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DENVER — The Colorado Department of Public Health and Environment said it has confirmed 14 cases of acute flaccid myelitis this year.

All of the patients are children who have needed to be hospitalized, the department said, noting “nearly all have fully recovered.”

“The state health department has been monitoring this situation closely since early spring,” the department said. “In addition to investigating the outbreak, the state health department has issued alerts to health care providers on how to test for the viruses and enhanced guidance to child care centers on infection prevention.”

AFM is a polio-like illness that affects a person’s nervous system, including the spinal cord.

Symptoms can include sudden limb weakness, loss of muscle tone and reflexes, facial and eyelid drooping, facial weakness, difficulty moving the eyes, swallowing difficulty or slurred speech, according to the U.S. Centers for Disease Control and Prevention.

The rare condition can be caused by a virus, a genetic disorder and environmental toxins.

The type of viruses found in 12 of the Colorado cases, enterovirus, typically increases in summer and fall and is common, the state department of health said.

However, 11 of the Colorado cases of AFM have tested positive for EV A71, a rare type of enterovirus not usually seen in the U.S. but instead in Asia and other parts of the world, according to Dr. Rachel Herlihy, the Colorado state epidemiologist.

“This is certainly the largest outbreak of enterovirus A71 we’ve seen in Colorado,” she said.

She referred to these 11 cases as an outbreak within an outbreak.

“We have 41 cases of children who have had some sort of illness of enterovirus A71, which is causing a wide spectrum of neurological illness,” Herlihy said.

In previous years, cases of AFM in Colorado and elsewhere have been positive for a different enterovirus, EV-D68.

Other states have also reported cases.

The Illinois Department of Public Health is investigating nine recent cases, according to a statement Wednesday.

All of the cases are in patients younger than 18 and have been clinically diagnosed by health care providers, the statement said.

State health officials are working with the care providers to obtain the samples and information to send to CDC for testing and confirmation of the diagnoses.

“The CDC will make the final determination on diagnoses and numbers are subject to change,” the statement said.

All of the patients are from northern Illinois, according to the health department, but no other location information was provided.

Since 2015, when Illinois began monitoring reports of AFM in the state, four confirmed cases have been identified.

Health officials in Washington state are investigating five possible cases in patients from four counties.

“All cases are among infants and children under age 6 who all reportedly had symptoms of a respiratory illness in the week prior to developing symptoms of AFM,” the Washington State Department of Health said in a statement Wednesday.

The children were hospitalized after experiencing “sudden onset of paralysis of one or more limbs.”

The state health department is working with the CDC to determine if these are indeed cases of AFM.

Separate from these five cases of illness, there has been one other case of AFM in Washington this year and there were three cases identified in 2017, according to the health department.

There is no treatment other than managing each patient’s symptoms.

Herlihy the best prevention is frequent hand-washing and keeping kids home when they are sick.

Last week, the Minnesota Department of Health said it was investigating six cases of AFM in children over the past few weeks but did not identify what virus or other cause may have led to the illnesses.

As of Sept. 30, according to the CDC, 38 cases of AFM have been confirmed in 16 states. This does not include all of the 14 cases announced by Colorado, as some of those cases were confirmed after Sept. 30.

It also does not include the cases in Minnesota or Illinois, as they are not confirmed.

Since August 2014, when the CDC began tracking the illness more closely, the agency has reported 362 cases.

In 2017, 33 cases were reported in 16 states. One hundred forty-nine cases were reported in 39 states in 2016 and 22 cases in 17 states in 2015.