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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 (December 4):
Question:
The first case of human infection of H7N9 avian influenza in Hong Kong, which was confirmed on the 2nd of this month, has aroused public concern. The patient concerned had physical contact with chickens while she was on the Mainland, where an H7N9 avian influenza epidemic broke out during the spring season this year, resulting in 139 infected cases in which 45 people died. In this connection, will the Government inform this Council whether:
(a) it has assessed the risk of an immediate outbreak of H7N9 avian influenza epidemic in Hong Kong; if it has, of the assessment results; if not, the reasons for that;
(b) it has put in place any emergency measures to counter the H7N9 avian influenza epidemic in case of such an outbreak, including measures to handle local live poultry, quarantine arrangements for poultry imported from the Mainland, epidemic prevention measures at boundary control points (including body temperature checks, health declarations by arriving and departing travellers, etc.), as well as issuing travel alerts and setting up an inter-departmental working group for coordinating efforts and conducting drills; if it has, of the conditions under which the various measures will be implemented and their details; if not, how the Government ensures that the epidemic will be under control; and
(c) it has put in place any medical preparations to counter an H7N9 avian influenza epidemic, including case identification check-ups at out-patient clinics as well as accident and emergency departments, infection control and isolation measures in hospitals, as well as clinical and medication guidelines; if it has, of the implementation details; if not, the reasons for that?
Reply:
President,
On March 31, 2013, the National Health and Family Planning Commission (NHFPC) notified the first confirmed human cases of avian influenza A (H7N9). As at December 2, a total of 139 human cases of avian influenza A(H7N9) have been confirmed in the Mainland across 10 provinces and 2 municipalities, including 2 cases in Guangdong. In addition, the health authorities of Taiwan also reported one imported case from Jiangsu.
On December 2, 2013, Hong Kong confirmed the first human infection with avian influenza A(H7N9) virus. On the day of confirmation, the Government escalated the response level under the Preparedness Plan for Influenza Pandemic from "Alert" to "Serious". On December 2 and 3 respectively, I chaired the Serious Response Level Steering Committee to co-ordinate the response measures by relevant bureaux and departments. We note that some press reports have alleged a delay in the identification of the case of avian influenza A(H7N9). I would like to clarify that the Hospital Authority (HA) took specimens of the patient on November 28 and 30, 2013 respectively for preliminary rapid tests, but the results were negative. On December 2, 2013, HA did further tests on the patient and the results were only confirmed positive at the time.
(a) According to epidemiological and laboratory investigation, contact with infected poultry or visiting wet markets with live poultry are important risk factors of human infection caused by the avian influenza A(H7N9) virus. At present, there is no evidence showing that avian influenza A(H7N9) virus can cause sustained human-to-human transmission, and the risk of community outbreaks remains low.
As regards the confirmed case in Hong Kong, according to our preliminary investigation, we believe it is likely an imported sporadic case. A number of people who have had close contact with the patient have received rapid testing and the results so far have been negative.
We will continue to closely monitor the developments and continue to investigate the source of infection and mode of transmission of the case, in order to conduct risk assessment in greater detail.
(b) and (c) The Government has been adopting the Preparedness Plan for Influenza Pandemic in taking measures for preparedness and response in case of an influenza pandemic. The document defines the response levels, the corresponding command structures to be set up, and measures to be taken. To make better preparations for influenza pandemic, on-going preventive measures adopted by the Government include:
(i) Enhanced surveillance: Influenza A(H7) is a statutorily notifiable disease and the virus is a scheduled infectious agent under the Prevention and Control of Disease Ordinance (Cap. 599). Any suspected or confirmed cases are required to be notified to the Centre for Health Protection (CHP) of the Department of Health (DH). On the other hand, CHP works with HA and private hospitals to enhance laboratory testing. DH also reviews its laboratory diagnostic strategy, enhances diagnostic service capacity, stockpiles necessary reagents and strengthens liaison with overseas counterparts on collection of updated information.
(ii) Liaison with other health authorities: All along, CHP maintains liaison with the World Health Organization (WHO), the Mainland and overseas health authorities to monitor the latest development, obtain timely and accurate information from places outside Hong Kong, and will modify local surveillance activities according to recommendations issued by the WHO.
(iii) Enhanced port health measures: DH has implemented a series of port health measures, including the display of posters about the disease at all boundary control points, delivery of health leaflets to arriving travellers coming from affected places, regular updates to the tourism industry through meetings and correspondences, enhanced surveillance of sick travellers and referral of suspected cases to public hospitals for further investigation. DH will continue to monitor and follow up on relevant recommendations on port health measures made by the WHO.
(iv) Prompt control and transparency in dissemination of results: Any suspected case fulfilling the reporting criteria and notified to CHP will be immediately isolated in a hospital setting. Specimens from the patient will be sent to the Public Health Laboratory Services Branch of CHP for testing. DH will release any positive testing results to the public as soon as possible.
(v) Infection control in healthcare settings: DH has provided guidelines on infection control to healthcare professionals, residential care homes and schools. It has also organised training to provide updated information to healthcare workers. Moreover, DH has collaborated with HA to set up a referral mechanism for cases from private sectors. DH has also urged the management of all private hospitals to be vigilant and to enhance their preparedness against the disease. They are advised to review and update the infection control guidelines and contingency plans in view of the latest development of the disease, and to ensure sufficient stock of personal protective equipment. Briefings for the hospital management and the healthcare workers have been arranged to provide them with the latest information on the disease and training on the related infection control measures.
(vi) Enhanced risk communication: DH promulgates in press releases and public announcements that travellers returning from affected places presenting with respiratory symptoms are advised to wear face masks, seek medical attention and reveal their travel and contact history to doctors. DH also provides updates on the disease and health advice to members of the public.
(vii) Publicity and public education: DH has organised various health education activities and provided health advice on the prevention of the disease, personal hygiene and environmental hygiene, targeting the general public as well as specific sectors of the community. DH has reminded and will continue to remind members of the public to take heed of personal hygiene, especially washing hands. A dedicated page has been set up on the CHP website which carries the latest information on the disease, guidelines for different sectors of the community and health advice. There is also a communication plan in the HA which includes staff forums, designated infectious disease information corners, establishment of a website etc.
(viii) Contingency plan and drills for concerted interdepartmental actions: DH will continue to update contingency plans on major outbreaks of infectious diseases, as well as conduct interdepartmental exercises and drills with concerned parties and stakeholders in close partnership. HA's designated contingency plans are in place. Since CHP was established in 2004, it has organised 13 exercises testing the preparedness and responsiveness of relevant departments on public health actions.
In connection with the first confirmed case of human infection of avian influenza A(H7N9) in Hong Kong, the Serious Response Level Steering Committee set up under the Preparedness Plan for Influenza Pandemic held a discussion and decided to, in addition to strengthening various on-going measures, adopt special measures as follows:
(i) CHP has taken immediate action and successfully located 17 close contacts and more than 200 other contacts of the first case. Seventeen close contacts of the patient have been quarantined and prescribed with Tamiflu prophylaxis. Close contacts without symptoms will be arranged to stay in non-hospitalised quarantine facilities. The Lady MacLehose Holiday Village of the Leisure and Cultural Services Department in Sai Kung has been converted as a quarantine centre and is ready to receive asymptomatic close contacts.
(ii) HA has also activated the Serious Response Level in public hospitals since December 3. Frontline hospital staff at accident and emergency departments and general outpatient clinics are reminded to stay vigilant to patients seeking consultation at public hospitals. Enhanced surveillance and patient triage guidelines are in place to ensure timely reporting and early arrangement of clinical tests. More stringent infection control measures are enforced in public hospitals, which include restrictions on visiting. Visitors to public hospitals and clinics are now required to put on surgical masks and perform hand hygiene before and after visiting patient areas. An expert working group under HA has met to discuss the treatment protocol of human infections of avian influenza A(H7N9).
(iii) With regard to imported live poultry, in this first case of confirmed human contraction with avian influenza A (H7N9) in Hong Kong, the patient has reportedly visited a live bird market in Shenzhen, slaughtered and cooked a live chicken for consumption. However, details are not available. As a precautionary measure, we have suspended the import of live poultry from the registered farms in Shenzhen. CHP will continue to trace the possible source of infection of the patient. Upon availability of further information, we will discuss with the relevant Mainland authorities the import suspension arrangement on live poultry.
(iv) The Food and Environmental Hygiene Department (FEHD) has stepped up cleansing and disinfection of retail outlets for live poultry, as well as enhanced inspection to ensure strict compliance with the rule against overnight stocking of live poultry. FEHD has also disinfected the patient's residence.
(v) The Agriculture, Fisheries and Conservation Department (AFCD) conducted visits to 15 local chicken farms and taken specimens for testing on December 3. No irregularity was detected. It will conduct visits to the remaining 15 local chicken farms today. At the same time, AFCD will continue to inspect the poultry wholesale market, Yuen Po Street Bird Garden and pet bird shops etc. to ensure that the birds are in healthy and normal condition. It has also issued letters to the trade reminding them to stay alert and strictly follow the biosecurity and hygiene measures. AFCD will continue to take samples from dead birds and poultry for testing of avian influenza.
(vi) The confirmed case has been notified to the WHO, the NHFPC, the health authorities of Guangdong and Macau, the General Administration of Quality Supervision, Inspection and Quarantine of the Mainland as well as quarantine authorities of Guangdong, Zhuhai and Macau. We have liaised with the Shenzhen Entry-Exit Inspection and Quarantine Bureau in paying attention to travellers and cross-boundary students who present with fever or are symptomatic. Suspected cases will be immediately referred to public hospitals for follow-up investigation.
(vii) In addition to a dedicated webpage, CHP has also set up a hotline at 2125 1111 to answer the public's questions. The hotline operates from 9am to 6pm.
Thank you, President.
Ends/Wednesday, December 4, 2013
Issued at HKT 15:26
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