So far this year, CDC reports have confirmed 38 cases of AFM, a condition that causes muscle weakness and paralysis, primarily in children.

Health officials report an unusually high number of cases of a rare polio-like illness known as Acute Flaccid Myelitis (AFM) that causes muscle weakness and paralysis, usually in children. The Centers for Disease Control and Prevention (CDC) indicated it has received reports of 362 cases of AFM across the United States since August 2014, and 38 cases have been reported in 16 states so far this year — already exceeding last year’s total of 33 cases.

While public health officials say they are getting better at diagnosing and tracking the condition, which affects the nervous system, it remains unclear why cases of the condition have spiked each autumn since 2014.

Diagnosed mostly in children, AFM specifically strikes the spinal cord. Some children have mild cases, such as temporary limb weakness — flaccid or floppy limb strength — and fully recover. But children with severe cases often experience sudden paralysis or weakness in the arms or legs that persists. They can also have droopy eyelids and difficulty swallowing and speaking. In the worst cases, respiration is suppressed, requiring life-saving use of a ventilator.

A Rare but Alarming Condition

Fewer than one in one million people develop the illness in the United States each year, but the recent increase in cases has alarmed public health officials because not all of the children fully recover.

“It’s a concern any time you have something recurring every few years and we don’t know exactly what causes it,” says Mobeen Rathore, MBBS, chief of the division of Pediatric Infectious Diseases and immunology at the University of Florida College of Medicine in Jacksonville, who serves on the American Academy of Pediatrics committee on infectious diseases. “This has a significant impact on the children, and it occurs in mostly healthy kids.”

While there have been 38 confirmed cases this year, the number of suspected cases is much higher. Health officials in 26 states are reportedly investigating 87 possible cases. The number slightly exceeds the 33 reported cases in 2017 count, but it is less than the surge in 2016, when 149 cases were confirmed, according to the CDC.

“Many of the cases are not recognized unless you are attentive to it or suspect it,” Dr. Rathore says. “It’s probably the tip of the iceberg.”

Mild cases can be especially difficult to diagnose, he adds. No diagnostic test exists; doctors use criteria from the CDC to make a diagnosis, which includes an MRI exam to look for lesions in the spinal cord.

Condition Linked to a Common Virus

The cause of acute flaccid myelitis is unknown and is the subject of intense scrutiny by public health experts and infectious disease specialists. Some cases diagnosed over the last few years are thought to be caused by a common virus called enterovirus D68 that circulates in the summer months and typically causes minor cold symptoms.

“Enterovirus is a common cause of summertime colds,” says C. Buddy Creech, MD, an associate professor of pediatrics at Vanderbilt University School of Medicine in Nashville, Tennessee, and a pediatric infectious diseases specialist. “We’re always concerned when there are new, more severe and more long-lasting complications to what is a really common virus.”(Read: Signs, Symptoms and Tips For Preventing Lyme Disease)

An enterovirus can cause polio and AFM resembles polio, but it is not polio, says Rathore.

Risk Factors Remain Unclear

It’s unclear whether some children are particularly susceptible to the condition.

“The data is still coming out,” Dr. Creech says. “To my knowledge, we have not been able to put together a silhouette for the child who is most at risk. This is happening to very healthy children coming into contact with a very common virus. Maybe it’s the strain of virus. Maybe it’s their immune systems going a little sideways.“

There is no cure for the condition. Doctors instead try to prevent further complications and help the patient recover from the symptoms by prescribing physical or occupational therapy.

“There are some children who if they develop weakness, particularly in the upper extremities, they don’t recover their strength and movement,” Creech says. “That can have a very big impact on their lives. We are trying to understand what is happening to those kids who recover fast. Can we mirror that? Is it something about treatment or rehabilitation or something about their immune systems?”

Important Steps for Prevention

The CDC has asked healthcare providers to look out for any signs of AFM and to test the blood and spinal fluid of patients to better understand the illness.

“We have some leads, but it’s much like working a crime scene where we’re getting bits and pieces and we’re trying to fit the pieces together,” Creech says. “We know we see increases every couple of years with certain strains of enterovirus.”

Parents should consult a physician if a child has any unusual symptoms. In terms of prevention, Creech says, “Wash your hands and stay away from folks who have fevers and are sick. It is important to recognize enterovirus is remarkably common. It causes so many types of infections, from a simple cold to meningitis to inflammation of the heart.”

By next month, cases of acute flaccid myelitis should begin to wane, he says.

“We should start to see enterovirus falling and see an uptick in cases of flu or other respiratory viruses,” Creech says. “That’s a reminder that it’s not just during flu season that we need to be careful with how we cough and sneeze and how we act around others.”

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