Hong Kong

The Centre for Health Protection (CHP) of the Department of Health is today (January 5) investigating an imported human case of avian influenza A(H7N9) in Hong Kong, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

The male patient, aged 62 with underlying illnesses, departed Hong Kong since December 15 last year and travelled to Zengcheng, Guangzhou. He has developed fever, cough and shortness of breath since January 1. He was admitted to a hospital for treatment in Dongguan during January 2 to 3. The patient discharged himself against medical advice on January 3 and returned to Hong Kong via Lo Wu on the same day. He attended the Accident and Emergency Department of Yan Chai Hospital yesterday (January 4) and was admitted for treatment on the same day. His condition deteriorated today and has been transferred to intensive care unit for further management. The patient is now in critical condition.

His endotracheal aspirate and nasopharyngeal aspirate specimen were confirmed to be positive for influenza A(H7N9) virus by the CHP’s Public Health Laboratory Services Branch tonight.

The patient denied recent exposure to poultry or wet market.

His close contacts have remained asymptomatic so far and have been put under medical surveillance. Tracing of his other contacts in Hong Kong is underway.

“The case has been reported to Guangdong and Macau health authorities. We are communicating with the Mainland authority to follow up the patient’s exposure and movements in the Mainland. Based on information available thus far, it is classified as an imported case. Epidemiological investigations are ongoing,” a spokesman for the CHP said.

“Locally, three confirmed human cases of avian influenza A(H7N9) were recorded in the past three weeks. The activity of avian influenza is expected to increase in winter based on its seasonal pattern. Letters to doctors, hospitals, schools and institutions will be issued to alert them to the latest situation, ” a spokesman for the CHP added.

Meanwhile, the CHP is closely monitoring 14 additional human cases of avian influenza A(H7N9) in Guangdong. According to the Health and Family Planning Commission of Guangdong Province’s announcement today, the distribution of the additional cases of last month are as follows: Guangzhou (3), Jiangmen (3), Jieyang (2), Shenzhen (2), Zhaoqing (2), Dongguan (1) and Zhongshan (1).

“The public should avoid touching birds, poultry or their droppings and visiting poultry markets or farms during travel, particularly in the upcoming Lunar New Year holidays. If feeling unwell such as having fever or cough, wear a mask and seek medical advice at once. Travellers returning from affected areas should consult doctors promptly if symptoms develop and let them know their travel history,” the spokesman said.

The CHP’s Port Health Office conducts health surveillance measures at all boundary control points. Thermal imaging systems are in place for body temperature checks on inbound travellers. Suspected cases will be immediately referred to public hospitals for follow-up.

The display of posters and broadcasting of health messages in departure and arrival halls as health education for travellers is underway. The travel industry and other stakeholders are regularly updated on the latest information.

The public should maintain strict personal, hand, food and environmental hygiene and take heed of the advice below while handling poultry:

• Avoid touching poultry, birds, animals or their droppings;
• When buying live chickens, do not touch them and their droppings. Do not blow at their bottoms. Wash eggs with detergent if soiled with faecal matter and cook and consume them immediately. Always wash hands thoroughly with soap and water after handling chickens and eggs;
• Eggs should be cooked well until the white and yolk become firm. Do not eat raw eggs or dip cooked food into any sauce with raw eggs. Poultry should be cooked thoroughly. If there is pinkish juice running from the cooked poultry or the middle part of its bone is still red, the poultry should be cooked again until fully done;
• Wash hands frequently, especially before touching the mouth, nose or eyes, before handling food or eating, and after going to the toilet, touching public installations or equipment such as escalator handrails, elevator control panels or door knobs, or when hands are dirtied by respiratory secretions after coughing or sneezing; and
• Wear a mask if fever or respiratory symptoms develop, when going to a hospital or clinic, or while taking care of patients with fever or respiratory symptoms.

The public may visit the CHP’s pages for more information: the avian influenza page, the weekly Avian Influenza Report, global statistics and affected areas of avian influenza, the Facebook Page and the YouTube Channel.

CIDRAP

**  4 were fatal.

**  The latest illnesses lift the global total from the disease to 752

Centre for Health Protection

The Controller of the Centre for Health Protection (CHP) of the Department of Health (DH), Dr Leung Ting-hung, announced today (February 23) the investigation into the first imported human case of avian influenza A(H7N9) in Hong Kong this winter, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

“Due to the seasonal pattern, our risk assessment shows that the activity of avian influenza viruses is expected to remain at a high level in winter months. In view of this sporadic case, the public, particularly travellers and those who may visit the Mainland, should heighten vigilance. Do not visit poultry markets and farms. Avoid poultry contact,” Dr Leung said at a briefing this evening.

The male patient, aged 60 with good past health, lives and works in Suzhou, Jiangsu. He came to Hong Kong on February 5 and reported onset of fever, chills, rigor, cough and shortness of breath since February 8. He consulted a private doctor on February 10 and 11 who referred him to Pamela Youde Nethersole Eastern Hospital (PYNEH) for management on February 11. Upon admission and laboratory testing by PYNEH, his specimen collected on February 12 preliminarily tested negative for influenza A. He was discharged on February 15. Clinical diagnosis was pneumonia and he has been in stable condition all along.

The man subsequently sought advice from another private doctor on February 18 and 22. Further testing by the CHP’s Public Health Laboratory Services Branch on his specimens taken on February 12 returned a result that was today confirmed as being positive for avian influenza A(H7N9) virus. He has been admitted to the Hospital Authority Infectious Disease Centre (HAIDC) in Princess Margaret Hospital today for further management.

The patient visited a wet market near his residence in Suzhou in which he reported no poultry contact.

Initial enquiries revealed the patient’s afebrile son with sore throat since February 22, who has also been admitted to the HAIDC for observation this evening. To date, his wife has remained asymptomatic while tracing of the patient’s other close contacts in Hong Kong is ongoing.

“The case will be notified to the World Health Organization and the National Health and Family Planning Commission. We are communicating with the Mainland health authority to follow up on the patient’s exposure and movements in the Mainland. Based on information available thus far, it is classified as an imported case. Investigations are ongoing,” Dr Leung said.

Letters to doctors, hospitals, kindergartens, child care centres and primary and secondary schools as well as residential care homes for the elderly and the disabled will be issued to alert them to the latest situation.

This is the 14th imported human case of avian influenza A(H7N9) confirmed in Hong Kong. Since March 2013 to date, 707 cases have been reported in the Mainland, while from October 2015, 50 have been reported.

The DH’s Port Health Office conducts health surveillance measures at all boundary control points. Thermal imaging systems are in place for body temperature checks on inbound travellers. Suspected cases will be immediately referred to public hospitals for follow-up.

The display of posters and broadcast of health messages in departure and arrival halls as health education for travellers is under way. The travel industry and other stakeholders are regularly updated on the latest information.

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

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

* Do not visit live poultry markets and farms. Avoid contact with poultry, birds and their droppings;
* If contact has been made, thoroughly wash hands with soap;
* Avoid entering areas where poultry may be slaughtered and contact with surfaces which might be contaminated by droppings of poultry or other animals;
* 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); and 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 pages below for more information:

* The avian influenza page (www.chp.gov.hk/en/view_content/24244.html);
* The weekly Avian Influenza Report (www.chp.gov.hk/en/view_content/3879.html);
* The avian influenza-affected areas and global statistics (www.chp.gov.hk/files/pdf/global_statistics_avian_influenza_e.pdf);
* The Facebook Page (www.fb.com/CentreforHealthProtection); and
* The YouTube Channel (www.youtube.com/c/ChpGovHkChannel).

Ends/Tuesday, February 23, 2016
Issued at HKT 20:17

WHO

Human infection with avian influenza A(H7N9) virus – China

On 5 February 2016, the National Health and Family Planning Commission (NHFPC) of China notified WHO of 28 additional laboratory-confirmed cases of human infection with avian influenza A (H7N9) virus, including five deaths.

Onset dates ranged from 21 December 2015 to 25 January 2016. Cases ranged in age from 14 to 91 years, with a median age of 58 years. Of these 28 cases, 18 (64%) were male. The majority (25 cases, 89%) reported exposure to live poultry or live poultry markets; the exposure history of three cases is unknown or no clear exposure to poultry. No clusters were reported. Cases were reported from six provinces and municipalities: Zhejiang (13), Jiangsu (5), Guangdong (4), Fujian (3), Shanghai (2) and Hunan (1). See attachment for individual case information.

Detailed information concerning these cases can be found in a separate document (see related links).

Public health response

The Chinese Government has taken the following surveillance and control measures:

• strengthening outbreak surveillance and situation analysis;
• reinforcing all efforts on medical treatment; and
• conducting risk communication with the public and dissemination of information.

WHO risk assessment

WHO is assessing the epidemiological situation and conducting further risk assessment based on the latest information. Based on the information received thus far, the overall public health risk from avian influenza A(H7N9) viruses has not changed.

If the pattern of human cases follows the trends seen in previous years, the number of human cases may rise over the coming months. Further sporadic cases of human infection with avian influenza A(H7N9) virus are expected in affected and possibly in the neighboring areas. Should human cases from affected areas travel internationally, their infection may be detected in another country during travels or after arrival. If this were to occur, community level spread is considered unlikely as the virus has not demonstrated the ability to transmit easily among humans.

WHO advice

WHO advises that travellers to countries with known outbreaks of avian influenza should avoid poultry farms, contact with animals in live bird markets, entering areas where poultry may be slaughtered, or contact with any surfaces that appear to be contaminated with faeces from poultry or other animals. Travellers should also wash their hands often with soap and water. Travellers should follow good food safety and good food hygiene practices.

WHO does not advise special screening at points of entry with regard to this event, nor does it currently recommend any travel or trade restrictions. As always, a diagnosis of infection with an avian influenza virus should be considered in individuals who develop severe acute respiratory symptoms while travelling or soon after returning from an area where avian influenza is a concern.

WHO encourages countries to continue strengthening influenza surveillance, including surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns, in order to ensure reporting of human infections under the IHR (2005), and continue national health preparedness actions.

NEJM

“…..A 28-year-old man (index patient), with repeated exposure to live poultry, presented with respiratory infection and was admitted to the respiratory department, where his condition worsened. Laboratory investigation of serum and sputum samples obtained later in the course of illness showed that he was positive for H7N9 by serologic testing and polymerase-chain-reaction (PCR) assay. Seven days after admission of the index patient, influenza-like illness developed in a 33-year-old male physician (Doctor 1) who attended the index patient. The acute respiratory distress syndrome later developed in this physician. Four days after the onset of symptoms in Doctor 1, influenza-like illness and bronchial pneumonia developed in a second attending physician (Doctor 2), a 35-year-old man, in the same department. He too had close contact with the index patient…….The three viruses isolated from the index patient, Doctor 1, and Doctor 2 suggest direct human-to-human transmission……”

Xinhua

WHO

On 11 January 2016, the National Health and Family Planning Commission (NHFPC) of China notified WHO of 10 additional laboratory-confirmed cases of human infection with avian influenza A (H7N9) virus, including 3 deaths.

The cases were reported in the provinces of Zhejiang (6), Jiangsu (2), Guangdong (1) and Jiangxi (1). The median age of the patients is 52.5 years old (ranging from 29 to 77 years old). The cases are split equally between men and women. One of the patients is a health care worker. All cases reported a history of exposure to live poultry.

Detailed information concerning these cases can be found in a separate document (see related links).

Public health response

The Chinese Government has taken the following surveillance and control measures:

• strengthening outbreak surveillance and situation analysis;
• reinforcing all efforts on medical treatment; and
• conducting risk communication with the public and dissemination of information.

WHO risk assessment

WHO is assessing the epidemiological situation and conducting further risk assessment based on the latest information. Based on the information received thus far, the overall public health risk from avian influenza A(H7N9) viruses has not changed.

If the pattern of human cases follows the trends seen in previous years, the number of human cases may rise over the coming months. Further sporadic cases of human infection with avian influenza A(H7N9) virus are expected in affected and possibly in the neighboring areas. Should human cases from affected areas travel internationally, their infection may be detected in another country during travels or after arrival. If this were to occur, community level spread is considered unlikely as the virus has not demonstrated the ability to transmit easily among humans.

WHO advice

WHO advises that travellers to countries with known outbreaks of avian influenza should avoid poultry farms, contact with animals in live bird markets, entering areas where poultry may be slaughtered, or contact with any surfaces that appear to be contaminated with faeces from poultry or other animals. Travellers should also wash their hands often with soap and water. Travellers should follow good food safety and good food hygiene practices.

WHO does not advise special screening at points of entry with regard to this event, nor does it currently recommend any travel or trade restrictions. As always, a diagnosis of infection with an avian influenza virus should be considered in individuals who develop severe acute respiratory symptoms while travelling or soon after returning from an area where avian influenza is a concern.

WHO encourages countries to continue strengthening influenza surveillance, including surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns, in order to ensure reporting of human infections under the IHR (2005), and continue national health preparedness actions.

Department of Health- Hong Kong

11 January 2016

CHP closely monitors two additional human cases of avian influenza A(H7N9) in Mainland

The Centre for Health Protection (CHP) of the Department of Health (DH) is today (January 11) closely monitoring two additional human cases of avian influenza A(H7N9) in the Mainland, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel. According to the Health and Family Planning Commission of Ningbo Municipality, one of the patients is in critical condition while the other is in stable condition. From 2013 to date, 670 human cases of avian influenza A(H7N9) have been reported by the Mainland health authorities. “We will remain vigilant and work closely with the World Health Organization and relevant health authorities to monitor the latest developments,” a spokesman for the DH said. The DH’s Port Health Office conducts health surveillance measures at all boundary control points. Thermal imaging systems are in place for body temperature checks on inbound travellers. Suspected cases will be immediately referred to public hospitals for follow-up. The display of posters and broadcast of health messages in departure and arrival halls as health education for travellers is under way. The travel industry and other stakeholders are regularly updated on latest information. Travellers, especially those returning from avian influenza-affected areas 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. The public should remain vigilant and take heed of the advice against avian influenza below: * Do not visit live poultry markets and farms. Avoid contact with poultry, birds and their droppings; * If contact has been made, thoroughly wash hands with soap; * Avoid entering areas where poultry may be slaughtered and contact with surfaces which might be contaminated by droppings of poultry or other animals; * 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); and 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 pages below for more information: * The avian influenza page (www.chp.gov.hk/en/view_content/24244.html); * The weekly Avian Influenza Report (www.chp.gov.hk/en/view_content/3879.html); * Global statistics and affected areas of avian influenza (www.chp.gov.hk/files/pdf/global_statistics_avian_influenza_e.pdf); * The Facebook Page (www.fb.com/CentreforHealthProtection); and * The YouTube Channel (www.youtube.com/c/ChpGovHkChannel). Ends/Monday, January 11, 2016

H7N9

**  The patient is a 58-year-old woman in Jieyang and in critical condition.
**  From 2013 to date, 667 human cases of avian influenza A(H7N9) have been reported by the Mainland health authorities.

CDC

What is the current situation?

According to the World Health Organization, 667 cases and 229 deaths from H7N9 flu have been reported globally from March 2013 through October 14, 2015, most from the mainland of China. Cases have been confirmed in the following administrative areas of China: Anhui, Beijing, Fujian, Guangdong, Guangxi, Guizhou, Hebei, Henan, Hubei, Hunan, Jiangsu, Jiangxi, Jilin, Shandong, Shanghai, Xinjiang, and Zhejiang. Smaller numbers of cases have been identified in travelers from Hong Kong, Taiwan, Malaysia, and Canada.

CDC advises people traveling to China to avoid contact with poultry (including poultry markets and farms), birds, and their droppings. There are no recommendations against travel to China.

What is avian influenza A (H7N9)?

Avian influenza A (H7N9) is an influenza (flu) virus found in birds that does not normally infect humans. However, in spring of 2013, China began reporting infections with the virus in people. Most of these infections have been associated with contact with infected poultry or contaminated environments (such as poultry markets) in China. Early symptoms are consistent with seasonal flu and may include fever, cough, sore throat, muscle aches and fatigue, loss of appetite, and runny or stuffy nose. However, infection with this virus often causes severe respiratory illness and, in some cases, death (see http://www.cdc.gov/flu/avianflu/h7n9-virus.htm).

What can travelers do to protect themselves?

There is no vaccine to prevent H7N9 flu.

• Do not touch birds, pigs, or other animals.
  • Don’t touch animals, whether they are alive or dead.
  • Avoid live bird or poultry markets.
  • Avoid other markets or farms with animals (wet markets).

• Eat food that is fully cooked.
  • Eat meat and poultry that is fully cooked (not pink) and served hot.
  • Eat hard-cooked eggs (not runny).
  • Don’t eat or drink dishes that include blood from any animal.
  • Don’t eat food from street vendors.

• Practice hygiene and cleanliness.
  • Wash your hands often.
  • If soap and water aren’t available, clean your hands with hand sanitizer containing at least 60% alcohol.
  • Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.
  • Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.
  • Try to avoid close contact, such as kissing, hugging, or sharing eating utensils or cups, with people who are sick.
• If you feel sick and think you may have avian flu after visiting China:

• Talk to your doctor or nurse if you feel seriously ill, especially if you have a fever, cough, or shortness of breath.
  • Tell them about your travel to China.
  • For more information about medical care abroad, see Getting Health Care Abroad(http://wwwnc.cdc.gov/travel/page/getting-health-care-abroad).
• Avoid contact with other people while you are sick.

Clinician information

Clinicians should consider the possibility of avian influenza A (H7N9) virus infection in people presenting with respiratory illness within 10 days of travel to China, particularly if the patient reports exposure to birds or poultry markets. Although most H7N9 cases have resulted in severe respiratory illness in adults, infection may cause mild illness in some and may cause illness in children as well. Influenza diagnostic testing in patients with respiratory illness of unknown etiology may identify human cases of avian influenza A or new cases of variant influenza (such as human infections caused by influenza viruses from pigs) in the United States. Patients with H7N9 are expected to have a positive test result for influenza A virus via reverse-transcription polymerase chain reaction (RT-PCR testing) that will be unsubtypeable by most assays. Nonmolecular rapid test results may be variable. Clinicians who suspect avian influenza A (H7N9) should obtain appropriate specimens and notify their local or state health department promptly. State health departments should notify CDC of suspected cases within 24 hours.

Additional information

• Avian Influenza A (H7N9) Virus (CDC)
• Avian Influenza Travel Health Disease Page(http://wwwnc.cdc.gov/travel/diseases/avian-bird-flu)
• Human infection with influenza A (H7N9) in China—update (WHO)
• Frequently Asked Questions on human infection with influenza A (H7N9) virus, China (WHO).