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The CDC said the cause of most AFM cases is unknown, but a few cases have been linked to other viruses

More possible cases of a rare, polio-like virus have been reported, health officials say.

The Centers for Disease Control and Prevention has been investigating more than 360 cases of acute flaccid myelitis dating back to 2014. The disorder, which mainly affects children, can paralyze a child’s arms and legs. The average age of AFM patients is 4 years old, Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, said Tuesday.

Brittany Fowler of the Maryland Department of Health told USA TODAY that there have been five possible cases of AFM in the state, all in children under 18. The Minnesota Department of Health announced six cases were reported in children under 10. The CDC has confirmed cases in 22 states.

The CDC said the cause of most AFM cases is unknown, but a few cases have been linked to other viruses. Symptoms are similar to poliovirus, West Nile virus and adenoviruses, which makes it difficult for doctors to diagnose.

Symptoms include drooping face and eyelids, difficulty with eye movement and swallowing, and slurred speech. In severe cases, children might have trouble breathing and need a ventilator because of muscle weakness. There is one report of a child dying from AFM in 2017.

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