A preschool student in Hamilton, N.J., Eli Waller, is the country’s first death linked to Enterovirus D68, a serious respiratory illness that has swept the U.S.

According to officials, Eli who is only 4 years old, died in his sleep on Sept. 25 and a series of tests confirmed the virus.

ELi attended Yardville Elementary School’s preschool in the afternoon and may have picked up the virus from another student who had a respiratory illness and shared the same classroom as him during the mornings. The Centers of Disease Control and Prevention are currently reviewing test samples, from that student, for the virus.

According to the CDC, a total of 594 people across 43 states and the District of Columbia have experienced illness caused by enterovirus D68 between mid-August and Monday.The virus has been detected in four other people who have died, the centers said. The role EV-D68 played in these deaths is unclear; state and local health departments are investigating, the CDC said.

The New Jersey Department of Health has also confirmed that nine cases of the virus have been confirmed in eight counties. Their spokeswoman, Donna Leusner claimed that they are communicating with health and school officials and posting information on their website but what is really important is for parents to be on the lookout for signs and symptoms.

Those symptoms include coughing, a runny nose, body and muscle aches and, sometimes, fever. What first appears to be a common cold can progress to wheezing, problems breathing and possible paralysis. That’s because EV-D68 is related to the virus that causes polio, which crippled thousands of American children before a vaccine was developed in the 1950s.
The infection is also spread through contact with infected people, coughs, sneezes and touching objects and surfaces with the virus.

Young Eli, however, did not have these symptoms only showing signs of what seemed to be pink eye.

There is no vaccine for EV-D68, which was first identified in California in 1962 and is among more than 100 non-polio enteroviruses. Infants, young children and teenagers are most susceptible to infection, particularly during outbreaks in the summer and fall. Infections generally taper off in late fall and there are no antivirals.

In Hamilton, school officials are taking extra precautions and focusing on three areas: cleanliness, education and monitoring. Superintendent James Parla said in a statement that among other things the district will increase custodial hours “to ensure a thorough cleaning” in the schools, principals will share information with staff every day and all illnesses in the schools are being tracked.

Eli Waller’s parents plan to honor their late son by establishing The First Day of School Foundation, which they say will provide support for students involved in special education.