NIANTIC, N.H. — The two people who died of the New Hampshire coronavirus believed to have been caused by exposure to the sewage at the Riverbend Family Health Center are linked to a more recent case of the disease, the officials said on Monday.
The infection, known as SARS-like enterovirus 68, had not been linked to bacterial diseases.
One of the two patients with the virus in Rhode Island also died. The Health Department said it did not believe that the two cases were linked.
Both the health department in New Hampshire and that in Rhode Island have been investigating whether enterovirus has been found in any private homes in the two states.
The most recent cases of enterovirus 68 that were reported in New Hampshire occurred at the health center in September, 2017, and November 2017, said Jeremy Johnson, deputy director of the state health department’s communicable disease division. In Rhode Island, the most recent case was reported in June.
The health department also disclosed that on Feb. 26, it sent letters of notification to 426 private businesses in this state that New Hampshire health inspectors had tested at their water supply wells.
“There are no reports of exposure to enterovirus-68 at either health center,” the letter said. “However, we are not taking any chances. Our preference would be to contact you directly, if you are not already notified.”
The CDC has identified 29 cases of the strain in 12 states — New Hampshire, New York, Connecticut, Massachusetts, Rhode Island, Delaware, New Jersey, Maryland, Pennsylvania, Virginia and Maryland. Six of those cases, including the two people who died, had been confirmed by laboratories in a CDC lab.
With states urging people to avoid contact with water, officials are stepping up health inspections of establishments that may have used showers or bathtubs or did not have sufficient filtration to protect the water supply from this strain of enterovirus.
Dr. Joseph Garvey, director of the Center for Infectious Disease at the University of New Hampshire, said the outbreak may have begun with hospital workers returning from their shifts, and so the infection may not be as well understood.
“The real thing is, what are those other cases and why have we not had one before?” Garvey said. “That’s what we’re looking for.
Enterovirus 68 appeared in the United States for the first time in 2009 and is seasonal. When new infections are reported, hospitals, nursing homes and public pools typically test for enterovirus 68.
It is spread by touch — by putting something into the mouth of an infected person, for example — and is known to cause the same symptoms as the common cold, such as fever, runny nose, cough and body aches. People may not have any symptoms or may have a fever for longer than three days.
However, those with a weakened immune system or who have had a recent heart procedure can have a more severe case of the virus.
Dr. Colleen McKeown, the executive director of the New Hampshire chapter of the American Lung Association, said the group has been working closely with health officials on this outbreak. “We’re encouraging folks with respiratory illnesses to be diligent,” she said.