Submitted by Dr LAI Kang Yiu, Consultant of the Intensive Care Unit, Queen Elizabeth Hospital on 30 May 2009
NEW! UPDATED 19 August 2009, VERSION  9
Extra information regarding use of High-dose N-Acetylcysteine

Click Read More to read Version 9.
Version 9, updated 19 August 2009 [High-dose N-Acetylcysteine]

Version 8, updated 2 August 2009

Version 7, updated 7 July 2009

Version 6, updated 29 June 2009

Version 5, updated 12 June 2009

Version 4, updated 3 June 2009

墨西哥的疫情對中國的啟示

從基因測試 2009 H1N1 豬流感是綜合病毒,含有四種不同的流感病毒基因,其中包括:北美洲的豬流感、歐亞型的豬流感、北美洲型的禽流感、及人類流感。其中 HA, NS1 and NP 則是於1918年傳入北美豬隻 。因此我們現今第一波時實已處身於1918年的第二波。

15歲以下小童染病率為 61%, 15歲以上為 29% 。但小童死亡率未有預期高。小童流感死亡率多因細菌混合感染併發症。流感的細菌混合感染三成至六成為肺炎鏈球菌及嗜血桿菌。墨西哥早於1999年已為小童提供免費 b型嗜血桿菌疫苗。及後更於2006為兩歲以下小童免費提供肺炎鏈球菌疫苗。因此現時四歲以下小童已為疫苗保障。

吸煙是流感死亡高危因素之一。因吸煙會令血小板活化因數增加,增加肺炎鏈球菌感染的機會。

中國的嬰兒死亡率與孕婦死亡率與墨西哥基本相近。墨西哥的疫情可於中國重演。但中國小童並沒b型嗜血桿菌和肺炎鏈球菌疫苗保障及中國成年人煙民數目及比例為世界之冠。因此疫情可能比墨西哥嚴峻。

中國因此應盡速為小童提供免費 b型嗜血桿菌和肺炎鏈球菌疫苗及呼籲成年煙民自行接種肺炎鏈球菌疫苗。

Version 3, updated 30 May 2009

Version 2, updated 27 May 2009:

Dr LAI would like to share with us his view on some possible preventive measures for the emerging pandemic of H1N1 influenza. Click Read More to see the summary of his presentation, download the presentation file, and leave your comments.

From Dr Lai, "This means that what has happened in Mexico would also be repeated in China. Worst of all, Mexico has included HIb vaccination in 1999 and PCV-7 in 2006. Therefore all the children <4 is protected. Therefore the mortality rate from 0-9 was low compared with other age group > 20. In China, there is no vaccination program."


Version 1, updated 21 May 2009:

- Analysis on the implication to China added because the maternal and infant mortality rate of Mexico and China are exactly the same.
- More information over the exact mortality rate in Mexico

 

  1. The 2009 H1N1 Human Swine Influenza has a high attack rate among children.  The mortality rate would increase 10x in the presence of bacterial co-infection.  Thirty to 80% of the co-infection are related to pneumococcus and Haemophilus influenzae, which are vaccine preventable.

    The government should prevent such complication by immunization programme.

     
  2. Many of our frontline staff who are working mothers and fathers have increased nasal colonization with pneumococcus.  Elderly (age>65) has increased cardiovascular and pneumonic mortality related to pneumococcal co-infection during influenza period.  Hong Kong pneumococcal population has high rate of penicillin resistance.

    The government should prepare the above at risk population against pneumococcal co-infection by vaccination before pandemic.

     
  3. Acetylcysteine 600mg b.d. has been show to reduce symptomatic influenza from 79% to 25% in elderly population.

    Before vaccine are available, acetylcysteine prophylaxis is an attractive option in conserving the existing workforce during a pandemic outbreak.

     
  4. Animal experiment has shown that acetylcysteine and Tamiflu have synergistic action in improving survival of mice against lethal influenza infection.

    Incorporation of acetylcysteine into the Tamiflu treatment regimen of human swine influenza infection should be considered.