View source for 2018 United States adenovirus outbreak

{{Infobox event
| title                    = 2018 United States adenovirus outbreak
| image                    = 2018 U.S. adenovirus outbreak map.jpg
| caption                  = Map showing the two outbreak locations, in Maryland and New Jersey
| duration                 = Three months
| date                     = <!-- {{start date|2015|10|06}} or {{start and end dates|YYYY|MM|DD|YYYY|MM|DD}} -->  October 2018 to December 2018
| venue                    =
| location                 = [[Maryland]], [[New Jersey]]
| coordinates              = <!-- {{coord|LAT|LON|region:XXXX_type:event|display=inline,title}} -->
| also_known_as            =
| type                     = [[Adenovirus]] outbreak
| theme                    =
| cause                    = Unknown
| first_reporter           =
| reported deaths          = 12
| reported injuries        = 70+
}}

The '''2018 United States adenovirus outbreak''' was an occurrence in which an unusual number of [[adenovirus]] cases were reported at two locations, one in [[Maryland]] and one in [[New Jersey]], from September to December of 2018, resulting in deaths in both states.<ref name="NBC">{{cite web|url=https://www.nbcnews.com/health/health-news/cdc-watches-adenovirus-outbreak-killed-college-student-n939206|title=University of Maryland student dies in adenovirus outbreak|website=NBC News|first=Maggie|last=Fox|date=November 21, 2018}}</ref><ref name="WP">{{cite news|url=https://www.washingtonpost.com/local/three-new-cases-of-adenovirus-reported-at-u-md-s-college-park-campus/2018/11/27/5119cfb6-f24b-11e8-aeea-b85fd44449f5_story.html?noredirect=on|title=Three new cases of adenovirus reported at U-Md.' s College Park campus|newspaper=[[The Washington Post]]|first=Dana|last=Hedgpeth|date=November 27, 2018}}</ref> At least 35 people contracted the disease in each location of the outbreak.<ref name="Fox Baltimore">{{cite web|url=http://foxbaltimore.com/news/local/adenovirus-cases-at-university-of-maryland-up-to-35|title=Adenovirus cases at University of Maryland up to 35|publisher=Fox Baltimore|date=December 13, 2018|website=WBFF}}</ref><ref name="CNN">{{cite web|url=https://www.cnn.com/2018/11/21/health/university-of-maryland-death-adenovirus/index.html|title=University of Maryland freshman dies from adenovirus-related illness|first=Madeline|last=Holcombe|publisher=CNN|date=November 21, 2018}}</ref> In New Jersey, the ill ranged in age from toddlers to adults,<ref name="Requiring Outbreak"/> and eleven children died.<ref name="NJ"/><ref name="Problem After 4th"/> It was "one of the nation's deadliest long-term-care outbreaks"<ref name="Problem After 4th"/> and "one of the nation's worst recorded outbreaks of the [adeno]virus."<ref name="Familes At Hearing"/> The adenovirus outbreak led to the passage of new legislation in 2019 concerning the containment of outbreaks in long-term care centers in New Jersey.<ref name="New Requirements"/>

==History==
===Sept. 2018: New Jersey outbreak===
In September 2018, an adenovirus outbreak began at the [[Wanaque Center for Nursing and Rehabilitation]],<ref name="NJ">{{cite web|url=https://www.nj.com/news/2018/12/is-the-deadly-nj-viral-outbreak-that-killed-11-kids-finally-over.html|title=Deadly viral outbreak that killed 11 kids at Wanaque appears to be over|website=nj.com|first=Ted|last=Sherman|date=December 11, 2018}}</ref> a care facility for those with short-term rehab or long-term needs in [[Wanaque, New Jersey]].<ref name="The Home Website">{{Cite web|url=http://www.wanaquerehab.com/|title=The Wanaque Center for Nursing and Rehabilitation, Passaic County|website=www.wanaquerehab.com|language=en-US|access-date=2019-05-06}}</ref> on September 26, 2018, when a child developed symptoms of a respiratory ailment in the pediatric ventilator unit,<ref name="Adenovirus Wanaque Center">{{cite web|title=Adenovirus victim's parents: Shut down Wanaque center where 10 children died |url=https://www.northjersey.com/story/news/health/2018/11/02/adenovirus-outbreak-2018-parents-victim-want-wanaque-center-shut-down-viral-outbreak/1845824002/ |date=November 2, 2018 |work=NorthJersey.com |publisher= }}</ref> followed by a second child misdiagnosed as having respiratory ailments.<ref name="NJ"/> At the time, Wanaque did not have enough space to isolate the ill children from others.<ref name="NJTV News Daurio"/> The parents of ill patients were notified on October 19, 2018,<ref name="11th Dies by Nedelman">{{cite web|title=11th child dies in adenovirus outbreak in New Jersey |url=https://www.cnn.com/2018/11/16/health/wanaque-adenovirus-deaths-new-jersey-bn/index.html |date=November 19, 2018 |work=CNN |publisher= }}</ref> and that day as well the NJ health department was notified of a "cluster of respiratory illnesses."<ref name="Adenovirus Wanaque Center"/> Two children had died at that point<ref name="NJ"/> while twenty overall had showed symptoms.<ref name="Familes At Hearing"/> On October 10, 2018, the state Health Department sent a communicable disease specialist to the center.<ref name="Presently Ongoing Issues"/> The outbreak proved to be the type 7 adenovirus.<ref name="Requiring Outbreak"/> Not typically dangerous, it can be deadly to vulnerable patients.<ref name="NJTV News Daurio">{{cite web|title=State calls for infection control plans following child deaths at nursing facility |url=https://www.njtvonline.org/news/uncategorized/state-calls-for-infection-control-plans-following-child-deaths-at-nursing-facility/ |date=June 6, 2019 |work=NJTV News |publisher=NJTV News }}</ref>

The commissioner of the New Jersey Department of Health was notified about the outbreak on October 19, when five children had died.<ref name="CBS on Protocol Breakdown">{{cite web|title="Breakdown in protocols" led to deadly adenovirus outbreak, official says |url=https://www.cbsnews.com/news/new-jersey-adenovirus-outbreak-breakdown-in-protocols-at-wanaque-center-officials-say/ |date=December 5, 2018 |work=[[CBS News]] |publisher= }}</ref> The state sent inspectors on October 21<ref name="NJ">{{cite web|url=https://www.nj.com/news/2018/12/is-the-deadly-nj-viral-outbreak-that-killed-11-kids-finally-over.html|title=Deadly viral outbreak that killed 11 kids at Wanaque appears to be over|website=nj.com|first=Ted|last=Sherman|date=December 11, 2018}}</ref> in a surprise inspection, concluding that the center had yet to "establish and maintain an infection prevention and control program."<ref name="Time Writing About Outbreak"/> Six employees were observed inadequately washing their hands, continued in inspections on November 9, 11, and 13.<ref name="Presently Ongoing Issues">{{cite web|title=Adenovirus outbreak: Health Department orders admissions at Wanaque center to cease |url=https://www.northjersey.com/story/news/health/2018/11/14/adenovirus-outbreak-wanaque-nj-center-ordered-hire-specialists-nj-health-department/2004996002/ |date=November 16, 2018 |publisher=North Jersey Record }}</ref>  [[Medicare (United States)|Medicare]] inspections of the facility in 2016 and 2017 had also found "infection control issues."<ref name="Time Writing About Outbreak"/> 
 
On October 24, 2018, a government inspection report cited Wanaque for several deficiencies from 2015 to 2018. Elnahal, head of the state health department, asserted the issues had been corrected<ref name="Wanaque has Been Cited">{{cite web|title=Wanaque facility where seven children died from virus outbreak has been cited for deficiencies |url=https://www.northjersey.com/story/news/health/2018/10/24/wanaque-facility-where-six-children-died-has-been-cited-deficiencies-nj-inspectors-adenovirus/1742679002/ |date=October 24, 2018 |publisher=NorthJrsey.com }}</ref> and that the state would permanently surveil the facility.<ref name="Permanently Surveil">{{cite web|title=State surveillance underway at NJ facility where 7 children died from adenovirus |url=https://pix11.com/2018/10/25/state-surveillance-underway-at-nj-facility-where-7-children-died-from-adenovirus/ |date=October 25, 2018 |publisher=Pix11 }}</ref>

Reported on November 9, 2018, two anonymous employees spoke to [[NJ Advance Media]] and claimed that "senior administrators delayed sending kids to the hospital" to keep the pediatric unit as full as possible, maximizing funds amounting to $519.46 from Medicaid per patient per day. After the report, the state health commissioner sent inspectors to the facility.<ref name="Team Dispatched">{{cite web|title= N.J. dispatches inspection team to pediatric center after workers allege delays in hospital care|url=https://www.nj.com/news/2018/11/nj_dispatches_surprise_inspection_team_at_embattle.html |date=November 9, 2018 |publisher=NJ.com }}</ref> After November 12, 2018, the outbreak was reported under control.<ref name="Problem After 4th">{{cite web|title='I knew we had a problem after the 4th death': Failures led to 11 Wanaque center deaths |url=https://www.northjersey.com/story/news/watchdog/2019/02/27/wanaque-center-for-nursing-and-rehabilitation-failures-contributed-adenovirus-deaths/2952837002/ |date=February 27, 2019 |publisher=NorthJersey.com }}</ref>

===Nov-Dec 2018: Wanaque aftermath=== 
 
On November 14, the center was ordered by the state to isolate sick patients<ref name="Problem After 4th"/> by November 21<ref name="Separates Patients"/> and curtail all new admissions.<ref name="Problem After 4th"/> By November 16, there were 43 children on the first-floor ventilator unit where the virus was spreading. 19 children were in a second-floor unaffected pediatric unit, with 125 adult patients in the facility.<ref name="Presently Ongoing Issues"/> On November 19, 2018, it was reported that The Wanaque Center had separated its medically fragile patients from those with adenovirus symptoms. The dropping number of patients had allowed enough space to separate beds, whereas previously patients were being cared for in close proximity.<ref name="Separates Patients">{{cite web|title=Wanaque Center separates patients with adenovirus |url=https://www.njtvonline.org/news/uncategorized/wanaque-center-separates-patients-with-adenovirus/ |date=November 19, 2018 |publisher=NJTV News }}</ref>

From October to November 2018, the virus infected 35 people at the Wanaque Center, including 23 children.<ref name="PhillyVoice">{{cite web|url=https://www.phillyvoice.com/adenovirus-virus-outbreak-death-maryland-new-jersey/|title=A Maryland college student died from the same adenovirus causing death toll in New Jersey|website=PhillyVoice|first=Bailey|last=King|date=November 21, 2018}}</ref>  Ultimately, 36 residents and one staff member were diagnosed with the adenovirus.<ref name="Requiring Outbreak"/> The ill ranged in age from toddlers to teens,<ref name="Requiring Outbreak"/> and eleven children died.<ref name="NJ"/><ref name="Problem After 4th"/> It was "one of the nation's deadliest long-term-care outbreaks"<ref name="Problem After 4th"/> and "one of the nation's worst recorded outbreaks of the [adeno]virus."<ref name="Familes At Hearing"/>

Over three visits in early November, state inspectors gave the Wanaque Center the worst rating possible, "immediate jeopardy."<ref name="Presently Ongoing Issues"/> Federal inspectors also visited the center, from November 13 through 17, giving the center six "immediate jeopardy violations" for systemic deficiencies in care.<ref name="Problem After 4th"/> Inspectors initially blamed poor hygiene for the outbreak.<ref name="Problem After 4th"/> However, later, federal inspectors also implicated poor planning by management.<ref name="Problem After 4th"/> A November 17<ref name="Problem After 4th"/> report by the New York office of the [[Centers for Medicare and Medicaid Services]] (CMS)<ref name="Time Writing About Outbreak">{{cite web|title=Federal Investigators Find Critical Failings at Health Center Where 11 Children Died in Virus Outbreak |url=http://time.com/5540986/wanaque-adenovirus-federal-report/ |date=March 4, 2019 |work=TIME |publisher= |access-date=August 22, 2019}}</ref> blamed the outbreak on the center's response, particularly management for lack of planning and slow responses, leading to delays "in identifying, reporting and controlling the outbreak."<ref name="Problem After 4th"/> The pediatric medical director, for example, was not informed what exactly his job was,<ref name="Time Writing About Outbreak"/><ref name="Problem After 4th"/> and was not informed of the number of infected patients until after the fourth death.<ref name="Problem After 4th"/> Wanaque Center strongly contested the findings, calling the report flawed<ref name="Time Writing About Outbreak"/> and appealing the report to dispute "unfounded allegations."<ref name="Problem After 4th"/> Several lawsuits concerning the outbreak were filed against the center in late 2018.<ref name="Problem After 4th"/><ref name="Kids like William">{{cite web|title=Lawsuit |url=https://www.cnn.com/2018/11/09/health/adenovirus-lawsuit-new-jersey/index.html |date= November 9, 2018|publisher=CNN |access-date=August 22, 2019}}</ref>

===Nov-Dec 2018: University of Maryland outbreak===
At the height of the outbreak in New Jersey, an outbreak of the same strain of the virus occurred among students at the [[University of Maryland, College Park]]. The college learned about the first case of adenovirus on November 1,<ref name="CNN"/> and by mid-December, 35 cases involving the same strain of the virus had been reported at the university. Among those cases, 18-year old freshman Olivia Paregol, who was "immunosuppressed because of medication for [[Crohn's disease]]",<ref name="Fox Baltimore"/> died on November 18, 2018.<ref name="WP"/> In its coverage, the press noted that an [[adenovirus vaccine]] exists but not generally available to the public.<ref name="NBC"/><ref>{{cite web|url=https://www.nbcnews.com/health/health-news/adenovirus-killed-college-student-there-s-vaccine-she-couldn-t-n951061|title=Adenovirus strain that killed a college student may be growing more common|work=NBC News|first=Maggie|last=Fox|date=December 24, 2018}}</ref> It has been proposed that the Maryland outbreak was connected to a [[Mold (fungus)|mold]] outbreak on the campus during the same period.<ref name="PhillyVoice"/>

In January 2019, the University of Maryland began a weeks-long effort to have a contracted cleaning company disinfect all surfaces in the dorms where the outbreak occurred.<ref>{{cite web|url=https://baltimore.cbslocal.com/2019/01/07/cleaning-underway-at-umd-to-get-rid-of-adenovirus/|title=Cleaning Underway At UMD To Get Rid Of Adenovirus|publisher=CBS Baltimore|date=January 7, 2019}}</ref> The death of Paregol prompted Maryland Governor [[Larry Hogan]] to address the matter as "very concerning".<ref name="WP"/>

===2018-2019: New Jersey responses===
On November 20, 2018, members of the [[New Jersey Legislature]] representing the affected district sent a letter to [[New Jersey Attorney General]] [[Gurbir Grewal]] requesting an investigation of claims that "the facility delayed sending children for treatment for non-medical reasons" relating to the collection of [[Medicaid]] payments.<ref>{{cite web|url=https://www.northjersey.com/story/news/health/2018/11/20/adenovirus-outbreak-nj-legislators-want-care-delays-investigated/2071458002/|title=Wanaque virus outbreak: Legislators ask attorney general to investigate delays in care|website=North Jersey|first=Lindy|last=Washburn|publisher=North Jersey Record|date=November 20, 2018}}</ref>

A hearing on the outbreak was held by the NJ Senate Health Committee<ref name="Problem After 4th"/> on December 3, 2018.<ref name="Problem After 4th"/><ref name="Familes At Hearing">{{cite web|title=Virus outbreak: Families of Wanaque children attend hearing, but not center's owners |url=https://www.northjersey.com/story/news/health/2018/12/03/wanaque-virus-outbreak-centers-owners-decline-appear-hearing/2140926002/ |date=December 3, 2018 |work=NorthJersey.com |publisher= }}</ref> At the hearing, the NJ health department head announced that state health policy had been changed as a result of the outbreak, requiring the health commissioner to be notified immediately when outbreaks result in the deaths of children.<ref name="CBS on Protocol Breakdown"/>

In direct response to the Wanaque outbreak,<ref name="Requiring Outbreak">{{cite news|last=Catalini|first=Mike|title=State Health Department calls for requiring outbreak plan |url=https://apnews.com/8ccdfe8859d34eebb6c6e74dcda10e2c |date=June 6, 2019 |work=AP News |publisher=AP |access-date=September 1, 2020}}</ref> a June 2019 report from the [[New Jersey Health Department]] called for new legislation that would require New Jersey's long-term care centers to submit outbreak response plans to the state.<ref name="Mike Catalini"/> Other recommendations included quickly separating sick residents and designated staff, as well as quickly notifying guardians when outbreaks occur.<ref name="ONcisiedered">{{cite web|url=https://www.northjersey.com/story/news/health/2019/06/06/adenovirus-nj-outbreak-lead-changes-nursing-homes/1358602001/ |date=June 6, 2019 |work=NorthJersey.com |publisher= |title=Adenovirus NJ outbreak deaths of 11 children lead to policy changes at nursing homes}}</ref> The issue was included through $2.5 million in competitive grant funding by the proposed budget of [[New Jersey Governor]] [[Phil Murphy]].<ref name="Budget">{{cite web|title=After 11 Children Died, NJ Has Plan to Avoid Future Outbreak |url=https://nj1015.com/after-11-children-died-nj-has-plan-to-avoid-future-outbreak/ |date= |work=NJ1015 |publisher= |access-date=June 13, 2019}}</ref> The resultant state bill, A5527,<ref name="New Response to Outbreak">{{cite web|title=Governor Murphy Signs Legislation Requiring Outbreak Response Plans at Long-Term Care Facilities |url=https://www.nj.gov/governor/news/news/562019/approved/20190815b.shtml |date=August 15, 2019 |work=NJ.gov |publisher= |access-date=August 19, 2019}}</ref> was based on the report and faced no opposition when passing both houses of the state legislature<ref name="New Requirements">{{cite web|title=After 11 died at Wanaque nursing home, Murphy signs law to prevent future deadly outbreaks |url=https://www.northjersey.com/story/news/health/2019/08/15/after-11-died-wanaque-nursing-home-murphy-law-prevent-future-outbreaks/2022492001/ |date=August 15, 2019 |work=NorthJersey.com |publisher= |access-date=August 19, 2019}}</ref> in late June 2019.<ref name="New Owners Again">{{cite web|title=New owners to take over Wanaque nursing home where 11 children died in virus outbreak |url=https://www.northjersey.com/story/news/watchdog/2019/07/01/new-owners-take-over-nj-center-where-11-died-adenovirus-outbreak/1606174001/ |date=July 1, 2019 |publisher=NorthJersey.com |access-date=August 19, 2019}}</ref> On August 15, 2019, Murphy cited the 11 dead children of the Wanaque Center outbreak when signing the bill into law. Among other regulations, A5527 requires certain long-term facilities to provide outbreak response plans to the state<ref name="Mike Catalini">{{cite web|title=Response plans required after fatal outbreak under NJ law |url=https://www.apnews.com/bb78d269391d4017b23c9e08cc42f09b |date=August 15, 2019 |publisher=[[Associated Press]] |access-date=August 19, 2019}}</ref> within 180 days of signing.<ref name="Faster and Better">{{cite web|title= Deaths of 11 children at nursing home sparks new law demanding faster, better response to outbreaks|url=https://www.nj.com/news/2019/08/deaths-of-11-children-at-nursing-home-sparks-new-law-demanding-faster-better-response-to-outbreaks.html |date=August 16, 2019 |work=NJ.com |publisher=August 19, 2019 }}</ref> Other new requirements involve promptly notifying residents, families, staff, and visitors of an outbreak.<ref name="New Requirements"/> At the time the bill was signed, Wanague remained under state and federal investigation for how it handled the outbreak.<ref name="Patch on the New Law">{{cite web|title=Wanaque Fatal Virus Outbreak Prompts New NJ Law |url=https://patch.com/new-jersey/wayne/wanaque-fatal-virus-outbreak-prompts-new-nj-law |date=August 16, 2019 |work=Patch.com |publisher= |access-date=August 19, 2019}}</ref>

==References==
{{reflist}}

[[Category:Adenoviridae]]
[[Category:2010s disease outbreaks]]
[[Category:Disease outbreaks in the United States]]