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(Above image: a non-polio enterovirus as seen using an immunoelectron microscopic technique. Courtesy: CDC)

The lastest confirmed victim was a four-year-old New Jersey boy, Eli Waller. He died at home on September 25. The Centers for Disease Control (CDC) confirmed the cause of death Friday night. But health officials say they have no idea how he contracted the virus. A health official says Eli was "asymptomatic and fine" when he went to bed but died overnight. He had no known preexisting immune weakness.

CDC Overview of EV-D68

A 10-year girl Rhode Island girl infected with EV-D68, Emily Otrando, died less than 24 hours after being rushed to the hospital with breathing problems. Three other patients with EV-D68 also died in September.

The CDC reports that in the past month and a half, at least 538 people in 43 states and the District of Columbia have become ill with EV-D68. Most of them are children and some developed limb paralysis. Polio, which can cause paralysis and death, is a type of enterovirus. EV-D68 is one of more than a hundred “non-polio” enteroviruses.

The actual number of EV-D68 infections is likely significantly higher than reported since some state health officials are not testing every suspected case.

Link to Illegal Immigrant Children?

Enteroviruses commonly circulate in the U.S. during summer and fall. EV-D68 was first identified in California in 1962. Over the past thirty years, only small numbers were reported in the U.S.

The CDC hasn’t suggested reasons for the current uptick or its origin. Without that answer, some question whether the disease is being spread by the presence of tens of thousands of illegal immigrant children from Central America admitted to the U.S. in the past year.

The origin could be entirely unrelated.

However, a study published in Virology Journal, found EV-D68 among some of the 3,375 young, ill people tested in eight Latin American countries, including the Central American nations of El Salvador and Nicaragua, in 2013. (See Fig. 3)

Though the U.S. government is keeping secret the locations of the illegal immigrant children, there are significant numbers of them in both cities in which the current outbreak was first identified, Kansas City, Missouri and Chicago, Illinois, according to local advocates and press reports.

CDC list of states with confirmed EV-D68 cases

The EV-D68 outbreak was first recognized after Children’s Mercy Hospital in Kansas City, Missouri notified CDC on August 19 of an increase in severe respiratory illnesses. Four days later, on August 23, the University of Chicago Medicine Comer Children’s Hospital notified CDC of a similar increase.

What is an enterovirus?

An enterovirus is a positive-sense (“plus-strand”) RNA (ribonucleic acid) virus. Other diseases caused by RNA viruses include Ebola, SARS, polio and measles.

According to CDC, there are no available vaccines, antiviral medications or specific treatments for EV-D68. Most cases are mild.

Hand, foot and mouth disease: another enterovirus

In March of 2012, CDC reported emergence of a new strain of another non-polio enterovirus in the U.S. responsible for what’s known as hand, foot and mouth disease. The patients’ age range and the severity of the illness were considered unusual in the U.S. and resulted in a more severe and extensive rash. It had been previously seen in Taiwan, Japan, Singapore and Finland. Hand, foot and mouth disease is typically not considered a serious illness and usually resolves itself.

Recently, schools reported an uptick in the enterovirus hand, foot and mouth disease in Illinois, Indiana, Florida, Virginia, Wisconsin with cases also reported in Oregon.

Additional reports in southwest Virginia

Accidental Release of Live Polio Virus into Water in Belgium

In other enterovirus news: The European Centre for Disease Control and Prevention (ECDC) recently reported the “accidental release” by pharmaceutical company GlaxoSmithKline of more than 11 gallons of concentrated live polio virus solution into the environment in Belgium.

Authorities say the release, due to “human error,” happened in Rixensart city and the liquid “was conducted directly to a water-treatment plant (Rosieres) and released after treatment in river Lasne affluent of river Dyle which is affluent of the Escaut/Scheldt river.”

Belgium’s High Council of Public Health stated the risk of infection for those exposed to the contaminated water is “extremely low due to the high level of dilution and the high vaccination coverage (95%) in Belgium.”

A statement from ECDC said, “ECDC's assessment is that the accidental release in the environment of large amounts of live polio virus represents a risk to public health if susceptible populations, such as areas with low polio vaccine coverage, are exposed to contaminated waters or mud. Particularly since the Lasne and Dyle rivers are joining the Escaut/Scheldt river which flows in the southwestern part of the Netherlands where various orthodox protestant communities present a lower polio vaccination coverage, before reaching the North Sea.”