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Zika Virus – Jan. 29, 2016Texas has six confirmed travel-related cases of Zika virus disease in the state. The travelers were infected abroad and diagnosed after they returned home. There has been no reported local transmission of the disease in the continental United States. Zika is a mosquito-borne virus that can cause fever, rash, muscle and joint aches and pinkeye. Symptoms are usually mild, and most people exposed to Zika virus won’t develop any symptoms at all. There have been reports of microcephaly and other poor pregnancy outcomes in babies of mothers who were infected with Zika virus while pregnant. The Texas Department of State Health Services is encouraging people to follow travel precautions for regions and certain countries where Zika virus transmission is ongoing. DSHS recommends travelers avoid mosquito bites while abroad and for seven days after returning, in case they have been exposed to Zika virus. People can protect themselves from mosquito bites by: Wearing long-sleeved shirts and long pantsUsing EPA-registered insect repellentsUsing permethrin-treated clothing and gear Staying and sleeping in screened-in or air-conditioned rooms. Texas Zika Virus CDC Zika Virus https://www.dshs.state.tx.us/news/updates.shtm

Texas has reported Six Confirmed Cases of Zika Virus as of January 29th, 2016

Zika-affected Areas Recommend on FacebookTweetWhere has Zika virus been found?Prior to 2015, Zika virus outbreaks have occurred in areas of Africa, Southeast Asia, and the Pacific Islands.In May 2015, the Pan American Health Organization (PAHO) issued an alert regarding the first confirmed Zika virus infections in Brazil.Currently, outbreaks are occurring in many countries.Zika virus will continue to spread and it will be difficult to determine how the virus will spread over time.For the latest Travel Notice InformationZika in the United States and its territories: No locally transmitted Zika cases have been reported in the continental United States, but cases have been reported in returning travelers.Locally transmitted Zika virus has been reported in the Commonwealth of Puerto Rico.With the recent outbreaks, the number of Zika cases among travelers visiting or returning to the United States will likely increase.These imported cases could result in local spread of the virus in some areas of the United States.Countries and territories with active Zika virus transmission AMERICASBarbadosBoliviaBrazilColombiaDominican RepublicEcuadorEl SalvadorFrench GuianaGuadeloupeGuatemalaGuyanaHaitiHondurasMartiniqueMexicoPanamaParaguayPuerto RicoSaint MartinSurinameU.S. Virgin IslandsVenezuelaOCEANIA/PACIFIC ISLANDSSamoaAFRICACape Verde Page last reviewed: June 1, 2015Page last updated: January 26, 2016http://www.cdc.gov/zika/geo/

On 25 January 2016, the National IHR Focal Point for the United States of America notified PAHO/WHO of the first laboratory-confirmed cases of Zika virus infection in St. Croix, one of the three main islands in the United States Virgin Islands (USVI). The USVI Department of Health received laboratory confirmation of the case on 22 January. The patient is a non-pregnant woman from USVI who reported the onset of fever, rash, conjunctivitis and arthralgia on 1 January. She had not travelled in the three weeks that preceded the onset of symptoms. A serum sample obtained from the patient on 8 January tested IgM positive at the U.S. Centers for Disease Control and Prevention. The sample was negative for dengue and chikungunya virus infections.View the full article

On 17 January 2016, the National IHR Focal Point (NFP) of Lao People’s Democratic Republic (PDR) notified WHO of 2 additional cases of vaccine-derived poliovirus type 1 (VDPV1). Both cases are from Longsane district, Xaisomboun Province. The first new case is a 14-month-old male from Longsane district, Xaisomboun Province. He developed fever on 16 November, progressing to hyporeflexia and asymmetric paralysis in both legs by 18 November. Local health authorities reported the AFP case on 19 November. Vaccination history indicated that the child had received three doses of oral polio vaccine (OPV). On 1 and 3 December, samples of the patient were collected and shipped to the National Institute of Infectious Diseases (NIID) in Japan for testing. On 21 December, the samples tested negative for any polioviruses. However, a sample taken from his asymptomatic sister tested positive for VDPV1. The 14-month old AFP case was classified by the National Coordination Committee as VDPV1 case based on the epidemiological link with the positive contact and also as one additional AFP case from the same district tested positive for VDPV1 indicating the plausibility of VDPV1 circulation in the area. View the full article

On 24 January 2016, the National IHR Focal Point of Thailand notified WHO of 1 laboratory-confirmed case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection. This is the country’s second case of MERS-CoV infection (see DON published on 10 July 2015). The case is a 71-year-old Omani national who arrived in Bangkok, Thailand on 22 January. The patient travelled to Thailand to seek medical care. Once in Bangkok, the patient was admitted to hospital. On 23 January, he tested positive for MERS-CoV. View the full article

The National IHR Focal Point of Nigeria has notified WHO of different outbreaks of Lassa fever occurring in the country. Between August 2015 and 23 January 2016, 159 suspected cases of Lassa fever, including 82 deaths, were reported across 19 states. Investigations are ongoing and a retrospective review of cases is currently being performed; therefore, these figures are subject to change. View the full article

On 23 January 2016, the National IHR Focal Point for the Dominican Republic notified PAHO/WHO of 10 laboratory-confirmed cases of Zika virus infection. Of the 10 cases, 8 are locally-acquired and 2 imported from El Salvador. The cases are from Distrito Nacional, and the municipalities of Santo Domingo Norte, Jimani-Independencia and Santa Cruz-Barahona. While 8 of the 10 cases are aged 15 to 57 years old, the remaining 2 cases are children under five years old. Onset of symptoms ranges from 3 to 18 January. All cases presented fever and rash; 8 of the 10 cases had conjunctivitis, 6 of the 10 cases experienced malaises, headache and arthralgia; and, 5 of the 10 cases reported myalgia. View the full article

Between 27 December 2015 and 13 January 2016, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 4 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection. Globally, since September 2012, WHO has been notified of 1,630 laboratory-confirmed cases of infection with MERS-CoV, including at least 586 related deaths.View the full article

Between 11 and 14 January 2016, the National IHR Focal Point of the United Arab Emirates notified WHO of 2 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 1 death. Contact tracing of household and healthcare contacts is ongoing for these cases.View the full article

On 18 January 2016, the National Health and Family Planning Commission (NHFPC) of China notified WHO of 1 additional laboratory-confirmed case of human infection with avian influenza A(H5N6) virus. The case is a 31-year-old female from Shenzhen City, Guangdong Province who developed symptoms on 8 January. The patient was admitted to a local hospital and is now in critical condition. View the full article

Affected Counties 2016 County & Flock # Date Confirmed Positive Number of Poultry Type of Operation StatusType Dubois 1Jan. 14, 2016 62,109Commercial TurkeyDepopulated H7N8 Dubois 2Jan. 16, 2016 37,798Commercial TurkeyDepopulated LPAI H7N8 Dubois 3 Jan. 16, 2016 28,751Commercial TurkeyDepopulatedLPAI H7N8 Dubois 4 Jan. 16, 2016 12,392Commercial TurkeyDepopulatedLPAI H7N8 Dubois 5 Jan. 16, 2016 22,227Commercial TurkeyDepopulatedLPAI H7N8 Dubois 5aDangerous Contact Not Infected** 156,178Commercial Layers Depopulated Negative Dubois 6 Jan. 16, 2016 24,732Commercial TurkeyDepopulatedH7 Suspect Dubois 7 Jan. 16, 2016 11,705Commercial TurkeyDepopulatedLPAI H7N8 Dubois 8 Jan. 16, 2016 36,695Commercial TurkeyDepopulatedLPAI H7N8 Dubois 9 Jan. 16, 201616,591Commercial TurkeyDepopulatedLPAI H7N8 Dubois 10 Jan. 16, 2016 5,325Commercial TurkeyDepopulatedLPAI H7N8 UPDATED: Jan. 22, 2016 at 8:45 a.m. **This negative flock is depopulated because of its proximity to infected turkeys. Current Statewide Situation Total number of affected premises = 10 Total number of affected counties = 1 Premises by County/Number of flocks Dubois : 10 Total number of birds affected in Indiana Commercial Turkey: 258,325 Commercial Chickens (Layers): 156,178 _________________ Total: 414,503

State of Indiana Response to Avian Flu in Dubois County 1/22/16 New information is in bold italics. DEVELOPING SITUATION On January 15, it was announced that confirmed cases of Highly Pathogenic Avian Influenza were found in Dubois County. State, local and federal agencies are working together on containment and depopulation operations. On January 16, nine additional avian influenza detections were announced, with the United States Department of Agriculture’s (USDA) Animal and Plant Health Inspection Service (APHIS) confirming on January 17 that eight flocks have been confirmed as low pathogenic avian influenza. More information on the ninth positive could not be confirmed through the original testing, and more in-depth testing is being conducted at the USDA National Services Laboratory. A 10 kilometer control area has been established, primarily in Dubois County. An extension of an extra 10-kilomenter “surveillance zone,” beyond the 10-km control zone, has been put in place as a precaution. The surveillance zone includes parts of Crawford, Daviess, Martin and Orange counties. All infected sites are in Dubois County. There were no new positive tests overnight, but aggressive testing continues inside the 10-km control area and additional 10-km surveillance zone. All commercial poultry farms located in the control area and the surveillance zone have completed at least one round of negative tests, and will begin a planned second round of tests in the next 24 hours. Testing will continue for several more weeks within the control and surveillance zone to ensure that no H7N8 remains in the area. Birds have been depopulated on all ten premises. Disposal processes have begun on all depopulated sites. Turkeys are being composted in the buildings in which they were euthanized. The composting process takes about three weeks, after which time, the compost can be used agriculturally because it will not contain the virus. An additional 156,000 hens (chickens) that were NOT infected with H7N8 have been depopulated and disposed of in a landfill. The facility was considered a “dangerous contact” to an infected turkey flock. The laying facility is located very close to an infected barn and shares a vehicular traffic zone with the original site, putting the birds at high risk of contracting the virus. No chickens are infected. Previous depopulation tallies have been based on estimated flock sizes. Final reporting has been completed on all sites, with 258,325 turkeys and 156,178 chickens affected. State and federal teams have visited 1,985 residences in a 10-kilometer radius control area around the original site to search for small, backyard flocks of birds for precautionary monitoring and testing. A total of 96 backyard flocks have been found, and sampling of these flocks continues. All 76 small flock samples tested so far have been negative. After initial testing, these flocks will be retested in 14 days. Several mental health treatment options are available to those affected: - Phone hotline offered by Southern Hills Counseling Center in Jasper, at 812-482-3020. If the call is made after hours, the caller should press 0. - A 24-hour phone hotline through Memorial Hospital and Healthcare Center, at 812-827-6222. - Daily group sessions are available at the command post from 11 a.m. to 1 p.m., and at the staging area from 6 to 8 p.m. Services will be provided as long as needed. RESPONSE A total of 421 state, federal and local responders are working in Dubois County on surveillance and response efforts. STATE RESPONSE A Unified Incident Command Post (UCP) has been established in Jasper, Indiana. The post is staffed by the District 1 Incident Management Team, along with federal and local partners. State Agencies supporting activities in the UCP: The State Board of Animal Health, Indiana State Department of Agriculture, Indiana Department of Homeland Security, Indiana Department of Natural Resources, Indiana State Department of Health, Indiana Department of Environmental Management, Integrated Public Safety Commission, Indiana State Police and mental health services teams from the Family and Social Services Administration. Other organizations supporting activities in the UCP: United States Department of Agriculture, Indiana University, Vincennes University Jasper Campus, Indiana State Poultry Association, Dubois County Emergency Management Agency, Dubois County Health Department, Dubois Water Utility, City of Jasper, Dubois County Highway Department, and all Dubois County fire departments. State Emergency Operations Center: Under the leadership of the Indiana Department of Homeland Security (IDHS), the Indiana Emergency Operations Center (EOC) has been activated at Level III and will remain activated 24 hours a day to monitor conditions and provide resource support to local county emergency agencies. Other organizations supporting activities: Purdue Extension FEDERAL RESPONSE The United States Department of Agriculture has approximately 87 representatives, along with private contractors, in Dubois County assisting with state and local efforts. A National Incident Management Team is in place, with additional staff continuing to arrive in Indiana to help coordinate efforts. PUBLIC ADVISORIES Avian influenza does not present a food safety risk; poultry and eggs are safe to eat. Officials are not aware of any public health significance with this virus. Human infection from an H7 virus is uncommon, but can cause some conjunctivitis and/or upper respiratory tract symptoms. Human health agencies will be monitoring workers and others in contact with birds to monitor for illness. Backyard poultry owners are encouraged to be aware of the signs of avian influenza and report illness and/or death to the USDA Healthy Birds Hotline: 866-536-7593. Callers will be routed to a state or federal veterinarian in Indiana for a case assessment. Dead birds should be double-bagged and refrigerated for possible testing. Signs include: sudden death without clinical signs; lack of energy or appetite; decreased egg production; soft-shelled or misshapen eggs; swelling or purple discoloration of head, eyelids, comb, hocks; nasal discharge; coughing; sneezing; lack of coordination; and diarrhea. A great resource for backyard bird health information is online at: http://healthybirds.aphis.usda.gov/. Situation updates and status reports about ongoing avian influenza activities, along with critical disease-related information, will be posted online at: www.in.gov/boah/2390.htm. Users may subscribe to email updates on a link at that page.

FOR IMMEDIATE RELEASE: Jan. 22, 2016 Local Responders Turn Out in Force for Behind-the-Scenes Role to Fight Bird Flu Public safety professionals in Dubois County, Ind., have played a behind-the-scenes but important role in the response to avian flu detected recently in commercial turkey flocks. “They haven’t been out front due to the type of response, but their participation and expertise has been paramount,” said Dr. Brett Marsh of the Indiana State Board of Animal Health. “We could not have accomplished what we have without local team partners.” The firefighters, police officers, emergency medical technicians and health officials who call Dubois County home have braved long hours, severe cold and stressful conditions to keep residents safe and to help stop the flu from spreading to other bird flocks. They are among 518 professionals from local, state and federal agencies, and from private organizations, joining forces to combat the avian flu challenge on the front lines in the southwestern Indiana county. The following local organizations have assisted in the incident response: · The Dubois County Health Department has assisted by interviewing and monitoring the responders, farm personnel and residents who have been involved in the incident. · The Dubois County Emergency Management Agency (EMA) has continuously provided personnel and resources for the response efforts and has been assisted by emergency management staff from the following EMAs: the Knox County EMA, Daviess County EMA, Martin County EMA, Gibson County EMA, Pike County EMA, Crawford County EMA, Posey County EMA, Vanderburgh County EMA, Warrick County EMA, Spencer County EMA, and Perry County EMA. · Memorial Hospital and Healthcare has provided equipment and nursing staff to assist in specimen collection. The Memorial Hospital Behavioral Health Service and the Southern Hills Counseling Center are providing counseling and mental health services for individuals in the community and those involved in the incident. · The City of Jasper has provided equipment, and the Jasper Street Department has helped plow snow from parking lots offered by the Vincennes University Jasper campus to provide parking for incident personnel. The Dubois County Highway Department has salted roadways and laid rock to make incident areas more accessible for responders. The Dubois County Commissioners and all members of the Dubois County Council have regularly visited the Incident Command Post and offered county assistance. The Dubois County Sheriff’s Departmenthas made all personnel available if needed for the incident. The Dubois Water Utility and Patoka Regional Water have supplied water for depopulation efforts. · The following fire departments have supplied tankers and personnel for water transport to assist in depopulation efforts: Birdseye Fire Department, Celestine Fire Department, Dubois Fire Department, Ferdinand Fire Department, Haysville Fire Department, Holland Fire Department, Huntingburg Fire Department, Ireland Fire Department, Jasper Fire Department, St. Anthony Fire Department, St. Henry Fire Department and the Schnellville Fire Department. · The American Red Cross has assisted by providing food and support to responders. · The Dubois County 4-H Fairgrounds manager Bob Gress has allowed the fairgrounds to be used as a staging area for incident response. John Erickson, Indiana Department of Homeland Security Director of Public Information, said, “Everyone plays a role. Local responders have been low key and effective. This enterprise wouldn’t have been nearly as successful without the local teams.” A case of Highly Pathogenic Avian Influenza – specifically, a virus known as H7N8 – was detected in a Dubois County commercial turkey flock on Jan. 15. A “low pathogenic” form of the virus, which can mutate into the more severe form found on the original site, was detected at an additional nine sites in the county. Birds at the 10 sites were humanely euthanized to help stop the virus from spreading. Dubois is Indiana’s largest turkey-producing county, producing 1.4 million birds annually. Indiana ranks fourth in the nation in turkey production. As a major supplier of eggs, ducks and chickens, in addition to turkeys, Indiana’s poultry industry generates $2.4 billion and employs 14,000 Hoosiers.

https://www.aphis.usda.gov/animal_health/downloads/animal_diseases/ai/hpai-preparedness-and-response-plan-2015.pdf

USDA Issues Updates to Highly Pathogenic Avian Influenza Fall PlanUSDA Animal and Plant Health Inspection Service sent this bulletin at 01/22/2016 02:30 PM ESTUSDA Issues Updates to Highly Pathogenic Avian Influenza Fall Plan The U.S. Department of Agriculture’s (USDA) Animal and Plant Health Inspection Service (APHIS) today issued updates to its Highly Pathogenic Avian Influenza (HPAI) Fall Plan. The updates include additional detail around reimbursement for any virus elimination activities and the results from an August 2015 industry survey on preparedness. APHIS has also finalized its vaccination policy, which was previously released as a draft policy. These updates will help APHIS, states, industry and producers to be even better prepared to address the HPAI virus if it returns this winter or spring. In the original fall plan, released in September 2015, APHIS outlined its intent to use a flat rate reimbursement for virus elimination activities (cleaning, disinfecting) on infected properties. However, the details were still being finalized. The updated plan provides greater detail about how flat rate reimbursement will work. APHIS will provide a flat rate to the producer, based upon the type of facility and the number of birds in the flock. The flat rates are based upon averages and lessons learned during the spring outbreak. They cover the cost of barn preparation, dry cleaning and heat disinfection. The flat rates are: Turkey $3.55 / bird Layer $6.45/ bird Broiler $1.15 / bird (This is an estimate based on industry averages because no broiler flocks were affected in the previous outbreak) The producer will be able to use the funds provided to do the work themselves or to hire an outside contractor. They can also use the flat rate money to help fund alternate effective virus elimination methods after consultation with APHIS representatives. The survey on industry preparedness was in progress when the original version of the plan was published, so APHIS is including the results in today’s update. The survey found that the poultry industry has made important efforts in implementing preparedness and response capabilities for future HPAI cases. However, APHIS is recommending some additional actions, such as increasing the use of premises IDs and having these entered in APHIS’ emergency database, which would greatly facilitate response activities. The original fall plan included a draft vaccination policy, which has since been updated and finalized over the past several months to clarify a few points. The policy updates include: Clarifying that while USDA will cover the cost of purchasing vaccine, it will not incur the costs associated with administering the vaccine. Clarifying that should USDA decide to vaccinate, there may be justification for not vaccinating certain commercial subpopulations within an area, such as short-lived birds (broilers, ducks) or primary breeders that are under high biosecurity or compartmentalization Clarifying that surveillance testing for layer flocks would be through serological testing of vaccinates and dead bird surveillance using rRT-PCR followed by confirmatory testing at NVSL. The changes APHIS made to the HPAI fall plan are important and support continued preparation for any future HPAI outbreak that might occur. The current version of the plan is available at the top of ourAvian Influenza Web page. http://content.govdelivery.com/accounts/USDAAPHIS/bulletins/131cd2a

APHIS has updated its HPAI Fall Plan.

FOR IMMEDIATE RELEASE Indiana State Veterinarian Optimistic, While Reminding the Avian Flu Event is Not Over More testing to be done in Dubois County INDIANAPOLIS (22 Jan. 2016)--Although tests in the Dubois County avian influenza incident continue to prove negative, much more work must still be completed before this event can be considered over, according to Indiana State Veterinarian Bret D. Marsh, DVM. “We are optimistic with each day that yields more negative flock tests,” said Dr. Marsh. “But we are mindful that the situation could change, and that continued testing and surveillance are the vitally important next steps that will be ongoing for a few weeks.” Weekly testing and monitoring of commercial poultry farms in the 10-kilometer control area will continue for several weeks as Indiana moves through the process to be declared avian flu-free. Indiana established an additional 10-kilometer surveillance zone with aggressive testing requirements to assure the industry and partners the disease is not present. Birds and eggs may be moved into and out of the control area only after negative testing. In addition, state and federal teams have visited 1,935 residences in the 10 km control area to identify small/backyard flocks for testing. Tests of those 96 identified flocks, which are nearly complete, have all proven negative. After initial testing, these flocks will be retested in 14 days. “The State Board of Animal Health continues our resolve to eliminate this virus wherever it is found,” Dr. Marsh said. “We know this virus is unpredictable, and it can pop-up again. So reporting bird illness and maintaining high biosecurity is vital to protecting Indiana poultry.” Depopulation of the affected farms concluded Wednesday evening, Jan. 20. Disposal of the turkeys, via indoor composting, will be followed by thorough cleaning and disinfection of all barns on the 10 infected sites. “The cooperation and diligence of the affected farmers have been vital to this response, and we encourage all Hoosiers to stay the course as this work continues,” added Marsh. “We still have a lot of work to do.” Clinical signs of highly pathogenic avian influenza (HPAI) Birds affected with HPAI may show one or more of the following signs: Sudden death without clinical signs;Lack of energy and appetite;Decreased egg production;Soft-shelled or misshapen eggs;Swelling of the head, eyelids, comb, wattles, and hocks;Purple discoloration of the wattles, combs, and legs;Nasal discharge;Coughing, sneezing;Incoordination;Diarrhea.Hoosier poultry owners who notice illness in their birds should report them to the Healthy Birds Hotline: 1-866-536-7593. Hoosiers can also report dead wild birds (five or more) to the Indiana Department of Natural Resources at 812-334-1137. Although there have been no reported human cases of the H7N8 strain, the Dubois County Health Department continues to monitor those exposed for signs of illness. Avian influenza does not present a food safety risk; poultry and eggs are safe to eat. About Indiana Poultry: Dubois County is Indiana's largest turkey-producing county, growing 1.4 million birds annually. The state ranks fourth in the nation in turkey production. As a major supplier of eggs, ducks and chickens, too, Indiana's poultry industry generates $2.4 billion and employs 14,000 Hoosiers. UPDATES and INFORMATION: Situation updates and status reports about ongoing avian influenza response activities, along with critical disease-related information, will be posted online at: www.in.gov/boah/2390.htm. Users may subscribe to email updates on a link at that page.

State of Indiana Response to Avian Flu in Dubois County 1/21/16 New information is in bold italics. DEVELOPING SITUATION On January 15, it was announced that confirmed cases of Highly Pathogenic Avian Influenza were found in Dubois County. State, local and federal agencies are working together on containment and depopulation operations. On January 16, nine additional avian influenza detections were announced, with the United States Department of Agriculture’s (USDA) Animal and Plant Health Inspection Service (APHIS) confirming on January 17 that eight flocks have been confirmed as low pathogenic avian influenza. More information on the ninth positive could not be confirmed through the original testing, and more in-depth testing is being conducted at the USDA National Services Laboratory. A 10 kilometer control area has been established, primarily in Dubois County. An extension of an extra 10-kilomenter “surveillance zone,” beyond the 10-km control zone, has been put in place as a precaution. The surveillance zone includes parts of Crawford, Daviess, Martin and Orange counties. All infected sites are in Dubois County. There were no new positive tests overnight, but aggressive testing continues inside the 10-km control area and additional 10-km surveillance zone. All commercial poultry farms located in the control area and the surveillance zone have completed at least one round of negative tests, and will begin a planned second round of tests in the next 24 hours. Testing will continue for several more weeks within the control and surveillance zone to ensure that no H7N8 remains in the area. Birds have been humanely depopulated on all ten premises. Disposal processes have begun on all depopulated sites. Turkeys are being composted in the buildings in which they were euthanized. The composting process takes about three weeks, after which time, the compost can be used agriculturally because it will not contain the virus. An additional 156,000 hens (chickens) that were NOT infected with H7N8 have been depopulated and disposed of in a landfill. The facility was considered a “dangerous contact” to an infected turkey flock. The laying facility is located very close to an infected barn and shares a vehicular traffic zone with the original site, putting the birds at high risk of contracting the virus. No chickens are infected. State and federal teams have visited 1,788 residences in a 10-kilometer radius control area around the original site to search for small, backyard flocks of birds for precautionary monitoring and testing. A total of 81 backyard flocks have been found, and sampling of these flocks continues. All 44 small flock samples tested so far have been negative. Several mental health treatment options available to those affected: - Phone hotline offered by Southern Hills Counseling Center in Jasper, at 812-482-3020. If the call is made after hours, the caller should press 0. - A 24-hour phone hotline through Memorial Hospital and Healthcare Center, at 812-827-6222. - Daily group sessions are available at the command post from 11 a.m. to 1 p.m., and at the staging area from 6 to 8 p.m. Services will be provided as long as needed. RESPONSE A total of 516 state, federal and local responders are working in Dubois County on surveillance and response efforts. STATE RESPONSE A Unified Incident Command Post (UCP) has been established in Jasper, Indiana. The post is staffed by a state Incident Management Team, along with federal and local partners. State Agencies supporting activities in the UCP: The State Board of Animal Health, Indiana State Department of Agriculture, Indiana Department of Homeland Security, Indiana Department of Natural Resources, Indiana State Department of Health, Indiana Department of Environmental Management, Indiana Department of Correction, Integrated Public Safety Commission, Indiana State Police and mental health services teams from the Family and Social Services Administration. Other organizations supporting activities in the UCP: United States Department of Agriculture, Indiana University, Vincennes University Jasper Campus, Indiana State Poultry Association, Dubois County Emergency Management Agency, Dubois County Health Department, the Indiana Civil Air Patrol, Dubois Water Utility, City of Jasper, Dubois County Highway Department, and all Dubois County fire departments. State Emergency Operations Center: Under the leadership of the Indiana Department of Homeland Security (IDHS), the Indiana Emergency Operations Center (EOC) has been activated at Level III and will remain activated 24 hours a day to monitor conditions and provide resource support to local county emergency agencies. Other organizations supporting activities: Purdue Extension FEDERAL RESPONSE The United States Department of Agriculture has approximately 80 representatives, along with private contractors, in Dubois County assisting with state and local efforts. A National Incident Management Team is in place, with additional staff continuing to arrive in Indiana to help coordinate efforts. PUBLIC ADVISORIES Avian influenza does not present a food safety risk; poultry and eggs are safe to eat. Officials are not aware of any public health significance with this virus. Human infection from an H7 virus is uncommon, but can cause some conjunctivitis and/or upper respiratory tract symptoms. Human health agencies will be monitoring workers and others in contact with birds to monitor for illness. Backyard poultry owners are encouraged to be aware of the signs of avian influenza and report illness and/or death to the USDA Healthy Birds Hotline: 866-536-7593. Callers will be routed to a state or federal veterinarian in Indiana for a case assessment. Dead birds should be double-bagged and refrigerated for possible testing. Signs include: sudden death without clinical signs; lack of energy or appetite; decreased egg production; soft-shelled or misshapen eggs; swelling or purple discoloration of head, eyelids, comb, hocks; nasal discharge; coughing; sneezing; lack of coordination; and diarrhea. A great resource for backyard bird health information is online at: http://healthybirds.aphis.usda.gov/. Situation updates and status reports about ongoing avian influenza activities, along with critical disease-related information, will be posted online at: www.in.gov/boah/2390.htm. Users may subscribe to email updates on a link at that page.

On 18 January 2016, the National IHR Focal Point (NFP) for France notified WHO of the first laboratory-confirmed case of locally-acquired Zika virus in Saint Martin, an overseas department of France. On the same day, 1 autochthonous case of Zika virus infection was confirmed in Guadeloupe, another overseas department of France. The proximity of mosquito vector breeding sites to human habitation is a significant risk factor for Zika virus infection. Prevention and control relies on reducing the breeding of mosquitoes through source reduction (removal and modification of breeding sites) and reducing contact between mosquitoes and people. This can be achieved by reducing the number of natural and artificial water-filled habitats that support mosquito larvae, reducing the adult mosquito populations around at-risk communities and by using barriers such as insect screens, closed doors and windows, long clothing and repellents. Since the Aedes mosquitoes (the primary vector for transmission) are day-biting mosquitoes, it is recommended that those who sleep during the daytime, particularly young children, the sick or elderly, should rest under mosquito nets (bed nets), treated with or without insecticide to provide protection. View the full article

On 18 January 2016, the National IHR Focal Point for Haiti notified PAHO/WHO of 5 laboratory-confirmed cases of Zika virus infection. Of the 5 confirmed cases, 4 are from the Delmas commune while the remaining case is from the Pétion-Ville commune. Samples of the patient were sent to the Caribbean Public Health Agency (CARPHA) laboratory in Trinidad and Tobago for testing. All cases were confirmed by reverse transcription polymerase-chain reaction (RT-PCR). In addition, between 4 and 12 January 2016, the National IHR Focal Point for Germany notified PAHO/WHO of 2 cases of Zika virus infection in German nationals who had returned from Haiti to Germany in late December. Samples from both patients were collected and sent for laboratory testing to the national reference centre for tropical diseases in Germany. While one of the cases was confirmed by both RT-PCR and serology, the other was confirmed only by serology. View the full article

The National IHR Focal Point of El Salvador has notified PAHO/WHO of an unusual increase of Guillain-Barré Syndrome (GBS) in the country. In El Salvador, the annual average number of GBS is 169; however, from 1 December 2015 to 6 January 2016, 46 GBS were recorded, including 2 deaths. Of the 46 GBS cases, 25 (54%) are male and 35 (76%) are 30 years old or older. All cases were hospitalized and treated with plasma exchange or intravenous immunoglobulin. One of the two deceased patients had a history of multiple underlying chronic diseases. Out of the 22 patients whose information was available, 12 (54%) presented with febrile rash illness in the 15 days prior to the onset of symptoms consistent with GBS.View the full article

State of Indiana Response to Avian Flu in Dubois County 1/20/16 New information is in bold italics Second update is highlighted below DEVELOPING SITUATION On January 15, it was announced that confirmed cases of Highly Pathogenic Avian Influenza were found in Dubois County. State, local and federal agencies are working together on containment and depopulation operations. On January 16, nine additional avian influenza detections were announced, with the United States Department of Agriculture’s (USDA) Animal and Plant Health Inspection Service (APHIS) confirming on January 17 that eight flocks have been confirmed as low pathogenic avian influenza. More information on the ninth positive could not be confirmed through the original testing, and more in-depth testing is being conducted at the USDA National Services Laboratory. A 10 kilometer control area has been established, primarily in Dubois County. An extension of an extra 10-kilomenter “surveillance zone,” beyond the 10-km control zone, has been put in place as a precaution. The surveillance zone includes parts of Crawford, Daviess, Martin and Orange counties. All infected sites are in Dubois County. There were no new positive tests overnight, but aggressive testing continues inside the 10-km control area and additional 10-km surveillance zone. In the last 24 hours, 114 commercial farms have tested negative for influenza; 62 in the control area and 52 in the added surveillance zone. All commercial poultry farms located in the control area and the surveillance zone have completed at least one round of negative tests. Birds have been humanely depopulated on all ten premises. Disposal processes have begun on all depopulated sites. Turkeys are being composted in the buildings in which they were euthanized. The composting process takes about three weeks, after which time, the compost can be used agriculturally because it will not contain the virus. An additional 156,000 hens (chickens) that are NOT infected with H7N8 have been depopulated and disposed of in a landfill. The facility is considered a “dangerous contact” to an infected turkey flock. The laying facility is located very close to an infected barn and shares a vehicular traffic zone with the original site, putting the birds at high risk of contracting the virus. No chickens are infected. State and federal teams have visited 1,599 residences in a 10-kilometer radius control area around the original site to search for small, backyard flocks of birds for precautionary monitoring and testing. A total of 67 backyard flocks have been found, and sampling of these flocks continues. Several mental health treatment options available to those affected: - Phone hotline offered by Southern Hills Counseling Center in Jasper, at 812-482-3020. If the call is made after hours, the caller should press 0. - A 24-hour phone hotline through Memorial Hospital and Healthcare Center, at 812-827-6222. - Daily group sessions are available at the command post from 11 a.m. to 1 p.m., and at the staging area from 6 to 8 p.m. Services will be provided as long as needed. RESPONSE A total of 398 state, federal and local responders are working in Dubois County on surveillance and response efforts. Thirty offenders and five Department of Correction staff members are participating in the response. STATE RESPONSE A Unified Incident Command Post (UCP) has been established in Jasper, Indiana. The post is staffed by a state Incident Management Team, along with federal and local partners. State Agencies supporting activities in the UCP: The State Board of Animal Health, Indiana State Department of Agriculture, Indiana Department of Homeland Security, Indiana Department of Natural Resources, Indiana State Department of Health, Indiana Department of Environmental Management, Indiana Department of Correction, Integrated Public Safety Commission, Indiana State Police and mental health services teams from the Family and Social Services Administration. Other organizations supporting activities in the UCP: United States Department of Agriculture, Indiana University, Vincennes University Jasper Campus, Dubois County Emergency Management Agency, Dubois County Health Department, the Indiana Civil Air Patrol, Dubois Water Utility, City of Jasper, Dubois County Highway Department, and all Dubois County fire departments. State Emergency Operations Center: Under the leadership of the Indiana Department of Homeland Security (IDHS), the Indiana Emergency Operations Center (EOC) has been activated at Level III and will remain activated 24 hours a day to monitor conditions and provide resource support to local county emergency agencies. State Agencies supporting activities in the EOC: State Board of Animal Health, Indiana Department of Homeland Security, Indiana State Department of Agriculture, Indiana State Department of Health, Indiana Department of Transportation, Indiana Department of Environmental Management, Indiana State Police, Indiana Department of Natural Resources and Indiana Department of Correction. Other organizations supporting activities in the EOC: Purdue Extension FEDERAL RESPONSE The United States Department of Agriculture has approximately 80 representatives, along with private contractors, in Dubois County assisting with state and local efforts. A National Incident Management Team is in place, with additional staff continuing to arrive in Indiana to help coordinate efforts. PUBLIC ADVISORIES Avian influenza does not present a food safety risk; poultry and eggs are safe to eat. Officials are not aware of any public health significance with this virus. Human infection from an H7 virus is uncommon, but can cause some conjunctivitis and/or upper respiratory tract symptoms. Human health agencies will be monitoring workers and others in contact with birds to monitor for illness. Backyard poultry owners are encouraged to be aware of the signs of avian influenza and report illness and/or death to the USDA Healthy Birds Hotline: 866-536-7593. Callers will be routed to a state or federal veterinarian in Indiana for a case assessment. Dead birds should be double-bagged and refrigerated for possible testing. Signs include: sudden death without clinical signs; lack of energy or appetite; decreased egg production; soft-shelled or misshapen eggs; swelling or purple discoloration of head, eyelids, comb, hocks; nasal discharge; coughing; sneezing; lack of coordination; and diarrhea. A great resource for backyard bird health information is online at: www.healthybirds.aphis.usda.gov. Situation updates and status reports about ongoing avian influenza activities, along with critical disease-related information, will be posted online at: www.in.gov/boah/2390.htm. Users may subscribe to email updates on a link at that page.

State of Indiana Response to Avian Flu in Dubois County 1/20/16 New information is in bold italics DEVELOPING SITUATION On January 15, it was announced that confirmed cases of Highly Pathogenic Avian Influenza were found in Dubois County. State, local and federal agencies are working together on containment and depopulation operations. On January 16, nine additional avian influenza detections were announced, with the United States Department of Agriculture’s (USDA) Animal and Plant Health Inspection Service (APHIS) confirming on January 17 that eight flocks have been confirmed as low pathogenic avian influenza. More information on the ninth positive could not be confirmed through the original testing, and more in-depth testing is being conducted at the USDA National Services Laboratory. A 10 kilometer control area has been established, primarily in Dubois County. An extension of an extra 10-kilomenter “surveillance zone,” beyond the 10-km control zone, has been put in place as a precaution. The surveillance zone includes parts of Crawford, Daviess, Martin and Orange counties. All infected sites are in Dubois County. There were no new positive tests overnight, but aggressive testing continues inside the 10-km control area and additional 10-km surveillance zone. In the last 24 hours, 114 commercial farms have tested negative for influenza; 62 in the control area and 52 in the added surveillance zone. All commercial poultry farms located in the control area and the surveillance zone have completed at least one round of negative tests. Birds have been humanely depopulated on nine premises, the remaining site is currently underway and nearing completion. Disposal processes have begun on all depopulated sites. Turkeys are being composted in the buildings in which they were euthanized. The composting process takes about three weeks, after which time, the compost can be used agriculturally because it will not contain the virus. An additional 156,000 hens (chickens) that are NOT infected with H7N8 have been depopulated and disposed of in a landfill. The facility is considered a “dangerous contact” to an infected turkey flock. The laying facility is located very close to an infected barn and shares a vehicular traffic zone with the original site, putting the birds at high risk of contracting the virus. No chickens are infected. State and federal teams have visited 1,599 residences in a 10-kilometer radius control area around the original site to search for small, backyard flocks of birds for precautionary monitoring and testing. A total of 67 backyard flocks have been found, and sampling of these flocks continues. Several mental health treatment options available to those affected: - Phone hotline offered by Southern Hills Counseling Center in Jasper, at 812-482-3020. If the call is made after hours, the caller should press 0. - A 24-hour phone hotline through Memorial Hospital and Healthcare Center, at 812-827-6222. - Daily group sessions are available at the command post from 11 a.m. to 1 p.m., and at the staging area from 6 to 8 p.m. Services will be provided as long as needed. RESPONSE A total of 398 state, federal and local responders are working in Dubois County on surveillance and response efforts. Thirty offenders and five Department of Correction staff members are participating in the response. STATE RESPONSE A Unified Incident Command Post (UCP) has been established in Jasper, Indiana. The post is staffed by a state Incident Management Team, along with federal and local partners. State Agencies supporting activities in the UCP: The State Board of Animal Health, Indiana State Department of Agriculture, Indiana Department of Homeland Security, Indiana Department of Natural Resources, Indiana State Department of Health, Indiana Department of Environmental Management, Indiana Department of Correction, Integrated Public Safety Commission, Indiana State Police and mental health services teams from the Family and Social Services Administration. Other organizations supporting activities in the UCP: United States Department of Agriculture, Indiana University, Vincennes University Jasper Campus, Dubois County Emergency Management Agency, Dubois County Health Department, the Indiana Civil Air Patrol, Dubois Water Utility, City of Jasper, Dubois County Highway Department, and all Dubois County fire departments. State Emergency Operations Center: Under the leadership of the Indiana Department of Homeland Security (IDHS), the Indiana Emergency Operations Center (EOC) has been activated at Level III and will remain activated 24 hours a day to monitor conditions and provide resource support to local county emergency agencies. State Agencies supporting activities in the EOC: State Board of Animal Health, Indiana Department of Homeland Security, Indiana State Department of Agriculture, Indiana State Department of Health, Indiana Department of Transportation, Indiana Department of Environmental Management, Indiana State Police, Indiana Department of Natural Resources and Indiana Department of Correction. Other organizations supporting activities in the EOC: Purdue Extension FEDERAL RESPONSE The United States Department of Agriculture has approximately 80 representatives, along with private contractors, in Dubois County assisting with state and local efforts. A National Incident Management Team is in place, with additional staff continuing to arrive in Indiana to help coordinate efforts. PUBLIC ADVISORIES Avian influenza does not present a food safety risk; poultry and eggs are safe to eat. Officials are not aware of any public health significance with this virus. Human infection from an H7 virus is uncommon, but can cause some conjunctivitis and/or upper respiratory tract symptoms. Human health agencies will be monitoring workers and others in contact with birds to monitor for illness. Backyard poultry owners are encouraged to be aware of the signs of avian influenza and report illness and/or death to the USDA Healthy Birds Hotline: 866-536-7593. Callers will be routed to a state or federal veterinarian in Indiana for a case assessment. Dead birds should be double-bagged and refrigerated for possible testing. Signs include: sudden death without clinical signs; lack of energy or appetite; decreased egg production; soft-shelled or misshapen eggs; swelling or purple discoloration of head, eyelids, comb, hocks; nasal discharge; coughing; sneezing; lack of coordination; and diarrhea. A great resource for backyard bird health information is online at: www.healthybirds.aphis.usda.gov. Situation updates and status reports about ongoing avian influenza activities, along with critical disease-related information, will be posted online at: www.in.gov/boah/2390.htm. Users may subscribe to email updates on a link at that page. ### FOLLOWING CONTACT INFORMATION NOT FOR PUBLIC DISCLOSURE: For Media Only: Indiana Joint Information Center (JIC) 317.238.1784, [email protected]

Between 14 and 15 January 2016, the National IHR Focal Points (NFP) for Guyana, Barbados and Ecuador notified PAHO/WHO of cases of Zika virus infection. On 14 January, the NFP for Guyana reported the first laboratory-confirmed case of locally-acquired Zika virus infection in the country. The case is a 27-year-old female from Berbice, Region 6, with onset of symptoms on 1 January. View the full article