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Centre for Health Protection Symposium 2014 (see slides PDF by Dr. Janice LO) H7N9 Case Presentation

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  • Centre for Health Protection Symposium 2014 (see slides PDF by Dr. Janice LO) H7N9 Case Presentation

    Centre for Health Protection Symposium 2014

    Centre for Health Protection Symposium 2014 - Speakers

    Dr. CHUANG Shuk Kwan
    Consultant Community Medicine (Communicable Disease)
    Surveillance and Epidemiology Branch, CHP
    Hong Kong, China
    Topic: Avian flu - Local efforts in prevention and control of human avian flu H7N9 infection
    Date: 25 October 2014 (Saturday)
    Time: 3:25pm - 3:40pm (15 mins)

    Avian influenza first caught global attention in 1997 when Hong Kong experienced the first human outbreak of H5N1 infection with about 20% positive detections in chickens in farms and markets. Since then a series of prevention and control measures have been put in place by multiple sectors to prevent and control of both poultry and human avian influenza infection. Such measures have been refined and stepped up over the years in response to local poultry outbreaks. No locally acquired human H5N1 infection has been recorded since 1997 despite a few imported infections.

    H7N9 virus differs from H5N1 in that it causes a low pathogenic infection in poultry but is highly lethal in human. Local prevention and control measures for H5N1 are applicable for H7N9 but there is not yet poultry H7N9 vaccine and there are no chicken dies off to signify infected poultries. This makes the prevention and surveillance of H7N9 more difficult in poultry populations. The speed of spread of human H7N9 infections has been faster than in the case of H5N1 with more than 400 cases reported in the Mainland since March 2013. In addition, 15 cases were imported into other areas from Mainland China (10 cases in Hong Kong, 4 cases in Taiwan and 1 case in Malaysia). The affected cases were older with a case fatality rate of about 40%. With the extensive contact tracing, Tamiflu chemoprophylaxis of close contacts and medical surveillance, no secondary transmission occurred among the contacts of the 10 imported cases.

    With the likely re-emergence of H7N9 in the coming winter, the prevention and control will become more challenging. The Government has a Preparedness Plan for Influenza Pandemic with preparedness in antiviral stockpiling. We have enhanced surveillance of suspected human cases in collaboration with the medical community. Any suspected case will be notified, isolated and tested. We will continue to maintain close liaison with the World Health Organization, the Mainland and overseas health authorities to monitor the latest development and obtain timely information. Regarding risk communication, we maintain a high degree of transparency in dissemination of results and providing updates on the disease to the general public, healthcare professionals and relevant stakeholders. We have organised various health education activities and provided health advice on disease prevention, personal hygiene and environmental hygiene to increase the publicity and raise community awareness. On the infection control front, we have promulgated guidelines and organised training to healthcare workers, residential care homes and schools. The CHP will continue to maintain a high degree of vigilance to monitor the situation and implement necessary control measures timely to prevent the spread of the disease in collaboration with other relevant government departments and stakeholders.

    Dr. Janice LO
    Public Health Laboratory Services Branch, CHP
    Hong Kong, China

    Topic: Avian flu - Laboratory testing of human H7N9 infection - Hong Kong experience
    Date: 25 October 2014 (Saturday)
    Time: 3:40pm - 3:55pm (15 mins)

    2 December 2013
     5 p.m.: Request from a hospital laboratory for confirmation of influenza A H7 positive result
     Molecular testing result of influenza A (H7N9) reported at 8:30 p.m.
    21 November – 2 December 2013
     F/36
     21 November: Onset of cough
     22 November: Fever
     25 and 26 November: Visited GP
     27 November: Shortness of breath, attended AED, CXR right lower lobe consolidation, admitted to hospital
     28 November: Collected NPS
    21 November – 2 December 2013
     29 November (Friday):
     NPS received by PHLC
     Patient transferred to ICU
     30 November (Saturday):
     Condition deteriorated
     Collected NPA
     Transferred to another hospital for ECMO
     NPA received by PHLC
    21 November – 2 December 2013
     NPS and NPA inoculated to cell cultures
     1 December: Sunday
     2 December:
     Cell cultures continuing incubation
     NPA with early CPE insufficient for identification tests
    PCR for NPS and NPA
     NPS (collected 28 November – Day 7)
     M: 39.97
     H7: 39.2
     N9: 35.6
     NPA (collected on 30 November – Day 9)
     M: 28.05
     H7: 27.03
     N9: 25.01
    Clinical course
     2 December 2013: On mechanical ventilation and ECMO
     8 December 2013: Condition changed from “critical” to “serious” (nasal ventilation with 50% oxygen)
     27 December 2013: Transferred back to original hospital
     13 January 2014: Discharged from hospital
    Genetic characterization
     All 8 gene segments belonged to avian origin
     Antimicrobial susceptibility
     M gene: S31N (resistant to adamantanes)
     N gene: 292R (susceptible to neuraminidase inhibitors)

    10 Strain designations (GISAID clipping by Dr. Janice LO ~)
    A/Hong Kong/5942/2013 (EPI_ISL_151417) MDCK passage
    A/Hong Kong/734/2014 (EPI_ISL_153338) MDCK passage
    A/Hong Kong/2212982/2014 (EPI_ISL_154553) original
    A/Hong Kong/156471/2014 (EPI_ISL_156471) MDCK passage
    A/Hong Kong/470129/2013 (EPI_ISL_157487) _____
    A/Hong Kong/4495/2014 (EPI_ISL_157702) MDCK passage
    A/Hong Kong/8113530/2013 (EPI_ISL_157703) original
    A/Hong Kong/5581/2014 (EPI_ISL_159477) MDCK passage
    A/Hong Kong/8122430/2014 (EPI_ISL_159478) original
    A/Hong Kong/5731/2013 (EPI_ISL_160290) MDCK passage

    Alignment of 9 cases H7, N9, M gene

    3 slides/pdf
    10 Hong Kong Isolates

    Prof. ZHONG Nanshan
    State Key Laboratory of Respiratory Disease
    Guangzhou, China
    Topic: Avian flu - Perspectives of the control of H7N9 infection in the mainland of China
    Date: 25 October 2014 (Saturday)
    Time: 2:55pm - 3:25pm (30 mins)