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DH and HA update on follow-up on probable botulism cases
     The Department of Health (DH) and the Hospital Authority (HA) today (August 5) reported an update on their follow-up on 10 probable botulism cases after receiving injections since May following an additional case reported.
     The additional case affected a female patient, aged 46 with good past health, who developed slurred speech and difficulty in swallowing followed by limb weakness around July 11. She attended the Accident and Emergency Department of North District Hospital on August 3 and was admitted for management, and was also found to have facial diplegia (bilateral paralysis). The clinical diagnosis was suspected iatrogenic botulism. She has been in a stable condition.
     According to the patient, she received multiple injections suspected to be botulinum toxins over her face at a premises in Qinghu, Shenzhen, on July 8.
     In a briefing today, the Principal Medical and Health Officer of the DH, Dr Wan Yuen-kong, again warned the public that such injections should only be prescribed and performed by registered doctors. "Those who must receive injections outside Hong Kong should pay special attention to ensure that practitioners are qualified or registered with the relevant jurisdictions. If in doubt, stop receiving it immediately. Promptly consult qualified healthcare professionals if feeling unwell," he said.
     Among the 10 female patients aged from 21 to 47 since May, apart from the above additional patient currently hospitalised and a woman aged 38 reported on July 21 who declined hospital admission, all have been discharged.
     The Consultant of the Hong Kong Poison Information Centre (HKPIC) of the HA, Dr Tse Man-li, said that the 10 patients had been treated in six public hospitals from May 24 to August 3 mainly for different degrees of weakness in the neck, throat and limbs. Of note, more severe cases had difficulties in standing and walking, swallowing, speaking and breathing.
     "Antitoxin was used in three of the patients who suffered from more severe conditions to prevent further deterioration. These poisoning cases were likely due to the quality of toxins or improper injections," Dr Tse said.
     In total, eight reported that they had received injections on the Mainland - seven in Shenzhen and one in Guangzhou. No evidence has been detected at this stage that they had received injections in the same premises. Epidemiological investigations are ongoing.
     "We have been maintaining close liaison with Mainland health and drug regulatory counterparts to identify if there are similar cases. We noted that follow-up measures have been taken by the relevant Mainland health authority," Dr Wan said.
     The DH has reminded doctors and hospitals to observe information compiled by the multi-disciplinary Hong Kong Poison Control Network on the diagnosis and management of botulism following botulinum toxin injections. Clinicians should consult the HKPIC of the HA or the Poison Treatment Centre in Prince of Wales Hospital if necessary.
     The DH has stepped up publicity and public education on differentiating medical procedures from beauty services, including an Announcement in the Public Interest (API) entitled "Think twice and get the details before deciding on beauty procedures". Fact sheets with health advice on various common cosmetic procedures are available on the DH's dedicated page to alert the public to potential risks and complications.
     Patients with compatible symptoms following injections should promptly seek medical advice for diagnosis and management, while clinicians must report to the Centre for Health Protection in case of patients suspected of botulism.

     The DH urged the public to observe the health advice below before receiving botulinum toxin injections:
  • Injections should only be performed by locally registered doctors;
  • Understand the procedure, potential risks and complications before receiving botulinum toxin injections. Consult a doctor for an informed decision;
  • Do not receive an injection in case of a history of allergy to botulinum toxin, or there is infection or inflammation on the injection site;
  • Request the full name of the doctor in writing if referred by a beauty service provider for the procedure, as well as the professional qualifications and relevant experience; and
  • If symptoms develop, such as fever or feeling unwell, seek medical attention immediately.
Ends/Friday, August 5, 2016
Issued at HKT 17:00
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