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Severe Acute Respiratory Syndrome in Hong Kong

Severe Acute Respiratory Syndrome in Hong Kong. Department of Health Hong Kong SAR (as at 10 April 2003). Background. Background. The World Health Organization has recently received reports of “Severe Acute Respiratory Syndrome” in various parts of the World.

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Severe Acute Respiratory Syndrome in Hong Kong

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  1. Severe Acute Respiratory Syndrome in Hong Kong Department of Health Hong Kong SAR (as at 10 April 2003)

  2. Background

  3. Background • The World Health Organization has recently received reports of “Severe Acute Respiratory Syndrome” in various parts of the World. • There are people affected by atypical pneumonia in Hong Kong. • The Department of Health,in conjunction with Hospital Authority, the University of Hong Kong and the Chinese University of Hong Kong are conducting a detailed investigation into the matter. • Hong Kong is working closely with the World Health Organization to control and prevent the spread of atypical pneumonia

  4. What is Pneumonia? • Pneumonia refers to an inflammation of lung or infection of lung which results in abnormal lung function. • Pneumonia can be classified into typical and atypical cases. • Typical pneumonia is usually caused by bacteria such as streptococcus pneumoniae. Symptoms include sudden onset of fever, chest pain, cough and purulent sputum.

  5. What is SARS/ atypical pneumonia? • Atypical pneumonia is usually caused by influenza virus, mycoplasma, chlamydia and other unknown micro-organism. • Common symptoms include fever, chills, cough, headache and general malaise • Severe Acute Respiratory Syndrome, or SARS, is a form of atypical pneumonia caused by a new agent

  6. General Situation in Hong Kong

  7. Hong Kong SAR Communicable Disease Surveillance System • Comprising hospitals, clinics and laboratories in the public and private sectors • monitoring the trends of influenza, pneumonia, Hand-foot-mouth disease, acute diarrhoeal disease, acute conjunctivitis and so forth • stepped up surveillance on severe pneumonia cases in view of the atypical pneumonia outbreak in Guangdong Province in early February 2003 • Investigation, contact tracing of all severe community-acquired cases carried out

  8. Statistics on community-acquired pneumonia(CAP) • The estimated death rate per 100,000 pop as at10April 03 is 1.8 for SARS. • There is no unusual rise in the number of CAP • The causes of CAP are similar to previous years (50% each of known causes and unknown causes)

  9. Chronology of SARS development in Hong Kong

  10. 10.3.2003 12.3.2003 13.3.2003 18.3.2003 19.3.2003 21.3.2003 Hospital Authority notified Department of Health (DH) DH made public findings of initial investigations and notified WHO WHO issued global alert on atypical pneumonia Set up a Steering Committee and an expert working group to oversee investigation and to implement preventive measures to contain spread Daily update on local situation WHO experts invited to provide technical support Paramyxovirus was identified by CUHK in some patients. Further investigation is required to establish if this is the causative agent. WHO issued preliminary clinical description of SARS & recommended hospital discharge & follow-up policy

  11. 22.3.2003 24.3.2003 25.3.2003 26.3.2003 27.3.2003 31.3.2003 1. 4. 2003 2.4.2003 10.4.2003 Coronavirus identified by HKU & rapid diagnostic test established Interdepartmental effort stepped up to disseminate public health advice to the public Chief executive emphasized that prevention & control of SARS was top priority of Government First seven cases of Amoy Garden residents reported Government announced major steps including quarantine of contacts in curbing the spread of the disease Amoy Garden Block E isolated Amoy Garden Block E residents evacuated & isolated in camps while epidemiological investigations continued WHO advised postponing non-essential travel to HK Government announced home treatment programme

  12. Latest Developments

  13. Update of SARS situation in Hong Kong as at 1 pm, 10 April 2003 • Total: 998 cases (25% were health care workers & medical students, 75% were patients and their close contacts) • 154 patients (15.4%) were discharged • Majority showing positive response to new treatment protocol • 120 (12 %) needs ICU care • 30 deaths (3%) reported • 70% of the deaths occurred in those aged >60 years old & 77% in those with chronic illness

  14. Main epidemiological observations • Low case fatality so far • 3% (30 deaths out of 998 cases) • most deaths among the elderly & with underlying disease • Majority of SARS cases can be linked to close contact with known SARS cases • Healthcare workers, household contacts & hospital visitors were major risk groups • No SARS outbreaks occurred at community institutions • e.g. schools, nursery, elderly homes • Excluding Amoy Garden related cases, SARS in general community remains steady, about 20 cases a day

  15. Evidence from epidemiological findings • Outbreak caused by new virus • Close contact required for transmission, via respiratory droplets or fomite on contaminated surfaces • No evidence of airborne transmission to date • Incubation period typically 2 to 7 days, as long as 10 days • Healthcare workers and close contacts at higher risk

  16. Prince of Wales Hospital Cases

  17. PWH SARS outbreak • Sex distribution:Sex distribution (M:F)=1:1.2 • Likely mode of transmission of the disease is respiratory droplets spread & close contacts • Use of nebuliser in index patient facilitated spread of disease • Health care workers, patients in ward & visitors to patients, close contacts of hospital staff & visitors were infected

  18. Symptoms of the PWH SARS cases Fever with diarrhoea has been reported in some cases

  19. Epidemiological linkage for PWH cluster 1 Mainland visitor Onset: 15 Feb 03 PWH index patient Onset: 24 Feb 03 Metropole hotel Succumbed at KWH 1 American Chinese 3 Singapore visitors Hanoi outbreak index case 2 Canadian visitors Outbreak in Toronto, Canada Outbreak in Singapore A private hospital outbreak on Hong Kong Island

  20. Amoy Gardens Cases

  21. Amoy Garden SARS Outbreak • Brief description • Private housing estate established for 20 years • Floor area of each flat: 400 to 500 sq. ft. • 19 blocks (Block A to S) • Each block has 36 storeys & each storey has 8 flats • 2001 census • 19200 residents from 6755 domestic households • SARS cases reported since 26 March • As of 10 April, 289 cases were related to the AG cluster

  22. Epidemic curve of SARS cases in Amoy Garden as of 9 April 2003

  23. Preliminary assessment of Amoy Garden SARS outbreak • SARS cases first reported on 26.3.03, peaked on 31.3.03 • The majority were adults aged 19 & above • More household in Block E were affected with clustering in Rooms 7 & 8 • Other blocks residents have later onset dates—representing secondary transmission • Unusual clustering suggest local factors at work • Need to rule out continuing source or predisposing factors affecting other blocks

  24. Control measures at Amoy Garden • Epidemiological, environmental & laboratory investigations • Case investigation and contact tracing • Call interdepartmental investigation group—collect environmental samples , case control study, etc. • Isolation • Isolate Block E on 31 March 2003 • Evacuate Block E residents and placed them under isolation for 10 days • Disinfection, Cleansing • home environment • public areas environmental hygiene • Public education

  25. Prevention &Control Measures

  26. Political commitment • Secured funding of $200 million for: • Health service provision & treatment • Prevention of infection • Public education

  27. Enhanced measures by DH • Prevented introduction & spread of SARS cases into & outside Hong Kong at entry points • Contact tracing • Put close contacts of confirmed cases under stringent medical surveillance • Public Health Laboratory Centre to accord top priority to test SARS cases • Enhanced community liaison & education targeting people at all walks of life • Liaised with WHO & other health authorities

  28. Prevent introduction & spread of SARS • Set up medical posts at the airport, ports & border points since March 29 • People arriving at HK to complete health declaration cards for arrivals & be given health advice • Sent symptomatic arrivals/departures to treatment centres for check-up • Stopped those suspected SARS cases from checking in for flights • Set up hotlines for health advice

  29. Contact tracing • Set up hotlines • Requested all visitors of Ward 8A of PWH after 1.3.2003, Metropole Hotel (9/F) UCH, etc. to call hotlines • Requested air passengers of certain flights where SARS cases had been on board to call hotlines

  30. Stringent medical surveillance • SARS has been made statutorily notifiable since March 27 • Appointed 4 clinics as centres of medical surveillance since 31 March 03 • Requested close contacts to stay at home & report at centres daily for 10 days for medical surveillance • Social contacts are given health advice & advised to call hotline if anyfever/cough developed

  31. Public Health Education Campaign • Public places • Housing estates • Public transport, transport operators • Schools, kindergartens, childcare centers • Travelers • Food premises • General public • Medical practitioners

  32. Productions by DH for the public • TV/radio messages • Health talk • Hotline (1872222) • Website • Posters • Pamphlets Productions by GIS • Announcement in Public Interest • Newspaper supplements

  33. Health advice to the public • Build up good body immunity • having a proper diet, regular exercise and adequate rest, reducing stress and avoiding smoking • Maintain good personal hygiene • wash hands after sneezing, coughing or cleaning the nose • Maintain good ventilation • Avoid visiting crowded places with poor ventilation • Visitors to hospital patients are advised to take due precautions in infection control • e.g. wearing face mask and gowns, wash hands

  34. Major Breakthroughs

  35. Major breakthrough(1) 1. Epidemiologic investigation of outbreaks • to identify likely mode of transmission, incubation period, common presenting symptoms, high risk groups, linkages between clusters 2. Identification of agent: • CUHK: human metapneumovirus • HKU: Corona virus 3. Developed a rapid diagnostic test—GVU, HKU,CUHK,HA • Reliability still under test • Important for getting early treatment

  36. Major breakthrough(2) 4.Treatment • Effective treatment available • Over 95% of patients can recover • Early treatment reduce the need for ICU care 5.Cooperation with the Mainland • Held meetings with Hong Kong to share experience

  37. Conclusions

  38. Hong Kong is safe for local residents as well as visitors • Hong Kong has high quality medical and public health services: • adequate medical facilities to handle the situation • effective disease surveillance and control • WHO: Up to date, the likely mode of transmission is via respiratory droplets • Hong Kong continues to work with WHO & CDC to prevent the spread of SARS • WHO travel advice on 2 April 2003 • Consider postponing non-essential travel to Hong Kong & Guangdong Province

  39. To know more • Department of Health’s Hotline: 187 2222 • Department of Health’s 24 hour pre-recorded health education hotline:2833 0111 • Department of Health’s websitewww.info.gov.hk/dh

  40. Thank you

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