| Widespread concern about the current influenza outbreak in Hong Kong centers most significantly on the 3 fatal cases suspected to be flu related.
The first one is only now retrospectively reported by the hospial. This was a 21-month old boy admitted to hospital on Feb 22 with fever and cough, and had convulsions when first seen in the emergency room. He was transferred to ICU and died on Feb 24. Respiratory tract samples tested negative to both flu A and B. I am not sure why they are investigating this, I guess it is probably a case of prudence, to check recent deaths that may have been flu related.
The second case was the 3-year old girl died on March 1. Her 6-year old sister became ill on Feb 26 with fever, cough, and runny nose. 3 days later (Feb 29th) the 3-year old became ill as well with the same symptoms including high fever. They were both seen by a private physician.
On March 1, the 3-year old was taken to the Emergency room at Tuen Mun Hospital at around 5am with high fever and respiratory difficulties (as reported here and here). Chest x-ray was taken and said to be normal, and the girl was sent home. She was taken to the ER again at 4:30pm already comatose, with no heart rate and pulse detected. She was declared dead after an hour of failed resuscitation. Her sister was admitted to hospital with 'viral pneumonia' and tested positive for H3.
There is some indication this girl may have suffered from Reye's syndrome a complication that may have been caused by taking medications containing aspirin.
The third case is the most recent 7-year old boy who died yesterday. Note that he also lived in the same district of Tuen Mun as the girl who died. He started getting sick on Feb 24, and was absent from school on Feb 26. On March 6th, he was taken to the Tuen Mun Hospital Emergency room because of continuous fever for 2 days and coughing for more than a week. He was sent home with some meds, but did not improve. He was seen in a private hospital the next day. At 2am on March 8th, his parents found him to be unconscious with 'stiff limbs'. He was taken to Tuen Mun Hospital again and admitted to the ICU. On March 10th, he deteriorated and was put on a ventilator. His parents were told that he had 'encephalitis' and was brain dead. He was pronounced dead on 11 March. The Government Information Service is reporting that "further laboratory tests yielded positive results for influenza-A, or H1N1."
This case is worrisome because many children in his school has fallen ill as well, and 7 of them are still in hospital. They are all said to be in stable condition. Prof Yuen Kwok-yung of the University of Hong Kong says that this is a super-spreader event, and that they will sequence the virus to determine whether any mutation may have happened to cause an increase in virulence.
Current case in ICU Another 3-year old boy is being treated at the Princess Margaret Hospital ICU for respiratory infection and has tested positive for H1N1. His condition is said to be stable.
A team of experts headed by Yuen has been appointed to investigate these deaths. Their investigation will focus on 3 areas:
1) from the epidemiological viewpoint, why were so many children in one school infected with severe disease, with 7 still hospitalized and one dead.
2) why the clinical courses were so rapid and death happened so soon after onset of disease
3) review of the pathology plus the sequence of viral samples, to discover any mutations that may explain the severity..
Finally, here's an interesting chart from the Centre for Health Protection's influenza report March 12 March 14. There appears to be a lot of H1N1 around this year compared to last year.
|
