Replies to LegCo questions
LC Urgent Q1: Scarlet fever
Following is a question by the Hon Chan Hak-kan under Rule 24(4) of the Rules of
Procedure and a reply by the Secretary for Food and Health, Dr York Chow, in the
Legislative Council today (June 29):
Question:
The cumulative number of cases of scarlet fever (SF) this year has exceeded 600,
nearly three times over the record high of 235 infected cases in 2008, and two
fatal SF cases have occurred. An increase in the number of SF cases is also
noted in neighbouring Macao and the Pearl River Delta (PRD) region, reflecting
that the epidemic is spreading in the region. At present, the epidemic in Hong
Kong has not yet come under control and is posing a threat to the health of
children. The Department of Microbiology of the University of Hong Kong has
earlier on performed a genetic study on the bacterium and has discovered the
condition of a mutated strain which increases its resistance to antibiotics and
transmissibility. In this connection, will the Government inform this Council:
(a) as the genetic mutation of the scarlet fever prevailing in Hong Kong at
present has increased the disease's resistance to antibiotics and
transmissibility, whether the Government has put in place emergency measures to
cope with the spread of SF, such as guidelines on clinical practices and drug
utilisation, isolation arrangements and early commencement of the summer break
for schools, etc.; if it has, of the circumstances under which the Government
will implement such arrangements; if not, whether the Government is of the view
that the SF epidemic at present is still under control and its impact on the
health of the public is limited; and
(b) whether there is evidence showing signs of abnormality in the spread of SF
in the PRD region; if there is, whether the Hong Kong SAR Government, the Macao
SAR Government and the health authorities of Guangdong Province have held
discussions on the spread of SF and have explored immediate measures to deal
with the situation?
Reply:
President,
Scarlet fever (SF) is a bacterial infection caused by Group A Streptococcus and
mostly affects children under 10 years of age. The bacteria can be transmitted
through either respiratory droplets or direct contact with infected respiratory
secretions. For patients with suspected SF, the penicillin group of antibiotics
is the treatment of choice and should be given for at least 10 days for
effective treatment.
The Centre for Health Protection (CHP) under the Department of Health (DH)
receives case reports of SF under the established statutory notification system.
There has been an increase in the number of SF case reports since April this
year.
The underlying reasons for the SF upsurge are being examined. The overall
epidemiologic and clinical characteristics of SF cases in this outbreak resemble
those in the past, although infrequently some cases may have atypical clinical
presentation. The case fatality rate so far is not significantly higher than
historical or international figures. In any case, we urge the general public to
remain vigilant against the disease.
My response to the two parts of the question is as follows:
(1) The Government is taking a multi-pronged approach to prevent and control SF
in the community, as well as to cope with the potential rise in cases in the
coming months.
CHP is closely monitoring the situation and has been publishing online daily
updates on the SF situation in Hong Kong. To enhance monitoring of severe SF
cases in the community, CHP has set up an enhanced surveillance mechanism with
public and private hospitals for intensive care unit admissions or deaths
associated with SF and Group A Streptococcus infection since June 24, 2011.
The Hospital Authority (HA) has devised guidelines on clinical and drug
treatment guidelines in association with CHP. It will monitor the utilisation
rates of Paediatric Intensive Care Units, remind frontline staff on the
infection control measures, and ensure the supply of antibiotics.
In addition, CHP, HA and the University of Hong Kong (HKU) have been working in
collaboration on laboratory testing for the bacterium causing SF, including
tests on antimicrobial resistance, serotypes, virulence genes and the new gene
fragment reported by HKU.
At an earlier juncture, CHP commissioned the Department of Microbiology of HKU
to perform genetic study on the bacterium (Group A Streptococcus) causing
scarlet fever. A new genetic fragment was discovered in an isolate of Group A
Streptococcus from a SF case in Hong Kong. Given the latest epidemiology and
laboratory findings, the two relevant Scientific Committees under CHP are of the
view that the relation between this new genetic fragment and the current upsurge
in SF requires further scientific investigations. So far, all the isolates
detected are sensitive to penicillin.
On the publicity and education front, CHP has stepped up publicity and health
education with regard to SF prevention since June this year. CHP has maintained
close liaison and communication with stakeholders and healthcare workers.
Letters have been issued to institutions and schools to promulgate prevention
and control measures to prevent any potential spread of SF in schools and
institutions. Updated situation and information pertaining to clinical diagnosis
and management of SF patients have been disseminated through letters to doctors
and biweekly publication of Communicable Disease Watch.
For the general public, a new radio Announcement in the Public Interest on SF
has been produced to strengthen public education. Health information on SF will
be disseminated through various channels, including a designated webpage,
posters and leaflets. CHP has also given press briefings and interviews to
update the public on preventive measures. These risk communication activities
will go on in the coming weeks.
Regarding school outbreaks, only 7% of all SF cases are associated with school
clusters and the number of persons affected in each cluster is small, ranging
from 2 to 7 persons. CHP will investigate SF outbreaks and give advice on the
management of such cases and appropriate control measures. In special
circumstances, CHP may advise individual school with SF case(s) to suspend
classes, taking into account the epidemiological assessment.
We expect high SF activity to persist into the summer. DH has convened an
interdepartmental meeting attended by representatives from Social Welfare
Department, Education Bureau, Home Affairs Department, Food and Environmental
Hygiene Department, Leisure and Cultural Services Department, Information
Services Department and HA to plan for the preventive strategies in the coming
summer holidays. Various Government departments will work together to strengthen
hygiene measures and publicity on SF at different venues.
(2) CHP notes a simultaneous increase of SF cases in Mainland China and Macao,
where the condition is a notifiable disease as in Hong Kong. The rise of SF
cases in Hong Kong is likely a regional phenomenon. Of the 637 SF cases reported
this year, only ten cases had history of visiting Mainland China during the
incubation period. Based on the Cooperation Agreement on Contingency Measures
during Public Health Emergency signed between Guangdong, Hong Kong and Macao,
the three places regularly exchange statistics and control measures of
infectious diseases such as SF, and notify the concerned counterpart for
cross-boundary incidents. Health authorities of Guangdong, Hong Kong and Macao
have exchanged the surveillance data and the analysis of SF in view of the
rising number of cases this year.
Ends/Wednesday, June 29, 2011
Issued at HKT 12:51
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