Provisional Legislative Council
PLC Paper No. CB(2) 1447
(These minutes have been
seen by the Administration)
Ref : CB2/PL/HS
Provisional Legislative Council
Panel on Health Services
Minutes of meeting held on Monday, 9 February 1998 at 8:30 am
in Conference Room B of the Legislative Council Building
Members present :
Dr Hon TANG Siu-tong, JP (Chairman)
Dr Hon LEONG Che-hung, JP (Deputy Chairman)
Hon WONG Siu-yee
Hon Henry WU
Hon CHEUNG Hon-chung
Hon MOK Ying-fan
Members absent :
Hon CHAN Yuen-han
Hon Howard YOUNG, JP
Member attending :
Hon CHAN Choi-hi
Public officers attending :
- Health and Welfare Bureau
- Mr Gregory LEUNG, JP
- Deputy Secretary for Health and Welfare
- Miss Eliza YAU
- Principal Assistant Secretary for Health and Welfare (Medical) 1
- Mr Edward LAW
- Principal Assistant Secretary for Health and Welfare (Medical) 2 (Ag)
- Ms Manda CHAN
- Assistant Secretary for Health and Welfare (Medical) 2
- Department of Health
- Dr P Y LAM, JP
- Deputy Director of Health
- Dr Gloria TAM
- Assistant Director (Hygiene)
- Dr K H MAK
- Consultant (Community Medicine)
- Hospital Authority
- Dr W M KO
- Deputy Director (Operations)
- Agriculture and Fisheries Department
- Mr Joseph SHAM Chun-hung
- Senior Capture Fisheries Officer
Clerk in attendance :
- Ms Doris CHAN
- Chief Assistant Secretary (2) 4
Staff in attendance :
- Mr Stanley MA
- Senior Assistant Secretary (2) 7
Members agreed to discuss the research report on "Health Care Expenditure and Financing in Hong Kong" prepared by the PLC Secretariat at the next meeting. Members also briefly discussed the questions to be raised under agenda items III and VI.
I.Confirmation of minutes of the special meeting held on 17 December 1997 and matters arising
2.The minutes of the special meeting held on 17 December 1997 were confirmed.
3.Responding to Dr LEONG Che-hung's enquiry, Principal Assistant Secretary for Health and Welfare (Medical) 2 (Acting) clarified that funds had been earmarked for the provision of 200 additional half-way house (HWH) places from 1998-99 to 2001-02. The comprehensive review on HWH services to be conducted by the Social Welfare Department in early 1999 would concentrate on the referral system and the admission procedures for allocation of HWH.
II.Date of next meeting and items for discussion
4.Members agreed to discuss the following items at the next meeting to be held on 9 March 1998 -
- the research paper on "Health Care Expenditure and Financing in Hong Kong" prepared by the Research and Library Services Division of the PLC Secretariat; and
- the progress of legislation of traditional Chinese medicine.
III.Test reagent suspected to be contaminated by the causative agent of Creutzfeldt-Jakob Disease
(PLC Paper No. CB(2)958(01))
5.Deputy Director of Health (DDH) briefed members on the salient points of the Administration's paper on the subject. He highlighted that according to the World Health Organization (WHO), there was so far no evidence that Creutzfeldt-Jakob Disease (CJD) could infect human patients through blood products. The WHO nevertheless recognized the importance of maintaining a worldwide surveillance network against the spread of the disease and had recommended its members to take additional precautionary measures in screening of blood donations.
6.Deputy Director (Operations) of the Hospital Authority (DD(O)/HA) supplemented that a total of 108 and 20 patients were respectively affected in the recent two incidents of a diagnostic test reagent and another drug reported to have been contaminated by the causative reagent of CJD. The HA found that 11 of those patients had already died of diseases other than CJD. So far the HA had arranged medical appointment and diagnosis for 109 affected patients and would continue to contact the remaining eight for attending the medical appointments.
7.Mr CHEUNG Hon-chung enquired about the legal framework and procedures providing for recall of registered medicines under the Pharmacy and Poisons Ordinance (the Ordinance). DDH replied that recall of a medicine registered under the Ordinance should be initiated by the importer concerned. He should notify the Department of Health (DH) the cause(s) and details of the recall as early as possible and should provide explanations to persons who were affected by the medicine. However, the importer of the batches of serum albumin supplied with a radioactive substance to act as a diagnostic reagent had only obtained a licence in accordance with the Radiation Ordinance for the radioactive substance in the test reagent and had not registered the non-radioactive pharmaceutical component in the test reagent under the Ordinance. Since legal proceedings might be instituted against the importer concerned, DDH said that he could not disclose the details of the two incidents at this stage. DD(O)/HA supplemented that according to international practice, the importer concerned should co-ordinate the recall of a medicine in a systematic manner and issue an appropriate notice to all local medical and health authorities involved in the use and control of the medicine. Responding to Mr CHEUNG's further question, DDH said all pharmaceutical products, including reagents having a radioactive component, should be registered under the Ordinance before they could be used in Hong Kong. He stressed that there was so far no evidence that the CJD could be transmitted through blood and for patients who had been injected with the test reagent suspected to have been contaminated, the risk of being infected with the disease was minimal. DD(O)/HA added that the HA procured medicines collectively for its public hospitals and specialist clinics through open tenders and prospective suppliers were required to specify the constituents of the pharmaceutical products in their tender submissions.
8.In response to Dr LEONG Che-hung's enquiries, DDH reiterated that there was no evidence that CJD could be transmitted through blood. Patients in England and European countries who were injected with the test reagent in question were not informed of the risk of being infected with CJD, whereas patients in USA might, subject to the discretion of the doctors concerned, be alerted of such risk. Given the differences in values and culture, it was understandable that different communities would adopt different approaches to tackle the issue. The legal responsibility of the supplier and the affected patients eligibility for compensation would have to be judged by the jurisdictions concerned. As recommended by the WHO, the general principle was that a country should not export to other countries any pharmaceutical products which under its domestic legislation were forbidden for use. DD(O)/HA supplemented that although telling the truth would create much psychological pressure on the patients concerned, the HA, like most of the overseas health authorities, had decided to inform the affected patients of the details of the possible contamination. In order to prevent further transmission of the CJD through blood, the HA had also advised each of those affected patients not to donate blood in the future. As regards compensation for affected patients, he said that in the absence of evidence that the CJD could be transmitted by blood and since there was no test for detecting the disease, it was difficult to prove negligence on the part of the supplier of the test reagent. However, the HA would take a coordination role to assist those affected patients who wished to make a claim for compensation by providing relevant information on similar cases and compiling medical reports for the necessary legal proceedings.
9.Dr LEONG doubted whether all suppliers/agents of radioactive and pharmaceutical products were aware of the need to register their products under both Ordinances. He considered that the local authorities should proactively advise them to comply with the relevant statutory requirements and enquired whether the Administration had plans to enhance control of imported medicine and food in the long run. DDH explained that in applying for a licence under the Radiation Ordinance, the supplier had failed to declare that the diagnostic test reagent contained a pharmaceutical component. He added that the staff of the Pharmacy Division and Radiation Health Unit had discussed the two incidents and agreed on measures to improve communication in the future. With increasing varieties of proprietary Chinese medicine (PCM), health food and western style herbs available at the retail outlets, he agreed that additional control mechanisms to monitor the qualities of those products would certainly be beneficial to the health of the community as a whole. In this connection, he informed members that a new and advance laboratory centre would come into operation in around 2001. It would substantially enhance the efficiency of conducting tests and analysis on food and medicine. DS/HW supplemented that with such additional resources, the DH would be able to perform its role in control of imported food and medicine in a more cost-effective manner. Dr LEONG agreed that the DH should be provided with sufficient resources to better safeguard the health of the community.
10. In response to Mr MOK Ying-fan's enquiries, DD(O)/HA said that the HA had thoroughly considered a list of follow-up actions for the affected patients. In addition to a series of medical interviews, diagnoses and tests, the HA's experienced medical officers would advise the affected patients to return for regular medical check-ups at least once a year and to report any unusual developments for immediate medical treatment and advice. As regards legal compensation, DD(O)/HA said that so far only a few of the affected patients had indicated such an intention. Nevertheless, the HA was always ready to offer assistance to those who decided to lodge a claim later.
IV.Ciguatera Fish Poisoning
(PLC Paper No. CB(2)958(02))
11.Assistant Director (Hygiene) of the DH (AD(H)/DH) briefed members on the main points of the Administration's paper on the subject. Senior Capture Fisheries Officer of the Agriculture and Fisheries Department (SCFO/AFD) supplemented that following the recent incidents of ciguatoxin poisoning, the AFD had discussed with traders of reef fishes and concluded that it was most likely that the contaminated fishes were imported from a new supplier. In the interest of public health, traders had agreed to send samples of reef fishes imported from any future new suppliers to the DH for test on ciguatoxin. Since there was at present no quick and reliable screening test procedures for detection of the toxin in fish and that only a small portion of imported live reef fish was contaminated, the AFD considered it not justified at this stage to impose a ban on the import of live reef fish.
12.In reply to Mr CHAN Choi-hi's enquiries, SCFO/AFD said that the existing method of food analysis was time-consuming and not 100 % reliable in detecting the presence of ciguatoxin. When the test kit for rapid screening which was now being developed in the USA became available, the AFD would help examine if it could work. In view of the vast quantities of live marine fishes imported into Hong Kong daily, SCFO/AFD expressed reservations about the feasibility of implementing a system of labelling for the trade. He also pointed out that apart from killing the live fish under test, results of the existing mouse test performed with the assistance of the Department of Zoology of the University of Hong Kong might not be made available to Government within a short period of time.
13. Responding to Mr Henry WU's concerns, AD(H)/DH said that in tracking the sources of the 34 cases of ciguatoxin poisoning arising from consumption of ciguatera contaminated fish, the DH had good reasons to believe that the contaminated fishes were mostly tiger grouper imported from a new supplier in the Maldives. As for the quick field screening test which was being developed in USA, the result of such test could be available in around three hours but its accuracy was also not 100%. In this connection, the DH would continue to maintain close contacts with the WHO for other screening methods which might be developed in the future. Meanwhile, the DH would educate consumers through the public media to avoid intake of alcohol and nuts together with reef fishes in their meals because, if the reef fishes were contaminated, there was evidence that such combination of food would aggravate the symptoms and effects of ciguatoxin poisoning.
|14.In response to Dr LEONG Che-hung's enquiry, AD(H)/DH said that live marine fishes cultured in Hong Kong and overseas was almost 100% free from ciguatoxin. In this connection, Dr LEONG commented that in the interest of public health, the Administration should seriously consider the need for the establishment of an independent authority solely responsible for the enforcement of various legal regulations and requirements relating to the control of imported live marine fishes, food, PCM and herbs, western medicines and herbs, etc.
V.Prevention of Hepatitis A
(PLC Paper No. CB(2)958(03))
15.DDH briefed members on the key points of the Administration's paper on the subject.
16. In reply to Dr LEONG Che-hung's enquiries, DDH said that since the symptoms of Hepatitis A were not apparent in infected youths, he agreed that the current recorded number of Hepatitis A infection might not represent the actual number of cases in a year. With the existing infectious disease surveillance network, the DH was able to monitor the trends and activities of a full range of infectious diseases. Before an infectious disease could develop into an epidemic, the DH was well prepared to take necessary measures to prevent the spread of the disease. As far as prevention of viral hepatitis was concerned, the DH would continue to educate food handlers to maintain a high standard of food and personal hygiene, and as recommended by the WHO, advise them to take a vaccine injection against Hepatitis A. Given the high mobility of catering staff and that a large portion of them were employed on a part-time and temporary basis, it was in practice difficult to require that all food handlers must take a vaccine injection. Apart from publicity and education focusing on observance of good food and personal hygiene, the DH would strengthen the existing surveillance system, which was commonly accepted as the most effective means in preventing the spread of infectious diseases, to contain the occurrence of the disease in the long term. In reply to Dr LEONG's further enquiries, DDH said that the DH was considering to provide Hepatitis A vaccination to travellers visiting highly endemic area on a cost-recovery basis. As regards the availability of vaccine injection for food handlers, he said that private medical practitioners should be able to provide an efficient service. Responding to Mr Henry WU's concern, DDH added that currently travellers visiting highly endemic areas would be advised to consult general medical practitioners for Hepatitis A vaccination.
|17.As a practising traditional Chinese medicine practitioner, Mr MOK Ying-fan pointed out that young persons infected with Hepatitis A would display a symptom of tiredness. In view of a possible upsurge of Hepatitis A infections in 1998, he commented that the DH should consider requiring all food handlers to take a vaccine injection. DDH responded that so far there was no evidence suggesting that Hepatitis A would spread in 1998. Regarding the prevention of Hepatitis A by vaccination, the two advisory bodies, namely the Scientific Working Group on Viral Hepatitis Prevention and the Advisory Committee on Immunization, had discussed the issue and concluded that the most effective method for preventing hepatitis A disease in the community was observance of good food and personal hygiene. They jointly recommended that food handlers should be educated to maintain a high standard of food hygiene and be informed about the availability of a vaccine. In response to Dr LEONG's comments, DDH undertook to relay members views to the DH for consideration.
VI.Infectious disease surveillance and data collection/management
(PLC Paper No. CB(2)958(04))
At the Chairman's request, Consultant (Community Medicine) (Con(CM)) briefed members on the main points of the Administration's paper on the subject.
18. Dr LEONG Che-hung commented that the Administration's paper was too brief. Noting that the DH should in accordance with the Quarantine and Prevention of Disease Ordinance (Cap.141) work closely with other departments and health care providers to carry out the necessary investigations into source of infection, contact tracing and other preventive and control measures, he was concerned about the power and authority of the DH in overseeing follow-up actions for reported cases of infectious diseases. Referring to the dissemination of information on the latest development of Influenza A H5N1, he opined that the existing channels for distribution of information on infectious diseases to health care professionals and the general public were inadequate. In anticipation of the establishment of a highly automated Public Health Laboratory Centre (PHLC) in mid-2001, he urged the Administration to review the staffing position of the DH with the aim of enhancing its efficiency and effectiveness in carrying out its role in the prevention and control of communicable diseases. In response, Con(CM) said that in addition to the regular issue of the Public Health and Epidemiology Bulletin and annual reports, the DH would progressively upload information on infectious diseases and soft copies of the relevant notification forms onto the Internet to facilitate communication between the DH and private medical practitioners. In collaboration with the Urban Services Department (USD), the Regional Services Department (RSD) and the AFD, the DH had in the past year, as a result of the investigations into the sources of infectious diseases, exercised its statutory power to order owners of two local food factories and a Chinese restaurant to clean up and disinfect their premises to the satisfaction of the DH before they could resume operation. Since Influenza A H5N1 was a new human pathogen, the DH had provided private medical practitioners and health care services providers with professional guidelines and updated information at the earliest opportunities. In particular, based on the best available knowledge and experience, a briefing session on the H5N1 virus had been organized for private medical practitioners. DDH supplemented that the DH was considering the need to establish a special team to reinforce its on-going surveillance of infectious diseases. He added that the future automated PHLC, which would increase the Department's capacity for laboratory testing from the current 875 000 to 1.2 million tests per year, would enhance the efficiency of laboratory tests and consequently the effectiveness of Hong Kong's surveillance system for infectious diseases. Dr LEONG responded that in the light of the H5N1 incident, the Administration should review the communication between the public and the private health care sectors as well as the role and functions of the DH in the context of safeguarding the health of Hong Kong people.
19.Members agreed that the roles and functions of the three departments, i.e., the DH, the USD and the RSD; and the two municipal councils in relation to prevention and control of infectious diseases should be comprehensively reviewed. As a member of both the PLC and the Provisional Urban Council, Mr MOK Ying-fan commented that due to historical reasons, there were policies issues and organization constraints affecting the co-operation and efficiency of the two councils and the three departments. DS/HW responded that at the current level of resources and authorities, each of the three departments and two municipal councils had performed their functions in a smooth and effective manner. He assured members that the Administration would continuously review the situation with the aim of enhancing their co-operation and communication.
|20.Mr WONG Siu-yee enquired whether the future PHLC could enable the DH to complete sample tests for all consignments of food imported into Hong Kong before they were allowed to be distributed to the retail outlets. DDH briefly described the surveillance system for infectious diseases and the operation of the future PHLC in relation to sample testing on imported food. While the PHLC would substantially increase the capacity of laboratory testing and improve the efficiency and speed in tracing the source of infection, it would not be feasible to hold a consignment of food until the results of sample tests were available. In exceptional circumstances, the DH could prescribe special arrangements and mandatory sample tests for each consignment of a particular food imported from an identified source. At Mr Wong's request, DDH agreed to provide the Panel with further information on the functions and operations of the future PHLC as soon as practicable.
VII.Update on H5N1 Virus
21.Con(CM) said that the total of 18 confirmed cases of human infection of Influenza A H5N1 virus (the virus) had remained unchanged after the slaughtering of all live chickens in Hong Kong which was completed on 31 December 1997.
22.Responding to Mr WONG Siu-yee's enquiry about the source of infection, Con(CM) said that according to the Expert Working Group on H5N1, the virus was most likely transmitted from migratory water-fowl to live poultry and was then passed on to humans. Whilst the blood samples collected from the investigation of those confirmed H5N1 cases were being analyzed by the WHO, the import of live ducks and geese from the Mainland had been temporarily suspended to avoid cross-infection of H5N1 among live poultry in local farms, wholesale and retail markets. In order to minimize the risk of transmission of the virus in the long run, the Administration was considering the feasibility of formulating a long term segregation policy for the farming, transportation, slaughtering and trading of live chickens and water-fowl at all levels.
23.Mr CHAN Choi-hi was concerned that under the new quarantine system, some live chickens imported from the Mainland in plastic cages were found dead before the results of the quick H5 test conducted by the AFD were available. DS/HW replied that the AFD would continuously review the existing arrangements in the light of experience and collaborate with the Animal and Plant Quarantine Services in the Mainland to monitor the situation closely.
|24. While appreciating the joint efforts of the AFD, the RSD and the USD in ensuring that all local farms, retail and wholesale markets were exhaustively cleansed and disinfected before the resumption of import of live chickens from the Mainland, Dr LEONG Che-hung was concerned about the enforcement arrangements in the wholesale and retail markets. DS/HW replied that the AFD would inspect the hygiene standards of local chicken farms before re-issuing a licence to operators concerned. Together, the AFD, the USD and the RSD would ensure an acceptable level of hygiene standards in wholesale and retail poultry markets as well as supervise the implementation of the segregation policy to reduce the risk of cross-contamination of H5N1 virus among live poultry. Legislative measures to achieve such purposes would also be considered. In response to Dr LEONG's follow-up question on licensing arrangements, DS/HW said that the AFD would provide the Panel with a paper on licensing requirements and conditions for local poultry farms.
25.Referring to the analysis of blood samples collected from persons having direct and indirect contacts with those confirmed H5N1 patients, Mr MOK Ying-fan opined that the results of the analysis should be made available to the public. Con(CM) replied that the conduct of chemical analysis on blood samples for H5N1 virus was a complicated and time-consuming process because it was a virus newly known to cause human disease. The Centres for Disease Control and Prevention understood the seriousness of the matter and would report on the findings as early as practicable.
26.In reply to Mr CHAN Choi-hi's enquiry about the production of vaccines for H5N1 virus, Con(CM) said that at the request of the WHO, the four collaborating vaccine production centres in the world had been working hard to search for a suitable seed virus from which efficacious and safe vaccine for human use could be produced.
27.Referring to the motion passed at the last meeting on 12 January 1998, Dr LEONG asked whether the Administration would prepare a contingency plan in the form of a flow-chart in the event of an epidemic of influenza A H5N1. DS/HW explained that in the absence of a better understanding of the virus and its genetical structure, it was difficult to draw up a detailed plan without running the risk of being too simplistic.
VIII.Any other business
Recent cholera cases
28. Responding to Dr LEONG Che-hung's enquiries, Con(CM) said that there were a total of three confirmed cholera cases in early February 1998. The DH and other Government departments concerned had followed up the cases immediately and identified that the source of infection was cockles imported from a supplier in Thailand. AD(H)/DH supplemented that with the assistance of the trader concerned, the two municipal services departments had successfully advised all related retail outlets and restaurants to stop selling the cockles in the consignment suspected to be contaminated. In the light of the incident, the DH had strengthened the surveillance and sampling of seafood at retail level and would continue to enhance public education on personal and food hygiene, in particular the proper cooking and storage of shellfish.
29.There being no other business, the meeting ended at 11:00 am.
Provisional Legislative Council Secretariat
12 May 1998