Child Death Toll Hits 7 In Adenovirus Outbreak At NJ Rehab Center

by NCN Health And Science Team Posted on October 24th, 2018

Wanaque, New Jersey, USA : 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 died this month. But the center said it learned Tuesday night that another child had died.

Adenoviruses are a group of common viruses that typically cause mild illnesses, from cold-like symptoms to conjunctivitis. But people with weakened immune systems, particularly children, are at higher risk of severe illness.

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 Health Department hasn’t released the names or the ages of the victims.

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.

EARLIER : 6 Children Dead In Adenovirus Outbreak At NJ Hospital

Six children at a long-term care medical facility in North Jersey have died after a “severe outbreak” of adenovirus virus, while twelve others have been infected, according to the state’s Department of Health.

New Jersey Department of Health officials said children were recently infected with adenovirus at the Wanaque Center for Nursing and Rehabilitation in Passaic County

The facility has been instructed not to admit any new patients until the outbreak ends and they are in full compliance, the Department of Health says.

Adenoviruses are common viruses that can cause a range of illnesses, according to the Centers for Disease Control and Prevention. The viruses cause cold-like symptoms, sore throat, bronchitis, pneumonia, diarrhea, and pink eye. Adenoviruses can pose serious complications to certain people, particularly those with weakened immune systems, respiratory issues and cardiac disease.

That is the case at the Wanaque Center, health officials said.

“Unfortunately, the particular strain of adenovirus (#7) in this outbreak is affecting medically fragile children with severely compromised immune systems,” the New Jersey Department of Health in a statement. “This strain has been particularly associated with disease in communal living facilities.”

According to the CDC, adenoviruses are typically spread from an infected person to others through: close personal contact such touching or shaking hands; through the air by coughing and sneezing; or by touching an object or surface with adenoviruses on it, then touching your mouth, nose, or eyes before washing your hands.

Health investigators visited the facility over the weekend as part of their probe, officials said.

The state Department of Health further said that it is monitoring the situation “very closely” and has been in contact with the staff at the center “providing guidance on infection control and cleaning procedures.”

The Wanaque Center is a for-profit facility that, according to its website, works with “with medically fragile children” from newborn to 22 years of age. The center also serves as an adult nursing home and rehabilitation center for short- and long-term care.

A spokesperson for the Wanaque Center did not respond to repeated request for comment.

The cause of the outbreak remains unclear.

The DOH statement is below:

Statement on adenovirus at Wanaque Center for Nursing and Rehabilitation

“The Department of Health today is confirming 18 cases of adenovirus among pediatric residents at the Wanaque Center for Nursing and Rehabilitation in Haskell. Of these 18 cases, there have unfortunately been six deaths of pediatric residents.

The facility has been instructed not to admit any new patients until the outbreak ends and they are in full compliance.

A Department team is at the facility today and an inspection team was also there Sunday. The team on Sunday found minor handwashing deficiencies and the Health Department is continuing to work closely with the facility on infection control issues.

This is an on going outbreak investigation.

Adenoviruses are a family of viruses that often cause mild illness, particularly in young children.

Unfortunately, the particular strain of adenovirus (#7) in this outbreak 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.” DOH statement ends here.

About Adenovirus Infections

Adenoviruses are a group of viruses that can infect the membranes (tissue linings) of the respiratory tract, eyes, intestines, urinary tract, and nervous system. They account for about 10% of fever-related illnesses and acute respiratory infections in kids and are a frequent cause of diarrhea.

Adenoviral infections affect babies and young children much more often than adults. Childcare centers and schools sometimes have multiple cases of respiratory infections and diarrhea caused by adenovirus.

Adenoviral infections can occur at any time of the year, but:

  • respiratory tract problems caused by adenovirus are more common in late winter, spring, and early summer
  • conjunctivitis (pinkeye) and pharyngoconjunctival fever caused by adenovirus tend to affect older kids, mostly in the summer

Adenoviral infections can affect children of any age, but most occur in the first years of life — and most kids have had at least one before age 10. There are many different types of adenoviruses, so some kids can have repeated adenoviral infections.

Signs And Symptoms Of Adenovirus Infections

Depending on which part of the body is affected, the signs and symptoms of adenoviral infections vary:

Febrile respiratory disease, an infection with fever of the respiratory tract, is the most common result of adenoviral infection in kids. The illness often appears flu-like and can include symptoms of pharyngitis (inflammation of the pharynx, or sore throat), rhinitis (inflammation of nasal membranes, or a congested, runny nose), cough, and swollen lymph nodes (glands). Sometimes the respiratory infection leads to acute otitis media, an infection of the middle ear.

Adenovirus often affects the lower respiratory tract as well, causing bronchiolitis, croup, or viral pneumonia, which is less common but can cause serious illness in infants. Adenovirus can also produce a dry, harsh cough that can resemble whooping cough (pertussis).

Gastroenteritis is an inflammation of the stomach and the small and large intestines. Symptoms include watery diarrhea, vomiting, headache, fever, and abdominal cramps.

Genitourinary infections: Urinary tract infections can cause frequent urination, burning, pain, and blood in the urine. Adenoviruses are also known to cause a condition called hemorrhagic cystitis, which is characterized by blood in the urine. Hemorrhagic cystitis usually resolves on its own.

Eye infections:

Pinkeye (conjunctivitis) is a mild inflammation of the conjunctiva (membranes that cover the eye and inner surfaces of the eyelids). Symptoms include red eyes, discharge, tearing, and the feeling that there’s something in the eye.

Pharyngoconjunctival fever, often seen in small outbreaks among school-age kids, occurs when adenovirus affects both the lining of the eye and the respiratory tract. Symptoms include very red eyes and a severe sore throat, sometimes accompanied by low-grade fever, rhinitis, and swollen lymph nodes.

Keratoconjunctivitis is a more severe infection that involves both the conjunctiva and cornea (the transparent front part of the eye) in both eyes. This type of adenoviral infection is extremely contagious and occurs most often in older kids and young adults, causing red eyes, photophobia (discomfort of the eyes upon exposure to light), blurry vision, tearing, and pain.

Nervous system infections:

Meningitis and encephalitis (inflammation of the lining of the brain and spinal cord) can sometimes happen due to adenovirus infection. Symptoms can include fever, headache, nausea and vomiting, stiff neck, or skin rash.

Contagiousness

Adenovirus is highly contagious, so multiple cases are common in close-contact settings like childcare centers, schools, hospitals, and summer camps.

The types of adenovirus that cause respiratory and intestinal infections spread from person to person through respiratory secretions (coughs or sneezes) or fecal contamination. Fecal material can spread via contaminated water, eating food contaminated by houseflies, and poor hand washing (such as after using the bathroom, before eating or preparing food, or after handling dirty diapers).

A child might also pick up the virus by holding hands or sharing a toy with an infected person. Adenovirus can survive on surfaces for long periods, so indirect transmission can occur through exposure to the contaminated surfaces of furniture and other objects.

The types of adenovirus causing pinkeye may be transmitted by water (in lakes and swimming pools), by sharing contaminated objects (such as towels or toys), or by touch.

Once a child is exposed to adenovirus, symptoms usually develop from 2 days to 2 weeks later.

Treatment

Adenoviral illnesses often resemble certain bacterial infections, which can be treated with antibiotics. But antibiotics don’t work against viruses. To diagnose the true cause of the symptoms so that proper treatment can be prescribed, your doctor may want to test respiratory or conjunctival secretions, a stool specimen, or a blood or urine sample.

The doctor will decide on a course of action based on your child’s condition. Adenoviral infections usually don’t require hospitalization. However, babies and young children may not be able to drink enough fluids to replace what they lose during vomiting or diarrhea and so might need to be hospitalized to treat or prevent dehydration. Also, young (especially premature) infants with pneumonia usually need to be hospitalized.

In most cases, a child’s body, with the help of the immune system, will get rid of the virus over time. Antibiotics cannot treat a viral infection, so it’s best to just make your child more comfortable. Children with weakened immune systems, transplants, HIV or AIDS, or congenital immunodeficiencies may have a more difficult time fighting adenovirus, so stronger treatment might be needed. (A congenital immunodeficiency is a condition a baby is born with that causes the immune system to not work properly.)

If your child has a respiratory infection or fever, getting plenty of rest and taking in extra fluids are essential. A cool-mist humidifier (vaporizer) may help loosen congestion and make your child more comfortable. Be sure to clean and dry the humidifier thoroughly each day to prevent bacterial or mold contamination. If your child is under 6 months old, you may need to clear his or her nose with nasal saline drops and a bulb syringe.

Don’t give any over-the-counter (OTC) cold remedies or cough medicines without checking with your doctor. You can use acetaminophen to treat a fever (your doctor will tell you the proper dose); however, do not give aspirin because of the risk of Reye syndrome, a life-threatening illness.

If your child has diarrhea or is vomiting, increase fluid intake and check with the doctor about giving an oral rehydration solution to prevent dehydration.

To relieve the symptoms of pinkeye, use warm compresses and, if your doctor recommends them, a topical eye ointment or drops.

Duration

Most adenoviral infections last from a few days to a week. However:

severe respiratory infections may last longer and cause lingering symptoms, such as a cough
pneumonia can last anywhere from 2–4 weeks
pinkeye can persist for another several days to a week
more severe keratoconjunctivitis can last for several weeks
adenovirus can cause diarrhea that lasts up to 2 weeks (longer than other viral diarrhea episodes)
Prevention

There’s no way to completely prevent adenoviral infections in kids. To reduce their spread, parents and other caregivers should encourage frequent hand washing, keep shared surfaces (such as countertops and toys) clean, and remove kids with infections from group settings until symptoms pass.

When to Call the Doctor

Most of these adenoviral conditions and their symptoms are also associated with other causes. Call your doctor if:

a fever continues more than a few days
symptoms seem to get worse after a week
your child has breathing problems
your child is under 3 months old
any swelling and redness around the eye becomes more severe or painful
your child shows signs of dehydration, such as appearing tired or lacking energy, producing less urine or tears, or having a dry mouth or sunken eyes

Remember, you know your child best. If he or she appears to be severely ill, don’t hesitate to call your doctor right away.

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NCN Health And Science Team

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