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Center for Health Protection, Chinese Special Administrative Region of Hong Kong Update on H5N1 avian influenza. Communicable Diseases Watch Volume 10, Number 5, Week 8-9 (Feb 17, 2013 ? Mar 2, 2013) , 7 March 2013
Reported by Miss Amy Li, Scientific Officer, Respiratory Disease Office, Surveillance and Epidemiology Branch, CHP.
Snip:
Twelve human cases were recorded so far this year (as of March 1, 2013), include 9 cases from Cambodia, 2 cases from Mainland China (Guizhou) and 1 case from Egypt. Eleven of them were fatal. According to WHO, epidemiological investigations revealed that all cases from Cambodia this year had either exposure to poultry or recent deaths among poultry in their villages. While the case from Egypt also had exposure to backyard sick and dead poultry i, the 2 fatal cases from Mainland China (Guizhou) had no clear history of contacting poultry before symptom onset.
According to WHO (as of March 1, 2013), age distribution of all cases ranged from 3 months to 81 years (median 18 years, n = 599).The age group with the largest number of cases was 20-29 years of age (22.4%, 134/599), relative to other age groups (0-4; 5-9; 10-19; 30-39; 40-49; 50-59; 60-69; 70+ years). 53.9% of the cases were female (322/597). A total of 371 cases died,giving a case fatality rate of 59.6%.The highest case fatality rate (CFR) (73.2%) was among persons 10-19 years of age. Among the countries with more than 10 reported cases, Cambodia had the highest CFR of 90.0% (27 out of 30) i. Figure 1 shows the annual trend of human cases.
See: Avian Influenza Weekly Update Number 371 (22 February 2013), Western Pacific Regional Office of the World Health Organization http:// https://www.wpro.who.int/emerging_di.../en/index.html
Local Situation
In Hong Kong, a total of 22 cases of human H5N1 cases (including 7 deaths) were recorded so far since human H5N1 infection first occurred in 1997. 18 confirmed cases were recorded in 1997 and 6 of them passed away due to viral pneumonia or other medical complications. In 2003, two imported cases were confirmed. They were a 33-year-old man and his 9-year-old son. They had travelled to Fujian province and the man passed away while his son recovered. In November 2010, another imported case was confirmed, involving a 59-year-old lady who had history of visiting wet market in Mainland China. She was fully recovered.
The most recent human case was reported in June 2012, involving a 2-year-old boy who had onset of symptoms while in Guangdong province. He was brought to Hong Kong to seek medical treatment, and was subsequently discharged home in July 2012. Epidemiological investigation revealed that he spent the whole incubation period in the Mainland and had visited a wet market there. The case was classified as an imported sporadic infection.
There has been no H5N1 outbreak in local poultry farms in Hong Kong since 2008.The last detection of H5N1 in the Cheung Sha Wan Temporary Wholesale Market was in December 2011, when a chicken carcass was tested positive for H5N1 and all poultry in the wholesale market were culled. In July 2012, an environmental swab collected from a pet bird shop in Yuen Po Street Bird Garden in Mongkok was tested positive for H5N1 virus during routine avian influenza surveillance and the Bird Garden was closed and put under quarantine for 21 days. No human cases were identified.
As for wild birds, the Agriculture, Fisheries and Conservation Department (AFCD) has offered sick and dead bird collection services in Hong Kong since October 2005.The annual number of sick/dead birds infected with H5N1 virus ranged from 2 to 22 each year from 2006 to 2011. In 2012, a total of 22 birds were found infected with H5N1 virus. As of March 1, 2013, a H5N1 infected Black-headed gull was found in Tuen Mun this year. Details of H5 in sick/dead birds found in Hong Kong are available at the AFCD?s website http://www.afcd.gov.hk/english/quara...etlab_ndr.html
In September 2012, the Scientific Committee on Emerging and Zoonotic
Diseases (SCEZD) under the Centre for Health Protection (CHP) of the Department of Health met and discussed the use of human influenza H5N1 pre-pandemic and pandemic vaccines. After reviewing the latest scientific data, including local disease epidemiology, international experience and WHO's recommendations, the SCEZD recommended providing human influenza H5N1 pre-pandemic vaccine for the protection of specific laboratory workers at higher risk of exposure to avian influenza H5N1 virus during the inter-pandemic phase. Moreover, given the uncertainties about the timing and the strain/subtype of the next pandemic, physical stockpiling of additional human influenza H5N1 pre-pandemic vaccine was not recommended by SCEZD. The recommendation is published at the CHP website. (
http://www.chp.g ov.hk/files/pdf/ recommendations_on_h5n1_prepandemic_and_pandemic_v accines_r.pdf
As sporadic human cases and poultry outbreaks of H5N1 continue to occur globally, the public is advised to remain vigilant against avian influenza. Members of the public is reminded to maintain strict personal and environmental hygiene to prevent avian influenza, especially avoid direct
contact with birds and poultry (live or dead) or their droppings and thoroughly cook poultry and eggs before eating. Persons who are required to
handle the carcass should observe the following ?Safety Guidelines for Handling and Disposing of Dead Wild Birds? (http://www.chp.gov.hk/files/pdf/ Handling_of_Dead_Birds_Eng.pdf).
Note: 2 (M) from 2012
2 (M) backgound was reported thouroughly in an earlier issue!
Communicable Diseases Watch, VOLUME 9, NUMBER 12 MAY 27 - JUN 9, 2012
n imported human case of influenza A (H5N1) infection in Hong Kong, June 2012
Reported by DR HENRY WONG, Medical Officer, and Dr Alice
Wong, Senior Medical Officer, Respiratory Disease Office,
Surveillance and Epidemiology Branch, CHP.
Snip:
The Centre for Health Protection (CHP) confirmed a case a imported human influenza A (H5) infection affecting a 2-year-old
boy on June 1, 2012.
He lived with his parents and maternal grandmother in Guangzhou, Mainland China. He presented with fever and runny nose since May 23,2012 while in Guangzhou. He sought medical attention but his symptoms persisted. He was then brought to Hong Kong on May 26
and sought medical attention from a private medical clinic in Mong Kok.
Subsequently, he developed febrile seizures and was admitted to Caritas Medical Centre (CMC) Special Care Unit (SCU) on May 28.
The clinical diagnosis was encephalitis. His nasopharyngeal aspirate (NPA) collected on May 28 was confirmed to be influenza A virus of
subtype H5 by Public Health Laboratory Branch (PHLSB) of CHP on June 1 and later confirmed to be influenza A(H5N1) infection on June 2. The patient was put on Tamiflu and antibiotics. He was transferred to Princess Margaret Hospital (PMH) for isolation and treatment on June 1. Magnetic resonance imaging (MRI) scan for the brain on June 2 was suggestive of obstructive hydrocephalus. Emergency operation was performed on the same day to relieve the hydrocephalus.
Cerebrospinal fluid specimens taken on June 2, 3, 4 and brain tissue specimen taken on June 2 were tested positive for influenza A(H5) by polymerase chain reaction. He is currently under intensive care treatment in PMH and is in serious condition. His parents were asymptomatic and had been quarantined in PMH until June 9. NPAs taken from them were tested negative for influenza A(H5).
CHP had traced around 90 people who might have got into contact with the patient in the private medical clinic in Mong Kok, ambulance and CMC. NPAs taken from eight contacts including three healthcare workers from CMC, two patients from CMC, two health care workers of the private clinic and another patient who attended the same clinic, who reported respiratory symptoms were tested negative for Influenza A (H5). They were all put under medical surveillance.
Epidemiological investigation revealed that the patient was brought by his mother to buy a live duck in a wet market near his residence in Guangzhou during the period of May 17-19. From May 20-22, he travelled with his parents by private car to Anhui province but had no direct poultry contact during the trip.
CHP is communicating with the Department of Health of Guangdong Province to investigate the source of his infection. As of June 5, the Department of Health of Guangdong Province had traced 23 human contacts and all of them were asymptomatic. In addition, the Centre for Disease Control and Prevention (CDC) of Guangdong Province together with the Guangzhou CDC had conducted environmental investigation to the wet markets visited by the patient and near his residence and collected specimens from poultry workers and the environment.
Laboratory investigation showed that the throat swabs collected from poultry workers were tested negative for influenza A nucleic acid, whereas five environmental swabs collected from cages, chopping board, etc., yielded influenza A(H5) nucleic acid and one yielded influenza A(H9) nucleic acid.
Further tests conducted by PHLSB on the influenza A virus isolate from the NPA taken from the boy showed that the H5 gene of the
isolate belonged to clade 2.3.2.1, which was the same clade as the isolates from wild birds detected in 2011 and 2012 and in the
imported human infection case in late 2010. So far all the genes characterized belong to avian origin and there is no evidence of
resistance to the antiviral agent oseltamivir.
Upon confirmation of this case, the Government has raised the influenza response level from ?Alert? Response Level to ?Serious?
Response Level under the Framework of Government?s Preparedness Plan for Influenza Pandemic. To further strengthen the surveillance, CHP alerted doctors to report any suspected human case of influenza A(H5N1) infection with special attention to those who presented with influenza like illness and had history of visiting wet market or contacting poultry in Guangzhou within the incubation period (i.e. 7 days before onset of symptoms).
" I had a feeling he survived as the death wasn't reported by WHO but no further reports by CHP/DH kept me hanging on the outcome details!" LOL "recovered and discharge July 2012"
Reported by Miss Amy Li, Scientific Officer, Respiratory Disease Office, Surveillance and Epidemiology Branch, CHP.
Snip:
Twelve human cases were recorded so far this year (as of March 1, 2013), include 9 cases from Cambodia, 2 cases from Mainland China (Guizhou) and 1 case from Egypt. Eleven of them were fatal. According to WHO, epidemiological investigations revealed that all cases from Cambodia this year had either exposure to poultry or recent deaths among poultry in their villages. While the case from Egypt also had exposure to backyard sick and dead poultry i, the 2 fatal cases from Mainland China (Guizhou) had no clear history of contacting poultry before symptom onset.
According to WHO (as of March 1, 2013), age distribution of all cases ranged from 3 months to 81 years (median 18 years, n = 599).The age group with the largest number of cases was 20-29 years of age (22.4%, 134/599), relative to other age groups (0-4; 5-9; 10-19; 30-39; 40-49; 50-59; 60-69; 70+ years). 53.9% of the cases were female (322/597). A total of 371 cases died,giving a case fatality rate of 59.6%.The highest case fatality rate (CFR) (73.2%) was among persons 10-19 years of age. Among the countries with more than 10 reported cases, Cambodia had the highest CFR of 90.0% (27 out of 30) i. Figure 1 shows the annual trend of human cases.
See: Avian Influenza Weekly Update Number 371 (22 February 2013), Western Pacific Regional Office of the World Health Organization http:// https://www.wpro.who.int/emerging_di.../en/index.html
Local Situation
In Hong Kong, a total of 22 cases of human H5N1 cases (including 7 deaths) were recorded so far since human H5N1 infection first occurred in 1997. 18 confirmed cases were recorded in 1997 and 6 of them passed away due to viral pneumonia or other medical complications. In 2003, two imported cases were confirmed. They were a 33-year-old man and his 9-year-old son. They had travelled to Fujian province and the man passed away while his son recovered. In November 2010, another imported case was confirmed, involving a 59-year-old lady who had history of visiting wet market in Mainland China. She was fully recovered.
The most recent human case was reported in June 2012, involving a 2-year-old boy who had onset of symptoms while in Guangdong province. He was brought to Hong Kong to seek medical treatment, and was subsequently discharged home in July 2012. Epidemiological investigation revealed that he spent the whole incubation period in the Mainland and had visited a wet market there. The case was classified as an imported sporadic infection.
There has been no H5N1 outbreak in local poultry farms in Hong Kong since 2008.The last detection of H5N1 in the Cheung Sha Wan Temporary Wholesale Market was in December 2011, when a chicken carcass was tested positive for H5N1 and all poultry in the wholesale market were culled. In July 2012, an environmental swab collected from a pet bird shop in Yuen Po Street Bird Garden in Mongkok was tested positive for H5N1 virus during routine avian influenza surveillance and the Bird Garden was closed and put under quarantine for 21 days. No human cases were identified.
As for wild birds, the Agriculture, Fisheries and Conservation Department (AFCD) has offered sick and dead bird collection services in Hong Kong since October 2005.The annual number of sick/dead birds infected with H5N1 virus ranged from 2 to 22 each year from 2006 to 2011. In 2012, a total of 22 birds were found infected with H5N1 virus. As of March 1, 2013, a H5N1 infected Black-headed gull was found in Tuen Mun this year. Details of H5 in sick/dead birds found in Hong Kong are available at the AFCD?s website http://www.afcd.gov.hk/english/quara...etlab_ndr.html
In September 2012, the Scientific Committee on Emerging and Zoonotic
Diseases (SCEZD) under the Centre for Health Protection (CHP) of the Department of Health met and discussed the use of human influenza H5N1 pre-pandemic and pandemic vaccines. After reviewing the latest scientific data, including local disease epidemiology, international experience and WHO's recommendations, the SCEZD recommended providing human influenza H5N1 pre-pandemic vaccine for the protection of specific laboratory workers at higher risk of exposure to avian influenza H5N1 virus during the inter-pandemic phase. Moreover, given the uncertainties about the timing and the strain/subtype of the next pandemic, physical stockpiling of additional human influenza H5N1 pre-pandemic vaccine was not recommended by SCEZD. The recommendation is published at the CHP website. (
http://www.chp.g ov.hk/files/pdf/ recommendations_on_h5n1_prepandemic_and_pandemic_v accines_r.pdf
As sporadic human cases and poultry outbreaks of H5N1 continue to occur globally, the public is advised to remain vigilant against avian influenza. Members of the public is reminded to maintain strict personal and environmental hygiene to prevent avian influenza, especially avoid direct
contact with birds and poultry (live or dead) or their droppings and thoroughly cook poultry and eggs before eating. Persons who are required to
handle the carcass should observe the following ?Safety Guidelines for Handling and Disposing of Dead Wild Birds? (http://www.chp.gov.hk/files/pdf/ Handling_of_Dead_Birds_Eng.pdf).
Note: 2 (M) from 2012
2 (M) backgound was reported thouroughly in an earlier issue!
Communicable Diseases Watch, VOLUME 9, NUMBER 12 MAY 27 - JUN 9, 2012
n imported human case of influenza A (H5N1) infection in Hong Kong, June 2012
Reported by DR HENRY WONG, Medical Officer, and Dr Alice
Wong, Senior Medical Officer, Respiratory Disease Office,
Surveillance and Epidemiology Branch, CHP.
Snip:
The Centre for Health Protection (CHP) confirmed a case a imported human influenza A (H5) infection affecting a 2-year-old
boy on June 1, 2012.
He lived with his parents and maternal grandmother in Guangzhou, Mainland China. He presented with fever and runny nose since May 23,2012 while in Guangzhou. He sought medical attention but his symptoms persisted. He was then brought to Hong Kong on May 26
and sought medical attention from a private medical clinic in Mong Kok.
Subsequently, he developed febrile seizures and was admitted to Caritas Medical Centre (CMC) Special Care Unit (SCU) on May 28.
The clinical diagnosis was encephalitis. His nasopharyngeal aspirate (NPA) collected on May 28 was confirmed to be influenza A virus of
subtype H5 by Public Health Laboratory Branch (PHLSB) of CHP on June 1 and later confirmed to be influenza A(H5N1) infection on June 2. The patient was put on Tamiflu and antibiotics. He was transferred to Princess Margaret Hospital (PMH) for isolation and treatment on June 1. Magnetic resonance imaging (MRI) scan for the brain on June 2 was suggestive of obstructive hydrocephalus. Emergency operation was performed on the same day to relieve the hydrocephalus.
Cerebrospinal fluid specimens taken on June 2, 3, 4 and brain tissue specimen taken on June 2 were tested positive for influenza A(H5) by polymerase chain reaction. He is currently under intensive care treatment in PMH and is in serious condition. His parents were asymptomatic and had been quarantined in PMH until June 9. NPAs taken from them were tested negative for influenza A(H5).
CHP had traced around 90 people who might have got into contact with the patient in the private medical clinic in Mong Kok, ambulance and CMC. NPAs taken from eight contacts including three healthcare workers from CMC, two patients from CMC, two health care workers of the private clinic and another patient who attended the same clinic, who reported respiratory symptoms were tested negative for Influenza A (H5). They were all put under medical surveillance.
Epidemiological investigation revealed that the patient was brought by his mother to buy a live duck in a wet market near his residence in Guangzhou during the period of May 17-19. From May 20-22, he travelled with his parents by private car to Anhui province but had no direct poultry contact during the trip.
CHP is communicating with the Department of Health of Guangdong Province to investigate the source of his infection. As of June 5, the Department of Health of Guangdong Province had traced 23 human contacts and all of them were asymptomatic. In addition, the Centre for Disease Control and Prevention (CDC) of Guangdong Province together with the Guangzhou CDC had conducted environmental investigation to the wet markets visited by the patient and near his residence and collected specimens from poultry workers and the environment.
Laboratory investigation showed that the throat swabs collected from poultry workers were tested negative for influenza A nucleic acid, whereas five environmental swabs collected from cages, chopping board, etc., yielded influenza A(H5) nucleic acid and one yielded influenza A(H9) nucleic acid.
Further tests conducted by PHLSB on the influenza A virus isolate from the NPA taken from the boy showed that the H5 gene of the
isolate belonged to clade 2.3.2.1, which was the same clade as the isolates from wild birds detected in 2011 and 2012 and in the
imported human infection case in late 2010. So far all the genes characterized belong to avian origin and there is no evidence of
resistance to the antiviral agent oseltamivir.
Upon confirmation of this case, the Government has raised the influenza response level from ?Alert? Response Level to ?Serious?
Response Level under the Framework of Government?s Preparedness Plan for Influenza Pandemic. To further strengthen the surveillance, CHP alerted doctors to report any suspected human case of influenza A(H5N1) infection with special attention to those who presented with influenza like illness and had history of visiting wet market or contacting poultry in Guangzhou within the incubation period (i.e. 7 days before onset of symptoms).
" I had a feeling he survived as the death wasn't reported by WHO but no further reports by CHP/DH kept me hanging on the outcome details!" LOL "recovered and discharge July 2012"