New Jersey officials confirmed four new cases of the potentially fatal adenovirus in medically fragile children at a pediatric hospital in Camden County, but federal experts said it is a different, less-deadly strain of the disease that killed 10 and sickened 27 at a similar facility in Passaic County.
News of the recent outbreak at Voorhees Pediatric Facility — which was first discovered on October 26 and does not pose an immediate threat to the lives of the children involved, officials said — was announced late Wednesday. That’s just 24 hours after the state Department of Health shared a final inspection report from their visit last week to the Passaic facility, the Wanaque Center for Nursing and Rehabilitation.
The Wanaque report identified minor deficiencies in infection-control protocols, but they do not indicate substandard care, according to federal standards, the DOH said. The state has installed a monitor onsite and administrators have suspended admissions until the outbreak is declared over.
A population at risk
The violations — as minor as a seven-second gap in handwashing protocol — also underscore the extreme vulnerability of these patients, given their complex combination of healthcare needs. Many of the residents at these facilities require medical devices to eat, breathe, and move and, given their medically compromised state, they are extremely susceptible to disease, officials said.
State DOH Commissioner Dr. Shereef Elnahal said the Wanaque report raises questions about the current standards for care in facilities that care for these patients.
Elnahal said he is encouraged by new guidelines from the federal Centers for Disease Control and Prevention, scheduled to take effect next year, which would require more stringent infection protocols in long-term care facilities like these, including requiring administrators to hire an onsite expert. He is also talking to them about how to “better align standards” for these types of care sites.
“We also need to think about whether there is more we can do as healthcare leaders to protect immune-compromised children, such as those served at Wanaque Center,” Elnahal said Wednesday, and his staff is looking at all options, including adopting similar standards in New Jersey ahead of the federal changes.
Reviewing infection protocols
The Wanaque Center, which is licensed to care for some 92 pediatric patients (half of whom are on ventilators to assist with breathing), is one of four long-term care facilities for medically complex children in New Jersey. On Monday, the DOH announced that, as a result of the Wanaque outbreak, it would send expert teams to review infection protocols with staff at all four of the state’s pediatric hospitals, including Wanaque, Voorhees, and Children’s Specialized Hospital facilities in Toms River and Mountainside.
Administrators at the Wanaque Center first notified the state on October 10 that they had confirmed a diagnosis of the adenovirus, a pathogen that is likely to cause only minor cold-like symptoms in healthy individuals, but can prove deadly in those with challenged immune systems. Parents were alerted 10 days later and the state sent a team on October 21 to assess the situation and reinforce proper infection protocols; the report is a result of that visit.
Confirmed a diagnosis
According to state officials, all 27 patients now diagnosed contracted adenovirus Type 7 — considered particularly deadly to medically complex individuals — between late September and October 22. The most recent patient, diagnosed on October 29 and announced Wednesday, also was infected during that time, the DOH said, indicating that the virus is not necessarily still active at the facility.
Officials at Voorhees, with beds for just over 100 young patients, first identified the adenovirus in a resident on October 26, the DOH said Wednesday, and all four cases can be traced to some time between October 20 and October 27. A DOH team visited Tuesday and issued no citations, according to the department, and additional visits — part of the planned assessment and review for all facilities — will happen in the coming month.
While the DOH is awaiting additional results, initial lab tests from the CDC — which has assisted in the investigations — found that the four pediatric patients at Voorhees were indeed infected by adenovirus, but it was not Type 7, the deadly form that is responsible for the infections and deaths at Wanaque. Lab tests could lead experts to identify additional cases at both facilities.
Voorhees patients not in critical condition
“The pediatric patients in Voorhees do not have the severity of illnesses we’re seeing among residents at the Wanaque Center for Nursing and Rehabilitation,” Elnahal said. “While we cannot release private medical information, these patients in Voorhees are not in critical condition.”
The department is now working closely with Camden County health officials and Voorhees administrators to control the outbreak and identify any other cases, Elnahal said. They have curtailed new admissions, but are accepting re-admissions, he noted.
The Camden County facility had the capacity to “safely and swiftly” separate sick patients, Elnahal added, to reduce contact with the infection and limit the reach of the disease. It has also been updating state officials daily and has advised parents and other family members of patients of the situation.
While the Wanaque outbreak has been particularly deadly, the appearance of adenovirus is not necessarily a rare occurrence. The virus is most common among individuals that live in proximity, like military quarters or hospitals.
State officials identified 79 probable cases of adenovirus Type 7 in a Cumberland County drug rehabilitation facility in early 2017; four were hospitalized and three died as a result of the infection. The disease brought on respiratory failure that proved fatal, given the patients’ history of alcoholism, cirrhosis, and diabetes, the agency found.
“Every year in the state, there are hundreds of outbreaks at healthcare facilities,” Elnahal said. “Facility outbreaks are not always preventable, but best practices can be used to minimize the chance they occur among the most vulnerable patients in New Jersey.”