Socioeconomic Patterns of COVID-19 Clusters in Low-Incidence City,Hong Kong

Although coronavirus disease (COVID-19) outbreaks have been relatively well controlled in Hong Kong, containment remains challenging among socioeconomically disadvantaged persons. They are at higher risk for widespread COVID-19 transmission through sizable clustering, probably because of exposure to social settings in which existing mitigation policies had differential socioeconomic effects.     

Restaurant-Based Measures to Control Community Transmission of COVID-19, Hong Kong

Controlling transmission in restaurants is an important component of public health and social measures for coronavirus disease. We examined the effects of restaurant measures in Hong Kong. Our findings indicate that shortening operating hours did not have an effect on time-varying effective reproduction number when capacity was already reduced.     

Acceptance of the COVID-19 vaccine based on the health belief model: A population-based survey in Hong Kong

BackgroundVaccines for COVID-19 are anticipated to be available by 2021. Vaccine uptake rate is a crucial determinant for herd immunity. We examined factors associated with acceptance of vaccine based on (1). constructs of the Health Belief Model (HBM), (2). trust in the healthcare system, new vaccine platforms and manufacturers, and (3). self-reported health outcomes.MethodsA population-based, random telephone survey was performed during the peak of the third wave of COVID-19 outbreak (27/07/2020 to 27/08/2020) in Hong Kong. All adults aged ≥ 18 years were eligible. The survey included sociodemographic details; self-report health conditions; trust scales; and self-reported health outcomes. Multivariable regression analyses were applied to examine independent associations. The primary outcome is the acceptance of the COVID-19 vaccine.ResultsWe conducted 1200 successful telephone interviews (response rate 55%). The overall vaccine acceptance rate after adjustment for population distribution was 37.2% (95% C.I. 34.5–39.9%). The projected acceptance rates exhibited a “J-shaped” pattern with age, with higher rates among young adults (18–24 years), then increased linearly with age. Multivariable regression analyses revealed that perceived severity, perceived benefits of the vaccine, cues to action, self-reported health outcomes, and trust in healthcare system or vaccine manufacturers were positive correlates of acceptance; whilst perceived access barriers and harm were negative correlates. Remarkably, perceived susceptibility to infection carried no significant association, whereas recommendation from Government (aOR = 10.2, 95% C.I. 6.54 to 15.9, p < 0.001) was as the strongest driving factor for acceptance. Other key obstacles of acceptance included lack of confidence on newer vaccine platforms (43.4%) and manufacturers without track record (52.2%), which are of particular relevance to the current context.ConclusionsGovernmental recommendation is an important driver, whereas perceived susceptibility is not associated with acceptance of COVID-19 vaccine. These HBM constructs and independent predictors inform evidence-based formulation and implementation of vaccination strategies.     

Factors associated with COVID-19 vaccination intent in Singapore,Australia and Hong Kong

BackgroundCOVID-19 pandemic has caused significant morbidity and mortality globally. As vaccines have been developed under expedited conditions, their safety and efficacy are being questioned by some populations leading to vaccine hesitancy, resulting in delayed vaccine uptake and herd immunity. This study aims to adopt a combination of Health Belief Model and other independent risk factors associated with high vaccine acceptance.MethodsAn anonymized cross-sectional survey was distributed between 15 January and 3 February 2021 across Singapore, Hong Kong and Australia among adult respondents through a certified online panel. Exploratory factor analysis and confirmatory factor analysis were carried out to assess perception constructs followed by multivariate regression modelling to assess factors associated with high vaccine acceptance against SARS_CoV-2.ResultsA total of 3,133 anonymised participants from Singapore (n = 1,009), Australia (n = 1,118) and Hong Kong (n = 1,006) completed the survey. While age and gender were not significantly associated, Asian ethnicity, current smokers and self-efficacy were significant associated factors of increased vaccine acceptance. While specific practices like taking micronutrients more frequently, cleaning and disinfecting their house more often were positively associated with increased vaccine acceptance, seeking medical help for COVID-19 symptoms like loss of smell/taste and overall COVID-19 knowledge score were negatively associated. Increased likelihood of vaccine acceptance was seen among those that obtained COVID-19 information less frequently and used digital media or non-health-related sources like influencers as a source of information. Among the eight perception constructs, perceived susceptibility and perceived response efficacy were positively associated, while perceived barriers were negatively associated with high vaccine acceptance.ConclusionWhile demographic parameters have weak association with vaccine acceptance, perceptions and practices parameters can help to better understand and influence vaccine acceptance. Study findings should provide guidance on the risk communication strategy to enhance vaccine acceptance for vaccination and boosters against new SARS-CoV-2 variants.     

新型冠状病毒进化、相关流行特征和特异性防控中的关键问题

阐明2022年春季上海市新型冠状病毒（SARS⁃CoV⁃2）感染暴发的流行病学特征,分析其发病趋势,并与同期吉林省和2020年初湖北省武汉市SARS⁃CoV⁃2感染暴发的发病特征进行比较。

收集上海市卫生健康委员会公布的2022年3月1日—4月18日的SARS⁃CoV⁃2阳性感染者每日新增本土确诊病例、新增境外确诊病例、每日新增本土无症状感染者、新增境外无症状感染者,进行描述性分析。

2022年3月1日—4月18日期间,SARS⁃CoV⁃2感染者报告397 933例,其中确诊病例27 613例,重症21例,死亡10例。感染的病毒为奥密克戎变异株BA.2。3月24日以后,病毒感染者数量迅速增加,呈暴发趋势。重症和死亡病例多为有严重基础疾病和缺乏疫苗接种者。无症状感染者占所有感染者的93.06%,显著高于同期吉林省疫情水平（48.08%,P<0.001）,确诊病例上升速度明显低于2020年初武汉疫情水平。每日新增境外输入确诊病例及无症状感染者呈下降趋势。

致使本次上海市暴发疫情的奥密克戎病毒具有较高的传染性和较低的致病能力,奥密克戎变异株在无症状携带者中迅速复制,使无症状者为主要传染源。SARS⁃CoV⁃2灭活疫苗完全接种可降低奥密克戎病毒株致病性和病死率,奥密克戎变异株很有可能通过气溶胶和飞沫混合传播,这为人口密度高和出行方式主要为公共交通的大城市新型冠状病毒肺炎疫情防控带来新挑战。

     

Three-Dose Primary Series of Inactivated COVID-19 Vaccine for Persons Living with HIV,Hong Kong

In a cohort of persons living with HIV in Hong Kong, surrogate virus neutralization testing for COVID-19 yielded a median level of 89% after the third dose of an inactivated COVID-19 vaccine, compared with 37% after the second dose. These results support using a 3-dose primary series for enhanced immune protection.     

A Bayesian Approach to Characterize Hong Kong Influenza Surveillance Systems

Objective

Our goal is to develop a statistical model for characterizing influenza surveillance systems that will be helpful in interpreting multiple streams of influenza surveillance data in future outbreaks.

Introduction

Syndromic surveillance has been widely used in influenza surveillance worldwide. However, despite the potential benefits created by the large volume of data, biases due to the changes in healthcare seeking behavior and physicians’ reporting behavior, as well as the background noise caused by seasonal flu epidemics, contribute to the complexity of the surveillance system and may limit its utility as a tool for early detection [1,2]. Since most current analysis methods are developed for outbreak detection, there are few tools to characterize influenza surveillance data for situational awareness purposes in a quantitative manner.Hong Kong Centre for Health Protection (CHP) has a comprehensive influenza surveillance system based on healthcare providers, laboratories, schools, daycare centers and residential care homes for the elderly. Hong Kong usually experiences a summer peak in July and August [3], which potentially doubles the data volume and constitutes a natural experiment to assess the effect of school-age children in the influenza transmission dynamics. The richness of the available data and the unique epidemiological characteristics make Hong Kong an ideal study object to develop and evaluate our model.

Methods

We have constructed a Bayesian statistical model for influenza surveillance data by parameterizing factors that describe disease transmission, behavior patterns in health care seeking and provision, and biases and errors embedded in the reporting process (Figure 1). The prior distributions are selected for each of the parameters to reflect knowledge of influenza epidemiology and the likely biases in each data system. Using the Markov Chain Monte-Carlo (MCMC) method in OpenBUGS, a posterior distribution can be generated for every parameter to characterize each data stream. The ratios of specific pairs of data streams are assessed in order to identify patterns in the change of ratios at different stage of the flu season.

Results

Preliminary results, as shown in Figure 2, incorporate confirmed influenza infection (solid line), influenza-like illness (double solid line), fever cases (dashed line), and Google search index (round dashed line). Although most of these data series track together, differences among them suggest reporting bias related to public awareness, which will be addressed in the statistical modeling.

Conclusions

The posterior distribution for parameters and ratios between individual data streams can be used to characterize influenza surveillance systems in terms of tendency in peak early or late, or to over or under represent actual influenza cases. To better interpret syndromic surveillance data for situational awareness purposes, behavioral data related to healthcare resource utilization, such as the percentage of intended GP visit among people with ILI, need to be collected together with the flu activity surveillance.Open in a separate windowConceptual model for influenza surveillance statistical modelBlue circles: unobservable true value; white boxes: observation; orange boxes: factorsOpen in a separate windowHong Kong flu activity in 2009 pH1N1 outbreak     

Effects of Nonpharmaceutical COVID-19 Interventions on Pediatric Hospitalizations for Other Respiratory Virus Infections,Hong Kong

To determine the effects of nonpharmaceutical interventions (NPIs) for coronavirus disease on pediatric hospitalizations for infection with respiratory viruses other than severe acute respiratory syndrome coronavirus 2, we analyzed hospital data for 2017–2021. Compared with 2017–2019, age-specific hospitalization rates associated with respiratory viruses greatly decreased in 2020, when NPIs were in place. Also when NPIs were in place, rates of hospitalization decreased among children of all ages for infection with influenza A and B viruses, respiratory syncytial virus, adenovirus, parainfluenza viruses, human metapneumovirus, and rhinovirus/enterovirus. Regression models adjusted for age and seasonality indicated that hospitalization rates for acute febrile illness/respiratory symptoms of any cause were reduced by 76% and by 85%–99% for hospitalization for infection with these viruses. NPIs in Hong Kong were clearly associated with reduced pediatric hospitalizations for respiratory viruses; implementing NPIs and reopening schools were associated with only a small increase in hospitalizations for rhinovirus/enterovirus infections.     

Psychobehavioral Responses and Likelihood of Receiving COVID-19 Vaccines during the Pandemic,Hong Kong

To access temporal changes in psychobehavioral responses to the coronavirus disease (COVID-19) pandemic, we conducted a 5-round (R1–R5) longitudinal population-based online survey in Hong Kong during January–September 2020. Most respondents reported wearing masks (R1 99.0% to R5 99.8%) and performing hand hygiene (R1 95.8% to R5 97.7%). Perceived COVID-19 severity decreased significantly, from 97.4% (R1) to 77.2% (R5), but perceived self-susceptibility remained high (87.2%–92.8%). Female sex and anxiety were associated with greater adoption of social distancing. Intention to receive COVID-19 vaccines decreased significantly (R4 48.7% to R5 37.6%). Greater anxiety, confidence in vaccine, and collective responsibility and weaker complacency were associated with higher tendency to receive COVID-19 vaccines. Although its generalizability should be assumed with caution, this study helps to formulate health communication strategies and foretells the initial low uptake rate of COVID-19 vaccines, suggesting that social distancing should be maintained in the medium term.     

Upper Respiratory Infections in Schools and Childcare Centers Reopening after COVID-19 Dismissals,Hong Kong

A large number of common cold outbreaks in Hong Kong schools and childcare centers during October–November 2020 led to territorywide school dismissals. Increased susceptibility to rhinoviruses during prolonged school closures and dismissals for coronavirus disease and varying effectiveness of nonpharmaceutical interventions may have heightened transmission of cold-causing viruses after school attendance resumed.     

Multilevel Determinants of COVID-19 Vaccine Uptake Among South Asian Ethnic Minorities in Hong Kong: Cross-sectional Web-Based Survey

BackgroundThe COVID-19 pandemic continues to have a disproportionate effect on ethnic minorities. Across countries, greater vaccine hesitancy has been observed among ethnic minorities. After excluding foreign domestic helpers, South Asians make up the largest proportion of ethnic minorities in Hong Kong. It is necessary to plan for COVID-19 vaccination promotional strategies that cater to the unique needs of South Asians in Hong Kong.ObjectiveThis study investigated the prevalence of COVID-19 vaccine uptake among a sample of South Asians in Hong Kong. We examined the effects of sociodemographic data and factors at individual level (perceptions), interpersonal level (information exposure on social media), and sociostructural level (cultural) based on the socioecological model.MethodsA cross-sectional web-based survey was conducted on May 1-31, 2021. Participants were South Asian people aged 18 years or older living in Hong Kong; able to comprehend English, Hindi, Nepali, or Urdu; and having access to a smartphone. Three community-based organizations providing services to South Asians in Hong Kong facilitated the data collection. The staff of the community-based organizations posted the study information in WhatsApp groups involving South Asian clients and invited them to participate in a web-based survey. Logistic regression models were fit for data analysis.ResultsAmong 245 participants, 81 (33.1%) had taken at least one dose of the COVID-19 vaccine (one dose, 62/245, 25.2%; and both doses, 19/245, 7.9%). After adjusting for significant background characteristics, cultural and religious reasons for COVID-19 vaccine hesitancy were associated with lower COVID-19 vaccine uptake (adjusted odds ratio [AOR] 0.83, 95% CI 0.71-0.97; P=.02). At the individual level, having more positive attitudes toward COVID-19 vaccination (AOR 1.31, 95% CI 1.10-1.55; P=.002), perceived support from significant others (AOR 1.29, 95% CI 1.03-1.60; P=.03), and perceived higher behavioral control to receive COVID-19 vaccination (AOR 2.63, 95% CI 1.65-4.19; P<.001) were associated with higher COVID-19 vaccine uptake, while a negative association was found between negative attitudes and the dependent variable (AOR 0.73, 95% CI 0.62-0.85; P<.001). Knowing more peers who had taken the COVID-19 vaccine was also associated with higher uptake (AOR 1.39, 95% CI 1.11-1.74; P=.01). At the interpersonal level, higher exposure to information about deaths and other serious conditions caused by COVID-19 vaccination was associated with lower uptake (AOR 0.54, 95% CI 0.33-0.86; P=.01).ConclusionsIn this study, one-third (81/245) of our participants received at least one dose of the COVID-19 vaccine. Cultural or religious reasons, perceptions, information exposure on social media, and influence of peers were found to be the determinants of COVID-19 vaccine uptake among South Asians. Future programs should engage community groups, champions, and faith leaders, and develop culturally competent interventions.     

Monitoring International Travelers Arriving in Hong Kong for Genomic Surveillance of SARS-CoV-2

We sequenced ≈50% of coronavirus disease cases imported to Hong Kong during March–July 2021 and identified 70 cases caused by Delta variants of severe acute respiratory syndrome coronavirus 2. The genomic diversity detected in Hong Kong was similar to global diversity, suggesting travel hubs can play a substantial role in surveillance.     

Teleconsultation adoption since COVID-19: Comparison of barriers and facilitators in primary care settings in Hong Kong and the Netherlands

The COVID-19 pandemic has boosted the adoption of digital health technologies such as teleconsultation. This research aimed to assess and compare barriers and facilitators for teleconsultation uptake for primary care practitioners in Hong Kong and the Netherlands and evaluate the role of their different healthcare funding models in this adoption process within the context of the COVID-19 pandemic.A qualitative research following a social constructivist paradigm was performed. The study employed a conceptual framework from Lau and colleagues that identifies four levels of factors influencing change in primary care: (1) external contextual factors; (2) organization-related factors; (3) professional factors; and (4) characteristics of the intervention. The four levels were studied through semi-structured, open-ended interviews with primary care physicians. External factors were additionally assessed by means of a literature review.Hong Kong and the Netherlands showed different penetration rates of teleconsultation. Most stakeholders in both settings shared similar barriers and facilitators in the organizational, professional, and intervention levels. However, external contextual factors (i.e., current teleconsultation legislation, available incentives, and level of public awareness) played an important and differing role in teleconsultation uptake and had a direct effect on the organization, the professionals involved, and the type of technology used. Political and organizational actions are required to develop a comprehensive legal framework for the sustainable development of teleconsultation in both settings.     

新型冠状病毒肺炎疫情期间的流感病毒监测结果分析

目的 了解新型冠状病毒肺炎疫情期间的流感病毒监测结果,探讨新冠肺炎疫情防控措施对流感病毒感染的影响.方法 收集珠海金湾中心医院2019年春季(1月20日-4月30日)与2020年春季(1月20日-4月30日)两年同期的流感样病例的咽拭子标本,共计4 527份,采用胶体金免疫层析技术检测甲型流感(Flu A)病毒抗原、乙型流感(Flu B)病毒抗原,并对检验结果进行回顾性分析.结果 2019年春季与2020年春季分别检测流感样咽拭子标本2 455份、2 072份,甲型流感病毒抗原阳性检出率分别为6.92％、3.19％,乙型流感病毒抗原阳性检出率分别为3.42％、0.29％.2020年春季的流感病毒抗原阳性检出率显著低于2019年春季,差异有统计学意义(x2=79.389,P＜0.01).与2019年春季(13.50％)相比,2020年春季小于15岁儿童的流感样病例的流感病毒抗原阳性检出率(6.57％)明显降低,差异有统计学意义(X2 = 14.090,P＜0.05),15～60岁的成年人的流感病毒抗原阳性检出率也明显降低,2019年春季和2020年春季分别为8.44％和2.62％,差异有统计学意义(x2 = 46.578,P＜0.05),而 60岁以上老年人的流感病毒抗原阳性检出率虽然降低了 3.80％,但差异无统计学意义(x2 = 2.431,P＞0.05),女性 与男性的流感阳性检出率也无明显差异(P＞0.05).结论 新型冠状病毒肺炎疫情期间,甲、乙型流感病毒阳性检出率均降低,表明疫情期间的防控措施对流感病毒的传播同样具有控制作用.     

SARS-CoV-2 in Quarantined Domestic Cats from COVID-19 Households or Close Contacts,Hong Kong,China

We tested 50 cats from coronavirus disease households or close contacts in Hong Kong, China, for severe acute respiratory syndrome coronavirus 2 RNA in respiratory and fecal samples. We found 6 cases of apparent human-to-feline transmission involving healthy cats. Virus genomes sequenced from 1 cat and its owner were identical.     

The Use of Cremation Data for Timely Mortality Surveillance During the COVID-19 Pandemic in Ontario,Canada: Validation Study

BackgroundEarly estimates of excess mortality are crucial for understanding the impact of COVID-19. However, there is a lag of several months in the reporting of vital statistics mortality data for many jurisdictions, including across Canada. In Ontario, a Canadian province, certification by a coroner is required before cremation can occur, creating real-time mortality data that encompasses the majority of deaths within the province.ObjectiveThis study aimed to validate the use of cremation data as a timely surveillance tool for all-cause mortality during a public health emergency in a jurisdiction with delays in vital statistics data. Specifically, this study aimed to validate this surveillance tool by determining the stability, timeliness, and robustness of its real-time estimation of all-cause mortality.MethodsCremation records from January 2020 until April 2021 were compared to the historical records from 2017 to 2019, grouped according to week, age, sex, and whether COVID-19 was the cause of death. Cremation data were compared to Ontario’s provisional vital statistics mortality data released by Statistics Canada. The 2020 and 2021 records were then compared to previous years (2017-2019) to determine whether there was excess mortality within various age groups and whether deaths attributed to COVID-19 accounted for the entirety of the excess mortality.ResultsBetween 2017 and 2019, cremations were performed for 67.4% (95% CI 67.3%-67.5%) of deaths. The proportion of cremated deaths remained stable throughout 2020, even within age and sex categories. Cremation records are 99% complete within 3 weeks of the date of death, which precedes the compilation of vital statistics data by several months. Consequently, during the first wave (from April to June 2020), cremation records detected a 16.9% increase (95% CI 14.6%-19.3%) in all-cause mortality, a finding that was confirmed several months later with cremation data.ConclusionsThe percentage of Ontarians cremated and the completion of cremation data several months before vital statistics did not change meaningfully during the COVID-19 pandemic period, establishing that the pandemic did not significantly alter cremation practices. Cremation data can be used to accurately estimate all-cause mortality in near real-time, particularly when real-time mortality estimates are needed to inform policy decisions for public health measures. The accuracy of this excess mortality estimation was confirmed by comparing it with official vital statistics data. These findings demonstrate the utility of cremation data as a complementary data source for timely mortality information during public health emergencies.     

Implementing a Pilot Work Injury Management Program in Hong Kong

Introduction This paper reports the results of implementing a pilot case management system for work injuries in Hong Kong. The case management approach was characterized by use of a case manager who worked closely with each of the reported injury cases. The case manager undertook the roles of assessor, referral agent, counselor, work-site liaison, and return-to-work (RTW) expert. Methods A quasi-experimental study design was used. The study compared the RTW and workers’ compensation outcomes in injured workers in a cleaning company in a case management group (n = 296) and a conventional rehabilitation group (n = 137). Outcomes of the intervention were followed up at 6 months. Results The results indicated that the RTW rate was 97.0% and 94.2% for the case management and conventional rehabilitation groups respectively, with no significant differences between them. Participants in the case management group had significantly fewer days of sick leave (mean = 27.5 and 41.6 days, respectively) and lower compensation costs (mean = HK$7,212.2 and $20,617.3, respectively) than those in the comparison group. Age of the participants was found to influence the outcomes with those who were between 41 and 50 years old and received case management intervention had shorter sick leave and lower cost of compensation than their conventional rehabilitation counterpart. The majority of the participants who had returned to work in both the case management (95.8%) and the conventional rehabilitation (96.2%) groups were found to maintain their work status 6 months after the intervention. Implications The findings suggested that applying the case management approach to the Hong Kong workers’ compensation system was more effective overall. Nevertheless, the inherent problems associated with implementing such an approach within the existing system, which focuses on compensation and medical interventions, remained unresolved.