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BMJ. Aug 9, 2003; 327(7410): 308.
PMCID: PMC1126722

Hong Kong under WHO spotlight after flu outbreak

The World Health Organization is monitoring an outbreak of influenza in Hong Kong after it occurred in two homes for elderly people and two hostels for people with learning difficulties. A total of 31 people were admitted to hospital, including two who were admitted to intensive care. By 1 August, six were still in hospital in a stable condition.condition.

Figure 1

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Freshly slaughtered chicken increases the risk of infection

Credit: ANAT GIVON/AP

Initial fears that it might be another outbreak of severe acute respiratory syndrome (SARS) have, however, proved unfounded. The Hong Kong government's virus unit isolated two viruses from the outbreak, both similar to the reference strain A/Panama/2007/99 (H3N2).

“The reason this outbreak was drawn to our attention was because there were questions early on as to whether it could be severe acute respiratory syndrome,” said Iain Simpson, spokesman for WHO in Geneva. “Clearly it's not, but any outbreak of respiratory disease is something we want to know about because all the indications are that we are living on borrowed time and are due a flu pandemic,” he added.

Hong Kong is at particular risk from a new flu strain because of its proximity and close links to Guangdong province—the most likely source of a future global flu pandemic. It is also because of local preferences for buying freshly slaughtered rather than chilled or frozen poultry, according to Professor Yuen Kwok-yung, head of the department of microbiology and chairman of infectious diseases at the University of Hong Kong.

“There are more than 500 retail markets in Hong Kong selling live poultry, and there is a concentration of animals—each chicken has a caged floor area the size of a piece of A4 paper. There is also a lot of animal excreta and dirty water on the ground, and people are carrying freshly slaughtered chickens home with them. Any infection can spread rapidly,” he said.

If more than one virus is present in the poultry population at any one time, such markets provide an ideal breeding ground for a mutant virus. “They create the environment for genetic mutation, re-assortment, and recombination, and the higher the number of viruses the higher the chance mutation will occur,” said Professor Yuen.

The idea of banning the sale of live chickens was mooted in Hong Kong in the wake of the 1997 bird flu outbreak, which resulted in the slaughter of the city's entire poultry population. But the idea was shelved in the face of public and industry opposition. “Eating habits are one of the deep-seated traits of Chinese culture, and to change them causes a lot of dissatisfaction among the locals. But centralised slaughtering, either in Hong Kong or over the border in China, would make it very easy to control hygiene conditions,” said Professor Yuen.


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