Burden of influenza in Hong Kong

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Alicia Walton
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1 F ebj unj ulo c tn ovd ecja nf ebj unj ulo c td ecj anf ebma rap rma yj unj uloc tj anf ebma rm ayj unj uloc tj anf ebm arm ay J unj ulo ctj anf ebm arm ay J unj ulo ctno vj anm arm ayj unj ulau go ctj anfe bj unau go c t Laboratory surveillance Dr Thomas Tsang Controller, Centre for Health Protection Department of Health, HKSAR Sentinel surveillance Influenza-like illness (ILI) in GOPC, GP, Chinese medical practitioners Fever/cough/absenteeism in CCC Fever/hospital admission in RCHE Surveillance of institutional outbreaks Surveillance of influenza associated severe complications in children 1 2 Burden of influenza in Hong Kong Influenza accounts for: 66 hospitalizations per 1, population per year for acute respiratory disease for all age groups, ranging from 6 (in age 15-39) to 266 (in age 75+) [1] 73 deaths per 1, population per year from cardiorespiratory diseases among individuals aged 4-64 and 12 death per 1, population per year among individuals aged 65 and above [2] No of outbreaks Number of influenza outbreaks and persons affected, No of influenza outbreaks No of persons affected No of persons affected 1 Wong CM, Yang L, Chan KP, et al Influenza-associated hospitalization in a subtropical city PLOS Medicine 26; 3(4):e121 2 Wong CM, Chan KP, Hedley AJ, et al Influenza-associated mortality in Hong Kong Clin Infect Dis 24; 39: Seasonality of influenza in Guangdong Total number of influenza virus detections from PHLSB, Guangdong - Influenza Rate (per 1 pop) No of Cases Number Month 1 26-case 27-case 28-case 26-rate 27-rate 28-rate Source: Tripartite data 5 6

2 Influenza virus detection by PHLSB, CHP Flu season Peak Major circulating strain in Hong Kong Vaccine strain (WHO recommendation for Northern hemisphere) /8 Summer A/H1N1/Brisbane/59/27-like A/H3N2/Brisbane/1/27-like Winter A/H1N1/Solomon Islands/3/26-like A/H1N1/Brisbane/59/27-like A/H3N2/Brisbane/1/27-like A/Solomon Islands/3/26(H1N1)-like virus; A/Wisconsin/67/25 (H3N2)-like virus; B/Malaysia/256/24-like virus (B/Victoria/2/87 lineage) Number of detection /7 Summer A/H3N2/Wisconsin/67/25-like A/H3N2/Brisbane/1/27-like Winter A/H3N2/Wisconsin/67/25-like A/H1N1/New Caledonia/2/99-like A/New Caledonia/2/99(H1N1)-like virus; A/Wisconsin/67/25(H3N2)-like virus; B/Malaysia/256/24-like virus (B/Victoria/2/87 lineage) A(H1N1) A(H3N2) A(not subtyped) B C 7 8 Influenza during ch 28 Flu season Major circulating strain in Hong Kong Vaccine strain (WHO recommendation for Northern hemisphere) 5/6 A/H1N1/New Caledonia/2/99-like A/H3N2/California/7/24-like A/New Caledonia/2/99(H1N1)-like virus; A/California/7/24(H3N2)-like virus; B/Shanghai/361/22-like virus () 4/5 3/4 2/3 A/H3N2/Fujian/411/22-like A/H3N2/California/7/24-like A/H3N2/Fujian/411/22-like A/H3N2/Moscow/1/99-like A/New Caledonia/2/99(H1N1)-like virus A/Fujian/411/22(H3N2)-like virus B/Shanghai/361/22-like virus () A/New Caledonia/2/99(H1N1)-like virus A/Moscow/1/99(H3N2)-like virus B/Hong Kong/33/21-like virus () A/New Caledonia/2/99(H1N1)-like virus A/Moscow/1/99(H3N2)-like virus B/Hong Kong/33/21-like virus () 9 1 Influenza outbreak recorded by CHP in 28 (s 1-39) (by place of occurrence) Influenza-like Illness Surveillance Among Private doctors, 28 Number of outbreak(s) Rate (per 1 consultations) Influenza-like Illness Surveillance Among General Outpatient Clinics, Child Care Centre Correctional Facility Elderly Home Home Hospital Institutions (Other than Hospitals, Elderly Homes and Correctional Facilities) Kindergarten Mental Hospital / Residential Institution for Mentally Handicapped Other Residential Institution / Hostel Primary School Secondary School Rate (per 1 consultations)

3 Number Number of influenza virus detections from PHLSB, 28 Influenza vaccine effectiveness (Local study) Objectives To compare the vaccine effectiveness when the vaccine strain matched/mismatch with circulating strain during institutional outbreaks; To compare the vaccine effectiveness when the outbreaks occurred 6 and >6 months of vaccination Findings When vaccine strain matched circulating strain, vaccine was associated with: 41% reduction of influenza-like-illness 47% reduction of hospitalizations 53% reduction of pneumonia The vaccine was still effective when the vaccine strain did not match with the circulating strain; Vaccine has similar effectiveness when the outbreak occurred within and after 6 months of vaccination A (H1N1) A (H3N2) A (Not subtyped) B C Source: Lau TW Effectiveness of influenza vaccine among elderly people living in residential care homes (RCHs) in Hong Kong Influenza vaccine effectiveness (Local study) Objective A prospective cohort study to evaluate the effectiveness of the influenza vaccination among non-institutionalized elderly patients between 24 and 25 Methods A random sample was taken among elderly patients (age > 65 years) registered at eight general outpatient departments or hospitals A total of 1559 and 156 patients in the vaccinated and non-vaccinated groups respectively completed the study Findings The all cause mortality rate was significantly higher for patients of the nonvaccinated group during the study period Hospitalization due to pneumonia was significantly higher in the nonvaccinated group in 25 during which high influenza activity was reported from sentinel surveillance and virus isolation rates There were no differences in incidences of ILI and ILI related asthma, COPD exacerbations and congestive heart failure Government Influenza Vaccination Programme (GIVP) Source: Yung R and Kwok H Effect of influenza vaccination on hospitalization of non-institutionalized elderly with chronic illness in Hong Kong CDW (26) 3(13): Eligible groups under GIVP Eligible groups under GIVP Elderly living in residential care homes Disabled people living in residential care homes Elderly with chronic illness or financial subsidy Health care staff in government departments and Hospital Authority Poultry workers Health care staff in residential care homes for elderly and disabled Children between 6 months and less than 6 years from families on Comprehensive Social Security Allowance (CSSA) Pregnant women on CSSA Free vaccinations Centrally procured by Government Vaccinations given by Department of Health and Hospital Authority 17 18

GIVP vaccine utilisation trend Number of doses 35 3 25 2 15 1 5 23-4 24-5 25-6 26-7 27-8 Influenza Vaccination Subsidy Scheme (IVSS) Year 19 2 Hospitalization Associated with Influenza and Pneumonia

4 GIVP vaccine utilisation trend Number of doses Influenza Vaccination Subsidy Scheme (IVSS) Year 19 2 Hospitalization Associated with Influenza and Pneumonia in Hong Kong Influenza Vaccination Subsidy Scheme 25 Newly introduced this year (ember 1, 28) Episodes per 1, population year 2-5 years 6-11 years years years Vaccinations delivered by private sector Eligibility children aged between 6 months and less than 6 years, or children 6 years or above attending a kindergarten or child care centre Subsidy and pricing IVSS Logo Level of Government subsidy $8 per dose of influenza vaccine given a maximum of 2 doses per child Parents pay private doctors a discounted fee Doctors have to enroll to participate No restriction on doctors price Require price transparency display at clinic publish in IVSS website 23 24

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Influenza Weekly Surveillance Report

Influenza Weekly Surveillance Report A REPORT BY THE HEALTH PROTECTION SURVEILLANCE CENTRE IN COLLABORATION WITH THE IRISH COLLEGE OF GENERAL PRACTITIONERS, THE NATIONAL VIRUS REFERENCE LABORATORY & THE