LINCOLN, Neb. (AP) — Nebraska state health officials say a fourth case of a rare, polio-like illness has been confirmed in the state.

The Nebraska Department of Health and Human Services said in a news release Wednesday that the case of acute flaccid myelitis, or AFM, has been confirmed in a child in northeastern Nebraska. No other information about the child has been released.

The state’s first case was reported in November.

AFM can cause paralysis in the arms and legs and affects mainly children.

An increase in cases nationwide started in 2014. The department says from August 2014 through October 2018, there have been 527 confirmed cases of AFM in the U.S.