(HealthDay News) — A 4-year-old boy from New Jersey is the first confirmed death due to Enterovirus D68, health officials report.

According to the US Centers for Disease Control and Prevention, 43 states and the District of Columbia now have a total of 538 confirmed cases of Enterovirus D68, the severe respiratory illness that has been infecting children since the summer.

Health officials are also trying to determine if the virus is associated with cases of muscle weakness and even paralysis that have struck 10 children in the Denver area. Other cases of muscle weakness or paralysis have been reported in Massachusetts, Michigan, and Missouri, according to The New York Times. Doctors don’t know if the limb weakness or paralysis is temporary or will be long-lasting—or whether it has anything to do with Enterovirus D68.

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The 43 states with confirmed cases of Enterovirus D68 are: Alabama, Arkansas, California, Colorado, Connecticut, Delaware, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin and Wyoming.

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