Department of Health, HKSAR : H9N2 press releases from 1999-2013

[Biological100]

Preliminary Global Human H9N2 case list ver. 1.1

1. H9N2 Case 1 1998 Guangdong 14M Acute respiratory infection, live chickens in dwelling A/Shaoguan/402/98
2. H9N2 Case 2 1998 Guangdong 75M Acute respiratory infection, lives near farmer?s market A/shaoguan/408/98
3. H9N2 Case 3 1998 Guangdong 4M Acute respiratory infectionExposure Unknown A/Shantou/217/98
4. H9N2 Case 4 1998 Guangdong1F Acute respiratory infectionExposure Unknown A/Shantou/239/98
5. H9N2 Case 5 1998 Guangdong 36F Acute respiratory infection, Exposure to live poultry A/Shantou/252/98
6. H9N2 Case 6 1999 Guangdong 22-Months F Fever (38?C), cough No exposure to poultry, A/Guangzhou/33/99 (BJ 94lineage)
7. H9N2 Case 7 1999 Hong Kong 13-Months F Fever (39.5?C), poor appetite, vomiting, inflamed oropharynx A/Hong Kong /1073/99
8. H9N2 Case 8 1999 Hong Kong 4F Fever (38.9?C), malaise, sore throat, headache, vomiting, abdominal pain, diarrhoea, inflamed oropharynx A/Hong Kong/ 1074/99 (G1-lineage)
9. H9N2 Case 9 2003 Hong Kong 5M Mild fever, cough, and mild dehydration with dried lips and decreased skin turgor
10. H9N2 Case 10 2003 Hong Kong one year old boy [DOH] Onset 25-Nov-03Hosp 27-Nov-03 United Christian Hospital Discharged 29-Nov-03 confirmed 10-Dec-03
11. H9N2 Case 11 2007 Hong Kong [Tseung Kwan O] 9-Month F onset 4-Mar-07 Hosp- 6-Mar-07 , Discharged 9-Mar-07Mild upper respiratory infection [ strain] unknown exposure
12. H9N2 Case 12 2008 Hong Kong ex Shenzhen Guangdong SAR [22month F] Onset 22-Dec-08 Tuen Mun Hospital 23-Dec-08 discharged readmitted Cough and vomiting exposure local restaurant breeding chickens A/Hong Kong/3239/2008
13. H9N2 Case 13 2009 Hong Kong [Sha Tin] [7th] 35 months F onset end of end of November 2009, admitted to Prince of Wales Hospital, 11-Dec-09 discharged
14. H9N2 Case 14 2011 161479 Bangladesh Kamalapur 51Month F Onset 25-Feb-11 38.2?C , symptoms subsided, Recovered 28-Feb-11, close contact with poultry, including sick quails [and dead sparrow on veranda 5 days before onset] / Bangladesh/0994/2011 [Vaccine candidate WHO]
15. H9N2 Case 15 2013 Hunan Yongzhou Lengshuitan District, 7M Onset 19-Nov-13, outpt , recovered as 24-Nov-13 close contact with poultry A/Lengshuitan/11197/2013
16. H9N2 Case 16 2013 86M Hong Kong ex Shenzhen, Guangdong province Onset 28-Dec-13 , Hosp 28-Dec-13, stable as of 30-Dec-13 No clear history of exposure
17. H9N2 Case 17 2015 Egypt Aswan 3M Onset 15-Jan-15 Hosp 16-Jan-15 exposure poultry , confirmed 2-Feb-15
18. H9N2 Case 18 2015 Egypt Cairo 7F onset unknown Hospitalisation No, Co infection Inf B and H9N2, exposure to poultry
19. H9N2 Case 19 2015 Bangladesh 3.5-year-old F Onset 1-Feb-15 recovered 7-Feb-15 close contact with poultry, including sick quails, prior to her onset of illness [2nd in Bangladesh]
20. H9N2 Case 20 2015 Egypt Cairo 9 Months F onset unknown Mild illness recovered at home, likely exposure to an environment contaminated with poultry waste
21. H9N2 Case 21 2015 China Anhui Hefei Moumou 4F 14 April 2015 cured 16-Apr-15 Live animal market mild disease and none were hospitalised live poultry market exposure [He Jun et al. 2016]
22. H9N2 Case 22 2015 China Hunan 2M 1 Sept 2015 Unknown mild disease and none were hospitalised
23. H9N2 Case 23 2015 Missing Case - Anhui Chuzhou Tao Moumou, male, 6 years old, students; Onset-September 6, 2015 Cured September 7 [He Jun et al. 2016]
24. H9N2 Case 24 2015 China Hunan 15F 15 Sept 2015 No known exposure mild disease and none were hospitalised
25. H9N2 Case 25 2015 China Hunan 1F 27 Oct 2015 Unknown mild disease and none were hospitalised
26. H9N2 Case 26 2016 209864 2016 No # Bangladesh 46M poultry worker Onset 27-Oct-16 handling sick poultry recovered [3rd in Bangladesh] close contact with poultry, including sick quails
27. H9N2 Case 27 2016 211296 28th 57F Sichuan Onset unknown- Hospitalised 9-Feb-16 UMC 16-Feb-16 Confirmed
28. H9N2 Case 28 2016 211990 18 months Male Cairo Minshat Nasir Onset 10-Apr-16, Confirmed 20-Apr-16 good condition, Exposure Live poultry market

I'll update references when I have time! The order of the first 5 cases will be reshuffled around according to above post on 4-Jan!

Another case was referenced to Sichuan by WHO so I consider it as a preliminary report until further clarification.

by Michael Fraser

Please see Flu trackers H9N2 Line list for further WHO reports and updates.

https://flutrackers.com/forum/forum/...list-1998-2016

[Biological100]

Also see
Song Li et al.2015 Avian influenza H9N2 seroprevalence among pig population and pig farm staff in Shandong, China, Virology Journal 2015, 12:34 doi:10.1186/s12985-015-0265-9
Table 4 Six swine farm workers of with the positive results of HI and MN Locations Age(years) Gender Results HI MN
Weifang 56 Female 160 80
Weifang 52 Female 40 --
Taian 46 Male 40 --
Linyi 49 Female 160 160
Jining 45 Male 80 40
Binzhou 50 Female 80 40

Virology Journal | Abstract | Avian influenza H9N2 seroprevalence among pig population and pig farm staff in Shandong, China

http://www.virologyj.com/content/12/1/34/abstract

[Biological100]

Here's the table

[sharon sanders]

I had trouble downloading the pdf. I will try later.

[Biological100]

Just to note the above post clarifies specific ages:

H9N2 influenza virus in China: a cause of concern , Yipeng Sun,Jinhua Liu, Protein Cell 2015, Vol. 6 Issue (1) : 18-25 DOI: 10.1007/s13238-014-0111-7, Yipeng Sun, Jinhua Liu&
http://journal.hep.com.cn/pac/EN/10....8-014-0111-7#1

Please clip if possible open access journal article table and place here please!

[Biological100]

Please see: After my post on Flu trackers I found this issued by coincidence:

H9N2 influenza virus in China: a cause of concern , Yipeng Sun,Jinhua Liu, Protein Cell 2015, Vol. 6 Issue (1) : 18-25 DOI: 10.1007/s13238-014-0111-7, Yipeng Sun, Jinhua Liu&
Key Laboratory of Animal Epidemiology and Zoonosis, Ministry of Agriculture, College of Veterinary Medicine, China Agricultural University, Beijing 100083, China & Correspondence: ljh@cau.edu.cn (J. Liu) Received September 1, 2014 Accepted September 30, 2014

http://journal.hep.com.cn/pac/EN/10....8-014-0111-7#1


Please see the above summary for assistance :

RE: FluTrackers Global Cumulative H9N2 Partial Case List 1998-2016, January 26th, 2016, 08:58 AM
https://flutrackers.com/forum/forum/china-other-health-threats/hong-kong-emerging-diseases-other-health-threats/156906-department-of-health-hksar-h9n2-press-releases-from-1999-2013

[Biological]

Re: Department of Health, HKSAR : H9N2 press releases from 1999-2013

See: Hong Kong, CHP notified by NHFPC of human case of avian influenza A(H9N2) in Hunan (January 2 2014) - FluTrackers

http://www.flutrackers.com/forum/showthread.php?p=518624&posted=1#post518624

"January 3, Hunan CDC Epidemic prevention specialist Dr. Liu Fuqiang introduced by the literature search, from 1998 onwards, Guangdong, China, Hong Kong, reporting at least 17 cases of human infection with the H9N2 bird flu cases, including 10 cases in Guangdong, Hong Kong 7 cases."

I did a quick search of these documentated cases and here were my results

Documented Human cases in Southern Provinces in China/Hong Kong SAR

Intro:
Michael Greger, The Human/Animal Interface: Emergence and Resurgence
of Zoonotic Infectious Diseases
Clip:
"In Hong Kong survey studies in the late-1970s, H9N2 viruses were isolated from waterfowl but not from chickens (Shortridge 1982). The earliest H9N2 isolate in a terrestrial bird was discovered in Hong Kong quail in 1992 (Guo et al. 2000). By 1995, H9N2 was causing outbreaks of severe respiratory disease in chickens in China (Guo et al. 2000) and Korea (Mo et al. 1997) with mortality rates of 10–40%. Currently, H9N2 is widely enzootic in chickens in Eurasia (Xu et al. 2007) and has infected children in Hong Kong SAR in 1999 (Lin et al. 2000) and 2003
(Butt et al. 2005)."

http://www.moag.gov.il/NR/rdonlyres/...robiol2007.pdf

----
H9N2 viruses have also been isolated from pigs in Hong Kong in 1998 (1) and in Shandong Province in 2003 (2), raising the possibility of further reassortment with human-
like viruses from pigs.

1.Peiris, J. S., Y. Guan, D. Markwell, P. Ghose, R. G. Webster, and K. F. Shortridge. 2001. Cocirculation of avian H9N2 and contemporary “human”
H3N2 influenza A viruses in pigs in southeastern China: potential for genetic reassortment? J. Virol. 75:9679–9686.

2. Xu, C., W. Fan, R. Wei, and H. Zhao. 2004. Isolation and identification of swine influenza recombinant A/Swine/Shandong/1/2003 (H9N2) virus. Microbes
Infect. 10:919–925.


-----

Vincent C.C. Cheng, Jasper F.W. Chan, X. Wen, W.L. Wu, T.L. Que, H.
Chen, K.H. Chan, K.Y. Yuen Of Immunocompromised Human By Avian H9N2 Influenza A Virus, Journal of Infection, 10.1016/j.jinf.2011.02.007

http://www.journalofinfection.com/ar...052-1/abstract

Table 1. Characteristic of patients infected with culture documented avian influenza H9N2
Case no (sex/age) Underlying disease and Clinical features, diagnosis, and significant laboratory findings, and (outcome) Date & place of diagnosis and (viral strain)

(Table 1. Cases 1-11)
* a city in Guangdong province, China
# probable exposure to poultry


1 (M/4) NM Acute respiratory disease (recovered) July 1998, Shantou*
(A/Shantou/217/98, H9N2)
Guo Y, Li J, Chang X, Wang M, Zhou Y, Li C, et al. Discovery of men infected by avian influenza A (H9N2) virus. Chinese J Exp Clin Virol 1999;13:105–108.

http://www.ncbi.nlm.nih.gov/pubmed/12569771

2 (F/1) NM Acute respiratory disease (recovered) August 1998, Shantou*
A/Shantou/239/98, H9N2)
Guo Y, Li J, Chang X, Wang M, Zhou Y, Li C, et al. Discovery of men infected by avian influenza A (H9N2) virus. Chinese J Exp Clin Virol 1999;13:105–108.

http://www.ncbi.nlm.nih.gov/pubmed/12569771

3 (F/36) NM Acute respiratory disease (recovered) August 1998, Shantou*
A/Shantou/252/98, H9N2)
Guo Y, Li J, Chang X, Wang M, Zhou Y, Li C, et al. Discovery of men infected by avian influenza A (H9N2) virus. Chinese J Exp Clin Virol 1999;13:105–108.

http://www.ncbi.nlm.nih.gov/pubmed/12569771

4 (M/1) NM Acute respiratory disease (recovered) August 1998, Shaoguan*
(A/shaoguan/402/98, H9N2)
Guo Y, Li J, Chang X, Wang M, Zhou Y, Li C, et al. Discovery of men infected by avian influenza A (H9N2) virus. Chinese J Exp Clin Virol 1999;13:105–108.

http://www.ncbi.nlm.nih.gov/pubmed/12569771

5 (M/75) NM Acute respiratory disease (recovered) August 1998, Shaoguan*
(A/shaoguan/408/98, H9N2)
Guo Y, Li J, Chang X, Wang M, Zhou Y, Li C, et al. Discovery of men infected by avian influenza A (H9N2) virus. Chinese J Exp Clin Virol 1999;13:105–108.

http://www.ncbi.nlm.nih.gov/pubmed/12569771

6 (F/4)# Mild eczema, asthma Fever (rectal temperature 38.9oC), malaise, anorexia, sore
throat, headache, abdominal pain, and vomiting;
Neutrophilia of 10.2x109/L (normal 1.5-8.5x109/L);
lymphopenia of 1.3x109/L (normal 2.0-8.5x109/L); Creactive
protein of 25.4 (normal <8mg/L); normalchest radiograph
(Fever subsided within 6 days and recovered without complication)
March 1999, Hong Kong Special administrative region, China
(A/HK/1073/99, H9N2)
Peiris M, Yuen KY, Leung CW, Chan KH, Ip PL, Lai RW, et al. Human infection
with influenza H9N2. Lancet 1999;354:916-7. Pages 916 - 917, 11 September 1999 doi:10.1016/S0140-6736(99)03311-5

http://www.thelancet.com/journals/la...311-5/fulltext

and another case study described by

Timothy M. Uyeki, Yu-Hoi Chong, Jacqueline M. Katz, Wilina Lim, Yuk-Yin Ho, Sophia S. Wang, Thomas H.F. Tsang, Winnie Wan-Yee Au,† Shuk-Chi Chan, Thomas Rowe, Jean Hu-Primmer, Jensa C. Bell, William W. Thompson, Carolyn Buxton Bridges, Nancy J. Cox, Kwok-Hang Mak, and Keiji Fukuda, Lack of Evidence for Human-to- Human Transmission of Avian Influenza A (H9N2) Viruses in Hong Kong, China, 1999, Emerg. Infect. Dis. 8, 154– Emerging Infectious Diseases • Vol. 8, No. 2, February 2002

http://wwwnc.cdc.gov/eid/article/8/2/pdfs/01-0148.pdf

7 (F/1) Failure to thrive Fever (rectal temperature 39.9oC), coryza vomiting, poor appetite;
March 1999, Hong Kong Special administrative region,
Monocytosis of 2.22x109/L (normal <1.4x109/L);
Elevated aspartate aminotransferase of 60 IU/L (normal
<40 IU/L); normal chest radiograph;
co-culture of adenovirus type 3 in nasopharyngeal aspirates
(Fever subsided within 3 days and recovered without complication)
China
(A/HK/1074/99, H9N2)
Peiris M, Yuen KY, Leung CW, Chan KH, Ip PL, Lai RW, et al. Human infection
with influenza H9N2. Lancet 1999;354:916-7. Pages 916 - 917, 11 September 1999 doi:10.1016/S0140-6736(99)03311-5

http://www.thelancet.com/journals/la...311-5/fulltext

and another case study described by

Timothy M. Uyeki, Yu-Hoi Chong, Jacqueline M. Katz, Wilina Lim, Yuk-Yin Ho, Sophia S. Wang, Thomas H.F. Tsang, Winnie Wan-Yee Au,† Shuk-Chi Chan, Thomas Rowe, Jean Hu-Primmer, Jensa C. Bell, William W. Thompson, Carolyn Buxton Bridges, Nancy J. Cox, Kwok-Hang Mak, and Keiji Fukuda, Lack of Evidence for Human-to- Human Transmission of Avian Influenza A (H9N2) Viruses in Hong Kong, China, 1999, Emerg. Infect. Dis. 8, 154–Emerging Infectious Diseases • Vol. 8, No. 2, February 2002

http://wwwnc.cdc.gov/eid/article/8/2/pdfs/01-0148.pdf

8 (F/2) NM Fever, cough, and bronchitis (recovered within 2 weeks) November 1999, Guangzhou*
(A/GZ/333/99, H9N2)
* a city in Guangdong province, China; # probable exposure to poultry
Guo Y, Xie J, Wang M, Dang J, Guo J, Zhang Y, et al. A strain of influenza A
H9N2 virus repeatedly isolated from human population in China. Chinese J Exp
Clin Virol 2000;14:209–212.

http://www.ncbi.nlm.nih.gov/pubmed/11498680

9 (M/5) Good health Fever (temperature 38.7oC) and cough;
Neutrophilia of 10.0x109/L (normal 1.5-8.5x109/L);
lymphopenia of 1.6x109/L (normal 2.0-8.5x109/L);
normal chest radiograph
(Fever subsided within 2 days and recovered without complication)
November 2003, Hong Kong
Special administrative region, China
(A/HK/2108/03, H9N2)
Peiris M, Yuen KY, Leung CW, Chan KH, Ip PL, Lai RW, et al. Human infection
with influenza H9N2. Lancet 1999;354:916-7. Pages 916 - 917, 11 September 1999 http://www.ncbi.nlm.nih.gov/pubmed/10489954


10 (F/3)#
Initially good health
Afebrile, cough, nasal obstruction, and vomiting;
(Diagnosis of acute leukemia 4 days later)
December 2008, Hong Kong Special administrative region, China
Vincent C.C. Cheng, Jasper F.W. Chan, X. Wen, W.L. Wu, T.L. Que, H.
Chen, K.H. Chan, K.Y. Yuen Of Immunocompromised Human By Avian H9n2 Influenza A Virus, Journal of Infection, 10.1016/j.jinf.2011.02.007 ,

http://www.journalofinfection.com/ar...052-1/abstract

11 (F/47)
Post blood marrow transplantation
Fever (temperature of 38.1oC), chills, cough, and increasing dyspnea; chest radiograph showed extensive bilateral interstitial infiltrates;
(Discharged in day 10 with long term oxygen supplement at home)
October 2009, Hong Kong
Special administrative region, China
(A/HK/464419/09)
Vincent C.C. Cheng, Jasper F.W. Chan, X. Wen, W.L. Wu, T.L. Que, H.
Chen, K.H. Chan, K.Y. Yuen Of Immunocompromised Human By Avian H9n2 Influenza A Virus, Journal of Infection, 10.1016/j.jinf.2011.02.007

http://www.journalofinfection.com/ar...052-1/abstract

GenBank accession numbers genes and proteins of avian influenza A (H9N2) viruses isolated from 1997 to 2009 from humans. (Butt et al. 2010 NCBI search)

A/Hong Kong/1074/1997 - Nucleotide - NCBI

http://www.ncbi.nlm.nih.gov/nuccore/...%2F1074%2F1997

A/Shantou/239/98 - Nucleotide - NCBI

http://www.ncbi.nlm.nih.gov/nuccore/...tou%2F239%2F98

A/Shaoguan/408/98 - Nucleotide - NCBI

http://www.ncbi.nlm.nih.gov/nuccore/...uan%2F408%2F98

A/Shaoguan/447/98 - Nucleotide - NCBI

http://www.ncbi.nlm.nih.gov/nuccore/...uan%2F447%2F98

A/Hong Kong/1073/99 (a) - Nucleotide - NCBI

http://www.ncbi.nlm.nih.gov/nuccore/...ng%2F1073%2F99

Influenza A virus (A/Hong Kong/1074/99(H9N2)) np gene for nucleoprotei - Nucleotide - NCBI

http://www.ncbi.nlm.nih.gov/nuccore/8894684

Influenza A virus (A/Guangzhou/333/99(H9N2)) hemagglutinin gene, parti - Nucleotide - NCBI

http://www.ncbi.nlm.nih.gov/nuccore/21632599

A/HK/2108/2003 - Nucleotide - NCBI

http://www.ncbi.nlm.nih.gov/nuccore/...%2F2108%2F2003

(A/Hong Kong/3239/2008 - Nucleotide - NCBI

http://www.ncbi.nlm.nih.gov/nuccore/...%2F3239%2F2008

A/Hong Kong/33982/2009 (b) - Nucleotide - NCBI

http://www.ncbi.nlm.nih.gov/nuccore/...2F33982%2F2009

Influenza A virus (A/Hong Kong/35820/2009(H9N2)) segment 4 sequence - Nucleotide - NCBI

http://www.ncbi.nlm.nih.gov/nuccore/287029356

(a) A(H9N2) Available vaccine virus (G1 Clade; WHO report, 2010)
(b) A(H9N2) Proposed vaccine virus (G1 Clade; WHO report, 2010)
see
Butt et al. and others (2010) ,Avian influenza A (H9N2): computational molecular analysis and phylogenetic characterization of viral surface proteins isolated between 1997 and 2009 from the human population, Published online 2010 November 15. Virol J. 2010; 7: 319. doi: 10.1186/1743-422X-7-319
Avian influenza A (H9N2): computational molecular analysis and phylogenetic characterization of viral surface proteins isolated between 1997 and 2009 from the human population

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2994543/

Phylogenetic relationships of HA genes in H9N2 influenza viruses isolated from humans between 1997 and 2009.

Phylogenetic relationships of NA genes in H9N2 influenza viruses isolated from humans between 1997 and 2009.

Current:Antigenic and genetic characteristics of zoonotic influenza viruses and development of candidate vaccine viruses for pandemic preparedness
September 2013

http://www.who.int/influenza/vaccines/virus/201309_h5h7h9_vaccinevirusupdate.pdf

Summary of status of development and availability of A(H9N2) candidate vaccine viruses*

http://www.who.int/influenza/vaccines/virus/candidates_reagents/summary_a_h9n2_cvv_20130129.pdf

----
Y. P. Lin, and others, Avian-to-human transmission of H9N2 subtype influenza A viruses: Relationship between H9N2 and H5N1 human isolates, Y. P. Lin, 9654–9658, doi: 10.1073/pnas.160270697

http://www.pnas.org/content/97/17/9654.full#ref-list-1

Zhao M, Liu Q, Sun Q, Zhang W, Zhao G, Gu M, Wang X, Hu S, Liu X, Liu X. 2013. Full genome sequence of a natural reassortant H9N2 avian influenza virus isolated from domestic ducks in Jiangsu Province, China. Genome Announc. 1(4):e00463-13. doi:10.1128/genomeA.00463-13.

http://genomea.asm.org/content/1/4/e....full.pdf+html

Wang J-Y, Ren J-J, Liu W-H, Tang P, Wu N, Wang C-Y, Chang C-D, Liu H-J. 2013. Complete genome sequence of a new H9N2 avian influenza virus isolated in China. Genome Announc. 1(3):e00261-13. doi:10.1128/genomeA.00261-13.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3668003/

----
Wan H, Sorrell EM, Song H, Hossain MJ, Ramirez-Nieto G, et al. (2008) Replication and Transmission of H9N2 Influenza Viruses in Ferrets: Evaluation of Pandemic Potential. PLoS ONE 3(8): e2923. doi:10.1371/journal.pone.0002923

http://www.plosone.org/article/info%...l.pone.0002923

[Biological]

Department of Health, HKSAR : H9N2 press releases from 1999-2013

This is a compilation of reports from the Department of Health, HKSAR


1999 Influenza A virus H9N2 in Hong Kong
Discovery of first cases of influenza A virus (H9N2) in humans in HK
April 7, 1999
The Government Virus Unit of the Hong Kong Department of Health (DH) had isolated, in collaboration with local and international health authorities, a new strain of influenza A virus (H9N2) from two patients recently.
"This is the first time H9N2 viruses, an avian influenza virus, are isolated from humans in Hong Kong," Deputy Director of Health, Dr Paul Saw said today.
The two patients are girls aged one and four who recovered fully from influenza-like illnesses last (March) month.
Atypical influenza viruses were picked up from their clinical specimens of throat secretion by the enhanced influenza surveillance system set up to monitor the avian flu situation in Hong Kong since late 1997.
The specimens were sent to World Health Organisation (WHO) Influenza Collaborating Reference Laboratories in United Kingdom and United States for further identification.
Results available today confirmed that the virus was influenza A (H9N2). The WHO was informed of the finding.
Speaking at a press briefing, Dr Saw said: "This influenza A (H9N2) is an avian influenza virus which has been isolated from duck and chicken for many years."
"Detailed investigations are underway to find out how the patients contracted the viruses."
"At this stage, the two cases appeared isolated. Notwithstanding this, the Department of Health's special investigation team on avian influenza will work closely with local and overseas experts to assess the global health impact of this new discovery and its mode of transmission."
"This information will be released to the medical professions and the public when available."
Dr Saw said that this virus is sensitive to the drugs amantadine and rimantadine.
He added that Hong Kong has a good medical and health system with adequate resources to provide appropriate treatment for this condition.
With the experience gained in the control of the avian flu outbreak in late 1997, he said that the Department would be better equipped to co-ordinate efforts from international health authorities and local experts to monitor and control the situation.
Members of the public are advised at this stage to observe good ventilation, to have proper diet, exercise and rest to build up body resistance to combat infection. They are also advised to wash their hands after handling poultry or the birds' excreta.
The public can obtain updated information on influenza from the Department of Health's Homepage (http://www.info.gov.hk/dh/). They can also get information on the prevention of influenza from the Department's Central Health Education Hotline on Tel No: 2833 0111.
Department of Health - Press Release

http://www.dh.gov.hk/english/press/1999/07_04_99.html

Information and advice to doctors on H9N2 influenza
April 8, 1999
The Government Virus Unit of Hong Kong Department of Health (DH) had isolated, in collaboration with local and international experts, a new strain of influenza A virus (H9N2) from two patients recently in April 1999.
The two patients were girls aged one and four. The four-year-old girl had history of asthma and eczema on regular steroid inhalation and salbutamol inhalation. The one-year-old girl had history of failure to thrive still under investigation. Both of them were hospitalised in early March 1999 due to influenza-like illnesses with fever 39 - 40 oC. Their initial clinical presentations were similar to those of typical influenza, with fever of acute onset, sore throat, vomiting and headache. Both of them had no complication and recovered fully.
Influenza A (H9N2) viruses have been isolated in birds for many years. They may cause very mild illness in birds like turkey, chicken and duck. They were isolated for the first time in humans in Hong Kong. The Department of Health is working closely with local and overseas experts to ascertain the mode of transmission of the virus and determine its public health impact.
The information gathered so far suggests that influenza A (H9N2) has similar clinical presentation as other influenza viruses. The appropriate management should consist of adequate rest, fluid replacement and antipyretic as necessary. Aspirin should be avoided in children. If there are signs of complications such as pneumonia, the patient should be hospitalised. The H9N2 virus is sensitive to amantadine and rimantadine.
Appropriate counselling on prevention of influenza should be given to patients and members of general public. Important messages include a balanced diet, regular exercise, adequate rest to maintain body immunity and no smoking. Observation of good personal hygiene and maintaining good ventilation are also useful. Members of the public are also advised to wash their hands after handling poultry or the birds' excreta.
Department of Health - Press Release

http://www.dh.gov.hk/english/press/1999/08_04_99.html

Information and advice to child care workers & school teachers on H9N2 influenza
April 9, 1999
Influenza
Influenza is an acute illness characterised by fever, headache, muscle ache, running nose, cough and sore throat. The disease is usually self-limiting with recovery in 2-7 days. Three types of influenza virus are recognized : A, B and C, in which type A is more common. In Hong Kong, the two subtypes of influenza A (H1N1 and H3N2) are most commonly seen and the disease is more prevalent in February/March and July.
Avian ( H9N2) Influenza
To date, there are only two types of avian influenza virus, H5N1 and H9N2, that can affect humans. Influenza A (H9N2) viruses have been isolated in birds for many years. For the first time in Hong Kong, influenza A (H9N2) was recently found to have infected two children aged one and four. They developed acute fever (39-40oC), vomiting, sore throat and headache. Both of them recovered fully without any complication. The Department of Health is working closely with local and overseas experts to ascertain the mode of transmission of the virus and determine its public health impact.
Prevention
Good body resistance is important. This can be achieved through a balanced diet, regular exercise, adequate rest, reducing stress and no smoking. When one is feeling unwell, it is better to avoid crowded public places where the air ventilation is not good. Avoiding contact with live poultry will also minimise the chance of getting bird flu. Hands should be washed thoroughly with soap and water after handling live poultry. It is also prudent for children not to contact birds and chicken.
Treatment
The H9N2 virus is sensitive to amantadine. However, this drug should only be used carefully under doctor's supervision because it can cause neurological and gastrointestinal side effects. For general management, patients should have adequate rest and fluid intake. Anti-fever medicine and cough syrup are useful to reduce symptoms. Patients should also observe personal hygiene and wash their hands frequently. Aspirin should not be used in children because of the association with Reye's Syndrome.
For patients with underlying diseases or when there are signs of deterioration e.g. persistent high fever or shortness of breath, they should seek early medical advice. It is preferable to follow up the illness by the same doctor to avoid delay in diagnosis and treatment.
Advice to child care workers and school teachers
1. Child care workers and teachers are advised to take note of the health of children under their care and ensure that proper personal hygiene is observed. Children with influenza like illness should seek medical advice and stay at home. The Department of Health's Regional Offices are ready to provide assistance and support. Their addresses and telephone numbers are:
Hong Kong Region
30/F Wu Chung House
213 Queen's Road East
Wanchai
Hong Kong
Tel. No. : 2961 8729
Kowloon Region
1/F, Hospital authority
Building
147B Argyle Street
Kowloon
Tel. No. : 2199 9100
New Territories Region (East)
5/F Citylink Plaza
1 Shatin Station Circuit
New Territories
Tel. No. : 2684 5138
New Territories Region (West)
1/F
115 Castle Peak Road
Tsuen Wan
Tel. No. : 2413 8388 Ext 24, 25 or 40, or 2411 6949
2. Small animals kept at schools or child care centres should be carefully looked after. Replacement by other suitable substitutes should be considered. Children should be guided to keep a safe distance from the animals and refrain from direct contact with them.
Department of Health - Press Release

http://www.dh.gov.hk/english/press/1999/09_04_99_2.html

Special Investigation Group on Avian Flu recommends close monitoring of situation and more scientific studies
April 11, 1999
The Special Investigation Group on Avian Flu met today to assess the impact of the discovery of influenza A (H9N2), an avian influenza virus, in humans and to make recommendations on the way forward.
The Group was chaired by the Deputy Director of the Hong Kong Department of Health, Dr Paul Saw and comprised public health doctors, veterinarians as well as both local and overseas experts in microbiology and epidemiology.
The Group commended the prompt detection of the two cases in Hong Kong which reflected the effectiveness of Hong Kong's influenza surveillance system.
It noted the satisfactory outcome and full recovery of the two girls in Hong Kong found to have contracted influenza A (H9N2). It also noted that the virus is usually causing mild symptoms, if any, among birds and poultry.
The Special Investigation Group initially considered that the discovery of the virus does not appear to pose an imminent major threat to public health. However, several investigations should be started, in case other H9 human cases appear later and because H9 viruses, similar to other influenza viruses, can change or re-assort and become more easily transmitted.
The situation should therefore be kept under close monitoring and surveillance.
Speaking after the meeting, Dr Keiji Fukuda, Chief of Epidemiology Section of the Influenza Branch of the Centres for Disease Control and Prevention (CDC) in Atlanta said: "The major question about the isolation of influenza A (H9N2) virus in humans is whether they pose a major health risk for people."
To answer this question, Dr Fukuda said the Group should find out
* whether there are other H9N2 infections in people in Hong Kong
* the mode of transmission of the virus to humans
* the risk factors of contracting this virus
* the relation between H9 infection in poultry and in people
To do this, the Special Working Group recommended that several different studies and activities be conducted. These included:
* most importantly, enhanced influenza surveillance should be continued
* epidemiological studies to identify risk factor and mode of transmission of these viruses
* prevalence studies to find out how common these infections are right now in birds and human
Dr Paul Saw said the Department of Health would co-ordinate actions recommended by the Special Investigation Group.
He said the Group also agreed that chicken and poultry are safe to eat if they are cooked thoroughly. However, public are reminded again to observe good personal hygiene by washing hands thoroughly after contact with poultry, animals and their excreta.
Department of Health - Press Release

http://www.dh.gov.hk/english/press/1999/11_04_99.html

2003
Boy recovered from influenza A virus (H9N2)
December 9, 2003
The Department of Health (DH) is investigating a case of influenza A virus (H9N2) involving a five?year-old boy who has just recovered after treatment in hospital.
"This is the second time H9N2 viruses, an avian influenza virus, are isolated from humans in Hong Kong. The last case was detected in 1999 involving two girls who also made full recovery after having flu like symptoms," Dr Thomas Tsang, Consultant (Community Medicine) of DH said today (December 9).
The boy developed symptoms of fever, cough and runny nose on November 25. He was admitted to United Christian Hospital on November 27 and was subsequently discharged two days later.
Dr Tsang said that influenza A (H9N2) viruses were detected from the boy's nasopharyngeal aspirate specimen by the DH Public Health Laboratory Centre today. Further tests are being conducted to sequence the virus to confirm its identity.
The department has informed the World Health Organisation (WHO), Macau and Guangdong about the findings.
DH investigations so far revealed that the boy did not travel outside Hong Kong recently. Some family members have recent mild cough.
"This is an isolated case and the source of infection is being investigated. Based on previous experience, however, we will look especially into bird-to-human transmission.
"We will look into histories of bird and poultry exposure, visits to places with birds and animals, contact with diseased people or animals," Dr Tsang said.
The department will issue letters to doctors to alert the medical community, and liaise with the Education and Manpower Bureau to reinforce messages to kindergartens and schools on the importance of hygiene matters to prevent avian flu and other infectious diseases.
Influenza A (H9N2) is an avian influenza virus which has been isolated from duck and chicken for many years. Infection in humans is rare, and appears to present as a mild form of disease.
Dr Tsang said that Hong Kong has a very comprehensive avian influenza surveillance programme to detect the presence of any avian influenza in our environment and the possible reassortment of the viruses so that prompt responsive measures can be taken.
As a precautionary measure, members of the public are reminded to avoid contacts with live poultry to minimize the chance of being infected with avian influenza.
"Hands should be washed thoroughly with soap and water after handling live poultry.
"To build up good body resistance against influenza, the public are encouraged to maintain a balanced diet, do regular exercise, and have adequate rest. They should not smoke," Dr Tsang noted.
The public can obtain updated information on influenza from the Department of Health's Hompage (This link will open in a new windowhttp://www.dh.gov.hk). They can also get information on the prevention of influenza from the Department's Central Health Education Hotline on 2833 0111.
Department of Health - Press Release

http://www.dh.gov.hk/english/press/2003/03_12_09_1.html

Investigation into H9N2 case continues
December 10, 2003
Health team from the Department of Health (DH) today (December 10) visited a kindergarten in Lam Tin to carry out investigation and environmental inspection, and to provide health education to the school.
A five-year-old student of the kindergarten was found to have preliminary positive test result for influenza A (H9N2) yesterday. Gene sequencing today confirmed that the virus isolated from his nasopharyngeal aspirate was H9N2.
A spokesman for the department said the hygiene of the school was satisfactory but DH staff had reminded the school to take precautionary measures to prevent influenza in institutional setting. Staff of the Food and Environmental Hygiene Department (FEHD) carried out thorough disinfection in the kindergarten this morning.
"Investigation has also revealed that there was no abnormal sick leave pattern in the kindergarten in recent weeks.
"A total of 15 birds' excreta samples were collected in the open area outside the kindergarten for laboratory tests," the spokesman said, adding:"a health talk has been arranged for the parents of the students this evening".
Subject to the consent of the parents, DH staff will take blood and throat swab samples from their children to ascertain if they had been infected with influenza A (H9N2), the spokesman added.
DH staff visited the home of the five-year-old boy last night and disinfection was conducted by the FEHD. Three family members have mild cough without fever. Specimens were collected from his family members for examination. Laboratory results will be available in about a week's time. Environmental samples were also collected from the poultry stalls in the shopping arcade near the patient's residence.
The department has also sent letters to all doctors and Chinese medicine practitioners to alert them of the case.
The spokesman reiterated that influenza A (H9N2) is very rare, and appears to present as a mild form of disease. Bird-to-human transmission is the most likely possibility based on previous studies. The five-year-old boy and two girls who had contracted the disease in 1999 had fully recovered.
As a precautionary measure, members of the public are reminded to avoid contacts with live poultry to minimize the chance of being infected with avian influenza.
"Hands should be washed thoroughly with soap and water after handling live poultry.
"To build up good body resistance against influenza, the public are encouraged to maintain a balanced diet, do regular exercise, and have adequate rest. They should not smoke," the spokesman said.
The public can obtain updated information on influenza from the Department of Health's Homepage This link will open in a new window(http://www.dh.gov.hk/). They can also get information on the prevention of influenza from the Department's Central Health Education Hotline on 2833 0111.
Department of Health - Press Release

http://www.dh.gov.hk/english/press/2003/03_12_10_1.html

Experts discuss case of Influenza A (H9N2)
December 16, 2003
The Expert Working Group on Avian Influenza met today (December 16) to examine the progress of investigation over a recent case of influenza A virus (H9N2) involving a five-year-old boy who had recovered after treatment in hospital.
This remark was made by the Acting Deputy Director of Health, Dr Regina Ching, who chaired the meeting of the Expert Working Group on Avian Influenza today.
At the meeting, members of the working group were briefed of the epidemiologic investigations being carried out by the staff of the Department of Health (DH).
Results of the gene sequencing conducted by DH's Public Health Laboratory Centre confirmed the virus to be H9N2 but different from the two viruses isolated in 1999. Sequencing of internal genes had also been completed and showed that the virus genes were purely avian in origin.
Furthermore, initial test by the University of Hong Kong show that the virus from the boy was similar to the two virus strains found earlier this year through an on-going surveillance programme at the poultry markets. H9N2 viruses are widely distributed in nature and commonly found in live birds.
"At this point, we do not see evidence of circulation of the H9N2 virus in the human population. Our sentinel influenza rates are stable and our laboratory does not have further potential H9 virus isolated," Dr Ching said.
The meeting agreed that further epidemiologic and virologic investigations would be required to assess the significance of this finding and determine the source of infection in the child. In 1999, two girls with H9N2 also made full recovery after having flu like symptoms.
"As a precautionary measure, members of the public, including poultry traders should strictly observe personal and environmental hygiene.
"Parents should not let children touch live poultry and wild birds because young children may not be compliant in washing their hands," Dr Ching said.
The Expert Working Group on Avian Influenza was set up in 1997 to co-ordinate and keep under review the measures for the prevention and control of influenza A H5N1 infections.
Department of Health - Press Release

http://www.dh.gov.hk/english/press/2003/03_12_10_1.html

2004
Influenza A (H7 & H9) to be gazetted as notifiable diseases
30 December, 2004
The Government is to step up surveillance of influenza by adding influenza A(H7) and influenza A(H9) to the list of infectious diseases specified in the First Schedule to the Quarantine and Prevention of Diseases Ordinance.
Legislative amendment will take effect upon publication in the gazette tomorrow (December 31).
The amendment is made in view of the rapidly evolving global situation with avian influenza, a spokesman of the Department of Health (DH) said today (December 30).
The World Health Organization held an influenza pandemic consultation meeting earlier this month and it noted that human infections with influenza A(H5), A(H7), and A(H9) have been occurring at increasing frequency in recent years, the spokesman said.
Noting that Influenza A(H5) has been included in the list of statutorily notifiable diseases since January 30, 2004, the spokesman said the strengthening surveillance of influenza A(H7) and influenza A(H9) in Hong Kong is in line with local and global public health need.
"This will enhance the coverage of our infectious diseases surveillance system, enabling more effective and early detection and the implementation of appropriate public health control measures when necessary," he said.
Under the Prevention of the Spread of Infectious Diseases Regulations of the Ordinance, medical practitioners are required to notify the Director of Health if they have reason to suspect the existence of any infectious diseases listed in the First Schedule to the Ordinance.
"The Centre for Health Protection of DH is sending letters to individual doctors informing them about the amendment," the spokesman said.
A total of 30 infectious diseases are currently included in the First Schedule to the Ordinance.
Department of Health - Press Release

http://www.dh.gov.hk/english/press/2004/041230.html

2007
Girl recovered from influenza A virus (H9N2)
20 March 2007
The Centre for Health protection (CHP) of the Department of Health is investigating a case of influenza A virus (H9N2), a mild form of avian influenza, involving a nine?
Department of Health - Press Release

http://www.dh.gov.hk/english/press/2007/070320.html

H9N2 case update
22 March 2007
The nasopharyngeal aspirate (NPA) specimen taken on March 20 from the nine-month-old girl at the Princess Margaret Hospital (PMH) was found to be negative to H9 virus, a spokesman for the Centre for Health Protection (CHP) said today (March 22).
The girl was originally admitted to the United Christian Hospital (UCH) on March 6 for fever and was discharged three days later.
She developed another episode of mild symptoms of upper respiratory tract infection since March 17, and was admitted to PMH for observation when her NPA specimen taken at UCH was confirmed to be influenza A (H9N2) on March 20.
She is currently diagnosed to have respiratory syncytial virus infection and is in stable condition.

The spokesman said the CHP had visited the girl's home and conducted contact tracing.
?NPA specimen taken from all the girl's home contacts also yielded negative result to H9 while serology tests are pending,? the spokesman said.
Meanwhile, the CHP has contacted the 10 children who had stayed in the same cubicle with the girl while the latter was under treatment in UCH.
Three of the 10 children and a healthcare worker of the hospital who had in contact with the girl reported to have mild upper respiratory infection symptoms.
?Clinical specimens are being taken from them, and preliminary results are expected in a few days.
?A variety of common respiratory viruses and bacteria can cause mild upper respiratory infection symptoms,? the spokesman added.
The spokesman said further genetic sequencing was being conducted to determine if the virus found in the girl's specimen from UCH was completely of avian origin.
Further investigation into the case with emphasis on the source of infection is ongoing.
Department of Health - Press Release

http://www.dh.gov.hk/english/press/2007/070322_1.html

Gene sequencing on H9N2 virus shows bird to human transmission more likely
23 March 2007
Genetic sequencing studies of the virus isolated from a nine-month-old girl with H9N2 infection showed that all the genes from the virus were entirely of avian origin, a spokesman for the Centre for Health Protection (CHP) of the Department of Health said today (March 23).
The spokesman explained that the test results indicated it was more likely that the virus was directly transmitted from bird to human and that there was no re-assortment with human influenza virus.
As regards the laboratory tests on the respiratory specimens taken from a healthcare worker and three children staying in the same cubicle in the United Christian Hospital with the baby girl in early March, all of them yielded negative result to H9 virus.
The four had shown mild upper respiratory infection symptoms and specimens were taken from them for testing yesterday.
Department of Health - Press Release

http://www.dh.gov.hk/english/press/2007/070323.html

CHP investigating a case of influenza A (H9N2) infection
30 Dec 2008
The Centre for Health Protection (CHP) of the Department of Health is investigating a case of influenza A (H9N2) infection, a mild form of avian influenza, involving a two?month-old girl.
The Controller of CHP, Dr Thomas Tsang said today (December 30) the baby girl, living in Shenzhen with her parents, developed vomiting, cough and runny nose (but no fever) and was admitted to Tuen Mun Hospital (TMH) on December 22. She was discharged on the next day.
The girl was taken back to Shenzhen and was re-admitted to TMH on December 29 because of high white blood cell count, which may be suggestive of underlying hematological condition.
Dr Tsang said influenza A (H9N2) virus was detected from the girl's respiratory specimen taken on December 22.
The girl was staying at hospital for isolation and further investigation. Her family members are asymptomatic all along and have been put under medical surveillance.
"Further genetic sequencing is being conducted to determine if the virus is completely of avian origin," Dr Tsang said.
"As the girl was staying in Shenzhen for the whole incubation period, we have informed the Guangdong health department of this case and they will carry out necessary investigation and follow up actions.
The department will inform the World Health Organization, the Ministry of Health, health authorities of Macao about the findings.
Influenza A (H9N2) is an avian influenza virus which has been isolated from duck and chicken for many years. Infection in humans is rare, and appears to present as a mild disease.
Dr Tsang noted that this was the fifth time H9N2 viruses, an avian influenza virus, were isolated from humans in Hong Kong.
Three girls and a boy were confirmed to have suffered from H9N2 infection in 1999, 2003 and 2007 respectively.
Hong Kong has a very comprehensive avian influenza surveillance programme to detect the presence of any avian influenza in our environment and the possible reassortment of the viruses so that prompt responsive measures can be taken, Dr Tsang said.
As a precautionary measure, people are reminded to avoid contact with live poultry to minimise the chance of being infected with avian influenza.
"Hands should be washed thoroughly with soap and water after handling live poultry.
"To build up good body resistance against influenza, the public are encouraged to maintain a balanced diet, do regular exercise, and have adequate rest. They should not smoke," Dr Tsang said.
Members of the public can obtain updated information on influenza from the CHP's website
Department of Health - Press Release

http://www.dh.gov.hk/english/press/2008/081230-2.html

Update on H9N2 case
31 Dec 2008
The two-month-old baby girl who was confirmed to have been infected with influenza A H9N2 yesterday is still under isolation in Tuen Mun Hospital (TMH) in stable condition and her symptoms of the disease have subsided.
Nasopharyngeal aspirate specimens taken from her parents were tested negative for influenza A H9N2.
Staff of the Centre for Health Protection has contacted other patients and health care workers who might have been exposed to the baby girl and has put them under medical surveillance. So far, none of them have developed symptoms of respiratory infection.
Meanwhile, preliminary investigation by the health authority of Guangdong showed that a small number of chickens were kept in a food premises near the baby girl?s home in Shenzhen.
All her close contacts in Shenzhen and the workers in the food premises were asymptomatic and have been put under medical surveillance by the Guangdong health authority.
Department of Health - Press Release

http://www.dh.gov.hk/english/press/2008/081231-3.html

Gene sequencing of H9N2 virus shows avian origin
7 Jan 2009
The Centre for Health Protection (CHP) of the Department of Health today (January 7) completed gene sequencing on an influenza A (H9N2) virus found in a two-month-old girl in December 2008 and the results indicated all the genes were of avian origin.
A CHP spokesman said all the eight genes of the virus sample taken from the girl had been sequenced.
"DNA sequences of the genes concerned show that they are of avian origin and re-assortment with genes of human influenza origin has not been found.
"The virus is highly similar to the H9N2 virus isolated from another case involving a nine-month-old girl in 2007," he said.
The spokesman noted that the virus found in the two-month-old girl was sensitive to Tamiflu and Amantadine , two kinds of antiviral medicines.
The girl is still under treatment in Tuen Mun Hospital for another disease. Her symptoms of H9N2 infection have subsided. Nasopharyngeal aspirate specimens taken from the girl on January 2 were tested negative for influenza A H9N2.
All close contacts of the girl did not developed symptoms of H9N2 infection.
"The epidemiological and genetic findings so far suggest that the H9N2 virus has shown no signs of increased risk for human-to-human transmission," the spokesman said.
Department of Health - Press Release

http://www.dh.gov.hk/english/press/2009/090107-2.html

3 Nov 2009
The Centre for Health Protection (CHP) of the Department of Health is investigating an imported case of influenza A (H9) infection, a mild form of avian influenza.
A spokesman for CHP said today (November 3) the woman, who aged 47 and lived in Guangdong Province, developed shortness of breath and cough with sputum on October 26. She went to Hong Kong for medical treatment and was admitted to Queen Mary Hospital on October 28. She is now in stable condition.
Influenza A (H9) virus was detected in the patient's respiratory specimen taken on October 29.
The patient had an underlying medical condition, requiring regular medication. As she stayed in Guangdong Province during the whole incubation period, CHP had informed health authority of Guangdong for its follow-up actions.
The woman is staying in isolation in hospital for further investigation. Her family members are asymptomatic and they have been put under medical surveillance.
The department informed the World Health Organization, the Ministry of Health, and the health authorities of Guangdong and Macao of the development, the spokesman said.
Influenza A (H9) is an avian influenza virus which has been isolated from duck and chicken for many years. Infection in humans is rare, and appears to present as a mild disease.
This is the sixth time that H9 viruses was found in humans in Hong Kong.
Four girls and a boy were confirmed to have suffered from H9 infection in 1999, 2003, 2007 and 2008 respectively.
The spokesman said, "Hong Kong has a comprehensive avian influenza surveillance programme to detect the presence of any avian influenza in our environment and the possible reassortment of the viruses so that prompt responsive measures can be taken."
As a precautionary measure, people are reminded to avoid contact with live poultry to minimise the chance of being infected with avian influenza.
"Hands should be washed thoroughly with soap and water after handling live poultry.
"To build up good body resistance against influenza, the public are encouraged to maintain a balanced diet, do regular exercise, and have adequate rest. They should not smoke." the spokesman said.
For further information on avian influenza, please visit the CHP website
Department of Health - Press Release

http://www.dh.gov.hk/english/press/2009/091103-2.html

CHP investigating case of influenza A (H9N2) infection
23 Dec 2009
The Centre for Health Protection (CHP) of the Department of Health is investigating a case of influenza A (H9N2) infection - a mild form of avian influenza - involving a 35-month-old girl.

A spokesman for CHP said today (December 23) the girl, living in Sha Tin, developed symptoms of cough, fever, runny nose since late November. She was admitted to the Prince of Wales Hospital and was discharged on December 11. She has now recovered.

Influenza A (H9N2) was detected in the patient's respiratory specimen.

Investigation is ongoing.

The department will inform the World Health Organization.

Influenza A (H9) is an avian influenza virus which has been isolated from duck and chicken for many years. Infection in humans is rare, and appears to present as a mild disease.

This is the seventh time that H9 viruses was found in humans in Hong Kong. Five females and a male were confirmed to have suffered from H9 infection in 1999, 2003, 2007, 2008 and 2009.

"Hong Kong has a comprehensive avian influenza surveillance programme to detect the presence of any avian influenza in our environment and the possible reassortment of the viruses so that prompt responsive measures can be taken," the spokesman said.

As a precautionary measure, people are reminded to avoid contact with live poultry to minimise the chance of being infected with avian influenza.

"Hands should be washed thoroughly with soap and water after handling live poultry.

"To build up good body resistance against influenza, the public are encouraged to maintain a balanced diet, do regular exercise, and have adequate rest. They should not smoke." he said.

For further information on avian influenza, please visit the CHP website at
Department of Health - Press Release

http://www.dh.gov.hk/english/press/2009/091223-3.html

Epidemiological investigation and follow-up actions by CHP on confirmed human case of influenza A(H9N2)
30 Dec 2013
The Centre for Health Protection (CHP) of the Department of Health (DH) is today (December 30) investigating a confirmed human case of influenza A(H9N2) affecting a man aged 86.

The patient is a Hong Kong resident living in Huangbeiling, Luohu, Shenzhen. He has underlying illnesses and has developed chills and cough with sputum since December 28. Upon entry at Lo Wu Border Control Point (BCP) on the same day, he was transferred by ambulance direct to the Accident and Emergency Department of North District Hospital (NDH), where he presented with low fever. He was then admitted to the isolation ward. He was transferred to Princess Margaret Hospital today for further management.

His clinical diagnosis was chest infection. He has been in stable condition all along and is currently afebrile.

His sputum specimen tested positive for the influenza A(H9N2) virus upon testing by the CHP's Public Health Laboratory Services Branch.

"The epidemiological investigations, enhanced disease surveillance, port health measures and health education against avian influenza are all ongoing," a spokesman for the DH remarked.

Investigations by the CHP revealed that the patient had no recent poultry contact, consumption of undercooked poultry, or contact with patients. His home contact in Shenzhen has remained asymptomatic.

Over 50 health-care workers of NDH and the ambulance service have been put under medical surveillance.

"The H9N2 virus is of avian origin and has been isolated mainly from poultry. Rare and sporadic human cases have been reported and are generally mild respiratory tract infections. The public should avoid contact with poultry and other birds, including chickens, ducks and sparrows," the spokesman explained.

Influenza A(H9) is a local statutorily notifiable infectious disease. Two local cases were reported in 1999. One local case was respectively filed each in 2003 and 2007. An imported case was recorded in 2008 while an imported case and one with the source of infection unclassified were filed in 2009. All are mild infections and the patients have recovered. No deaths have been recorded so far.

Locally, enhanced surveillance over suspected cases in public and private hospitals is under way.

As the patient was staying in Shenzhen for the whole incubation period, the CHP will inform the health authority of Guangdong of the case for necessary investigation and follow-up action.

The case will also be notified to the World Health Organization (WHO), the National Health and Family Planning Commission, and the health authority of Macau.

The CHP will issue letters to doctors and hospitals to keep them abreast of the latest situation.

"We will remain vigilant and maintain liaison with the WHO, the Mainland and overseas health authorities. Local surveillance activities will be modified according to the WHO's recommendations," the spokesman said.

"All BCPs have implemented disease prevention and control measures. Thermal imaging systems are in place for body temperature checks of inbound travellers. Suspected cases will be immediately referred to public hospitals for follow-up investigation," the spokesman added.

Regarding health education for travellers, distribution of pamphlets, display of posters in departure and arrival halls, in-flight public announcements, environmental health inspection and provision of regular updates to the travel industry via meetings and correspondence are all proceeding.

"We have enhanced publicity and health education against avian influenza. The CHP has also sent letters to government departments and related organisations to reinforce health advice against avian influenza," the spokesman said.

"Travellers, especially those returning from avian influenza-affected areas and provinces with fever or respiratory symptoms, should immediately wear masks, seek medical attention and reveal their travel history to doctors. Health-care professionals should pay special attention to patients who might have had contact with poultry, birds or their droppings in affected areas and provinces," the spokesman advised.

Members of the public should remain vigilant and take heed of the preventive advice against avian influenza below:

* Do not visit live poultry markets. Avoid contact with poultry, birds and their droppings. If contact has been made, thoroughly wash hands with soap;
* Poultry and eggs should be thoroughly cooked before eating;
* Wash hands frequently with soap, especially before touching the mouth, nose or eyes, handling food or eating; after going to the toilet or touching public installations or equipment (including escalator handrails, elevator control panels and door knobs); or when hands are dirtied by respiratory secretions after coughing or sneezing;
* Cover the nose and mouth while sneezing or coughing, hold the spit with a tissue and put it into a covered dustbin;
* Avoid crowded places and contact with fever patients; and
* Wear masks when respiratory symptoms develop or when taking care of fever patients.

The public may visit the CHP's avian influenza page (www.chp.gov.hk/en/view_content/24244.html) and website (https://www.chp.gov.hk/files/pdf/glo...nfluenza_e.pdf) for more information on avian influenza-affected areas and provinces.
Ends/Monday, December 30, 2013
Issued at HKT 18:43

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Epidemiological investigation and follow-up actions by CHP on confirmed human case of influenza A(H9N2)

http://www.info.gov.hk/gia/general/201312/30/P201312300427.htm