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The CDC has investigated hundreds of possible cases of acute flaccid myelitis in several states.
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Quinton Hill, age 7, of Lakeville, Minnesota, is one of the state's children diagnosed with acute flaccid myelitis, a polio-like disorder that can cause paralysis.(Photo: KARE-TV, Minneapolis-St. Paul)

Scientists are investigating whether the rare but paralyzing disease that has affected many children this year is linked to a respiratory virus that circulates in late summer and early fall.

The Centers for Disease Control and Prevention reported this week 386 cases of acute flaccid myelitis since August 2014. The disease strikes mainly children.

Cases are extremely rare; less than one in a million children is affected. But for a small number of children, the results are devastating.

It can paralyze the arms and legs of a child. Some sufferers need fans to breathe. It can also cause muscle weakness, speech problems and difficulty in moving your eyes and swallowing.

CDC officials have not identified the causes of acute flaccid myelitis, or AFM. Although described as a polio-like disease, each confirmed case gave a negative result to the polio virus.

A strain of a respiratory virus called enterovirus has been detected in several cases, but federal health officials say they do not have enough evidence to conclude that only one culprit is responsible for the MFA. They also study whether genetic or environmental factors are involved.

"It's a mystery so far and we have not solved it yet," said Nancy Messonnier, director of the CDC's National Center for Immunization and Respiratory Diseases.

More: What parents should know about the polio-like crippling disease that the CDC warns about

More: People in 22 states have been diagnosed with this rare disease similar to polio. What you need to know about the AFM

More: 6 Minnesota children diagnosed with a rare disorder, similar to polio

More: A crippling disease similar to polio affects more children, according to the Maryland Department of Health

The disease peaks every two years, from the end of summer to the beginning of autumn. Public health officials began screening in 2014 with 120 cases in 34 states. There were fewer than two dozen cases in 2015, but the disease increased again in 2016, with 149 cases in 39 states.

So far this year, 62 cases have been confirmed in 22 states and another 65 suspected cases are under investigation, according to the CDC.

Priya Duggal, a genetic researcher at the Johns Hopkins Bloomberg School of Public Health in Baltimore, is currently studying the disease.

"It seems to be cyclical – it's every two years," she said. "It's pretty tragic to see these families and talk to these parents and realize how upset their lives have been."

The Duggal study of about 60 families compares the genetic profile of children and adults in families affected by the disease. In some families, parents and siblings quickly recovered from minor cold symptoms while a child was paralyzed.

Duggal is looking for genetic clues as to why some children are susceptible to the more serious effects of the disease.

Some researchers believe that the disease may be linked to a strain of enterovirus called D68, which circulated widely in 2014 among children hospitalized in hospitals where it was difficult to breathe. The respiratory virus is transmitted by coughing, sneezing and unwashed hands.

The Children's Hospital of Colorado found that a subgroup of children infected with the D68 outbreak in 2014 had developed muscle weakness.

Since then, the hospital follows both the D68 virus and the acute flaccid myelitis.

"We have observed a trend every year, towards the end of summer or early autumn, to an increase in the number of cases of acute flaccid myelitis," said Kevin Messacar, a specialist in Infectious infections at the child in the Aurora Hospital. "This corresponds directly to the moment when D68 circulates in our institution and is reported by colleagues in other parts of the country."

Messacar suspects that the number of cases is probably higher than the confirmed total. Health professionals are not required to inform the authorities when they encounter a case; all reports are voluntary.

To be confirmed as AFM, cases must meet a strict definition: signs of a weak or flaccid limb confirmed by MRI images of a patient's spine.

If the D68 continues to circulate every two years, Messacar said, public health authorities may need to develop a vaccine.

The most serious cases "are undeniable," Messacar said. "They are paralyzed children who do not move and who do not get better."

Several states have reported AFM cases this year. The Maryland Department of Health has confirmed six cases; the Ministry of Health in Minnesota has confirmed seven, all in children under 10 years of age.

Jayne Griffith, an epidemiologist at the Minnesota Department of Health, said people with the condition usually developed the disease as a result of a respiratory illness or stomach.

Griffith said that it was often difficult to detect the virus in time, as hospital lab tests are not sensitive enough to identify the disease.

"This specimen must be examined by a state laboratory," she said. "There is a bit of a lag."

The CDC said that "several" AFM cases had shown strain D68, but had not given a figure.

Messonnier said that other cold viruses, such as rhinovirus, have also been detected in some cases.

"There is sort of a long list of other agents that we found in one or two," said Messonnier. "But if you experience the peaks of illness every late summer or early fall, you might think we only find one agent, which we do not find out."

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