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   香港醫學會警告冬季或現「雙重疫情」

呼籲公眾接種流感疫苗「防疫未然」

新冠疫情延續至今已近三年，針對新冠病毒病而實施的「非藥物性介入措施」，如戴口罩、社交距離等，除了令新冠疫情獲得控制外，同步也讓流行性感冒（流感）幾乎在本港絕跡。但隨著新冠疫情趨穩，國際、本地防疫措施逐漸復常，流感恐怕會出現一波反彈。國際上，英美多國先後已發出警告，今年冬天或會因為流感再度流行、加上新冠疫情升溫而導致「雙重流行病疫情」。政府的季節性流感疫苗接種計劃於今日（10月6日）展開，而衛生署下的疫苗可預防疾病科學委員會建議今年接種的疫苗成份有下列幾種^[1]：

香港醫學會亦於今日（10月6日）舉辦記者會，由會長鄭志文醫生率領一眾醫生會董，親身示範接種流感疫苗，藉此提醒市民對接種流感疫苗的迫切性。

香港醫學會傳染病顧問委員會聯席主席曾祈殷醫生在記者會中指出，澳洲今年出現了流感大爆發，確診宗數在8月已超過20萬宗，創下五年新高^[2]。其流感高峰期往常為6月到9月，但今年不但提早開始，當中大部分病例由甲型流感引起，更容易導致嚴重流行病^[3]。曾祈殷醫生認為，這些南半球國家的數據能有助預測今年冬季北半球的流感嚴重程度，市民必須提高防疫意識，「防疫於未然」。另一位聯席主席曹忠豪醫生則指，由於過去三年本港幾乎沒有自然流感感染，當前市民對流行病毒的免疫力已大幅下降；而長者、兒童等以往較少外出或社交接觸的群組，情況將會更加嚴重。他提醒流感疫苗需時兩週才能有效發揮作用，高風險人士，如長者、兒童及長期病患者應在流感高峰期前接種，及時築起免疫屏障。

對於有部分市民擔心流感疫苗副作用而不想接種，本身是心臟科專科醫生的醫學會義務司庫蘇睿智醫生指出，嚴重流感會增加體內炎症，甚至觸發免疫風暴，加強凝血，從而增加心臟病發及中風機會；更有外國研究顯示，在流感發病後一星期，心肌梗塞和中風風險分別會增加10倍和8倍^[4]；而接種疫苗則可減少心臟病相關情況達15至45％^[5]。他強調，除之前提及的高風險人士外，心臟病患者及曾經中風的人士亦要格外小心。

醫學會副會長陳沛然醫生認為，由於本港新冠疫情尚未結束，如果加上冬季流感爆發，「一波未平，一波又起」，將對本港醫療系統構成龐大壓力。他提醒50歲或以上市民，現時可以透過社區疫苗接種中心，預約同時接種新冠、流感兩款疫苗。他亦建議政府和醫管局需及早作好準備，增加床位、人手等軟硬件配套，以提升公院在高峰期間的應變能力。

醫學會會長鄭志文醫生指，過去三年社會較著眼於新冠疫情，導致市民或對流感「掉以輕心」。去年兒童、長者及高風險人士的流感疫苗接種率比2020/21年下降了6%^[6]，即減少7萬8千多人。他認為即使口罩令仍然持續，但社交距離措施已大為放寬，兒童等亦開始回復實體課，感染風險遠較過去三年為高；一旦雙重感染新冠病毒及流感，研究顯示住院死亡風險更會大增2.35倍^[7]。鄭志文醫生最後提醒市民，若對注射疫苗有任何疑問，或不知道自己是否適合接種，可先向醫生尋求意見。

二零二二年十月六日

參考資料：

[1] Frequently Asked Questions on Seasonal Influenza Vaccination for the 2022/23 Session in Hong Kong, Department of Health. https://www.chp.gov.hk/en/features/100764.html

[2] Bi-weekly Influenza Situation Update, WHO, https://www.who.int/docs/default-source/wpro---documents/emergency/surveillance/seasonal-influenza/influenza-20220824.pdf?sfvrsn=4f9b0451_105

[3] “Is the UK prepared for seasonal influenza in 2022–23 and beyond?”, The Lancet (Infectious Diseases), https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00503-5/fulltext

[4] Laboratory-confirmed respiratory infections as triggers for acute myocardial infarction and stroke: a self-controlled case series analysis of national linked datasets from Scotland, https://pubmed.ncbi.nlm.nih.gov/29563170/

[5] Acute Cardiovascular Events Associated With Influenza in Hospitalized Adults, Annals of Internal Medicine, https://www.acpjournals.org/doi/10.7326/M20-1509　

[6]過去三年疫苗接種計劃的統計數字, https://www.chp.gov.hk/tc/features/102226.html

[7] SARS-CoV-2 co-infection with influenza viruses, respiratory syncytial virus, or adenoviruses, The Lancet, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00383-X/fulltext

                                                                                                          *********************************************************************                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      6 October 2022   

                                The HKMA Warns of "Twindemic" In Winter And Call For Flu Vaccination Now For Early Prevention                      

The COVID-19 pandemic has persisted for nearly three years. Consequently, using "Non-Pharmaceutical Interventions" against the pandemic, such as masks wearing and social distancing, not only brought the pandemic under control but also made seasonal influenza (flu) almost disappear in Hong Kong. However, as the COVID-19 pandemic stabilizes and international and local anti-epidemic measures gradually return to normal, the flu may have a chance to rebound this year. Western countries such as the UK and the US have warned that this winter could be the first time we see the effects of the so-called "twindemic", with both COVID and flu in full circulation. Locally, the Government's seasonal influenza vaccination (SIV) programme was launched today (6 October). This year the Scientific Committee on Vaccine Preventable Diseases of Department of Health made the following vaccines recommendation^[8]:

The Hong Kong Medical Association (HKMA) held a press conference on the same day, with Dr CHENG Chi Man, President of the HKMA, leading a group of doctor council members to demonstrate SIV vaccination on the spot in order to raise public awareness.

Dr TSANG Kay Yan, Co-Chairman of the Advisory Committee on Communicable Diseases of the HKMA, pointed out at the press conference that there had been a significant flu outbreak in Australia this year, and the number of cases exceeded 200,000 in August^[9], hitting a five-year high. The peak season of flu usually started from June to September in Australia, but this year not only it started earlier, but most of the cases were due to influenza A (H3N2), which was known to cause more severe epidemics^[10]. Dr TSANG believed that the data from the southern hemisphere warned of an earlier and more severe flu season in the northern hemisphere. The public must boost their awareness of a potential flu outbreak and "stop it before it happens." Another Co-chairman, Dr Raymond TSO, addressed that since there had been little natural influenza infection for the past 3 years. As a result, herd immunity against currently circulating viruses would probably be substantially lower compared with previous years. Elderly, children and other groups who used to go out less or did not have much social contact, their situation would likely be exacerbated. He reiterated that it would take two weeks for antibodies to develop after vaccination; high-risk individuals, such as the elderly, children and chronic disease patients, should get vaccinated before the peak season to establish an immune barrier.

For some citizens who are concerned about the side effects of the SIV vaccine, Dr SO Yui Chi, the Honorary Treasurer of the HKMA and a cardiologist, stated that severe flu could increase inflammation in the body and even trigger a cytokine storm and develop abnormal blood clotting, thereby increasing the incidence of heart attacks and strokes. Foreign studies found that myocardial infarction and stroke rates increased 10 and 8 times^[11], respectively, in the week after influenza virus infection; and vaccination could reduce heart disease-related conditions by 15 to 45%^[12]. He stressed that, in addition to the high-risk individuals mentioned earlier, heart disease patients and those who had a stroke before should also pay extra attention.

Dr Pierre CHAN, Vice President of the HKMA, believed that since the COVID-19 epidemic in Hong Kong had not yet died down, if it were to be supplemented with the winter flu outbreak, Hong Kong healthcare system would be hit “wave after wave” and faced enormous pressure. He reminded the general public aged 50 or above that they could now be vaccinated with both COVID-19 and SIV vaccines simultaneously at the Community Vaccination Centres. He also suggested that the Government and the Hospital Authority should prepare ahead, such as increasing the number of hospital beds and manpower to enhance the public hospitals’ resilience during winter.

Dr CHENG Chi Man, President of the HKMA, pointed out that in the past three years, society had paid more attention to the COVID disease, which caused the public to "take the flu lightly". SIV vaccination rates for children, the elderly and those at high risk fell by 6%^[13] last year compared to 2020/21, meaning 78,000 fewer people were vaccinated. He believed that even though the mandatory mask-wearing order was still in place, as social distancing measures had been significantly relaxed, and children had begun to resume physical classes, the risk of infection would be much higher than in the past three years. What was worse, once a person was co-infected with COVID-19 and flu, the risk of in-hospital mortality would substantially increase by 2.35 times^[14]. At the end of the press conference, Dr CHENG reminded the public that if they had any doubts about vaccines or did not know whether they would be suitable for vaccination, they could first seek advice from a doctor.

Reference:

[8] Frequently Asked Questions on Seasonal Influenza Vaccination for the 2022/23 Session in Hong Kong, Department of Health. https://www.chp.gov.hk/en/features/100764.html

[9] Bi-weekly Influenza Situation Update, WHO, https://www.who.int/docs/default-source/wpro---documents/emergency/surveillance/seasonal-influenza/influenza-20220824.pdf?sfvrsn=4f9b0451_105

[10] Is the UK prepared for seasonal influenza in 2022–23 and beyond?”, The Lancet (Infectious Diseases), https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00503-5/fulltext

[11] Laboratory-confirmed respiratory infections as triggers for acute myocardial infarction and stroke: a self-controlled case series analysis of national linked datasets from Scotland, https://pubmed.ncbi.nlm.nih.gov/29563170/

[12] Acute Cardiovascular Events Associated With Influenza in Hospitalized Adults, Annals of Internal Medicine, https://www.acpjournals.org/doi/10.7326/M20-1509

[13]過去三年疫苗接種計劃的統計數字, https://www.chp.gov.hk/tc/features/102226.html

[14] SARS-CoV-2 co-infection with influenza viruses, respiratory syncytial virus, or adenoviruses, The Lancet, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00383-X/fulltext

編輯備忘：香港醫學會成立於一九二零年，旨在聯繫政府、各公立醫療機構、大學及私人執業的醫務工作者，交流意見，團結一心。醫學會致力將最新的醫療資訊及醫務發展傳遞與會員，提倡會員遵行專業操守，進而服務社會，維護民康。

Notes to editors:  The Hong Kong Medical Association, founded in 1920, aims to bring together Hong Kong's government, institutional, university and private medical practitioners for an effective exchange of views and co-ordination of efforts.  The foremost objective of the Association is to safeguard and promote public health.  The Association speaks collectively for its members and aims to keep its members abreast of medical ethics, issues and advances around the world.  In fulfilling these goals, the association hopes to better serve the people of Hong Kong.