Announcement

**Shiloh** · June 13, 2011, 05:29 PM

Re: Hong Kong: Scarlet fever warning after student, 15, dies

Source: http://7thspace.com/headlines/385896...estigated.html

Severe case of scarlet fever investigated

Hong Kong (HKSAR) - The Centre for Health Protection (CHP) of the Department of Health is today (June 13) investigating a severe case of scarlet fever involving a 6-year-old boy.

The boy presented with a sore throat and skin rash since June 1, and fever since June 7. He was admitted to Queen Mary Hospital on June 11. He developed septicemia and was transferred to the Paediatric Intensive Care Unit the next day.

He is now in stable condition.

Laboratory test on the patient's blood specimen yielded positive result for Streptococcus pyogenes (Group A).

The CHP's investigation revealed that the boy did not have recent travel history. His home and school contacts were asymptomatic.

Investigation continues.

A CHP spokesman explained that scarlet fever is caused by Group A Streptococcus bacteria. It can be cured by appropriate antibiotics. This disease usually affects children between 2 and 8 years of age.

It presents as fever, sore throat and rash. The rash appears over the trunk, neck and spreads to the limbs, especially the armpits, elbows and groin.

"Typically scarlet fever rash does not involve the face.

It is transmitted through the respiratory route or direct contact with infected respiratory secretions," he said.

People suspect they may have scarlet fever should consult their doctors.

To prevent infection, members of the public are advised to
* maintain good personal and environmental hygiene;
* keep hands clean and wash hands properly;
* wash hands when they are dirtied by respiratory secretions, e.g. after sneezing;
* cover nose and mouth while sneezing or coughing and dispose of nasal and mouth discharge properly;
* maintain good ventilation.

**Shiloh** · June 20, 2011, 07:35 AM

Re: Hong Kong: 2011 Scarlet fever warnings/cases

Source: http://7thspace.com/headlines/386619...ver_cases.html

Alert over high level of scarlet fever cases

Hong Kong (HKSAR) - The Centre for Health Protection (CHP) of the Department of Health today (June 20) urged members of the public to maintain vigilance against scarlet fever as the number of reported cases remains at a high level.

A spokesman for the CHP said that the number of scarlet fever cases reported tothe CHP up to June 17 this year reached 419, which exceeded figures for the annual number of cases recorded in the past 10 years. The number of reports has surged since April, with 75 cases recorded in April, 100 cases in May and 142 cases (up to June 17) in June.

Among the 419 cases, the patients were aged between 1 month and 37 years old. Ninety-three per cent of cases were children under 10 years old.

Most cases were mild and their characteristics were similar to cases reported in previous years.

So far, there have been six institutional outbreaks in 2011, involving three kindergartens/child care centres, two primary schools and one residential special child care centre. A total of 22 persons were affected, with two to seven cases involved in each outbreak.

Another 11 small clusters occurred in household settings, affecting two to three persons in each cluster.

The spokesman said, "The CHP is attentive to the high level of scarlet fever activity this year and is closely monitoring the situation. A simultaneous increase of scarlet fever cases is also noted in the Mainland and Macao, suggesting a regional phenomenon at play.

"Letters have been issued to doctors, institutions and schools to remind them to take prevention and control measures."

The CHP has commissioned the Department of Microbiology of the University of Hong Kong (HKU) to perform genetic study on the bacterium (Group A Streptococcus) causing scarlet fever. On testing an isolate from the 6-year-old boy who developed septicaemia, as reported on June 13, the HKU team found that one unique gene fragment was inserted into the genome of the bacteria, which might contribute to increased transmissibility of this strain...

**Shiloh** · June 20, 2011, 07:37 AM

Re: Hong Kong: 2011 Scarlet fever warnings/cases

Source: http://www.news24.com/SciTech/News/D...-kids-20110620

Deadly scarlet fever kills 2 kids
2011-06-20 12:46

Hong Kong - Scientists in Hong Kong warned on Monday a powerful new strain of scarlet fever was sweeping the city, killing two children and infecting dozens more.

University of Hong Kong scientists said they had discovered a mutation of the Streptococcus pyogenes bacteria that causes scarlet fever, making it more infectious and deadly...

**Shiloh** · June 20, 2011, 10:11 PM

Re: Hong Kong: 2011 Scarlet fever warnings/cases

Source: http://www.chinadaily.com.cn/hkediti...t_12739546.htm

Scarlet fever strain more virulent
By Carmen Zhang (HK Edition)
Updated: 2011-06-21 06:57

University scientists discover mutation of potentially deadly virus fuels record outbreak

Scientists at the University of Hong Kong have warned that the strain of scarlet fever that has already killed two children and infected dozens of others has mutated and become more contagious.

"This (mutation) may nicely explain the 'unusual' large outbreak of the scarlet fever in Hong Kong recently," Thomas Tsang, director of the Centre for Health Protection (CHP) said on Monday.

He added that the Chinese mainland and Macao also face widespread outbreaks of the disease.

The strain has already shown resistant to several antibiotics normally used to treat the disease.

The scientists, confronted with a record 419 cases so far this year and the newly developed resistance to antibiotics, began to suspect that genetic mutation may be responsible.

The research led them to a unique genome fragment reflecting a genetic recombination of Group A Streptococcus pyogenes, the virus which causes scarlet fever.

The scientists believe this mutation may have contributed to the increase in transmissibility of the strain, and may account for the fact that the number of cases of scarlet fever is multiply higher than the number recorded last year.

The researchers added the findings provide important genetic information for tracking the spread of the new strain.

"With 100 cases in May and 142 cases in June, we believe the high incidence of the disease will continue for months in this summer," noted Tsang.

The current outbreak has already claimed the lives of a 15-year-old boy and a 7-year-old girl.

They are the first recorded deaths from the disease in Hong Kong over the past decade.

Dr Tse ****-hing from Hong Kong Medical Association suggested the doctors use penicillin group of antibiotics instead of erythromycin for treatment.

He also advised parents to take children to the hospital as early as possible when the patients present the clinical symptoms of scarlet fever, including fever, sandpaper rash, sore throat and strawberry tongue.

However, he also pointed out there's no need for panic.

Usually the fever can be controlled within 48 hours with antibiotics if the patient gets the proper treatment in the early phase.

In total 90 percent of the cases reported have occurred outside schools and kindergartens, and no consideration has been given to starting the summer holidays ahead of schedule, said Tse.

The CHP said it will enhance cooperation with the schools and kindergartens to avoid a larger-scale outbreak, and work closely with the related departments on the mainland and Macao to tackle the problem.

Scarlet fever bacteria are transmitted through either the respiratory tract or through direct contact with infected respiratory secretions. Usually children aged 2-10 are most susceptible.

China Daily

(HK Edition 06/21/2011 page1)

**Shiloh** · June 21, 2011, 10:32 AM

Re: Hong Kong: 2011 Scarlet fever warnings/cases

Source: http://7thspace.com/headlines/386759...stigation.html

Suspected fatal case of scarlet fever under investigation

Hong Kong (HKSAR) - The Centre for Health Protection (CHP) of the Department of Health is investigating a suspected fatal case of scarlet fever involving a 5-year-old boy.

The boy presented with fever from June 15. He was admitted to Princess Margaret Hospital on June 19 after sudden deterioration in his condition. The boy developed toxic shock syndrome and passed away today (June 21).

According to his parent, the child had consulted a general practitioner for chickenpox earlier.

The patient's clinical diagnosis was scarlet fever and toxic shock syndrome. A laboratory test on his blood specimen revealed gram positive cocci. Further tests are being conducted by the hospital to confirm diagnosis.

The Public Health Laboratory Centre under the CHP will also carry out tests on any positive isolate obtained. Further investigation is ongoing to collect more complete clinical information from the parents and doctors who have seen the child.

The kindergarten that the boy attended, SA Tin Ka Ping Kindergarten in Sha Tin, had no other scarlet fever cases, but an ongoing chickenpox outbreak since May 4 has affected 11 other students aged between 3 and 5. As a precautionary measure, the CHP advised the kindergarten to suspend classes for seven days starting tomorrow (June 22).

"The CHP paid a visit to the kindergarten and advised its staff to conduct thorough cleansing and disinfection in the campus," a spokesman for the CHP said.

Starting from today, the CHP will provide a daily update on the scarlet fever situation online...

**Ronan Kelly** · June 23, 2011, 04:45 AM

Re: Hong Kong: 2011 Scarlet fever warnings/cases

Hong Kong confirms second scarlet fever death - a five-year-old boy From correspondents in Hong Kong From: AFP June 23, 2011 3:07PM

HONG Kong confirmed a five-year-old boy had died from scarlet fever, the second death in the southern Chinese city as dozens of new cases were reported.
The number of infections in the territory has soared to nearly 500, said health authorities today, adding more than 9000 had been infected in the Chinese mainland - double the average figure in recent years.

Local scientists say the outbreak may be linked to a deadly new strain of the disease that could make it more contagious than in the past.

It was discovered by researchers at the University of Hong Kong and appears to be resistant to antibiotics traditionally used to fight the illness.

"Test results showed that the five-year-old boy who died on Tuesday is confirmed to have suffered from scarlet fever," a spokeswoman from the Centre for Health Protection said. The test results were released yesterday.

...

Read more: http://www.news.com.au/breaking-news...#ixzz1Q5hCQfqN

**Shiloh** · June 23, 2011, 02:45 PM

Re: Hong Kong: 2011 Scarlet fever warnings/cases

Source: http://rthk.hk/rthk/news/englishnews..._56_764821.htm

Scarlet fever cases continue to rise

24-06-2011
Health officials have reported more than 30 newly confirmed cases of scarlet fever, and four more outbreaks in kindergartens across the territory.

Meanwhile, laboratory tests on blood samples from a boy who died on Tuesday after contracting scarlet fever have shown that he did not catch a mutated form of the disease. However, an infectious disease specialist, Dr Lo Wing-lok, said even conventional strains of scarlet fever can be fatal in certain unusual circumstances.

He said the boy who died was already suffering from chicken pox. In addition to his immunity being compromised, these chicken pox blisters provided a multiple entry points for the scarlet fever bacteria, thereby worsening his situation.

**Shiloh** · June 23, 2011, 04:44 PM

Re: Hong Kong: 2011 Scarlet fever warnings/cases

Source: http://www.thestandard.com.hk/news_d...=20110624&fc=7

Tests on fever victims show different strains

Mary Ann Benitez

Friday, June 24, 2011

The investigation into the deadly scarlet fever outbreak has taken a surprising turn.

Results of the laboratory tests into the strains of Streptococcus pyogenes bacterium found in the two dead children differ, the Centre for Health Protection said yesterday.

This comes as 32 people - 20 males and 12 females aged from one to 18 years old - were recorded having scarlet fever in the past 24 hours, taking the total to 526.

Gene-typing tests on bacterium from the seven-year-old girl who died on May 29 show the "emm 12" strain.

Tests on that from a five-year-old boy who died on Tuesday however, identify the strain as "emm 1," the center said.

The cell wall M protein, encoded by the "emm" gene, has been shown to cause tissue invasiveness by the scarlet fever bacterium, a US-based professor told The Standard.

Matthew Levison, professor of public health at the Drexel University School of Public Health in Pennsylvania, said serotypes M1 and M3 in particular "have been associated with invasive infection."

Levison said in the past, half of the scarlet fever bacterium in Hong Kong has been reported to be "resistant to the antibiotics erythromycin and clindamycin, but they have all been susceptible to penicillin."

He called for the serotypes and common genotypes in the Hong Kong outbreak to be described.

Diagnosis of scarlet fever is clinical, but throat culture or rapid streptococcal test can usually reveal the bacteria.

Four outbreaks of scarlet fever - characterized by fever, strawberry tongue and body rashes - in four kindergartens involving 10 children were also reported in the same period. It was the biggest one-day toll since the center began daily situational updates on Tuesday.

The six boys and four girls aged three to six study at Pok Oi Hospital Chan Hsu Fong Lam Kindergarten in Kwun Tong, Munsang College Kindergarten in Kowloon City, Christian The Faith Love Church Yat Tung Kindergarten and Hong Kong Ling Liang Church Kindergarten in Wan Chai.

Four of them were admitted to hospital where they were in stable conditions last night.

**Emily** · June 24, 2011, 02:28 PM

Re: Hong Kong: 2011 Scarlet fever warnings/cases

http://www.physorg.com/news/2011-06-...let-fever.html

Hong Kong declares scarlet fever outbreak
June 21, 2011 by Joyce Woo
[snip]
The boy -- who also had chicken pox -- developed a fever last Wednesday and was admitted to hospital on Sunday with symptoms of the illness.

His condition deteriorated rapidly and he died Tuesday morning, Thomas Tsang, controller of Hong Kong's Centre for Health Protection, said....

**Giuseppe** · June 24, 2011, 02:45 PM

Re: Hong Kong: 2011 Scarlet fever warnings/cases

I am a bit unsettled after this news from HK government site about a case of Necrotizing Fasciitis due to Streptococcus Pyogenes Group A. See the full text: http://www.flutrackers.com/forum/sho...d.php?t=169669

**Giuseppe** · June 24, 2011, 02:48 PM

Re: Hong Kong: 2011 Scarlet fever warnings/cases

Merck manual shows this about Streptococcus Pyogenes Group A toxic shock syndrome with bacteremia / necrotizing fasciitis:

S. pyogenes TSS is defined as any group A β-hemolytic streptococci (GABHS) infection associated with shock and organ failure. Risk factors for GABHS TSS include minor trauma, surgical procedures, viral infections (eg, varicella) and use of NSAIDs.

See full page: http://www.merckmanuals.com/professi...71/ch171e.html

**Shiloh** · June 30, 2011, 08:05 AM

Re: Hong Kong: 2011 Scarlet fever warnings/cases

Source: http://7thspace.com/headlines/387689...ing_areas.html

LC Urgent Q2: Scarlet fever in Hong Kong and neighbouring areas

Hong Kong (HKSAR) - Following is a question by the Hon Cheung Man-kwong urder Rule 24(4) of the Rules of Procedure and a reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (June 29):

Question:

There has been a rapid increase in the number of cases of scarlet fever (SF) infection in recent months, including the fatal cases of two young children, and a study conducted by the University of Hong Kong has revealed that a mutated strain of the SF bacterium has increased its transmissibility. Some microbiologists has pointed out that such genetic variation of the bacterium may be attributed to the abuse of antibiotics, which is an issue that the Government should address proactively and seriously. In this connection, will the Government inform this Council:

(a) whether it knows if the SF bacterium with mutated strain has been found in other countries or regions; whether there is a rapid increase in the number of SF infection cases in the neighbouring regions recently; whether cases found in Hong Kong are mainly local infectious cases or imported cases from other regions; whether the authorities have examined if there is a need to boost surveillance measures at entry control points;

(b) of the respective numbers of cases with complications and even causing death due to contracting SF in each of the past six months; whether the critical cases are caused by the mutated bacterium; whether it has affected treatment method; if so, whether the authorities have provided public and private medical practitioners with the relevant information; and

(c) what emergency measures have been put in place to prevent the epidemic from worsening; given that most patients are young children and institutional outbreaks have happened in kindergartens, child care centres and primary schools, what measures the authorities have to prevent large scale outbreaks in schools and organisations holding summer activities; and under what circumstances requests will be initiated for closure of nurseries, kindergartens, child care centres and secondary and primary schools or early commencement of the summer break?

Reply:

President,

My response to the three parts of the question is as follows:

(1) The Centre for Health Protection (CHP) of the Department of Health (DH) has been monitoring scarlet fever (SF) in Hong Kong and neighbouring areas.

CHP notes a simultaneous increase of SF cases in Mainland China and Macao, where the condition is a notifiable disease as in Hong Kong. The rise of SF cases in Hong Kong is likely a regional phenomenon. Of the 637 SF cases reported this year, only ten cases had history of visiting Mainland China during the incubation period.

The remaining were local cases.

It should be noted that SF is not a notifiable disease in many neighbouring countries such as Singapore, Australia, New Zealand and Malaysia.

We will maintain vigilance on suspected cases of SF at boundary control points. We may advise travellers to seek medical attention or refer severe cases to hospital.

(2) As of June 28, there have been four SF cases with complications and two fatal cases of SF in Hong Kong. Details are set out in the Annex.

Laboratory investigation of the two fatal cases showed that two different strains of Group A Streptococcus were involved (emm type 1 and emm type 12).

CHP, the Hospital Authority and the University of Hong Kong (HKU) have been working in collaboration on laboratory testing for the bacterium causing SF, including tests on antimicrobial resistance, serotypes, virulence genes and the new gene fragment reported by HKU.

Further studies will be done to characterise the role and prevalence of the new genetic change and to project the outlook of the outbreak over time.

So far, all the Group A Streptococcus isolates detected are sensitive to penicillin, meaning that all antibiotics belonging to the penicillin group or first generation cephalosporins can effectively treat SF.

Local antibiotic resistance surveillance data showed that around 50-60% of Group A Streptococcus isolated in 2011 are resistant to erythromycin (which also predicts resistance to azithromycin and clarithromycin). As a result, antibiotics belonging to the macrolide group (e.g. erythromycin) should not be used as empirical treatment for SF.

Updated situation and information pertaining to clinical diagnosis and management of SF patients have been disseminated through letters to doctors and biweekly publication of Communicable Disease Watch.

(3) The majority of SF cases are sporadic. Only 7% of the cases are associated with school clusters and the number of persons affected in each cluster has been small, ranging from 2 to 7 persons. CHP will investigate SF outbreaks and give advice on the management of such cases and appropriate control measures.

In special circumstances, CHP may advise individual school with SF case(s) to suspend classes, taking into account the epidemiological assessment.

We expect high SF activity to persist into the summer. DH has convened an interdepartmental meeting attended by representatives from Social Welfare Department, Education Bureau, Home Affairs Department, Food and Environmental Hygiene Department, Leisure and Cultural Services Department, Information Services Department and Hospital Authority to plan for the preventive strategies in the coming summer holidays. Various Government departments will work together to strengthen hygiene measures and publicity on SF at different venues.

CHP has stepped up publicity and health education with regard to SF prevention since June this year.

CHP has maintained close liaison and communication with stakeholders and healthcare workers. Letters have been issued to institutions and schools to promulgate prevention and control measures to prevent any potential spread of SF in schools and institutions.

For the general public, a new radio Announcement in the Public Interest on SF has been produced to strengthen public education.Health information on SF will be disseminated through various channels, including a designated webpage, posters and leaflets. CHP has also given press briefings and interviews to update the public on preventive measures.

These risk communication activities will go on in the coming weeks.

Source: HKSAR Government

**Shiloh** · July 15, 2011, 07:50 PM

Re: Hong Kong: 2011 Scarlet fever warnings/cases

Source: http://www.monstersandcritics.com/ne...l-in-Hong-Kong

Flesh-eating disease takes a grim toll in Hong Kong
Jul 15, 2011, 6:28 GMT

Hong Kong - A flesh-eating bacterial disease has already killed more people in Hong Kong this year than in the previous two years combined, a newspaper report said Friday.

Five people have died so far this year from the disease, which mainly affects the elderly and chronically ill, compared with one death in all of 2010 and two in 2009, the South China Morning Post said.

Sixteen people with the disease have been admitted to public hospitals this year against 11 admissions for the whole of 2009...

...Doctors said the surge in cases coincided with an outbreak of scarlet fever, which has infected more than 830 people this year against 128 last year and 187 in 2009...

**Shiloh** · August 29, 2011, 02:54 PM

Re: Hong Kong: 2011 Scarlet fever warnings/cases

Source: http://www.thestandard.com.hk/news_d...=20110830&fc=1

Scarlet fever alert remains as sick days are slashed

Phila Siu and Kelly Ip

Tuesday, August 30, 2011

ADVERTISEMENT

Sick leave for children with scarlet fever has been shortened.

The move is in line with the latest scientific findings but the community should still remain alert for the bacterial infection at the center of a rare outbreak this year that claimed two young lives.

Centre for Health Protection controller Thomas Tsang Ho-fai gave the warning ahead of the start of a new school year on Thursday.

Enhanced surveillance for the childhood disease, in place since June 24, will be extended to September 30...

...At its peak in June there were 120 cases of scarlet fever a week but recently there were only 20 to 30 cases a week.

But the number of recent cases is still higher than that recorded in the corresponding periods in past years, the center said last night...

Announcement

Hong Kong: 2011 Scarlet fever warnings/cases

Hong Kong: 2011 Scarlet fever warnings/cases

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