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With five deaths now associated with enterovirus D68 in the U.S., many parents are understandably worried.  

4-year-old Eli Waller of New Jersey, who died last month in his sleep, is the first fatality directly linked to EV-D68.

"What’s concerning about this case — and why we’re all a little bit taken aback by it — is that reportedly this child had no underlying pulmonary conditions such as asthma, which is what we think is a susceptibility factor here," said Dr. Natalie Azar, assistant clinical professor of medicine at NYU Langone Medical Center.

This strain has been around since the early 1960s, but doctors are puzzled why it has become so virulent now, she added. Here's what parents should do:

  • Get serious about clean hands. "I'm definitely one of those mothers who says that kids should play in dirt, but I've started to remind them to do a little more hand-washing in school," Azar said. That means washing with soap and water for 20 seconds. "The most important thing is hand hygiene," agreed Dr. Sampson Davis, an emergency room physician. "Wash your hands after you touch doorknobs, and cough into your elbow."
  • Make sure children with asthma are up-to-date with their medications and their asthma is under control.
  • Look for signs of breathing trouble, Azar said, such as "any wheezing, or using the chest muscles or the neck muscles to help them breathe, or taking more than one breath per second." If you see those signs, "Get them to the doctor immediately," Azar said. "Don't second-guess yourself." 

A 10-year girl in Rhode island died as a result of a bacterial infection associated with the enterovirus D68, according to health officials. The enterovirus was also found in three other patients who died in September. At least 500 people in the U.S. have been sickened so far. Almost all have been children.

It's unsettling that health officials are still unclear about what role EV-D68 played in some of the deaths. But parents can be reassured that severe illnesses related to EV-D68 infections are very rare, says Dr. Amesh Adalja, an infectious disease physician at the University of Pittsburgh Medical Center.

“This is a virus that for the vast majority of people is going to be pretty similar to the common cold,” Adalja says. For most, symptoms will be a runny nose and mild fever. 

“However there are people with predisposing lung conditions, like asthma, who will have a more severe illness,” says Adalja.

Parents of asthmatic kids already know that an attack can be set off by a cold, Adalja says. 

It's similar with enterovirus. Adalja says be alert to: 

  • Wheezing
  • Shortness of breath

If either condition occurs, seek medical attention "sooner than later," says Adalja. 

In rare cases, having EV-D68 can leave a child vulnerable to bacterial pneumonia.

Symptoms of paralysis are also rare. Several children who have tested positive for enterovirus D-68 have developed paralysis or limb weakness, but, again, doctors are not sure why. “It’s been known for a while that the virus can cause neurologic disease such as paralysis,” Adalja says. “It’s in the same category of viruses as polio. Sometimes the paralysis is temporary, sometimes it’s permanent.”

Treatment for EV-D68 is similar to cold and flu: bed rest, fluids and analgesics, if needed. It's a virus, so antibiotics do not help. 

But no matter how careful you are, the virus is hard to prevent. The best way to protect your kids? The same as with any cold or flu.

Hand washing. Lots of it. With soap and water, for at least 20 seconds. Tell kids to keep their hands away from their eyes, noses and mouths. 

And while doctors expect many more cases of EV-D68 this year, the vast majority of children will recover. “Lots of people have very mild cases — some people may not have any symptoms," says Adalja. 

Linda Carroll contributed to this story. She is co-author of "The Concussion Crisis: Anatomy of a Silent Epidemic” and the recently published “Duel for the Crown: Affirmed, Alydar, and Racing’s Greatest Rivalry.”