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Press Briefing Transcript Tuesday, September 23, 2016, at 1 P.M. EST Audio recording[MP3 6MB] https://www.cdc.gov/media/releases/2016/t0923-zika-briefing-update.html

Investigations of Two Cases of Isolated Local Transmission of Zika Virus As of July 22, 2016, among the 321 cases of Zika virus infection in Florida residents or visitors, Miami-Dade County and neighboring Broward County reported the highest and second highest numbers of cases in Florida (93 and 51, respectively), accounting for 30.4% and 16.7% of travel-associated cases in nonpregnant women, respectively. In early July 2016, an adult female resident of Miami-Dade County (patient A) sought treatment at a local hospital with fever, rash, and arthralgia. Serum and urine specimens, which were collected 3 days after symptom onset, were positive for Zika virus by rRT-PCR. Less than 1 week later, an adult male resident of Broward County (patient B) sought treatment for fever, rash, and arthralgia. Zika virus infection was confirmed by rRT-PCR on a urine specimen and serum IgM by enzyme-linked immunosorbent assay (ELISA) (to minimize the potential for false positives, the Florida Department of Health protocol requires two positive results for index case identification). Investigation of both cases indicated no recent travel to or sexual contact with a recent traveler to an area with active Zika virus transmission, no association with household contacts who recently traveled, and no close personal contact with a patient with confirmed Zika virus infection. There were no epidemiologic links between the two patients, and their residences were separated by >10 miles. BG-Sentinel (Biogents AG, Regensburg, Germany) mosquito traps, designed for researchers, collected a limited number of Ae. aegypti and Ae. albopictus specimens around the patients’ residences, and PCR testing of pooled mosquitoes for Zika virus was negative (Sharon Isern, Department of Biological Sciences, Florida Gulf Coast University, personal communication, 2016). To identify additional evidence of local transmission, household contacts of patients A and B were interviewed regarding recent illness and travel, and specimens were requested for Zika virus testing. Among seven household contacts of the two patients, none reported symptomatic illness and only one had laboratory evidence of recent flavivirus virus infection (Zika virus IgM results and neutralizing antibodies for both Zika virus and dengue, indicating probable Zika virus infection). This person had moved from Haiti to Florida 1 month before onset of symptoms in patient A and was classified as having a travel-associated case of Zika virus disease. To identify recent infections in the surrounding neighborhoods of patients A and B, systematic surveys were conducted of all households located within 150–300 meters (164–328 yards) of each patient’s residence. In addition, an outdoor worksite near patient B’s residence also was sampled; these areas were selected based on the typical flight range of Ae. aegypti (4). Surveys were conducted at the end of July and consisted of urine specimen collection and a standardized questionnaire regarding general risk factors. Three visit attempts were made for each occupied residence. Children aged <5 years and persons with recent travel to an area with ongoing Zika virus transmission were excluded. Among 116 urine specimens collected from persons from 54 households and one worksite, all were negative for Zika virus by rRT-PCR. In addition, enhanced passive surveillance through syndromic surveillance, review of public health and commercial laboratory results, and notification by local health care providers did not identify any additional cases related to patients A and B.

During the first 6 months of 2016, large outbreaks of Zika virus disease caused by local mosquito-borne transmission occurred in Puerto Rico and other U.S. territories, but local mosquito-borne transmission was not identified in the continental United States (1,2). As of July 22, 2016, the Florida Department of Health had identified 321 Zika virus disease cases among Florida residents and visitors, all occurring in either travelers from other countries or territories with ongoing Zika virus transmission or sexual contacts of recent travelers.* During standard case investigation of persons with compatible illness and laboratory evidence of recent Zika virus infection (i.e., a specimen positive by real-time reverse transcription–polymerase chain reaction [rRT-PCR], or positive Zika immunoglobulin M [IgM] with supporting dengue serology [negative for dengue IgM antibodies and positive for dengue IgG antibodies], or confirmation of Zika virus neutralizing antibodies by plaque reduction neutralization testing [PRNT]) (3), four persons were identified in Broward and Miami-Dade counties whose infections were attributed to likely local mosquito-borne transmission. Two of these persons worked within 120 meters (131 yards) of each other but had no other epidemiologic connections, suggesting the possibility of a local community-based outbreak. Further epidemiologic and laboratory investigations of the worksites and surrounding neighborhood identified a total of 29 persons with laboratory evidence of recent Zika virus infection and likely exposure during late June to early August, most within an approximate 6-block area. In response to limited impact on the population of Aedes aegypti mosquito vectors from initial ground-based mosquito control efforts, aerial ultralow volume spraying with the organophosphate insecticide naled was applied over a 10 square-mile area beginning in early August and alternated with aerial larviciding withBacillus thuringiensis subspecies israelensis (Bti), a group biologic control agent, in a central 2 square-mile area. No additional cases were identified after implementation of this mosquito control strategy. No increases in emergency department (ED) patient visits associated with aerial spraying were reported, including visits for asthma, reactive airway disease, wheezing, shortness of breath, nausea, vomiting, or diarrhea. Local and state health departments serving communities where Ae. aegypti, the primary vector of Zika virus, is found should continue to actively monitor for local transmission of the virus.†

Anna Likos, MD1; Isabel Griffin, MPH1; Andrea M. Bingham, PhD1; Danielle Stanek, DVM1; Marc Fischer, MD2; Stephen White, MS1; Janet Hamilton, MPH1; Leah Eisenstein, MPH1; David Atrubin, MPH1; Prakash Mulay, MBBS1; Blake Scott, MPH1; Patrick Jenkins, MPH1; Danielle Fernandez, MPH1; Edhelene Rico, MPH1; Leah Gillis, PhD1; Reynald Jean, MD1; Marshall Cone, MPH1; Carina Blackmore, PhD1; Janet McAllister, PhD2; Chalmers Vasquez3; Lillian Rivera, PhD1; Celeste Philip, MD1 Corresponding author: Anna Likos, [email protected], 850-245-4111. Top 1Florida Department of Health; 2Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC; 3Miami-Dade County Mosquito Control District, Florida.

Summary What is already known about this topic? During the first half of 2016, large outbreaks of Zika virus infection caused by local mosquito-borne transmission of Zika virus occurred in many countries in Latin America and the Caribbean in Puerto Rico and other U.S. territories, but local mosquito-borne transmission was not identified in the continental United States. What is added by this report? During June 30−August 5, 2016, the first recognized outbreak of mosquito-borne transmission of Zika virus in the continental United States occurred in a neighborhood in Miami-Dade County, Florida. Twenty-nine persons with Zika virus infection had likely exposure within an approximate 6-block area. The outbreak ended after aerial spraying to control mosquitoes. No increases in short-term health effects were associated with spraying. What are the implications for public health practice? To reduce the risk for local Zika virus transmission within the continental United States, persons returning to the continental United States from areas with ongoing Zika virus transmission should use daily mosquito repellent for 3 weeks and follow CDC published guidance to prevent sexual transmission of Zika virus. Investigation of reported cases by local and state health departments provides opportunities to control Zika virus outbreaks within the continental United States. Jurisdictions with Aedes aegyptipresent should ensure ongoing capacity for comprehensive mosquito control.

Local Mosquito-Borne Transmission of Zika Virus — Miami-Dade and Broward Counties, Florida, June–August 2016 Early Release / September 23, 2016 / 65 http://www.cdc.gov/mmwr/volumes/65/wr/mm6538e1.htm?s_cid=mm6538e1_w

Updated tree with Wynwood sequences

Initial branch with five Miami sequences at Genbank

Last week the Andersen Lab at Scripps http://andersen-lab.com/ released a series of sequences from 2 patients and 3 mosquito batches collected in Miami. These data indicated all five sequences fell on the same branch of a phylogenetic tree which was shared by sequences from an English traveler to Guadeloupe and an Italian traveler to the Dominican Republic (see tree posted below). The lab is preparing to release another series, and has posted the sequence data on their website. Included are six full Zika sequences from collections between July 16 and August 17. The July collections (ZF 21 and ZF 22) are likely sequences from Wynwood, based on descriptions of local Florida cases. All six of the sequences in progress fall on the same branch as the five sequences deposited at Genbank (see second tree posted below), raising concerns of an introduction into Florida that significantly pre-dates Wynwood..

ACTIVE INVESTIGATIONS Information on Active Investigations When a local case of Zika virus is confirmed through laboratory testing, the department conducts a thorough investigation around the case to determine if additional people are infected. The department interviews and tests close contacts and community members around the case. Knowing if additional people are infected helps the department determine if there is a zone where mosquitoes are transmitting the virus. Not every case results in a designation of active transmission in an area. In some instances, a case of Zika is an isolated incident with no additional people infected. For more information on the department’s testing and investigation process, click here. Current Number of Active Investigations: 11 Miami-Dade County: 7 open investigations Pinellas County: 1 open investigation Palm Beach: 3 open investigations Current Number of Closed Investigations: 16 Miami-Dade County: 14 closed investigations Palm Beach County: 1 closed investigation Broward County: 1 closed investigation Sampling Activities For Active Investigations Miami Beach in Miami-Dade County Total # of Samples Collected Positive Negative Pending Results 1,038 44 990 4 Palm Beach County – 3 Investigations Total # of Samples Collected Positive Negative Pending Results 77 1 76 0 Miami-Dade Investigations Outside of Wynwood and Miami Beach – 6 Investigations Total # of Samples Collected Positive Negative Pending Results 2 0 1 1 Pinellas County – 1 Investigation Total # of Samples Collected Positive Negative Pending Results 71 0 70 1 Wynwood Area in Miami-Dade County – Note: This investigation is closed, but the department is providing the sampling results below for reference. Data as of Sep. 23, 2016 - 3:10pm ET Total # of Samples Collected Positive Negative Pending Results 521 30 491 0

September 23, 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 is one new travel related case today in Hillsborough County. Please visit our website to see the full list of travel-related cases. There are three new non-travel related cases today in Miami-Dade County, which are all associated with the Miami Beach investigation. DOH continues door-to-door outreach and targeted testing in Pinellas, Palm Beach and Miami-Dade counties 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 area in Miami Beach in Miami-Dade County, see map below. 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 683 Non-Travel Related Infections of Zika 95 Infections Involving Pregnant Women 90 Out of State Cases (not Florida Residents) 10 Total 878 The department is currently conducting 11 active investigations. The department has closed 16 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 8,127 people statewide. Florida currently has the capacity to test 6,662 people for active Zika virus and 7,830 for Zika antibodies. At Governor Scott’s direction, all county health departments now offer free Zika risk assessment and testing to pregnant women. Florida’s small case cluster is not considered widespread transmission, however, pregnant women are advised to avoid non-essential travel to the impacted area in Miami-Dade County (see map 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 consider testing all pregnant women with a history of travel to a Zika affected area for the virus. 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 90. 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 6,512 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. Miami Beach Map 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.

September 23, 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 is one new travel related case today in Hillsborough County. Please visit our website to see the full list of travel-related cases. There are three new non-travel related cases today in Miami-Dade County, which are all associated with the Miami Beach investigation. DOH continues door-to-door outreach and targeted testing in Pinellas, Palm Beach and Miami-Dade counties 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 area in Miami Beach in Miami-Dade County, see map below. 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 683 Non-Travel Related Infections of Zika 95 Infections Involving Pregnant Women 90 Out of State Cases (not Florida Residents) 10 Total 878 The department is currently conducting 11 active investigations. The department has closed 16 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 8,127 people statewide. Florida currently has the capacity to test 6,662 people for active Zika virus and 7,830 for Zika antibodies. At Governor Scott’s direction, all county health departments now offer free Zika risk assessment and testing to pregnant women. Florida’s small case cluster is not considered widespread transmission, however, pregnant women are advised to avoid non-essential travel to the impacted area in Miami-Dade County (see map 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 consider testing all pregnant women with a history of travel to a Zika affected area for the virus. 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 90. 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 6,512 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. Miami Beach Map 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.

There is one new travel related case today in Hillsborough County. Please visit our website to see the full list of travel-related cases. There are three new non-travel related cases today in Miami-Dade County, which are all associated with the Miami Beach investigation.

There are three new non-travel related cases today in Miami-Dade County, which are all associated with the Miami Beach investigation.

Infection Type Infection Count Travel-Related Infections of Zika 683 Non-Travel Related Infections of Zika 95 Infections Involving Pregnant Women 90 Out of State Cases (not Florida Residents) 10 Total 878 http://www.floridahealth.gov/newsroom/2016/09/092316-zika-update.html

Infection Type Infection Count Travel-Related Infections of Zika 683 Non-Travel Related Infections of Zika 95 Infections Involving Pregnant Women 90 Out of State Cases (not Florida Residents) 10 Total 878 http://www.floridahealth.gov/newsroom/2016/09/092316-zika-update.html

ACTIVE INVESTIGATIONS Information on Active Investigations When a local case of Zika virus is confirmed through laboratory testing, the department conducts a thorough investigation around the case to determine if additional people are infected. The department interviews and tests close contacts and community members around the case. Knowing if additional people are infected helps the department determine if there is a zone where mosquitoes are transmitting the virus. Not every case results in a designation of active transmission in an area. In some instances, a case of Zika is an isolated incident with no additional people infected. For more information on the department’s testing and investigation process, click here. Current Number of Active Investigations: 11 Miami-Dade County: 7 open investigations Pinellas County: 1 open investigation Palm Beach: 3 open investigations Current Number of Closed Investigations: 16 Miami-Dade County: 14 closed investigations Palm Beach County: 1 closed investigation Broward County: 1 closed investigation Sampling Activities For Active Investigations Miami Beach in Miami-Dade County Total # of Samples Collected Positive Negative Pending Results 1,036 41 990 5 Palm Beach County – 3 Investigations Total # of Samples Collected Positive Negative Pending Results 77 1 76 0 Miami-Dade Investigations Outside of Wynwood and Miami Beach – 6 Investigations Total # of Samples Collected Positive Negative Pending Results 2 0 0 2 Pinellas County – 1 Investigation Total # of Samples Collected Positive Negative Pending Results 71 0 69 2 Wynwood Area in Miami-Dade County – Note: This investigation is closed, but the department is providing the sampling results below for reference. Total # of Samples Collected Positive Negative Pending Results 521 30 491 0 Data as of Sep. 22, 2016 - 2:40pm ET

September 22, 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 five new travel-related cases today with two in Miami-Dade, one in Orange, one in Volusia and one involving a pregnant woman. Please visit our website to see the full list of travel-related cases. There are two new non-travel related cases today in Miami-Dade County. One is associated with the Miami Beach investigation and the department is investigating the other case to determine where exposure occurred. DOH continues door-to-door outreach and targeted testing in Pinellas, Palm Beach and Miami-Dade counties 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 area in Miami Beach in Miami-Dade County, see map below. 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 682 Non-Travel Related Infections of Zika 92 Infections Involving Pregnant Women 90 Out of State Cases (not Florida Residents) 10 Total 874 The department is currently conducting 11 active investigations. The department has closed 16 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 8,061 people statewide. Florida currently has the capacity to test 6,748 people for active Zika virus and 7,969 for Zika antibodies. At Governor Scott’s direction, all county health departments now offer free Zika risk assessment and testing to pregnant women. Florida’s small case cluster is not considered widespread transmission, however, pregnant women are advised to avoid non-essential travel to the impacted area in Miami-Dade County (see map 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 consider testing all pregnant women with a history of travel to a Zika affected area for the virus. 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 90. 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 6,476 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. Miami Beach Map 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.

September 22, 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 five new travel-related cases today with two in Miami-Dade, one in Orange, one in Volusia and one involving a pregnant woman. Please visit our website to see the full list of travel-related cases. There are two new non-travel related cases today in Miami-Dade County. One is associated with the Miami Beach investigation and the department is investigating the other case to determine where exposure occurred. DOH continues door-to-door outreach and targeted testing in Pinellas, Palm Beach and Miami-Dade counties 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 area in Miami Beach in Miami-Dade County, see map below. 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 682 Non-Travel Related Infections of Zika 92 Infections Involving Pregnant Women 90 Out of State Cases (not Florida Residents) 10 Total 874 The department is currently conducting 11 active investigations. The department has closed 16 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 8,061 people statewide. Florida currently has the capacity to test 6,748 people for active Zika virus and 7,969 for Zika antibodies. At Governor Scott’s direction, all county health departments now offer free Zika risk assessment and testing to pregnant women. Florida’s small case cluster is not considered widespread transmission, however, pregnant women are advised to avoid non-essential travel to the impacted area in Miami-Dade County (see map 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 consider testing all pregnant women with a history of travel to a Zika affected area for the virus. 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 90. 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 6,476 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. Miami Beach Map 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.

There are five new travel-related cases today with two in Miami-Dade, one in Orange, one in Volusia and one involving a pregnant woman. Please visit our website to see the full list of travel-related cases. There are two new non-travel related cases today in Miami-Dade County. One is associated with the Miami Beach investigation and the department is investigating the other case to determine where exposure occurred.

There are two new non-travel related cases today in Miami-Dade County. One is associated with the Miami Beach investigation and the department is investigating the other case to determine where exposure occurred.

Infection Type Infection Count Travel-Related Infections of Zika 682 Non-Travel Related Infections of Zika 92 Infections Involving Pregnant Women 90 Out of State Cases (not Florida Residents) 10 Total 874 http://www.floridahealth.gov/newsroom/2016/09/092216-zika-update.html

Infection Type Infection Count Travel-Related Infections of Zika 682 Non-Travel Related Infections of Zika 92 Infections Involving Pregnant Women 90 Out of State Cases (not Florida Residents) 10 Total 874 http://www.floridahealth.gov/newsroom/2016/09/092216-zika-update.html

Zika Virus – September 22, 2016. Texas has had 196 reported cases of Zika virus disease. All the cases were associated with travel to an area where Zika is being spread. This count includes 12 pregnant women, two infants infected before birth, and two people who had sexual contact with travelers. Texas Zika Cases by County: County Cases Angelina 1 Bell 6 Bexar 13 Brazos 3 Burnet 1 Cameron 1 Collin 5 Dallas 35 Denton 6 El Paso 3 Ellis 1 Fort Bend 7 Frio 1 Gray 1 Galveston 7 Grayson 1 Gregg 1 Hamilton 1 Harris 55 Jefferson 2 Lee 1 Lubbock 1 Matagorda 1 Medina 1 Midland 1 Montgomery 1 Palo Pinto 1 Randall 1 Tarrant 21 Travis 5 Upshur 1 Val Verde 1 Walker 1 Williamson 6 Webb 1 Wise 1 Total 196

http://www.cdc.gov/zika/geo/pregnancy-outcomes.html Pregnancy Outcomes in the United States and the District of Columbia Liveborn infants with birth defects* 20 Includes aggregated data reported to the US Zika Pregnancy Registry as of September 15, 2016 Pregnancy losses with birth defects** 5 Includes aggregated data reported to the US Zika Pregnancy Registry as of September 15, 2016