Questions and offers at N.J. meeting on enterovirus

HAMILTON TOWNSHIP, N.J. - One man asked whether officials would test for "hot spots," as was done in 2001 after samples of anthrax were sent through the mail.

Another resident volunteered to donate cleaning supplies. Still another said he represented a company that could disinfect school rooms with ultraviolet light.

At a public meeting Sunday night, more than 100 people sought answers after the death of a 4-year-old boy was blamed on a microbe called enterovirus D68.

"It is scary," Mayor Kelly Yaede told the audience at Steinert High School, no doubt echoing the feelings of many.

Since mid-August, four children have died who later tested positive for the virus out of more than 500 cases nationwide, according to the federal Centers for Disease Control and Prevention, though the microbe has not been ruled a cause of those four deaths.

The boy who died here, during the night of Sept. 24 or the morning of Sept. 25, represented a fifth such case when N.J. health officials confirmed it Friday. And unlike the other four so far, on Saturday, the Mercer County medical examiner attributed it to the virus.

The apparent death toll due to enterovirus D68 is small when compared with more common bugs, notably the flu, which typically kills more than 100 children a year, especially those with weakened immune systems or other preexisting conditions.

Still, the handful of cases are a reminder that respiratory illnesses, whatever the cause, can be serious, said Esther Chernak, an infectious-disease physician who teaches at Drexel University's School of Public Health.

The best advice is the same as in every cold and flu season: Wash hands, cover the mouth with the crook of the elbow when coughing or sneezing, and stay home when sick, she said.

Parents of children with asthma should be especially vigilant.

Unlike the flu, D68 may have another troubling element: There is evidence it is connected to muscle weakness due to a lesion on the spinal cord. At least four Colorado children with these neurological symptoms have tested positive for the virus, though it remained unclear whether that was a coincidence.

Other hospitals have been asked to report any children with similar symptoms of weakness accompanied by evidence of a lesion. Three such children have been treated at Children's Hospital of Philadelphia, though tests on whether they have D68 are pending, said Brenda Banwell, hospital chief of neurology.

"We would love to know if this is really the cause, but it's not at all clear yet that it is," Banwell said about whether the virus can be blamed for the muscle weakness.

More than 100 types of enteroviruses have been identified, including some others that can lead to muscle weakness, notably the microbe that causes polio. But physicians cautioned against drawing any parallels between that virus and D68, which mostly seems to lead to respiratory symptoms.

Chernak said in some respects enterovirus D68, first reported in 1962, is more like the rhinoviruses - the family that includes the common cold. In the case of the Hamilton Township boy, Eli Waller, his parents noticed no symptoms when they put him to bed Sept. 24, according to township health officer Jeff Plunkett. The youngest of triplets, he had stayed home earlier in the week with symptoms of pinkeye, Plunkett said.

The reason the medical examiner attributed the death to D68 was the boy had swollen lymph nodes and no test results that pointed in any other direction besides the positive test for the virus, Plunkett said. "There were no other signs of any illness," he said.

Via the mayor's office, Eli's father, Andy, posted a moving tribute to the boy in which he thanked residents for their support. He said the family was starting a foundation to support children involved in special education.

"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 father wrote.

As for questions the audience posed, Plunkett spoke Sunday night to quell some of the misinformation. Unlike anthrax, enterovirus is not a bacterium, but a virus, and it survives outside the body for a few hours, a day at most, he said, so there is no need to test for hot spots.

School officials elsewhere have been disseminating information, in some cases a tad off-base. In the Quakertown Community School District in Bucks County, for example, officials told parents hand sanitizer would be placed in all classrooms and offices. But this type of virus is not especially susceptible to alcohol-based sanitizers, Chernak said.

Inquirer staff writer Don Sapatkin contributed to this article.