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Surveillance of acute flaccid paralysis in Hong
Kong: 1997 to 2002
RMK Lam, THF Tsang, KY Chan,
YL Lau, WL Lim, TH Lam, NK Leung; National Committee for the Certification
of Wild Poliovirus Eradication
Centre for Health Protection, Department of Health, Hong Kong
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.
MAIN OUTCOME MEASURES. The prevalence of urinary
symptoms was assessed using telephone interview. The urinary symptoms
investigated were as listed in a validated Chinese version of Urogenital
Distress Inventory Short Form (UDI-6). The impact on quality of
life was quantified using a validated Chinese version of Incontinence
Impact
Questionnaire Short Form (IIQ-7).
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- Barré 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.
Hong Kong Med J 2005;11:164-73
Key words: Evaluation studies; Guillain-Barre syndrome;
Paralysis; Poliomyelitis; Sentinel surveillance
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