Category Archives: China

Mr Leung (third right) tours the simulation training modules.

China | Launch of Hong Kong Jockey Club Disaster Preparedness and Response Institute

Mr Leung (third right) tours the simulation training modules.
Mr Leung (third right) tours the simulation training modules.

Following is the speech by the Chief Executive, Mr C Y Leung, at the launching ceremony of the Hong Kong Jockey Club Disaster Preparedness and Response Institute this evening (August 20):

Dr Li, Mr Stevenson, colleagues, distinguished guests, ladies and gentlemen,

It is a great pleasure to join you today to celebrate the launch of the Hong Kong Jockey Club Disaster Preparedness and Response Institute.

Life is full of challenges and risk. Even though Hong Kong is one of the safest cities in the world, disasters and accidents can and do occur. Last week, a pregnant woman was killed by a falling tree in the Mid-Levels and we were all deeply saddened by the tragic accident. We definitely do not want to see similar incidents happening again and this reminds us of the importance of disaster preparedness and response to our community.

With climate change also comes change in weather patterns – this is something the whole world needs to deal with. Here in Hong Kong, just in the last week or two, we have experienced heavy rainfall in a short span of time. We are in the middle of the typhoon season. Our topography means that landslips can occur at such times, as well as flooding in low-lying areas. We have very good systems in place to deal with all of these weather incidents, but sometimes Mother Nature has other ideas.

Our densely populated and highly urbanised community, coupled with an open immigration policy, means that we are also vulnerable to outbreaks of infectious disease. We remain vigilant against the current Ebola virus scare, and we speak with the sad wisdom that comes from dealing with the SARS outbreak in 2003, not to mention avian flu and swine flu.

Here in Hong Kong, we have learnt much and already done much to prepare for emergencies or disasters. Preparedness plans and emergency strategies have been drawn up to cover various scenarios. We provide training, and stage drills to test our responses and actions in real-time situations. Thankfully, with the dedication of health-care personnel, law enforcement agencies and civil servants, as well as the co-operation of the community, we have been able to overcome many difficult moments in the past.

Yet, given the serious consequences of a disaster, and no matter how thorough our preparations are, we should never be complacent. That is why the establishment of the Disaster Preparedness and Response Institute – the first in Hong Kong – is so important. And here I must offer my heartfelt thanks to the Hong Kong Jockey Club Charities Trust and the Hong Kong Academy of Medicine for making it happen. Well done.

The Institute will provide comprehensive and detailed training for personnel involved in disaster management. It will provide a platform to enhance co-ordination between clinical and non-clinical responders, and will help build a common language among all agencies and professionals. It is a visionary undertaking that will contribute greatly to the provision of safe, high-quality disaster services for the community.

Disaster response cannot be effective if carried out in a piecemeal and disconnected manner – especially in today’s fast-changing and interconnected world. Close partnership with relevant players is essential to ensure a well co-ordinated disaster response.

I congratulate the Hong Kong Academy of Medicine on lining up experts and partners from the Chinese University of Hong Kong and the University of Hong Kong, as well as from reputable overseas universities including Harvard and Oxford University, among others. The Institute has also established contacts with the Security Bureau and the Department of Health of Hong Kong Government, both of which have extensive expertise and experience to share.

I look forward to and welcome future co-operation and exchanges between the Institute and the Government to enhance disaster preparedness and response in Hong Kong.

In the long run, I am sure the Institute will not only help enhance our own skills and understanding, it will also help establish Hong Kong as a local and regional training centre in disaster preparedness and emergency response. Hong Kong has a fine record of helping our compatriots and neighbours in times of trouble; the Institute will add a new dimension and greater depth to such efforts.

Ladies and gentlemen, may I take this opportunity to wish the Institute an excellent start and convey my gratitude to all who have tendered their time and effort that has led to the launch of the Institute today.

Thank you.

China | Hong Kong launches Ebola Preparedness and Response Plan

On August 20, the Government announced the launch of the Preparedness and Response Plan for Ebola Virus Disease (EVD). The Plan sets out the Hong Kong Special Administrative Region Government’s preparedness and response plan in case of an outbreak of EVD.

“The EVD Plan ensures that when EVD may have a significant public health impact on Hong Kong, the Hong Kong Special Administrative Region Government would be equipped with the core capacities to prevent, detect, characterise and respond quickly, efficiently and in a co-ordinated manner to the EVD threats in order to reduce mortality and morbidity,” a spokesman for the Centre for Health Protection (CHP) of the Department of Health remarked.

In the EVD Plan, a three-tier response level, which is adopted for the preparedness plans of influenza pandemic and Middle East Respiratory Syndrome, is used. The three response levels, namely Alert, Serious and Emergency, are based on the risk assessment of the EVD that may affect Hong Kong and its health impact on the community.

The EVD Plan includes comprehensive response measures, clear command structures, and mechanisms for the activation and standing down of response levels. It also serves as a tool for clear communication of the level of risk with the public. Relevant agencies, companies and organisations should take note of this plan in devising their contingency plans and response measures.

In accordance with the EVD Plan, the Alert Response Level is activated with reference to the current epidemiological situation.

The EVD Plan has been uploaded to the CHP’s EVD page (www.chp.gov.hk/en/view_content/34199.html).

China | Hong Kong – 3,500 chickens dead – AFCD continues to investigate

Officers of the Agriculture, Fisheries and Conservation Department (AFCD) today (August 11) conducted further investigation at the farm where abnormal chicken deaths occurred last week.

The owner of the farm reported to the AFCD  on August 9 that death of chickens has been observed since the afternoon of August. A Veterinary Officer of the AFCD immediately carried out on-site investigation.

The auditing result has revealed that the cumulative total of chicken deaths in the incident has amounted to about 3,500 so far.

The AFCD officers checked the hygiene conditions, ventilation and vaccination of the chickens at the farm. More samples were also collected for testing.

Samples taken earlier and today have tested negative for Newcastle disease virus by Polymerase Chain Reaction (PCR). However, the PCR results must be confirmed by virus isolation, which is under way. Further testing and autopsies will also be conducted to ascertain the cause of death.

The AFCD officers today commenced inspections at all local chicken farms. No abnormalities have been observed at the 14 farms inspected so far. Inspection of the remaining chicken farms will continue.

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.