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Following is a question by the Hon Mrs Anson Chan and a reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (April 9):
Question:
Last month, a rampant outbreak of influenza (flu) was suspected to have caused the deaths of three children. In view of the situation, the Government announced on the 12th of last month that the Easter holiday for all primary schools and kindergartens in Hong Kong would be advanced to start from the following day and last for two weeks. In this connection, will the Government inform this Council:
(a) for the past five years, of a breakdown of the monthly number of flu infection cases by age groups; the number of people who died of flu and associated complications each year; the number of people who received flu vaccine each year and, among them, the respective numbers of children and elderly people; the respective numbers of flu outbreaks in schools and residential homes for the elderly; and the respective numbers of flu cases confirmed by private doctors and doctors in the public medical system;
(b) given that the Secretary for Food and Health had told the media at noon on March 12 that school closure was unnecessary but then late that night he suddenly announced the advancement of the holidays for primary schools and kindergartens, of the factors considered by the authorities which led to the inconsistent decisions; the reasons for announcing the decision on school closure so late at night, which resulted in many parents, who were unaware of the authorities' decision, being unable to make appropriate arrangements; how the Government will prevent similar incidents which cause nuisance to the public from happening in the future; and
(c) of the other measures, apart from appointing an expert group to investigate the three cases of child death, to be implemented to avoid children being killed by flu?
Reply:
Madam President,
First of all, I would like to clarify the point raised in the question about the death of three children. As already mentioned in the information released by the Centre for Health Protection (CHP) under the Department of Health (DH) earlier, influenza virus was identified in two of the children, while no influenza virus was found in the remaining child. I now reply to different parts of the question.
(a) As a member of the World Health Organisation's Global Surveillance Network, Hong Kong has a comprehensive influenza surveillance system. We adopt a multi-pronged approach for influenza surveillance, which includes the setting up of sentinel surveillance systems in private and government clinics, monitoring hospital admissions, conducting laboratory surveillance, etc. From 2004 to 2007, the number of influenza-like illness(*) recorded by sentinel private doctors ranged between 30.3 and 89.5 per 1 000 consultations each year while the corresponding number at general outpatient clinics ranged between 1.4 and 19.7 per 1 000 consultations each year. Please refer to Table 1 for details.
From 2004 to 2007, the number of admissions to hospitals under the Hospital Authority (HA) due to a principal diagnosis of influenza was about 1 800 to 3 200 each year and the average admission rate was around 270 to 470 per million population. As to the age distribution, the figures vary from year to year, but in general the admission rates of elderly persons (aged 65 or above) and children (aged 14 or below) were higher. Hospital admissions and admission rates from 2004 to 2007 broken down by age groups are set out in Table 2 and Figure 1.
The Public Health Laboratory Centre (PHLC) of the DH is responsible for laboratory surveillance of influenza viruses. Out of the influenza virus samples tested, most of the viruses detected in 2003, 2004, 2005 and 2007 were influenza A (H3N2) virus while most of those detected in 2006 were influenza A (H1N1) virus. As at March 29 this year, the PHLC has conducted tests on a total of 1 974 influenza virus samples, of which the majority (971 samples) were influenza B virus. Please refer to Table 3 for details.
According to death registration statistics, the number of deaths principally caused by influenza each year from 2002 to 2006 ranged between 0 and 26 (0 in 2002, 7 in 2003, 19 in 2004, 26 in 2005 and 8 in 2006).
We do not have the total number of persons receiving influenza vaccination each year. However, the quantity of vaccines used for the annual Government Influenza Vaccination Programme (GIVP) increased from around 170 000 doses in 2003-04 to around 280 000 doses in 2007-08. In 2007-08, about 190 000 elderly persons and 2 600 children aged between 6 and 23 months from families receiving Comprehensive Social Security Assistance (CSSA) were given influenza vaccination under the GIVP. According to the information provided by vaccine importers, around 670 000 to 1.1 million doses of influenza vaccines were purchased by private doctors and private hospitals each year. Please refer to Table 4 and Table 5 for details.
From 2004 to 2007, the number of influenza outbreaks in schools ranged between 32 and 94 each year, while the corresponding number in residential care homes for the elderly (RCHEs) ranged between 9 and 162. Please refer to Table 6 for details.
Although the sentinel surveillance systems in private and public clinics are by no means representing all confirmed cases of influenza, they are able to duly reflect the overall influenza situation and trend in Hong Kong.
(b) As I mentioned at the media session in the morning of March 12, the Administration would closely monitor the influenza situation and would, in the light of the disease situation in the whole community, decide if there was a need to step up control measures. In the evening of March 12, I announced the decision for all kindergartens, kindergartens cum child care centres, primary schools and special schools to take an early Easter break, having regard to the increased number of reported influenza cases in that afternoon and the expectation that the influenza peak would continue for some time, as well as the concerns and anxiety of parents and the school management as to whether children should be allowed to attend schools. This was coupled with the fact that in the evening of March 12, influenza virus was known to have been identified in the deceased seven-year-old child, and that the CHP received increasing number of reported cases of influenza from schools in the afternoon of the same day. Having taken into account the above factors and after discussion among relevant policy bureaux and departments, we made the decision to advance the Easter break and announced the decision immediately with a view to minimising public health risk and relieve the anxiety of the school management and parents.
The decision was made as a precautionary measure, which aimed to minimise the chance for children contracting influenza in schools and allow schools to be thoroughly cleansed to ensure environmental hygiene.
The CHP under the DH will closely monitor the influenza situation in Hong Kong and provide timely data analysis and health advice. Should there be a similar incident in the future, the Administration will still notify parents and schools as early as practicable to facilitate their preparations.
(c) To prevent and control infectious diseases, the Administration will provide timely information and proper analysis to the public as soon as practicable to enhance their understanding of the disease situation. The CHP also keeps the public informed of the disease situation and trends of influenza by uploading updates to its website.
In curbing the spread of influenza so as to reduce the development of complications in infected children and the resultant child deaths, one of the CHP's key tasks is to educate the community on how to prevent and control the disease. Among other things, people who have influenza symptoms should take rest at home to prevent the spread of the disease to others. In March this year, the CHP and the Education Bureau (EDB) organised four large-scale talks on "Prevention and Control of Influenza" for schools to enhance their knowledge of prevention and control of influenza and provide a platform for schools to exchange experience.
To prepare for class resumption, apart from the guidelines on school resumption arrangements issued by the EDB, the CHP has issued to all schools up-to-date guidelines on measurement of body temperature, cleansing and disinfection, and personal hygiene. The CHP also advised the schools to deploy dedicated staff or set up a crisis management team to co-ordinate and oversee matters relating environmental hygiene of schools, to brief staff and students on influenza, and advise parents to adopt influenza prevention measures in order to prevent the spread of influenza in schools.
Note:
(*) Influenza-like illness is a clinical diagnosis. It generally refers to cases where the patient develops fever (over 38 degrees Celsius) and cough or sore throat. The illness is not equivalent to confirmed influenza.
Ends/Wednesday, April 9, 2008
Issued at HKT 16:08
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