13 results on '"Albert Ka Wing Au"'
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2. Cocirculation of two SARS-CoV-2 variant strains within imported pet hamsters in Hong Kong
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Kin-Hang Kok, Shuk-Ching Wong, Wan-Mui Chan, Wen Lei, Allen Wing-Ho Chu, Jonathan Daniel Ip, Lam-Kwong Lee, Ivan Tak-Fai Wong, Hazel Wing-Hei Lo, Vincent Chi-Chung Cheng, Alex Yat-Man Ho, Bosco Hoi-Shiu Lam, Herman Tse, David Lung, Kenneth Ho-Leung Ng, Albert Ka-Wing Au, Gilman Kit-Hang Siu, and Kwok-Yung Yuen
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animal ,coronavirus ,hamster ,interspecies ,transmission ,sars-cov-2 ,Infectious and parasitic diseases ,RC109-216 ,Microbiology ,QR1-502 - Abstract
During the investigation of a pet shop outbreak of severe acute respiratory coronavirus 2 (SARS-CoV-2) with probable hamster-to-human transmission, the environmental and hamster samples in epidemiologically linked pet shops were found positive for SARS-CoV-2 Delta variant AY.127 strains which are phylogenetically closely related to patient and reported European strains. This interspecies spill-over has triggered transmission chains involving 58 patients epidemiologically linked to three pet shops. Incidentally, three dwarf hamsters imported from Netherlands and centralized in a warehouse distributing animals to pet shops were positive for SARS-CoV-2 spike variant phylogenetically related to European B.1.258 strains since March 2020. This B.1.258 strain has almost disappeared since July 2021. While no hamster-to-human transmission of B.1.258-like strain was found in this outbreak, molecular docking showed that its spike receptor binding domain (RBD) has similar binding energy to human ACE2 when compared with that of Delta variant AY.127. Therefore, the potential of this B.1.258-related spike variant for interspecies jumping cannot be ignored. The co-circulation of both B.1.258-related spike variants with Delta AY.127 which originated in Europe and was not previously found in Hong Kong suggested that hamsters in our wholesale warehouse and retail pet shops more likely have acquired these viruses in Netherlands or stopovers during delivery by aviation than locally. The risk of human-to-hamster reverse zoonosis by multiple SARS-CoV-2 variants leading to further adaptive spike mutations with subsequent transmission back to human cannot be underestimated as outbreak source of COVID-19. Testing of imported pet animals susceptible to SARS-CoV-2 is warranted to prevent future outbreaks.
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- 2022
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3. Transmission of Omicron (B.1.1.529) - SARS-CoV-2 Variant of Concern in a designated quarantine hotel for travelers: a challenge of elimination strategy of COVID-19
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Shuk-Ching Wong, Albert Ka-Wing Au, Hong Chen, Lithia Lai-Ha Yuen, Xin Li, David Christopher Lung, Allen Wing-Ho Chu, Jonathan Daniel Ip, Wan-Mui Chan, Hoi-Wah Tsoi, Kelvin Kai-Wang To, Kwok-Yung Yuen, and Vincent Chi-Chung Cheng
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Public aspects of medicine ,RA1-1270 - Published
- 2022
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4. Complementation of contact tracing by mass testing for successful containment of beta COVID-19 variant (SARS-CoV-2 VOC B.1.351) epidemic in Hong Kong
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Vincent Chi-Chung Cheng, Gilman Kit-Hang Siu, Shuk-Ching Wong, Albert Ka-Wing Au, Cecilia Suk-Fun Ng, Hong Chen, Xin Li, Lam-Kwong Lee, Jake Siu-Lun Leung, Kelvin Keru Lu, Hazel Wing-Hei Lo, Evelyn Yin-Kwan Wong, Shik Luk, Bosco Hoi-Shiu Lam, Wing-Kin To, Rodney Allan Lee, David Christopher Lung, Mike Yat-Wah Kwan, Herman Tse, Shuk-Kwan Chuang, Kelvin Kai-Wang To, and Kwok-Yung Yuen
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SARS-CoV-2 ,Variants of Concern ,Contact tracing ,Mass testing ,Phylogenetic analysis ,Public aspects of medicine ,RA1-1270 - Abstract
Background: Global dissemination of SARS-CoV-2 Variants of Concern (VOCs) remains a concern. The aim of this study is to describe how mass testing and phylogenetic analysis successfully prevented local transmission of SARS-CoV-2 VOC in a densely populated city with low herd immunity for COVID-19. Methods: In this descriptive study, we conducted contact tracing, quarantine, and mass testing of the potentially exposed contacts with the index case. Epidemiological investigation and phylogeographic analysis were performed. Findings: Among 11,818 laboratory confirmed cases of COVID-19 diagnosed till 13th May 2021 in Hong Kong, SARS-CoV-2 VOCs were found in 271 (2.3%) cases. Except for 10 locally acquired secondary cases, all SARS-CoV-2 VOCs were imported or acquired in quarantine hotels. The index case of this SARS-CoV-2 VOC B.1.351 epidemic, an inbound traveler with asymptomatic infection, was diagnosed 9 days after completing 21 days of quarantine. Contact tracing of 163 contacts in household, hotel, and residential building only revealed 1 (0.6%) secondary case. A symptomatic foreign domestic helper (FDH) without apparent epidemiological link but infected by virus with identical genome sequence was subsequently confirmed. Mass testing of 0.34 million FDHs identified two more cases which were phylogenetically linked. A total of 10 secondary cases were identified that were related to two household gatherings. The clinical attack rate of household close contact was significantly higher than non-household exposure during quarantine (7/25, 28% vs 0/2051, 0%; p
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- 2021
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5. Evolution and Control of COVID-19 Epidemic in Hong Kong
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Shuk-Ching Wong, Albert Ka-Wing Au, Janice Yee-Chi Lo, Pak-Leung Ho, Ivan Fan-Ngai Hung, Kelvin Kai-Wang To, Kwok-Yung Yuen, and Vincent Chi-Chung Cheng
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COVID-19 ,SARS-CoV-2 ,variants ,infection control ,Microbiology ,QR1-502 - Abstract
Hong Kong SAR has adopted universal masking, social distancing, testing of all symptomatic and high-risk groups for isolation of confirmed cases in healthcare facilities, and quarantine of contacts as epidemiological control measures without city lockdown or border closure. These measures successfully suppressed the community transmission of pre-Omicron SARS-CoV-2 variants or lineages during the first to the fourth wave. No nosocomial SARS-CoV-2 infection was documented among healthcare workers in the first 300 days. The strategy of COVID-19 containment was adopted to provide additional time to achieve population immunity by vaccination. The near-zero COVID-19 situation for about 8 months in 2021 did not enable adequate immunization of the eligible population. A combination of factors was identified, especially population complacency associated with the low local COVID-19 activity, together with vaccine hesitancy. The importation of the highly transmissible Omicron variant kickstarted the fifth wave of COVID-19, which could no longer be controlled by our initial measures. The explosive fifth wave, which was partially contributed by vertical airborne transmission in high-rise residential buildings, resulted in over one million cases of infection. In this review, we summarize the epidemiology of COVID-19 and the infection control and public health measures against the importation and dissemination of SARS-CoV-2 until day 1000.
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- 2022
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6. Decreased Antibiotic Consumption Coincided with Reduction in Bacteremia Caused by Bacterial Species with Respiratory Transmission Potential during the COVID-19 Pandemic
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Vincent Chi-Chung Cheng, Shuk-Ching Wong, Simon Yung-Chun So, Jonathan Hon-Kwan Chen, Pui-Hing Chau, Albert Ka-Wing Au, Kelvin Hei-Yeung Chiu, Xin Li, Patrick Ip, Vivien Wai-Man Chuang, David Christopher Lung, Cindy Wing-Sze Tse, Rodney Allan Lee, Kitty Sau-Chun Fung, Wing-Kin To, Raymond Wai-Man Lai, Tak-Lun Que, Janice Yee-Chi Lo, and Kwok-Yung Yuen
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antibiotic consumption ,bacteremia ,transmission ,COVID-19 ,Therapeutics. Pharmacology ,RM1-950 - Abstract
Nonpharmaceutical interventions implemented during the COVID-19 pandemic (2020–2021) have provided a unique opportunity to understand their impact on the wholesale supply of antibiotics and incidences of infections represented by bacteremia due to common bacterial species in Hong Kong. The wholesale antibiotic supply data (surrogate indicator of antibiotic consumption) and notifications of scarlet fever, chickenpox, and tuberculosis collected by the Centre for Health Protection, and the data of blood cultures of patients admitted to public hospitals in Hong Kong collected by the Hospital Authority for the last 10 years, were tabulated and analyzed. A reduction in the wholesale supply of antibiotics was observed. This decrease coincided with a significant reduction in the incidence of community-onset bacteremia due to Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, which are encapsulated bacteria with respiratory transmission potential. This reduction was sustained during two pandemic years (period 2: 2020–2021), compared with eight pre-pandemic years (period 1: 2012–2019). Although the mean number of patient admissions per year (1,704,079 vs. 1,702,484, p = 0.985) and blood culture requests per 1000 patient admissions (149.0 vs. 158.3, p = 0.132) were not significantly different between periods 1 and 2, a significant reduction in community-onset bacteremia due to encapsulated bacteria was observed in terms of the mean number of episodes per year (257 vs. 58, p < 0.001), episodes per 100,000 admissions (15.1 vs. 3.4, p < 0.001), and per 10,000 blood culture requests (10.1 vs. 2.1, p < 0.001), out of 17,037,598 episodes of patient admissions with 2,570,164 blood culture requests. Consistent with the findings of bacteremia, a reduction in case notification of scarlet fever and airborne infections, including tuberculosis and chickenpox, was also observed; however, there was no reduction in the incidence of hospital-onset bacteremia due to Staphylococcus aureus or Escherichia coli. Sustained implementation of non-pharmaceutical interventions against respiratory microbes may reduce the overall consumption of antibiotics, which may have a consequential impact on antimicrobial resistance. Rebound of conventional respiratory microbial infections is likely with the relaxation of these interventions.
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- 2022
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7. Explosive outbreak of SARS-CoV-2 Omicron variant is associated with vertical transmission in high-rise residential buildings in Hong Kong
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Vincent Chi-Chung Cheng, Shuk-Ching Wong, Albert Ka-Wing Au, Cheng Zhang, Jonathan Hon-Kwan Chen, Simon Yung-Chun So, Xin Li, Qun Wang, Kelvin Keru Lu, David Christopher Lung, Vivien Wai-Man Chuang, Eric Schuldenfrei, Gilman Kit-Hang Siu, Kelvin Kai-Wang To, Yuguo Li, and Kwok-Yung Yuen
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Environmental Engineering ,Geography, Planning and Development ,Building and Construction ,Civil and Structural Engineering - Abstract
The phenomenon of vertical transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in high-rise residential buildings (HRRBs) is unique in our densely populated cosmopolitan city. The compulsory testing of a whole building under the scheme of restriction-testing declaration (RTD) during the fourth wave (non-Omicron variant) and fifth wave (mostly Omicron variant) of COVID-19 outbreak in Hong Kong allowed us to study the prevalence of this phenomenon, which may represent a form of airborne transmission. From 23 January 2021 to 24 March 2022, 25,450 (5.8%) of 436,397 residents from 223 (63.0%) of 354 HRRBs under RTD were test-positive for SARS-CoV-2. Using the clustering of cases among vertically aligned flats with shared drainage stack and lightwell as a surrogate marker of vertical transmission, the number of vertically aligned flats with positive COVID-19 cases was significantly higher in the fifth wave compared with the fourth wave (14.2%, 6471/45,531 vs 0.24%, 3/1272; p 0.001; or 2212 vs 1 per-million-flats; p 0.001). Excluding 22,801 residents from 38 HRRBs who were tested negative outside the 12-week periods selected in fourth and fifth waves, the positive rate among residents was significantly higher among residents during the fifth wave than the fourth wave (6.5%, 25,434/389,700 vs 0.07%, 16/23,896; p 0.001). Within the flats with COVID-19 cases, the proportion of vertically aligned flats was also significantly higher in the fifth wave than in the fourth wave (95.6%, 6471/6766 vs 30.0%, 3/10, p0.001). The proportion of HRRBs with COVID-19 cases was significantly higher during the corresponding 12-week period chosen for comparison (78.2%, 219/280 vs 11.1%, 4/36; p 0.001). Whole-genome phylogenetic analysis of 332 viral genomes showed that Omicron BA.2 was the predominant strain, supporting the high transmissibility of BA.2 by airborne excreta-aerosol route in HRRBs of Hong Kong.
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- 2022
8. Probable Animal-to-Human Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Delta Variant AY.127 Causing a Pet Shop-Related Coronavirus Disease 2019 (COVID-19) Outbreak in Hong Kong
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Jasper Fuk Woo Chan, Gilman Kit Hang Siu, Shuofeng Yuan, Jonathan Daniel Ip, Jian Piao Cai, Allen Wing Ho Chu, Wan Mui Chan, Syed Muhammad Umer Abdullah, Cuiting Luo, Brian Pui Chun Chan, Terrence Tsz Tai Yuen, Lin Lei Chen, Kenn Ka Heng Chik, Ronghui Liang, Hehe Cao, Vincent Kwok Man Poon, Chris Chung Sing Chan, Kit Hang Leung, Anthony Raymond Tam, Owen Tak Yin Tsang, Jacky Man Chun Chan, Wing Kin To, Bosco Hoi Shiu Lam, Lam Kwong Lee, Hazel Wing Hei Lo, Ivan Tak Fai Wong, Jake Siu Lun Leung, Evelyn Yin Kwan Wong, Hin Chu, Cyril Chik Yan Yip, Vincent Chi Chung Cheng, Kwok Hung Chan, Herman Tse, David Christopher Lung, Kenneth Ho Leung Ng, Albert Ka Wing Au, Ivan Fan Ngai Hung, Kwok Yung Yuen, and Kelvin Kai Wang To
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Microbiology (medical) ,Mammals ,Infectious Diseases ,SARS-CoV-2 ,Cricetinae ,Animals ,COVID-19 ,Hong Kong ,Humans ,RNA, Viral ,Female ,Disease Outbreaks - Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can infect human and other mammals, including hamsters. Syrian (Mesocricetus auratus) and dwarf (Phodopus sp.) hamsters are susceptible to SARS-CoV-2 infection in the laboratory setting. However, pet shop-related Coronavirus Disease 2019 (COVID-19) outbreaks have not been reported. Methods We conducted an investigation of a pet shop-related COVID-19 outbreak due to Delta variant AY.127 involving at least 3 patients in Hong Kong. We tested samples collected from the patients, environment, and hamsters linked to this outbreak and performed whole genome sequencing analysis of the reverse transcription polymerase chain reaction (RT-PCR)-positive samples. Results The patients included a pet shop keeper (Patient 1), a female customer of the pet shop (Patient 2), and the husband of Patient 2 (Patient 3). Investigation showed that 17.2% (5/29) and 25.5% (13/51) environmental specimens collected from the pet shop and its related warehouse, respectively, tested positive for SARS-CoV-2 RNA by RT-PCR. Among euthanized hamsters randomly collected from the storehouse, 3% (3/100) tested positive for SARS-CoV-2 RNA by RT-PCR and seropositive for anti-SARS-CoV-2 antibody by enzyme immunoassay. Whole genome analysis showed that although all genomes from the outbreak belonged to the Delta variant AY.127, there were at least 3 nucleotide differences among the genomes from different patients and the hamster cages. Genomic analysis suggests that multiple strains have emerged within the hamster population, and these different strains have likely transmitted to human either via direct contact or via the environment. Conclusions Our study demonstrated probable hamster-to-human transmission of SARS-CoV-2. As pet trading is common around the world, this can represent a route of international spread of this pandemic virus.
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- 2022
9. Outbreak investigation of airborne transmission of Omicron (B.1.1.529) - SARS-CoV-2 variant of concern in a restaurant: Implication for enhancement of indoor air dilution
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Vincent Chi-Chung Cheng, David Christopher Lung, Shuk-Ching Wong, Albert Ka-Wing Au, Qun Wang, Hong Chen, Li Xin, Allen Wing-Ho Chu, Jonathan Daniel Ip, Wan-Mui Chan, Hoi-Wah Tsoi, Herman Tse, Ken Ho-Leung Ng, Mike Yat-Wah Kwan, Shuk-Kwan Chuang, Kelvin Kai-Wang To, Yuguo Li, and Kwok-Yung Yuen
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Environmental Engineering ,Restaurants ,SARS-CoV-2 ,Health, Toxicology and Mutagenesis ,Air Pollution, Indoor ,Environmental Chemistry ,COVID-19 ,Humans ,Pollution ,Waste Management and Disposal ,Phylogeny ,Disease Outbreaks - Abstract
Airborne transmission of SARS-CoV-2 has been increasingly recognized in the outbreak of COVID-19, especially with the Omicron variant. We investigated an outbreak due to Omicron variant in a restaurant. Besides epidemiological and phylogenetic analyses, the secondary attack rates of customers of restaurant-related COVID-19 outbreak before (Outbreak R1) and after enhancement of indoor air dilution (Outbreak R2) were compared. On 27th December 2021, an index case stayed in restaurant R2 for 98 min. Except for 1 sitting in the same table, six other secondary cases sat in 3 corners at 3 different zones, which were served by different staff. The median exposure time was 34 min (range: 19-98 min). All 7 secondary cases were phylogenetically related to the index. Smoke test demonstrated that the airflow direction may explain the distribution of secondary cases. Compared with an earlier COVID-19 outbreak in another restaurant R1 (19th February 2021), which occurred prior to the mandatory enhancement of indoor air dilution, the secondary attack rate among customers in R2 was significantly lower than that in R1 (3.4%, 7/207 vs 28.9%, 22/76, p0.001). Enhancement of indoor air dilution through ventilation and installation of air purifier could minimize the risk of SARS-CoV-2 transmission in the restaurants.
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- 2022
10. Outbreak Investigation of Airborne Transmission of Omicron (B.1.1.529) - Sars-Cov-2 Variant of Concern in a Restaurant: Implication for Enhancement of Indoor Ventilation
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Vincent Chi-Chung Cheng, David Christopher Lung, Shuk-Ching Wong, Albert Ka-Wing Au, Qun Wang, Hong Chen, Li Xin, Allen Wing-Ho Chu, Jonathan Daniel Ip, Wan-Mui Chan, Hoi-Wah Tsoi, Herman Tse, Ken Ho-Leung Ng, Mike YE Kwan, Shuk-Kwan Chuang, Kelvin Kai-Wang To, Yuguo Li, and Kwok-Yung Yuen
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- 2022
11. The effect of seasonal influenza vaccine on medically-attended influenza and non-influenza respiratory viruses infections at primary care level, Hong Kong SAR, 2017/18 to 2019/20
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Albert Ka-Wing Au, Shuk-Kwan Chuang, Emily Chi-mei Leung, Miu-ling Wong, Fong-yuen Kwok, and Yung-wai Chan
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Influenza vaccine ,viruses ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,030231 tropical medicine ,Virus ,Seasonal influenza ,03 medical and health sciences ,0302 clinical medicine ,Influenza A Virus, H1N1 Subtype ,Pandemic ,Influenza, Human ,Medicine ,Humans ,030212 general & internal medicine ,Respiratory system ,Pandemics ,General Veterinary ,General Immunology and Microbiology ,Primary Health Care ,business.industry ,SARS-CoV-2 ,Influenza A Virus, H3N2 Subtype ,Vaccination ,Public Health, Environmental and Occupational Health ,Case-control study ,virus diseases ,COVID-19 ,Virology ,Infectious Diseases ,Influenza Vaccines ,Case-Control Studies ,Molecular Medicine ,Hong Kong ,Seasons ,business - Abstract
Effectiveness of seasonal influenza vaccine (SIV) varies with the degree of matching with the vaccine and circulating viruses. We continued our SIV effectiveness against medically-attended influenza-like illness (ILI) under the Department of Health Hong Kong's sentinel private medical practitioners (PMP) network, using the test-negative case-control design, for the 2018/19 and 2019/20 season. In addition, we studied the potential interference between SIV and ILI caused by non-influenza respiratory viruses (NIRV) based on data collated from 2017/18 to 2019/20 seasons. 3404 patients were analysed. Across the 2017/18 to 2019/20 seasons, the vaccine effectiveness (VE) of SIV was 44% (95% CI 30-56%) against pan-negative controls, 57% (95%CI. 42-68%) against NIRV controls and 50% (95%CI 38-59%) against both. SIV was moderately effective against medically-attended ILI caused by influenza A/B in both 2018/19 and 2019/20 winter seasons (53.2% (95%CI 36.7-65.5%) and 41.8% (95%CI 6.3-64.1%), respectively). The VE against the main circulating subtype, influenza A(H1), was higher for the 2018/19 season (57.2% (95%CI 39.8-69.9%), compared to 34.6% (95%CI -9.6-61.4%) in the 2019/20 season). When compared to pan negative controls, those with single NIRV infections were similarly likely to have received SIV (OR 1.05 (95%CI 0.72-1.54) within the influenza season; OR 0.97 (95%CI 0.73-1.29) when including non-influenza seasons). Analyses by type of virus showed no increased risk of SIV identified among those with single infections of EV/RV, HMPV and parainfluenza but a 2-fold increased risk was shown for those with single infections of adenovirus and parainfluenza virus (adenovirus: OR 2.54 (95%CI 1.24-5.14) within influenza season and OR 1.78 (95%CI 1.01-3.09) for the whole period; parainfluenza virus: OR 2.01 (95%CI 1.22-3.29) within influenza season and OR 1.89 (95%CI 1.29-2.76) for the whole period). SIV programme and surveillance of influenza and NIRV, including SARS-CoV-2, should continue during the COVID-19 pandemic.
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- 2020
12. Complementation of contact tracing by mass testing for successful containment of beta COVID-19 variant (SARS-CoV-2 VOC B.1.351) epidemic in Hong Kong
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Jake Siu-Lun Leung, Kelvin K. W. To, Albert Ka-Wing Au, Shuk-Ching Wong, Lam-Kwong Lee, Bosco Hoi-Shiu Lam, Gilman Kit Hang Siu, Hazel Wing-Hei Lo, Kwok-Yung Yuen, Kelvin Keru Lu, Shuk-Kwan Chuang, Vincent C.C. Cheng, David Christopher Lung, Rodney A. Lee, Herman Tse, Shik Luk, Wing-Kin To, Hong Chen, Evelyn Yin Kwan Wong, Mike Yat-Wah Kwan, Cecilia Suk-Fun Ng, and Xin Li
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medicine.medical_specialty ,Attack rate ,Mass testing ,Article ,Herd immunity ,law.invention ,Contact tracing ,law ,Environmental health ,Quarantine ,Epidemiology ,Internal Medicine ,medicine ,Index case ,Phylogenetic analysis ,SARS-CoV-2 ,Transmission (medicine) ,Health Policy ,Public Health, Environmental and Occupational Health ,Obstetrics and Gynecology ,Psychiatry and Mental health ,Infectious Diseases ,Geography ,Infectious disease (medical specialty) ,Pediatrics, Perinatology and Child Health ,Variants of Concern ,Public aspects of medicine ,RA1-1270 ,Geriatrics and Gerontology - Abstract
Background Global dissemination of SARS-CoV-2 Variants of Concern (VOCs) remains a concern. The aim of this study is to describe how mass testing and phylogenetic analysis successfully prevented local transmission of SARS-CoV-2 VOC in a densely populated city with low herd immunity for COVID-19. Methods In this descriptive study, we conducted contact tracing, quarantine, and mass testing of the potentially exposed contacts with the index case. Epidemiological investigation and phylogeographic analysis were performed. Findings Among 11,818 laboratory confirmed cases of COVID-19 diagnosed till 13th May 2021 in Hong Kong, SARS-CoV-2 VOCs were found in 271 (2.3%) cases. Except for 10 locally acquired secondary cases, all SARS-CoV-2 VOCs were imported or acquired in quarantine hotels. The index case of this SARS-CoV-2 VOC B.1.351 epidemic, an inbound traveler with asymptomatic infection, was diagnosed 9 days after completing 21 days of quarantine. Contact tracing of 163 contacts in household, hotel, and residential building only revealed 1 (0.6%) secondary case. A symptomatic foreign domestic helper (FDH) without apparent epidemiological link but infected by virus with identical genome sequence was subsequently confirmed. Mass testing of 0.34 million FDHs identified two more cases which were phylogenetically linked. A total of 10 secondary cases were identified that were related to two household gatherings. The clinical attack rate of household close contact was significantly higher than non-household exposure during quarantine (7/25, 28% vs 0/2051, 0%; p Interpretation The rising epidemic of SARS-CoV-2 VOC transmission could be successfully controlled by contact tracing, quarantine, and rapid genome sequencing complemented by mass testing. Funding Health and Medical Research Fund Commissioned Research on Control of Infectious Disease (see acknowledgments for full list).
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- 2021
13. Risk Factors for Severe Outcomes following 2009 Influenza A (H1N1) Infection: A Global Pooled Analysis
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Tomi Sunagawa, Patricia Santa-Olalla, Darren Hunt, Rhonda Owen, Isabelle Bonmarin, Yu Hongjie, Juno Thomas, Jeffrey Cutter, Artemis Koukounari, Katelijn Vandemaele, Maria D. Van Kerkhove, Silke Buda, Albert Ka-Wing Au, Vivek Shinde, Kumnuan Ungchusak, Richard Pebody, Arnaud Orelle, Christl A. Donnelly, Claudia González, Gérard Krause, C. C. H. Lieke Wielders, Walter Haas, Luis O. Carlino, Yoshihiro Takayama, Kiyosu Taniguichi, Kensuke Nakajima, Shuk Kwan Chuang, Feng Zijian, Louise Pelletier, Tokuaki Shobayashi, Seema Jain, Beverly Paterson, Julie Vachon, Anthony W. Mounts, Maria J. Sierra-Moros, Marianne A B van der Sande, Wanna Hanshaoworakul, Vernon J. Lee, Giovanna Jaramillo-Gutierrez, Jean-Michel Heraud, Ethel Palacios, Medical Research Council (MRC), Department of Infectious Disease Epidemiology [London] (DIDE), Imperial College London, Global Influenza Programme, Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Ministerio de Salud de la Nacion, Department of Health and Ageing, Influenza Surveillance Section, Surveillance Branch, Office of Health Protection (DHAISS), Department of Health and Ageing, Influenza Surveillance Section, Surveillance Branch, Office of Health Protection, Woden, ACT, Australia, Public Health Agency of Canada, Departamento de Epidemiologıa, Division de Planificacion Sanitaria, Ministerio de Salud de Chile, Chinese Center for Disease Control and Prevention, Surveillance and Epidemiology Branch, Centre for Health Protection of Department of Health, Robert Koch Institute [Berlin] (RKI), Département des maladies infectieuses, Institut de Veille Sanitaire (INVS), Infectious Disease Surveillance Center, National Institute of Infectious Diseases [Tokyo], Ministry of Health, Labour and Welfare, Institut Pasteur de Madagascar, Réseau International des Instituts Pasteur (RIIP), Directorate General of Epidemiology, National Institute for Public Health and the Environment [Bilthoven] (RIVM), New Zealand Ministry of Health, Communicable Diseases Division at the Ministry of Health, Biodefence Centre, Ministry of Defence, Yong Loo Lin School of Medicine [Singapore], Epidemiology and Surveillance Unit, Respiratory Virus Unit, National Institute for Communicable Diseases [Johannesburg] (NICD), Coordinating centre for Health Alerts and Emergencies, Direccion General de Salud Publica y Sanidad Exterior Ministerio de Sanidad y Polıtica Social, Bureau of Vector Borne Disease, Department of Disease Control, Ministry of Public Health - Thailande, Health Protection Agency, Epidemiology and Prevention Branch, Influenza Division, Centers for Disease Control and Prevention (CDC), MDVK, CAD, and AK acknowledge funding from the Medical Research Council UK and the Bill and Melinda Gates Foundation (MDVK) for funding, and on behalf of the WHO Working Group for Risk Factors for Severe H1N1pdm Infection
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Male ,NEW-ZEALAND ,A(H1N1) INFECTION ,MESH: Global Health ,Global Health ,Body Mass Index ,HOSPITALIZED-PATIENTS ,MESH: Pregnancy ,0302 clinical medicine ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Pregnancy ,MESH: Child ,Odds Ratio ,Young adult ,Child ,[SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases ,0303 health sciences ,education.field_of_study ,MESH: Middle Aged ,MESH: Influenza, Human ,11 Medical And Health Sciences ,General Medicine ,3. Good health ,MESH: Young Adult ,Child, Preschool ,[SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology ,World Health ,Medicine ,Public Health ,MESH: Pandemics ,medicine.medical_specialty ,MESH: Body Mass Index ,MESH: Influenza A Virus, H1N1 Subtype ,03 medical and health sciences ,Intensive care ,SURVEILLANCE ,Humans ,Risk factor ,education ,MESH: Prevalence ,Aged ,MESH: Adolescent ,MESH: Humans ,Science & Technology ,030306 microbiology ,MESH: Child, Preschool ,MESH: Adult ,[SDV.BBM.BM]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Molecular biology ,WHO Working Group for Risk Factors for Severe H1N1pdm Infection ,Odds ratio ,Influenza ,Relative risk ,RA Public aspects of medicine ,MESH: Data Interpretation, Statistical ,MESH: Female ,Body mass index ,Demography ,Viral Diseases ,Pediatrics ,MESH: Hospitalization ,Influenza A Virus, H1N1 Subtype ,MESH: Risk Factors ,Risk Factors ,Epidemiology ,Prevalence ,ADULT PATIENTS ,030212 general & internal medicine ,MESH: Aged ,Middle Aged ,Hospitalization ,Intensive Care Units ,Infectious Diseases ,Data Interpretation, Statistical ,Female ,Life Sciences & Biomedicine ,CRITICALLY-ILL PATIENTS ,PREGNANT-WOMEN ,Research Article ,Adult ,Adolescent ,Population ,UNITED-STATES ,macromolecular substances ,VIRUS-INFECTION ,PANDEMIC INFLUENZA ,Young Adult ,Medicine, General & Internal ,General & Internal Medicine ,Influenza, Human ,medicine ,Pandemics ,business.industry ,MESH: Chronic Disease ,MESH: Male ,MESH: Odds Ratio ,Chronic Disease ,MESH: Intensive Care Units ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,business - Abstract
This study analyzes data from 19 countries (from April 2009 to Jan 2010), comprising some 70,000 hospitalized patients with severe H1N1 infection, to reveal risk factors for severe pandemic influenza, which include chronic illness, cardiac disease, chronic respiratory disease, and diabetes., Background Since the start of the 2009 influenza A pandemic (H1N1pdm), the World Health Organization and its member states have gathered information to characterize the clinical severity of H1N1pdm infection and to assist policy makers to determine risk groups for targeted control measures. Methods and Findings Data were collected on approximately 70,000 laboratory-confirmed hospitalized H1N1pdm patients, 9,700 patients admitted to intensive care units (ICUs), and 2,500 deaths reported between 1 April 2009 and 1 January 2010 from 19 countries or administrative regions—Argentina, Australia, Canada, Chile, China, France, Germany, Hong Kong SAR, Japan, Madagascar, Mexico, the Netherlands, New Zealand, Singapore, South Africa, Spain, Thailand, the United States, and the United Kingdom—to characterize and compare the distribution of risk factors among H1N1pdm patients at three levels of severity: hospitalizations, ICU admissions, and deaths. The median age of patients increased with severity of disease. The highest per capita risk of hospitalization was among patients, Editors' Summary Background In April 2009, a new strain of influenza A H1N1 was first identified in Mexico and the United States and subsequently spread around the world. In June 2009, the World Health Organization (WHO) declared a pandemic alert phase 6, which continued until August 2010. Throughout the pandemic, WHO and member states gathered information to characterize the patterns of risk associated with the new influenza A H1N1 virus infection and to assess the clinical picture. Although risk factors for severe disease following seasonal influenza infection have been well documented in many countries (for example, pregnancy; chronic medical conditions such as pulmonary, cardiovascular, renal, hepatic, neuromuscular, hematologic, and metabolic disorders; some cognitive conditions; and immunodeficiency), risk factors for severe disease following infection early in the 2009 H1N1 pandemic were largely unknown. Why Was This Study Done? Many countries have recently reported data on the association between severe H1N1 influenza and a variety of underlying risk factors, but because these data are presented in different formats, making direct comparisons across countries is difficult, with no clear consensus for some conditions. Therefore, to assess the frequency and distribution of known and new potential risk factors for severe H1N1 infection, this study was conducted to collect data (from 1 April 2009 to 1 January 2010) from surveillance programs of the Ministries of Health or National Public Health Institutes in 19 countries―Argentina, Australia, Canada, Chile, China, France, Germany, Hong Kong (special administrative region), Japan, Madagascar, Mexico, the Netherlands, New Zealand, Singapore, South Africa, Spain, Thailand, the United States, and the United Kingdom. What Did the Researchers Do and Find? As part of routine surveillance, countries were asked to provide risk factor data on laboratory-confirmed H1N1 in patients who were admitted to hospital, admitted to the intensive care unit (ICU), or had died because of their infection, using a standardized format. The researchers grouped potential risk conditions into four categories: age, chronic medical illnesses, pregnancy (by trimester), and other conditions that were not previously considered as risk conditions for severe influenza outcomes, such as obesity. For each risk factor (except pregnancy), the researchers calculated the percentage of each group of patients using the total number of cases reported in each severity category (hospitalization, admission to ICU, and death). To evaluate the risk associated with pregnancy, the researchers used the ratio of pregnant women to all women of childbearing age (age 15–49 years) at each level of severity to describe the differences between levels. The researchers were able to collect data on approximately 70,000 patients requiring hospitalization, 9,700 patients admitted to the ICU, and 2,500 patients who died from H1N1 infection. The proportion of patients with H1N1 with one or more reported chronic conditions increased with severity—the median was 31.1% of hospitalized patients, 52.3% of patients admitted to the ICU, and 61.8% of patients who died. For all levels of severity, pregnant women in their third trimester consistently accounted for the majority of the total of pregnant women. The proportion of patients with obesity increased with increasing disease severity—median of 6% of hospitalized patients, 11.3% of patients admitted to the ICU, and 12.0% of all deaths from H1N1. What Do These Findings Mean? These findings show that risk factors for severe H1N1 infection are similar to those for seasonal influenza, with some notable differences: a substantial proportion of people with severe and fatal cases of H1N1 had pre-existing chronic illness, which indicates that the presence of chronic illness increases the likelihood of death. Cardiac disease, chronic respiratory disease, and diabetes are important risk factors for severe disease that will be especially relevant for countries with high rates of these illnesses. Approximately 2/3 of hospitalized people and 40% of people who died from H1N1 infection did not have any identified pre-existing chronic illness, but this study was not able to comprehensively assess how many of these cases had other risk factors, such as pregnancy, obesity, smoking, and alcohol misuse. Because of large differences between countries, the role of risk factors such as obesity and pregnancy need further study—although there is sufficient evidence to support vaccination and early intervention for pregnant women. Overall, the findings of this study reinforce the need to identify and target high-risk groups for interventions such as immunization, early medical advice, and use of antiviral medications. Additional Information Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001053. WHO provides a Global Alert and Response (GAR) with updates on a number of influenza-related topics The US Centers for Disease Control and Prevention provides information on risk factors and H1N1
- Published
- 2011
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