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Two more Michigan children have been diagnosed with a polio-like illness, bringing the total cases of acute flaccid myelitis confirmed this month in the state to four, officials said Tuesday. 

The Michigan Department of Health and Human Services said it has been notified by the Centers for Disease Control and Prevention of the two additional confirmed cases of AFM — out of Ottawa and Macomb counties — in the state for 2018.

The state's first case was confirmed Dec. 5 and involves a child in Wayne County. The second was confirmed in an Oakland County child on Dec. 12.

Five other suspected AFM cases of the disease remain under investigation, while one other case has been ruled out by the CDC, officials said.

All of the confirmed cases had the onset of illness between August and October.

Nationally, the CDC has confirmed 165 cases of AFM in 36 states, primarily in children.

Despite increases in cases across the country since 2014, the CDC estimates that less than one to two in a million children in the United States will contract AFM annually.

The rare disease is similar to polio and affects the nervous system and can cause the muscles and reflexes of the body to become weak.

Polio is a contagious virus that causes severe nerve damage and can lead to paralysis or death. It was mostly eradicated in the U.S. by 1979 thanks to vaccines.

Most patients report a mild respiratory illness or fever consistent with a viral infection before developing AFM. The cause or trigger for the disorder is not yet known.

The CDC recommends vaccination against the poliovirus, which is one of the viruses known to cause AFM. It also urges protections against mosquitoes, which can carry the West Nile Virus, another cause of the disorder. 

Healthcare providers are asked to report all suspected cases of AFM to their local health departments. 

For information, visit the MDHHS Communicable Disease Information and Resources website or CDC.gov/AFM.

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