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LC Urgent Q2: Scarlet fever in Hong Kong and neighbouring areas

     Following is a question by the Hon Cheung Man-kwong urder 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):


     There has been a rapid increase in the number of cases of scarlet fever (SF) infection in recent months, including the fatal cases of two young children, and a study conducted by the University of Hong Kong has revealed that a mutated strain of the SF bacterium has increased its transmissibility. Some microbiologists has pointed out that such genetic variation of the bacterium may be attributed to the abuse of antibiotics, which is an issue that the Government should address proactively and seriously. In this connection, will the Government inform this Council:

(a) whether it knows if the SF bacterium with mutated strain has been found in other countries or regions; whether there is a rapid increase in the number of SF infection cases in the neighbouring regions recently; whether cases found in Hong Kong are mainly local infectious cases or imported cases from other regions; whether the authorities have examined if there is a need to boost surveillance measures at entry control points;

(b) of the respective numbers of cases with complications and even causing death due to contracting SF in each of the past six months; whether the critical cases are caused by the mutated bacterium; whether it has affected treatment method; if so, whether the authorities have provided public and private medical practitioners with the relevant information; and

(c) what emergency measures have been put in place to prevent the epidemic from worsening; given that most patients are young children and institutional outbreaks have happened in kindergartens, child care centres and primary schools, what measures the authorities have to prevent large scale outbreaks in schools and organisations holding summer activities; and under what circumstances requests will be initiated for closure of nurseries, kindergartens, child care centres and secondary and primary schools or early commencement of the summer break?



     My response to the three parts of the question is as follows:

(1) The Centre for Health Protection (CHP) of the Department of Health (DH) has been monitoring scarlet fever (SF) in Hong Kong and neighbouring areas. 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. The remaining were local cases.

     It should be noted that SF is not a notifiable disease in many neighbouring countries such as Singapore, Australia, New Zealand and Malaysia.

     We will maintain vigilance on suspected cases of SF at boundary control points. We may advise travellers to seek medical attention or refer severe cases to hospital.

(2) As of June 28, there have been four SF cases with complications and two fatal cases of SF in Hong Kong. Details are set out in the Annex.

     Laboratory investigation of the two fatal cases showed that two different strains of Group A Streptococcus were involved (emm type 1 and emm type 12).

     CHP, the Hospital Authority 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. Further studies will be done to characterise the role and prevalence of the new genetic change and to project the outlook of the outbreak over time.

     So far, all the Group A Streptococcus isolates detected are sensitive to penicillin, meaning that all antibiotics belonging to the penicillin group or first generation cephalosporins can effectively treat SF.  

     Local antibiotic resistance surveillance data showed that around 50-60% of Group A Streptococcus isolated in 2011 are resistant to erythromycin (which also predicts resistance to azithromycin and clarithromycin). As a result, antibiotics belonging to the macrolide group (e.g. erythromycin) should not be used as empirical treatment for SF. 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.

(3) The majority of SF cases are sporadic. Only 7% of the cases are associated with school clusters and the number of persons affected in each cluster has been 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 Hospital Authority 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.   

     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.  

     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.

Ends/Wednesday, June 29, 2011
Issued at HKT 13:43


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