A tenth child has died in a severe adenovirus outbreak at a New Jersey rehabilitation center that has come under scrutiny for what one worker described as “filthy” conditions. The state Department of Health confirmed the death late Wednesday, identifying the victim only as a “medically fragile child” who fell ill at the Wanaque Center for Nursing and Rehabilitation in Haskell before Oct. 22. The outbreak of adenovirus, a respiratory virus that can be fatal for those with compromised immune systems, was first reported to authorities on Oct. 9. At least 28 people—27 children and one adult—were sickened between Sept. 26 and Oct. 29. A state inspection of the facility released Tuesday found deficiencies in hand-washing procedures, though it’s not clear if those issues would have played a role in the outbreak. The Department of Health said all children affected “had severely compromised immune systems” prior to the outbreak.