Replies to LegCo questions
LCQ1: Prevention and control of Ebola virus disease
Following is a question by the Hon Paul Tse and a reply by the Secretary for
Food and Health, Dr Ko Wing-man, in the Legislative Council today (November 5):
Question:
It has been reported that New York City had its first confirmed case of Ebola
virus disease (EVD) infection on the 23rd of last month. Since the patient had
patronised restaurants and a bowling alley and had travelled on subway lines
during the incubation period of the virus, the authorities concerned had to
embark on a large-scale exercise to track down people who might have been
infected. With the risk of an EVD outbreak continuing to increase, the media
have pointed out that a "perfect storm" is brewing amid the impending EVD
outbreak, emerging impacts of the Occupy Central movement, sky-high property
prices which refuse to go down and gloomy global economic outlook, etc., which
may inflict a severe onslaught on Hong Kong's economy and people's livelihood.
In this connection, will the Government inform this Council:
(1) given that the arrival screenings at New York City have failed to stop the
spread of EVD to the United States, whether the Government has assessed if the
arrival screenings in Hong Kong are able to prevent the importation of EVD into
the territory; if such assessment has been made, of the details; whether it will
consider taking more stringent preventive measures;
(2) under the situation that some EVD patients are found to have travelled on
modes of public transportation such as MTR, buses and trams, etc. in Hong Kong
and/or roamed areas with a heavy flow of people, what contingency measures the
authorities have in place to track down or even quarantine a large number of
people who may have been infected without causing any public panic; and
(3) what contingency policies are available to withstand the severe onslaught of
the aforesaid perfect storm on Hong Kong's economy and people's livelihood?
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 current EVD outbreak in West Africa.
The World Health Organization (WHO) announced on October 31, 2014 that there
have been 13 567 cases, including 4 951 deaths, in Guinea, Liberia, Sierra
Leone, Nigeria, Senegal, Mali, Spain and the United States. The latest case
fatality rate is about 36.5%. Besides, WHO also reported that there have been 66
EVD cases, including 49 deaths, in the Equateur Province of the Democratic
Republic of the Congo, but these cases are not connected with the EVD outbreak
in West Africa. As at November 3, 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 measures are recommended. Hong Kong has
established an effective and comprehensive disease prevention and response
system.
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.
Against the above background, my reply to the three parts of the question is as
follows:
(1) Regarding the measures to prevent the importation of EVD, I would like to
reiterate that due to extensive international travel, the risk of importation of
EVD cases into Hong Kong does exist. One of the key measures recommended by the
WHO is for the EVD affected countries to implement stringent exit health check
to ensure that the outbound travellers are free of EVD symptoms. On the other
hand, at the local level, our main strategy is to enhance the surveillance at
boundary control points (BCPs) and locally for early detection of suspected EVD
cases for proper follow-up. Hence, the Administration has already implemented a
series of preventive measures at various aspects.
Regarding enhanced surveillance, in Hong Kong, 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 this connection, any suspected or
confirmed cases and leakage of the virus in a laboratory are required to be
notified to the Centre for Health Protection (CHP) of the Department of Health
(DH).
The CHP has issued letters to doctors and private hospitals to provide them with
information of outbreak development, EVD affected countries, reporting criteria
as well as recommendations on infection control; and remind them to notify the
CHP any suspected cases promptly. Taking into account the latest recommendations
of the WHO and epidemiological experience of overseas cases, the CHP has revised
the reporting criteria of EVD cases on October 20, lowering the body temperature
of fever patients suspected of EVD from 38 to 37.5 degrees Celsius, with a view
to enhancing surveillance over patients with low grade fever probably at the
early stage of infection of Ebola virus.
The CHP will initiate immediate investigation and follow-up measures once
notification of a suspected case is received. 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
for laboratory testing.
The DH has convened two meetings of the Scientific Committee for Emerging and
Zoonotic Diseases to assess the risk of and local response to EVD. The DH has
also convened interdepartmental meetings to gear up other Government departments
with necessary preparatory work. The CHP also arranged briefings for private
hospitals, relevant Government departments, hotel and guesthouse operators,
community organisations, public and private property management bodies and
transport operators on latest situation of EVD as well as the infection control
and response measures.
The DH promulgates in press releases that travellers returning from affected
countries presenting with compatible symptoms are reminded to call 999 and
inform the staff about their condition to arrange consultation in Accident and
Emergency Department. The dissemination of information on EVD is prompt and
transparent. Whenever there is a suspected case, the CHP will release
information to the public as soon as possible.
On port health control measures, temperature screening using thermal imaging
scanners has been in place at all boundary control points (BCPs) for all
arriving travellers. Any febrile travellers will be further assessed.
Surveillance of sick travellers has been enhanced and all suspected cases
identified at the Hong Kong International Airport (the Airport) and other BCPs
would be referred to the HAIDC for further assessment. To enhance dissemination
of relevant information to travellers, the DH has been delivering updated
EVD-related health message to travellers through health leaflets and broadcast
at the Airport and other BCPs as well as the Travel Health Service website. The
DH has requested 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.
Since August 2, 2014, Immigration officers at all BCPs have been assisting in
identifying incoming passengers holding travel documents issued by the affected
countries and providing them with information sheets about EVD and the measures
to be adopted in case they develop relevant symptoms. Moreover, a health
surveillance questionnaire was launched at the Airport on October 20. Arriving
passengers at the Airport will complete the health surveillance questionnaire if
he/she has travelled to the EVD affected countries in the past 21 days or is
holding a travel document issued by these countries. They are requested to fill
in their personal information, travel history, health status and contact history
with EVD patients. As of November 3, the DH received 199 questionnaires from
targeted travellers. None of them required referral to HAIDC for further
management.
The Administration will continue to closely monitor the latest developments of
overseas situation and communicate with the WHO as well as the Mainland and
neighbouring health authorities to exchange information, and will update local
response strategy and health surveillance if necessary.
(2) Once the notification of a suspected EVD case is received, the CHP will
initiate immediate epidemiological investigation, including contact tracing and
field investigation. CHP will also implement disease control measures in
collaboration with other government departments.
Patients with EVD are only infectious after they begin to present symptoms.
Therefore, epidemiological investigations will identify the places visited by
the patient after symptom onset for contact tracing. In general, a person who
has been exposed to a EVD patient or to his bodily fluids/secretions after the
patient has developed symptoms is regarded as a "contact". These persons will be
further classified into "close contacts" or "other contacts" based on their
nature of contact with the patients.
In Hong Kong, persons who are classified as "close contacts" of a EVD patient
will be quarantined at a designated site for 21 days counting from the day of
last contact with the patient. Persons who are classified as "other contacts"
will be put under active medical surveillance for 21 days during which CHP will
contact them regularly to enquire their health status. If they develop relevant
symptoms of EVD during this period, they will immediately be transferred to
HAIDC for treatment. After the initial 21 days, they will still be instructed to
monitor their health condition closely in the following 21 days and to report
immediately to the CHP if they develop symptoms.
Epidemiological investigation will also identify places or substances that are
contaminated by the patient after symptom onset. Disinfection of the patient's
home will be conducted by the staff of the Food and Environmental Hygiene
Department. For public areas/ workplace contaminated by the patient, the CHP
will instruct the management to perform proper disinfection. Guidelines for the
public transport sector and properties management, including instructions on
environmental cleansing and disinfection, have been published by the CHP and are
available at CHP's website.
(3) Whilst there is a risk of importation of EVD cases into Hong Kong, I have
confidence in the well-developed public health and hospital infrastructure in
Hong Kong, as well as the series of preventive and control measures adopted by
the Government. With heightened vigilance on the part of the public and
healthcare professionals, the risk of EVD spreading across the Hong Kong
community can be effectively reduced. As regards the development of the Occupy
Central movement, changes in property prices and global economic outlook, etc.,
these are matters closely connected with the Hong Kong's economy and people's
livelihood. The relevant bureaux and departments of the Government will closely
monitor the relevant development, and make timely consideration according to the
actual situations of the economy and livelihood of the society.
Ends/Wednesday, November 5, 2014
Issued at HKT 15:17
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