10th child dies after viral outbreak at Wanaque care center

A 10th child died Wednesday night from adenovirus after an outbreak at a Wanaque long-term care center that has infected 27 medically fragile children, the state Health Department said.  

The death came as the outbreak entered its sixth week at the Wanaque Center for Nursing and Rehabilitation. A second outbreak, believed to be a different type of adenovirus, was confirmed Wednesday at the Voorhees Pediatric Center in Camden County.  

Four children have been affected in Voorhees with a milder form of illness, Dr. Shereef Elnahal, the state health commissioner, said Wednesday.  Preliminary tests indicated it was not the same type of the virus as has swept through the Wanaque center.

“The loss of these young lives is heartbreaking, and our thoughts are with the families who are affected,” Elnahal said of the death. “We are working closely with the facility to conduct respiratory illness surveillance and ensure all infection control protocols are continuously followed.”  

All of the children infected in the two outbreaks have severely compromised immune systems, the Health Department said. The department has not identified the children by name, age or gender, citing privacy concerns. They have ranged from toddlers to young adults, the vast majority under 18.  Most depend on ventilators or tracheostomies to breathe. 

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The Health Department has stationed a staff member at the Wanaque long-term care center full-time to monitor its implementation of infection-control procedures.

The center has stopped admitting new patients until the end of the outbreak. The diagnosis of the most recent case on Wednesday means the earliest endpoint for the outbreak would come in four weeks, or Nov. 24. 

The department is also discussing potential tightening of inspection and infection-prevention measures at facilities that care for such frail children 

A surprise inspection of the Wanaque center on Oct. 21 found lapses in hand-washing and basic hygiene, but they were considered minor deficiencies. Elnahal plans to meet with federal officials to discuss whether the standards should be tightened

The outbreaks in Wanaque and Voorhees do not appear to be related, Elnahal said. “I really don’t believe that’s the case," he said. “They’re very far away, and it’s a different disease presentation.” 

Additional diagnoses of adenovirus may be likely, because of the two-week incubation period for the disease, Elnahal said. While adenovirus typically causes cold- and flu-like symptoms in healthy people, it can be devastating to those with compromised immune systems.

Camden County health officials have been working with members of the state Health Department staff to control the Voorhees outbreak and were at the facility Tuesday and Wednesday to make sure infection protocols were followed, said Ron Tomasello, the Camden County public information officer. "The facility has been fully cooperative since [the state was] first in contact on Friday,” he said.

A surprise inspection of the facility by the Health Department on Tuesday revealed no infection-control deficiencies and no citations were issued, Elnahal said. 

"Even when you have a facility that has a perfect score on our infection-control survey, this can still happen," he said. "Not all outbreaks are preventable."

The center was able to "safely and swiftly separate sick, exposed and well individuals into separate areas," a step that is recommended to stop the spread of the disease, the state Health Department said. It has voluntarily curtailed new admissions.

The facility notified families with children at the Voorhees center about the Wanaque outbreak last week. Another letter was issued Wednesday to tell the Voorhees families about the outbreak there and the preventive steps that have been taken. The facility said it would notify parents of any changes in the status of their children.

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The Voorhees facility is owned by a for-profit corporation, Forkid Care. The facility received an overall rating of two out of five stars on the federal government's "nursing home compare" website, scoring above average on staffing and much below average for health inspections. The telephone number provided for the owners on the state Health Department's website is the same as that for the facility. 

Its patients may have degenerative diseases, complex seizure disorders, traumatic brain injuries and a variety of other conditions that require assistance in nutrition and respiration.

Teams from the state Health Department will be visiting the four pediatric long-term care facilities in New Jersey this month to discuss infection-control practices and the spread of disease. The two other facilities are branches of Children’s Specialized Hospital in Toms River and Mountainside.