Following is a question by the Hon Holden Chow and a written reply by the Secretary for Health, Professor Lo Chung-mau, in the Legislative Council today (May 14):

Question:

     It has been reported that there were outbreaks of scabies infection in residential care homes for the elderly (RCHEs) in the past, and the Centre for Health Protection has indicated that people with weaker immunity or the elderly are more susceptible to infection. Regarding the prevention of skin diseases among elderly people in RCHEs, will the Government inform this Council:

(1) whether it has compiled statistics on the number of cases of elderly people in RCHEs suffering from the following skin diseases across the territory in each of the past five years: (i) pruritus, (ii) scabies, and (iii) herpes zoster (set out in a table);

(2) of the measures the authorities have put in place to support RCHEs in enhancing their cleanliness and hygiene, so as to prevent as early as possible outbreaks of the skin diseases mentioned in (1) in RCHEs; and

(3) whether the authorities will consider introducing artificial intelligence tools to assist in the early detection and prevention of the infection and outbreak of the skin diseases mentioned in (1) in RCHEs?

Reply:

President,

     The Residential Care Homes for the Elderly (RCHEs) are regulated by the Residential Care Homes (Elderly Persons) Ordinance (Cap. 459), the Residential Care Homes (Elderly Persons) Regulation (Cap. 459A) and the Code of Practice for Residential Care Homes (Elderly Persons)/ the Code of Practice for Residential Care Homes (Nursing Homes) for the Elderly (the Code of Practice), oversighted by the Social Welfare Department (SWD). Infectious diseases can spread rapidly in communal living environments, and residents of the RCHEs are generally more susceptible and at high risk. As the health advisor of the Government, the Department of Health (DH) provides guidelines on infection control for the residential care homes (RCHs) to prevent infectious diseases, and collaborates with the SWD in promoting these guidelines to effectively prevent occurrence of infectious diseases in the RCHs and reduce the health risks and hazards posed by infectious diseases.

     The reply, in consultation with the Labour and Welfare Bureau and the DH, to the question raised by the Hon Holden Chow is as follows:

(1) Scabies is a skin disease caused by the mite Sarcoptes scabiei var. hominis, which is a parasite that burrows into, resides and reproduces in human skin. It affects people of all ages, but the elderly or people with weakened immunity are more susceptible. Scabies can spread rapidly in communal living environments; hence outbreaks of scabies have been reported from time to time in institutional settings (such as the RCHEs).

     Although scabies is not a statutorily notifiable infectious disease, it can spread rapidly in crowded environments and may lead to large-scale outbreaks. Therefore, the Centre for Health Protection (CHP) of the DH encourages institutional settings to report scabies outbreaks. This enables early treatment of patients and their contacts, as well as the implementation of appropriate infection control measures to reduce the number of affected individuals. From 2020 to April 30, 2025, the number of scabies outbreaks in the RCHEs as recorded by the CHP is as follows:
 

Year	Number of Outbreaks
2020	41
2021	35
2022	27
2023	37
2024	40
2025 (up to April 30)	16

     Herpes Zoster (also known as Shingles) is an infectious disease that causes belt-like, painful skin rash with blisters. It is caused by varicella-zoster virus which is responsible for varicella (also known as Chickenpox). The virus resides in the nervous system of patients recovered from Chickenpox. Years later, in times of weakened immune system, such as due to ageing or stress, the virus may induce Herpes Zoster. A person with Herpes Zoster cannot pass this disease to others. However, individuals who have never had Chickenpox and have not received the Chickenpox vaccine may be infected and develop Chickenpox if they have contact with the sores of a Herpes Zoster patient.

     As regards pruritus (itchy skin), since there are many possible reasons (including causes relating to non-communicable diseases), confirmation of the cause(s) of the relevant symptom should be diagnosed by a medical practitioner.

     Herpes Zoster is not a statutorily notifiable infectious disease and neither is pruritis. Therefore, the CHP does not have statistics on Herpes Zoster and pruritis in the RCHEs. Nevertheless, the CHP also encourages the RCHEs to report suspected outbreaks of infectious diseases (such as respiratory tract infections, acute gastroenteritis and scabies) in their institutions to facilitate investigation and provision of appropriate control measures recommendation according to situation.

(2) and (3) The Guidelines on Prevention of Communicable Diseases in Residential Care Homes for the Elderly published by the CHP provides infection control advice for the RCHEs to prevent communicable diseases, including those transmitted by contact such as scabies, and measures to prevent skin or subcutaneous tissue infections. Specific measures include taking contact transmission-based precaution measures, such as wearing gloves when contacting patients; arranging early medical consultation for the patients; special disinfection of bedding and clothing used by scabies patients; and isolating infected residents until completion of treatment. The Guidelines will be updated in a timely manner having regard to prevailing situation and scientific evidence.

     The Code of Practice issued by the SWD sets out detailed requirements and guidelines on infection control, including requesting the RCHEs to assist residents in maintaining good personal hygiene and to keep the RCHE environment clean, as well as to prevent infectious diseases with reference to the Guidelines on Prevention of Communicable Diseases in Residential Care Homes for the Elderly issued by the CHP. The home manager of an RCHE shall appoint either a nurse or a health worker as an Infection Control Officer to handle matters related to infection control and the prevention of infectious diseases in the RCHE.

     The Licensing Office of Residential Care Homes for the Elderly of the SWD, in collaboration with the DH, also regularly organises training courses, thematic talks and workshops for RCHE staff on infection control measures and latest prevention and control information. On-site observations are also conducted at the RCHEs with advice rendered to enhance their infection control capabilities and skills.

     In addition, the Government makes use of technology to help monitor and follow up on infection-related situations in RCHs. For instance, the SWD launched the "e-platform for infection control in RCHs" in June 2024 to facilitate RCHs' one-stop submission of various information concerning infection prevention and control. This enables the DH and the SWD to keep abreast of the latest situation of infectious disease outbreak cases and infection control in RCHs in a timely and accurate manner for continuous monitoring and appropriate follow-up actions whilst assessing and arranging timely vaccination for RCH residents in prevention of infectious diseases. The Government will continue to monitor the development in relevant technology (including Artificial Intelligence tools).

Ends/Wednesday, May 14, 2025
Issued at HKT 16:35

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