The Centre for Health Protection (CHP) of the Department of Health (DH) today (February 23) reported the latest updates of the third confirmed imported human case of avian influenza A(H7N9) in Hong Kong this winter. The patient travelled to the city(DongGuan) twice this month and bought two slaughtered chickens at a wet market there on February 14.He returned to Hong Kong, and developed a cough and shortness of breath since February 16.He was admitted to Queen Mary Hospital on February 20 and tested positive for influenza A(H7).He is in critical condition in the Intensive Care Unit.

     "We again urge the public to maintain strict personal, food and environmental hygiene both locally and during travel as the Serious Response Level under the Preparedness Plan for Influenza Pandemic remains activated. If symptoms develop after travel, immediately wear masks, seek medical attention and reveal travel history to doctors," a spokesman for the CHP said.

Laboratory investigation
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     Both the nasopharyngeal and endotracheal aspirates of the male patient aged 61 tested positive for influenza A(H7N9) virus and negative for influenza A(H1) and (H3) viruses this morning upon preliminary testing by the CHP´s Public Health Laboratory Services Branch. Genetic characterisation is under way.

     "While the activity of avian influenza viruses in the Mainland and human seasonal influenza viruses in Hong Kong remains high this winter and heightened vigilance and extra attention to hygiene are warranted, we will closely monitor the virus activity and genetic nature. Genetic analysis to date has revealed that H7N9 viruses confirmed in Hong Kong have remained to be of avian origin and had no significant differences from those detected in the Mainland, nor has there been evidence of reassortment with genes from human seasonal influenza viruses or resistance to the antiviral oseltamivir (Tamiflu)," the spokesman said.

Epidemiological investigations and control
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     Epidemiological investigations by the CHP have so far located 10 close contacts and 16 other contacts of the patient.

(A) Close contacts

     The close contacts will be put under quarantine and prescribed with antiviral presumptive treatment until the completion of the five-day treatment or 10 days since last exposure to the patient, whichever is earlier. They include:

* A family member who remained asymptomatic. Her nasopharyngeal aspirate has been collected pending laboratory testing;
* Seven in-patients admitted to the same cubicle as the patient in Queen Mary Hospital (QMH) among which six were asymptomatic while the remaining one is under tracing; and
* Two asymptomatic patients who attended the same private clinic in Aberdeen with the patient.

     The Lady MacLehose Holiday Village in Sai Kung under the Leisure and Cultural Services Department will be converted to a quarantine centre for the quarantine of asymptomatic close contacts.

(B) Other contacts

     The other contacts have been put under medical surveillance and they include:

* Another family member who visited the confirmed patient in QMH and remained asymptomatic;
* Ten clinic contacts including the private doctor, staff and patients of the private clinic who remained asymptomatic; and
* Five colleagues of the patient among which one had mild upper respiratory tract infection symptoms before exposure to the patient while the rest are asymptomatic.

     Tracing of the health-care workers involved in QMH is under way.

     The CHP is communicating with the health authorities of Guangdong and Shenzhen to follow up on the patient´s movements and contacts during his stay in the Mainland. Based on information available thus far, it is classified as an imported case. Investigations are ongoing.

Enhanced surveillance
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     The CHP has enhanced surveillance of suspected cases in public and private hospitals, and activated an electronic reporting system to monitor cases in real time with the Hospital Authority. Clinicians should pay special attention to patients with fever or influenza-like illness who visited wet markets with live poultry or had contact with poultry in affected areas within the incubation period, i.e. 10 days before onset.

     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.

     The case will be notified to the World Health Organization, the National Health and Family Planning Commission, the health authorities of Guangdong and Macau, and the quarantine authorities of Guangdong and Shenzhen.

     "This is the 13th imported human case of avian influenza A(H7N9) confirmed in Hong Kong. To date, 582 cases have been reported by the Mainland health authorities since March 2013 while seven were reported in Taiwan (four cases), Canada (two cases) and Malaysia (one case). Cases in the Mainland are on the rise this winter and 142 cases with onsets since November 2014 were reported with 62 of them (42 per cent) from Guangdong. The remaining cases are from Fujian (36 cases), Zhejiang (17 cases), Jiangsu (14 cases), Xinjiang (seven cases), Shanghai (four cases), Jiangxi (one case) and Shandong (one case)," the spokesman remarked.

Port health measures
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     Health surveillance measures have been implemented at all boundary control points. Thermal imaging systems are in place for body temperature checks of inbound travellers and the DH also conducts temperature checks by handheld devices. Suspected cases will be immediately referred to public hospitals for follow-up.

     Regarding health education for travellers, the display of posters and broadcasting of health messages in departure and arrival halls, environmental health inspection and provision of regular updates to the travel industry and other stakeholders are ongoing.

Risk communication
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     The CHP´s avian influenza hotline (2125 1111) operates from 9am to 6pm from Monday to Friday.

     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.