Story highlights Seven died and at least 11 others were infected in an adenovirus outbreak among medically fragile children in a New Jersey health care facility Adenoviruses may cause mild flu-like illness in healthy people, but people with weakened immune systems may be at greater risk (CNN) — Health officials continue to investigate after seven people died and at least 11 others have been infected with an adenovirus at a New Jersey health care facility, the New Jersey Department of Health said Wednesday. This is up from the six deaths announced Tuesday among medically fragile children at the Wanaque Center for Nursing and Rehabilitation in Haskell, New Jersey. “They range in age from toddlers to young adults,” New Jersey Department of Health Commissioner Dr. Shereef Elnahal told reporters Wednesday. “The vast majority are under the age of 18. Some have been hospitalized, and some are being cared for at this facility.” The outbreak appears to be confined to the facility’s respiratory unit, he added. While the timing of the deaths remains unclear, the health department was notified of respiratory illness at the facility on October 9. The facility notified parents ten days later, on October 19, according to health department spokeswoman Nicole Kirgan. “Health professionals and other people don’t think of the common cold as being serious, but when you’re a child, disabled, chronic disease, immunosuppressed, elderly, multiple medical conditions, the common cold can be life-threatening,” said Dr. David Gifford, senior vice president of quality and regulatory affairs for the American Health Care Association. The association – whose member organizations represent nursing homes and other health care facilities across the country – does not own or operate individual facilities. Though the Wanaque facility is a member of the national organization by default, Gifford said the association does not take positions to individually represent individual facilities. Gifford said that the amount of time it takes to respond to a potential outbreak and notify families is variable. “There are so many nuances,” he said, including how long health experts need to investigate a potential outbreak, culture a virus and confirm its identity. “Generally, if you’re seeing a number of people in an institutional setting who have an illness, you start to take some precautions about the spread,” said Gifford, but that may not necessarily include notifying families of something that initially resembles a common cold. In a statement Tuesday, the Wanaque facility said it “promptly notified all appropriate government agencies when the virus was initially identified.” On Wednesday, an additional statement by the facility said the health department “continues to work very closely with the facility to ensure that all infection control measures are being followed.” The facility did not respond to multiple calls and emails for further comment. It has been “instructed not to admit any new patients until the outbreak ends and they are in full compliance,” according to the state health department. According to Elnahal, the outbreak can only be declared over once four weeks pass without an additional case. “Nursing homes don’t call the health department that often,” Gifford said, though there has been a push for nursing homes and health care facilities to get health departments involved in outbreak investigations earlier. Adenoviruses are known to persist on unclean surfaces and medical instruments for long periods of time, may not be eliminated by common disinfectants, and rarely cause severe illness in healthy people. However, people with weakened immune systems have a higher risk for severe disease, and they may remain infectious long after they recover, according to the US Centers for Disease Control and Prevention. “The strain of adenovirus seen in this outbreak is associated with communal living arrangements and known to cause severe illness,” the state health department said. “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 said. “But we are working with the CDC on this ongoing outbreak investigation.” The state health department said Tuesday that an inspection team at the facility on Sunday found minor handwashing deficiencies. In a review by the Centers for Medicare and Medicaid Services, the Wanaque Center was awarded an above-average ranking in overall quality but 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.” The review found carpeted areas that “smelled of old carpet and mildew.” On Wednesday, Elnahal described these as “low-level, self-limited deficiences” that were subsequently resolved when health inspectors rechecked. A May 2017 inspection report “determined that the facility failed to ensure infection control practices were followed.” Among the deficiencies cited were improperly stored syringes, which were used to measure liquid medication, and over-bed tables and medication trays that were not properly cleaned and disinfected. The deficiencies were listed as corrected a month later and were lower in number than the US average. “It is rare that in any inspection a facility would come out with no citations,” Elnahal said. “If it’s a number of citations, all of which are low-level, we ask for a plan of correction. We make sure the facility follows through – and that’s what this facility did here.” “If the findings are severe enough to take further action, we will,” he added. Nurses at the facility had previously reported a shortage of nursing staff and supplies, according to a statement Tuesday from the union that represents the nursing staff. The Health Professionals and Allied Employees said the shortages may have led to “poor infection control practices.” The union said it represents the 70 nurses that work at the Wanaque Center for Nursing and Rehabilitation. ’Hardy’ viruses Adenoviruses can cause mild to severe illness, though serious illness is less common. People with weakened immune systems or existing respiratory or cardiac disease are at higher risk of developing severe illness from an adenovirus infection, according to the CDC. This outbreak, caused by adenovirus type 7, “is affecting medically fragile children with severely compromised immune systems,” the health department said Tuesday. “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 could result in death. That said, most adenovirus infections are mild, with symptoms usually lasting about 10 days, according to the CDC. And for most patients, home remedies and over-the-counter medicines to relieve the symptoms will be the only treatment necessary. Adenoviruses, unlike the flu, are not seasonal and can cause illness throughout the year. And while an adenovirus vaccine exists, it’s available only to military recruits. The viruses themselves are also “resistant to many common disinfectants and can remain infectious for long periods on environmental surfaces and medical instruments,” the CDC says. Adenoviruses 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 adenoviruses can live and remain infectious for days or weeks. Adenoviruses 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.” Adenovirus 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. Get CNN Health's weekly newsletter Sign up here to get The Results Are In with Dr. Sanjay Gupta every Tuesday from the CNN Health team. This small number of cases is believed to be an underrepresentation of the actual number of cases due to the fact that most people who become sick either do not go to a doctor, or their doctors do not test for this virus. And adenoviruses 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’s Nadia Kounang and Liv Kiely contributed to this report.<doc-sep>(Reuters) - A deadly viral outbreak claimed the life of a seventh child at a New Jersey rehabilitation center, where 11 other medically fragile young patients remain hospitalized with adenovirus infections, state health officials said on Wednesday. The outbreak at the Wanaque Center for Nursing and Rehabilitation in Haskell, New Jersey, was first reported by the New Jersey Department of Health on Tuesday with the deaths six children with compromised immune systems. The facility, which includes a pediatric center, has been instructed not to admit new patients until the outbreak ends, the department said. Adenoviruses frequently cause mild to severe illness with cold-like symptoms, particularly in young children. The infection can cause other illnesses, including pneumonia, diarrhea and bronchitis, the department said. “The strain of adenovirus seen in this outbreak is associated with communal living arrangements and known to cause severe illness,” the department said in a statement. The Wanaque Center said its pediatrics center serves newborns to 22-year-olds who are “medically fragile” and provides an individualized program for each child. The 18 patients at the facility, located about 32 miles (50 km) northwest of New York, range in age from a toddler through young adulthood, with most under 18 years old, health department spokeswoman Nicole Kirgan said in an email on Tuesday. The department was not releasing exact ages for privacy reasons, Kirgan said. Health officials found minor hand-washing deficiencies at the facility during visits on Tuesday and Sunday, and were working with the center on infection-control issues, the health department said. New Jersey Governor Phil Murphy said state health officials would continue with active on-site surveillance. “Heartbroken that several children have lost their lives in an adenovirus outbreak in Haskell,” Murphy said on Twitter on Tuesday. The Centers for Disease Control and Prevention has been notified, the Wanaque Center said in a statement emailed by its administrator Rowena Bautista.<doc-sep>
HASKELL, N.J. -- Six children are dead and 12 others sick following a severe viral outbreak at a rehabilitation center in New Jersey.The state Department of Health on Tuesday confirmed 18 cases of adenovirus at the Wanaque Center for Nursing and Rehabilitation in Haskell, Passaic County.Adenoviruses usually cause mild illnesses, but the health department says this outbreak is particularly severe because it is affecting medically fragile children with severely compromised immune systems. "This strain has been particularly associated with disease in communal living facilities," the department said in a statement. "The combination of a worse strain of adenovirus together with a fragile population has led to a more severe outbreak. "The conditions of the other 12 victims are unknown. The facility has been instructed to not admit any new patients until the outbreak ends. "Adenovirus is very contagious virus," said Dr. Sejal Bhavsar, of Hackensack University Medical Center. "However, in these situations, they are very contagious in long-term facilities because they are often transported by sneezing and coughing, but also the particles that are passed from sneezing and coughing land on other objects. And other people go and touch it and then touch their mouths without washing their hands. That's how they can obtain the virus. "A health department team is at the facility, and an inspection team was also there Sunday. The team on Sunday found minor hand-washing deficiencies, and the department is continuing to work closely with the facility on infection control issues.This is an ongoing outbreak investigation.Wanaque Center administrator Rowena Bautista issued the following statement:"The Wanaque Center for Nursing and Rehabilitation has recently experienced some cases of the Adenovirus in its pediatric unit. The facility promptly notified all appropriate government agencies when the virus was initially identified, including the New Jersey Department of Health, The Passaic County Department of Health, The Communicable Disease Service and the Centers for Disease Control. The Wanaque Center continues to fully cooperate with these agencies and has sought out their medical guidance with respect to the virus. 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."