LCQ22: Influenza surges
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Question:
Hong Kong is now in the winter surge of influenza, with sporadic outbreaks of influenza in the community, institutions and schools. As at the 8th of this month, more than 400 winter influenza outbreaks were recorded by the Centre for Health Protection, outnumbering the figure of the same period last year. In this connection, will the Government inform this Council:
(1) whether it knows, in each of the past five years, the quantities of influenza vaccines supplied to and used by the healthcare systems of the public and private sectors respectively;
(2) of the normal differences between the influenza epidemic during the influenza summer surge and winter surge; whether it has compiled statistics on the respective numbers of persons diagnosed with influenza during the influenza summer surge and winter surge in each of the past five years and, among them, the respective numbers and percentages of children and elderly persons;
(3) of the methods adopted by the Government for projecting the future trend of influenza epidemic; whether it has formulated new measures to ensure that the supply of influenza vaccines for and the number of hospital beds in the healthcare systems of the public and private sectors in Hong Kong are sufficient for tackling influenza surges; and
(4) whether it knows, in each of the past five years, the respective numbers of influenza patients who sought treatment at the accident and emergency departments of public and private hospitals and, regarding those patients among them who needed to be hospitalised for treatment, the respective average duration for which they had to wait for admission to the wards?
Reply:
President,
(1) Each year, the Government provides free and subsidised influenza vaccination to eligible Hong Kong residents through the Government Vaccination Programme (GVP) and Vaccination Subsidy Scheme (VSS) (details at Annex 1 and Annex 2 respectively).
The number of people receiving seasonal influenza vaccination under the GVP and VSS over the past five years are set out in the following table:
| 2012/13 | 2013/14 | 2014/15 | 2015/16 | 2016/17 | |
| GVP | 241 800 | 240 700 | 356 100 | 392 100 | 414 500 |
| VSS | 202 100 | 222 100 | 234 700 | 184 300 | 288 400 |
| Total | 443 900 | 462 800 | 590 800 | 576 400 | 702 900 |
Note: The above figures do not include the number of people receiving vaccination in the private sector at their own expenses.
The quantity of influenza vaccines procured by the Government under GVP and imported by vaccine suppliers for private market over the past five years are listed below:
| Year | Influenza vaccines procured by the Government under GVP (doses) | Influenza vaccines imported by vaccine suppliers for private market (doses)# |
| 2012/13 | 285 000 | about 567 500 |
| 2013/14 | 285 000 | about 585 000 |
| 2014/15 | 378 453 | about 622 000 |
| 2015/16 | 402 730 | about 539 000 |
| 2016/17 | 426 107 | about 596 500 |
# Information provided by vaccine suppliers
(2) Seasonal influenza, a common respiratory infection in Hong Kong, is prevalent throughout the year, particularly during the influenza seasons. Hong Kong usually experiences two influenza seasons every year, the winter influenza season normally occurs between January and March/April, and the summer influenza season between July and August. Past experience has shown that winter is the main influenza season in Hong Kong. Comparatively speaking, the summer influenza season normally lasts for a shorter period with lower influenza activity than that in the winter season. However, there are exceptions such as the summer influenza season last year which was far more severe than the winter influenza season early last year.
For healthy individuals, influenza is usually self-limiting with recovery within a week. The majority of infected cases in the community are not tested and confirmed. Given its prevalent nature, seasonal influenza is not a statutory notifiable disease in Hong Kong. Hence, the Centre for Health Protection (CHP) of the Department of Health (DH) does not maintain statistics on the total number of people diagnosed with influenza in the community. Nevertheless, the CHP conducts routine surveillance of the number of admissions with principal diagnosis of influenza in public hospitals. The total number of public hospital admissions associated with influenza in each winter/summer influenza season over the past five years were in the range of 569 to 9 813 (median: 1 780), while the percentages of children aged under 18 and elders aged 65 or above ranged from 16.1 to 49.4 per cent and 21.0 to 67.8 per cent respectively. The relevant figures are listed out in the table below:
| Year | Influenza season | Persons aged 0-17 |
Persons aged 18-64 |
Persons aged 65 or above |
Accumulative total | |||
| No. | % | No. | % | No. | % | |||
| 2013 | 2012/13 Winter | 533 | 46.2% | 378 | 32.8% | 242 | 21.0% | 1 153 |
| 2013 Summer |
429 | 34.2% | 217 | 17.3% | 610 | 48.6% | 1 256 | |
| 2014 | 2013/14 Winter | 1 516 | 39.0% | 1 119 | 28.8% | 1 255 | 32.3% | 3 890 |
| 2014 Summer |
166 | 29.2% | 100 | 17.6% | 303 | 53.3% | 569 | |
| 2015 | 2014/15 Winter | 1 118 | 16.1% | 1 118 | 16.1% | 4 698 | 67.8% | 6 934 |
| 2015 Summer |
537 | 23.3% | 439 | 19.0% | 1 329 | 57.7% | 2 305 | |
| 2016 | 2015/16 Winter | 2 356 | 49.4% | 1 170 | 24.5% | 1 248 | 26.1% | 4 774 |
| 2016 Summer |
276 | 29.0% | 148 | 15.5% | 528 | 55.5% | 952 | |
| 2017 | 2016/17 Winter | 396 | 39.3% | 207 | 20.6% | 404 | 40.1% | 1 007 |
| 2017 Summer |
2 586 | 26.4% | 1 947 | 19.8% | 5 280 | 53.8% | 9 813 | |
(3) The CHP has been closely monitoring the activities of influenza and various respiratory pathogens in the community through a series of surveillance systems. It has established laboratory surveillance and sentinel surveillance networks which cover childcare centres, residential care homes for the elderly, the Hospital Authority (HA)'s general out-patient clinics (GOPCs), clinics of private practitioners, the Accident and Emergency (A&E) departments in public hospitals and Chinese medicine clinics. In addition, the CHP has been monitoring the weekly number of admissions in public hospitals with diagnosis of influenza and the daily number of admissions with laboratory confirmation of influenza.
Regarding the monitoring of influenza severity, the CHP conducts routine surveillance of pediatric influenza-associated severe complications or deaths among children (aged below 18). For adults, the CHP has collaborated with the HA and private hospitals to monitor the cases of intensive care unit admission or death with laboratory confirmation of influenza. This surveillance mechanism has been regularised as a routine surveillance operating throughout the year since 2018. Forecast of the trend of local influenza activity will be carried out according to the data of various local surveillance systems, the situation of neighbouring and overseas areas, and local epidemiological experience. Meanwhile, publicity and risk communication activities will also be conducted in a timely manner, including issuing press releases and letters to schools, residential care homes and doctors, with a view to raising risk awareness among the public and healthcare personnel and enabling them to remain vigilant at all times.
On the supply of influenza vaccines, the World Health Organization (WHO) will review the global epidemiology of influenza every year to recommend virus strains for inclusion in influenza vaccine for use in the northern hemisphere in accordance with the available data. Each year, the Government will determine the scope of the GVP and VSS with reference to the expert recommendations of WHO and the Scientific Committee on Vaccine Preventable Diseases. Given the limited global supply of influenza vaccines and the time required for manufacturing vaccines (take around six to eight months) and the vaccines manufactured are for use only for a single influenza season, the Government must estimate in advance at the beginning of each year the quantity of vaccine doses required for the coming season under the GVP. The Government will then place orders with the suppliers in accordance with its established procurement procedures to secure adequate supply of vaccines for the GVP. On the supply of vaccines in local private healthcare sector, private healthcare institutions will purchase directly from vaccine suppliers on their own. Nevertheless, the DH will also actively liaise with vaccine suppliers in order to reserve sufficient stock of vaccines for use by private healthcare institutions, including those participating in the VSS.
In respect of beds in public hospitals, the HA has been progressively increasing the number of beds and addressing the shortage of manpower through allocating manpower and resources under its annual plans and progressing with the ten-year Hospital Development Plan, so as to meet the incremental service demand. Besides, to cope with the upsurge in service demand during influenza surges, the HA will allocate additional resources for provision of additional time-limited beds and temporary beds during peak seasons every year, and adopt a wide range of measures to strengthen the services. These measures include:
(i) continuing to recruit full-time and part-time healthcare staff, and encouraging higher participation of existing healthcare staff during peak seasons through the Special Honorarium Scheme;
(ii) enhancing virology services to facilitate and expedite patient management decision;
(iii) enhancing ward rounds of senior clinicians and related supporting services in the evenings, at weekends and on public holidays to facilitate early discharge of patients;
(iv) enhancing discharge support (e.g. non-emergency ambulance transfer service, pharmacy and portering services) to shorten the waiting time for patients on discharge so that their beds can be allocated to other patients at the earliest possible time;
(v) increasing the service quotas of GOPCs during Christmas, Lunar New Year and Easter holidays as well as the whole surge period to enhance the service capacity of GOPCs; and
(vi) strengthening geriatrics support to A&E departments and continuing the A&E Support Session Programme.
(4) The HA and the DH do not maintain statistics on the number of influenza patients who sought treatment at the A&E departments of public and private hospitals, as well as the average waiting time for admitting these patients to the wards.
Ends/Wednesday, February 28, 2018
Issued at HKT 18:25
Issued at HKT 18:25
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