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Puerto Rico: 1st baby born with microcephaly due to Zika By DANICA COTO 47 minutes ago SAN JUAN, Puerto Rico (AP) — Puerto Rico on Friday reported its first case of a baby born with microcephaly as a result of a Zika infection, raising concerns because officials said the medical condition wasn't identified until the mother was nearly eight months pregnant. The baby was born in the past two weeks with severe brain defects as well as hearing and vision problems and remains hospitalized, according to Health Secretary Ana Rius. She said authorities are investigating why the microcephaly case was identified so late although the mother presented Zika symptoms between her second and third month of pregnancy. She added that the mother did not receive continuous prenatal care until late in her second trimester. Rius declined to provide any other details, except to say that the case occurred in the capital of San Juan. She also stressed that all pregnant women should demand to be tested for Zika in their first, second and third trimester. Puerto Rico is facing a Zika epidemic with nearly 31,500 cases reported, including more than 2,400 pregnant women. A total of 233 people have been hospitalized and six deaths have been reported, four of them linked to Zika and other medical conditions and the remaining two to a paralysis condition called Guillain-Barre that has been tied to the virus. The U.S. Centers for Disease Control and Prevention has warned it expects a surge of babies being born with severe deformities in Puerto Rico in upcoming months. A recent study estimates that up to 10,300 pregnant women on the island could be infected with Zika and that between 100 to 270 babies could be born with microcephaly. Rius said at least five other pregnant women in Puerto Rico whose fetuses have microcephaly will give birth between November and January. The epidemic hits at a time when Puerto Rico is mired in amid a deep economic crisis that officials say has depleted government funds. The island has been seeking more federal funds to help fight the weekly increase in cases that has hit the tourism industry hard. The baby born with microcephaly will be referred to public health clinics, where it will receive medical care up to age 3, Rius said. "If it survives, it will be referred to other childhood programs," she said.

Puerto Rico on Friday reported its first case of a baby born with microcephaly as a result of a Zika infection, raising concerns because officials said the medical condition wasn't identified until the mother was nearly eight months pregnant. The baby was born in the past two weeks with severe brain defects as well as hearing and vision problems and remains hospitalized, according to Health Secretary Ana Rius. https://apnews.com/2909c1f1a62949cab685b2fde51ed4f1

As of Thursday, *October 27, 2016, VDH has reported 87 cases of Zika virus disease in Virginia residents to the CDC ( 10 in Northwest Region, 43 in Northern Region, 10 in Eastern Region, 15 in Central Region and 9 in Southwest Region). All Virginia cases are associated with travel to a Zika-affected area. CDC has issued a travel alert (Level 2-Practice Enhanced Precautions) for people traveling to regions and certain countries where Zika virus transmission is ongoing. *Updated weekly. Week runs Thursday – Wednesday.

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Wisconsin Annual Summary Data - 2016 Updated October 26, 2016 Confirmed Zika virus cases 49 Probable* Zika virus cases 2 Completed testing - Total 822 * Probable cases have presumptive positive laboratory results without confirmatory CDC testing. https://www.dhs.wisconsin.gov/arboviral/zika.htm

Wisconsin Annual Summary Data - 2016 Updated October 26, 2016 Confirmed Zika virus cases 49 Probable* Zika virus cases 2 Completed testing - Total 822 * Probable cases have presumptive positive laboratory results without confirmatory CDC testing.

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Laboratory-confirmed Zika virus disease cases reported to ArboNET by state or territory — United States, 2015–2016 (as of October 26, 2016)§ States Travel-associated cases* No. (% of cases in states) (N=3,952) Locally acquired cases† No. (% of cases in states) (N=139) Alabama 28 (1) 0 (0) Arizona 40 (1) 0 (0) Arkansas 13 (<1) 0 (0) California 309 (8) 0 (0) Colorado 46 (1) 0 (0) Connecticut 58 (1) 0 (0) Delaware 16 (<1) 0 (0) District of Columbia 25 (1) 0 (0) Florida 708 (18) 139 (100) Georgia 93 (2) 0 (0) Hawaii 14 (<1) 0 (0) Idaho 4 (<1) 0 (0) Illinois 76 (2) 0 (0) Indiana 40 (1) 0 (0) Iowa 17 (<1) 0 (0) Kansas 16 (<1) 0 (0) Kentucky 24 (1) 0 (0) Louisiana 34 (1) 0 (0) Maine 12 (<1) 0 (0) Maryland 105 (3) 0 (0) Massachusetts 101 (3) 0 (0) Michigan 62 (2) 0 (0) Minnesota 47 (1) 0 (0) Mississippi 23 (1) 0 (0) Missouri 32 (1) 0 (0) Montana 7 (<1) 0 (0) Nebraska 12 (<1) 0 (0) Nevada 15 (<1) 0 (0) http://www.cdc.gov/zika/geo/united-states.html

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Laboratory-confirmed Zika virus disease cases reported to ArboNET by state or territory — United States, 2015–2016 (as of October 26, 2016)§ States Travel-associated cases* No. (% of cases in states) (N=3,952) Locally acquired cases† No. (% of cases in states) (N=139) Alabama 28 (1) 0 (0) Arizona 40 (1) 0 (0) Arkansas 13 (<1) 0 (0) California 309 (8) 0 (0) Colorado 46 (1) 0 (0) Connecticut 58 (1) 0 (0) Delaware 16 (<1) 0 (0) District of Columbia 25 (1) 0 (0) Florida 708 (18) 139 (100) Georgia 93 (2) 0 (0) Hawaii 14 (<1) 0 (0) Idaho 4 (<1) 0 (0) Illinois 76 (2) 0 (0) Indiana 40 (1) 0 (0) Iowa 17 (<1) 0 (0) Kansas 16 (<1) 0 (0) Kentucky 24 (1) 0 (0) Louisiana 34 (1) 0 (0) Maine 12 (<1) 0 (0) Maryland 105 (3) 0 (0) Massachusetts 101 (3) 0 (0) Michigan 62 (2) 0 (0) Minnesota 47 (1) 0 (0) Mississippi 23 (1) 0 (0) Missouri 32 (1) 0 (0) Montana 7 (<1) 0 (0) Nebraska 12 (<1) 0 (0) http://www.cdc.gov/zika/geo/united-states.html

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Laboratory-confirmed Zika virus disease cases reported to ArboNET by state or territory — United States, 2015–2016 (as of October 26, 2016)§ States Travel-associated cases* No. (% of cases in states) (N=3,952) Locally acquired cases† No. (% of cases in states) (N=139) Alabama 28 (1) 0 (0) Arizona 40 (1) 0 (0) Arkansas 13 (<1) 0 (0) California 309 (8) 0 (0) Colorado 46 (1) 0 (0) Connecticut 58 (1) 0 (0) Delaware 16 (<1) 0 (0) District of Columbia 25 (1) 0 (0) Florida 708 (18) 139 (100) Georgia 93 (2) 0 (0) Hawaii 14 (<1) 0 (0) Idaho 4 (<1) 0 (0) Illinois 76 (2) 0 (0) Indiana 40 (1) 0 (0) Iowa 17 (<1) 0 (0) Kansas 16 (<1) 0 (0) Kentucky 24 (1) 0 (0) Louisiana 34 (1) 0 (0) Maine 12 (<1) 0 (0) Maryland 105 (3) 0 (0) Massachusetts 101 (3) 0 (0) Michigan 62 (2) 0 (0) Minnesota 47 (1) 0 (0) Mississippi 23 (1) 0 (0) Missouri 32 (1) 0 (0) http://www.cdc.gov/zika/geo/united-states.html

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Laboratory-confirmed Zika virus disease cases reported to ArboNET by state or territory — United States, 2015–2016 (as of October 26, 2016)§ States Travel-associated cases* No. (% of cases in states) (N=3,952) Locally acquired cases† No. (% of cases in states) (N=139) Alabama 28 (1) 0 (0) Arizona 40 (1) 0 (0) Arkansas 13 (<1) 0 (0) California 309 (8) 0 (0) Colorado 46 (1) 0 (0) Connecticut 58 (1) 0 (0) Delaware 16 (<1) 0 (0) District of Columbia 25 (1) 0 (0) Florida 708 (18) 139 (100) Georgia 93 (2) 0 (0) Hawaii 14 (<1) 0 (0) Idaho 4 (<1) 0 (0) Illinois 76 (2) 0 (0) Indiana 40 (1) 0 (0) Iowa 17 (<1) 0 (0) Kansas 16 (<1) 0 (0) Kentucky 24 (1) 0 (0) Louisiana 34 (1) 0 (0) Maine 12 (<1) 0 (0) Maryland 105 (3) 0 (0) Massachusetts 101 (3) 0 (0) http://www.cdc.gov/zika/geo/united-states.html

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Laboratory-confirmed Zika virus disease cases reported to ArboNET by state or territory — United States, 2015–2016 (as of October 26, 2016)§ States Travel-associated cases* No. (% of cases in states) (N=3,952) Locally acquired cases† No. (% of cases in states) (N=139) Alabama 28 (1) 0 (0) Arizona 40 (1) 0 (0) Arkansas 13 (<1) 0 (0) California 309 (8) 0 (0) Colorado 46 (1) 0 (0) Connecticut 58 (1) 0 (0) Delaware 16 (<1) 0 (0) District of Columbia 25 (1) 0 (0) Florida 708 (18) 139 (100) Georgia 93 (2) 0 (0) Hawaii 14 (<1) 0 (0) Idaho 4 (<1) 0 (0) Illinois 76 (2) 0 (0) Indiana 40 (1) 0 (0) Iowa 17 (<1) 0 (0) Kansas 16 (<1) 0 (0) http://www.cdc.gov/zika/geo/united-states.html

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Laboratory-confirmed Zika virus disease cases reported to ArboNET by state or territory — United States, 2015–2016 (as of October 26, 2016)§ States Travel-associated cases* No. (% of cases in states) (N=3,952) Locally acquired cases† No. (% of cases in states) (N=139) Alabama 28 (1) 0 (0) Arizona 40 (1) 0 (0) Arkansas 13 (<1) 0 (0) California 309 (8) 0 (0) Colorado 46 (1) 0 (0) Connecticut 58 (1) 0 (0) Delaware 16 (<1) 0 (0) http://www.cdc.gov/zika/geo/united-states.html

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Laboratory-confirmed Zika virus disease cases reported to ArboNET by state or territory — United States, 2015–2016 (as of October 26, 2016)§ States Travel-associated cases* No. (% of cases in states) (N=3,952) Locally acquired cases† No. (% of cases in states) (N=139) Alabama 28 (1) 0 (0) Arizona 40 (1) 0 (0) Arkansas 13 (<1) 0 (0) California 309 (8) 0 (0) Colorado 46 (1) 0 (0) http://www.cdc.gov/zika/geo/united-states.html

Pregnant Women with Any Laboratory Evidence of Possible Zika Virus Infection US States and the District of Columbia* 953 *Includes aggregated data reported to the US Zika Pregnancy Registry as of October 20, 2016 US Territories** 2,027 **Includes aggregated data from the US territories reported to the US Zika Pregnancy Registry and data from Puerto Rico reported to the Zika Active Pregnancy Surveillance System as of October 20, 2016

As of October 26, 2016 (5 am EST) Zika virus disease and Zika virus congenital infection are nationally notifiable conditions. This update from the CDC Arboviral Disease Branch includes provisional data reported to ArboNET for January 01, 2015 – October 26, 2016. US States Locally acquired mosquito-borne cases reported: 139 Travel-associated cases reported: 3,951 Laboratory acquired cases reported: 1 Total: 4,091 Sexually transmitted: 33 Guillain-Barré syndrome: 13 MAPS OF ZIKA IN THE US More US Territories Locally acquired cases reported: 28,627 Travel-associated cases reported: 96 Total: 28,723* Guillain-Barré syndrome: 43 *Sexually transmitted cases are not reported for US territories because with local transmission of Zika virus it is not possible to determine whether infection occurred due to mosquito-borne or sexual transmission. Laboratory-confirmed Zika virus disease cases reported to ArboNET by state or territory — United States, 2015–2016 (as of October 26, 2016)§ States Travel-associated cases* No. (% of cases in states) (N=3,952) Locally acquired cases† No. (% of cases in states) (N=139) Alabama 28 (1) 0 (0) Arizona 40 (1) 0 (0) Arkansas 13 (<1) 0 (0) California 309 (8) 0 (0) Colorado 46 (1) 0 (0) Connecticut 58 (1) 0 (0) Delaware 16 (<1) 0 (0) District of Columbia 25 (1) 0 (0) Florida 708 (18) 139 (100) Georgia 93 (2) 0 (0) Hawaii 14 (<1) 0 (0) Idaho 4 (<1) 0 (0) Illinois 76 (2) 0 (0) Indiana 40 (1) 0 (0) Iowa 17 (<1) 0 (0) Kansas 16 (<1) 0 (0) Kentucky 24 (1) 0 (0) Louisiana 34 (1) 0 (0) Maine 12 (<1) 0 (0) Maryland 105 (3) 0 (0) Massachusetts 101 (3) 0 (0) Michigan 62 (2) 0 (0) Minnesota 47 (1) 0 (0) Mississippi 23 (1) 0 (0) Missouri 32 (1) 0 (0) Montana 7 (<1) 0 (0) Nebraska 12 (<1) 0 (0) Nevada 15 (<1) 0 (0) New Hampshire 10 (<1) 0 (0) New Jersey 134 (3) 0 (0) New Mexico 9 (<1) 0 (0) New York 886 (22) 0 (0) North Carolina 72 (2) 0 (0) North Dakota 2 (<1) 0 (0) Ohio 67 (2) 0 (0) Oklahoma 27 (1) 0 (0) Oregon 31 (1) 0 (0) Pennsylvania†† 147 (4) 0 (0) Rhode Island 32 (1) 0 (0) South Carolina 53 (1) 0 (0) South Dakota 2 (<1) 0 (0) Tennessee 53 (1) 0 (0) Texas 232 (6) 0 (0) Utah 14** (<1) 0 (0) Vermont 9 (<1) 0 (0) Virginia 88 (2) 0 (0) Washington 51 (1) 0 (0) West Virginia 11 (<1) 0 (0) Wisconsin 43 (1) 0 (0) Wyoming 2 (<1) 0 (0) Territories Travel-associated cases* No. (% of cases in territories) (N=96) Locally acquired cases† No. (% of cases in territories) (N=28,627) American Samoa 7 (7) 47 (<1) Puerto Rico 87 (91) 28,111*** (98) US Virgin Islands 2 (2) 469 (2) §Only includes cases meeting the probable or confirmed CSTE case definition and does not include asymptomatic infections unless the case is a pregnant woman with a complication of pregnancy *Travelers returning from affected areas, their sexual contacts, or infants infected in utero †Presumed local mosquito-borne transmission ††One additional case acquired through laboratory transmission **Includes one case with unknown route of person-to-person transmission. ***The Puerto Rico Department of Health is retroactively reporting cases, resulting in larger than normal increases in cases in recent weeks. Page last reviewed: October 26, 2016 Page last updated: October 26, 2016 Content source: Centers for Disease Control and Prevention National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) Division of Vector-Borne Diseases (DVBD)

October 27, 2016 Department of Health Daily Zika Update Contact: Communications [email protected] (850) 245-4111 Tallahassee, Fla.—In an effort to keep Florida residents and visitors safe and aware about the status of the Zika virus, the department will issue a Zika virus update each week day. Updates will include a Zika case count by county and information to keep Floridians informed and prepared. In order to keep the public informed, the department has posted our investigation process here. There are 14 new travel associated cases with four in Miami-Dade, one in Collier, one in Monroe, one in Palm Beach and seven involving pregnant women. Please visit our website to see the full list of travel-related cases. There is one non-travel associated case today. The individual had exposure in Wynwood with symptom onset in July. The department just received confirmatory testing from CDC. This case does not impact the lifting of the Zika zone in Wynwood. DOH continues door-to-door outreach and targeted testing in Miami-Dade County and mosquito abatement and reduction activities are also taking place around the locations that are being investigated. DOH believes ongoing transmission is only taking place within the identified areas in Miami-Dade County. One case does not mean ongoing active transmission is taking place. DOH conducts a thorough investigation by sampling close contacts and community members around each case to determine if additional people are infected. If DOH finds evidence that active transmission is occurring in an area, the media and the public will be notified. For a complete breakdown of non-travel and travel-related Zika infections to-date, please see below. Infection Type Infection Count Travel-Related Infections of Zika 765 Non-Travel Related Infections of Zika 181 Infections Involving Pregnant Women 122 Out of State Cases (not Florida Residents) 19 Undetermined 6 Total 1,093 click image above to enlarge click image above to enlarge click image above to enlarge The department is currently conducting 12 active investigations. The department has closed 33 investigations. Information regarding the investigations can be found here. If investigations reveal additional areas of active transmission, the department will announce a defined area of concern. The department has conducted Zika virus testing for more than 9,657 people statewide. Florida currently has the capacity to test 8,236 people for active Zika virus and 6,455for Zika antibodies. At Governor Scott’s direction, all county health departments offer free Zika risk assessment and testing to pregnant women. Florida’s small case clusters is not considered widespread transmission, however, pregnant women are advised to avoid non-essential travel to the impacted areas in Miami-Dade County (see maps below). If you are pregnant and must travel or if you live or work in the impacted area, protect yourself from mosquito bites by wearing insect repellent, long clothing and limiting your time outdoors. According to CDC guidance, providers should test all pregnant women who lived in, traveled to or whose partner traveled to Miami-Dade County after Aug. 1, 2016. It is also recommended that all pregnant women who reside in or travel frequently to the area where active transmission is likely occurring be tested for Zika in the first and second trimester. Pregnant women in the identified area can contact their medical provider or their local county health department to be tested and receive a Zika prevention kit. CDC recommends that a pregnant woman with a history of Zika virus and her provider should consider additional ultrasounds. Additionally, the department is working closely with the Healthy Start Coalition of Miami-Dade County to identify pregnant women in the impacted areas to ensure they have access to resources and information to protect themselves. CDC recommends that a pregnant woman with a history of Zika virus and her provider should consider additional ultrasounds. Pregnant women can contact their local county health department for Zika risk assessment and testing hours and information. A Zika risk assessment will be conducted by county health department staff and blood and/or urine samples may be collected and sent to labs for testing. It may take one to two weeks to receive results. Florida has been monitoring pregnant women with evidence of Zika regardless of symptoms. The total number of pregnant women who have been or are being monitored is 122. On Feb. 12, Governor Scott directed the State Surgeon General to activate a Zika Virus Information Hotline for current Florida residents and visitors, as well as anyone planning on traveling to Florida in the near future. The hotline, managed by the Department of Health, has assisted more than 6,913 callers since it launched. The number for the Zika Virus Information Hotline is 1-855-622-6735. The department urges Floridians to drain standing water weekly, no matter how seemingly small. A couple drops of water in a bottle cap can be a breeding location for mosquitoes. Residents and visitors also need to use repellents when enjoying the Florida outdoors. For more information on DOH action and federal guidance, please click here. For resources and information on Zika virus, click here. click image above to enlarge click image above to enlarge About the Florida Department of Health The department, nationally accredited by the Public Health Accreditation Board, works to protect, promote, and improve the health of all people in Florida through integrated state, county and community efforts. Follow us on Twitter at @HealthyFla and on Facebook. For more information about the Florida Department of Health, please visit www.FloridaHealth.gov.