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State health officials have said the outbreak can be declared over only once four weeks pass without an additional case. Symptoms may appear two to 14 days after being exposed to the virus, the state health department said.The children affected by the outbreak became ill between September 26 and November 12, according to the health department. The number has risen from 18 cases, including six deaths, announced last month by the health department.A staff member was also affected by the outbreak but has recovered.The outbreak in the Wanaque facility was caused by adenovirus type 7. This type is "most commonly associated with acute respiratory disease," according to the US Centers for Disease Control and Prevention."This is an extremely severe strain of adenovirus that couldn't have occurred in a worse place," Elnahal said Friday.Other types of adenovirus infections can cause flu-like symptoms, pinkeye and diarrhea.Eight cases of adenovirus have also been found among children at a second New Jersey facility, Voorhees Pediatric Facility. However, tests suggest that the culprit is adenovirus type 3, a different strain than the one in Wanaque.Patients at the Voorhees facility became ill between October 20 and November 9. A previous inspection by the state health department found no infection control problems and issued no citations.Health officials say they are stepping up efforts to strengthen infection control at such facilities in the state. The health department announced plans last month to deploy a team of infection control experts to visit University Hospital and four pediatric long-term care facilities this month, including the Wanaque and Voorhees facilities, where experts will train staffers and evaluate how these facilities prevent and control infections."Facility outbreaks are not always preventable, but in response to what we have seen in Wanaque, we are taking aggressive steps to minimize the chance they occur among the most vulnerable patients in New Jersey," Elnahal said in a statement.Adenoviruses are often spread by touching a contaminated person or surface, or through the air by coughing or sneezing. They are known to persist on unclean surfaces and medical instruments for long periods of time, and they may not be eliminated by common disinfectants, but they rarely cause severe illness in healthy people. However, people with weakened immune systems have a higher risk of severe disease, and they may remain contagious long after they recover, according to the CDC.The infections and deaths come amid questions -- from former Wanaque Center employees, the mothers of children who got sick at the facility, and Elnahal himself -- about whether facility standards are high enough and whether more could have been done to prevent this from happening.Elnahal said in a statement that the findings of a recent unannounced health inspection at the Wanaque facility "raise questions about whether these general longterm care standards are optimal for this vulnerable population of medically fragile children."In statements last month, the Wanaque facility said that it's working alongside health experts to investigate the outbreak and that it "promptly notified all appropriate government agencies when the virus was initially identified." According to state health department spokeswoman Nicole Kirgan, health officials were notified of respiratory illness at the facility on October 9, and the facility notified parents 10 days later, on October 19.The facility has declined multiple requests for comment. 3555

Starting Friday, residents will be able to drop off their old flags in designated boxes at county libraries, as well as the city of San Diego's public libraries. Local Boy Scout troops will frequently collect the boxes and deliver them to local American Legion posts and associated nonprofits that will conduct flag retirement ceremonies. 338

Sooo a pipe exploded on the highway and this happens...here comes a potential sinkhole/road collapse ?? pic.twitter.com/z5Pvip7DnG— Chloe Bycoskie (@chloebycoskie) September 14, 2017 182

Since the center does not fall within the definition of minor-oriented facility," Measure U does not require any separation between the center and the dispensary.  The staff recommendation to the City Council is to uphold the Planning Commission’s approval."  274

The 880-page measure is the largest economic relief bill in U.S. history. It includes stimulus payments for many Americans, student loan changes, expanded unemployment coverage, a 7 billion program for small businesses, and more. 232