Three more children have been hospitalized with suspected acute flaccid myelitis (AFM) in Washington. If those are confirmed, that would bring the total this fall in the state to 11.

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Three more children in Washington have been hospitalized with symptoms of a rare, polio-like illness, state health officials said Monday.

If the new cases of suspected acute flaccid myelitis (AFM) are confirmed, they will bring the total in the state this fall to 11.

The children are between the ages of 3 and 14 and all showed signs of weakness or paralysis in one or more limbs and distinctive spinal-cord changes that are required for a diagnosis of AFM, said Julie Graham, a spokeswoman for the Washington state Department of Health.

“What’s known about AFM is it’s not subtle,” Graham said. “The reporting on it is likely to be fairly sufficient.”

Two of the new cases are from King County and one is from Spokane County, Graham said. One of the King County cases was hospitalized at Seattle Children’s and released, Graham said. The other King County child has been hospitalized at Mary Bridge Children’s Hospital in Tacoma. The Spokane County child remains hospitalized there, Graham said.

Of eight children previously hospitalized at Seattle Children’s, six have been released and two remain under care. The children fell ill starting in September.

Test results have been forwarded to the federal Centers for Disease Control and Prevention (CDC), which is responsible for confirming AFM cases. The agency has reported a sharp rise in AFM cases this year, with at least 89 logged in 33 states between January and September.

A 12th child suspected of having AFM died, but he was excluded from the cluster. Daniel Ramirez, 6, of Bellingham, died Oct. 30 of the results of severe brain swelling and encephalitis, an inflammation of the brain, after an illness with fever, according to a state death certificate issued Nov. 7.

The cause of AFM is unknown, though the illness has been associated with several viruses, including enteroviruses, adenoviruses and West Nile virus. It’s very rare — less than one case in every million people — and affects children more often than adults.

Cases can develop after a cold or other viral illness. There’s no specific action that can prevent AFM, but the best precaution is to prevent illnesses associated with it through good hand hygiene, avoiding sick people and disinfecting surfaces frequently to stop the spread of germs.

Some children paralyzed with AFM recover, but many do not, experts and families said. Two Washington state children were included in a nationwide rise of AFM in 2014, including Hayden Werdal, 15, of Bremerton, who is still grappling with the aftermath.