Epidemiology of Legionnaires' Disease, Hong Kong, China, 2005-2015.

We reviewed findings of clinical, epidemiologic, and environmental investigations for 288 confirmed case-patients with Legionnaires' disease reported in Hong Kong, China, during January 2005-December 2015. We found that chronic renal failure/impairment (adjusted odds ratio [aOR] 4.09), chronic pulmonary diseases (aOR 3.22), malignancy (aOR 3.04), and heart diseases (aOR 2.15) were independently associated with a higher risk for severe Legionnaires' disease. However, patients with hyperlipidemia had a lower risk for severe outcome (aOR 0.17). Legionella positivity rate was 22% for 1,904 water samples collected. We found a higher positivity rate in summer months (28%-30%), which corroborated with months of highest rainfalls. Our novel finding that Legionnaires' disease patients with hyperlipidemia had a lower risk for severe outcome deserves further study to confirm the observation and ascertain the underlying reason.

Protection by face masks against influenza A(H1N1)pdm09 virus on trans-Pacific passenger aircraft, 2009.

In response to several influenza A(H1N1)pdm09 infections that developed in passengers after they traveled on the same 2 flights from New York, New York, USA, to Hong Kong, China, to Fuzhou, China, we assessed transmission of influenza A(H1N1)pdm09 virus on these flights. We defined a case of infection as onset of fever and respiratory symptoms and detection of virus by PCR in a passenger or crew member of either flight. Illness developed only in passengers who traveled on the New York to Hong Kong flight. We compared exposures of 9 case-passengers with those of 32 asymptomatic control-passengers. None of the 9 case-passengers, compared with 47% (15/32) of control-passengers, wore a face mask for the entire flight (odds ratio 0, 95% CI 0-0.71). The source case-passenger was not identified. Wearing a face mask was a protective factor against influenza infection. We recommend a more comprehensive intervention study to accurately estimate this effect.

Epidemiology of human influenza A(H7N9) infection in Hong Kong.

BACKGROUND/PURPOSE: We conducted a case series study to review the epidemiology of human influenza A(H7N9) infection reported in Hong Kong. METHODS: We reviewed case records of confirmed human cases of influenza A(H7N9) infection reported in Hong Kong in the 2013-2014 winter season. We compared the median viral shedding duration and interval from illness onset to initiation of oseltamivir treatment between severe and mild cases. We estimated the incubation period of influenza A(H7N9) virus from cases with a single known date of poultry exposure. RESULTS: A total of 10 cases were reported and all were imported infection from Mainland China. Four patients died and the cause of death was related to influenza A(H7N9) infection in two patients. The median interval from illness onset to initiation of oseltamivir treatment for the severe cases (4.5 days) was significantly longer than the mild cases (2 days; p = 0.025). Severe cases had a significantly longer viral shedding duration than mild cases (p = 0.028). The median incubation period for cases with a single known exposure date was 4 days. Nasopharyngeal aspirate taken from the 88 close contacts of the 10 patients all tested negative for influenza A virus using reverse transcription polymerase chain reaction. CONCLUSION: Delayed administration of antiviral treatment may be associated with a more severe illness for influenza A(H7N9) infection. Despite our aggressive contact tracing policy with laboratory testing of all close contacts, no secondary case was identified which implied that the potential of human-to-human transmission of the circulating influenza A(H7N9) virus remains low.

Risk factors for community-associated methicillin-resistant Staphylococcus aureus infection in Hong Kong.

OBJECTIVES: The risk factors for community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection were not well understood. The objective of this study was to identify risk factors associated with CA-MRSA infection in Hong Kong. METHODS: We carried out a matched case control study. Cases and controls were recruited from 14 acute public hospitals in Hong Kong. One control was individually matched to one case based on sex, age, admission date and ward location. We interviewed each case and control by telephone using a standard questionnaire. We used a conditional logistic regression model for multivariate analysis. RESULTS: We successfully recruited 127 pairs of matched case and control. We found that sharing of personal items with other persons had a higher risk of CA-MRSA infection (Adjusted matched odds ratio [aOR]: 4.71, 95% confidence interval [CI] 1.43-15.59). On the other hand, patients who had frequent hand washing practice (aOR: 0.21, 95%CI 0.06-0.72) and those who reported history of acne (aOR: 0.12, 95%CI 0.02-0.74) had a lower risk of CA-MRSA infection. CONCLUSIONS: We concluded that sharing of personal items with other persons is a risk factor for CA-MRSA infection while frequent hand washing is a protective factor against the infection.

Investigation and control of a measles outbreak at the Hong Kong International Airport, 2019

Introduction@#Hong Kong SAR (China) achieved measles elimination status in 2016, and the incidence of measles infection had been low over the past few years. However, the Centre for Health Protection (CHP) at the Department of Health was notified on 22 March 2019 of an outbreak of three cases of measles infection among workers at the Hong Kong International Airport (HKIA).@*Methods@#We reviewed notifications of measles received by CHP from 1 January to 17 May 2019. We defined a confirmed case of measles as having laboratory evidence of measles infection. All confirmed cases among airport workers or those with epidemiological information suggesting they had been infected by contact with airport workers were included in the review. We described the epidemiological features and reviewed the control measures against the outbreak.@*Results@#We identified 33 cases, 29 of which were among airport workers. They comprised 22 men and 11 women, aged 20–49 years (median 25 years). The majority of people with confirmed measles presented with fever and rash. All required hospitalization. None developed complications. Control measures, including enhanced environmental hygiene and improved ventilation at HKIA and vaccinations for the airport community, were implemented.@*Discussion@#Early recognition of the outbreak and prompt control measures, especially targeted vaccination of the exposed population, effectively controlled the outbreak in just two weeks.

Respiratory infections during SARS outbreak, Hong Kong, 2003.

The effect of community hygienic measures during the outbreak of severe acute respiratory syndrome in Hong Kong was studied by comparing the proportion of positive specimens of various respiratory viruses in 2003 with those from 1998 to 2002. Community hygienic measures significantly reduced the incidence of various respiratory viral infections.