Child Death in Rhode Island First Linked to Rare Virus

A 10-year-old girl who died last week in Rhode Island is the first confirmed death from a respiratory virus that has hospitalized hundreds of children across the U.S., health authorities said.

The girl died from a staphylococcus aureus sepsis infection associated with Enterovirus D68, said Christina Batastini, a spokeswoman for the Rhode Island Department of Health. The child died within 24 hours of being taken to a hospital, she said.

The respiratory virus has been confirmed in 472 people, mostly children, in 41 states and Washington, according to the U.S. Centers for Disease Control and Prevention. Most infected with the virus suffer cold symptoms though it has caused breathing difficulties in some and may be linked to paralysis in 17 children. The CDC has detected EV-D68 in four patients who had died, including the Rhode Island girl, though the role the virus played in the deaths is unclear, said Mark Pallansch, director of CDC’s Division of Viral Diseases.

Deaths linked to enteroviruses “occur every year,” Pallansch said in a telephone interview. “We do expect to hear about more.”

Enteroviruses peak in last summer and early fall in the U.S., he said. The large number of respiratory illnesses linked to EV-D68 makes this year’s outbreak unique.

“It is too early to tell whether it is going down,” Pallansch said. “We don’t have any indication that it is going up.”

Rhode Island Death

Health department officials in Rhode Island declined to say what hospital treated the girl or provide further details about the case.

“We are all heartbroken to hear about the death of one of Rhode Island’s children,” Michael Fine, director of the Rhode Island Department of Health, said in a statement. “Many of us will have EV-D68. Most of us will have very mild symptoms and all but very few will recover quickly and completely.”

While the most severe condition commonly linked to strains of enterovirus is viral meningitis, a handful of patients each year develop more severe neurologic disease “and, of those, a small number die,” Pallansch said.

A cluster of patients in Colorado in the current outbreak with a neurologic disease also has confounded researchers.

“At this point, we don’t know the cause of that illness,” Pallansch said. “One question is whether it is related to enterovirus.”

Paralysis Cases

Health officials are investigating 10 paralysis cases in Colorado and at least three in Missouri. Boston Children’s Hospital is treating four children who developed severe muscle weakness or paralysis shortly after having a respiratory virus, which may have been EV-D68, hospital officials said yesterday.

While the rare virus is suspected, it hasn’t been detected in all of the patients who developed paralysis and further testing is needed to determine if there is a link.

The CDC has a backlog of “multiple hundreds” of specimens that need to be tested for EV-D68, Pallansch said. The agency developed the complicated diagnostic for the virus and it can take several days to produce a result.

CDC researchers are developing a rapid test that they expect to be ready next week and plan to make available to state health departments, he said. The rapid test could eliminate the backlog in a week compared with the six weeks it would take to get through it with the current test.

Higher Number

The actual number of EV-D68 cases is probably much higher than what the CDC has found. At least one hospital in Colorado reported seeing thousands of suspected cases, health authorities said.

“We don’t even have our finger on the pulse of how extensive this is, we have a guess,” Mary Anne Jackson, director of the division of infectious disease at Children’s Mercy Kansas City, said in a telephone interview. “We are in a very dynamic period right now.”

Jackson’s hospital has treated more than 700 suspected cases and was among the first to report an outbreak of the virus.

EV-D68 was first seen in 1962. There is no vaccine, and no specific medicine approved to treat it. The latest outbreak began in the Midwest, with clusters of cases in Kansas City and Chicago.

The CDC did look into compounds in various stages of clinical trials to possibly help treat the virus and none were active against the current EV-D68 strain, Pallansch said.

Common Symptoms

The enterovirus is related to the common cold, and this strain has hit children hardest. Most only experience symptoms such as a runny nose, though a small percentage develop trouble breathing and have to be admitted to the intensive care unit.

The possibility of paralysis adds another layer to the mystery around the virus as it has spread across the nation, and why it has caused such severe illness in so many children, particularly those with asthma or previous breathing difficulties.

Health officials are encouraging the standard approach to good hygiene to reduce the risk of spreading the virus, including regular hand washing, limiting time with ill people and staying home when sick. Parents should watch for signs their children are having trouble breathing or wheezing.

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