Toddler who died of swine flu visited mall

Cameron County Judge Carlos Cascos, who spoke with an aunt of the boy in Brownsville who made the Houston trip, said they spent three nights in Houston just before he fell ill and was hospitalized in Brownsville.

The hospital, city and health officials on Wednesday said the 23-month old boy had traveled from Mexico City to Brownsville, where he became sick. When the hospital in Brownsville, a city of 140,000, could no longer care for him, he was medically transported to Texas Children's Hospital. They said he had had no outside contact in Houston. The family has shown no symptoms. Calls seeking comment from Texas Children's Hospital were not immediately returned.

Dr. Susan Fisher-Hoch, a professor of epidemiology at The University of Texas School of Public Health in Brownsville, said that those infected can secrete the virus through their saliva 24 hours before they display symptoms.

The toddler then could have been infectious while he was in Brownsville the first time and was probably infectious while in Houston, said Fisher-Hoch, who was former deputy branch chief at the U.S. Centers for Disease Control's Special Pathogens Laboratory. Still, the toddler would not have likely transmitted the virus to many people at the mall, she said.

Kathy Barton, spokeswoman for the Houston Health and Human Services Department, said the city's epidemiologist would try to re-interview the family, but that the family didn't mention the first trip to Houston. Barton said the a large mall would also not be very conducive to transmitting the virus by a toddler who was likely in a stroller, she said.

Cascos' timeline of the boy's visit, assembled after speaking with his aunt shows the boy was not only in Brownsville before he fell ill. Cascos declined to identify the family, citing privacy.

"It's important because we don't know where he contracted it," Cascos said. "It could've been in Houston or somewhere on the way."

The boy's family flew from Mexico City into Matamoros, Mexico across the border from Brownsville on the evening of April 3. They spent that night and the night of April 4 at a Brownsville hotel. On Sunday April 5, the boy, three brothers, his mother and a cousin drove to Houston for a day of previously scheduled doctor's appointments for the mother and aunt. The boy, who officials said had several underlying health problems, did not see a doctor, Cascos said.

The day of doctor's visits on April 6 lasted from 9 a.m. to 5:30 p.m. Cascos was not sure what hospital the family visited that day.

The family spent April 7 shopping at the swanky Galleria mall in Houston. They spent three nights at another hotel near the mall, Cascos said.

Late April 7 or early April 8, the family began noticing some flu-like symptoms in the boy. They drove back to Brownsville April 8. By the time they returned, the boy had a fever and they took him to a family friend who was a doctor, Cascos said.

Within a day or two, the fever rose and they took him to another friend who was a doctor, where he was prescribed Tylenol, Cascos said. The fever continued to rise and April 13 they took him to Valley Baptist Medical Center in Brownsville.

By noon on April 14, the hospital said it could not give him the necessary care and recommended he be transferred. He was sent to Texas Children's Hospital in Houston. He died there April 27 and the CDC confirmed the boy had swine flu.