
 
 McKenzie Anderson, before and after she came down with a mysterious disease called acute flaccid myelitis, which is a lot like polio. (Family photos) 
 
 Before dinner on July 29, 3-year-old Carter Roberts of Chesterfield, Va., seemed perfectly healthy. That evening, he vomited. When he woke up the next morning with a slight fever of 99 degrees, his mother, Robin Roberts, figured that he was coming down with a cold. The next morning, she found him collapsed on his bedroom floor. 
 
 “Mommy,” she recalls him saying. “Help me, help me.” 
 
 Carter could barely stand when she picked him up, and his neck was arched backward. “What was most alarming,” she said, “is he had no control over his right arm whatsoever.” 
 
 In the hospital, Carter lost control of his right arm, then over his legs and other muscles within a few days. He now can only wiggle a toe and move the left side of his face. He has been diagnosed with a mysterious, polio-like illness called acute flaccid myelitis, a condition that seems to be surging this year. 
 
 Through July, 32 new cases of AFM have been confirmed across the United States this year by the Centers for Disease Control and Prevention, a sharp rise compared with last year, when just seven cases had been confirmed by that month. The numbers have risen steadily since April. In past years, most cases have occurred between August and December, with a peak in October. 
 
 [Mark Zuckerberg and Priscilla Chan’s $3 billion scientific effort aims to rid world of major diseases by end of century] 
 
 
 
 Source: Centers for Disease Control and Prevention 
 
 Among the many unanswered questions about the condition are what causes it, how best to treat it and how long the paralysis lasts. Although most cases occur in children, AFM occasionally affects adults. 
 
 The CDC official who leads the surveillance efforts said that confirmed numbers for August will not be available until the end of this month, but the number of reports she is receiving from doctors around the country continues to rise. 
 
 “CDC is looking at these trends very carefully,” Manisha Patel said. “We have sent out several health alerts to states to let them know we are seeing an increase in reporting and to encourage them to communicate with doctors to report these cases in a timely fashion.” 
 
 The CDC began tracking AFM in 2014, when 121 cases were confirmed. That year, the CDC counted only children affected by the disease. Their average age was 7. Most had a fever or a respiratory illness a few days before developing paralysis. Many had to be placed on respirators. Although 85 percent of the children recovered partially, only three of them recovered fully. 
 
 Five-year-old Braden Scott sits up unassisted at a rehab facility two months after he was struck with acute flaccid myelitis. It's a major improvement for someone with this polio-like illness. (Facebook/Team Braden Luke) 
 
 Health officials and physicians around the country said they are concerned that the rising number of cases through July could foretell a repeat of 2014. 
 
 “You hate to be an alarmist, but there’s reason to have some concern,” said Avindra Nath, chief of the section of infections of the nervous system at the National Institute of Neurological Disorders and Stroke. “What we don't know is where are these cases. Are they clustered? Do they all look alike? Getting more information on these cases would be helpful.” 
 
 Beyond saying that confirmed cases have been reported in 17 states through July, Patel declined to reveal which states have been involved. But conversations and emails with physicians around the country indicate that at least four cases have occurred in California and at least three in Massachusetts, and that others have been seen in Florida, Texas, Pennsylvania and New York, as well as Virginia. 
 
 “We are definitely hearing of cases from our colleagues across the country,” said Teri Schreiner, a neurologist at the University of Colorado and Children's Hospital Colorado. “It’s a trend that’s worrisome … what I'm hearing from others seems to be coming at a tempo similar to what happened in 2014.” 
 
 Jean-Baptiste Le Pichon of Children’s Mercy Hospital in Kansas City, Mo., said that doctors on a U.S. email list for pediatric neurologists reported five new cases of AFM in just the past few days. “There is definitely an explosion of cases,” Le Pichon said. 
 
 No treatment other than physical therapy has yet been shown to markedly improve outcomes, although some doctors have reported that treatment with intravenous immunoglobulin (IVIG), used to treat some other viral infectious diseases afflicting the nervous system, might help. It’s also been suggested that Prozac could prove beneficial. The degree of paralysis in the first month has generally improved only slightly over the course of a year. 
 
 “After about a year or so, what you’ve got is what you’ve got,” said Max Wiznitzer, a pediatric neurologist at Case Western Reverse University in Cleveland. 
 
 Most perplexing is what causes the disease. The 2014 outbreak of AFM occurred at the same time as a far larger outbreak of enterovirus D68 across the United States. The vast majority of patients infected with the virus developed only a respiratory illness. Some physicians were convinced that EV-D68 was the cause, not only because both outbreaks occurred at the same time but also because of a study that identified a particular strain of EV-D68 in the airways of children with AFM. But officials at the CDC and some doctors, including Wiznitzer, insist that the cause remains unproved. 
 
 So far this year, no similarly widespread outbreak of EV-D68 respiratory infections has been reported, although cases of it and other enteroviruses have been seen in some areas. 
 
 On Friday, Le Pichon, in Kansas City, said, “I just got confirmation that we have an epidemic of enterovirus breaking out here and at least a few cases [of enterovirus] have typed positive for EV-D68.” 
 
 Carol Glaser, a pediatric infectious-disease specialist at Kaiser Permanente in Oakland, Calif., said: “If the theory is right that it’s caused by EV-D68, which some of us believe more than others, this would be the time of year we start seeing it. It’s an enterovirus, and they tend to peak in late summer and early fall.” 
 
 Because the CDC’s surveillance of AFM is less than two years old, it remains unclear if some of this year’s apparent rise in confirmed cases is due simply to more doctors sending in case reports, Patel said. And Wiznitzer emphasized that with just 32 confirmed cases across the United States so far, AFM remains extremely rare 
 
 Glaser, however, said she is convinced that the condition is new. She worked at the California Department of Public Health when, in 2012, some of the first reports of AFM anywhere in the country came in from physicians there. 
 
 “I was there for 15 years and talked to neurologists every single day,” she said. “It wasn’t until the fall of 2012 when the first physician called in and wanted a test for polio on one of his patients. One of my colleagues in the office chuckled and said to me, ‘We don't have polio in the United States.’ But in the next two weeks, I got two very similar phone calls. We had never had a report like that. I do think there was something new going on. Fortunately, it’s still rare.” 
 
 If EV-D68 does somehow cause AFM, studying the virus may lead to prevention or treatment. One glimmer of good news came from Kenneth Tyler, chair of neurology at the University of Colorado School of Medicine. He and his colleagues have been conducting experiments to infect mice with EV-D68 and have them develop loss of muscle control like that seen in AFM. He says he has submitted a paper to a peer-reviewed medical journal describing his success in doing so. 
 
 The goal, he said, is to use mice to study how EV-D68 causes harm to the spinal cord and muscles, and to test potential therapies, such as IVIG. 
 
 “It looks like we’re seeing protection with IVIG in the mouse model,” he said. 
 
 Robin Roberts said she wishes more was known about the condition that has harmed her son. “In this day and age to not have information about something like this is very frustrating. There needs to be more done about it, and for more parents and doctors to know about it,” she said. 
 
 Angie Andersen said that her daughter McKenzie was sent home from the hospital twice in the first two weeks of her illness because doctors did not understand the severity of what was happening. Finally her pediatrician told Andersen to bring McKenzie to another hospital. 
 
 McKenzie was 6 years old when she developed sniffles in December 2014. “Within 12 days,” Andersen said, “she was paralyzed from the neck down, on a ventilator to breathe for her. She was left with her left hand and her feet and toes that move.” 
 
 “You know you could understand the bad that comes from a car wreck, or if she got cancer,” Andersen said. “How do you ever wrap your brain around the fact that she got a cold, and now she’s a quadriplegic on a ventilator? It’s a nightmare you never wake up from.” 
 
 Still, she said, McKenzie can now speak and even sing softly despite having a tracheotomy. “She has a lot of spunk, and that is helping her through,” Andersen said. 
 
 Correction: This article originally misnamed Robin Roberts as Robin Carter. 
 
 1 of 26 Full Screen Autoplay Close Skip Ad × The case files: Medical mysteries View Photos From a daily afternoon fever to a debilitating reaction to chemotherapy, here’s a look at perplexing medical mystery cases. Caption From a daily afternoon fever to a debilitating reaction to chemotherapy, here’s a look at perplexing medical mystery cases. Doctors were stumped by this 2-year-old boy’s symptoms. He had swollen thumbs, bleeding gums and anemia. He cried whenever anyone touched his legs. Doctors were running out of time. Read the case Cam Cottrill/For The Washington Post Buy Photo Wait 1 second to continue. 
 
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 The Centers for Disease Control and Prevention (CDC) is warning against a polio-like illness that is causing paralysis among an increasing number of Americans. 
 
 From Jan. 1 to Aug. 31, 2016, the CDC reported 50 people in 24 U.S. states had been diagnosed with acute flaccid myelitis (AFM), compared with only 21 people in 2015 in 16 U.S. states. From August to December 2014, 120 people, mostly patients 21 and younger, in 34 U.S. states, were diagnosed with the condition. 
 
 AFM affects the nervous system, specifically the spinal cord, according to the CDC. The cause is unknown, but it has been linked to viral infections like polio and non-polio enteroviruses, adenoviruses, and the mosquito-borne West Nile virus. Enteroviruses can cause neurologic illness such as meningitis, but more serious disease like encephalitis and AFM are less common. 
 
 Symptoms of AFM include pain in the arms and legs, an inability to pass urine, and, most severely, respiratory failure that can occur when muscles involved in breathing become weak. The latter symptom can require urgent ventilator support, according to the CDC. There is no specific treatment for AFM, but rather neurologists may prescribe therapy on a case-by-case basis. 
 
 Although the AFM outbreak in 2014 coincided with an outbreak of enterovirus D68, the CDC did not detect traces of the severe respiratory virus in the AFM specimens collected that year. Among the people with AFM in 2015, the CDC also did not detect the virus in the specimens collected, and only limited sporadic cases of the virus have been detected in the United States in 2016. 
 
 As health officials investigate the current rise of AFM cases, to prevent illness, they are advising people wash their hands with soap and water, avoid close contact with sick people, and clean surfaces with a disinfectant, especially those that a sick person has touched. 
 
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 / Updated By Lauren Dunn and Parminder Deo 
 
 Little Carter Roberts, of Chesterfield, Virginia, was a typical 3-year-old — playful, healthy, and active. But over the course of a weekend Carter went from his happy-go-lucky self to a paralyzed patient unable to move his arms or legs. 
 
 “He needed a tube to help him breath,” says his mother Robin Roberts. “Doctors were working really hard to try and figure out what was going on.” 
 
 At the hospital, the Roberts family was left with more questions than answers. Doctors considered a list of diagnoses from Guillain-Barré Syndrome to various other auto-immune diseases. Finally, after an MRI scan and hours of waiting, Carter was diagnosed with acute flaccid myelitis (AFM) — a mysterious muscle weakness, similar to polio — that appears to be on the rise this year. 
 
 Carter Roberts and his two sisters before he was diagnosed with acute flaccid myelitis. Robin Roberts 
 
 On Monday, the Centers for Disease Control and Prevention reported that, as of August 2016, there have been 50 cases of confirmed AFM across 24 states. That's nearly double over 2015, when 21 cases for the whole year were reported. 
 
 AFM has been linked to a strain of enterovirus that's now circulating again. Some doctors are warning this could be the same mysterious, polio-like illness detected in 2014 that paralyzed 120 children. 
 
 Related: CDC Develops Faster New Test For Enterovirus D68 
 
 Enteroviruses are common and typically cause milder illnesses in children, such as respiratory infections or even summer colds. However, when enteroviruses get into the central nervous system they can cause more serious illnesses like inflammation of the brain. 
 
 “August to October is typically when enteroviruses circulate,” says Dr. Kevin Messacar, pediatric infectious disease physician at Children's Hospital Colorado. “We see more acute flaccid myelitis during that season and we do seem to be seeing an increase in the cases that have been reported.” 
 
 “Acute flaccid myelitis is a very rare complication of an illness,” says Messacar. “I think it's important that we take it seriously because the effects of this condition appear to be long term and are disabling. 
 
 Related: New Strain of Enterovirus May Have Caused Mystery Paralysis 
 
 There are no vaccines for this strain of enterovirus, so doctors urge good hygiene as the best defense: 
 
 Cover your mouth when you cough and sneeze 
 
 Don’t go to work or school when you’re sick 
 
 Remain vigilant about hand washing 
 
 Carter, who was diagnosed in July, can now only move the left side of his face and wiggle a toe. He sticks his tongue out and blinks his eyes to certain questions. According to researchers, unfortunately there are still no proven effective therapies for this condition. However, speech therapy has given his mother hope. 
 
 Related: 6 Things to Know about Enterovirus 
 
 “I got to hear him talk and he said just a handful of words and as a mom, it was the sweetest sound ever,” says Robin. “I wake up and am hopeful every day that he's going to make some progress. It's hard not a feel a little bit robbed because this happened so quickly, but it was just a virus.” ||||| Get the latest from TODAY Sign up for our newsletter 
 
 / Source: TODAY By A. Pawlowski 
 
 A mystery illness that leaves children barely able to move is on the rise again, two years after an outbreak alarmed doctors and parents. 
 
 There have been 50 cases of acute flaccid myelitis (AFM) reported across 24 states so far this year, the Centers for Disease Control and Prevention reported Monday. Though the syndrome is still rare, that's more than double compared to 2015, when 21 cases were confirmed for the whole year. 
 
 AFM can be caused by a variety of germs, such as enteroviruses, which are common and typically cause milder illnesses in children such as respiratory infections. However, when enteroviruses get into the central nervous system, they can cause more serious illnesses like inflammation of the brain. 
 
 AFM affects the spinal cord, but the exact trigger is often elusive and there’s no specific treatment, according to the CDC. 
 
 Symptoms include: 
 
 limb weakness 
 
 facial droop 
 
 difficulty breathing or swallowing, or slurred speech 
 
 The best prevention is to wash your hands, stay up-to-date on vaccinations and protect yourself from mosquitoes — since the mosquito-borne West Nile virus is linked to AFM — the CDC advises. 
 
 The illness seemed to peak in 2014, with 120 cases reported between August and December — all children. 
 
 The average age for children stricken with AFM is 7 and many had to be placed on respirators. Although 85 percent of the children recovered partially, only three have fully recovered, according to the CDC. 
 
 Related: New strain of enterovirus may have caused mystery paralysis 
 
 Laura Carson was a healthy, active 4-year-old before she suddenly developed acute flaccid myelitis (AFM) in 2014. Courtesy Sara Carson 
 
 Sara Carson was among the families thrust into the medical mystery when her daughter Laura suddenly developed the polio-like paralysis. 
 
 “Every new case you see, the pit of your stomach drops out again,�? Carson, who lives in suburban Chicago, told TODAY. 
 
 “You flash back to that moment in time where you’re sitting in the hospital room thinking you don’t know where the next day is going to take you, or the next hour or the next minute.�? 
 
 Related: What parents need to know about enterovirus D68 
 
 Laura spent 25 days in the hospital. At her worst, she could only move parts of her left arm and left leg. Courtesy Sara Carson 
 
 In August 2014, Laura — then 4 — was playing at home when she suddenly developed a headache. When the little girl woke up the next morning with rapid shallow breathing, Carson took her to her pediatrician, but was told everything was fine. 
 
 Over the next few days, Carson noticed Laura was fatigued, lethargic and developed a tremor. The left side of Laura's face looked a little weaker. 
 
 Another alarming symptom showed up soon after. 
 
 “When she woke up, she asked me why the pillows were stacking themselves and why there were two of me, and at that point, I realized she was having double vision,�? Carson recalled. 
 
 The family rushed Laura to an emergency room, only to be told again that everything was fine. Once home, Laura’s head started to fall to the right and she could no longer lift her right arm, so the Carsons took her to a different hospital, where she was finally admitted. 
 
 By the next morning, Laura was like a limp rag doll, her mom said. When she tried to help the little girl out of bed, her head dropped back and her arms fell to the side. 
 
 Laura spent the next 25 days in the hospital, bedridden and unable to walk. At her worst, she could only move parts of her left arm and left leg. 
 
 “I kept looking at the doctors and saying, ‘She’s going to be OK, right?’ They would look at me and they couldn’t answer that question,�? Carson said. 
 
 “Nobody had a clue what was going on. … It’s fear because you don’t know: at some point, is this going to stop or are we looking at losing our daughter?�? 
 
 As she began to recover, Laura had to use a wheelchair. Courtesy Sara Carson 
 
 An MRI revealed lesions on Laura’s spine, a frequent finding in AFM cases. She was given steroids and made “teeny, tiny little gains,�? her mom said. Laura was released from the hospital just as a cluster of AFM cases among children in Colorado was coming to light. Laura’s neurologist said her case looked like an exact match, Carson noted. Some, but not all, of the children with AFM were diagnosed with enterovirus. Laura tested negative for it. 
 
 Meanwhile, the family tried to adjust to a new reality. 
 
 “If she wanted to play with her dolls, you’d have to literally hold her arm and lift it out for her and grasp it. It was all consuming to help her to try to be a kid again,�? she recalled. 
 
 An MRI revealed lesions on Laura's spine, a frequent finding in AFM cases. Courtesy Sara Carson 
 
 Months of rehabilitation followed, with Laura receiving intensive physical, speech and occupational therapy. She also took part in aquatic therapy and muscle stimulation; visited an acupuncturist and a homeopath; took various supplements and received chiropractic adjustments. 
 
 Two years later, Laura is doing much better. She still has weakness on the right side of her body, but she’s able to run, play and go to school. 
 
 Today, 6-year-old Laura is active again and continues to improve. Courtesy Sara Carson 
 
 “We’re very blessed. We’re one of the ‘lucky’ families in terms of how much return [to normal] we’ve received,�? Carson said. 
 
 “You just have to take it a day at a time and be thankful for every little blessing that you’re given and every little gain that you make.�? 
 
 Follow A. Pawlowski on Facebook, Instagram and Twitter. ||||| Notes from the Field: Acute Flaccid Myelitis Among Persons Aged ≤21 Years — United States, August 1–November 13, 2014 
 
 Division of Viral Diseases, National Centers for Immunization and Respiratory Diseases, CDC; Division of Vector-Borne Diseases, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Children's Hospital Colorado; Council of State and Territorial Epidemiologists 
 
 In August 2014, physicians at Children's Hospital Colorado in Aurora, Colorado, noted a cluster of cases of acute limb weakness among children (1). Most patients were found to have distinctive abnormalities of the central spinal cord (i.e., gray matter) on magnetic resonance imaging, and most reported a respiratory or febrile illness preceding the onset of neurologic symptoms. On September 12, the Colorado Department of Public Health and Environment alerted CDC about this cluster. These cases coincided with a national outbreak of severe respiratory disease among children caused by enterovirus D68 (EV-D68) (2). 
 
 On September 26, CDC issued a health advisory requesting state and local health departments to report cases and send specimens to CDC for testing (3). A case was defined as acute onset of focal limb weakness occurring on or after August 1, 2014, and a magnetic resonance image showing a spinal cord lesion largely restricted to gray matter in a patient aged ≤21 years. 
 
 As of November 13, CDC had verified reports of 88 cases in 32 states (Figure). The median age of patients was 7.6 years (range = 5 months–20 years), and 54 (61%) were males. Limb weakness was asymmetrical in most patients. Cranial nerve motor dysfunction was reported in 30 (34%) cases. Six (7%) patients had altered mental status, and three (3%) had seizures. Most patients reported a respiratory illness (81%), a febrile illness (68%), or both, occurring before neurologic symptom onset; 8% had neither condition. Among 86 patients for whom past medical history was reported, 65 (76%) were previously healthy, and 21 (24%) had underlying illnesses, most commonly asthma (nine [10%]). All but one patient was hospitalized because of neurologic illness, and 17 (19%) required ventilator support. Among 80 patients from whom cerebrospinal fluid was obtained, 68 (85%) showed a moderate pleocytosis and normal or mildly elevated protein. Information regarding current clinical status was reported for 77 patients (median follow-up = 19 days). Of those, 49 (64%) reported some symptom improvement, and 28 (36%) showed no improvement; none were fully recovered. No deaths were reported. 
 
 Among 71 patients with cerebrospinal fluid testing performed by their health care providers, state and local public health departments, or CDC, no enteroviruses or other pathogens have been confirmed to date. Among 41 patients whose upper respiratory tract samples were available for enterovirus/rhinovirus testing at CDC, 17 (41%) tested positive: eight (20%) for EV-D68 and nine (22%) for eight other enterovirus/rhinovirus types. Of the 19 patients whose upper respiratory tract samples were obtained <14 days from respiratory illness onset, 10 (53%) were positive: seven (37%) for EV-D68 and three (16%) for rhinoviruses. Laboratory testing for other pathogens is ongoing. 
 
 On November 7, CDC published interim clinical management considerations, summarizing expert opinion based on current evidence on management and care of children with acute flaccid myelitis (4). CDC continues to collaborate with partners nationally to investigate reported cases, risk factors, and possible etiologies of this condition. Although the specific causes of this illness are still under investigation, and causal relationship to EV-D68 has not yet been substantiated, being up to date on all recommended vaccinations is essential to prevent a number of severe diseases. Vaccine-preventable diseases include poliomyelitis, which is caused by poliovirus; infection with this enterovirus can present with acute flaccid paralysis. There are also numerous other vaccine-preventable diseases that can result in severe illness. Prevention of viral infections includes general hygienic measures, such as frequent hand washing with soap and water, avoiding close contact with sick persons, and disinfecting frequently touched surfaces. Additional information is available at http://www.cdc.gov/flu/protect/habits/index.htm. If a child appears to have a sudden onset of weakness in arms or legs, caregivers should contact a health care provider to have the child assessed for possible neurologic illness. Health care providers are encouraged to report patients meeting the case definition to their state or local health department. Health departments should report patients with illness meeting the case definition to CDC using a brief patient summary form* and may contact CDC by e-mail to arrange further laboratory testing (limbweakness@cdc.gov). Additional information is available at http://www.cdc.gov/ncird/investigation/viral/sep2014.html. 
 
 (Corresponding author: Eyal Leshem, eleshem@cdc.gov, 404-639-7251) 
 
 References
– At first, it seemed like 4-year-old Laura Carson was suffering from a simple headache. Then came rapid shallow breathing, a tremor, double vision. Within days in August 2014, she was "a limp rag doll," reports Today—but it took doctors some time to diagnose her with acute flaccid myelitis, a rare disease the CDC warns is becoming increasingly more common. Not much is known about the polio-like disease that plagues mostly children, including what causes it. What is known is that AFM affects the spinal cord and causes weak limbs or paralysis, drooping in the face, and slurred speech or difficulty breathing. About 200 kids have been diagnosed since 2014, and this year's figures are especially troubling. The CDC reports 121 cases of AFM were confirmed in 2014, but that was followed by just 21 cases in 2015, reports Fox News. From January to August of this year, however, there were 50 confirmed cases in 24 states. Among that first spike of cases in 2014, the Washington Post reports that 85% of kids recovered partially, but only three recovered fully. A CDC study found 68% of patients had a fever and 81% had a respiratory illness before AFM symptoms appeared. Some had been diagnosed with the West Nile virus, and others with an enterovirus. "August to October is typically when enteroviruses circulate" and "we see more acute flaccid myelitis during that season," a doctor tells NBC News. Washing your hands and covering your mouth when coughing or sneezing are among the ways suggested to help. (Four siblings suffer from a mysterious disease.)