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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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