United in action

Avian influenza has once again reared its ugly head. As of 17 February, 348 human cases of avian influenza A (H7N9) had been confirmed on the Mainland, while Hong Kong identified its first case in December last year. Public hospitals have implemented a series of preventive measures to better monitor the situation and guard against the spread of the virus. Dr Liu Shao-haei, Chief Manager (Infection, Emergency & Contingency), tells us how staff at Head Office are coordinating with hospitals to fight avian influenza and help people stay healthy.

Prevention is better than cure

“Hong Kong’s first confirmed case of H7N9 avian influenza A was recorded on 3 December last year. In accordance with the established response mechanism for influenza pandemics, the Hospital Authority worked with the Government to activate the ‘Serious Response Level’ alert, and reminded frontline staff in A&E departments and general outpatient clinics to strengthen surveillance and triage procedures for patients,” Dr Lau says.

On 6 February this year, HA strengthened the existing surveillance criteria as part of its ‘early reporting, early isolation and early testing’ strategy to minimise the risk of large-scale infection. The Centre for Health Protection will immediately be informed of any patient who is diagnosed as suffering from community-acquired pneumonia and has travelled to an avian flu-affected region within 10 days of becoming ill. Such patients will be placed on an isolation ward and undergo an expedited testing process.

Pre-planning ensures effective response

Dr Liu says: “Preparedness planning has long been an important part of HA’s strategy for controlling the outbreak of contagious diseases.”

In 2006, HA established an Infection, Emergency and Contingency Department at its Head Office with the aim of working to prevent the outbreak of infectious diseases, initiating a rapid response to large-scale disasters and coordinating the management of emergency situations.

The Department is in close and regular contact with HA hospitals, including through the Major Incident Control Centre (MICC), to coordinate response measures with internal and external parties; the Central Committee on Infectious Diseases and Emergency Response, to consolidate input from relevant experts; and the Chief Infection Control Officer Office, to align the standards and practices of hospital infection control teams.

Major Incident Control Centre: key communications hub

The tireless efforts of the entire HA team plays a major role in the Authority’s ability to respond efficiently and effectively to major emergency situations. The MICC plays a pivotal role in emergency situations. In addition to operating as the central monitoring facility, it also serves as the main communication and coordination hub for the HA network.

With the recent activation of ‘Serious Response Level’ (S2), the MICC immediately swung into action – communicating closely with Government departments such as the Fire Services Department and the Hong Kong Police Force. At an internal level, it is in close contact with the hospitals – collecting information via the electronic patient record (ePR), Accident and Emergency Information System (AEIS), the electronic influenza surveillance system (eFlu) and the Notifiable Disease Outbreak Reporting System (NDORS). It also disseminates key messages to staff on monitoring and follow-up policies via HA’s rapid communication system.

To help ensure the early isolation of suspected avian influenza cases, the MICC is cooperating with the IT Department to monitor the occupancy rate of isolation wards and help coordinate the efficient use of wards across hospitals.

The MICC team is responsible for coordinating the HA’s overall response to an incident. It also serves as an inter-department liaison point in communication with external parties.

On-site report from the restricted zone : close encounters with suspected avian influenza specimens

Despite the threat of avian influenza constantly casting a shadow over the community, HA laboratory staff remain fearless. They are the frontline warriors – tireless in their determination to unmask the deadly viruses that lurk in patient specimens as quickly as possible so that clinicians can prescribe appropriate treatment.

Each of the seven HA clusters has its own laboratory focusing on infectious diseases. In 2004, these labs joined hands to form the ‘Rapid Diagnostic Laboratory Network on Influenza’. The Network played a major role during the 2009 human swine influenza outbreak, with colleagues working round the clock to analyse about 130,000 suspected specimens. In appreciation of their contribution, the network received an ‘Outstanding Teams Award’ from HA in 2010.

A system is in place for every member laboratory to maintain a stock of 1,680 testing reagents to help tackle any potential threat. Each laboratory will immediately mobilise appropriate manpower and equipment if such a threat emerges.

Staff at the molecular laboratory at Queen Elizabeth Hospital (QEH) recently took time out of theirbusy schedule to explain to HASLink readers how they achieve a four-hour turnaround time on results from the ‘real-time polymerase chain reaction’ (rt-PCR) test.

Developed to identify the presence of human swine influenza viruses, the test has an accuracy rate of over 90%.

1.Laboratory staff collect the required respiratory specimens, which may include nasopharyngeal specimens, sputum and tracheal aspirates. Staff perform the extraction step in a biosafety cabinet that uses a one-way airflow system to avoid the spread of any airborne viruses and protect the health and safety of everyone working in the laboratory.	2.An extraction reagent is added to the specimens. This initiates a 45-minute breaking-up and purification process that will allow the ribonucleic acid (RNA) to be extracted from the specimen for further processing.
3.As the amount of RNA extracted from a sample is usually minute, an amplification step is required. In preparing for the PCR process, a member of laboratory staff adds an amplification reagent to the extracted RNA, which will create millions of copies of the RNA for detection by the relevant laboratory instruments.	4.Specimens being analysed for Influenza A undergo three different PCR tests: M gene, H1/H3 and H1 human swine influenza. After the amplification reagent has been added to the extracted RNA, the mixture is sealed and placed in the diagnostic equipment.
5.The PCR test is initiated. The entire testing process takes about two-and-a-half hours.	6.If the specimen tests positive for M gene and negative for H1/H3 or H1 human swine influenza, laboratory staff must immediately alert the Public Health Laboratory Centre for H5 or H7 testing. They must also report the result to HA Head Office and the Centre for Health Protection.

More about microorganisms

Microorganisms are categorised into one of four risk groups (RG), depending on the level of threat posed to individuals and the community. RG1 microorganisms pose the lowest risk and there are few examples in this category. The majority of microorganisms seen in the laboratory are classified as RG2 and RG3 microorganisms.

The molecular laboratory at QEH is a member of the ‘Rapid Diagnostic Laboratory Network on Influenza’. With many different influenza viruses to identify and analyse, Dr Christopher Lai (front row, left), coordinator of the Network and Associate Consultant at QEH, and the team are kept busy.

The ABCs of ‘H’ and ‘N’

Battle of HxNx in Hong Kong

Enhanced measures to fight winter surge

With the looming threat of the H7N9 virus and the recent cold weather snap that has hit Hong Kong during the peak influenza season, public hospitals have experienced a surge in patient numbers at A&E departments. Between 20 January and 17 February, around 163,000 people sought A&E services. On certain days, the number of attendance at A&E exceeded 6,000 a day, and the medical inpatient bed occupancy rate at some hospital on a specific day climbed to as high as 137%.

Dr Simon Tang, the Hospital Authority’s Central Coordinating Committee Chairman (A&E) and Chief of Service (A&E) of Tuen Mun Hospital / Pok Oi Hospital, says: “To cope with the spike in service demand, many colleagues have been willing to work overtime and specialists from other hospitals have come in to assist. We are delighted that most patients have expressed appreciation for the efforts of colleagues – this is probably the greatest source of support for frontline staff.”

To manage the surge in demand for services, HA has implemented the following measures:

• Cessation of non-emergency operations as appropriate


• Redeployment of manpower support to relieve medical ward congestion


• Provided additional 1,500 consultation appointments at general outpatient clinics during the Chinese New Year holiday


• Advised the Central Committee on Infectious Diseases and Emergency Response on review and suspension of Vancomycin Resistant Enterococci (VRE) screening


• Enhanced cross-cluster collaboration


• Provision of information about private outpatient clinics to patients


• Strengthened communication with general public

Cheers to A&E colleagues during New Year period

While the Lunar New Year holiday generally brings a festive spirit to Hong Kong, it often also sees a spike in activity at Hospital Authority A&E departments across the city. With frontline staff under considerable pressure, HA Chairman Professor John Leong and Chief Executive PY Leung saddled up for a two-day tour (28 January and 4 February) separately to Tuen Mun, United Christian, Queen Elizabeth, Pamela Youde Nethersole Eastern, Prince of Wales and Kwong Wah (KWH) hospitals – bringing gifts and good cheer to colleagues for the Year of the Horse.

Secretary for Food and Health Ko Wing-man also offered his good wishes and sincere thanks to colleagues for their hard work during visits to the A&E departments at Yan Chai Hospital and KWH on 30 January.