The CDC reported that enterovirus D68 has been detected in specimens from four patients who have died and had samples submitted for testing, according to its website.
The role of enterovirus D-68 (EV-D68) infections in the deaths currently is unclear, with state health departments continuing to investigate, the CDC said.
A Rhode Island child died as a result of Staphylococcus aureus sepsis associated with EV-D68, according to a press release from the state’s department of health.
The CDC or state public health laboratories now have confirmed 500 people from 42 states and the District of Columbia with respiratory illness caused by EV-D68, according to the CDC.
Additionally, in Colorado and Virginia, there have been reports of children hospitalized with neurologic illness with limb weakness of unknown cause, with some patient specimens typed as EV-D68, according to separate health advisories.
“The possible linkage of this cluster of neurologic disease to this large EV-D68 outbreak is part of the current investigation,” a CDC health advisory said. “CDC is seeking information about other similar neurologic illnesses in all states, especially states clustered in time and place.”
The rash of EV-D68 illnesses primarily has affected children and in some cases required hospitalization, particularly among those with a history of asthma and wheezing, the CDC reported.
“CDC is prioritizing testing of specimens from children with severe respiratory illness,” the CDC website said. “Of the specimens tested by CDC lab, about half have tested positive for EV-D68. About one-third have tested positive for an enterovirus or rhinovirus other than EV-D68.”
In the CDC health advisory, it reported it is working with the Colorado Department of Public Health and Environment and Children’s Hospital of Colorado to investigate “a cluster of nine pediatric patients hospitalized with acute neurologic illness of undetermined etiology.”
The illnesses have occurred since Aug. 1, coinciding with an increase in respiratory illnesses among children (median age, 10 years), according to the advisory, and are characterized by focal limb weakness and abnormalities of the spinal cord gray matter on MRI.
Cerebrospinal fluid analyses have been negative for West Nile virus and enteroviruses, including poliovirus, the advisory reported. Eight of the nine children were confirmed to be current on polio vaccinations.
Nasopharyngeal specimens tested positive for rhinovirus/enterovirus in six of eight patients who were tested. Four of the positive specimens were typed as EV-D68, the advisory reported, with the other two pending typing results.
The Virginia Department of Health said it had received one report of a child with “acute neurological illness of unknown etiology.”