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Download Statutory Reporting of “Variant Influenza A(H3N2) ”
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Surveillance And Epidemiology Branch 監測及流行病學處 本署檔號 Our Ref. : (57) in DH SEB CD/8/27/1 Pt.19 17 August 2012 Dear Doctor, Statutory Reporting of “Variant Influenza A(H3N2) ” Recently in the United States, a significant increase in the number of infections with influenza A(H3N2) variant [A(H3N2)v] has been reported. In order to prepare in advance for possible importations of this infection into Hong Kong and their consequences, there is public health justification to strengthen the surveillance of this type of influenza to enable effective public health preventive and control measures be implemented locally. It is considered necessary to amend the Prevention and Control of Disease Ordinance (Cap. 599) to include “variant influenza A(H3N2)” in the list of scheduled infectious diseases, with effect from 17 August, 2012. Influenza A virus infections are common in pigs, but these viruses are generally different from those circulating among human. Swine influenza A viruses can occasionally cause human infections. These viruses are called “variant viruses” when people are infected with them. Human infections with variant influenza viruses usually occur in people with exposure to infected pigs (e.g. workers in the swine industry, children near pigs at a fair). In 2011, a new A(H3N2)v virus that had acquired the matrix or M gene from influenza A(H1N1)pdm09 [A(H1N1)pdm09] virus was detected in the United States. Such viruses are expected to test positive for influenza A, and variably for different subtype markers. 衞生防護中心乃衞生署 轄下執行疾病預防 及控制的專業架構 The Centre for Health Protection is a professional arm of the Department of Health for disease prevention and control In the United States, while a total of 12 cases infected with this new A(H3N2)v were reported in 2011, increasing number of infections have been reported since July 2012. As of 10 August, the United States Centers for Disease Control and Prevention (USCDC) reported 166 cases, of which 153 cases were reported recently in July and early August 2012. Most of the cases were mild and self-limited, presenting with symptoms and signs of influenza and most cases have recovered. USCDC has not received any report of deaths 香港九龍亞皆老街 147C 號 3 樓 3/F, 147C Argyle Street, Kowloon, Hong Kong -2- associated with variant influenza A(H3N2), and there have been two confirmed hospitalizations with variant influenza A(H3N2) so far in 2012. Both patients have recovered and have been discharged. Of the 138 reported cases for which demographic information was available, 128(93%) occurred in persons aged <18 years, and 10(7%) occurred in adults. Limited serologic studies conducted in the United States to date indicate that children would have little to no immunity to this virus, whereas adults may have some cross-protective immunity. No sustained community transmission of A(H3N2)v has been observed yet. However, it is possible that this A(H3N2)v could gain increased capacity for efficient and sustained human-to-human transmission because influenza viruses are constantly evolving. So far, no human infection with this A(H3N2)v has been reported outside the United States. However, with the frequent international travel, it is possible that an imported case of variant influenza A(H3N2) may occur in Hong Kong. To detect these cases early, medical practitioners are reminded to notify the Department of Health any suspected cases of variant influenza A(H3N2) fulfilling the reporting criteria (see attached) and collect relevant respiratory specimens. The Public Health Laboratory Services Branch of the Centre for Health Protection (CHP) has the ability to diagnose these cases. Please report suspected cases to the Central Notification Office (CENO) of CHP via fax (2477 2770) using the reporting form attached, phone (2477 2772) or CENO On-line (http://ceno.chp.gov.hk/). Please also call our Medical Control Officer at 7116 3300 a/c 9179 outside office hour for prompt investigation. The case definition of variant influenza A(H3N2) is attached in Appendix for your reference. The reporting form and the case definition are also available on CENO On-line website. May I take this opportunity to thank you for your continuous support in combating infectious disease in Hong Kong. Yours faithfully, (Dr SK CHUANG) Consultant Community Medicine (Communicable Disease) Centre for Health Protection Department of Health -3- Appendix Variant Influenza A(H3N2) (Effective on 17 August, 2012) Description Influenza A viruses that are different from those circulating among human are called “variant viruses” when people are infected with them. Human infections with influenza A(H1N1) variant [A(H1N1)v], A(H3N2)v and A(H1N2)v viruses determined to be of swine origin have been occasionally reported. In the United States, increasing number of infections with A(H3N2)v with the influenza A (H1N1)pdm09 virus M gene have been reported since July 2011, mostly in people with direct exposure to pigs (e.g. workers in the swine industry, attendants to agricultural fairs). Most cases presented with symptoms and signs of influenza (fever, cough, runny nose, sore throat, muscle aches). Limited human-to-human transmission of A(H3N2)v had been identified but sustained and efficient community transmission of A(H3N2)v has not yet been detected. Case Definition Laboratory Criteria One of the following positive results reported by a reference laboratory z nucleic acid detection for specific A(H3N2)v genome; OR z isolation of an A(H3N2)v; OR z seroconversion or four-fold rise in A(H3N2)v specific antibodies. Confirmed Case A clinically compatible illness fulfilling the laboratory criteria. -4- Reporting criteria for suspected variant influenza A(H3N2) Reporting criteria An individual fulfilling both the Clinical Criteria AND Epidemiological Criteria should be reported to CHP for further investigation. Clinical Criteria z z z person with acute respiratory illness, characterized by fever (temperature >38oC) and cough and/or sore throat, OR person with pneumonia, OR person died of unexplained acute respiratory illness Epidemiological Criteria z History of recent contact (7 days before onset of illness) with swine in the United States or areas with known variant influenza A(H3N2); OR patient with variant influenza A(H3N2) FORM 2 PREVENTION AND CONTROL OF DISEASE ORDINANCE (Cap. 599) Notification of Infectious Diseases other than Tuberculosis Particulars of Infected Person Name in English: Name in Chinese: Age / Sex: I.D. Card / Passport No.: Telephone No. (Home) : Residential address: (Mobile) : Name and address of workplace / school: (Office / school / others): Job title / Class attended: Hospital / Clinic sent to (if any): Hospital / A&E No.: Disease [“9”] below Suspected / Confirmed on ______ / _______ / _________ (Date: dd/mm/yyyy) □ Acute poliomyelitis □ Amoebic dysentery □ Anthrax □ Bacillary dysentery □ Botulism (H3N2), Influenza A (H5), □ Scarlet fever □ Chickenpox Influenza A (H7), Influenza A (H9) □ Severe Acute Respiratory □ Chikungunya fever □ Japanese encephalitis □ Cholera □ Legionnaires' disease □ Community-associated methicillin-resistant □ Leprosy Staphylococcus aureus infection □ Leptospirosis □ Smallpox □ Creutzfeldt-Jakob disease □ Listeriosis □ Streptococcus suis infection □ Dengue fever □ Malaria □ Tetanus □ Diphtheria □ Measles □ Typhoid fever □ Enterovirus 71 infection □ Meningococcal infection □ □ Food poisoning □ Haemophilus influenzae □ Rabies type b infection (invasive) □ Relapsing fever □ Hantavirus infection □ Rubella and congenital □ Influenza A (H2), Variant Influenza A rubella syndrome Syndrome □ Shiga toxin-producing Escherichia coli infection (invasive) Typhus and other rickettsial diseases Number of persons known to be affected: □ Mumps □ Viral haemorrhagic fever Place and district of consumption (e.g. “XX Restaurant in Mongkok”): □ Paratyphoid fever □ Viral hepatitis □ Plague □ West Nile Virus Infection □ Psittacosis □ Whooping cough □ Q fever □ Yellow fever Date of consumption: Notified under the Prevention and Control of Disease Regulation by Dr. ______________________________ of ___________________________Hospital / Clinic / Private Practice (Full Name in BLOCK Letters) ____________________________Ward / Unit / Specialty on ______ / _______ / ________ (Date: dd/mm/yyyy) Telephone No.: ________________ Remarks: DH 1(s)(Rev. August 2012) Fax No.: ___________________ ___________________________ (Signature)