10th child dies from adenovirus outbreak in New Jersey

Ten children have died after an adenovirus outbreak at Wanaque Center for Nursing and Rehabilitation in New Jersey.

(CNN)Ten children have died and 18 others have become sick in connection with an adenovirus outbreak at a New Jersey health care facility, the state's Department of Health announced Thursday.

The patients are children with serious medical issues, many of whom require assistance to breathe and function, at the Wanaque Center for Nursing and Rehabilitation in Haskell, New Jersey.
The confirmed cases became ill between September 26 and October 30, according to the health department. The number of illnesses has risen from 18 cases, including six deaths, announced last week by the health department.
"They range in age from toddlers to young adults," New Jersey Department of Health Commissioner Dr. Shereef Elnahal said last week. "Some have been hospitalized, and some are being cared for at this facility."
    A staff member was also affected by the outbreak but has recovered.
    The health department also announced Wednesday that four cases of adenovirus were found among kids at a second New Jersey facility, Voorhees Pediatric Facility. However, preliminary tests suggest that it's a different strain than the one in Wanaque, and these patients are not in critical condition.
    Health officials say they are stepping up efforts to strengthen infection control at such facilities in the state. On Monday, the health department announced plans to deploy a team of infection control experts this month to visit University Hospital and four pediatric long-term care facilities, including the Wanaque and Voorhees facilities, where experts will train staff and evaluate how these facilities prevent and control infections.
    "Facility outbreaks are not always preventable, but in response to what we have seen in Wanaque, we are taking aggressive steps to minimize the chance they occur among the most vulnerable patients in New Jersey," Elnahal said in a statement Monday.
    Adenoviruses are often spread by touching a contaminated person or surface, or through the air by coughing or sneezing. They are known to persist on unclean surfaces and medical instruments for long periods of time, and they may not be eliminated by common disinfectants, but they rarely cause severe illness in healthy people. However, people with weakened immune systems have a higher risk for severe disease, and they may remain contagious long after they recover, according to the US Centers for Disease Control and Prevention.
    Symptoms may appear two to 14 days after being exposed to the virus, the state health department said.
    The outbreak in the Wanaque facility was caused by adenovirus type 7. This type is "most commonly associated with acute respiratory disease," the CDC says. Other types of adenovirus infections can cause flu-like symptoms, pinkeye and diarrhea.
    "We are working every day to ensure all infection control protocols are continuously followed and closely monitoring the situation at the facility," Elnahal said.

    Could more have been done?

    The Wanaque outbreak was caused by an adenovirus strain known to affect "communal living arrangements," according to the state health department -- but some wonder whether more could have been done to prevent this, according to former employees and the mother of one child who died as a result of the outbreak.
    "I'm upset that the kids I took care of -- that were all getting better and getting stronger and learning to walk -- are now dead," said Javier Guzman, who worked at the Wanaque facility for nearly five years as a recreational assistant until March 2017, when he said multiple staffers were let go.
    Each US city has its own distinct pattern of flu spread