Thursday, October 9, 2014

Preschool Enterovirus Victim Died in His Sleep - ABC News

Preschool Enterovirus Victim Died in His Sleep - ABC News

The New Jersey preschooler who died of the respiratory illness enterovirus 68 went to sleep and never woke up, health officials say.

The death of 4-year-old Eli Waller is the first to be blamed on the virus that has swept the country, but health officials say he went to bed with none of its symptoms, which include cold-like symptoms but in some cases can involve wheezing and difficulty breathing.
"I think Eli's case is the exception to the other cases around the country," said Jeffrey Plunkett, the Hamilton, New Jersey, health officer. "He had no signs of any illness that night, and his passing was sudden and shocking."
Eli, of Hamilton, New Jersey, was the youngest of three triplets, born "smaller and lighter than his sisters," but he was never one to let that stand in his way, his father Andy Waller said in a letter released Sunday evening. His siblings are "perfectly healthy," Plunkett said, but one of Eli's classmates was being tested for possible infection this morning.
"Eli was not the type to give up, and even though things never really came easily to him, he would just plug away, day after day, practicing sounds, or movements, or skills, until he would eventually get them," his father said.
"He did this entirely in an effort to make his Mom and Dad proud, and we can unequivocally say that we were, and will continue to be, so very proud of our little Eli," he said.
He compared his son to "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."
Andy Waller said the family was establishing The First Day of School Foundation, to provide support for students involved in Special Education.
"Like so many kids his age, Eli was both nervous and excited about starting school, and it is our sincere hope that this Foundation can work to help kids in a way that will make Eli proud of us all, in the same way that we were all so proud of him," he said.
PHOTO: Eli Waller, the 4-year-old New Jersey boy who was the first child confirmed to have died of the Enterovirus-68, seen in a family photo.

Sharing a very informative comment on this article.

Sharing a very informative comment posted under this report by questioningyou

"Many here are confusing the issues. We are researching the explosion of EV-d68 and what can only be classified as an uncharacteristic, potentially deadly strain. We are focusing on the distribution patterns first and foremost. Ancient citations about EV-d68 are not applicable in this case at this point. The message I hope to convey is that Americans should be diligent. They should know what’s happening in their communities and schools and take basic protective measures to minimize exposure. But I am also now compelled to discuss, somewhat, the applicable science, mainly because of the misleading information being spread on the internet by others, some of whom seem to have personal or even professional agendas.

First and foremost, the world, including the Philippines in 2009 (often mentioned in many of these forums) has NEVER seen a widespread epidemic of EV-d68 like we are experiencing now in the United States. And the resulting high incidents of serious illness associated with this outbreak are unprecedented. I reiterate, unprecedented. I reiterate high incidents. Cause and effect: What is different about this strain and where did it originate? Can we establish a pattern of distribution by reverse-engineering the latest epicenters of EV-d68 backwards to the first and subsequent occurrences? Can we establish a common source? The answer to this question is yes. We can: Clearly and convincingly. I would prefer to focus on that issue alone, however, there are many who continue to cite historical information about EV’s and EV-d68, in spite of my opinion that it is premature to do so at this point, especially when prominent researchers, one being Dr. Anthony Fauci of the National Institutes of Health, who calls the pattern of infection “unusual.” I worked in one of Dr. Fauci’s labs myself thirty years
ago in the early days of HIV and have enormous respect for his opinion.

EV-d68 refers specifically to a virus, known as Enterovirus species D, serotype 68; more commonly referred to as EV68. It should not be confused with EVD (Ebola).
Currently EV68 has been documented in 43 states plus Washington, D.C. It is my
prediction that it will continue to spread rapidly. Again, this type of widespread outbreak is uncharacteristic of EV68. Never before in our history has EV68 spread so quickly to so many states or affected so many people, primarily children. I am a scientist. This is not a political statement about immigration policies, or an attempt to blame innocent children for bringing EV68 with them from Central America. It’s more likely most of them contracted it here, at the border reception stations where they were subjected to appalling living conditions while they were being processed. However, it is
documented that there were several cases of TB which did arrive with the children, along with other health issues. Their subsequent possible connections to this particularly virulent strain of EV68 cannot be discounted. Yet. Nevertheless, From a public health perspective I will say that it is appalling and unacceptable that any of these children were displaced nationwide without adequate health screening first. And to all of the detractors I say that distribution data we are developing clearly shows correlation between known epicenters of outbreaks and the placement of these children throughout the country. These data are now emerging as irrefutable patterns, which I intend to submit to peer review scrutiny within the next 24 – 48 hours. It’s critical that we understand how this happened and not let ourselves get sidelined by
opposing political views and opinions of those who are clearly trying to distance this crisis from US Policy, the way the border crisis has been managed, or potential adverse effect on immigration reform. I could care less about any of these issues within the context of researching and understanding this epidemic.

EV68 is not a new disease. The key difference now is the widespread explosion in the general population. Increased occurrence leads to greater probability of mutation.
That’s a real concern. In spite of studying the virus for more than fifty years, historical data are not entirely relevant in this case. This particular strain is different and potentially deadly. We can’t predict the run of its course now because the spread of this strain is very unique. Normally most people experience few if any symptoms. But normally the virus exists in clusters where isolated exceptional cases don’t warrant public health intervention or cause a nationwide health crisis. The virus has been enigmatic, generally predictable, until now. Normal core standards do not apply to this

Enteroviruses are grouped in a larger family called the picornaviruses. Scientist have been slicing and dicing and classifying EVs for more than fifty years. There are currently twelve species and more than a hundred serotypes. A well known EV is Enterovirus C, serotype poliovirus, or Polio. Enteroviruses closely resemble rhinoviruses, which mean they are generally respiratory viruses. Most patients experience common cold-like symptoms with little or no resulting complications. Outbreaks tend to have chartable peaks which can be tracked over years and
demonstrate higher rates of infections certain years and lower rates in other years. But never in the classified history of EV68 has any place in the world experienced the widespread, lightening fast explosion we are seeing now. Someone suggested in this forum that reviewing viral patterns would help the lesser informed understand that EV68 is no big deal. But the frequency of EV68 in 2014 cannot be determined until the final numbers are in, and we are in mid crisis. What we DO know is that EV68 has never spread so rapidly or been so widespread in the United States. Therefore historic charts and tables offer little scientific value towards understanding this very uncharacteristic strain. The viral pattern “peak” for 2014 will be astronomically higher than in any previous year.

Many enteroviruses have similar properties and produce similar infections and symptoms. But it’s important to remember that EV strains exist with different antigenicity, resulting in positive tests for EV-d68, but different symptom sets. A similar
EV-d68 crisis occurred in Philippines in 2008-2009. The virus underwent several mutations and spread rapidly but primarily in the Eastern Visayas region. It did not spread to the general population as a whole. Breathing difficulties were observed here also, but the outbreak, though large, was clustered and the outbreak was not considered problematic relative to other diseases, i.e. pneumonia. But that is not the case with the EV-d68 strain endemic in United States today. Clear data show the relationship between children with other respiratory problems and the severity of symptoms. Much work has to be done to study the antigenicity and receptor binding properties of the current strain of EV-d68 in comparison to the prototype strain of EV-d68. This is the main reason I have called attempts to explain and define, and even minimize the current crisis “premature” and “irresponsible”. We must study the pathogenesis to determine why so many children are the primary groups infected. The correlation of the age groups of the immigrant children on the border and the placement of those children in similar population age groups, where EV-d68 is now exploding cannot be ignored, even though it has been observed in this age group in the past. Particularly when emerging distribution patterns verify the placement of many of these children across the United States with outbreak epicenters. More alarming, we now understand that EV-d68 behaves like a flu virus insofar as it affects a cell by binding to the same target as a flu virus - α2-6 sialic acids. Evidence now suggests that EV-d68 may actually be capable of evading the immune system, breaking down certain chemical signals before the immune system can be alerted to the “attack.” Utilizing a protein called 3C protease, EV-d68 can break down immune signal in cells and prevent some of the normal immune system response. This enables the virus to continue to infect a person who may be unaware they are sick. But then they become seriously ill very quickly.

While I’m confident that Public Health officials are ready and able to deal with an increasing number of cases, there will still likely be numerous children who will become
seriously ill and some of them will succumb to their illnesses. My opinion is that would be a preventable tragedy for the majority of them. This particular outbreak appears to have had a lot of help distributing itself across the country. To the “historic data” flag wavers, I remind you that an EV-d68 outbreak of this magnitude has never occurred before, and; for more than half a century, EV-d68 has been infecting population clusters. So why is it so widespread now? Why is it causing numerous more serious symptoms, more severe infections?

Like the common cold or flu, infection is preventable by washing your hands with soap and water and also regularly disinfecting surfaces. If you do get sick, there is only a small chance it will get worse; most children and adults will have few symptoms. Finally, if there is a problem, such as respiratory distress, our hospitals are prepared to provide the appropriate care to help facilitate a full recovery.

Parents, pay close attention to what’s happening in the schools in your community. EV-d68 isn’t generally a big problem, but this year it’s different and we simply don’t know enough about this strain to dismiss the possibility that EV-d68 infection could
be catastrophic, particularly for children. If you suspect a problem in your child’s school, inquire. Keep your child home if necessary. As the weather cools the threat will subside. Then we can factually draw conclusions about the consequences of this highly uncharacteristic strain of EV-d68."