48.5%. As at October 27, 2014, the EVD affected countries include Guinea, Liberia, Sierra Leone and the Equateur province of the Democratic Republic of the Congo.

WHO convened two Emergency Committee meetings on EVD under the International Health Regulations (2005) in August and September 2014. The WHO declared on August 8, 2014 the EVD outbreak in West Africa a Public Health Emergency of International Concern, and a series of preventive and control measures were recommended for the states with Ebola transmission and other member states. In this regard, Hong Kong has established an effective and comprehensive disease prevention and response system which can identify cases of EVD, and has already adopted the preventive strategies which are in line with those recommended by the WHO.

Against the above background, my reply to the five parts of the question is as follows:

(1) The Scientific Committee on Emerging and Zoonotic Diseases (SCEZD) under the Centre for Health Protection (CHP) of the Department of Health (DH) has convened two meetings to assess the risks that the Ebola outbreak in West Africa has posed to Hong Kong, and the corresponding local response measures. The second meeting was held on October 8, 2014. The SCEZD is of the view that there is a risk of importation of EVD cases into Hong Kong due to extensive international travel. However, the SCEZD has confidence in the well-developed public health and hospital infrastructure in Hong Kong. With heightened vigilance on the part of the public and healthcare professionals, the risk of EVD spreading across the community can be reduced.

(2) The Administration has adopted the following measures to prevent the importation of EVD into Hong Kong, as well as to strengthen the local response capacity when a confirmed case of EVD is found in Hong Kong:

Enhanced surveillance

(a) Since July 2008, viral haemorrhagic fever, including EVD, has been made a statutorily notifiable disease and the virus a scheduled infectious agent under the Prevention and Control of Disease Ordinance (Cap. 599) in Hong Kong. Any suspected or confirmed cases are required to be notified to the CHP.

(b) The CHP has issued letters to doctors and private hospitals in Hong Kong a number of times to provide them with information of outbreak developments, affected areas, reporting criteria as well as recommendations on applicable infection control measures and remind them to notify the CHP of any suspected cases (i.e. patients who resided in or had travel history to the EVD affected countries within 21 days before the development of fever and onset of illness) promptly. In view of latest situation in the United States where EVD patients had low-grade fever at the early stage of infection, the CHP has revised the reporting criteria of EVD cases, lowering the body temperature of fever patients suspected of having EVD from 38 degrees Celsius to 37.5 degrees Celsius, with a view to enhancing surveillance.

(c) The CHP will initiate immediate epidemiological investigation and follow-up actions upon notification of a suspected case. Patients will be referred to the Hospital Authority (HA) Infectious Disease Centre (HAIDC) in Princess Margaret Hospital for isolation, diagnosis and treatment; and specimens will be collected from patients for laboratory testing to confirm or refute the diagnosis of EVD.

Keep in view WHO's recommendations

(d) The CHP has been paying close attention to the latest information released by the WHO and monitoring the developments overseas, and will adjust local preventive and control measures according to the WHO's recommendations.

Enhanced risk communication

(e) Apart from convening two meetings of the SCEZD to assess the risk of and local response to EVD, the DH has also chaired two interdepartmental meetings to gear up other Government departments with necessary preparation.

(f) The DH advises, via the issue of press releases/public announcements, travellers returning from EVD affected countries and presenting with compatible symptoms to call 999 and inform the staff about their condition so that arrangement for consultation in the Accident and Emergency (A&E) Department can be made. The dissemination of information on EVD will be prompt and transparent. Whenever there is a suspected case, the CHP will release information to the public as soon as possible.

Publicity and public education

(g) The DH has been closely working with its partners to provide regular updates on the latest disease situation and solicit their collaboration in disseminating health information. The partners include government bureaux/departments such as the Home Affairs Department, the Transport Department and the Housing Department; District Councils; Healthy Cities projects at the district level; and non-governmental organisations.

(h) Targeting specific groups, including the local African community, the CHP has earlier visited guesthouses in relevant buildings to deliver pamphlets, posters and health advice, followed by health talks and briefings for representatives of guesthouses in Yau Tsim Mong District as well as management companies and owners' corporations of relevant buildings.

(i) The CHP has held briefings for private hospitals, relevant government departments as well as the hotel and guesthouse industry to provide updates on the latest epidemiology of, infection control for and preparedness against EVD. Health talks have also been delivered to community organisations, hotel and guesthouse operators, public and private property management bodies and the transport sector.

(j) Health educational materials, including leaflets, pamphlets and posters, have been produced and widely distributed in the community. A dedicated webpage on EVD has been produced under the CHP website with information including disease updates, travel advice, Frequently Asked Questions and guidelines for various sectors. Information on preventive measures has also been delivered via television and radio Announcements in the Public Interest and the 24-hour health education hotline (2833 0111).

(k) Travellers have been advised to avoid unnecessary travel to the affected countries. Travel advice has been uploaded to the front page of the CHP and DH's Travel Health Service websites, as well as the Outbound Travel Alert website of the Security Bureau.

Port health measures

(l) Targeted port health measures to prevent the importation of EVD into Hong Kong have been put in place. To enhance dissemination of relevant information to travellers, DH has been delivering updated EVD related health promotion message to travellers through health leaflets and broadcasting at the Hong Kong International Airport (the Airport) and other boundary control points (BCPs), as well as the travel health website. Although currently there is no direct flights from the EVD affected countries to Hong Kong, people from these countries may arrive Hong Kong through flights originated from other places. Hence, the DH has been requesting airlines through Airline Operators Committee to conduct in-flight broadcast of health message at all incoming passenger flights to alert travellers about the disease. In addition, regular updates to the airlines, the tourism industry and relevant stakeholders at BCPs are provided through meetings, briefings and correspondences.

(m) Immigration officers at all BCPs also assist in identifying arrival passengers holding travel documents issued by the EVD affected countries and provide them with information sheets on EVD (with versions in English and in French). The information sheets remind travellers presented with the symptoms to approach port health personnel immediately upon arrival. If these travellers develop symptoms during their visit to Hong Kong, they should call 999 for arrangement of ambulance for consultation in A&E Department. To address the continued spread of the epidemic overseas, the DH has also implemented a new BCP measure on October 20, 2014 requiring travellers from the EVD affected countries arriving at the Airport to complete a "health surveillance questionnaire" voluntarily. The new measure enables healthcare staff to understand the health condition and contact history of individual incoming travellers, hence increasing the chance of identifying EVD cases.

(n) The DH has set up thermal imaging systems at BCPs to check the body temperature of all inbound travellers, and those with fever will be examined. All suspected cases identified at the Airport and other BCPs would be referred to HAIDC for further examination.

To enhance the effectiveness of response to possible risks of EVD as well as to strengthen the handling capacity when a confirmed case of EVD is found in Hong Kong, the Government announced the "Preparedness and Response Plan for Ebola Virus Disease" (the EVD Plan) on August 20, 2014 which sets out in detail the Government's preparedness and response plan for the disease (including the corresponding surveillance and prevention measures at different response levels, clear command structures, and the activation and standing down mechanism of each response level). The EVD Plan continues to uphold the established principles of reducing the risk of human infection, early detection, prompt treatment and control, and responsive risk communication. Having considered the relevant factors, the Government activated the Alert Response Level accordingly on the same day. DH, HA and the relevant departments have put in place the response strategies and prevention measures under the Alert Response Level in the EVD Plan.

(3) The CHP has been exchanging information with the National and Guangdong health authorities on EVD and its latest preventive and control measures. A point-to-point notification mechanism has also been set up with related health authorities. Should there be any EVD cases reported in the Mainland or Hong Kong, there will be a prompt exchange of information so that preventive measures are taken as early as possible.

(4) The HA has already made preparation in response to possible outbreak of EVD in Hong Kong. Having regard to the recommendations of WHO and the outbreak updates, the HA has considered the risk of the disease and the responsiveness of public hospitals, as well as adopted the strategy of "early notification, early isolation and early testing", in order to reduce the risk of spread of the disease in Hong Kong.

The HA has procured personal protective equipment (PPE), including hoods, face shields, N95 masks, water-resistant protective gowns, gloves and shoe covers, that are compatible with the WHO standard for use by frontline staff to reduce their risk of contracting the disease. The HA has stock up PPE including hoods and water-resistant protective gowns sufficient for three months' use. The HA's infection control teams have also provided infection control training to healthcare workers, including the proper procedures for gowning and de-gowning PPE, disposal of clinical waste, environmental disinfection, handling of vomits and needle stick injuries, and disposal of dead bodies. Moreover, the HA will offer targeted infection control training to the attending healthcare workers and supporting staff of the HAIDC. The training requires the staff to correctly demonstrate the recommended procedures for gowning and de-gowning of PPE, and they are required to be trained every week to get familiarised.

(5) The CHP has been maintaining communication with various government departments and conducting ground-movement drills to test the departments' preparedness and response to implementing public health actions. The CHP will soon conduct another drill on the isolation and handling of EVD patients and relevant persons, disinfection and cleansing of contaminated household, and use of PPE.

On the other hand, the HA has conducted an inter-departmental drill on September 2, 2014 with the Fire Services Department to simulate the overall procedures and measures for the conveyance and handling of suspected EVD patient. The aim of the drill was to enhance the responsiveness of frontline healthcare workers in handling cases and strengthen the notification and communication of different departments. The drill also examined the steps for doctors in A&E Department to conduct assessment of patients on ambulance, the arrangements for conveyance of a suspected case to HAIDC in Princess Margaret Hospital, and some clinical procedures in handling patients including collection of samples, environmental disinfection and disposal of dead bodies, etc.

Furthermore, the 14 A&E Departments of the HA have since August 2014 conducted several small-scale drills with the objective of familiarising the healthcare workers about channelling of patients, isolation and procedures for gowning and de-gowning PPE.

The CHP and HA will continue to conduct drills in this regard to ensure and enhance the responsiveness of healthcare and other frontline workers in handling EVD cases.

Ends/Wednesday, October 29, 2014
Issued at HKT 16:54

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