Enterovirus 68 has now spread to 40 states, leading to four deaths, causing some parents to fear for the health of their children. The outbreak of the respiratory illness is infecting youth in ways previously unseen in other viruses.

The Centers for Disease Control and Prevention (CDC) has confirmed 500 infections by the virus in the United States. Investigators report that in the four victims who have died, it is uncertain what role the disease played in the fatalities. One of the victims was a 10-year-old girl from Cumberland, Rhode Island, who perished just one day after being admitted to the hospital.

Enterovirus is usually not fatal, and in most cases, is not even severe, meaning that many people are unaware they have been infected by the virus. Therefore, the actual number of people affected by the disease is likely much higher than reported by the CDC.

Children are often severely affected by the disease, especially those with previous respiratory conditions, such as asthma. Doctors are cautioning parents to be on the lookout for problems with breathing including wheezing, as well as chest pains and blue lips. Children exhibiting any of these symptoms should be provided with immediate professional care.

An outbreak of enterovirus 68 occurred in New York City during 2009. Since that time, other clusters of cases have been recorded elsewhere in North America, Europe, Africa, and southeast Asia. Symptoms of the disease are usually similar to that of a severe cold, or a mild flu, particularly in adults. Most people who come down with the disease believe they are just feeling under-the-weather, and often do not even seek medical treatment.

"But in certain individuals the symptoms are more severe, and that hasn't been seen before. What's different now is that kids are going to the I.C.U. But the fact is that we don't know a lot about this virus. Until the last 10 years or so it was very rare," Rafal Tokarz, an enterovirus expert at the Center for Infection & Immunity at Columbia University, said. It was Tokarz who first identified the cluster of infections seen in New York five years ago.

The virus is likely mutating, possibly becoming easier to transmit, and better-able to cause symptoms, the Columbia University associate research scientist believes. Strains of enteroviruses seen just 10 years ago are significantly different that the varieties affecting populations today.

No preventative vaccines or cures have been developed to fight the virus, but a test for the disease is available. Concerned parents can help to keep children healthy by following the same guidelines used to prevent other viral infections. These include making sure youth wash their hands regularly, and not sending them to school if they feel ill.

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