A viral outbreak at a New Jersey long-term medical care centre has killed six children and left a dozen more infected.
State officials confirmed a total of 18 cases of adenovirus among paediatric patients at the Wanaque Center for Nursing and Rehabilitation on Tuesday.
Adenoviruses typically cause "mild illness" but the children affected are "medically fragile", officials say.
The state investigation is ongoing. The centre is now closed to new patients.
The children involved have "severely compromised immune systems" rendering them more susceptible to the virus, the health department said.
"The combination of a worse strain of adenovirus together with a fragile population has led to a more severe outbreak," it added.
The health facility in Haskell is privately owned. The centre did not immediately respond to a request for comment from the BBC.