Provisional Legislative Council

PLC Paper No. CB(2) 1130
(These minutes have been
seen by the Administration)

Ref : CB2/PL/HS

Provisional Legislative Council
Panel on Health Services

Minutes of special meeting
held on Wednesday, 31 December 1997 at 8:30 am
in the Chamber of the Legislative Council Building

Members present :

Dr Hon TANG Siu-tong, JP (Chairman)

Dr Hon LEONG Che-hung, JP (Deputy Chairman)

Hon WONG Siu-yee

Hon Henry WU

Hon MOK Ying-fan

Hon CHAN Yuen-han

Hon Howard YOUNG, JP

　

Member absent :

　

Hon CHEUNG Hon-chung

　

Members attending :

　

Hon LEE Kai-ming

Hon Mrs Selina CHOW, JP

Hon Mrs Peggy LAM, JP

Hon Mrs Sophie LEUNG LAU Yau-fun, JP

Dr Hon Philip WONG Yu-hong

Hon IP Kwok-him

Hon LAU Kong-wah

Hon CHOY So-yuk

Public officers attending :

Health and Welfare Bureau

Mr Gregory LEUNG, JP

Secretary for Health and Welfare (Acting)

Miss Candy LEUNG

Assistant Secretary for Health and Welfare (Medical)1

Department of Health

Dr T A SAW

Deputy Director of Health

Dr K H MAK

Consultant (Community Medicine)

Agriculture and Fisheries Department

Mr LIU Kwei-kin

Assistant Director (Agriculture and Regulation)

Department of Housing

Mr LAU Kai-hung

Assistant Director/Management (1)

Environmental Protection Department

Mr J P Rockey

Assistant Director (Waste & Water)

Urban Services Department

Mr T W CHENG

Assistant Director (Environmental Health)1 (Acting)

Regional Services Department

Mr KAM Chi-sun

Assistant Director (Environment Health Policy) (Acting)

Hospital Authority

Dr W M KO

Deputy Director (Operations)

Clerk in attendance:

Ms Doris CHAN

Chief Assistant Secretary (2) 4

Staff in attendance :

Ms Joanne MAK

Senior Assistant Secretary (2) 4

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Closed Meeting

The Chairman welcomed non-Panel members attending the meeting. Dr LEONG Che-hung briefed members on the latest development of the influenza A H5N1 virus (H5N1) and his major concerns about the chicken slaughtering operation.

Open Meeting

2.The Chairman briefed the Administration on the purpose of this special meeting. He stressed that members were most concerned about the impacts of the slaughter exercise on the community and the Administration’s contingency plans against an H5N1 influenza epidemic.

3.Secretary for Health and Welfare (Acting) (SHW(Ag)) apologized for the late submission of the paper on H5N1 to the Panel. He briefed members on the details of the 13 confirmed and six suspected cases of infection. Since the first case of human infection was confirmed in August 1997, the Department of Health (DH) had been working closely with experts from the World Health Organization (WHO) and the Centres for Disease Control and Prevention (CDC) in Atlanta with the aim of tracing the source of the virus and ascertaining its main modes of transmission. So far evidence had showed that the transmission of the H5N1 virus was from birds to men. Although the possibility of man-to-man transmission remained open, experts of WHO and CDC were of the view that such transmission, if any, was inefficient and the screening of travellers coming in or going out of Hong Kong was not necessary.

4.As regards the Administration’s follow-up measures against the spread of the virus, SHW(Ag) stated that since the confirmation of the first case of human infection, the Administration had implemented territory-wide health surveillance measures through clinics and hospitals. To trace the source of the virus, blood samples of family members and certain contacts of confirmed patients were collected and sent to CDC for detailed analysis. According to CDC’s serological test results of the 502 blood samples collected from the contacts of the first H5N1 patient, nine samples (less than two percent) were found to have H5N1 antibodies. As analysis of the blood samples collected from family members and contacts of other infected patients were in progress, it was anticipated that additional information on the virus would be available by the end of January 1998. With the co-operation of the authorities concerned, import of chickens from the Mainland had been temporarily suspended since 24 December 1997. AFD had then conducted initial H5 tests and arranged N1 tests for blood samples taken from chickens in local farms. On 27 December 1997, a large number of chickens in a local farm in Yuen Long and in Cheung Sha Wan Wholesale Market were found positive to the test. As the spread of the virus among live chickens was rapid, the Administration had decided on 28 December 1997 (Sunday) to carry out an operation to slaughter all chickens in Hong Kong from 29 December 1997 (Monday). Joint departmental efforts were required for this large scale operation. AFD was mainly responsible for slaughtering chickens in poultry farms in the New Territories, and the Regional Services Department (RSD) and Urban Services Department (USD) were responsible for the operations in retail outlets within their districts. Basically the operation consisted of three sequential components, namely, the slaughtering of chickens in local farms, retail outlets and wholesale markets, the disposal of the carcasses at one of the three specified landfills; and finally the cleansing and disinfecting of all chicken farms, retail outlets and wholesale markets. The Administration would continue to liaise with Mainland authorities for establishing an effective quarantine system for future import of live chickens from the Mainland.

5.Mr Howard YOUNG was concerned about the original source of the virus and enquired whether there was any agreed international practice on imposing restrictions against travellers coming from an infected country. SHW(Ag) responded that while DH and the experts were still identifying the source of the virus, the slaughtering operation was aimed at preventing the virus from spreading further in Hong Kong. Deputy Director of Health (DDH) supplemented that WHO had advised that the best way to prevent the spread of a communicable disease was to establish a reliable surveillance network in the country. Imposing restrictions on travellers coming from an infected country was not considered an effective measure. According to international practice, restrictive measures against travellers coming from infected countries only applied to three communicable diseases, namely, the plague, yellow fever and cholera. The effectiveness of the well-established surveillance network in Hong Kong had long been recognized and on this occasion, this had been further substantiated by the detection of the H5N1 virus at its early development to infect human. Responding to Mr YOUNG’s follow-up question, DDH said members of WHO in general complied with its recommendations on health-related matters and would not at this stage impose any restrictions on travellers coming from Hong Kong. However, some areas might consider adopting additional measures in the hope that these would prevent the introduction of the virus through travellers coming from Hong Kong.

6.In reply to Dr Philip WONG’s enquiry, SHW(Ag) said that the current arrangement of sending blood samples to CDC for H5N1 test was necessary since Hong Kong did not have the advanced skills and technology to detect the H5 virus. Based on CDC’s test results and advice, DH would formulate the appropriate courses of actions to locate the source of the virus. As regards the slaughtering operation, Assistant Director (Agriculture and Regulation) (AD(AR)) said that surveillance on local poultry farms had been stepped up since the first H5N1 infection case was confirmed, but it was not until 27 December 1997 that a large number of chickens in a local chicken farm in Yuen Long and the wholesale market in Cheung Sha Wan Wholesale Market were found to be infected by the virus. Since local and imported live chickens were mixed together at retail outlets according to their sizes and prices, the source of virus could not be identified and it appeared very likely that the virus would spread among live chickens in Hong Kong. In order to eradicate the virus before it spread further, the Administration had decided as a matter of urgency to slaughter all live chickens in Hong Kong. Before the resumption of import of live chickens from the Mainland, an effective quarantine system would be put in place. Under the system, only chicken farms which were licensed and monitored by the Animal and Plant Quarantine Services in the Mainland would be allowed to export live chickens to Hong Kong. Staff of the Agriculture and Fisheries Department (AFD) could visit these licensed chicken farms regularly to inspect their hygiene standards. The chickens intended to be exported to Hong Kong would be segregated from other flocks in the licensed farms for five days before they were exported, and must be tested negative for H5 infection. They would also be examined clinically on the day of export and issued with a health certificate which specified the farm and the number of chickens and cages in the consignment. The health certificates would be collected and retained by AFD staff at entry points, and samples would be taken from each consignment for blood test, the results of which would be available within a few hours. Meanwhile the consignment would be withheld from distribution into the market until the sample tests results confirmed that the consignment was free from infection. In cases the H5 virus was found in the samples, AFD would destroy the entire consignment. All birds including water fowls would be subject to the same import control arrangements. As for the additional costs incurred as a result of the control arrangements, AD/AR agreed that it might be reflected as increased cost in production and subsequently passed on to consumers.

7.Mr LAU Kong-wah enquired about the efficiency of H5N1 transmission among humans, the illness and the symptoms caused by the virus, and the Administration’s contingency plans in case of an epidemic. DDH replied that since none of the blood samples of the four family members of the first H5N1 patient had the antibody and that five of the nine subjects having the antibody were mostly poultry workers and persons directly exposed to the virus, it was believed that man-to-man transmission of the virus was relatively inefficient. Based on the 13 confirmed cases, it had been observed that the initial symptoms of H5N1 were similar to those caused by other influenza viruses, i.e., patients would suffer from sudden and high fever, malaise, myalgia, sore throat and cough, etc. However, in some infected patients, the illness followed a rapid downhill course which ended up with viral pneumonia, respiratory distress syndrome and multi-organ failure. As regards emergency procedures for an epidemic, he said that in such circumstances available healthcare resources would be re-deployed to cope with the situation. He assured members that there was sufficient stock of amantadine in public hospitals and clinics and additional stock could be delivered upon receipt of an order. Full scale production of the vaccine for H5N1 could commence immediately when WHO so decided. Administrative measures such as closing down public congregation venues to contain the spread of the virus would also be considered. In response to the Chairman’s follow-up question, DDH added that WHO had asked the four collaborating vaccine production centres in the world to proceed with the first stage of vaccine production. Seed vaccines for large scale commercial production would be ready by early February 1998. When man-to-man transmission of H5N1 was confirmed and if it became likely that the virus would spread efficiently among humans, mass production of the vaccine would be recommended by WHO to start at once and would be completed in about six months. Regarding the suggestion of extracting H5N1 antibodies from patients who survived the H5N1 infection to cure H5N1 patients, he opined that while such operation appeared feasible in theory, it in practice involved many technical problems.

8.Mrs Selina CHOW enquired about the Administration’s share of control in the new arrangements for import of live poultry from the Mainland. She was also concerned about the high death rate of H5N1 patients due to complications arising from infection. Referring to the female patient whose infection of H5N1 could only be confirmed after she passed away, Mrs CHOW asked how suspected patients would be treated in public hospitals and clinics. Deputy Director (Operations) of the Hospital Authority (DD/HA) advised that both the serological and antibody tests would require a few days to confirm the infection of H5N1 in a human body In this connection, HA was now using a rapid test for H5 virus with an accuracy level ranging from 60 to 90 percent A patient whose sample was positive to the test would be regarded as a suspected H5N1 patient and provided with the medical treatment for H5N1 patients. As to the late confirmation of H5N1 infection of the female patient, DD/HA said that the main reason was that she had a history of chronic diseases and her health conditions during the first few days of hospitalization showed no symptom of H5N1 infection. Given a total of 13 confirmed cases, it was unlikely that the present list of H5N1 symptoms was comprehensive. While some of these 13 patients recovered after receiving medical treatment like patients suffering from other strains of influenza, some died of complications emerging a few days after they were infected. So far the common symptom appeared in infected patients was persistent high fever. X-ray of the chest could assist in the detection of early viral pneumonia arising out of H5N1 infection. As for patients having a history of chronic disease, the symptoms of H5N1 might not emerge. In the circumstances, DD/HA said that all observable symptoms would be readily updated to HA’s clinical procedures for the management of H5N1 cases in hospitals and the updated procedures would be made available on the Internet as soon as practicable. AD/AR supplemented that the new import control arrangements could ensure that live chickens imported from the Mainland in the future would be free from H5N1 virus. Since the main mode of transmission of H5N1 was from bird to human, it was anticipated that the spread of the virus would be contained. In reply to Mrs CHOW’s follow-up question, AD/AR advised that as both Mainland and local authorities would conduct separate H5 tests for each consignment of live chickens, the new quarantine system could ensure that live chickens imported from licensed farms in the Mainland were free from the virus.

9.Noting that only a total of 300 imported chickens had been tested for the H5 virus during the period of August to November 1997 while the daily average of import was around 70 000 to 80 000 chickens, the Chairman requested that when import of live chickens from the Mainland resumed, AFD should increase the number of sample tests for both local and imported live chickens to ensure that chickens available in the retail outlets were free from infection. SHW(Ag) responded that AFD, RSD and USD would cleanse the retail outlets and wholesale market as soon as the chicken carcasses there were removed and would spray disinfectant in areas they occupied. In the mean time, AFD would continue to keep close surveillance on the health state of other poultry in local farms such as ducks and geese. The Chairman reminded the Administration to pay attention to chickens being reared in some remote spots in the New Territories as well as on houseboats which might not be included in the slaughtering operation.

10. Dr LEONG Che-hung asked whether the Administration had prepared a set of contingency plans in the event that an outbreak of influenza A H5N1 occurred and mass production of the vaccine was urgently required. He also enquired about the available alternatives for patients of private practitioners to undergo a H5 test. DDH reiterated that seed vaccines for large scale commercial production would be available in early February 1998. When man-to-man transmission of H5N1 was confirmed and its spread among humans was likely, WHO would invite all qualified pharmaceutical companies to start the mass production of the vaccine. He advised members that DH had contingency plans in place to cater for different emergency situations. DDH said that in the event of an epidemic and the vaccine was not yet ready, public hospitals and clinics would use amantadine to cure H5N1 patients. All available medical and nursing resources would be deployed to look after the patients. Both public and private hospitals and clinics would be issued with updated guidelines on the management of H5N1 cases as soon as practicable. Places where crowds of people congregated would be advised to be temporarily closed to curb the spread of the disease. In order to reduce public anxiety, Dr LEONG requested the Administration to prepare a flow-chart to illustrate the emergency plans and procedures. DDH replied that based on existing information on the virus, a simple flow-chart could be prepared for such purpose. Due to limited knowledge of the virus, he stressed that such procedures would be subject to changes in light of new developments. For suspected patients as diagnosed by private practitioners, DDH said that they could be referred to the 33 specified private laboratories for a H5 test.

Adm

11.In response to Dr LEONG’s queries, AD/AR said that the related authorities in the Mainland had clarified that the massive death of chickens reported in some Mainland farms was caused by two other influenza virus. The import of live chickens from the Mainland would resume when the Administration had completed the post slaughtering cleansing operation and decided on a suitable date with the Animal and Plant Quarantine Services. With the rapid H5 test, AD/AR reiterated that future consignments of live chickens imported from licensed farms in the Mainland would be withheld from distribution until it was confirmed to be free of the avian flu infection. He added that the methods employed by AFD, RSD and USD staff to kill chickens were effective for the purpose of containing the spread of the virus and given the limited resources, the whole slaughtering operation would be completed on 31 December 1997. As for chickens being reared by households, AD/AR said that it was unlikely that these chickens were infected with the virus. He added that members of the public could use AFD’s hotline service to seek assistance in disposal of their live chickens.

12.Miss CHAN Yuen-han was concerned about the environmental impacts arising from the disposal of the 1.5 million chicken carcasses in the three landfills, the efficiency of service provided to patients who wished to be tested for the H5N1 virus, and the adequacy of AFD’s surveillance on other poultry against the spread of the virus. Assistant Director (Waste and Water) (AD(WW)) of the Environmental Protection Department (EPD) said that the chicken carcasses would be disinfected with chloride of lime and deposited into sealed industrial grade plastic bags before they were transported to the three landfills. On arrival, these bags would be placed in pre-excavated trenches up to six metres deep which were covered immediately with at least half a metre of soil to minimize exposure to the air. Additional cover materials were then placed over the trenches to increase the total thickness of cover material to no less than one metre. The whole procedure would be closely supervised by EPD staff. He added that these landfills were constructed in accordance with stringent environmental standards comparable to those of other developed countries. They were lined with a multiple-layer impermeable liner at the sides and bases to ensure that pollutants were prevented from entering groundwater or nearby watercourses. Any liquid contaminated by pollutants from these chicken carcasses would be collected by pre-constructed drainage channels, pumped out and treated before final disposal. Gases produced by the process of decomposition of the carcasses such as methane and carbon dioxide would be drawn off by a network of pipes laid within the landfill and were then either flared off or burned to generate electricity. He acknowledged that in the initial stage of the operation, some plastic bags were found broken during transport and in response, the responsible Departments had immediately used double bags and sealing to pack the chicken carcasses. Responding to the Chairman’s follow-up question, AD(WW) replied that the disposal of chicken carcasses by a purpose-built animal cremator was better than by landfills. He pointed out that EPD had proposed the construction of an animal cremator twice but unfortunately the proposals had not been well accepted by members of the former LegCo and PLC Panel on Environmental Affairs. He however added that the disposal of a total of 1.5 million chicken carcasses within a few days could only be accomplished by the use of the existing landfills. In order to reduce the service demand for H5 test in Accident and Emergency (A&E) Departments of public hospitals, DDH said that the consultation hours of the general out-patient clinics of DH in public holidays would be extended and redeployment of resources would be arranged to meet the huge service demand. As for surveillance on other poultry, AD/AR said that birds, ducks, geese, and other live poultry would be included under the new import arrangements. He added that so far there was no evidence that bird flu viruses could be transmitted to fishes.

13.Mr IP Kwok-him urged the Administration to improve public confidence in the Government’s ability to handle the H5N1 crisis and to advise the public on preventive measures against the infection of the virus. SHW(Ag) said that since the confirmation of the first H5N1 patient, DH had responded expeditiously and reinforced the surveillance network for this new strain of influenza and was co-ordinating international efforts to trace its source. In collaboration with the experts of CDC, a special investigation group on H5N1 Influenza had been established with the aim of tracking down the source and containing the spread of infection. With only a limited knowledge of the virus so far, the Administration would continue to provide guidelines to medical practitioners on the management of H5N1 influenza cases and launch a territory-wide campaign to enhance public awareness of the importance of cleanliness and personal hygiene. As for the preparation of a set of contingency procedures against an outbreak of H5N1 influenza, he highlighted that the Administration had sufficient medical and nursing manpower and medicine to combat an epidemic and stressed the importance of maintaining a healthy body which would provide immunity against influenza viruses. In response to the Chairman, SHW (Ag) said that the contingency flow-chart, however, might not be able to cover all possible scenarios, given the limited knowledge about the virus. Responding to Mr IP’s follow-up question, he said that services in public hospitals and clinics had been improved to cope with the recent increase in service demand and the attending doctors would decide whether a test for H5 virus should be conducted for a particular patient. DD/HA supplemented that the clinical procedures for the management of H5N1 influenza in public hospitals had been prepared with the assumption that the virus could transmit among humans. He assured members that staff of HA would take care of patients with Influenza like illness attending A&E Departments in accordance with the established arrangements under the triage system.

14.Miss CHOY So-yuk commented that the involvement of Mainland health experts in the investigation into the source of H5N1 was essential. DDH said that DH had approached the Health Ministry Office in Peking for assistance and WHO was organizing a joint visit to Mainland farms by representatives of WHO, CDC and DH. Responding to Miss CHOY’s further enquiry on resumption of import of live chickens, AD/AR reiterated that when the necessary control arrangements were in order, import of live chickens from the Mainland would resume as soon as possible.

15.Mr Henry WU enquired whether H5N1 could be transmitted from frozen chickens to humans and whether test for the H5 virus would be conducted for all poultry workers. DDH said that influenza viruses present in frozen chickens would be relatively dormant and could be killed by proper cooking at a temperature of 56 degree centigrade or above. As for poultry workers, he said that arrangements had been made to encourage them to take a H5 test at designated evening clinics for this purpose.

16.Noting that the symptoms of H5N1 were similar to those of other influenza viruses, Mrs Peggy LAM was worried that H5N1 patients would be treated as patients suffering from other types of influenza. DDH said that the incubation period of the virus in human body was between three to five days and briefly described the three available identification tests for the virus. DD/HA supplemented that HA would continue to update the list of symptoms and issued the list to medical practitioners for reference as frequently as possible. In view of the side effects, medical experts did not recommend the use of amantadine for all patients showing influenza-like symptoms at this stage and efforts would concentrate on a territory-wide surveillance network and investigative analyses of the virus. Responding to Mrs LAM’s two other enquiries, AD/AR said that AFD would assist households in disposal of their live chickens upon request and export of live birds from the Mainland to Korea and Macau were also subject to stringent quarantine measures agreed between the authorities concerned.

17.Mr WONG Siu-yee was concerned about the level of financial compensation which would be provided to chicken retailers and wholesalers and other associated merchants. AD/AR replied that the Administration would consider all relevant factors in its assessment of an appropriate compensation and financial assistance package for the affected traders and added that the matter would be discussed at the coming meeting of the PLC Panel on Economic Services.

18.In reply to Mrs Sophie LEUNG’s enquiries, DDH said studies of the genetical composition so far had shown that the virus was of avian origin and the main mode of transmission was from bird to human. Based on existing knowledge of the virus, he estimated that the virus could only survive in external environment for a few days to a month depending on the prevailing conditions. He added that avian flu had been known to infect birds only and Hong Kong was the first place where human infection of the virus was confirmed. A detailed understanding of the virus including its antigenic structure in addition to its potential for human to human transmission was essential before a decision would be reached on mass production of a vaccine. As far as farm management was concerned, AD/AR supplemented that AFD would make reference to the methodologies and techniques adopted by overseas countries. To ensure a high level of hygiene standard in local poultry farms, AFD had issued guidelines and demonstrated to farm owners on how to clean their farms. He added that local farms would only be allowed to restock after AFD had inspected them and was satisfied with their hygiene standards. In response to Mrs LEUNG’s further enquiries, AD/AR said that farm owners in Hong Kong were not as professional as their counterparts in advanced countries and farm management here was subject to environmental constraints such as wet weather, limited space, water pollution control regulations, etc. He assured members that before introducing any new farming techniques to local poultry farms, AFD would seek the comments of the affected farm owners first.

19.Mr MOK Yin-fan was concerned about chicken raising by occupants of public rental flats. He enquired whether briefings on the management of the virus would be arranged for traditional Chinese medicine practitioners who provided about 10 percent of the primary health care service. Assistant Director/Management (1) of the Housing Department (HD) replied that as stated in the tenancy agreement, chickens raising was not allowed to be kept in public rental flats. HD had appealed to occupants who still had live chickens in their flats to surrender the chickens to HD/AFD. AFD’s hotline service was also publicized. He added that estate assistants and security guards working in public housing estates had been instructed to reinforce inspections for such purpose. As regards briefing for TCM practitioners, SHW(Ag) supplemented that the Administration would consult the profession about an appropriate arrangement as soon as practicable.

20.Referring to AD(WW)’s earlier statement in paragraph 12 regarding the Administration’s previous proposals on the construction of an animal cremator which were turned down by the former LegCo and PLC, Dr LEONG Che-hung, as Chairman of the House Committee of the two Councils, expressed strong regret and pointed out that those proposals were not supported because of lack of adequate information provided. He stressed that the Administration should not consider the former LegCo and PLC as a rubber stamp which would approve the Administration’s legislative and financial proposals on request. AD(WW) accepted that the recommendations in the proposals could not have been sufficiently substantiated and undertook to provide more details when a new proposal on the subject was presented in future. SHW(Ag) supplemented that AD(WW)’s earlier response to the Chairman’s enquiry about the disposal of chicken carcasses by an animal cremator was not intended to indicate a negative meaning and extended his apology to members.

21.Miss CHAN Yuen-han urged the Administration to take forward steps to educate the public on how to maintain a healthy body immunity as well as on the likely symptoms of the H5N1 influenza. She was worried about the adverse psychological impacts of the slaughter exercise on school children. In response, SHW(Ag) agreed that appropriate assistance should be rendered to students who appeared to have strong emotional reaction against the recent news reporting of and management of the influenza A H5N1 virus and undertook to relay Miss CHAN’s views to the Education Department for consideration.

22.The meeting ended at 11:18 am.

Provisional Legislative Council Secretariat

4 March 1998