Acute flaccid paralysis (where there are no reflexes) is a relatively common occurrence. In this survey of Hong Kong cases, they found that none were due to polio, 15% were from TM. A neurological cause was defined in 67.5% of the cases, of which 42% were from Guillian-Barre.

Lam RM, Tsang TH, Chan KY, Lau YL, Lim WL, Lam TH and Leung NK (2005). Surveillance of acute flaccid paralysis in Hong Kong: 1997 to 2002. Hong Kong Med J 11: 164-73. OBJECTIVES: To describe the characteristics of patients reported with acute flaccid paralysis between 1997 and 2002, and to evaluate the performance of the acute flaccid paralysis surveillance system using indicators recommended by the World Health Organization. DESIGN: Retrospective study. SETTING: Department of Health, Hong Kong. PARTICIPANTS: Children aged younger than 15 years who were reported to the Department of Health between 1997 and 2002 with acute flaccid paralysis. RESULTS: Of 120 children with acute flaccid paralysis reported between 1997 and 2002, 42% were younger than 5 years of age. None of the cases were acute poliomyelitis or polio-compatible. A neurological cause was identified in 67.5% of cases, of which the most common was Guillain-Barre syndrome (42%), followed by transverse myelitis (15%). All except one of the performance indicators consistently met World Health Organization requirements and thus demonstrated the effectiveness of the acute flaccid paralysis surveillance programme. The acute flaccid paralysis notification rate consistently exceeded 1.0 per 100 000 population below 15 years of age. The requirement for adequate stool investigation was the single indicator that did not satisfy World Health Organization requirements. This highlighted the importance of maintaining physicians' awareness of acute flaccid paralysis surveillance. CONCLUSION: Hong Kong should remain vigilant for acute flaccid paralysis. The effective surveillance system and its evaluation may serve as a model for surveillance of other infectious diseases. Centre for Health Protection, Department of Health, Hong Kong.