Category Archives: China

Taiwan | Two additional confirmed cases of avian influenza H7N9

On 22-23 and 25 April 2014, Taipei Centers for Disease Control (CDC) reported 2 additional laboratory-confirmed cases of human infection with avian influenza A(H7N9). These are the third and fourth cases with infection of avian influenza A(H7N9) virus reported from Taipei CDC.

Details of the cases are as follows:

The patient reported on 22 April is a 44-year-old woman from Nanjing, Jiangsu Province, China, who travelled to Taipei with a 33-member tourist group. She was ill on 12 April and had been to a local hospital in Nanjing. The patient had an underlying medical condition. Despite general weakness and poor appetite, she travelled to Taipei with the group on 17 April. She was admitted to hospital in Taipei on 19 April and subsequently transferred to a medical center on 20 April. She was laboratory confirmed on 22 April.

Within one week before disease onset she had purchased a slaughtered chicken at a wet market and cooked in Mainland China.

Taipei CDC obtained the list of the other 32 tour members on 22 April; the tour group returned to its origin on 24 April. As of 23 April, one member developed fever.

The patient reported on 25 April is a previously healthy 39 year-old man who frequently travels across the Taiwan Strait. He became ill on 19 April and was hospitalized on 23 April. He was laboratory confirmed on 25 April. The patient visited Beijing and Jiangsu from 31 March to 19 April. He denied exposure to poultry or wet markets while in Mainland China.

The following measures have been taken by Taipei CDC:

1. Epidemiological investigation, tracing of close contacts, medical observation.

2. Strengthen surveillance of pneumonia of unknown causes and routine influenza sentinel surveillance, as well flu and avian flu virology surveillance.

3. The list of tour members relating to the case reported on 22 April has been sent to the National Health and Family Planning Commission of China for further investigation. The travel history of the case reported on 25 April has been sent to the National Health and Family Planning Commission of China for further investigation.

China | Study reveals conditions linked to deadly bird flu and maps areas at risks

A dangerous strain of avian influenza, H7N9, that’s causing severe illness and deaths in China may be inhabiting a small fraction of its potential range and appears at risk of spreading to other suitable areas of India, Bangladesh, Vietnam, Indonesia and the Philippines, according to a new study published today in the journal Nature Communications.

Researchers from the Université Libre de Bruxelles (ULB), the International Livestock Research Institute (ILRI), Oxford University, and the Chinese Center of Disease Control and Prevention analyzed new data showing the distribution and density of live poultry markets in China and of poultry production overall in the country. They found that the emergence and spread of the disease up until now is mainly linked to areas that have a high concentration of markets catering to a consumer preference for live birds and does not appear related to China’s growing number of intensive commercial poultry operations.

They have pinpointed areas elsewhere in Asia with similar conditions (places with a high density of live bird markets) that could allow H7N9—which has infected 429 people thus far and killed at least 100—to significantly expand its range. Places at risk include urban areas in China where the disease has not yet occurred, along with large swaths of the Bengal regions of Bangladesh and India, the Mekong and Red River deltas in Vietnam, and isolated parts of Indonesia and the Philippines.

“We’re not saying these are areas where we expect to see infections emerge, but the concentration of bird markets makes them very suitable for infection should the virus be introduced there, and that knowledge could help guide efforts to limit transmission,” said Marius Gilbert, an expert in the epidemiology of livestock diseases at ULB and the paper’s lead author.

Gilbert and his colleges developed a “risk map” for H7N9 in part to help anticipate where human infections—so far caused mainly by contact with birds and not through “human to human” transmission—might occur next. Unlike H5N1, the other virulent form of avian influenza to emerge in recent years, H7N9 produces little signs of illness in birds, which means it could move stealthily into poultry populations long before people get sick.

“The obvious use for such maps in the immediate future is to help target surveillance to areas most at risk, which could provide advance warning should the virus spread and allow authorities to move quickly to contain it,” said Tim Robinson, a scientist with ILRI’s Livestock Systems and Environment Program and a co-author of the study.

Isolating H7N9 Risk Factors to Help Control its Spread

The researchers found that the key factors facilitating the emergence and spread of H7N9 are dense clusters of live poultry markets, which aggregate birds from large geographical areas, located near or just outside densely populated urban areas.

The existence of “wetland-related” agriculture near the markets, such as farms that raise ducks in flooded rice fields, appeared to be a contributing factor linked to the initial emergence of the virus. But overall, the scientists did not find a link between the emergence of H7N9 and “intensive” poultry operations proliferating in China that raise a larger number of birds. In fact, the study notes that H7N9 has thus far been absent from live poultry markets in Northeastern China, a region that is home to many of the country’s commercial-scale poultry operations.

The study notes that there is evidence that certain factors within live poultry markets, such as the amount of time the birds are there, the rigor of sanitation measures, and “rest days,” that can influence the spread of the disease, suggesting potential options for reducing risks of further transmission of H7N9.

But researchers also point out that in China, despite “remarkably strict control efforts,” the virus has continued to slowly expand to new areas—evidence that “H7N9 is difficult to contain along poultry market chains and may spread beyond the distribution indicated by the human cases.”

Managing Livestock Risks via Better Maps

Many of the insights in the report have been possible because of a new set maps that are allowing researchers to observe, down to the square kilometer, the global distribution and density of the billions of poultry, cattle, pigs, goats and other livestock that exist in the world today.

Robinson said that mapping livestock populations is particularly important in the developing world—and especially in Asia—where soaring demand for animal-source foods is driving production growth in what has been termed a “livestock revolution.” For example, in the avian influenza study, the maps helped researchers rule out intensive poultry operations in Northeastern China as a source of H7N9 and thus possibly avert a costly and likely futile intervention aimed at indiscriminately culling poultry.

“The more we can annotate our maps with additional data on the modes of production and things like how many live bird markets are located in a particular area, the more successful we can be at reducing risks associated with intensifying livestock production in developing countries,” Robinson said. “We also need to keep in mind that while the rising demand for livestock products is presenting a number of challenges, livestock are essential to meeting the basic nutritional needs and providing income for several hundred million poor people around the world today.”

The maps were developed by ILRI in collaboration with the Food and Agriculture Organization of the United Nations (FAO), the Environmental Research Group Oxford (ERGO) at the University of Oxford, and the Université Libre de Bruxelles (ULB). They are freely accessible through a Livestock Geo-Wiki, a site maintained by collaborators at the International Institute for Applied Systems Analysis (IIASA).

China | Potential for H7N9 virus to spread through movement of live poultry

On 16 June 2014, the National Health and Family Planning Commission (NHFPC) of China notified WHO of one additional laboratory-confirmed case of human infection with avian influenza A(H7N9) virus.

The patient is a 42 year-old man from Jiangmen City, Guangdong Province. He became ill on 25 May, was admitted to a hospital on 31 May and died on 5 June. The patient had no exposure to live poultry.

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

  • Strengthen surveillance and situation analysis;
  • Reinforce case management and medical treatment;
  • Conduct risk communication with the public and release information.

The overall risk assessment has not changed.

The previous report of avian influenza A(H7N9) virus detection in live poultry exported from mainland China to Hong Kong SAR shows the potential for the virus to spread through movement of live poultry. At this time there is no indication that international spread of avian influenza A(H7N9) has occurred. However as the virus infection does not cause signs of disease in poultry, continued surveillance is needed. Further sporadic human cases of avian influenza A(H7N9) infection are expected in affected and possibly neighbouring areas.

Should human cases from affected areas travel internationally, their infection may be detected in another country during or after arrival. If this were to occur, community level spread is considered unlikely as the virus does not have the ability to transmit easily among humans. There has been no evidence of sustained human to human transmission, therefore the risk of ongoing international spread of H7N9 virus by travellers is low.

WHO advises that travellers to countries with known outbreaks of avian influenza should avoid poultry farms, or contact with animals in live bird markets, or 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.

China | Hong Kong – Three cases of suspected Middle East Respiratory Syndrome test negative for MERS

The Centre for Health Protection (CHP) of the Department of Health (DH) is today (May 8) investigating three suspected cases of Middle East Respiratory Syndrome (MERS) whose respiratory specimens all tested negative for MERS Coronavirus (MERS-CoV), and called on the public to stay alert and maintain good personal, food and environmental hygiene during travel.

The latest case was notified by Princess Margaret Hospital (PMH) today and involves a 25-year-old woman. The patient, with good past health, travelled with her mother to Dubai from April 21 to 24. The patient developed cough and runny nose since May 1 and fever on May 6. She had no contact with animals or patients during her trip.

She was admitted to PMH yesterday (May 7) for treatment. Her current condition is stable. Her nasopharyngeal aspirate was negative for MERS-CoV upon preliminary laboratory testing by the CHP’s Public Health Laboratory Services Branch (PHLSB). Her mother has remained asymptomatic.

The second case was notified by Queen Mary Hospital (QMH) last night and involves a 38-year-old man. The patient travelled to Dubai from April 26 to 28 and to London, the United Kingdom, from April 30 to May 6. He has presented with sweating and shortness of breath since May 5. He had no known exposure to animals or patients during his journey.

He was admitted to QMH yesterday for treatment. His current condition is stable. His nasopharyngeal aspirate was negative for MERS-CoV upon preliminary laboratory testing by the PHLSB.

The remaining case, which was announced last night, involves a 59-year-old woman. She was admitted to Alice Ho Miu Ling Nethersole Hospital yesterday and is now in stable condition. Her nasopharyngeal aspirates were negative for MERS-CoV upon PHLSB’s preliminary laboratory testing.

The patient, with underlyng medical conditions, has presented with double vision since April 29. She travelled to Tunisia with her husband from April 26 to May 5, with both flights transited at Dubai. During her trip, she had a camel ride on April 28. Her husband has remained asymptomatic.

China | Hong Kong – Case of suspected Middle East Respiratory Syndrome (MERS) under CHP investigation

The Centre for Health Protection (CHP) of the Department of Health (DH) is today (May 7) investigating a suspected case of Middle East Respiratory Syndrome (MERS) affecting a woman aged 59.

The patient, with underlyng medical conditions, has presented with double vision since April 29. She was admitted to Alice Ho Miu Ling Nethersole Hospital today and is now in stable condition.

Initial investigations by the CHP revealed that the patient had travelled to Tunisia with her husband from April 26 to May 5, with both flights transited at Dubai. During her trip, she had camel ride on April 28. Her husband has remained asymptomatic.

Her respiratory specimen will be taken for preliminary laboratory testing by the CHP’s Public Health Laboratory Services Branch (PHLSB).

“We strongly advise travel agents organising tours to the Middle East not to arrange camel rides and activities involving camel contact which may increase the risk of infection,” a spokesman for the DH remarked.

“As pre-existing major illnesses can increase the likelihood of medical problems, including MERS, during travel, in view of recent pilgrimage activities, pilgrims should consult a healthcare provider before travelling to assess whether it is medically advisable,” the spokesman advised.

Locally, the DH’s surveillance mechanism with public and private hospitals, practising doctors and at the airport is well in place. Suspected cases identified will be sent to public hospitals for isolation and management until their specimens are tested negative for MERS-CoV.

“MERS is a statutorily notifiable infectious disease and the PHLSB is capable of detecting the virus. No human cases have been recorded so far in Hong Kong,” the spokesman stressed.

“The Government will be as transparent as possible in the dissemination of information. Whenever there is a suspected case, particularly involving patients with travel history to the Middle East, the CHP will release information to the public as soon as possible,” the spokesman remarked.

Early identification of MERS-CoV is important, but not all cases can be detected in a timely manner, especially mild or atypical cases. Healthcare workers (HCWs) should maintain vigilance and adhere to strict infection control measures while handling suspected or confirmed cases to reduce the risk of transmission to other patients, HCWs or visitors. Regular education should be provided.

Travellers returning from the Middle East who develop respiratory symptoms should wear face masks, seek medical attention and report their travel history to the doctor. Healthcare workers should arrange MERS-CoV testing for them. Patients’ lower respiratory tract specimens should be tested when possible and repeat testing should be done when clinical and epidemiological clues strongly suggest MERS.

Travellers are reminded to take heed of personal, food and environmental hygiene:

* Avoid going to farms, barns or camel markets;
* Avoid contact with animals (especially camels), birds, poultry or sick people during travel;
* Wash hands regularly before and after touching animals in case of visits to farms or barns;
* Do not drink raw milk, or consume food which may be contaminated by animal secretions or products, unless they have been properly cooked, washed or peeled;
* Seek medical consultation immediately if feeling unwell;
* Avoid visit to healthcare settings with MERS patients;
* Wash hands before touching the eyes, nose and mouth, and after sneezing, coughing or cleaning the nose; and
* Wash hands before eating or handling food, and after using the toilet.

The public may visit the CHP’s MERS page (www.chp.gov.hk/en/view_content/26511.html), the DH’s Travel Health Service
(www.travelhealth.gov.hk/english/popup/popup.html) or the latest news of the World Health Organization (www.who.int/csr/don/archive/disease/coronavirus_infections/en/) for more information and health advice.

Tour leaders and tour guides operating overseas tours are advised to refer to the CHP’s health advice against MERS (www.chp.gov.hk/en/view_content/26551.html).

China | Hong Kong – Detection of avian influenza A(H5N6) virus from a patient in Sichuan closely monitored by DH

The Centre for Health Protection (CHP) of the Department of Health (DH) is today (May 6) closely monitoring the detection of avian influenza A(H5N6) virus from a patient in Sichuan according to the latest report of the Mainland health authority.

The male patient is a 49-year-old man who has passed away. Avian influenza A (H5N6) virus has been detected from the patient’s respiratory specimen.

“All novel influenza A infections (including H5N6) are notifiable diseases in Hong Kong,” a spokesman for the DH said.

“Locally, enhanced disease surveillance, port health measures and health education against avian influenza are ongoing. We will remain vigilant and maintain liaison with the World Health Organization (WHO) and relevant health authorities. Local surveillance activities will be modified upon the WHO’s recommendations,” the spokesman said.

“All boundary control points have implemented disease prevention and control measures. Thermal imaging systems are in place for body temperature checks of inbound travellers. Random temperature checks by handheld devices have also been arranged. Suspected cases will be immediately referred to public hospitals for follow-up investigation,” the spokesman added.

Regarding health education for travellers, 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 proceeding.

The spokesman advised travellers, especially those returning from avian influenza-affected areas and provinces with fever or respiratory symptoms, to 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.

Members of the public should remain vigilant and take heed of the preventive 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); 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 (www.chp.gov.hk/files/pdf/global_statistics_avian_influenza_e.pdf) for more information on avian influenza-affected areas and provinces.

China | Hong Kong hospitals hold infection control forum focused on MERS

The Hospital Authority (HA) held an infection control forum for public hospital health-care workers today (May 5) to keep them abreast of the latest epidemiology of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in view of the recent staggering surge in the reporting of confirmed cases of MERS-CoV in the Middle East countries. 

The frontline staff was also refreshed on the preparedness and response plans of public hospitals in handling suspected or confirmed cases with MERS-CoV.  So far there is no confirmed case of MERS-CoV in Hong Kong.

The HA spokesperson reiterated that the Authority will continue to closely collaborate with the Centre for Health Protection (CHP) in implementing the strategy of “Early Notification”, “Early Isolation” and “Early Diagnosis”.  HA has activated the Serious Response Level in public hospitals since December 2013 to dovetail the Government’s response level of the Preparedness Plan for Influenza Pandemic.  Frontline staff has been paying extra attention to patients with fever and respiratory symptoms requiring hospitalisation.  They always remain in high vigilance to screen patients with travel history and visiting to affected areas with confirmed case.

“According to prevailing surveillance and infection control guidelines, a patient who was classified as suspected case would be arranged for isolation in Airborne Infection Isolation Room.  CHP would be informed immediately and the sample of the patient concerned will also be delivered to the Public Health Laboratory Services Branch for testing of MERS-CoV.  The test outcome would be available within 24 hours.”

“Other enhanced infection control measures in public hospitals include all health-care workers and visitors entering the clinical areas are required to put on surgical masks, and environmental hygiene and hand hygiene are strengthened in particular at the overcrowded wards,” the HA spokesperson remarked.

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

On 23, 20 and 17 April 2014, the National Health and Family Planning Commission (NHFPC) of China notified WHO of 6 additional laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus.

Details of the cases reported on 23 April 2014 are as follows:

  • A 35 year-old health-care worker from Wuxi City, Jiangsu Province. She became ill on 10 April, was admitted to a hospital on 14 April and is currently in a critical condition.
  • A 50 year-old man from Yongzhou City, Hunan province. He became ill on 10 April, was admitted to a hospital on 19 April and is currently in a critical condition.

Details of the cases as reported on 21 April 2014 are as follows:

  • A 34 year-old man from Wuxi City, Jiangsu Province. He became ill on 10 April, was admitted to a hospital on 16 April, and is currently in a critical condition.
  • A 55 year-old woman from Shantou City, Guangdong Province. She became ill on 6 April, was admitted to a local hospital on 17 April, and is currently in a critical condition.

Details of the cases notified on 17 April 2014 are as follows:

  • A 60 year-old man from Changzhou City, Jiangsu Province. He became ill on 8 April, was admitted to a hospital on 13 April, and is currently in a severe condition. He had a history of contact with poultry before he became ill.
  • A 70 year-old man from Tongling City, Anhui Province. He became ill on 21 March, was admitted to a hospital on 25 March, and died on 14 April.

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

  • strengthen surveillance and situation analysis;
  • reinforce case management and treatment; and
  • conduct risk communication with the public and release information.

Current risk assessment

The overall risk assessment has not changed.

The previous report of avian influenza A(H7N9) virus detection in live poultry exported from mainland China to Hong Kong SAR shows the potential for the virus to spread through movement of live poultry, at this time there is no indication that international spread of avian influenza A(H7N9) has occurred. However as the virus infection does not cause signs of disease in poultry, continued surveillance is needed.

Further sporadic human cases of avian influenza A(H7N9) infection are expected in affected and possibly neighbouring areas.

Should human cases from affected areas travel internationally, their infection may be detected in another country during or after arrival. If this were to occur, community level spread is unlikely as the virus does not have the ability to transmit easily among humans. Until the virus adapts itself for efficient human-to-human transmission, the risk of ongoing international spread of H7N9 virus by travellers is low.

WHO advice

WHO advises that travellers to countries with known outbreaks of avian influenza should avoid poultry farms, or contact with animals in live bird markets, or 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.

China | Additional human infection with avian influenza H7N9

On 27 March 2014, the National Health and Family Planning Commission (NHFPC) of China notified WHO of an additional laboratory-confirmed case of human infection with avian influenza A(H7N9) virus.

Details of the case reported to WHO are as follows:

  • A 55 year-old woman from Huizhou City, Guangdong Province. She became ill on 16 March and was admitted to hospital on 23 March. She is currently in a critical condition. The patient had a history of exposure to poultry.

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

  • strengthen surveillance and situation analysis;
  • reinforce case management and treatment; and
  • conduct risk communication with the public and release information.

Current risk assessment

The overall risk assessment has not changed (see WHO Risk Assessment under ‘Related links’).

The previous report of avian influenza A(H7N9) virus detection in live poultry exported from mainland China to Hong Kong SAR shows the potential for the virus to spread through movement of live poultry, at this time there is no indication that international spread of avian influenza A(H7N9) has occurred. However as the virus infection does not cause signs of disease in poultry, continued surveillance is needed.

Further sporadic human cases of avian influenza A(H7N9) infection are expected in affected and possibly neighbouring areas.

Should human cases from affected areas travel internationally, their infection may be detected in another country during or after arrival. If this were to occur, community level spread is unlikely as the virus does not have the ability to transmit easily among humans. Until the virus adapts itself for efficient human-to-human transmission, the risk of ongoing international spread of H7N9 virus by travellers is low.

WHO advice

WHO advises that travellers to countries with known outbreaks of avian influenza should avoid poultry farms, or contact with animals in live bird markets, or 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.

China | Hong Kong – Ambulance crews’ working conditions questioned in Legislative Council

Following is a written reply by the Secretary for Security, Mr Lai Tung-kwok, to a question by the Dr Hon Leung Ka-lau in the Legislative Council today (March 19):

Question:

Under the existing arrangements of the Fire Services Department (FSD), ambulancemen work 12 hours per shift.  On each shift, ambulancemen may take turns to have meals for 30 minutes within a designated meal break of two to three hours (designated break).  If an ambulanceman cannot have a continuous meal break of 30 minutes due to attending service calls during the designated break, he/she may be compensated with another meal break of 30 minutes afterwards.  FSD has advised that about 90 per cent of day shift ambulancemen can have a continuous meal break of 30 minutes during the designated break.  However, the Hong Kong Fire Services Department Ambulancemen’s Union has earlier relayed to me that this figure does not reflect the actual situation, which is that the meal breaks of ambulancemen are often interrupted by service calls.  In this connection, will the Government inform this Council:

(1) of a breakdown of the following statistics on ambulance day and night shifts in various divisions under the Ambulance Command last year, and provide the statistics using tables of the same format as the table in Annex 1:

(i) Average number of ambulances on-call per shift;
(ii) Total number of ambulance shifts;
(iii) Total number of ambulance calls (including hospital transfer calls and emergency calls);
(iv) Number of emergency ambulance calls;
(v) Average number of calls per ambulance per shift;
(vi) Average number of emergency calls per ambulance per shift;
(vii) Percentage of ambulancemen having a continuous and uninterrupted meal break of 30 minutes for their first meals during the designated break per shift;
(viii) Percentage of ambulancemen whose meal breaks during the designated break were interrupted but subsequently had another continuous and uninterrupted meal break of 30 minutes within the designated break per shift;
(ix) Daily quota for compensatory meal breaks; and
(x) Average number of applications for compensatory meal breaks per day;

(2) whether it will continuously improve the meal arrangements for ambulancemen to ensure that they can have a continuous meal break of one hour during the designated break when no major incident occurs; if it will, of the details; if not, the reasons for that; and

(3) whether it has assessed the impact of having meals in a hasty manner and at irregular hours or even skipping meals on the occupational safety and health of ambulancemen; if it has; of the outcome; if not, the reasons for that?

Reply:

President,

The Administration’s reply to various parts of the question is as follows:

(1) As in the cases of many other disciplined services staff, the meal breaks of frontline ambulancemen of the Fire Services Department (FSD) may be interrupted because of the need to discharge emergency duties.  In ensuring the provision of emergency ambulance services to the public at all times, the department also has to make reasonable meal break arrangements for its frontline staff.  To this end, FSD has been taking measures to strike a balance between the provision of emergency ambulance services and the safeguarding of the welfare of ambulancemen as far as practicable.

In view of the fact that the meal breaks of frontline ambulancemen may be interrupted due to the need to discharge emergency duties, FSD has made flexible meal break arrangements for them, taking into account the emergency nature of ambulance service. In gist, ambulancemen may take turns to have meals during a designated meal break period (Note 1). If they are called out during the designated period before they have taken a continuous 30-minute meal break, they may be compensated with another 30-minute meal break within that period. However, if no other ambulances are available for dispatch at that time, they still have to stop their meals to respond to emergency calls. In the event that ambulancemen are unable to take a continuous 30-minute meal break during the designated period, they may take a 30-minute compensatory meal break afterwards, during which they will be free from attending ambulance calls. To ensure the provision of service would not be affected, FSD has set quota for compensatory meal breaks for some periods (Note 2), but there is no quota set for other periods of time.

Information relating to meal breaks of day-shift and night-shift ambulancemen in 2013 is at Annex 2.

(2) FSD has been paying close attention to the meal break arrangements for frontline ambulancemen, and has been discussing the matters with the staff side.  The management has formulated and implemented various improvement measures on the premise that the provision of emergency ambulance services to the public should not be affected.  For instance, the starting time of the meal break designated for early day-shift ambulancemen has been advanced to 11am, the Fire Service Mobilisation Centre accords a lower dispatch priority to ambulancemen not having taken their meal so as to facilitate them to return to the ambulance depot for meal, and ambulancemen who are unable to take a meal break during the designated period are eligible for a 30-minute off-call compensatory meal break afterwards, etc.

FSD will continue to maintain dialogue with the staff side on how to achieve a more effective deployment of manpower and further enhance the meal break arrangements, with a view to providing reasonable meal break arrangements for frontline staff while ensuring the efficient provision of emergency ambulance services to the public.

(3) FSD has been attaching great importance to the occupational safety and health of its staff.  When drawing up work arrangements, the department will assess the impact on staff safety and health and put in place corresponding measures to minimise the risks posed to the staff when necessary.  For example, ambulance equipment such as automatic chest compressors and patient sliding boards, etc have been introduced for use by ambulancemen to reduce their chances of sustaining injuries at work.  In light of the issue of meal breaks for ambulancemen, the department has also formulated the prevailing flexible meal break arrangements after consulting the staff side.  FSD is aware that the staff side still has demand and comments on the meal break arrangements.  Therefore, the department will continue to explore the scope for enhancing the meal break arrangements and take improvement measures as appropriate.

Note 1: In general, ambulancemen are on either day shift (8.30am to 8.30pm) or night shift (8.30pm to 8.30am the next day).  The designated meal break periods for day-shift and night-shift ambulancemen are 11.30am to 1.30pm and 12am to 3am respectively.

Note 2: The quota system for compensatory meal breaks each day is applicable only from 1pm to 2pm for day-shift ambulances and from 3am to 4.30am for night-shift ambulancemen. The quota system is not applicable to other periods of time