Health officials seek answers to deadly viral infection in New Jersey

Health officials are continuing their investigation after the deaths of seven people and at least 11 others have been infected with an adenovirus at a New Jersey health facility, the New Jersey Department of Health said Wednesday.

That's the six deaths reported Tuesday among medically fragile children at the Wanaque Center for Nursing and Rehabilitation in Haskell, New Jersey.

"They are very young children to young children," said Dr. Shereef Elnahal, commissioner of the New Jersey Department of Health, Wednesday. "The vast majority is under the age of 18. Some have been hospitalized and others are being cared for at this facility."

The epidemic seems to be limited to the respiratory unit of the institution, he added.

Although the timing of deaths remains to be determined, the health service was informed on October 9 of a respiratory illness in the facility. The facility informed the parents ten days later, Oct. 19, according to the spokesman of the Department of Health, Nicole Kirgan.

"Health professionals and others do not think the cold is serious, but when you're a child, a disabled person, a chronic illness, people who are immunocompromised, seniors, multiple health problems, colds can put your life in danger, "said Dr. David Gifford, senior vice president of quality and regulatory affairs at the American Health Care Association.

The association – whose member organizations represent nursing homes and other health care facilities across the country – neither owns nor operates individual facilities. Although Wanaque Institution is a member of the default national organization, Mr. Gifford stated that the association was not taking a stand for individually representing facilities.

Gifford said that the time needed to respond to an outbreak and inform families is variable. "There are so many nuances," he said, including how long health experts should investigate a possible outbreak, cultivate a virus and confirm its identity.

"Generally, if you meet a number of people in an institutional setting with an illness, you start taking precautions regarding the spread," said Gifford, without this necessarily involving informing families of something that initially looks like a common message. cold.

In a statement released on Tuesday, the Wanaque center said it "immediately informed all concerned government agencies when the virus had been identified." On Wednesday, another statement from the facility said that the health department "continues to work very closely with the facility to ensure that all anti-infection measures are followed ".

The property has not responded to several calls and emails for other comments. He was "instructed to no longer admit new patients until the end of the epidemic and that they are in full compliance," according to the state health department. According to Elnahal, the outbreak can only be declared once every four weeks without any other case.

"Nursing homes do not often call the health department," Gifford said, although there has been pressure for health centers and health care facilities to involve health departments in surveys. about epidemics earlier.

Adenoviruses are known to persist on soiled medical surfaces and instruments for extended periods of time, may not be removed by common disinfectants, and rarely cause serious illness in healthy persons. However, US Centers for Disease Control and Prevention have a higher risk of acquiring a serious illness and remaining infectious long after convalescence.

"The strain of adenovirus observed during this outbreak is associated with living conditions in the community and is known to cause serious illness," said the state health department.

"It can be difficult, if not impossible, to know how the virus has arrived in the institution, what is the source or what is its specific mechanism of spreading from one person to the other", said Elnahal. "But we are working with the CDC on this ongoing investigation into an outbreak."

The state health department announced Tuesday that an inspection team at the facility had discovered minor flaws in hand washing.

In a review done by the Centers for Medicare and Medicaid Services, the Wanaque Center was rated above average in terms of overall quality, but a lower level of health inspection. the average.

According to an inspection conducted in August, CMS reported that "it was determined that the facility had failed to provide a clean and welcoming physical environment to its residents". The magazine found carpeted areas that "smelled of old carpet and mildew".

On Wednesday, Elnahal described these as "low-level, resolving deficiencies" that were subsequently resolved during the health inspector's check.

A May 2017 inspection report "determined that the facility had failed to ensure that infection control practices were followed." Among the deficiencies cited were improperly stored syringes used to measure liquid medications, as well as poorly cleaned and disinfected medication bedsteads and trays. The deficiencies were corrected a month later and their number was lower than the American average.

"It is rare that during an inspection, an installation produces quotations without quotations," Elnahal said. "If there are a number of quotes, all of low level, we ask for a correction plan.We make sure that the installation works well – and that 's right. did this installation do here. "

"If the conclusions are serious enough that we can take other measures, we will do it," he added.

Institutional nurses had previously reported a shortage of nurses and supplies, according to a statement released Tuesday by the union representing nurses. Health professionals and allied employees said the shortages may have resulted in "poor infection control practices".

The union said it represented the 70 nurses working at the Wanaque Nursing and Rehabilitation Center.

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Adenoviruses can cause mild to severe diseases, although serious diseases are less common. According to the CDC, people with weakened immune systems or existing respiratory or cardiac disease are at higher risk of developing serious illness resulting from adenovirus infection.

This epidemic, caused by a type 7 adenovirus, "affects medically fragile children whose immune system is seriously compromised," said Tuesday the Department of Health.

"Most of the time, adenoviruses produce a flu-like illness with cough and runny nose and a feeling of mold, but you recover," Dr. William Schaffner, an infectious disease specialist at Vanderbilt University told CNN. . "But they can also cause conjunctivitis and, especially in children, diarrhea."

In rare cases, in people whose immune systems are weakened, viruses can cause pneumonia or inflammation of the brain and surrounding tissues. In extremely unusual cases, an adenovirus infection can lead to death.

That said, most adenovirus infections are benign, with symptoms that typically last about 10 days, according to the CDC. And for most patients, home remedies and over-the-counter medications to relieve symptoms will be the only treatment needed.

Adenoviruses, unlike the flu, are not seasonal and can cause illness throughout the year. And even if there is a vaccine against adenovirus, it is only available for army recruits.

The viruses themselves are also "resistant to many common disinfectants and can remain infectious for long periods of time on environmental surfaces and medical devices," says the CDC. Adenoviruses tend to spread through coughing and sneezing, direct contact with an infected person or contact with objects and surfaces, such as doorknobs and switches, where adenoviruses can live and remain infectious for days or weeks.

Adenoviruses can "stay stable at room temperature for weeks" on impure surfaces, according to Dr. Alex Valsamakis, Director of Clinical Virology and Molecular Microbiology and Professor of Pathology at the Faculty of Medicine of the University Johns Hopkins.

She described this family of viruses as "ecologically resistant".

"Wash your hands frequently and avoid touching your face," she told CNN. "It's the easiest way to avoid inadvertently transporting something from your fingers into your nose or mouth."

Adenovirus infections "usually occur sporadically – it is one case, one case – so the epidemics are quite rare," said Schaffner.

Between 2003 and 2016, the two most commonly reported types of adenovirus in the United States were types 2 and 3, although four additional types – 1, 4, 7 and 14 – also caused the disease, according to one 2017 report of the National Center for Immunization and Respiratory Diseases of the CDC. These six types represent 85.5% of the 1,497 laboratory-confirmed samples reported during the period.

It is thought that this small number of cases is an under-representation of the actual number of cases because most people who become ill do not consult their doctor or their doctors do not seek this virus.

And adenoviruses remain difficult to diagnose because they are usually not part of a set of tests used to identify specific viruses, according to Schaffner. He said that the situation was changing and that for this reason he thought that the number of cases would increase.

Still, Schaffner does not think people need to worry about adenoviruses. "They mainly cause a whole host of embarrassing minor infections transmitted by children, often from children to adults," he said.

"But they are not as bad as the flu."