WANAQUE — A 19th case of adenovirus was diagnosed at the Wanaque Center for Nursing and Rehabilitation, where seven pediatric patients have died from the illness.

Seven deaths of "medically fragile children" have been reported at the 227-room nursing, rehabilitation and pediatrics center with both short and long-term residents. The first case was reported to the state Department of Health on Oct. 9.

The DOH said it is possible that lab tests will reveal additional cases and a representative remains on site for the duration of the outbreak. A DOH inspection team during a surprise inspection on Sunday found minor hand-washing deficiencies. Health officials said they continued to work with the center on infection control issues.

The facility has been barred from taking new patients.

Many questions remain surrounding the death of seven children at the facility.

Deceased

The identities of the children were not disclosed in order to protect their identities. State officials said they were aged infant to young adult. Some of the parents have told the stories of their children.

Kristine Poulos told ABC 7 Eyewitness News that her 16-year-old daughter was at St. Joseph's Medical Center in Paterson with a bad fever and was taken to Wananque on Tuesday.

According to Kristine Deleg, she was not notified about the outbreak at the facility until three weeks after it first appeared, she told NorthJersey.com. Her 16-year-old daughter suffers from lifelong respiratory issues, stomach problems and seizures and had been at the facility for four years. She was taken to St. Joseph's University Medical Center in Paterson the day before she died.

What is adenovirus

Adenoviruses commonly cause respiratory illness, according to the DOH. They can result in mild to severe illness, produce cold-like symptoms and cause illnesses such as sore throats, bronchitis, pneumonia, diarrhea, pink eye, fever, bladder inflammation or infection, inflammation of the stomach and intestines and neurologic diseases.

The strain of adenovirus in this outbreak is associated with communal living arrangements and is known to cause severe illness—especially in those with compromised immune systems. The Centers for Disease Control is also involved with the investigation.

It is spread by shaking hands, touching, sneezing, coughing or touching objects or surfaces with adenoviruses on them and then touching your mouth, nose or eyes. It is also possible to get infected when changing a diaper on a child who is infected. You can also get sick from eating food prepared by someone who didn’t wash their hands properly after going to the restroom.

State officials say the outbreak won't be declared over until the Wanaque Center for Nursing and Rehabilitation can go four weeks without any new cases of people being infected with a germ called adenovirus 7.

Adenovirus 7 spreads easily in bodies of water such as small lakes or swimming pools without adequate chlorine and can cause outbreaks of febrile disease with conjunctivitis, according to the CDC.

Health Commissioner Shereef Elnahal said a surprise inspection at the facility this past weekend found only a hand-washing deficiency.

Is management at fault?

1199SEIU United Healthcare Workers East, which represents 136 certified nursing assistants, dietary aides, housekeepers, and laundry aides, issued a statement expressing concern about what has happened since a new for-profit company bought the center.

“Since new for-profit ownership took over at Wanaque Center in 2014, workers have expressed serious concerns over worsening staffing levels, lack of adequate supplies, and severe cutbacks to job standards. Publicly available data show that Wanaque Center earned nearly $2 million in profit over this period," the union said in a statement.

“We are deeply concerned by reports suggesting that Wanaque Center may have kept the severity of this outbreak from family members and staff. It is imperative that a full accounting take place of when and how this outbreak began and how it is now being addressed."

A parent who wished to remain anonymous told NJ.com there were unsanitary conditions at the facility with moldy bathrooms and rusty cribs. She showed the news site video of a wall full of ants.

Reaction

Gov. Phil Murphy in a message on his Twitter account said his administration is "devastated" and is confident in the DOH's ability to deal with the outbreak.

"As a father, my heart breaks for all families affected," Murphy said.

What's being done

Health Commissioner Shereef Elnahal said it can be difficult or impossible to know how the virus got to the facility, what its source was, or what its specific mechanisms of spread is from person to person."

"The consequences here have been drastic, and this has been absolutely wrenching for families, community members, our department, myself personally and the governor," Elnahal sad.

DOH personnel will remain at the center for the duration of the outbreak.

Material from the Associated Press was used in this report

Contact reporter Dan Alexander at Dan.Alexander@townsquaremedia.com or via Twitter @DanAlexanderNJ