Adenovirus outbreak in Wanaque is over, but state oversight remains

The virus outbreak at a Wanaque nursing home where 36 children were infected and 11 died has come to an end 11 weeks after it began, but state health officials are still barring new admissions to the children’s unit where the illness spread.  

Four weeks, or two full incubation cycles, have passed since the most recent patient at the Wanaque Center for Nursing and Rehabilitation came down with the symptoms of adenovirus — a virus that typically causes bad cold symptoms but can be life-threatening to patients with weak immune systems. For public health experts, that’s the standard for declaring an outbreak over. 

However, “given the unusual situation at Wanaque, we remain particularly vigilant,” said Donna Leusner, a spokeswoman for the state Health Department. The Wanaque center is the only long-term care facility in the state that cares for both pediatric and adult patients. Infection control lapses — in hand-washing, for example — led Health Department inspectors to cite the center after a spot visit in October for presenting “a serious and imminent risk of harm” to its residents.  

The Health Department continues to bar all new admissions to the center’s pediatric unit, which has 92 beds, more than 60 of which are reserved for patients who breathe with the aid of ventilators. Re-admissions — after a brief hospital stay, for example — are allowed in the general pediatric unit but must be approved on a case-by-case basis for the ventilator unit, Leusner said.  

"Out of an abundance of caution, we are continuing to work with the facility to ensure they have infection control procedures in place,” she said. “There is always a risk of the introduction of a new respiratory outbreak in this facility because it’s flu season.” 

Adenovirus outbreak:A timeline of events

Shortage of room:Wanaque virus outbreak shows New Jersey doesn't have room for children in long-term care

Trenton legislative hearing:Virus outbreak: Families of Wanaque children attend hearing, but not center's owners

Health Commissioner Shereef Elnahal has said the center must have the room to separate patients when an outbreak arises, which would mean that it cannot return to full capacity in the children's unit. The Wanaque center operated at full capacity and did not have room to separate sick children from asymptomatic residents until six weeks into the outbreak. 

Elnahal ordered the Wanaque center to hire two full-time consultants — one with a certification in infection control, the other a physician practice specializing in infectious diseases — on Nov. 14.  

Once the center had the space to do so, he also required it to separate the children in the ventilator unit to prevent the spread of the disease. They were grouped in red, yellow and green zones, depending upon whether they had been diagnosed with adenovirus, showed symptoms but were awaiting laboratory confirmation, or had shown no symptoms. Staff members, supplies and equipment were also “cohorted” in this way, to avoid cross-contamination.  

Since the cohorting was completed on Nov. 17, no children have developed adenovirus symptoms.  

Laboratory testing ordered by the infectious-disease specialists at the center, however, turned up two previously unrecognized cases of adenovirus. That was reflected in the higher case count — 36 children and one staff member — posted by the Health Department on Monday.  

One child who became sick on Oct. 12, after five patients had already died in the outbreak, was not tested at that time. “Symptoms resolved quickly,” the Health Department said in a statement, “and the patient has not experienced any respiratory symptoms since that time.”  

It’s not known how long a patient remains contagious, or “sheds” the virus, although the federal Centers for Disease Control and Prevention says it can be weeks or longer. The virus can remain in tonsils, adenoids and intestines without causing an infection. 

The Wanaque center patients who have recovered from the virus, including the recently identified resident and those who were hospitalized and have returned, have been grouped together to avoid any chance that they would spread the virus, the Health Department said.  

Meanwhile, a separate outbreak of a milder strain of adenovirus at the Voorhees Pediatric Facility in Camden County continues to spread. It has infected 17 patients so far, the most recent of whom developed symptoms on Monday.  

The Voorhees facility voluntarily agreed to curtail admissions until the outbreak is over, which would be Jan. 7 if no new cases develop. 

More on the adenovirus outbreak

The latest news:Children return to Wanaque facility where 11 have died

Adenovirus outbreak:A timeline of events

The families:Parents of the Wanaque children tell their stories