Replies to LegCo questions

LC Urgent Q1: Winter influenza peak season

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 (February 4):

Question:

It has been reported that the influenza epidemic in Hong Kong since the onset of the winter influenza season at the end of last year has been more severe than previous years. As of the end of last month, there were already 81 influenza-associated deaths and one of the deceased was a young person aged only 38. However, some members of the public have pointed out that they are unable to obtain the latest information on the epidemic on a daily basis through government channels at present and the ineffective flow of epidemic-related information is not conducive to containing the epidemic. In this connection, will the Government inform this Council:

(1) whether the Government will immediately strengthen the existing work relating to the dissemination of information on the influenza epidemic, including daily publication of information on the situation of various relevant target services provided by public hospitals and data on the influenza epidemic (including the number of influenza-associated hospitalisations that require admission to the intensive care units and the number of deaths, etc.) through press releases and government web sites during the peak of the influenza season;

(2) given that the vaccine targeting the H3N2 Switzerland influenza strain will only be available in sufficient numbers in March or April this year, whether the authorities have put in place immediate measures to ensure that prior to the supply of the vaccine in sufficient numbers, there are sufficient resources in public hospitals (such as the general wards, accident and emergency departments, infectious disease wards, intensive care units, extracorporeal membrane oxygenation machines, etc.) to cope with a major outbreak of influenza; if so, of the details of the various measures and the manpower and other resources involved; if not, whether they will immediately formulate such measures; and

(3) whether it has formulated other contingency measures for coping with a major outbreak of influenza, such as the introduction of preventive measures at community level, the formulation of clinical and medication guidelines for treating influenza patients and the implementation of class suspension arrangements at schools, etc.; if so, of the details of such measures; if not, whether it will immediately formulate such measures?

Reply:

President,

Hong Kong usually experiences two influenza peak seasons every year – one between January and March and the other in July and August. The 2014/15 winter influenza season arrived in late December 2014. The activity of seasonal influenza has continued to increase since then and rapidly reached a high level in mid to end of January.

The Centre for Health Protection (CHP) closely monitors influenza activity in the community through its surveillance systems covering childcare centres, residential care homes for the elderly, the Hospital Authority (HA)'s out-patient clinics and Accident and Emergency Departments, and clinics of private practitioners and Chinese medicine practitioners. Besides, CHP monitors the positive influenza detections among respiratory specimens received by its Public Health Laboratory Services Branch.

To monitor the severity of admitted influenza cases, the CHP, in collaboration with the HA and private hospitals, has been operating an enhanced surveillance system during influenza seasons. From noon January 2, 2015 to noon February 3, 2015, the CHP recorded 178 intensive care unit (ICU) admissions or deaths (including 111 deaths) with laboratory diagnosis of influenza for patients aged 18 years or above. 163 cases were influenza A(H3N2), five were influenza B and 10 were influenza A pending subtype. Among the cases mentioned above, 147 cases (82.6%) and 101 deaths (91.0%) involved elderly persons aged 65 or above. Separately, 11 paediatric cases of severe influenza associated complications with no deaths were recorded in the same period, amongst which 10 were influenza A(H3N2) and one was influenza A pending subtype. Among the severe cases reported in this season, about 85% so far were known to have underlying chronic illnesses.

According to the World Health Organization (WHO), an antigenically drifted H3N2 strain, from A/Texas/50/2012 (i.e. vaccine strain recommended by the WHO for the Northern Hemisphere 2014/15 season) to A/Switzerland/9715293/2013, has been observed. Locally, over 95% of the circulating H3N2 viruses also belonged to this drifted H3N2 strain. The mismatch of the circulating and vaccine strain of H3N2 may reduce the vaccine effectiveness for H3N2, but it is expected that the seasonal influenza vaccines would afford a certain degree of cross-protection against different but related strains, and also reduce the likelihood of severe outcomes such as hospitalisations and deaths, particularly for high-risk groups. As such, vaccination remains one of the important means to prevent influenza.

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

(1) The CHP is transparent and timely in the dissemination of information. Influenza surveillance data are uploaded to the CHP website every week (www.chp.gov.hk/en/view_content/14843.html). Such data are also summarised in the weekly on-line publication 'Flu Express' (www.chp.gov.hk/en/guideline1_year/29/134/441/304.html). Moreover, timely alerts are issued via press releases. For this influenza season, more than 20 press releases have been issued regarding surveillance data, outbreaks and severe paediatric influenza associated infections since the end of December 2014. Since February 2, the CHP has further stepped up information dissemination by providing daily update on the latest situation of severe influenza cases on the CHP website.

Furthermore, the CHP has issued notices to doctors, hospitals, kindergartens, child care centres, primary and secondary schools as well as residential care homes for the elderly and the disabled to alert them about the latest influenza situation.

(2) HA has already drawn up an overall response plan before the start of the surge in service demand during influenza season, and has been closely monitoring the service provision situation. In response to the surge in service demand since January 2015, HA and different clusters have deliberated and devised further response measures.

On hospital beds, to meet the continuously increasing service demand, HA has opened 205 additional beds in 2014-15, and will open 250 additional beds in 2015-16. To further increase the service capacity to cope with the influenza season, HA has opened a total of 282 additional beds on a time limited basis for 6 months from December 2014 during the influenza period. Since the demand for inpatient service has increased sharply in the past month, there have been insufficient beds in medical wards. Various clusters have, with regard to the actual demand and manpower situation, further augmented capacity through deploying beds among specialties and adding temporary beds in the existing medical wards as far as possible. If service demand rises further, HA will consider reducing non-urgent surgery to reserve beds and manpower to deal with the needs of seasonal influenza patients. Nevertheless, cancer surgery, urgent heart surgery and surgery involving body parts and important organs will not be affected.

To relieve pressure on A&E, HA had increased the quota for general outpatient clinics (GOPC) by 560 during Christmas in 2014 and will further increase the GOPC quota by 1,486 in the Chinese New Year. The above additional quota represents an increase of 14% and 30% of service capacity in the respective period.

As for infection control, HA has recommended the wearing of surgical masks by all healthcare workers and visitors upon entering the patient care area during the influenza peak period. HA has also put in place standard and droplet precaution measures for patients with influenza symptoms to prevent the spread of diseases in hospitals. HA has urged healthcare workers, patients and visitors to strengthen the hand hygiene, and to promote influenza vaccination to healthcare workers and eligible patient groups. Each cluster will arrange Vaccination Mobilisation Teams to provide influenza vaccines to staff at their workplace and at a time that is convenient to them. HA has also established a referral mechanism in 2014-15 to encourage eligible inpatient to have vaccine injection in outpatient clinics after discharge.

(3) Regarding prevention and control measures in the community, the CHP has produced a variety of health education materials on the prevention of influenza including a thematic web page, television and radio announcements in public interests (APIs), guidelines, pamphlets, posters, booklets, FAQs and exhibition boards. Various publicity and health education channels e.g. websites, television and radio stations, health education hotline, newspapers and media interviews have been deployed for promulgation of health advice. The CHP has also widely distributed the health education materials in public and private housing estates, health care settings, schools and non-governmental organisations, etc. The main message is to advise the public to maintain good personal and environmental hygiene against influenza, such as putting on a surgical mask when respiratory symptoms develop to avoid spreading the infections to others; avoid going to crowded or poorly ventilated public places when influenza is prevalent, and high-risk groups should consider wearing a surgical mask especially when staying in crowded places.

Moreover, the CHP keeps the stakeholders updated of the latest influenza activity and preventive measures, and solicits their co-ordination and support to strengthen the related health messages.

Regarding institutional and school outbreaks of influenza-like illness (ILI), the CHP conducts prompt epidemiological investigations, implements necessary public health control measures and provides appropriate health advice to the institutions concerned. Following field investigations, the CHP continues to closely monitor the institutions to ascertain that the outbreak of ILI is under control.

There are a spectrum of public health measures that are effective in controlling influenza transmission. The Government will consider a host of factors, such as the type of virus and the ability of the virus to cause disease, the sick leave rate, hospitalisation rate, number of affected persons with severe infection, etc., in considering the most appropriate public health measures to be deployed. The CHP will base on the situation of seasonal influenza outbreak in individual schools and institutions, such as the incident rate, number of affected persons with severe infection, etc., to adopt different response measures and provide advices to the institutions. The CHP will closely monitor the latest situations to consider whether there is a need to implement class suspension arrangements at schools.

Ends/Wednesday, February 4, 2015
Issued at HKT 19:17

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