First Confirmed Enterovirus Death Involves New Jersey Preschooler

A New Jersey child who is the first confirmed death from enterovirus D68 (EV-D68) exhibited no symptoms of the respiratory virus prior to being found dead in his home, according to state health care officials.

Eli Waller, 4, of Hamilton Township, New Jersey, was held out of school on September 24, 2014, after his parents thought he had pink eye. Although there were no signs of sickness in the child when he went to bed that night, he was found dead the following morning.

“He was asymptomatic and fine, and the next morning, he had passed,” said township health officer Jeffrey Plunkett in a New York Times report. “The onset was very rapid and very sudden.”

One week later, the US Centers for Disease Control and Prevention (CDC) confirmed that the child was infected with EV-D68. In a statement released to the media, the boy’s parents said Eli was the youngest of a set of triplets and was born much smaller and lighter than his sisters.

“Imagine a shy little puppy who wants only to make people proud and happy, maybe tripping a bit over his own paws, but truly full of unconditional love,” the statement read. “He was a beautiful mix of eagerness and hesitancy, need and striving, caution and surprise, all of which were grounded in a pure, unconditional love.”

Four other children who recently died have tested positive for EV-D68, though health care officials noted it is not yet clear what role, if any, the virus played in their deaths.

A 10-year-old child from Rhode Island who died on September 22, 2014, was the first death to be recorded with a confirmed presence of EV-D68. The Rhode Island Department of Health reported that the child died from Staphylococcus aureus sepsis associated with EV-D68, noting that the death was clearly due to sepsis, while the role EV-D68 played remains unclear.

As of October 6, 2014, there have been a total of 594 individuals from 43 states and the District of Columbia with confirmed respiratory illnesses caused by EV-D68.

Enteroviruses typically infect 10 to 15 million people annually in the late summer and early fall seasons, but the EV-D68 strain has led to more serious complications than the typical flu-like symptoms associated with the illness. Additionally, the CDC is currently investigating whether there is a link between EV-D68 and several recent cases of muscle weakness or paralysis in 9 children from Colorado.

The virus was found in 4 of 8 children, while the status of the ninth child has not yet been confirmed, according to the National Institutes of Health (NIH). Although the NIH noted that EV-D68 can cause paralysis, it said other germs can, too, so the actual cause of the symptoms in the 9 Colorado children has not yet been determined.

Symptoms for EV-D68 include fever, runny nose, difficulty breathing, muscle aches, hypoxemia, and possible wheezing. Approximately two-thirds of confirmed EV-D68 patients had a previous medical history of asthma.

"Parents and caregivers should be aware that children with weakened immune systems or underlying medical conditions, such as asthma, may experience severe complications and require hospitalization with supportive therapy," said New Jersey Health Commissioner Mary E. O'Dowd in a press release.