Hospital Authority Infectious Disease Center

Kowloon, Hong Kong

Hospital Authority Infectious Disease Center

Kowloon, Hong Kong
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Chan P.K.S.,Chinese University of Hong Kong | Lee N.,Chinese University of Hong Kong | Zaman M.,Khyber Teaching Hospital | Adisasmito W.,University of Indonesia | And 12 more authors.
Journal of Infectious Diseases | Year: 2012

Background. Oseltamivir is widely used as treatment for influenza virus A subtype H5N1 (hereafter, "H5N1") infection but, like any intervention, is not always effective. Methods. We used Avian Influenza Registry data from 10 countries to examine the risk of death in 215 patients with confirmed H5N1 infection who were treated with oseltamivir, according to viral clade, age, respiratory failure, and adjunctive treatment with corticosteroids or antibiotics. Results. The median age of infected individuals was 18 years, and 50 were male. The highest fatality rate occurred in a country with clade 2.1 virus circulation, and the lowest occurred in countries with clade 2.2 virus circulation (P <. 001). In univariate analyses, age of ≤5 years and treatment ≤2 days after symptom onset were protective against fatality. When accounting for all risk factors, early initiation of oseltamivir was found to be particularly effective in individuals without respiratory failure (odds ratio, 0.17; P =. 04). Patients who had advanced respiratory failure requiring ventilatory support at the time of oseltamivir initiation were more likely to die from the episode of H5N1 infection than patients who did not (P <. 001). Adjunctive therapy did not improve the likelihood of surviving the episode. Conclusions. Oseltamivir is especially effective for treating H5N1 infection when given early and before onset of respiratory failure. The effect of viral clade on fatality and treatment response deserves further investigation. © 2012 The Author. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.

Oner A.F.,Yuzuncu Yil University | Dogan N.,Atatürk University | Gasimov V.,Azerbaijan Ministry of Health | Adisasmito W.,University of Indonesia | And 10 more authors.
Clinical Infectious Diseases | Year: 2012

Background. Avian influenza continues to pose a threat to humans and maintains the potential for greater transmissibility. Understanding the clinical presentation and prognosis in children will help guide effective diagnosis and treatment.Methods.A global patient registry was created to enable systematic collection of clinical, exposure, treatment, and outcomes data on confirmed cases of H5N1. Bivariate and multivariate statistical tools were used to describe clinical presentation and evaluate factors prognostic of survival.Results.Data were available from 13 countries on 193 children <18 years who were confirmed as having been infected with H5N1; 35.2 of cases were from Egypt. The case fatality rate (CFR) for children was 48.7, with Egypt having a very low pediatric CFR. Overall, children aged ≤5 years had the lowest CFR and were brought to hospitals more quickly and treated sooner than older children. Children who presented for medical care with a complaint of rhinorrhea had a 76 reduction in the likelihood of death compared with those who presented without rhinorrhea, even after statistical adjustment for age, having been infected in Egypt, and oseltamivir treatment (P =. 02). Delayed initiation of treatment with oseltamivir increases the likelihood of death, with an overall 75 increase in the adjusted odds ratio for death for each day of delay.Conclusions.The presence of rhinorrhea appears to indicate a better prognosis for children with H5N1, with most patients surviving regardless of age, country, or treatment. For individuals treated with oseltamivir, early initiation of treatment substantially enhances the chance of survival. © 2012 The Author.

Lai P.-C.,University of Hong Kong | Chow C.B.,Hospital Authority Infectious Disease Center | Wong H.T.,Chinese University of Hong Kong | Kwong K.H.,University of Hong Kong | And 5 more authors.
International Journal of Geographical Information Science | Year: 2015

The outbreaks of new and emerging infectious diseases in recent decades have caused widespread social and economic disruptions in the global economy. Various guidelines for pandemic influenza planning are based upon traditional infection control, best practice and evidence. This article describes the development of an early warning system for detecting disease outbreaks in the urban setting of Hong Kong, using 216 confirmed cases of H1N1 influenza from 1 May 2009 to 20 June 2009. The prediction model uses two variables – daily influenza cases and population numbers – as input to the spatio-temporal and stochastic SEIR model to forecast impending disease cases. The fairly encouraging forecast accuracy metrics for the 1- and 2-day advance prediction suggest that the number of impending cases could be estimated with some degree of certainty. Much like a weather forecast system, the procedure combines technical and scientific skills using empirical data but the interpretation requires experience and intuitive reasoning. © 2015 Taylor & Francis.

Tsang O.T.-Y.,Hospital Authority Infectious Disease Center | Wong R.W.-C.,Princess Margaret Hospital | Lam B.H.-S.,Princess Margaret Hospital | Chan J.M.-C.,Hospital Authority Infectious Disease Center | And 2 more authors.
BMC Research Notes | Year: 2013

Background: Cyclospora is an uncommon pathogen. The diagnosis of Cyclospora infection can be difficult because of its scarcity in developed countries, intracellular mode of life, small size of the parasite and its inability to take up routine microscopic stains. However, it is endemic in many countries in Asia, Africa, Central and South America. With the increase in travels to these areas, the number of cases is expected to increase. Moreover, it is found to be associated with numerous food-borne outbreaks. Case presentation. We encountered a patient with human immunodeficiency virus presented with 6 months of diarrhoea. The initial investigation was unrevealing. The diagnosis of Cyclospora infection was finally made on the histological sample obtained by colonoscopy. Moreover, the initial therapy with ciprofloxacin was not effective, while trimethoprim/sulfamethoxazole resulted in final cure of the disease. Conclusion: Travel and food histories are important for the suspicion of Cyclospora infection. Histological examination is more sensitive in making a diagnosis of Cyclospora infection of the gut than fecal microscopic examination. Trimethoprim/sulfamethoxazole is a more reliable therapy for Cyclospora infection in patients with human immunodeficiency virus. © 2013 Tsang et al.; licensee BioMed Central Ltd.

Lee R.L.T.,World Health Organization | Leung C.,Hong Kong Polytechnic University | Tong W.K.,Hospital Authority Infectious Disease Center | Chen H.,Center for Health Protection | Lee P.H.,World Health Organization
American Journal of Infection Control | Year: 2015

Background: Infectious diseases are common among schoolchildren as a result of their poor hand hygiene, especially in those who have developmental disabilities. Methods: A quasi-experimental study using a pre- to post-test design with a control group was used to test the feasibility and sustainability of simplified 5-step handwashing techniques to measure the hand hygiene outcome for students with mild intellectual disability. Sickness-related school absenteeism was compared. Results: The intervention group experienced a significant increase in the rating of their handwashing quality in both hands from pre- to post-test: left dorsum (+1.05, P <.001); right dorsum (+1.00, P <.001); left palm (+0.98, P <.001); and right palm (+1.09, P <.001). The pre- to post-test difference in the intervention group (+1.03, P <.001) was significantly greater than the difference in the control group (+0.34, P =.001). There were no differences between the post-test and the sustainability assessment in the intervention group. The intervention school experienced a significantly lower absenteeism rate (0.0167) than the control group in the same year (0.028, P =.04).Students in this study showed better performance in simplified handwashing techniques and experienced lower absenteeism than those using usual practice in special education school settings. Conclusion: The simplified 5-step hand hygiene technique has been proven effective in reducing the spread of infectious diseases. Copyright © 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Chan W.M.,Hospital Authority Infectious Disease Center | Lee S.Y.,Hospital Authority Infectious Disease Center | Kwan Y.W.,Hospital Authority Infectious Disease Center | Chow C.B.,Hospital Authority Infectious Disease Center | Leung C.W.,Hospital Authority Infectious Disease Center
Hong Kong Journal of Paediatrics | Year: 2010

Background: Measles still causes significant morbidity and mortality. The diagnosis of measles relies on early recognition of clinical manifestations. We identified a group of young infants who presented with a modified clinical picture after contracting measles, but there is scarce literature describing this observation. Method: We conducted a retrospective study of all infants <1 year old with measles confirmed by serological or virological methods in Princess Margaret Hospital, a territory-wide tertiary referral centre for infectious diseases in Hong Kong, over a period of 10 years from 1999 to 2008. The study population (n=165) was divided into 2 groups: 29 infants were aged <7 months and 136 infants were 7-12 months of age. Their clinical manifestations were compared and analysed, which included the timing of skin rash in relation to onset of fever, duration of fever, presence or absence of characteristic clinical features of measles such as coryza, cough, conjunctivitis, Koplik's spots, staining of convalescent rash, and other associated features and complications. Results: The mean duration of fever in infants aged <7 months and 7-12 months were 4.6 and 6.8 days, respectively (p<0.001, 95% CI 1.24-3.04). Shorter duration of fever was noted in the younger age group with a positive correlation observed for age and duration of fever (r=0.307, p<0.001). The onset of skin rash was 2.3 and 3.7 days after the onset of fever for the 2 age groups, respectively (p=0.001, 95% CI 0.58-2.12). Earlier onset of skin rash was noted in the younger age group with a positive correlation observed for age and timing of skin rash from the onset of fever (r=0.255, p=0.001). Conjunctivitis (p=0.001) and staining of skin rash during convalescence (p=0.026) were significantly less common in the younger infant group. There were no significant differences between the 2 groups regarding presence of coryza (p=0.07), cough (p=0.28), Koplik's spots (p=0.18), diarrhoea (p=0.72), pneumonia (p=0.74) and the use of antibiotics (p=0.74). Conclusion: Our study revealed a modified clinical picture of non-specific and milder form of measles in young infants. The presence of modified features may be due to partial protection provided by maternally derived measles antibody (anti-measles IgG). We should maintain a high index of suspicion for measles presenting in this group of patients because of the possibility of atypical presentation. The use of rapid diagnostic test (e.g. anti-measles IgM) in such situation facilitates early diagnosis, proper treatment and institution of appropriate infection control measures. Early airborne isolation of hospitalised infants should be considered in all suspected cases to interrupt transmission and prevent potential nosocomial outbreaks.

Chan W.M.,Hospital Authority Infectious Disease Center | Kwan Y.W.,Hospital Authority Infectious Disease Center | Leung C.W.,Hospital Authority Infectious Disease Center
Hong Kong Journal of Paediatrics | Year: 2011

Bacillus Calmette-Guérin (BCG) related regional lymphadenitis is not an uncommon complication following BCG vaccination. We present a case series of 11 infants with suppurative BCG lymphadenitis managed in Hospital Authority Infectious Disease Centre of Hong Kong over a 5-year period. All of them presented with isolated left axillary mass which suppurated at a mean of 3.5 months (range 2 to 5 months) after BCG vaccination. The diagnosis of the condition is basically clinical. Five infants who were initially managed with needle aspiration alone showed significant regression in the sizes of their enlarged lymph nodes and surgical excision was spared. Surgical incision and drainage was performed in 5 other infants prior to referral to our centre. They all developed significant irregular scarring and 2 eventually developed keloids over their scars upon healing. We recommend that suppurative BCG lymphadenitis should be managed initially by needle aspiration. Total excision should be considered if aspiration fails or suppuration recurs despite repeated needle aspiration. Incision and drainage is mentioned to be condemned.

Li N.W.,Hospital Authority Infectious Disease Center | Chan W.M.,Hospital Authority Infectious Disease Center | Kwan Y.W.,Hospital Authority Infectious Disease Center | Leung C.W.,Hospital Authority Infectious Disease Center
Hong Kong Journal of Paediatrics | Year: 2011

Recurrent parotitis of childhood is the second most common disease of salivary glands in children next to mumps. It is defined as recurrent parotid inflammation that is non-obstructive and non-suppurative. However, the aetiology and management of this disease remains controversial. We report a series of 5 children presenting with this condition who were investigated by ultrasonography and sialography. All of them were managed conservatively. The aetiology, diagnosis and treatment of this condition is reviewed. A management plan for this disease is formulated to prevent over-investigated and over-treated situations.

Chan Y.C.,Hospital Authority Infectious Disease Center | Kwan Y.W.,Hospital Authority Infectious Disease Center | Chow C.B.,Hospital Authority Infectious Disease Center | Leung C.W.,Hospital Authority Infectious Disease Center
Hong Kong Journal of Paediatrics | Year: 2010

Objective: To describe the epidemiology of varicella-associated morbidities in paediatric patients hospitalised at a tertiary referral hospital in Hong Kong from 2004 to 2008. Methods: The hospital discharge database and medical records of Princess Margaret Hospital were retrospectively analysed for admissions associated with varicella from 2004 to 2008. Patients aged less than 18 years were included in the study. Results: During the study period, 598 children (328 males, 270 females) were hospitalised for varicella or its complications. The mean age on admission was 57.6 months (range 1-204 months) and the mean duration of hospitalisation was 3.7 days (range 1-27 days). The overall complication rate was 47%. Skin and soft tissue infections were the most common complication (43.1%), followed by surgical scarlet fever (35.2%), neurological complications (18.1%) and pneumonia (8.2%). Compared to immunocompetent children, immunocompromised children were more likely to be older (p <0.001) and hospitalised for longer periods (p<0.001), but had a lower complication rate (13.8% vs 48.7%) as a result of institution of specific antiviral therapy (p<0.001). Five patients required intensive care and two of them were immunocompromised. There was no mortality. Conclusion: Varicella can lead to serious complications and prolonged hospitalisation, even in previously healthy children. This study provides important information on the local epidemiology of children hospitalised for varicella in the era following the introduction of varicella vaccine.

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