A day after it confirmed the state’s first case of enterovirus D68, the Maine Center for Disease Control and Prevention refused to disclose which York County school district the child attends, citing patient privacy and the need for everyone to take steps to stop the spread of infectious diseases.

Health officials in other states say that approach is standard and that they would not identify an infected child’s school district. They said they have been working with all their school districts to improve hygiene and stop the outbreak.

Maine was the 42nd state to identify a case of the virus, and its case was the 440th positive test nationally. Since Wednesday, the number has grown to 514. Three-quarters of those affected had asthma or some other pre-existing respiratory problem.

It has predominantly affected children, possibly because adults have had enough exposure to different strains of enterovirus that they have built up an immunity.

Four people who were infected with the highly contagious respiratory virus have died, but the U.S. Centers for Disease Control and Prevention was unsure what role the virus played in the deaths. A 10-year-old Rhode Island girl who died tested positive for enterovirus D68 and had a drug-resistant strain of Staphylococcus.

Maine health providers took samples from four or five children who had severe respiratory illness, much like other children who have contracted the sometimes powerful strain of the enterovirus, said Dr. Sheila Pinette, director of the Maine CDC. Of the three results that have been returned, two were negative for the D68 strain and one was positive.

The patient was admitted to the hospital the week of Sept. 10. After four to five days of hospitalization, that child improved and was sent home. The child first became ill – and was contagious – three weeks ago. Because the virus has an incubation period of one to five days, anyone who would have contracted the illness from the child would already have been sick, Pinette said.

Pinette said the center does not identify patients’ communities or school districts because that could cost someone their privacy.

“People can get isolated and discriminated against,” she said. “They can be discriminated against in the workplace.”

Many people exposed to the virus do not become sick or only have very mild symptoms, making it difficult to prevent its spread, according to the U.S. CDC.

In Colorado, where 19 positive results for enterovirus D68 were returned from 25 samples, the Children’s Hospital Colorado announced it had treated 4,000 children for respiratory distress since the outbreak started, a spokesman for that state’s health department said. About 10 percent were hospitalized. Notifying individual school districts wouldn’t have made sense, he said.

In Washington State, where there have been three positive cases, officials announced the counties where the children lived but not the town. Massachusetts officials took a similar approach, a spokeswoman said.

Pinette issued an alert about the outbreak on Sept. 12, sending it to all school nurses and other school officials, as well as health care providers throughout the state.

“Before we even had a case, we started to educate,” Pinette said. “You could see it was starting to move rapidly.”

State education officials plan to distribute guidelines for schools to communicate to students and their families today, once they are received from the state CDC.

There can be a long wait for the CDC to determine whether a sample is positive for the D68 strain because the test must be done at the molecular level and there are many samples coming in, which must be prioritized, Pinette said.

Also, determining the presence of the D68 virus does not aid in treatment. There is no treatment for the illness itself, only for the symptoms like dehydration and difficulty breathing.

Because of the breadth of the outbreak, the U.S. CDC has outlined a multi-step procedure hospitals must follow before it will test a sample for D68.

First, a patient must be sick enough to be hospitalized – usually with severe wheezing or difficulty breathing. Next, a chest X-ray must show pneumonia-like congestion in the lungs. Then, hospital tests must rule out bacterial infections and come back positive for enterovirus.

For that reason, the state has not received an influx of case reports since it announced that the virus was in Maine, Pinette said.

Another hallmark of the illness is that it comes on very suddenly.

“They go from being healthy to being very sick within a matter of hours,” Pinette said.

A few of the patients in other states have had weakness or difficulty using some of their limbs.

There are 100 strains of enterovirus. The United States has had outbreaks of enterovirus D68 before, in the 1960s and in 2009 to 2010, but it affected far fewer people, Pinette said. Nobody knows why the outbreak is so widespread this time, but one reason might be because the virus persists on hard surfaces, which are more abundant today because of computer keyboards and cellphones, she said.

Families are encouraged to wash their hands frequently with soap and water – antibacterial lotions do not work against the virus. A mild solution of bleach and water can be used to wipe down surfaces that are frequently touched.

Standard practices for preventing the spread of infectious disease also can work with enterovirus D68, like coughing and sneezing into one’s arm and not touching one’s face with unwashed hands.

“It’s all about community containment. You can’t do more than that to prevent it from spreading,” Pinette said. “We really believe population health is crucial. If it’s present it can spread quickly. We know that.”

David Hench can be contacted at 791-6327 or at:

dhench@mainetoday.com

Twitter: @Mainehenchman