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The Controller for the Centre for Health Protection (CHP) of the Department of Health, Dr Thomas Tsang, today (September 12) presented the report of investigations into the deaths in August and earlier this month of four girls with acute febrile illness.
Dr Tsang said the combination of epidemiological, clinical and microbiological evidence did not support a common microbial agent or source for the cases.
"The most likely conclusion is that the cases were sporadic and unrelated, and there was no increase in the number of such deaths," he said.
Research into death statistics (2004-07) showed that the number of child death cases from primary infective causes in August was within historical baseline level, which ranged between 0 and five deaths per month.
The four girls, aged 3, 6, 7 and 9, passed away between August 11 and September 3.
Dr Tsang said extensive and in-depth laboratory tests were conducted on specimens taken from the cases. These tests were conducted by the CHP, the Hospital Authority, the University of Hong Kong and the Chinese University of Hong Kong.
Tests results had so far been negative in accounting for the deaths of the cases, he said.
He explained that the negative results were not unexpected given similar experience in other countries.
"It is a known fact from the medical literature that an etiological agent is not identified in many cases of encephalitis and myocarditis. This may be related to a number of factors, such as immune response, administration of antibiotics or anti-viral agents, timing of specimen collection and so on," he said.
Dr Tsang stressed that negative test results did not establish that the cases were caused by new pathogens.
He said the death of the 9-year-old girl, who developed fever on August 8 and passed away in Prince of Wales Hospital (PWH) on August 13, was likely to be related to acute viral myocarditis.
"She had a premature birth at 29-weeks complicated by respiratory distress syndrome, mild cerebral palsy with near normal neurodevelopment," he said.
As for the 7-year-old girl who was admitted to PWH on August 7 with drowsiness and convulsion and passed away on August 22, Dr Tsang said clinical and MRI (Magnetic resonance imaging) brain findings suggested acute viral encephalitis or post infectious encephalitis.
Dr Tsang said the 3-year-old girl who developed fever, cough, running nose and sore throat on August 8 and died in Kwong Wah Hospital on August 11 was found to have a very high white cell count.
"The diagnosis was fulminant sepsis," he said.
As for the 6-year-old girl who died in Pamela Youde Nethersole Eastern Hospital on September 3, Dr Tsang said post-mortem findings showed her death was probably linked to acute myocarditis.
He said the presence of host factors and underlying illnesses may have contributed at least partly to adverse outcomes in some of the girls.
Dr Tsang said the cases were not clustered in a single geographical area. The girls attended different schools and shared no common activity. Detailed epidemiological investigations revealed no common exposures among them. All family contacts and school contacts did not show similar illnesses and no secondary spread was evident.
He noted that the number of deaths from primary infective causes among children aged 9 and below living in Hong Kong during the month of August 2008 was compatible with baseline level.
"We conducted research to establish the historical pattern of child deaths from infective causes. Statistics gathered from death certificates indicated that in previous years, a normal baseline average of some 15-20 children aged 9 years or below died from primary infective causes in Hong Kong each year. The monthly number varied between 0 and 5 deaths. The major conditions were sepsis, encephalitis/encephalopathy, pneumonia, and myocarditis," he said.
While a small number of child deaths from infective causes may occur throughout the year, Dr Tsang said all child lives were precious and needed to be protected. He reminded parents and child carers to supervise children to observe personal hygienic measures to minimize the chance of infection.
"Children with acute febrile illness should not attend school until 48 hours post-defervescence. Rest is important for the recovery process and their immune system.
"In children running a fever, parents should observe closely their child's condition for signs of more serious disease. These may include persistent high fever not responding to medication, severe vomiting, decreased conscious level, breathing difficulties, convulsions, and so on. Consult a doctor immediately in such cases," Dr Tsang said.
Ends/Friday, September 12, 2008
Issued at HKT 18:36
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