2018 — Oct esp., Adenovirus 7, children, Wanaque Nursing & Rehabilitation Center, Haskell, NJ–11
–11 CBS News. “11th child dies in viral outbreak at N.J. health care facility.” 11-16-2018.
–10 CNN. “10th child dies from adenovirus outbreak in New Jersey.” 11-1-2018.
— 9 WLNY, CBS 2, NY. “Breaking: 9th Child Dies of Adenovirus Outbreak…” 10-28-2018.
— 8 NJ.com. “Death toll in N.J. adenovirus outbreak rises to 8; more sickened…” 10-26-2018.
— 7 Associated Press. “Child death toll hits 7 in viral outbreak at rehab center.” 10-24-2018.
Narrative Information
CDC: “Adenoviruses are common viruses that cause a range of illness. They can cause cold-like symptoms, sore throat, bronchitis, pneumonia, diarrhea, and pink eye (conjunctivitis). You can get an adenovirus infection at any age. People with weakened immune systems or existing respiratory or cardiac disease are more likely than others to get very sick from an adenovirus infection…” (CDC. Adenoviruses. 4-26-2018 update.)
Timeline[1]
Aug: Centers for Medicare & Medicaid Services, US Dept. of Health and Human Services, gives Wanaque an above average rating for overall quality, and below average health inspection rating.
Sep 26: First child in Wanaque ventilator unit is diagnosed with a respiratory ailment.
Sep 30: Doracase Ephraime Dolcin, 4, gets “a fever that would rise and fall over the next few days.”[2]
Oct 2-3: Elizabeth Poulous, 16-year-old Wanaque resident, develops fever; admitted to St. Joseph’s University Medical Center in Paterson.
Oct 3: Doracase Dolcin fever reaches 102° despite sponge baths and ice applied to break fever.
Oct 5: Doracase Dolcin is moved to St. Joseph’s Univ. Medical Center, Paterson late in the day. Mother later notes she had “repeatedly” sought such a transfer “for nearly a week.”
Oct 8: Dorcase Ephraime Dolcin, 4, dies.
Oct 9: Wanaque notifies NJ Health Dept., after work hours, of “cluster of respiratory illnesses” after 2nd child dies.
Oct 10: NJ Dept. of Health officials begin surveillance work at Wanaque.
Oct 11: NJ Health Department’s Communicable Disease Service, US CDC, and local health dept. begin working with Wanaque with infection control practice recommendations.
Oct 18: Wanaque sends letter to Kristine Deleg noting there had been an outbreak of adenovirus.
Oct 21: NJ Health Dept. makes 1st inspection Wanaque visit (surprise) — 2 registered nurses.
Oct 22: Another child becomes sick from adenovirus.
Oct 22: Kristine Deleg receives Oct 18 letter informing her of the adenovirus outbreak.
Oct 23: Elizabeth Poulous, 16, dies.
Oct 23: NJ Health Dept. makes 1st announcement concerning Wanaque — noting six children have died, 12 more infected, and that the center has been barred from taking any new patients. A Health Dept. staff member was posted at Wanaque to monitor the outbreak.
Oct 24: Another child [seventh] dies from adenovirus.
Oct 24: At a news conference outside Wanaque, Gov. Phil Murphy and the state health commissioner, Dr. Shereef Elnahal, say officials are investigating how the outbreak occurred.
Oct 25: Eighth child dies.
Oct 25: A 19th child is confirmed sick with adenovirus after lab tests. Elnahal says Wanaque did not have room to isolate the children when they became ill, and moving them was difficult.
Oct 26: After lab tests, four more children are positive for Adenovirus — 23 in all.
Oct 26: Stories appear in press noting complaints from relatives of former patients regarding sanitary conditions and lack of adequate care.
Oct 27: Another child diagnosed with adenovirus, bringing total to 25.
Oct 27: It is revealed that a Wanaque staff member had had Adenovirus, but had recovered.
Oct 28: Ninth child dies. Health Dept. states there have been no new cases since Oct 22.
Oct 28: Press report of previous nursing union complaint of staff and supply shortages.
Oct 29: Another child becomes sick.
Oct 29: State Dept. of Health announces it will send in a team of infection control experts and epidemiologists to Wanaque, and four other pediatric long-term care facilities.
Oct 30: Lab tests confirm another medically fragile child with adenovirus — total of 26 pediatric.
Oct 30: NJ Health Dept. releases it’s Oct 21 report on Wanaque inspection to the public.
Nov 1: Is announced that a 10th medically fragile child has died.
Nov 2: Reported that 27 children at Wanaque had become ill during the outbreak.
Nov 5: Two more children at Wanaque diagnosed with Adenovirus — total now 29.
Nov 5: Press reports that NJ legislators have announced intention to investigate outbreak.
Nov 6: NJ Health Dept. confirms 30th Adenovirus illness at Wanaque. — total now 30.
Nov 9: NJ Health Dept. makes 2nd unannounced Wanaque inspection after news report that Wanaque workers had stated that Wanaque delayed sending children to hospitals “because they did not want to lose Medicaid funding if a pediatric bed went empty.”
Nov 16: 11th child dies from Adenovirus at Wanaque.
Nov 23: State officials allow hospitalized children who have recovered to return to Wanaque, stating they cannot be reinfected with the same virus strain.
Dec 11: Adenovirus at Wanaque deemed over, though Center still prevented admitting patients to children’s unit where the virus spread.
Dec 17: State Dept. of Health releases report on a previous inspection of Wanaque. The report notes numerous problems.
Chronological Reporting
Oct 23: “The New Jersey Department of Health was working on Tuesday [Oct 23] to contain a severe viral outbreak at a pediatric center that has left six children dead and 12 others infected…. Children at the Wanaque Center, in northern New Jersey, are pediatric long-term care residents, with some reliant on ventilators and tracheal tubes.
“It was not clear when the children died, and though the department declined to release their ages, it said that the 18 people stricken with the virus ranged from a toddler to a young adult and that most were under 18.
“The health department said it was conducting an investigation at the center, which has been cited in the past for health code violations, and had a two out of five star rating on health inspections from the federal Centers for Medicare and Medicaid services.” (NYT/Nick Corasaniti. “Adenovirus Outbreak Leaves 6 Children Dead at N.J. Pediatric Center.” 10-23-2018.)
Oct 24: “Trenton, N.J. — Another child has died following a severe viral outbreak at a New Jersey rehabilitation center for “medically fragile children,” bringing the death toll to seven, the facility said Wednesday. There have been 18 cases overall of adenovirus at the Wanaque Center for Nursing and Rehabilitation in Haskell, about 30 miles (50 kilometers) northwest of New York, the state Health Department said. The 227-bed, for-profit facility cares for children and elderly residents.
“The agency had said Tuesday that six children had died this month. But the center said it learned Tuesday night that another child had died.
“The strain afflicting the children is usually associated with acute respiratory illness, according to the Centers for Disease Control and Prevention, which on its website instructs health workers to report unusual clusters to state or local health departments….
“The CDC is providing technical assistance to the state. In the past 10 years, cases of severe illness and death from the type of infection found at the facility have been reported in the United States, though it’s unclear how many deaths there have been.
“The center’s website says it helps educate “medically fragile children.” The facility was instructed not to admit new patients until the outbreak ends, and the Health Department said the number of new cases appears to be decreasing.” (Associated Press. “Child death toll hits 7 in viral outbreak at rehab center.” 10-24-2018.)
Oct 25: “An eighth child has died in the deadly viral outbreak that has already claimed the lives of seven at a pediatric long-term healthcare facility in New Jersey, state officials confirmed on Friday [Oct 26]…. Meanwhile, health department officials said more children were infected in the outbreak than originally thought, based on new lab results. There are now 23 confirmed cases of adenovirus in pediatric residents at the Wanaque Center for Nursing and Rehabilitation in Haskell. When the outbreak was first reported, the number of cases stood at 18.
“‘Oct. 22 was the last date in which an individual got sick. The last child became ill before Oct. 22, which remains the most recent date of illness onset,’ said health department spokeswoman Donna Leusner…. Officials said the outbreak remains under active investigation and it is possible that lab tests will confirm additional cases.
“Adenovirus is typically a mild illness that mimics flu- and cold-like symptoms. But experts say it can pose far more serious complications to some people, particularly those with weakened immune systems.
“The state said it will be launching an effort next week aimed at highlighting the need for infection control measures at other facilities in the state that treat immunocompromised children….
“The state said it first became aware of the outbreak at the Wanaque Center on Oct. 9. It became public earlier this week, after NJ Advance Media received an anonymous tip that there had been a number of deaths at the facility. However, neither the state Health Department nor the facility would confirm those fatalities until Tuesday [Oct 23].
“A state Department of Health Communicable Disease Service staff member is currently on site at the facility and monitoring the outbreak, officials said. The federal Centers for Disease Control and Prevention is assisting with lab testing and expertise, state officials said.
“The facility in northern Passaic County is a 227-bed nursing home, rehabilitation center and a pediatrics center, which offers short- and long-term care.
“Licensed for 92 pediatric beds, the facility has agreed to cease new admissions for the duration of the outbreak, said state officials. They added the Wanaque Center has also established a 24/7 hotline for families affected, and is also offering professional grief counseling to anyone impacted….” (Kent and Sherman. “Death toll in N.J. adenovirus outbreak rises to 8; more sickened than first thought.” NJ.com. 10-26-2018.)
Oct 26: “Haskell, N.J. (CBSNewYork) — Four more cases have been confirmed in an outbreak of adenovirus at the Wanaque Center for Nursing and Rehabilitation, bringing the total number of infections to 23. The New Jersey Department of Health said eight children who died are among the confirmed cases of the virus. The latest child death was announced Friday night [26th ].
“Relatives of former patients are coming forward to raise concern about the general conditions inside the facility. Pictures some of the women say they took inside the center in September paint a grim picture. ‘The mood in there is just very down and dirty, said one woman who did not want to be identified. ‘There’s stains on the wall you just can’t tell if they’re blood or fecal matter.’ The pair said they felt compelled to speak out for others who live there. ‘There are people in there that can’t talk and who is looking out for them?’ said one of the women. ‘We would go to visit, and we would go on different days at different times so [they] couldn’t set it up to look good.’ The daughter and mother would often visit a close family friend housed there for care. ‘That place is so filthy and so vile, and you walk in, the smell is just so…we were in tears when we would leave there because we were going home, and he was stuck.’ The New Jersey Department of Health confirms the smell, saying during an August inspection there was a strong unpleasant odor. The center was cited for not following proper infection control.
“The couple also showed photos they say showed the level of disregard to conditions. ‘Sitting in the dining room with them one day when playing bingo, and there’s oatmeal on table that’s crusted and growing mold, or the bed broken held together with scotch tape,’ she said. They say when they complained they were told the facility was understaffed. ‘We went to visit him and he didn’t have a blanket because they didn’t have blankets,“ she said. “We went to grab a bed spread off the bed next to him and there was a huge dried urine stain on the bed.’
“After the viral outbreak in the pediatric unit, the state found minor hand washing deficiencies. The mother says she called the Department of Health after she got her friend out of there earlier in October. She hopes bringing these conditions to light sparks compassion and intervention.
“In a statement to CBS2 on Friday night, the center said these claims run counter to its long-standing good reputation and that it is rated in the top 10 percent of all nursing facilities nationwide.” (WLNY CBS 2, New York. “Exclusive: Women Document Filthy Conditions at New Jersey Nursing Facility Amid Virus Outbreak.” 10-26-2018.)
Oct 28: “Haskell, N.J. (CBSNewYork) — The New Jersey Department of Health announced Sunday morning that a ninth child has died as a result of an outbreak of adenovirus at the Wanaque Center for Nursing and Rehabilitation. The health department said the child was one of the 25 previously confirmed cases of the virus. ‘This is a tragic situation, and our thoughts are with the families who are grieving right now,” Health Commissioner Dr. Shereef Elnahal said in a press release. “We are working every day to ensure all infection control protocols are continuously followed and closely monitoring the situation at the facility.’
“Despite the state’s assurances that they’re trying to limit exposure, CBS2’s Meg Baker spoke exclusively to a patient who described the grisly conditions he says he encountered at the Wanaque center. Eugene Dorio says he went through eight weeks of hell while living at the Wanaque Center for Nursing and Rehabilitation. ‘There’s just no compassion, ya know?’ the 66-year-old diabetic said. ‘It was really dirty, they didn’t really take care of me,’ he said. ‘It was like I had to wait for another shift to come in another two hours to change me, and this went on daily.’
“Dorio says he visited the pediatric unit, where the medically fragile children lived, about once a week. He says they always seemed to be sick. The former patient added the center would sometimes smell of urine or feces, something the staff would blame on patients’ bodily functions. ‘Well that’s your job,’ Dorio says. ‘Clean it up and get rid of the smell.’
“Wanaque Center for Nursing and Rehabilitation has pushed back against the former patient’s claims, citing its record of being ranked in the top ten percent of nursing facilities in the U.S….” (WLNY, CBS 2, NY. “Breaking: 9th Child Dies of Adenovirus Outbreak at N.J. Rehab Center.” 10-28-2018.)
Oct 28: “Nine children have been reported dead at a New Jersey nursing home in the last week, at least eight from viruses that cause respiratory illness, the state health department said. The ninth victim, described as ‘medically fragile with respiratory illness’ by the Wanaque Center for Nursing and Rehabilitation in Haskell, died late Saturday night at a hospital, the state health department said in a statement. It is awaiting laboratory confirmation of adenoviruses in a child who died Friday [Oct 26].
“The viruses are known to persist on unclean surfaces and medical instruments, and may not be eliminated by common disinfectants, but they rarely cause severe illness in healthy people. Those with weakened immune systems, though, have a higher risk for severe disease and may remain infectious long after they recover, the US Centers for Disease Control and Prevention says. They are common in places with large groups of children, such as child-care settings, schools and summer camps.
“There have been 25 confirmed pediatric adenovirus cases at Wanaque, including the eight child deaths. The confirmed cases became ill between September 26 and October 22. A staff member also became ill but has recovered, the health department said….
“The timing of the deaths is not clear. The health department was notified of respiratory illness at the center on October 9. Wanaque sent parents of children at the facility letters about the infection on October 19, according to the health department….
“The children’s ages are not being released to protect patient privacy, said Nicole Kirgan, a health department spokeswoman. They ranged in age “from a toddler through young adults, but most are under 18.”
“The outbreak, caused by adenovirus type 7, “is affecting medically fragile children with severely compromised immune systems. The strain has been particularly associated with disease in communal living arrangements and can be more severe,” according to the health department.
“In a statement, the facility said it “promptly notified all appropriate government agencies when the virus was initially identified.” “The Wanaque Center continues to fully cooperate with these agencies and has sought out their medical guidance with respect to the virus,” the facility said. “As a result, facility staff have diligently implemented all available infection control and prevention measures in order to protect the health and safety of the Wanaque Center’s residents.”
“Nurses at the facility previously had reported a shortage of nursing staff and supplies, according to a statement from the union that represents the nursing staff. The Health Professionals and Allied Employees (HPAE) said the shortages may have led to “poor infection control practices.” The union said it represents the 70 nurses that work at Wanaque.
“In a review by the government’s Centers for Medicare and Medicaid Services, Wanaque was awarded an above-average ranking in overall quality but was given a below-average health inspection rating. Based on an inspection conducted in August, CMS reported that “it was determined that the facility failed to provide a clean and homelike physical environment for their residents.”
“”Most of the time, adenoviruses produce influenza-like illness with cough and runny nose and feeling crummy, but you get better,” Dr. William Schaffner, an infectious disease specialist at Vanderbilt University, previously told CNN. “But they can also cause conjunctivitis and, particularly in children, diarrhea.” In rare cases among people with weakened immune systems, the viruses may cause pneumonia or inflammation of the brain and the tissues around it. In extremely unusual cases, an adenovirus infection can result in death.
“Most adenovirus infections are mild, with symptoms usually lasting about 10 days, according to the CDC. And for most patients, only home remedies and over-the-counter medicines to relieve symptoms are needed. The viruses, unlike the flu, are not seasonal and can cause illness throughout the year. And while a vaccine exists, it’s available only to military recruits.
“The viruses…tend to be spread by coughing and sneezing, direct contact with an infected person, or touching objects and surfaces, such as door handles and light switches, where the viruses can live and remain infectious for days or weeks. The viruses can “stay stable at room temperature for weeks” on unclean surfaces, according to Dr. Alex Valsamakis, director of Clinical Virology and Molecular Microbiology and a professor of pathology at the Johns Hopkins University School of Medicine. She described this family of viruses as “environmentally hardy.” “Wash your hands frequently and avoid touching your face,” she previously told CNN. “That’s kind of the easiest way to prevent inadvertently transporting something from your fingers into your nose or mouth.”
“The infections “usually occur sporadically — here a case, there a case — so outbreaks are pretty rare,” Schaffner said. From 2003 through 2016, the two most commonly reported adenovirus types in the US were types 2 and 3, though four additional types — 1, 4, 7 and 14 — also caused illness, according to a 2017 report from the National Center for Immunization and Respiratory Disease of the CDC. These six types accounted for 85.5% of 1,497 laboratory-confirmed specimens reported during the time period. This small number of cases is believed to be an under-representation of the actual number, since most people who become sick do not go to a doctor, or their doctors do not test for this virus. And the viruses are still difficult to diagnose since they’re not typically included in a panel of tests used to identify specific viruses, according to Schaffner. He said this is changing, and for that reason, he believes the number of cases will rise.
“Still, Schaffner doesn’t think people need to be worried about adenoviruses. ‘They cause principally a whole bunch of minor troublesome infections spread by children, often from children to adults,’ he said. ‘But they’re not nearly as serious as influenza.’” (CNN. “9th child dies after virus outbreak at New Jersey facility.” 10-28-2018.)
Oct 29: “….The death on Sunday at Wanaque Center for Nursing and Rehabilitation in Haskell, New Jersey, was reported over the weekend by the New Jersey Department of Health. ‘These children were all largely ventilator dependant and immuno-compromised,’ said NJDOH spokeswoman Donna Leusner….The strain of adenovirus is associated with communal living arrangements….” (Reuters. “Ninth child died in deadly viral outbreak in New Jersey.” 10-29-2018.)
Oct 30: “Laboratory tests have confirmed another medically fragile child with adenovirus as part of an ongoing outbreak investigation at the Wanaque Center for Nursing and Rehabilitation in Haskell. To date, a total of 26 confirmed pediatric cases have been associated with this outbreak. In addition, a staff member at the facility — who has since recovered — also became ill as part of the outbreak….October 22 remains the most recent date of illness onset. To date, the individuals associated with the outbreak became ill between Sept. 26 and Oct. 22. The affected children in the facility’s pediatric ventilator unit had severely compromised immune systems — including respiratory problems — before the outbreak began…. A Department of Health team of infection control experts and epidemiologists will visit University Hospital and four pediatric long-term care facilities — including Wanaque — in November to conduct training and assessments of infection control procedures, Commissioner Elnahal announced today.” (State of NJ Dept. of Health. “Total of 26 adenovirus cases at Wanaque Center for Nursing and Rehabilitation.” 10-30-2018.)
Oct 30: “The New Jersey Department of Health today released the final report from the October 21, 2018 unannounced inspection of the Wanaque Center for Nursing and Rehabilitation in Haskell. There are no new cases or additional deaths to report today. The Department had previously reported on preliminary findings of the visit, however the full extent of the survey needed to be assessed by inspection staff.
“According to Centers Medicare & Medicaid Services standards, the facility had deficiencies that did not indicate substandard care was delivered. “Now that the report is finalized, certain findings raise questions about whether these general long-term care standards are optimal for this vulnerable population of medically fragile children,” said New Jersey Health Commissioner Dr. Shereef Elnahal. “I will be engaging in collaborative discussions with CMS to assess how we can better align standards for theses pediatric long-term care facilities” As of November 28, 2019, CMS will implement new long-term care regulations that will require long-term care facilities to have an on-site infection preventionist responsible for the facility’s infection prevention control program….” (State of New Jersey Department of Health. “Department of Health Releases Wanaque Center for Nursing and Rehabilitation Inspection Report” (News Release). 10-30-2018.)
Nov 1: “A 10th child has died following an outbreak of adenovirus at a New Jersey rehabilitation facility, state health officials said….‘To date, the individuals associated with the outbreak became ill between Sept. 26 and Oct. 29,’ it said. ‘The affected children had severely compromised immune systems — including respiratory problems — before the outbreak began.’…. The outbreak appears to be confined to the facility’s respiratory unit…‘It can be difficult to impossible to know how the virus got to the facility, what its source was, or what its specific mechanism of spread is from person to person,’ Elnahal [NJ Health Commissioner] said. “But we are working with the CDC on this ongoing outbreak investigation.”….” (CNN, Michael Nedelman. “10th child dies from adenovirus outbreak in New Jersey.” 11-1-2018.)
Nov 2: “The parents of a 4-year-old girl who they say died in a viral outbreak that has killed nine other severely debilitated children at a long-term care center in Wanaque are calling for the facility to be shut down because they say their daughter was neglected. In an interview at their home in East Orange on Thursday night, the couple said their daughter, Dorcase Ephraime Dolcin, was one of the first children to die during an outbreak of adenovirus at the Wanaque Center for Nursing and Rehabilitation that is now in its sixth week. ‘It is negligence because they don’t take full responsibility for what happened over there,’ said Ocroimy Dolcin, the girl’s father. ‘They’re just satisfied to make money, not to take care of the sick people.’….
“Dorcase was so debilitated when she was born in September 2014 that she spent the first three months of her life in the neo-natal intensive care unit. She was brought home, but her parents soon discovered that she needed more care than they could provide. Dorcase required a ventilator to breathe and a tube in her stomach to be fed. She never spoke a word, but her mother said Dorcase was responsive to voices and would always laugh whenever someone called her name. She first stayed at a pediatric long-term care facility in Voorhees, a 90-minute drive from her parents’ home, where four children have been sickened in a separate adenovirus outbreak that was reported this week. Dorcase was moved to the Wanaque Center in June 2016, a few months before her second birthday. It was a welcome relief for her parents, who could now visit her more often. Auguste said she went to the center almost every other day. If her husband was away with the car, she would make the 23-mile trip in a taxi. ‘They would charge me a lot of money, but I didn’t care,’ she said. ‘That’s my baby.’
“But Auguste, a nurse’s aide at an Essex County geriatric facility, said the care at Wanaque was delinquent at times. Auguste said she once found Dorcase wearing two diapers, which she says indicates that the staff was trying to conceal her daughter’s waste rather than change her diaper. Auguste said Dorcase was hospitalized at least one other time for respiratory problems.
“The Wanaque center has been cited for deficiencies over the last four years, including instances of poor patient care and unsanitary practices that can lead to the spread of infection.
“Despite her concerns, Auguste said she had few other options for Dorcase. There are only three other long-term care facilities that serve children in New Jersey….
“…on Friday Oct. 5, Auguste said she received a phone call from the center telling her that Dorcase had a 101-degree fever and was being given Motrin and Tylenol to try to bring it down. Later that day, Auguste was told that Dorcase’s condition had worsened. She was taken to St. Joseph’s University Medical Center in Paterson. By that Sunday, Dorcase’s vital signs were plummeting. None of the treatments were helping, Auguste said. “I asked her doctor if there was hope,” Auguste said. “He said, ‘No. She is going to go.'” Dorcase died at St. Joseph’s the next day, Oct. 8. Auguste did not realize that other children were sick until she started seeing parents she knew at St. Joseph’s. She believes her daughter was one of the first to die from the outbreak.
“Elnahal [NJ Health Commissioner] has said it would be impossible to shut down the Wanaque center because of the lack of pediatric facilities in the state and the difficulty of moving many debilitated patients around at the same time….” (USA Today/ Scot Fallon. “Adenovirus victim’s parents: Shut down pediatric care center where 10 children died.” 11-2-2018.)
Nov 2: “HealthDay News…. The health department said that at least 27 children at the center have become ill, CNN reported.” (MPR, [Monthly Prescribing Reference]. “More Child Deaths Linked to Adenovirus Outbreak at NJ Facility.” 11-2-2018.)
Nov 5: “Two more children in New Jersey were diagnosed Monday [Nov 5] with adenovirus in separate outbreaks at pediatric long-term care centers in Passaic and Camden counties, state health officials said, bringing the total statewide to 34….State health officials confirmed a 29th case Monday among children at the Wanaque center…
“Meanwhile, a fifth child was confirmed to have adenovirus at the Voorhees Pediatric Facility, where the state’s second outbreak of viral illness was disclosed last week. The Voorhees outbreak has been attributed to a milder type of adenovirus than the type that swept through the Wanaque center. Three of the four children previously diagnosed at Voorhees have already recovered, the center said. None has died. Lab tests of four children who became ill at the Voorhees center last month confirmed they had adenovirus type 3, not type 7, which is known to be more dangerous and has been associated with the Wanaque deaths. Those tests were conducted by the federal Centers for Disease Control and Prevention. Confirmation by the CDC of the exact type of adenovirus in the most recent case will take a few more days, the state Health Department said….The first Voorhees children became ill between Oct. 20 and 29. Further testing may identify additional children with the virus, the Health Department said….
“The latest child to become ill at Wanaque developed symptoms on Nov. 5. The incubation period for adenovirus can be as long as two weeks. The Wanaque center is not admitting new patients until the outbreak is over. An outbreak is considered over when two full incubation periods have passed; in this case that would be Dec. 3, if no new cases are confirmed.
“A team of infection control experts from the Health Department visited both centers last week, as part of a deployment to educate staff members and to assess the facilities’ ability to limit the spread of disease. The team is also expected to visit two long-term care facilities operated by Children’s Specialized Hospital in Toms River and Mountainside, as well as the neonatal intensive care unit at University Hospital in Newark.
“State health officials and the Camden County Health Department have been working with the Voorhees facility “to provide infection control recommendations and identify other possible illnesses since the facility notified the department of a case of adenovirus in a resident on October 26,” Dr. Shereef Elnahal, the state health commissioner, said in a statement.
“The outbreak in Voorhees may have been less severe because the facility was able to separate the children into three groups — sick, well and exposed — and care for them in different areas. The staff implemented infection control measures such as cleaning and disinfecting environmental surfaces, and reinforcing appropriate hand-washing techniques.
“The Voorhees facility, which is associated with Weisman Children’s Hospital in Marlton, is licensed for 119 pediatric long-term care beds. The Wanaque center is licensed to care for 92 children.” (Washburn, Lindy. “Adenovirus outbreak: Two more children infected in outbreaks in Wanaque and Voorhees.” North Jersey Record, 11-5-2018.)
Nov 6: “Haskell, NJ (Passaic County) — New Jersey health officials say they’ve confirmed another case of adenovirus in an outbreak at a health facility that left ten people dead. The Health Department said in a statement Monday [Nov 5] the new diagnosis brings the total number of adenovirus cases at the Wanaque Center for Nursing and Rehabilitation to 30… The most recent date of illness onset was on Nov. 5….”(Edwards, Jay. “Officials identify 30th case of adenovirus at New Jersey health facility.” WRNJradio.com, 11-6-2018.)
Nov 6: “As new infections continue to be diagnosed at two long-term care facilities, legislators to investigate origin of the infections and what state can do to help in such crises. State lawmakers plan to hold a hearing early next month on the recent disease outbreaks at several New Jersey hospital operations dedicated to children’s care, including the Passaic County facility where a virus has killed ten youngsters with serious healthcare needs. Senate health committee chairman Joseph Vitale said yesterday he wants to gather input from hospital leaders, infection experts and New Jersey Health Commissioner Dr. Shereef Elnahal about the origin of these infections and what state officials can do to reduce the impact of these crises….
“As of Monday, 30 individuals have been infected by a serious strain of adenovirus at the Wanaque Center for Nursing and Rehabilitation in Passaic County, including ten patients who have died. A less serious strain of adenovirus sickened five patients with complex health needs at the Voorhees Pediatric Facility, in Camden County, but none have died.
“In addition, bacteria discovered in the neonatal intensive care unit of Newark’s University Hospital have caused symptoms in three medically fragile infants there, and may be linked to the death of a fourth baby. These pathogens would likely cause mild cold-like symptoms in healthy individuals….
“Elnahal [NJ Health Commissioner] said last week that he is now talking to the federal Centers for Disease Control and Prevention about its new infection-control protocols, which are set to be phased in next year, and how the state can better protect these kinds of seriously ill patients, many of which depend on ventilators to breathe and feeding tubes for nutrition. The commissioner said the existing blanket regulatory standards for long-term care facilities “may be missing the unique needs and risks these patients face,” adding that the goal of his team is to “see if there is something we can learn from and move forward.” While the state could advance stricter regulations on its own, Elnahal said that could result in confusion and inconsistent enforcement. “At this juncture, it is more prudent to explore possibilities with stakeholders at all regulatory levels,” he said.
“But Vitale — who praised Elnahal’s effort to keep him informed on the outbreaks — said waiting on the federal government could take too long. ‘That’s like molasses,’ the senator (D-Middlesex) said, adding, ‘I wonder if there are other responses or steps we can take’ here in the Garden State. He hopes to hold a hearing on December 3, one of only a handful of days all legislators are scheduled to be in Trenton before the year’s end.
“The New Jersey Hospital Association, which represents acute-care and long-term facilities like the pediatric hospitals, also has a role in addressing these outbreaks, explained vice-president of communications Kerry McKean Kelly. The organization partners with the DOH to host a biannual conference on infection protocols, which play a big role in its ongoing quality-improvement efforts; it also stresses the importance of risk-assessment and careful surveillance of any infections that do occur. Similar efforts have helped facilities drive down the rates of sepsis, a blood infection that can attack patients in hospital settings. ‘It’s very much a team-based approach, led by an infection prevention specialist but with buy-in from staff all across the facility — not just caregivers but housekeeping and other staff members,’ McKean Kelly said. While this essential training is routine, the NJHA also holds specialized training when needed, she added, like the two-day session on personal protective equipment — gloves, gowns and masks — the organization hosted in October….” (Stainton, Lilo H. “NJ Lawmakers to Delve into Deadly Disease Outbreaks at Pediatric Facilities.” NJSpotlight.com, 11-6-2018.)
Nov 7: “A woman whose teenage son was sickened in the adenovirus outbreak that has killed 10 children at a long-term care center in Wanaque sued the facility’s owners and management Wednesday, alleging that unsanitary practices allowed the virus to spread. The lawsuit is believed to be the first filed in connection with the outbreak, which began in late September at the Wanaque Center for Nursing and Rehabilitation. In the lawsuit, Paula Costigan says her son, William DelGrosso, contracted the virus because staff members at the center were “careless and reckless” in providing patient care and controlling the spread of infection…. William, 15, developed a fever on Oct. 11, two days after the center notified the state Health Department of the outbreak, according to the lawsuit, which was filed Wednesday in Superior Court in Paterson. His condition worsened and he was taken to Hackensack University Medical Center on Oct. 18 “in critical and life-threatening condition,” the suit says. He remains in the hospital’s intensive-care unit, said Paul da Costa, Costigan’s lawyer. William has suffered from a seizure disorder since he was a young child. When he was 10, a severe seizure caused him to go into cardiac arrest, da Costa said. Ever since then, William has needed a ventilator to breathe. He has lived at the Wanaque center since March 2015, da Costa said. ‘Like almost all the other kids there, he was very susceptible to these types of viruses,’ da Costa said in an interview Wednesday evening. ‘He deserved a level of care and treatment so that he wouldn’t be sickened from this virus.’
“The lawsuit cites inspection reports filed between 2015 and last month that show several deficiencies at the center that could lead to the spread of infection, such as poor hand-washing practices among staff members. An inspection in May 2017 documented instances in which nurses did not properly clean syringes used to give patients medicine orally. It also cited a nurse for not sanitizing medication trays between sessions with patients, and it said an inspector had observed that tubing from an oxygen tank that enters a patient’s nose was left exposed while the patient was away. The state health commissioner, Dr. Shereef Elnahal, has called the findings “low-level” and said many have been corrected….
“The lawsuit also criticizes the Wanaque center’s management for not informing Costigan of the outbreak until she received a letter on Oct. 22 — almost two weeks after the center informed the Health Department.
“Da Costa said Costigan does not want to send her son back to the Wanaque center but has few options, since only three other facilities in New Jersey provide long-term care for juveniles.” (Fallon, Scot. “Mother of sickened teen sues Wanaque center where 10 have died in adenovirus outbreak.” North Jersey Record, 11-7-2018, updated 11-8-2018.)
Nov 8: “As a deadly virus started sweeping through a New Jersey pediatric-care facility in late September… health care workers repeatedly asked why the sickest of their young patients were not being transferred out to hospitals. Two employees of the Wanaque Center for Nursing and Rehabilitation, speaking on the condition of anonymity over fears of losing their jobs, claimed that senior administrators delayed sending kids to the hospital — even as many started dying.
“The reason? They said senior staff at the for-profit facility have long been consumed by the need to keep the 92 beds in the pediatric unit full, to keep Medicaid funds flowing. At the same time, they claimed the facility was chronically understaffed to save money. ‘You would be surprised how slow they were to send these kids out, even after the deaths, even after the media knew. They are still delaying,’ said one employee.
“In fact, as child after child developed what appeared to be a stubborn respiratory infection and spiking fevers as high as 104 degrees, symptoms were merely ‘masked,’ not treated, the workers said. The pediatric workers said staff turned up the air conditioning on full blast in their rooms to bring down their fevers. In addition, they kept giving the children the same medications, even though they had not been effective for days….
“The Wanaque Center and other pediatric nursing facilities receive $519.46 per patient per day, and the money stops as soon as the patient is transferred to a hospital, according to the state Medicaid office.
“A spokesman for the Wanaque Center declined to comment. Eugene Ehrenfeld of New York, a co-owner for Continuum Healthcare, which operates the Wanaque Center, also declined to comment and hung up on a reporter. Continuum Healthcare operates seven other health care facilities in New Jersey and others outside the state, according to state records….
“One employee said there may have been other reasons Wanaque did not want to send children to the hospital for emergency care. ‘I think they were concerned about the Health Department being aware. They were concerned about the school that’s in the facility reporting them to the Department of Health,’ the pediatric worker said….
“Jacqueline Donker of Kinnelon, the aunt of one of the children at Wanaque who was hospitalized with adenovirus, said she had noticed the facility declined after the new owners, Continuum Healthcare, took over in 2014, with the pediatric unit becoming more run down and the nursing staff cut significantly. ‘The owners that took over … let this happen,’ Donker said….
“…Health Commissioner Shereef Elnahal said his office does not have the legal authority to investigate the medical decisions made by physicians or other Wanaque personnel to keep a child at the facility instead of sending them to the hospital.
(NJ Advance Media for NJ.com (Susan K. Livio and Spencer Kent). “Death stalked the Wanaque center. Sill, they delayed sending kids to the hospital, workers allege.” 11-8-2018.)
Nov 10: “The kids started getting sick on an unseasonably warm day in late September. Yet it would not be until Oct. 9 — and after the death of two children — when the Wanaque Center for Nursing and Rehabilitation notified the state Health Department of a viral outbreak inside the long-term care facility in northern New Jersey. And then another 12 days before state inspectors walked in the door….
“…an examination of how the outbreak unfolded and spread rapidly has raised questions over why state health officials waited two weeks before deploying a team to see for themselves how Wanaque was managing the crisis. The state’s response will be part of what the state Senate Health, Human Services and Senior Citizens Committee will examine when it holds a hearing on Dec. 3 to discuss the outbreak, said Sen. Joseph Vitale, the committee chairman said. ‘We will ask as many questions as we are able to, but this will be one of them,’ said Vitale, D-Middlesex. ‘We want to know when it was reported, how the department responded and how the facility responded,’ Vitale said, adding he wanted to be cautious ‘until we know all of the facts.’ ‘No doubt we are all concerned about this, and as a layperson, I say something is amiss here,’ he said.
“Wanaque notified the state and local health departments about the outbreak after business hours on Oct. 9., according to Health Department spokeswoman Donna Leusner. ‘The state immediately counseled the facility on infection control protocols, to be implemented immediately,’ Leusner said.
“The next day, the department’s Communicable Disease Service — along with the U.S. Centers for Disease Control and Prevention and the local health department began working with Wanaque to recommend infection control practices, she said.
“The state dispatched two registered nurses from its Health Facilities, Survey and Field Operations office on Oct. 21 and conducted a surprise inspection. A state inspection specialist has remained on site.
“The state conducted a second surprise inspection on Friday [Nov 9] after a report by NJ Advance Media citing workers at the Wanaque Center who alleged that administrators delayed sending critically ill kids to the hospital because they did want to lose Medicaid funding if a pediatric bed went empty.
“The decision to wait two weeks before sending in state health employees was based on the science of allowing one incubation period to elapse to see whether Wanaque’s handling of the outbreak was working, Leusner said…. ‘It would have been impossible to determine that an on-site presence could have been useful before an incubation period’s worth of time,’ health department spokeswoman Dawn Thomas said. “It should be understood that while on-site inspections, infection control consultations and the daily monitoring that are in place now are useful for information-gathering and determining possible enforcement, they do not have direct impact on containing the spread of the virus or preventing harm to patients,’ Thomas said. ‘Containing the virus ultimately depends on facility management and clinical staff following these protocols under all circumstances, for every patient, and Department of Health is taking every action it can to hold the facility accountable for this,’ she added….‘The Commissioner believes that DOH staff responded appropriately at each time point, given the information we had,’ she said.
“Wanaque Center’s for-profit owner, Continuum Healthcare, which has repeatedly refused comment, did not return calls on Friday….
“Why these died…remains puzzling to some. ‘These kids were really fragile and severe adenovirus certainly can be fatal,’ observed David Cennimo, an epidemiologist at University Hospital in Newark and a professor of medicine at Rutgers University Medical School. ‘It’s a bad respiratory illness and you can end up on a ventilator. But these kids were already on a ventilator and I wonder why they couldn’t support them through this.’….‘I don’t understand it. It’s a medical care facility. These kids are monitored. I can’t explain it,’ he said….Cennimo said there was a high likelihood that the only way it would have moved from one bed-bound patient to another was by someone who was caring for the kids. ‘I would be concerned that whoever was caring for the kids was the contact vector between them,’ Cennimo said.
“Vitale, the health committee chairman, said the he hopes to find out whether the outbreak spiraled because of human error or systemic weaknesses. Maybe it’s both. he said. ‘These children are medical fragile and depend on other people for their survival,’ Vitale added. ‘It shouldn’t have happened to this degree. One child gets sick and maybe two, but this many?’” (NJ Advance Media for NJ.com (Ted Sherman and Susan K. Livio). “Why did the state wait so long to react to deadly outbreak that killed 10 kids?” 11-10-2018.)
Nov 12: “Two more children at a Wanaque medical facility were diagnosed over the weekend with adenovirus… The two children bring the total number of pediatric cases at the Wanaque Center for Nursing and Rehabilitation to 33….
“The Health Department won’t divulge how many sickened children are still at the Wanaque center and how many have been taken to hospitals. But the two new cases confirm that the virus is still spreading among residents of the facility’s ventilator unit. No new cases were reported Monday [Nov 12]….
“Dr. Shereef Elnahal, the state health commissioner, has been reluctant to move recovering residents to other facilities, fearing they could spread the virus. Complicating things further, there are only four pediatric nursing homes in New Jersey. Wanaque and another facility in Voorhees have adenovirus outbreaks, and the other two are at capacity with significant waiting lists.
“An outbreak is considered to be over when two consecutive two-week incubation periods have passed. If no new cases are identified, the outbreak will be deemed over in the second full week of December.
“Meanwhile, health officials reported that another child was sickened with a milder form of adenovirus at the long-term care facility in Voorhees, in Camden County. That brings the total number of cases to eight at that facility. No one has died there.” (North Jersey Record. “Outbreak continues in Wanaque: 2 more children sickened with adenovirus that has killed 10.” 11-12-2018.)
Nov 12: “Lab testing over the weekend confirmed four more children are infected in the viral outbreak at a pediatric nursing home in Passaic County, bringing the total number of patients affected to 34, the state Health Department confirmed Monday [Nov 12]….The…most recent [case] was Friday, Nov. 9….” (NJ Advance Media for NJ.com. “Deadly viral outbreak continues to rage inside Wanaque as 4 more kids are infected.” 11-12-2018.)
Nov 14: “State officials on Wednesday [Nov 14] ordered all admissions to cease at a Wanaque nursing home where a virus outbreak has killed 10 children, saying that failures of infection control pose an “imminent and serious risk of harm” to its residents. The Wanaque Center for Nursing and Rehabilitation received the worst rating possible — ‘immediate jeopardy’ — from state inspectors after three visits over the last week. That rating can result in termination from participation in Medicaid and Medicare programs if deficiencies are not corrected. The two government programs provide the bulk of nursing home funding.
“There are currently 43 children in the first-floor ventilator unit where the virus has spread, 19 children in the second-floor pediatric unit who are unaffected, and 125 adult patients at the facility, the department said.
“An initial inspection on Oct. 21 found that four of the six employees observed had washed their hands inadequately when caring for patients. Subsequent inspections on Nov. 9, 11 and 13 found ‘evidence of continuing non-compliance’ that ‘is presently ongoing,’ Gene Rosenblum, the director of the Health Department’s office of program compliance, wrote in a letter to the center’s administrator on Wednesday. ‘The surveyors identified egregious deficient practices in infection prevention and control which pose an immediate jeopardy … to residents,’ Rosenblum wrote….
“Despite the presence at the center of a communicable disease specialist from the state Health Department since Oct. 10, additional cases continue to be identified. Two residents were diagnosed as recently as Monday….
“Closing the facility is impractical, the health commissioner [Dr. Shereef Elnahal] has said, because of the risks of moving the ventilator-dependent children and the real possibility that they would spread the infection elsewhere.
“New Jersey has only four long-term care facilities that are equipped to care for such children. The two largest — Wanaque and the Voorhees Pediatric Facility — are both battling adenovirus outbreaks. (Eight children have been sickened but none has died in the outbreak in Voorhees, which involves a milder strain of the virus.) The two others — branches of Children’s Specialized Hospital, a part of RWJBarnabas Health, in Mountainside and Toms River — have long waiting lists, Elnahal said….
“A spokesman for the facility’s owners, Eugene Ehrenfeld and Daniel Bruckstein of Continuum Healthcare LLC, said he was not able to comment immediately.
“The state demanded that the Wanaque center hire two consultants — a ‘certified infection control practitioner’ and a physician specializing in infectious diseases — by noon on Friday. Both must be on-site 40 hours a week and cover all shifts and weekends, the order said. The physician must be completely independent of the Wanaque center, with no ties to its principals, managers or employees or their relatives. Both must begin work on Monday. Further sanctions, including fines, suspension ‘and/or license revocation,’ may be applied if the facility does not comply, Rosenblum said in his letter to Rowena Bautista, the center’s administrator.
“The facility also must demonstrate that it can separate residents in the ventilator unit who do not have symptoms from those who have the virus, the department said. The outbreak has been confined to the ventilator unit so far.
“Once the consultants are retained, admissions to the adult and regular pediatric unit can resume. But no children can be admitted to the respiratory unit until the center has grouped the patients appropriately to control the infection and the Health Department gives its approval.
“Approval must also be requested from the Health Department before a child who has been hospitalized with adenovirus is readmitted to the Wanaque center, the letter said….
“Wednesday’s order to cease admissions can be lifted only by the state….” (North Jersey Record. “Adenovirus outbreak: Health Department orders admissions at Wanaque center to cease.” 11-14-2018.)
Nov 16: “Health officials say an 11th patient has died amid an outbreak of a respiratory virus at a care facility in New Jersey. The state health department on Friday confirmed that the ‘severely ill child’ at the Wanaque Center for Nursing and Rehabilitation had the adenovirus infection. The youth died Thursday night in a hospital, but further details about the child were not disclosed. The department says the child was among 34 pediatric cases that have been associated with the outbreak. Officials say the affected children became ill between Sept. 26 and Nov. 12….” (CBS News. “11th child dies in viral outbreak at N.J. health care facility.” 11-16-2018.)
Nov 23: “State health officials have begun allowing medically fragile children to return to the long-term care facility in Wanaque where they were sickened in an adenovirus outbreak that has been blamed for 11 deaths since early October. Three children had been returned, with their families’ permission, to the Wanaque Center for Nursing and Rehabilitation as of Friday afternoon [Nov 23] after recovering at area hospitals, said Dawn Thomas, a state Health Department spokeswoman.
“…a lawyer representing the families of six victims, two of whom have died, said his clients whose children survived the outbreak do not want them to return to Wanaque, fearing that they could get sick again.
“Thomas [Dept. of Health spokesperson] said the strain of adenovirus that infected nearly three dozen children at the Wanaque center is no longer a threat to those who have recovered at hospitals. ‘It is also not possible to be reinfected with the same virus, once recovered, so the risk to readmitted children who were positive for adenovirus is minimal,’ Thomas said.
“Of the 34 sickened children, 11 have died and seven were still hospitalized as of Friday afternoon….
“All of the children who were readmitted beginning Nov. 20 were placed in appropriate areas to ensure that any further outbreak is controlled, Thomas said. There has not been a new confirmed case since the separation of sick and well children was completed on Nov. 17, Thomas said….
“The parents of Dorcase Dolcin, 4, and Elizabeth Poulos, 16, who died as a result of the outbreak, are among six families who have retained [Paul] da Costa to sue the facility, he said.
“A spokeswoman for former U.S. Attorney Paul Fishman, who was hired last week to represent the Wanaque center, said she was unable to comment Friday afternoon….” (North Jersey Record. “Adenovirus outbreak: Children return to Wanaque facility where 11 have died.” 11-26-2018.)
Dec 3: “State lawmakers wanted to know whether the owners of a Wanaque nursing home where 11 children have died as the result of a virus outbreak notified the state quickly enough about the increasing number of sick children. But they didn’t get to ask the owners of the Wanaque Center for Nursing and Rehabilitation, who declined to attend a hearing that the state Senate Health Committee held Monday to investigate the outbreak. That led state Sen. Richard Codey to suggest that the Senate subpoena them if they refuse in the future. The Senate should subpoena the owners to “drag their butts in here and explain to the public what happened,” Codey, an Essex County Democrat, said at the start of the three-hour hearing….
“The parents of five of the children affected appeared at the hearing with their attorney, but neither of the owners of the facility — Eugene Ehrenfeld and David Bruckstein — attended, nor did their representative, former U.S. Attorney Paul Fishman….
“The president of a union that represents 70 nurses at the Wanaque center told legislators the facility was short-staffed and had failed to prepare adequately for such an outbreak. “When nurses are assigned too many patients, their ability to respond to patient needs and quality care decreases,” said Debbie White, president of the Health Professionals and Allied Employees union. But Vitale and Codey took issue with her. “Staff ratios matter,” Vitale said, “but not to follow [infection] protocol? There is no excuse.” He described an inspection report by the state Health Department that detailed multiple occasions when a caregiver should have washed her hands but didn’t.
“Sherry McGhie testified on behalf of 1199SEIU, a union that represents 130 employees at the Wanaque center, including certified nursing assistants and workers in the laundry, housekeeping and dietary departments. When state inspectors arrived at the facility in the past, “it was not a typical day,” she said. The center would use a code — “Extension 100” — that meant “the state is here; it’s showtime,” said McGhie, who worked at the center for 27 years and left in September. The nursing home industry tries to hide problems from the public, she said….” (North Jersey Record. “Virus outbreak: Families of Wanaque children attend hearing, but not center’s owners.” 12-3-2018.)
Dec 11: “The virus outbreak at a Wanaque nursing home where 36 children were infected and 11 died has come to an end 11 weeks after it began, but state health officials are still barring new admissions to the children’s unit where the illness spread. Four weeks, or two full incubation cycles, have passed since the most recent patient at the Wanaque Center for Nursing and Rehabilitation came down with the symptoms of adenovirus…For public health experts, that’s the standard for declaring an outbreak over.
“However, “given the unusual situation at Wanaque, we remain particularly vigilant,” said Donna Leusner, a health department spokeswoman. The Wanaque center is the only long-term care facility in the state to care for both pediatric and adult patients. Infection control lapses — in hand-washing, for example — led Health Department inspectors to cite it after a spot visit in October as presenting “a serious and imminent risk of harm” to its residents.
“The Health Department continues to bar all new admissions to the center’s pediatric unit, which has 92 beds, 66 of them for patients who breathe with the aid of ventilators. Re-admissions — following a brief hospital stay, for example — are allowed in the general pediatric unit but must be approved on a case-by-case basis for the ventilator unit, Leusner said. ‘Out of an abundance of caution, we are continuing to work with the facility to ensure they have infection control procedures in place,” she said. “There is always a risk of the introduction of a new respiratory outbreak in this facility because it’s flu season.’
“Health Commissioner Shereef Elnahal has said that the center must have the room to separate patients when an outbreak arises, which would mean that it cannot return to full capacity in the children’s unit. He also required the facility to separate the children in the ventilator unit to prevent the spread of the disease. They were grouped in red, yellow and green zones, depending upon whether they had been diagnosed with adenovirus, showed symptoms but were awaiting laboratory confirmation, or had shown no symptoms. Staff members, supplies and equipment were also “cohorted” in this way, to avoid cross-contamination. After the cohorting was completed on Nov. 17, no children developed adenovirus symptoms.
“Laboratory testing ordered by the infectious-disease specialists at the center, however, turned up two previously unrecognized cases of adenovirus. That was reflected in the higher case county — 36 children and one staff member — posted by the Health Department on Monday [Dec 10]….
“It’s not known how long a patient remains contagious, or “sheds,” the virus, although the federal Centers for Disease Control and Prevention says it can be weeks or longer. The virus can remain in tonsils, adenoids and intestines without causing an infection.
“The Wanaque center patients who have recovered from the virus, including the recently identified resident and those who were hospitalized and have returned, have been grouped together to avoid any chance that they would spread the virus, the Health Department said.
“Meanwhile, a separate outbreak of a milder strain of adenovirus at the Voorhees Pediatric Facility in Camden County continues to spread. It has infected 17 patients so far, the most recent of whom developed symptoms on Monday. The Voorhees facility voluntarily agreed to curtail admissions until the outbreak is over, which would be Jan. 7 if no new cases develop.” (North Jersey Record (Lindy Washburn). “Adenovirus outbreak in Wanaque is over, but state oversight remains.” 12-11-2018.)
Dec 17: State Dept. of Health releases report on a previous inspection of Wanaque. The report notes numerous problems. (North Jersey Record/Lindy Washburn. “Wanaque virus outbreak report: dirty conditions, empty rooms and urine-soaked diapers.” 10-18-2018.)
Sources
Associated Press. “Child death toll hits 7 in viral outbreak at rehab center.” 10-24-2018. Accessed 1024-2018 at: https://www.mypanhandle.com/news/national/another-child-dead-following-viral-outbreak-at-rehab-center/1546401649
CBS News. “11th child dies in viral outbreak at N.J. health care facility.” 11-16-2018. Accessed 11-16-2018 at: https://www.cbsnews.com/news/adenovirus-outbreak-11th-child-dies-new-jersey-nj-wanaque-center/
Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Viral Diseases. Adenoviruses. 4-26-2018 update. Accessed 10-24-2018 at: https://www.cdc.gov/adenovirus/index.html
Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services. Wanaque Center for Nursing & Rehabilitation, The. Printed: 10-29-2018. Accessed 11-6-2018 at: https://nj.gov/health/healthfacilities/documents/EA_facilities/2018/CMS2567_Wanaque102118.pdf
CNN, Laura Ly and Susan Scutti. “9th child dies after virus outbreak at New Jersey facility.” 10-28-2018. Accessed 10-28-2018 at: https://www.cnn.com/2018/10/27/health/adenovirus-outbreak-new-jersey/index.html
CNN, Michael Nedelman. “10th child dies from adenovirus outbreak in New Jersey.” 11-1-2018. Accessed 11-1-2018 at: https://www.cnn.com/2018/11/01/health/adenovirus-outbreak-new-jersey-mother/index.html
Edwards, Jay. “Officials identify 30th case of adenovirus at New Jersey health facility.” WRNJradio.com, 11-6-2018. Accessed 11-6-2018 at: http://wrnjradio.com/news/2018/officials-identify-30th-case-of-adenovirus-at-new-jersey-health-facility/
Fallon, Scot. “Mother of sickened teen sues Wanaque center where 10 have died in adenovirus outbreak.” North Jersey Record, 11-7-2018, updated 11-8-2018. Accessed 11-8-2018 at: https://www.northjersey.com/story/news/health/2018/11/07/adenovirus-outbreak-mother-sues-wanaque-center-where-10-children-have-died/1924519002/
Kent, Spencer, and Ted Sherman. “Death toll in N.J. adenovirus outbreak rises to 8; more sickened than first thought.” NJ.com. 10-26-2018. Accessed 10-26-2018 at: https://www.nj.com/news/index.ssf/2018/10/death_toll_in_nj_adenovirus_outbreak_rises_to_8_mo.html
MPR, [Monthly Prescribing Reference]. “More Child Deaths Linked to Adenovirus Outbreak at NJ Facility.” 11-2-2018. Accessed 11-2-2018 at: https://www.empr.com/news/adenovirus-outbreak-wanaque-center-nursing-and-rehab-children-deaths/article/812126/
NJ Advance Media for NJ.com (Susan K. Livio). “Deadly viral outbreak continues to rage inside Wanaque as 4 more kids are infected.” 11-12-2018. Accessed 11-13-2018 at: https://www.nj.com/news/index.ssf/2018/11/four_more_children_are_infected_in_outbreak_at_wan.html
NJ Advance Media for NJ.com (Susan K. Livio and Spencer Kent). “Death stalked the Wanaque center. Sill, they delayed sending kids to the hospital, workers allege.” 11-8-2018. Accessed 11-10-2018 at: https://www.nj.com/news/index.ssf/2018/11/kids_died_while_facility_delayed_sending_them_to_h.html
NJ Advance Media for NJ.com (Ted Sherman and Susan K. Livio). “Why did the state wait so long to react to deadly outbreak that killed 10 kids?” 11-10-2018. Accessed 11-10-2018 at: https://www.nj.com/news/index.ssf/2018/11/did_the_state_miss_the_signs_of_a_deadly_viral_out.html
New York Times/Nick Corasaniti. “Adenovirus Outbreak Leaves 6 Children Dead at N.J. Pediatric Center.” 10-23-2018. Accessed 10-24-2018 at: https://www.nytimes.com/2018/10/23/nyregion/adenovirus-children-dead-viral-outbreak.html
North Jersey Record. “Adenovirus outbreak: A timeline of events.” 10-28-2018, updated 10-29-2018. Accessed 10-29-2018 at: https://www.northjersey.com/story/news/health/2018/10/28/adenovirus-outbreak-timeline-events-wanaque-nj-medically-fragile/1799019002/
North Jersey Record (Monsy Alvarado and Scott Fallon) “Adenovirus outbreak: Children return to Wanaque facility where 11 have died.” 11-26-2018. Accessed 11-26-2018 at: https://www.northjersey.com/story/news/health/2018/11/26/adenovirus-outbreak-children-return-wanaque-facility-where-11-died/2091093002/
North Jersey Record (Lindy Washburn, Scott Fallon). “Adenovirus outbreak: Health Department orders admissions at Wanaque center to cease.” 11-14-2018. Accessed 11-16-2018 at: https://www.northjersey.com/story/news/health/2018/11/14/adenovirus-outbreak-wanaque-nj-center-ordered-hire-specialists-nj-health-department/2004996002/
North Jersey Record (Lindy Washburn). “Adenovirus outbreak in Wanaque is over, but state oversight remains.” 12-11-2018. Accessed 12-11-2018 at: https://www.northjersey.com/story/news/health/2018/12/11/adenovirus-outbreak-wanaque-over-but-state-oversight-remains/2276347002/
North Jersey Record (Scott Fallon). “Outbreak continues in Wanaque: 2 more children sickened with adenovirus that has killed 10.” 11-12-2018. Accessed 11-12-2018 at: https://www.northjersey.com/story/news/health/2018/11/12/adenovirus-outbreak-sickens-two-more-kids-wanaque-center/1977793002/
North Jersey Record (Lindy Washburn and Scott Fallon). “Virus outbreak: Families of Wanaque children attend hearing, but not center’s owners.” 12-3-2018. Accessed 12-3-2018 at: https://www.northjersey.com/story/news/health/2018/12/03/wanaque-virus-outbreak-centers-owners-decline-appear-hearing/2140926002/
North Jersey Record/Lindy Washburn. “Wanaque virus outbreak report: dirty conditions, empty rooms and urine-soaked diapers.” 10-18-2018. Accessed 12-18-2018 at: https://www.northjersey.com/story/news/watchdog/2018/12/18/wanaque-virus-outbreak-inspection-report-describes-dirty-conditions/2339301002/
Reuters. “Ninth child died in deadly viral outbreak in New Jersey.” 10-29-2018. Accessed 10-29-2018 at: https://www.reuters.com/article/us-new-jersey-health/ninth-child-dies-in-deadly-viral-outbreak-in-new-jersey-idUSKCN1N31PE
Stainton, Lilo H. “NJ Lawmakers to Delve into Deadly Disease Outbreaks at Pediatric Facilities.” NJSpotlight.com, 11-6-2018. Accessed 11-6-2018 at: https://www.njspotlight.com/stories/18/11/05/nj-lawmakers-to-delve-into-deadly-disease-outbreaks-at-pediatric-hospitals/
State of New Jersey Department of Health. “Department of Health Releases Wanaque Center for Nursing and Rehabilitation Inspection Report” (News Release). 10-30-2018. Accessed 11-6-2018 at: https://nj.gov/health/news/2018/approved/20181030a.shtml
State of New Jersey Department of Health. “Total of 26 adenovirus cases at Wanaque Center for Nursing and Rehabilitation.” 10-30-2018. Accessed 10-30-2018 at: https://nj.gov/health/news/2018/approved/20181029b.shtml
USA Today/ Scot Fallon. “Adenovirus victim’s parents: Shut down pediatric care center where 10 children died.” 11-2-2018. Accessed 11-2-2018 at: https://www.usatoday.com/story/news/nation-now/2018/11/02/adenovirus-outbreak-parents-victim-wanaque-center-shut-down/1857285002/
Washburn, Lindy. “Adenovirus outbreak: Two more children infected in outbreaks in Wanaque and Voorhees.” North Jersey Record, 11-5-2018. Accessed 11-6-2018 at: https://www.northjersey.com/story/news/health/2018/11/05/adenovirus-outbreak-2018-5th-child-infected-voorhees-facility/1895674002/
WLNY CBS 2, New York. “Exclusive: Women Document Filthy Conditions at New Jersey Nursing Facility Amid Virus Outbreak.” 10-26-2018. Accessed 10-28-2018 at: https://newyork.cbslocal.com/2018/10/26/photo-condition-nursing-facility-outbreak/
WLNY, CBS 2, NY. “Breaking: 9th Child Dies of Adenovirus Outbreak at N.J. Rehab Center.” 10-28-2018. Accessed 10-28-2018 at: https://newyork.cbslocal.com/2018/10/28/9th-child-dies-adenovirus-nj-center/
Reference
Kajon, Adriana E., et al. “Molecular Epidemiology and Brief History of Emerging Adenovirus 14 — Associated Respiratory Disease in the United States.” The Journal of Infectious Diseases, Vol. 202, Issue 1, 7-1-2010. Accessed 10-24-2018 at: https://academic.oup.com/jid/article/202/1/93/890091
[1] Idea from: North Jersey Record. “Adenovirus outbreak: A timeline of events.” 10-28-2018, updated 10-29-2018.
[2] The date is ours. The 11-8-2018 NJ Advance Media source we cite, notes this happened “four days after the first child became ill…” According to this and other sources, the first sickness was noted on Sept. 26.