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LCQ2: Seasonal influenza vaccination
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     Following is a question by the Hon Chan Han-pan and a reply by the Secretary for Food and Health, Professor Sophia Chan, in the Legislative Council today (January 31):

Question:

     The Government implements the Government Vaccination Programme and the Vaccination Subsidy Scheme annually to provide free or subsidised seasonal influenza vaccination to groups which are at a higher risk of infection (e.g. children and the elderly).  It has been reported that Hong Kong is now in the peak season of influenza and there have been sporadic outbreaks of influenza in the community and schools, resulting in the bed occupancy rates of many public and private hospitals reaching or even going beyond their capacities.  In this connection, will the Government inform this Council:

(1) whether it knows the number of people diagnosed with influenza and, among them, the number of those who had received influenza vaccinations within six months before contracting the disease, in each of the past five years; whether the Government has examined the reasons for some members of the public contracting influenza even after they had received vaccinations; if so, of the outcome;

(2) of the percentage of the number of people who received influenza vaccination in the population in each of the past five years; whether the Government has reviewed the effectiveness of the aforesaid programme and scheme in preventing or reducing influenza outbreaks in the community and schools; if so, of the outcome; and

(3) as it has been reported that as of the middle of this month, the paediatric inpatient bed occupancy rates of most of the public and private hospitals have reached or even gone beyond their capacities, e.g. the relevant occupancy rate of Tuen Mun Hospital was once as high as 225%, and since the overcrowdedness of wards will increase the risk of cross-infection among inpatient children, of the Government's immediate counter-measures to address the shortage of hospital beds in paediatric wards?

Reply:

President,

     Vaccination is one of the effective means to prevent seasonal influenza and its complications, and can reduce the risks of influenza-associated hospitalisation and mortality. Hence, the Government has all along been encouraging the public to receive seasonal influenza vaccination as early as possible.  It also provides subsidised or free seasonal influenza vaccination for eligible groups who are generally at a higher risk of severe complications or even death caused by influenza, or spreading the infection to those at high risk (please refer to Annexes 1 and 2 for details).  In 2017/18, the influenza vaccines procured and used under various influenza vaccination programmes in Hong Kong are those recommended by the World Health Organization (WHO) for use in the northern hemisphere.

     In consultation with the Centre for Health Protection (CHP) of the Department of Health and the Hospital Authority (HA), I provide a consolidated reply to three parts of the question as follows:

(1) For healthy individuals, influenza is usually self-limiting with recovery within a week.  The majority of infected cases in the community are not tested and confirmed.  Given its prevalent nature, seasonal influenza is not a statutory notifiable disease in Hong Kong.  Hence, the CHP does not maintain statistics on the total number of people diagnosed with influenza in the community.

     Nevertheless, the CHP conducts routine surveillance of cases of paediatric influenza-associated severe complication or death among children (aged under 18), and also cases of intensive care unit (ICU) admission or death with laboratory diagnosis of influenza among adult patients.  In the past five years, there were a total of 123 cases of paediatric influenza-associated severe complication or death.  Among these cases, only 12% had received the seasonal influenza vaccine for the respective season.  During the influenza seasons in the past five years, among the 2 368 adult cases of ICU admission or death with laboratory diagnosis of influenza, the percentages of adults aged from 18 to 64, community-living elderly people aged 65 or above, and elderly people aged 65 or above living in residential care homes having received the seasonal influenza vaccine for the respective season were 4%, 27% and 66% respectively.

     According to the WHO, when the vaccine strains closely match the circulating influenza viruses, efficacy of influenza vaccine in healthy individuals aged under 65 typically ranges from 70% to 90%.  However, the actual efficacy depends on a host of factors, e.g. degree of matching between the vaccine strains and the circulating strains, age of the vaccine recipients, timing of vaccination, and the presence of any underlying medical conditions that may impair the immune response.  Many scientific studies showed that influenza vaccine could provide some degree of protection in preventing hospital admissions or deaths caused by influenza.

(2) The total number of people receiving influenza vaccination under the Government Vaccination Programme and the Vaccination Subsidy Scheme in the past five years are listed in Annex 3.  Around 6.4% to 9.3% of the population joined the two programmes each year, and the percentage has been increasing year on year.  Some members of the public may have received influenza vaccination in the private sector at their own expense. In this connection, the actual percentage of people having received influenza vaccination should be higher.

     Past local research studies showed that the effectiveness of influenza vaccination in preventing influenza-associated hospitalisation among children ranged from about 40% to 80%.  According to the analysis made earlier by the CHP on the effectiveness of seasonal influenza vaccination in elderly people living in residential care homes from 2011/12 to 2016/17, it was found that the vaccine effectiveness in preventing influenza-associated ICU admissions or deaths ranged from 37% to 69%.  Besides, the CHP collaborated with the HA to analyse data of patients admitted to public hospitals for respiratory symptoms during the winter influenza season of 2015/16. It was found that the effectiveness of influenza vaccination in preventing influenza-associated admissions among elderly patients aged 65 or above for that season was about 40%.  Overseas studies have also shown that providing influenza vaccination for school children can reduce absenteeism and protect other high-risk groups (e.g. the elderly).  The CHP will continue to closely monitor local and global studies on influenza vaccine effectiveness and relevant scientific literature.

(3) In respect of public hospitals, the HA has been monitoring the bed occupancy rates in different specialties.  Various measures have been introduced to alleviate the overcrowding in wards.  During the peak seasons every year, public hospitals will exercise flexibility in deploying healthcare manpower and hospital beds, including increasing the number of time-limited beds and day beds, adding temporary beds as necessary, and transferring patients from crowded wards to alleviate the overcrowded conditions.  In the long term, the HA will include in its annual plan the initiative of increasing manpower and resources for the provision of new hospital beds, with a view to addressing the overall shortage of beds in a progressive manner.  During the days when some wards of public hospitals may be overcrowded because of a surge in the number of hospital admissions, hospitals will implement various measures to alleviate the situation as far as possible, including transferring patients to other wards.  Moreover, the HA will transfer suitable patients, such as clinically stable surgical patients, orthopaedic patients and medical patients receiving rehabilitation treatment, to private hospitals with low-cost hospital bed arrangement with HA for completion of treatment.

     In respect of private hospitals, there were a total of 414 paediatrics and neonatology inpatient beds in 12 private hospitals across the territory at the end of 2017.  As at January 22, 2018, approvals were granted to two of the hospitals for providing additional paediatric and neonatology inpatient beds, thus increasing the total number of paediatrics and neonatology beds to 440.  In addition, private hospitals have set up infection control teams and formulated policies, procedures and guidelines on prevention and control of infectious diseases inside the hospital.
 
Ends/Wednesday, January 31, 2018
Issued at HKT 16:05
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