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In March–June 2023, we conducted a test-negative study in 1671 children who were hospitalized with acute respiratory illness in Hong Kong. Two hundred and eighty-six children (17.2%) were tested positive for influenza virus including 188 with A(H1N1). We estimated influenza vaccine effectiveness against influenza-associated hospitalization as 69.6% (95% confidence interval: 49.3%, 81.7%). [ABSTRACT FROM AUTHOR]

Disruption of the lung endothelial barrier is a hallmark of acute respiratory distress syndrome (ARDS), for which no effective pharmacologic treatments exist. Prior work has demonstrated that FTY720 S-phosphonate (Tys), an analog of sphingosine-1-phosphate (S1P) and FTY720, exhibits potent endothelial cell (EC) barrier protective properties. In this study, we investigated the in vitro and in vivo efficacy of Tys against methicillin-resistant Staphylococcus aureus (MRSA), a frequent bacterial cause of ARDS. Tys-protected human lung EC from barrier disruption induced by heat-killed MRSA (HK-MRSA) or staphylococcal a-toxin and attenuated MRSA-induced cytoskeletal changes associated with barrier disruption, including actin stress fiber formation and loss of peripheral VE-cadherin and cortactin. Tys-inhibited Rho and myosin light chain (MLC) activation after MRSA and blocked MRSAinduced NF-κB activation and release of the proinflammatory cytokines, IL-6 and IL-8. In vivo, intratracheal administration of live MRSA in mice caused significant vascular leakage and leukocyte infiltration into the alveolar space. Pre- or posttreatment with Tys attenuated MRSA-induced lung permeability and levels of alveolar neutrophils. Posttreatment with Tys significantly reduced levels of bronchoalveolar lavage (BAL) VCAM-1 and plasma IL-6 and KC induced by MRSA. Dynamic intravital imaging of mouse lungs demonstrated Tys attenuation of HK-MRSA-induced interstitial edema and neutrophil infiltration into lung tissue. Tys did not directly inhibit MRSA growth or viability in vitro. In conclusion, Tys inhibits lung EC barrier disruption and proinflammatory signaling induced by MRSA in vitro and attenuates acute lung injury induced by MRSA in vivo. These results support the potential utility of Tys as a novel ARDS therapeutic strategy. [ABSTRACT FROM AUTHOR]

Seven species of coronavirus cause acute respiratory illness in humans. Coronavirus HKU 1 (CoV HKU 1) was first described in 2005 in an adult patient with pneumonia in Hong Kong. Although it is a well-known respiratory tract pathogen, there is not much information about its role in hospitalized adults, especially in southern Europe. Here, we describe a case of radiologically demonstrated CoV HKU 1-related bronchiolitis with acute respiratory failure in an adult female without significant comorbidities except obesity. [ABSTRACT FROM AUTHOR]

Background: Acute respiratory infections (ARI) are a major cause of sickness absenteeism among health care workers (HCWs) and contribute significantly to overall productivity loss particularly during influenza epidemics. The purpose of this study is to quantify the increases in absenteeism during epidemics including the 2009 influenza A(H1N1)pdm09 pandemic.Methods: We analysed administrative data to determine patterns of sickness absence among HCWs in Hong Kong from January 2004 through December 2009, and used multivariable linear regression model to estimate the excess all-cause and ARI-related sickness absenteeism rates during influenza epidemics.Results: We found that influenza epidemics prior to the 2009 pandemic and during the 2009 pandemic were associated with 8.4 % (95 % CI: 5.6-11.2 %) and 57.7 % (95 % CI: 54.6-60.9 %) increases in overall sickness absence, and 26.5 % (95 % CI: 21.4-31.5 %) and 90.9 % (95 % CI: 85.2-96.6 %) increases in ARI-related sickness absence among HCWs in Hong Kong, respectively. Comparing different staff types, increases in overall absenteeism were highest among medical staff, during seasonal influenza epidemic periods (51.3 %, 95 % CI: 38.9-63.7 %) and the pandemic mitigation period (142.1 %, 95 % CI: 128.0-156.1 %).Conclusions: Influenza epidemics were associated with a substantial increase in sickness absence and productivity loss among HCWs in Hong Kong, and there was a much higher rate of absenteeism during the 2009 pandemic. These findings could inform better a more proactive workforce redistribution plans to allow for sufficient surge capacity in annual epidemics, and for pandemic preparedness. [ABSTRACT FROM AUTHOR]

In Hong Kong during the severe acute respiratory syndrome outbreak of 2003, sustained uncertainty caused daily stress for residents for > 3 months. Expectant women experienced unexpected social disruption and isolation within their day-to-day life that have not been described in their own voice. The purpose of this study was to describe the experiences of women who became mothers during the outbreak and the ways in which these experiences impacted their early post-partum mothering. A phenomenological research design was chosen. The participants' responses then led the interview process. As the women's experiences had many similarities, saturation was reached after eight interviews. Four themes emerged: living with uncertainty, intense vigilance, isolation, and disrupted expectations. The participants spoke of disrupted daily routines as they tried to eliminate their risk of contracting this disease, including relationship difficulties with their spouse. None of the women had the birth experience they had hoped for because of changes in hospital practices. [ABSTRACT FROM AUTHOR]

Background: The outcome is reported of a prospective uncontrolled study based on a stepwise treatment protocol during an outbreak of severe acute respiratory syndrome (SARS) in Hong Kong.Method: One hundred and thirty eight patients were treated with broad spectrum antibiotics, a combination of ribavirin and low dose corticosteroid, and then intravenous high dose methylprednisolone according to responses. Sustained response to treatment was defined as (1) defervescence for > or =4 consecutive days, (2) resolution of lung consolidation by >25%, and (3) oxygen independence by the fourth day without fever. Patients with defervescence who achieved either criterion 2 or 3 were classified as partial responders. Patients who fell short of criteria 2 and 3 were non-responders.Results: Laboratory confirmation of SARS coronavirus infection was established in 132 (95.7%). None responded to antibiotics but 25 (18.1%) responded to ribavirin + low dose corticosteroid. Methylprednisolone was used in 107 patients, of whom 95 (88.8%) responded favourably. Evidence of haemolytic anaemia was observed in 49 (36%). A high level of C-reactive protein at presentation was the only independent predictor for use of methylprednisolone (odds ratio 2.18 per 10 mg/dl increase, 95% confidence interval 1.12 to 4.25, p = 0.02). Thirty seven patients (26.8%) required admission to the intensive care unit and 21 (15.2%) required invasive mechanical ventilation. There were 15 deaths (mortality rate 10.9%), most with significant co-morbidities, whereas 122 (88.4%) had been discharged home 4 months after the outbreak onset.Conclusion: The use of high dose pulse methylprednisolone during the clinical course of a SARS outbreak was associated with clinical improvement, but randomised controlled trials are needed to ascertain its efficacy in this condition. [ABSTRACT FROM AUTHOR]

Severe acute respiratory syndrome (SARS) is now a global public health threat with many medical, ethical, social, economic, political, and legal implications. The nonspecific signs and symptoms of this disease, coupled with a relatively long incubation period and the initial absence of a reliable diagnostic test, limited the understanding of the magnitude of the outbreak. This paper outlines our experience with public health issues that have arisen during this outbreak of SARS in Hong Kong. We confirmed that case detection, reporting, clear and timely dissemination of information, and strict infection control measures are essential in handling such an infectious disease outbreak. The need for an outbreak response unit is crucial to combat any future outbreak. [ABSTRACT FROM AUTHOR]

In March 2003, there was an outbreak of atypical pneumonia in Hong Kong. The World Health Organization has termed the illness severe acute respiratory syndrome (SARS). The disease is highly contagious and has spread rapidly throughout the world. Globally, there were more than 3000 reported cases and 154 related deaths as of April 14, 2003. We report a case of an eighty-one-year-old woman who sustained an intertrochanteric fracture. Her postoperative course was complicated by a suspected aspiration pneumonia. She did not have the typically reported clinical features of SARS or a definite history of contact with a patient with SARS. She died of severe respiratory failure. An autopsy showed typical findings of SARS.

The novel coronavirus Covid-19 follows transmission route and clinical presentation of all community-acquired coronaviruses. Instead, the rate of transmission is significative higher, with a faster spread of the virus responsible of the worldwide outbreak and a significative higher mortality rate due to the development of a severe lung injury. Most noteworthy is the distribution of death rate among age groups. Children and younger people are almost protected from severe clinical presentation. Possible explanation of this phenomenon could be the ability of past vaccinations (especially tetanic, diphtheria toxoids and inactivated bacteria as pertussis) to stimulate immune system and to generate a scattered immunity against non-self antigens in transit, as coronaviruses and other community-circulating viruses and make immune system readier to develop specific immunity against Covid-19. The first support to this hypothesis is the distribution of mortality rate during historical pandemics ("Spanish flu" 1918, "Asian flu" 1956 and "the Hong Kong flu" 1968) among age groups before and after the introduction of vaccines. The immunological support to the hypothesis derives from recent studies about immunotherapy for malignancies, which propose the use of oncolytic vaccines combined with toxoids in order to exploit CD4 + memory T cell recall in supporting the ongoing anti-tumour response. According to this hypothesis vaccine formulations (tetanus, diphtheria, Bordetella pertussis) could be re-administrate after the first contact with Covid-19, better before the development of respiratory severe illness and of course before full-blown ARDS (Acute Respiratory Distress Syndrome). The CD4 + memory exploiting could help immune system to recall immunity of already know antigens against coronaviruses, avoiding or limiting "lung crash" until virus specific immunity develops and making it faster and prolonged. Finally, this administration could be helpful not only in already infected patients, but also before infection. In fact, people could have an immune system more ready when the contact with the Covid-19 will occur. [ABSTRACT FROM AUTHOR]

Background: Placenta previa remains one of the major causes of massive postpartum hemorrhage and maternal mortality worldwide.Objective: To determine whether internal iliac artery balloon occlusion during cesarean delivery for placenta previa could reduce postpartum hemorrhage and other maternal complications.Study Design: This was a prospective randomized controlled trial conducted at a tertiary university obstetric unit in Hong Kong. Pregnant women who were diagnosed to have placenta previa at 34 weeks (defined as lower placenta edge within 2 cm from the internal os) and required cesarean delivery were invited to participate. Eligible pregnant women were randomized into internal iliac artery balloon occlusion (Occlusion) group or standard management (Control) group. Those randomized to the Occlusion group had internal iliac artery balloon catheter placement performed before cesarean delivery and then balloon inflation after delivery of the baby. The primary outcome was the reduction of postpartum hemorrhage in those with internal iliac artery balloon occlusion. Secondary outcome measures included hemoglobin drop after delivery; amount of blood product transfusion; incidence of hysterectomy; maternal complications including renal failure, ischemic liver, disseminated intravascular coagulation, and adult respiratory distress syndrome; length of stay in hospital; admission to intensive care unit; and maternal death.Results: Between May 2016 and September 2018, 40 women were randomized (20 in each group). Demographic and obstetric characteristics were similar between the 2 groups. In the Occlusion group, 3 women did not receive the scheduled procedure, as it was preceded by antepartum hemorrhage that required emergency cesarean delivery, and 1 woman had repeated scan at 36 weeks showing the placental edge was slightly more than 2 cm from the internal os. Intention-to-treat analysis found no significant differences between the Occlusion and the Control groups regarding to the median intraoperative blood loss (1451 [1024-2388] mL vs 1454 [888-2300] mL; P = .945), the median length of surgery (49 [30-62] min vs 37 [30-51] min; P = .204), or the need for blood transfusion during operation (57.9% vs 50.0%; P = .621). None of the patients had rebleeding after operation, complication related to internal iliac artery procedure, or any other maternal complications. Reanalyzing the data using on-treatment approach showed the same results.Conclusion: The use of prophylactic internal iliac artery balloon occlusion in placenta previa patients undergoing cesarean delivery did not reduce postpartum hemorrhage or have any effect on maternal or neonatal morbidity. [ABSTRACT FROM AUTHOR]

Most community acquired pneumonia's are bacterial and the hospitalized patient, often elderly, is rapidly rendered pathogen free by broad spectrum antibiotics. It was therefore an unpleasant and unexpected surprise when a cluster of hospital staff and trainee medical students in a Hong Kong hospital became ill with cough, breathlessness and a high temperature. A World Health Organization epidemiologist, C. Urbani, categorized the new clinical syndrome severe acute respiratory syndrome in Vietnam in February 2003 and later died of the virus which is now named after him. There has therefore been substantial virological and scientific investment in this area to monitor birds, pigs and humans for new influenza viruses and two outbreaks with family deaths of influenza H5 (avian type) have been described over the last 3 years as of July 2003.

Presents an update on the 2003 worldwide outbreak of Severe Acute Respiratory Syndrome (SARS) from the U.S. Centers for Disease Control (CDC). Updating of the case definition for the atypical pneumonia; Recommendation from the World Health Organization that trips to Hong Kong and Guangdong Province of China be postponed; Implementation of enhanced surveillance by the CDC to detect possible SARS cases among travelers returning to the U.S. from China.

Plagues are as certain as death and taxes. The emergence of new human infectious diseases or viruses is unsurprising. Severe acute respiratory syndrome was first recognised at the end of February 2003 in Hanoi, Vietnam. The most common early systemic symptoms in Hong Kong and Hanoi include fever, malaise, myalgia, headache, and dizziness. By the third week in March several hundred probable cases of the syndrome had been reported worldwide, with epidemiologically linked clusters in Hanoi, Vietnam, Hong Kong, Singapore, and Toronto, Ontario, and further linked cases in New Jersey, California, and Bangkok, Thailand.

Reports on the number of severe acute respiratory syndrome (SARS) cases in Hong Kong. Number of related deaths; Description of the practice of medicine in Hong Kong; Formulation of infection-control procedures in hospitals and public health measures.

Reports that the outbreak of severe acute respiratory syndrome (SARS) seems to have peaked in Canada, Hong Kong, Singapore, and Vietnam, according to the World Health Organization. Number of cases that have been reported; Concern that the disease will become endemic in some countries if it is not brought under control; Numbers in China that are expected to continue to climb; Measures that are being implemented by the Chinese government to try to contain SARS.

Presents a bulletin about severe acute respiratory syndrome (SARS) from infectious disease physicians affiliated with hospitals in Hong Kong, China. Confirmation that the virus was a coronavirus and that SARS patients demonstrated a specific antibody response against the infected cell lines.

Reports that scientists at the University of Hong Kong's department of microbiology believe the cause of the outbreak of severe acute respiratory syndrome is a strain of the coronavirus. Use of the polymerase chain reaction technology and an immunofluorescent antibody test to identify the virus; Belief that the disease originated with animals; Findings of the U.S. Centers for Disease Control and Prevention; Possibility of airborne transmission; Instances of death with the severe acute respiratory syndrome; Criticism of the Chinese authorities for not providing timely notification of the outbreak; Role of the World Health Organization in researching and treating the epidemic; Quarantines enforced in Hong Kong in an effort to contain the virus; Outbreak of the virus in Canada.

Reports that Hong Kong virus is spreading worldwide. Cases of severe acute respiratory syndrome, an atypical pneumonia that emerged in March 2003 in Hong Kong and Vietnam, have now been reported in 14 countries. The total includes 37 suspected and probable cases in 18 US states, although the latest available figures from the US Centers for Disease Control and Prevention put the total at 39. On March 10, 2003 researchers at the Chinese University of Hong Kong announced that they had isolated the mystery virus and identified it as a member of the paramyxovirus family, a large family that includes the viruses that cause measles, mumps, and various respiratory infections. Researchers in the U.S. cultured a new coronavirus in the same family as viruses that cause colds and upper respiratory tract infections and this is the CDC's leading hypothesis for the cause of the infection.

Discusses how the World Health Organization has issued a global alert as a result of cases of severe acute respiratory syndrome. How 150 cases of the illness have been found in Vietnam, Hong Kong, Thailand, and Singapore; Speculation that the outbreaks are related; Lack of identification for the index case in Hong Kong.