A rare, mysterious paralyzing illness called acute flaccid myelitis (AFM) could become more common in the United States, according to the head of the National Institute of Allergy and Infectious Diseases (NIAID).

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Dr. Anthony Fauci said AFM may bear similarities to polio, which affected tens of thousands of U.S. children a year before a vaccine was introduced in the 1950s, the Associated Press reported.

While AFM is unlikely to become as widespread as polio once was, Fauci cautioned: “Don’t assume that it’s going to stay at a couple of hundred cases every other year.”

He published a report about AFM Tuesday in the journal mBio.

U.S. public health officials are becoming concerned about AFM because it is affecting increasing numbers of children, the AP reported.

AFM cases have been reported in other countries, including Canada, France, Britain and Norway, but U.S. outbreaks have been more significant. More than 550 Americans have been diagnosed with AFM this decade. More than 90 percent were children, most around 4, 5 or 6 years old. The oldest patient was 32.

The first major U.S. outbreak occurred in 2014, when there were 120 confirmed cases. Most of them were in California and Colorado.

Since then, there has been a cyclical pattern, with 22 cases in 2015, 149 in 2016, 35 in 2017, and 228 last year. That number may rise because scores of possible cases are still under investigation. Only four cases have been confirmed so far this year, the AP reported.

But Fauci said it would be wrong to assume that surges will continue to take place every other year, warning that the next one “may be in 2019, for all we know.”

A growing number of experts believe that an enterovirus called EV-D68 is linked with AFM because spikes in cases have coincided with surges of respiratory illnesses caused by EV-D68.

NIAID has urged researchers to apply for federal funds to study AFM, and is enlisting a network of pediatric research centers to work on the disease, the AP reported.

The U.S. Centers for Disease Control and Prevention has created a scientific task force and plans to monitor AFM cases more closely.

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