Consumption of viscera as the most important risk factor in the largest outbreak of shellfish poisoning in Hong Kong, 2005.

Poisoning from shellfish toxins is associated with significant morbidity worldwide. During 10-15 March 2005, 36 clusters of shellfish poisoning related to consumption of fresh scallops (Atrina vexillum) were reported to the Center for Health Protection, Department of Health Hong Kong. We conducted a case-control study to identify the risk factors associated with shellfish poisoning. Detailed demographic, clinical, shellfish consumption data of these subjects were collected using standardized questionnaires. Fifty-eight cases and 44 controls were identified. The mean age for the cases was 37.5 years (range 10-81 years); 45% (n=26) were male. Ninety-five percent had onset of symptoms within 12 hours of consumption of scallops (range: 10 minutes to 30 hours, median: 45 minutes). Dizziness (87.9%) and blurred vision (53.4%) were the predominant symptoms. The mean number of pieces of scallop meat and viscera taken by the cases were 3.7 and 3.6, respectively, significantly higher than that for the controls, which were 1.6 (p<0.001) and 0.5 (p<0.001), respectively. Forty-two percent (n=22) and 19% (n=7) of cases and controls, respectively, took soup/sauce from the same dish that was cooked with the scallops (p=0.02). Consumption of scallop viscera was identified as the only significant risk factor (Adjusted OR=9.93, p=0.001) after adjusting for other risk factors. The result show that consumption of scallop viscera is an important risk factor for shellfish poisoning. The public should be warned specifically in health education messages to avoid eating viscera of scallops.

The threat of severe acute respiratory syndrome

Severe acute respiratory syndrome (SARS) is a recently recognized infectious disease associated with severe morbidity and mortality. It presents with non-specific signs and symptoms and because no definitive laboratory test is readily available, it poses a great risk to healthcare workers as well as difficulty in quarantine. The global response has been coordinated and enthusiastic in trying to understand and control this disease. Severe acute respiratory syndrome poses a threat to the Caribbean because of easy and convenient travel and the vibrant tourist industry

Síndrome agudo respiratorio severo: un panorama mundial de la epidemia / Severe acute respiratory syndrome: a global view of the epidemic

A principios de febrero de 2003 la Organización Mundial de la Salud comenzó a recibir reportes de pacientes con un síndrome caracterizado por neumonía atípica, con rápida progresión hacia insuficiencia respiratoria sin una causa identificada. Los casos aparentemente se iniciaron en el sur de China y se han diseminado a otras regiones en Asia, Europa, Sudáfrica, Norte América y Sur América. La causa de este síndrome es una nueva variedad de Coronavirus, aislado en secreciones respiratorias y en otras. El síndrome ha sido definido en inglés como SARS (Severe acute respiratory syndrome) por la Organización Mundial de la Salud y se caracteriza por un periodo de incubación de 1 a 10 días (promedio de cinco días), una fase febril prodrómica que aparece entre los días 1 a 3. Posteriormente, aparecen síntomas respiratorios como tos, disnea, y signos como hipoxemia, que en 10 a 40 por ciento de los casos requieren de ventilación mecánica. La tasa de letalidad ha variado de 3 por ciento hasta 16 por ciento. Los hallazgos de laboratorio incluyen trombocitopenia, leucopenia, elevación de creatinin-fosfokinasa, y, en ocasiones, de transaminasas hepáticas y deshidrogenasa láctica. El tratamiento incluye medidas de apoyo; la utilización empírica del antiviral ribavirina es controvertida, debido a que hasta el momento no existe un tratamiento específico. Se recomienda el aislamiento respiratorio de los pacientes, la utilización de máscaras protectoras y el lavado estricto de manos como principales medidas de prevención. Desde el inicio de esta epidemia México estableció un sistema de vigilancia, así como recomendaciones al personal de salud para la identificación, prevención de casos secundarios y manejo clínico de casos sospechosos

Adequacy and pitfalls of G6PD deficiency counseling in Hong Kong.

Glucose-6-Phosphate-Dehydrogenase (G6PD) deficiency is common in Hong Kong with an incidence of 4.5% in male and 0.36% in female (Lo et al. 1996).The Neonatal Screening Unit of Clinical Genetic Service started its territory-wide neonatal screening program for G6PD deficiency and congenital hypothyroidism in 1984 (Lam et al, 1986). Because of insufficient manpower and resource, we have been giving health counseling on the phone to parents of G6PD deficient babies and then refer them to nearby maternal and child health centres for monitoring of jaundice. The disease, mode of inheritance, recurrence risk and the precaution against certain medicines (Chan 1996) and chemicals are explained. The purpose (Lam, 1994) is to reassure the parents that their G6PD deficient babies can be as normal as everyone and that they can have normal life. Nevertheless, it has not been established whether telephone counseling has any effect on the affected family in the form of psychological trauma (Marteau, 1989; Fyro, 1987; Li et al, 1996) or significant influence on the decision on future reproduction. This study tried to evaluate the service from the parents' point of view by 1) gathering information on parents' awareness and perception of G6PD deficiency, 2) determination of parents' attitude towards the telephone counseling, and 3) finding out the effect of G6PD deficiency on parents' decision on future reproduction. Over 300 parents were contacted by telephone, and were asked to respond to questions on a questionnaire . The telephone interview focused on parents' understanding of G6PD deficiency, their attitude towards this disease and the possible effect on future reproduction decision. Results showed that over 90% of cases that we had counseled attended the maternal and child health centres. Most of them accepted the presence of G6PD deficiency in their family which did not affect their decision on future pregnancy. Telephone counseling failed to establish a helping relationship with the parent as face to face counseling was more personal. The findings revealed that though telephone counseling had its shortcoming it served the target group effectively. Telephone counseling is still the method of choice for the G6PD deficiency counseling in this locality.

Hospital admissions due to acute poisoning in the New Territories, Hong Kong.

To study the pattern of acute poisoning in the New Territories East of Hong Kong, 291 adult cases admitted to the Prince of Wales Hospital in 1989 were reviewed. The female-to-male ratio was 2.3 to 1 and the majority of patients (83%) were below the age of 40. The main poisons involved were hypnotics and sedatives (44.3%), household products (14.8%) and analgesics (10%). The poisoning was intentional in the majority of cases (98.6%). A specific antidote was necessary in 5.2% of cases. Four patients died after admission giving an overall mortality of 1.4%. When compared to the findings from other western countries, important variations in the pattern of acute poisoning were seen in Hong Kong. Firstly, a substantial proportion of drugs ingested were not dispensed labeled although their nature could usually be determined. Secondly, "Dettol", a household antiseptic, was commonly used in self-poisoning episodes. The lack of drug identification labeling on dispensed medicines outside hospitals is of great concern to all physicians in Hong Kong.

Disease profiles in Chinese in Hong Kong: an analysis of the primary diagnoses in 561 acute hospital medical admissions.

Little is known about the disease profiles in Chinese living in an urbanized community like Hong Kong. Accordingly, the discharge summaries of 561 acute hospital medical admissions were reviewed and the primary diagnoses (the main reason for admission or the most important clinical problem) were coded according to the International Classification of Diseases. Our data indicate that cardiovascular diseases are the most important cause of acute medical admissions and mortality and that gastrointestinal hemorrhage is very common amongst the Chinese in Hong Kong.

Hospitalizations due to acute pesticide poisoning in Hong Kong.

A review of 43 adult cases of pesticide poisoning admitted to the Prince of Wales Hospital in Hong Kong shows that acute exposures to pesticides are more often due to parasuicide (77%) than to accidents (23%). Most accidents are caused by contaminated green leafy vegetables. Serious intoxications or complications were seen in 11 patients (26%). Of the five fatalities, four were due to paraquat.

Current status of food-borne parasitic zoonoses in Hong Kong.

Although there have been no recent epidemiological studies on parasitic zoonoses in Hong Kong, the following diseases are known to occur locally: toxoplasmosis, clonorchiasis, fasciolopsiasis, cysticercosis, hydatidosis, sparganosis, trichinellosis, angiostrongyliasis, gnathostomiasis and trichostrongylosis. Most of them are due to the consumption of infected animals imported from China. Due to the general unawareness of parasitic diseases by physicians and health authorities, the importance of zoonoses has been under recognized.