Washington, D.C.: The New Jersey Department of Health is working to contain a severe viral outbreak at a paediatric centre that has left six children dead and 12 others infected.
The state has barred the facility, the Wanaque Centre for Nursing and Rehabilitation, from accepting new patients until the outbreak is contained. Children at the Wanaque Centre in northern New Jersey are paediatric 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 centre, 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.
“The New Jersey Department of Health was notified by the facility on October 9, 2018, of some respiratory illnesses,” said Donna Leusner, a spokeswoman for the department. “We have been working closely with the facility since then.”
But the facility did not send a letter to parents or families, notifying them of the outbreak, until October 19, according to the Health Department.
Inspectors from the Health Department arrived at Wanaque Centre on Sunday and found “minor hand-washing deficiencies,” the department said in a statement.
The outbreak, the agency said, was a strain of adenovirus, which often causes mild respiratory illness like the common cold and bronchitis, particularly in young children. Adenoviruses rarely result in serious illness but can be fatal to those with compromised immune systems.
According to the Centers for Disease Control and Prevention, adenovirus can be found on surfaces, such as doorknobs, objects and water in swimming pools and small lakes. The virus is often associated with communal living facilities.
“The combination of a worse strain of adenovirus together with a fragile population has led to a more severe outbreak,” the health department said.
Dr William Schaffner, an infectious disease expert at Vanderbilt University, said adenoviruses are easily transmitted, and outbreaks in health care facilities are not uncommon. In fragile patients with lowered immunity, they can cause respiratory infections that can turn into pneumonia. There are no antiviral medicines that work against adenoviruses, he said, but if bacterial infections set in later, those can be treated with antibiotics.
“It’s hard to keep adenoviruses out of health care facilities, and the outbreaks are tenacious,” Schaffner said.
But he added, “If you go into a facility, as the Centres for Disease Control and Prevention has done, and you do a full-court press on infection control, the outbreak stops.”
Schaffner said it can be hard to keep up with strict hand-washing requirements when taking care of very fragile patients, because those patients often require constant attention and there is little downtime.
The Health Department said it had recommended several infection control steps to the facility, including the use of a hospital-grade disinfectant effective against the virus, quarantining sick patients, ensuring that employees use gloves and masks and enforcing proper hand-washing protocol.
Rowena Bautista, administrator for the Wanaque Centre, said in a statement that the facility notified all the required officials and agencies when the virus was initially detected.
“The Wanaque Centre continues to fully cooperate with these agencies and has sought out their medical guidance with respect to the virus,” Bautista 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 Centre’s residents.”
The Wanaque Centre was rated a four out of five stars by the Centers for Medicare and Medicaid Services, which created a five-star rating system based on health inspections, staffing and “quality measures,” which assess “how well nursing homes are caring for their residents’ physical and clinical needs.”
The four out of five rating is considered “above average,” but the facility also had a two out of five star rating on its health inspections, which is considered “below average.” The past three health inspections found infractions related to issues that included hand-washing protocol and infection control, though each report rated the infraction as a minimal level of harm.