Officials said a 4-year-old Yardville Elementary School student from Hamilton Township, N.J., died from enterovirus 68, the symptoms of which resemble that of the common cold. Credit Jessica Kourkounis for The New York Times
Eli Waller’s parents thought it best to keep their 4-year-old son home from school, worried that he might have pink eye and could infect other children.
But they could not have suspected that their son was harboring a much more troubling virus, one that has been spreading across the country with unexpected virulence and is being investigated as a possible cause of severe respiratory illness and other complications.
When Eli went to bed on Sept. 24 in his family’s home in Hamilton Township, N.J., he seemed healthy. By morning, he was dead.
“He was asymptomatic and fine, and the next morning he had passed,” said Jeffrey Plunkett, the township’s health officer. “The onset was very rapid and very sudden.”
More than a week after his death, the federal Centers for Disease Control and Prevention confirmed that Eli was infected with enterovirus 68. The virus has been diagnosed in hundreds of children since August.
On Saturday, the local medical examiner said that the cause of Eli’s death was the virus.
It was the first reported fatality definitively caused by enterovirus 68, New Jersey health officials said, and it has stirred fears among parents, despite the reassurances of public health and education officials.
Part of the anxiety stems from the symptoms associated with the virus, which resemble those of a common cold. Also fueling concerns is that there is little that can be done to treat the virus and medical experts are still working to understand it.
More than 100 enteroviruses exist and they are a common cause of illness in the United States every year, infecting 10 million to 15 million people, according to the C.D.C.
While enterovirus 68 had been known to exist for decades, it was never known to have spread widely until this year.
Starting in August, when hospitals in Missouri and Illinois reported seeing an influx of children with respiratory illness, the virus spread to 43 states and at least 594 patients. The number of people who have actually contracted the virus is likely much higher, according to officials. The transmission of the disease is believed to be similar to that of the flu or common cold, where the virus can be found in saliva, mucus and other bodily secretions.
Public concern grew when hundreds of children in Colorado were hospitalized with respiratory illness and enterovirus 68 was named as the prime suspect in many of the cases.
Against this backdrop, Children’s Hospital Colorado reported a cluster of patients suffering from acute neurological illness, characterized by muscle weakness and partial paralysis. Investigators are still trying to determine if the virus is responsible for the neurological illness.
Separately, enterovirus 68 has been detected in four patients who died, but it remains unclear if the virus was solely responsible for their deaths, according to the C.D.C. website.
Dr. Jay Varma, the deputy commissioner for disease control at the New York City Department of Health, said it was important to keep the dangers posed by this virus in perspective.
“This is one of many viruses that can cause respiratory illness in children,” he said. “We do know that this virus tends to cause more severe illness with children who have an underlying condition like asthma. We don’t know why it has become more common this year.”
It is scientifically plausible that the virus is associated with the cases of paralysis, he said, noting that polio is also an enterovirus. But he said that no link had been established and much research needed to be done.
While the virus has been identified in patients in the city, he said, the department was not actively testing because it would not help the city prevent the spread of the virus.
Last year, he said, five children died of influenza in the city and many of the same guidelines that apply for controlling the spread of the flu apply for this virus.
They include making sure that a child who is sick stays home from school and, if there is fever, waiting at least a day after the fever lifts to return to class.
It also is vital for parents of children with asthma to make sure the condition is under control.
And simple measures like frequent hand-washing remain one of the best defenses against illness.
Dr. Tina Tan, the chief epidemiologist at the New Jersey Department of Health, offered a similar message.
While enterovirus 68 has been diagnosed in nine children in the state, a number that will likely rise, Dr. Tan said she had no qualms about sending her own child to school.
At the same time, officials have taken steps to reassure anxious parents. “You’re seeing schools working hard to get information out to students, staff and parents,” said Michael Yaple, a spokesman for the New Jersey Department of Education. “You’re seeing schools sending fliers home in students’ backpacks, hanging posters in the school hallways, holding community meetings and posting information online.”
Outside Yardville Elementary School on Monday, where Eli had just begun his first year, a janitor hauled plastic bins of toy plastic cars into the parking lot, where he washed each one by hand in a tub of disinfectant.
Many parents said that while they were concerned, there was not much that could be done.
“It’s really something that’s out of your control,” said Michelle Silva, 34, after she dropped off her 3-year-old son, a friend and classmate of Eli’s.
Ms. Silva said that she has tried to teach her son to wash his hands at home, and she trusts his teachers do the same at school.
Ms. Silva said that in late September, when Eli was still alive, her son fell ill too, with red eyes and a runny nose.
He stayed home for four days and then, when he went back to school a few days later, he noticed Eli wasn’t there anymore.
When Ms. Silva learned the cause of Eli’s death, she thought immediately of her son.