Hong Kong, Joint investigation into suspected outbreak of respiratory disease in Sheung Shui (November 26 2012): Contact with diseased parrots before illness onset - 3 cases confirmed psittacosis

[Giuseppe]

[Source: Centre for Health Protection, Hong Kong PRC SAR, full text: (LINK).]

Joint investigation into suspected outbreak of respiratory disease in Sheung Shui


The Centre for Health Protection (CHP) of the Department of Health is today (November 26) conducting a joint investigation with the Agriculture, Fisheries and Conservation Department (AFCD) into a suspected outbreak of respiratory disease involving five AFCD staff working in the New Territories North Animal Management Centre (NTNAMC) in Sheung Shui. They were all males aged between 27 and 64 with onset of symptoms from November 6 to November 24.

The first case affected a 64-year-old man who presented with upper respiratory symptoms since November 6. He was admitted to a hospital in Australia since November 12.
The second case is a 55-year-old man. He developed chills, cough and sore throat since November 8 and fever, shortness of breath, headache and myalgia since November 19. He was admitted to Queen Mary Hospital (QMH) on November 22. His chest X-ray showed bilateral upper zone patchiness and the clinical diagnosis was pneumonia. He is now receiving care in the Intensive Care Unit of QMH in stable condition.

Respiratory and urine specimens taken from the 55-year-old patient at QMH tested by the hospital yielded negative results for influenza virus, respiratory syncytial virus (RSV) and Legionnaires' Disease, while test results for psittacosis and leptospirosis are pending. CHP's Public Health Laboratory Centre performed tests on the patient's respiratory specimens and it was negative for Novel Coronavirus associated with Severe Respiratory Disease.

The third case affected a 62-year-old man who developed bilateral red eyes on November 12, and was admitted to Alice Ho Miu Ling Nethersole Hospital on November 17 because of cough with blood-stained sputum, malaise, chills, rigors and sore throat. His condition was stable. The diagnosis was pneumonia. Preliminary laboratory testing for influenza virus, parainfluenza virus, RSV and adenovirus was negative.

The fourth case is a 27-year-old man. He developed fever, headache and malaise on November 14 and was admitted to Yan Chai Hospital on November 18. The diagnosis was pneumonia. He recovered after treatment and was discharged home on November 22 and his condition was stable.

The fifth case affected a 62-year old man who presented with cough, chills and rigor since November 24 and was admitted to Princess Margaret Hospital for further management on November 26. His condition is stable.

The home contacts of the patients are asymptomatic.

CHP staff conducted a site visit to NTNAMC today and provided health advice to the staff.

According to the information provided by AFCD, there is a batch of 16 seized parrots being kept in NTNAMC since October 20. Subsequently, three died and 10 were euthanised as precautionary measures. The health condition of the three surviving birds is being closely monitored.

The possibility of psittacosis outbreak among these staff is being actively investigated.

The investigation is underway.

Ends/Monday, November 26, 2012
Issued at HKT 22:45
NNNN

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[Shiloh]

HK: Joint investigation into suspected outbreak of respiratory disease in Sheung Shui

Source: http://7thspace.com/headlines/426806...eung_shui.html

Joint investigation into suspected outbreak of respiratory disease in Sheung Shui

Hong Kong (HKSAR) - The Centre for Health Protection (CHP) of the Department of Health is today (November 26) conducting a joint investigation with the Agriculture, Fisheries and Conservation Department (AFCD) into a suspected outbreak of respiratory disease involving five AFCD staff working in the New Territories North Animal Management Centre (NTNAMC) in Sheung Shui. They were all males aged between 27 and 64 with onset of symptoms from November 6 to November 24...

[sharon sanders]

Re: HK: Joint investigation into suspected outbreak of respiratory disease in Sheung Shui

Sheung Shui is an area in New Territories, Hong Kong. Sheung Shui Town, a part of this area,

http://en.wikipedia.org/wiki/Sheung_Shui

[Giuseppe]

Re: HK: Joint investigation into suspected outbreak of respiratory disease in Sheung Shui

Center for Health Protection has issued a statment (full text: http://www.flutrackers.com/forum/sho...d.php?t=195525 ), reporting the patients' contacts with diseased parrots.

[sharon sanders]

Re: Hong Kong, Joint investigation into suspected outbreak of respiratory disease in Sheung Shui (November 26 2012): Contact with diseased parrots before illness onset

Thanks, I merged the threads.

[alert]

Re: Hong Kong, Joint investigation into suspected outbreak of respiratory disease in Sheung Shui (November 26 2012): Contact with diseased parrots before illness onset

http://www.promedmail.org/

Published Date: 2012-11-26 22:01:56
Subject: PRO/AH/EDR> Undiagnosed respiratory disease - China: (HK), psittacosis susp., RFI
Archive Number: 20121126.1425603

UNDIAGNOSED RESPIRATORY DISEASE - CHINA: (HONG KONG), PSITTACOSIS SUSPECTED, REQUEST FOR INFORMATION
************************************************** **************************************************
A ProMED-mail post

http://www.promedmail.org

ProMED-mail is a program of the
International Society for Infectious Diseases

http://www.isid.org

Date: 26 Nov 2012
Source: 7th Space

http://7thspace.com/headlines/426806/joint_investigation_into_suspected_outbreak_of_respiratory_disease_in_sheung_shui.html

[initial post of this thread, snipped out as a repeat]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[With the current attention focused on heightened surveillance for severe acute respiratory illness (SARI) worldwide, outbreaks of undiagnosed SARIs are being investigated and tested for the novel coronavirus identified in Saudi Arabia and Qatar. As noted above, testing for key known viral agents associated with SARI have been completed and were negative. The work locations of all 5 cases--all are staff working in an animal management center where 16 parrots were seized and under observation--and the history that 3 of the parrots had died raises the suspicion of psittacosis as the possible etiology of this outbreak.

Borrowing from Mod.LL's comment in Psittacosis - UK: (Scotland) susp. 20120315.1070385:

"Psittacosis, also known as ornithosis or parrot fever, is a human disease caused by the bacterium _Chlamydophila psittaci_. Classically associated with psittacine birds such as parakeets, parrots, and cockatiels, it may affect other avian species such as turkeys, ducks, pigeons, and pheasants. Human infection in general is caused by inhalation of dust containing the bacterium, which is shed in large amounts in the feces and secretions of the infected birds. Illegally imported decorative birds that have not been screened and/or treated can be a significant source of the pathogen.

"The respiratory infection, usually diagnosed serologically, can be fatal if untreated. Although most diagnosed cases have direct exposure to birds, the infection may be acquired indirectly through the aerosolization of infective material in the grass or ground such as when mowing a lawn. Because of such outbreaks, protective equipment may be recommended for individuals in areas frequented by free-ranging birds, if contact with birds and their droppings is likely when performing outdoor activities such as lawn mowing.

"People who are occupationally exposed to psittacosis include pet store workers, poultry farmers, poultry processing workers, and veterinarians.

"Historically (http://animal-health.library4farming...ittacosis.html), the 1st description of a disease marked by an atypical pneumonia was reported in 1879 among persons having contact with sick parrots. A severe and sometimes fatal atypical pneumonia was observed in various European countries and the USA in later years. An unusually severe epidemic occurred in Paris in 1892. The name psittacosis was suggested for the disease in 1895.

"An epidemic involving more than 100 cases of atypical pneumonia, diagnosed as psittacosis, occurred in Argentina in 1929. A year later, outbreaks in Europe and the USA were traced to parrots newly imported from South America."

More information on this outbreak would be greatly appreciated, including results of laboratory studies on the human cases as well as the parrots.

[Ronan Kelly]

Re: Hong Kong, Joint investigation into suspected outbreak of respiratory disease in Sheung Shui (November 26 2012): Contact with diseased parrots before illness onset

Update on psittacosis outbreak in Sheung Shui


Hong Kong (HKSAR) - The Centre for Health Protection (CHP) of the Department of Health today (November 27) provided an update on its joint investigation with the Agriculture, Fisheries and Conservation Department (AFCD) into an outbreak of psittacosis respiratory disease involving five AFCD male staff working in the New Territories North Animal Management Centre (NTNAMC) in Sheung Shui.

A CHP spokesman said that the respiratory specimens from three patients (a 55-year-old patient at Queen Mary Hospital, a 62-year-old patient in Alice Ho Miu Ling Nethersole Hospital and a 27-year-old patient who has been discharged from Yan Chai Hospital) tested positive for Chlamydophila psittaci by polymerase chain reaction as confirmed by the CHP's Public Health Laboratory Centre, suggesting that they were suffering from psittacosis infection.

So far, a total of five AFCD staff working in the NTNAMC have developed respiratory symptoms (mostly pneumonia) requiring admission to hospitals. One has recovered and the other four are currently in hospitals in Hong Kong (three) and Australia (one).

The CHP has successfully contacted 59 AFCD staff working in the NTNAMC and eight of them are found to currently have upper respiratory symptoms.

Arrangements will be made with the Hospital Authority for these eight persons to undergo medical assessment and laboratory investigation to rule out psittacosis.

The joint investigation is under way. The total number of laboratory confirmed cases so far in this outbreak is three.

The spokesman said that psittacosis is a disease caused by Chlamydophila psittaci. It is usually transmitted to humans by inhaling the agent from the dried droppings and secretions of infected birds.

Pet birds such as parrots, cockatiels, parakeets, macaws and poultry (turkeys and ducks) are most frequently involved. Person-to-person transmissions are rare.

Common symptoms include fever, headache, rash, muscle pain, chills and dry cough. Pneumonia may occur in serious cases.

Encephalitis, myocarditis and thrombophlebitis are occasional complications. The incubation period ranges from one to four weeks. Psittacosis can be effectively treated with antibiotics.

To prevent psittacosis, members of the public are advised to take heed of the following measures:

* Wear gloves and face masks when handling the droppings and secretions of birds;
* Wash both hands thoroughly after handling birds;
* Avoid close contacts with birds;
* Disinfect bird cages and surfaces contaminated by bird droppings and secretions; and
* Seek medical treatment if symptoms develop.


Source: HKSAR Government

http://7thspace.com/headlines/426876/update_on_psittacosis_outbreak_in_sheung_shui.html

[alert]

Re: Hong Kong, Joint investigation into suspected outbreak of respiratory disease in Sheung Shui (November 26 2012): Contact with diseased parrots before illness onset - 3 cases confirmed psittacosis

http://afludiary.blogspot.com/2012/11/psittacosis-identified-in-hong-kong.html

Tuesday, November 27, 2012
Psittacosis Identified In Hong Kong Respiratory Outbreak

Photo Credit USDA

# 6742

Yesterday, in Hong Kong: Investigating An Unidentified Respiratory Illness Outbreak, we learned of five workers at an animal management center in Sheung Shui who had contracted an as-yet unidentified respiratory infection.

Psittacosis (parrot fever) was suspected because they had been in direct contact with 16 seized parrots, three of which had subsequently died.

Today we get word that three patients have now tested positive for Chlamydophila psittaci, a bacteria shed in the feces of infected Psittaciformes (cockatoos, parrots, parakeets, lories, etc.) and poultry (ducks & turkeys primarily, less often in chickens) that can cause serious pneumonia in humans.

Human-to-human transmission, while rare, has been strongly suspected in the past (more on this after the HPC announcement below).

First, the statement from the Hong Kong Centre for Health Protection, then I?ll return with a bit more.

Update on psittacosis outbreak in Sheung Shui

The Centre for Health Protection (CHP) of the Department of Health today (November 27) provided an update on its joint investigation with the Agriculture, Fisheries and Conservation Department (AFCD) into an outbreak of psittacosis respiratory disease involving five AFCD male staff working in the New Territories North Animal Management Centre (NTNAMC) in Sheung Shui.

A CHP spokesman said that the respiratory specimens from three patients (a 55-year-old patient at Queen Mary Hospital, a 62-year-old patient in Alice Ho Miu Ling Nethersole Hospital and a 27-year-old patient who has been discharged from Yan Chai Hospital) tested positive for Chlamydophila psittaci by polymerase chain reaction as confirmed by the CHP's Public Health Laboratory Centre, suggesting that they were suffering from psittacosis infection.

So far, a total of five AFCD staff working in the NTNAMC have developed respiratory symptoms (mostly pneumonia) requiring admission to hospitals. One has recovered and the other four are currently in hospitals in Hong Kong (three) and Australia (one).

The CHP has successfully contacted 59 AFCD staff working in the NTNAMC and eight of them are found to currently have upper respiratory symptoms. Arrangements will be made with the Hospital Authority for these eight persons to undergo medical assessment and laboratory investigation to rule out psittacosis.

The joint investigation is under way. The total number of laboratory confirmed cases so far in this outbreak is three.

The spokesman said that psittacosis is a disease caused by Chlamydophila psittaci. It is usually transmitted to humans by inhaling the agent from the dried droppings and secretions of infected birds. Pet birds such as parrots, cockatiels, parakeets, macaws and poultry (turkeys and ducks) are most frequently involved. Person-to-person transmissions are rare.

Common symptoms include fever, headache, rash, muscle pain, chills and dry cough. Pneumonia may occur in serious cases. Encephalitis, myocarditis and thrombophlebitis are occasional complications. The incubation period ranges from one to four weeks. Psittacosis can be effectively treated with antibiotics.

To prevent psittacosis, members of the public are advised to take heed of the following measures:


?Wear gloves and face masks when handling the droppings and secretions of birds;
?Wash both hands thoroughly after handling birds;
?Avoid close contacts with birds;
?Disinfect bird cages and surfaces contaminated by bird droppings and secretions; and
?Seek medical treatment if symptoms develop.
Ends/Tuesday, November 27, 2012
Issued at HKT 19:01

Last March, in How Parrot Fever Changed Public Health In America, I briefly mentioned an ongoing investigation into a suspected parrot fever outbreak in Tayside, Scotland.

Two months later, the journal Eurosurveillance carried the following Rapid Communications that looked at onset dates and exposures in that outbreak (involving four family members and a health-care worker), all of which suggested human-to-human transmission.

Psittacosis outbreak in Tayside, Scotland, December 2011 to February 2012


C C McGuigan , P G McIntyre, K Templeton

A Tayside outbreak of psittacosis December 2011?February 2012 involved three confirmed and one probable cases. Confirmed cases were indistinguishable by sequencing of polymerase chain reaction (PCR) products.

The epidemiological pattern suggested person-to-person spread as illness onset dates were consistent with the incubation period and no single common exposure could explain the infections. In particular the only common exposure for a healthcare worker case is overlap in place and time with the symptomatic index case.

While outbreaks are uncommon, the CDC reports roughly 50 cases are diagnosed each year in the United States. As it can be difficult to diagnose, the true incidence of this disease probably much higher.

Treatment is via antibiotics, primarily with tetracycline.

One of the concerns with this disease is the widespread and essentially unregulated use of antibiotics by bird owners in treating their flocks. Overuse of antibiotics can lead to the development of resistant bacteria.

In 2007, an EID Journal report Chlamydophila psittaci Transmission from Pet Birds to Humans looked at the use of antibiotics at 39 breeding bird breeding facilities in Belgium, and found that more that 40% had used antibiotics to treat sick birds in the previous 12 months. More than 10% routinely gave antibiotics to birds prophylactically.

Although a small study, their findings suggested that bird owners may be infected ? and display only mild symptoms - more often than previously suspected.

That said, among a small survey of bird owners - roughly 25% had reported having had pneumonia after acquiring a Psittaciforme as a pet - a number far greater than would normally be seen in the general population.

Prior to the development of antibiotics in the middle of last century, the mortality rate from psittacosis pneumonia was on the order of 15% to 20%. Today, if properly diagnosed and treated, deaths are rare.

However, should antibiotic resistance develop in Chlamydophila psittaci due to overuse, we could see a return to the bad old days.

Posted by Michael Coston at 8:27 AM Labels: Hong Kong, Parrot Fever, Psittacosis

[alert]

Re: Hong Kong, Joint investigation into suspected outbreak of respiratory disease in Sheung Shui (November 26 2012): Contact with diseased parrots before illness onset - 3 cases confirmed psittacosis

http://www.thestandard.com.hk/news_detail.asp?we_cat=4&art_id=128762&sid=38339399&con_type=1&d_str=20121128&fc=2

Animal shelter shut as parrot fever hits five

Winnie Chong

Wednesday, November 28, 2012

A Sheung Shui animal shelter remains temporarily closed after five workers came down with parrot fever, health authorities said.
Eight other Agriculture, Fisheries and Conservation Department workers are being tested for psittacosis.

A department spokeswoman said 16 parrots, which were imported from South America, were placed in quarantine on October 20 while the importer prepared necessary documents.

[snip]