Severe Acute Respiratory Syndrome: Severe Acute Respiratory Syndrome: Response from Hong KongResponse from Hong Kong
Hong Kong Special Administrative Region GovernmentHong Kong Special Administrative Region Government17 June 200317 June 2003
Dr EK YeohSecretary for Health, Welfare and Food
SARS Disease Burden in Hong KongSARS Disease Burden in Hong Kong
As at 16.06.2003,Total confirmed cases 1755
Recovered & discharged 1386 (79.0%)Died 295 (16.8%)In convalescent facilities 28 ( 1.6%)In non-ICU setting 31 ( 1.8%)In ICU setting 15 ( 0.9%)
Epidemic Curve Epidemic Curve –– Hong KongHong KongAs at 16.06.2003As at 16.06.2003
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20
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Date of Onset
Num
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Initial Hospital OutbreakInitial Hospital Outbreak
02468
1012141618202224262830
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Doctors NursesOther health workers Other staffMedical students Hospital visitorsContacts of staff & MS Contacts of visitorsIndex case admission
Community Outbreak in Amoy GardensCommunity Outbreak in Amoy Gardens
Typical Floor Plan of Block E Typical Floor Plan of Block E at Amoy Gardensat Amoy Gardens
Epidemic Curve Epidemic Curve -- Amoy GardensAmoy Gardens
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12015
-Feb
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Date of Onset
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Others
Amoy Gardens
4TH floor
16th floor
28th floor
36th floor
14th March
Cumulative Cases perApartment By Day of Disease Onset
Index case/apartment
345
66 7
21
8
345
66 7
21
8
0 cases
1 case
2 cases
3 cases
4 cases
Apartment Number
(Same on each floor)
Amoy Gardens SARS Outbreak Block E3-D Animation 14-27th March
4TH floor
16th floor
28th floor
36th floor
21st March
Cumulative Cases perApartment By Day of Disease Onset
Apartment Number
(Same on each floor)
Index case/apartment
345
66 7
21
8
345
66 7
21
8
0 cases
1 case
2 cases
3 cases
4 cases
Amoy Gardens SARS Outbreak Block E3-D Animation 14-27th March
4TH floor
16th floor
28th floor
36th floor
23rd March
Amoy Gardens SARS Outbreak Block E3-D Animation 14-27th March
Index case/apartment
Cumulative Cases perApartment By Day of Disease Onset
Apartment Number
(Same on each floor)
0 cases
1 case
2 cases
3 cases
4 cases
345
66 7
21
8
345
66 7
21
8
4TH floor
16th floor
28th floor
36th floor
Amoy Gardens SARS Outbreak Block E3-D Animation 14-27th March
Index case/apartment
25th March
Cumulative Cases perApartment By Day of Disease Onset
Apartment Number
(Same on each floor)
345
66 7
21
8
345
66 7
21
8
0 cases
1 case
2 cases
3 cases
4 cases
4TH floor
16th floor
28th floor
36th floor
Amoy Gardens SARS Outbreak Block E3-D Animation 14-27th March
Index case/apartment
27th March
Cumulative Cases perApartment By Day of Disease Onset
Apartment Number
(Same on each floor)
345
66 7
21
8
345
66 7
21
8
5 cases
0 cases
1 case
2 cases
3 cases
4 cases
GovernmentGovernment’’s Strategiess Strategies
4 prolonged strategy 4 prolonged strategy centred centred on:on:--Early detection Early detection Swift contact tracingSwift contact tracingPrompt isolation & quarantinePrompt isolation & quarantineEffective containmentEffective containment
Strategies result in:Strategies result in:--Shortening the interval between onset of symptoms & Shortening the interval between onset of symptoms & admission to hospitaladmission to hospitalLimiting the infectious period of the SARS casesLimiting the infectious period of the SARS casesPreventing further spread of the diseasePreventing further spread of the disease
Public Health Control MeasuresPublic Health Control Measures
Comprehensive public education Comprehensive public education programmeprogrammeEnhanced surveillance system for case detection Enhanced surveillance system for case detection Application of modern technology for contact tracingApplication of modern technology for contact tracingUpdated legislation for isolation of patients & quarantine of Updated legislation for isolation of patients & quarantine of contactscontactsIntensive control efforts target at areas needing greater Intensive control efforts target at areas needing greater attention:attention:
Hospital settingsHospital settingsResidential care home for the elderlyResidential care home for the elderlyBorder control Border control
Environmental hygiene improvement Environmental hygiene improvement programmeprogramme
Comprehensive Public Comprehensive Public Eeducation Eeducation ProgrammeProgramme
Heighten awareness of SARS symptomsHeighten awareness of SARS symptoms
Emphasize message of Emphasize message of Prevention, andPrevention, andPrompt action of seeking medical advice earlyPrompt action of seeking medical advice early
Enhanced Surveillance SystemEnhanced Surveillance System
Early Detection of casesEarly Detection of casesSARS was made statutory notifiableSARS was made statutory notifiablePromulgate clear and wellPromulgate clear and well--defined case definition to all defined case definition to all practitionerspractitionersActive case finding through medical surveillance of contactsActive case finding through medical surveillance of contactsComprehensive support from laboratory for investigation and Comprehensive support from laboratory for investigation and detection of the virusdetection of the virus
Leads to prompt medical treatment & swift contact Leads to prompt medical treatment & swift contact tracingtracing
Swift Contact TracingSwift Contact Tracing
Extensive use of modern technologyExtensive use of modern technology
Online web access
Real-time information
Major Incident Investigation and Disaster Support System (MIIDSS)
Validate addressesMap geographical distributionReveal potential sources or routes of spreadShow connectivity between cases & contacts
Prompt case investigation
Rapid contact tracing
eSARS database
Major Incident Investigation and Major Incident Investigation and Disaster Support System (MIIDSS)Disaster Support System (MIIDSS)
Link analysis of:Who contact personWhere locationWhen event
Investigation workfloweSARS online (patient data)Investigator team (level I)
“Hot Spot” alertInvestigator team (level II)
Linkage of analyses with charts
Prompt Isolation and QuarantinePrompt Isolation and Quarantine
Close contacts of SARS patientsClose contacts of SARS patientsPlaced under home quarantine & medical surveillance Placed under home quarantine & medical surveillance Barred from leaving the territory during the 10Barred from leaving the territory during the 10--day incubation day incubation periodperiodWhere appropriate, contacts are isolated in designated Where appropriate, contacts are isolated in designated isolation camps located away from the cityisolation camps located away from the cityEnsure compliance of home quarantine by interdepartmental Ensure compliance of home quarantine by interdepartmental teams teams –– police, immigration, social welfare, home affairs & police, immigration, social welfare, home affairs & health dephealth dep’’tsts
Home quarantine statistics as at 15.06.2003 Home quarantine statistics as at 15.06.2003 No. of persons served home quarantine notice 1262No. of persons develop SARS 25
Monitoring of ContactsMonitoring of Contacts
Established 4 designated medical Established 4 designated medical centres centres staffed with chest physicians & nurses to conduct medical checksstaffed with chest physicians & nurses to conduct medical checksfor social contacts and hospital contactsfor social contacts and hospital contacts
Public health nurses monitor the health conditions of Public health nurses monitor the health conditions of contacts by telephone or through surprise home visits to contacts by telephone or through surprise home visits to ensure early presentationensure early presentation
Identification of Exposure SourceIdentification of Exposure Source
Experienced interviewers collect detail history 10 Experienced interviewers collect detail history 10 days before symptom onset: days before symptom onset:
on local movement (bus routes, shops, restaurants, etc)on local movement (bus routes, shops, restaurants, etc)on travel abroadon travel abroadon contact with SARS patientson contact with SARS patients
Data entered into MIIDSS to identify probable Data entered into MIIDSS to identify probable exposure source by time, place & personexposure source by time, place & person
Activate multidisciplinary response teams for actions Activate multidisciplinary response teams for actions
Effective Containment MeasuresEffective Containment Measures
MultiMulti--disciplinary response teamsdisciplinary response teams
Comprise experts in public health, building Comprise experts in public health, building management and environmental hygienemanagement and environmental hygiene
Undertake dual functionsUndertake dual functions::--
Investigation Investigation building, drainage & other piping systems, lifts & building, drainage & other piping systems, lifts & sewage systemssewage systems
Remedial actions Remedial actions environmental environmental disinfectiondisinfection, , disinfestationdisinfestation
eSARS MIIDSS
Patient contacts
Environment
Building services structures
Disinfection, cleasing & pest control
Structural rectification
Contact Isolation
Investigate
Control actions
MultiMulti--disciplinary disciplinary response teamsresponse teams
Enhanced Hospital Infection ControlEnhanced Hospital Infection Control
Protection of hospital staffProtection of hospital staffAll health care workers given advice on precautionary measure incaring for patientsProvide special training in infection control before deployment to high risk areasProvided with appropriate set of protective gear
Inpatient contactsContacts are recalled and cohorted in hospitals where indicatedOthers are required to attend designated medical centres to ensure early detection of cases
VisitorsNot allowed in SARS wardsNot allowed in SARS wardsLimited and controlled to non SARS wardsLimited and controlled to non SARS wards
Special Attention for the ElderlySpecial Attention for the Elderly
High risk of infection High risk of infection -- vulnerable and require vulnerable and require frequent frequent hospitalisationhospitalisation
Difficulty in early detection Difficulty in early detection –– may not have fever may not have fever at presentationat presentation
Potential of spread in residential care homes for Potential of spread in residential care homes for the elderly (RCHE) when dischargedthe elderly (RCHE) when discharged
High case fatality rate High case fatality rate –– frail and cofrail and co--morbiditymorbidity
Prevention & Control Measures in Prevention & Control Measures in Residential Care Homes Residential Care Homes
Education on preventive measuresIssue written guidelines on infection controlIssue written guidelines on infection controlTraining for Training for carers carers on the implementation of the guidelines on the implementation of the guidelines and step up inspections to ensure complianceand step up inspections to ensure complianceAdvise on precautionary measures in caring for all residentsAdvise on precautionary measures in caring for all residents
Reduce the risk of infection Reduce the risk of infection –– special supportspecial supportOutreach medical care to reduce the requirement for Outreach medical care to reduce the requirement for hospitalisationhospitalisation
Reduce the risk of spread Reduce the risk of spread -- discharge policydischarge policyStrict isolation of all hospital discharged patients for 10 daysStrict isolation of all hospital discharged patients for 10 days
Health Checks at Border PointsHealth Checks at Border Points
Mid MarchMid MarchSet up medical posts at all border pointsSet up medical posts at all border pointsAll incoming passengers required to complete a health All incoming passengers required to complete a health declarationdeclaration
Health Checks at Border PointsHealth Checks at Border Points
Mid AprilMid AprilTemperature checks for all departing, arriving & transiting passengers at airportTemperature measures extended to all border points by land, rail and sea80 infra-red devices have been installed at border points
To-date, 320 infrared devices have been installed
Environmental Hygiene Improvement Environmental Hygiene Improvement ProgrammeProgramme
Step up environmental hygiene and pest control measures all over the city
A high level Gov’t task force established to steer implementation
Intensive publicity to enhance public education on personal and environmental hygiene
Impose strict penalties on people who do not observe these measures
Concluding Remarks (1)Concluding Remarks (1)
SARS outbreak in Hong Kong effectively controlledLast SARS case admitted to hospital 02.06.2003Last SARS case admitted to hospital 02.06.2003
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4240
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3032
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4 5 69
53 4 3
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711
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3129
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Concluding Remarks (2)Concluding Remarks (2)
There remains a need to continue to maintain high vigilance
Continue publicity to keep up public awareness
Sustained efforts in hygienic measures
Further enhanced IT support for better surveillance
Timely analysis of data for early public health actions
Concluding Remarks (3)Concluding Remarks (3)
There is a further need to apply lessons learnt to There is a further need to apply lessons learnt to better prepare for future outbreaksbetter prepare for future outbreaks
Establish SARS Expert Committee to undertake review of outbreak management to identify lessons to be learnt
Highlight areas for system improvement
Apply lessons learnt
Concluding Remarks (4)Concluding Remarks (4)
Commitment of the GovernmentCommitment of the Government
Allocation of HK$200mn for works of infectious disease Allocation of HK$200mn for works of infectious disease prevention, public health education and treatment of diseaseprevention, public health education and treatment of disease
Allocation of HK$200mn for training and welfare health care Allocation of HK$200mn for training and welfare health care workersworkers
Allocation of HK$1.3bn to strengthen public health work and a Allocation of HK$1.3bn to strengthen public health work and a range of research activities on infectious diseases including range of research activities on infectious diseases including SARS SARS
Allocation of HK$500mn (donated by HKJCC) for Allocation of HK$500mn (donated by HKJCC) for establishment of a CDC like structureestablishment of a CDC like structure
Concluding Remarks (5)Concluding Remarks (5)
Effective control of infectious diseases requires strong international collaborative partnership
Mainland authoritiesMainland authoritiesNearby countries Nearby countries World Health OrganizationWorld Health OrganizationOther international bodiesOther international bodies
Thank YouThank You
