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Pregnant Women with Any Laboratory Evidence of Possible Zika Virus Infection US States and the District of Columbia* 749 *Includes aggregated data reported to the US Zika Pregnancy Registry as of September 15, 2016 US Territories** 1,348 **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 September 15, 2016

As of September 21, 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 – September 21, 2016. US States Locally acquired mosquito-borne cases reported: 43 Travel-associated cases reported: 3,314 Laboratory acquired cases reported: 1 Total: 3,358 Sexually transmitted: 28 Guillain-Barré syndrome: 8 MAPS OF ZIKA IN THE US More US Territories Locally acquired cases reported: 19,706 Travel-associated cases reported: 71 Total: 19,777* Guillain-Barré syndrome: 37 *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 September 21, 2016)§ States Travel-associated cases* No. (% of cases in states) (N=3,315) Locally acquired cases† No. (% of cases in states) (N=43) Alabama 27 (1) 0 (0) Arizona 29 (1) 0 (0) Arkansas 10 (<1) 0 (0) California 243 (7) 0 (0) Colorado 35 (1) 0 (0) Connecticut 58 (2) 0 (0) Delaware 13 (<1) 0 (0) District of Columbia 23 (1) 0 (0) Florida 652 (20) 43 (100) Georgia 79 (2) 0 (0) Hawaii 12 (<1) 0 (0) Idaho 3 (<1) 0 (0) Illinois 67 (2) 0 (0) Indiana 33 (1) 0 (0) Iowa 16 (<1) 0 (0) Kansas 14 (<1) 0 (0) Kentucky 24 (1) 0 (0) Louisiana 29 (1) 0 (0) Maine 11 (<1) 0 (0) Maryland 99 (3) 0 (0) Massachusetts 67 (2) 0 (0) Michigan 56 (2) 0 (0) Minnesota 47 (1) 0 (0) Mississippi 21 (1) 0 (0) Missouri 27 (1) 0 (0) Montana 7 (<1) 0 (0) Nebraska 8 (<1) 0 (0) Nevada 14 (<1) 0 (0) New Hampshire 8 (<1) 0 (0) New Jersey 117 (4) 0 (0) New Mexico 6 (<1) 0 (0) New York 715 (22) 0 (0) North Carolina 61 (2) 0 (0) North Dakota 1 (<1) 0 (0) Ohio 41 (1) 0 (0) Oklahoma 26 (1) 0 (0) Oregon 27 (1) 0 (0) Pennsylvania†† 106 (3) 0 (0) Rhode Island 29 (1) 0 (0) South Carolina 31 (1) 0 (0) South Dakota 1 (<1) 0 (0) Tennessee 49 (1) 0 (0) Texas 195 (6) 0 (0) Utah 12** (<1) 0 (0) Vermont 7 (<1) 0 (0) Virginia 81 (2) 0 (0) Washington 34 (1) 0 (0) West Virginia 11 (<1) 0 (0) Wisconsin 31 (1) 0 (0) Wyoming 2 (<1) 0 (0) Territories Travel-associated cases* No. (% of cases in territories) (N=71) Locally acquired cases† No. (% of cases in territories) (N=19,706) American Samoa 0 (0) 46 (<1) Puerto Rico 70 (99) 19,395*** (98) US Virgin Islands 1 (1) 265 (1) §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: September 17, 2016 Page last updated: September 21, 2016

Sequences producing significant alignments: Select:AllNone Selected:0 AlignmentsDownloadGenBankGraphicsDistance tree of resultsShow/hide columns of the table presenting sequences producing significant alignments Sequences producing significant alignments: Select for downloading or viewing reports Description Max score Total score Query cover E value Ident Accession Select seq gb|KX675261.1| Enterovirus D68 strain USA/FL/2016-19504, complete genome 11844 11844 100% 0.0 100% KX675261.1 Select seq gb|KX675263.1| Enterovirus D68 strain USA/TX/2016-19506, complete genome 11757 11757 100% 0.0 99% KX675263.1 Select seq gb|KU982559.1| Enterovirus D68 isolate EVD68/SZ02/CHN/2015, complete genome 11537 11537 100% 0.0 99% KU982559.1 Select seq gb|KU982558.1| Enterovirus D68 isolate EVD68/SZ01/CHN/2015, complete genome 11519 11519 100% 0.0 99% KU982558.1 Select seq gb|KX675262.1| Enterovirus D68 strain USA/NY/2016-19505, complete genome 11441 11441 100% 0.0 99% KX675262.1 Select seq gb|KT280500.1| Enterovirus D68 isolate 2014-R0672, complete genome 11185 11185 100% 0.0 98% KT280500.1 Select seq gb|KT711083.1| Enterovirus D68 isolate TW-00785-2014, complete genome 11176 11176 100% 0.0 98% KT711083.1 Select seq gb|KT711082.1| Enterovirus D68 isolate TW-00898-2014, complete genome 11162 11162 100% 0.0 98% KT711082.1 Select seq gb|KT711078.1| Enterovirus D68 isolate TW-00880-2014, complete genome 11162 11162 100% 0.0 98% KT711078.1 Select seq gb|KT711085.1| Enterovirus D68 isolate TW-00928-2014, complete genome 11149 11149 100% 0.0 98% KT711085.1 Select seq gb|KT711079.1| Enterovirus D68 isolate TW-00893-2014, complete genome 11149 11149 100% 0.0 98% KT711079.1 Select seq gb|KP240936.1| Enterovirus D68 isolate Beijing-R0132, complete genome 11149 11149 100% 0.0 98% KP240936.1 Select seq gb|KT711084.1| Enterovirus D68 isolate TW-00821-2014, complete genome 11144 11144 100% 0.0 98% KT711084.1 Select seq gb|KT285485.1| Enterovirus D68 isolate BCH4235A, complete genome 11135 11135 100% 0.0 98% KT285485.1 Select seq gb|KT711088.1| Enterovirus D68 isolate TW-02795-2014, complete genome 11126 11126 100% 0.0 98% KT711088.1 Select seq gb|KT711081.1| Enterovirus D68 isolate TW-00932-2014, complete genome 11126 11126 100% 0.0 98% KT711081.1 Select seq gb|KT711087.1| Enterovirus D68 isolate TW-02809-2014, complete genome 11122 11122 100% 0.0 98% KT711087.1 Select seq gb|KT280496.1| Enterovirus D68 isolate 2014-R1357, complete genome 11117 11117 100% 0.0 98% KT280496.1 Select seq gb|KT711080.1| Enterovirus D68 isolate TW-00909-2014, complete genome 11099 11099 100% 0.0 97% KT711080.1 Select seq gb|KT280497.1| Enterovirus D68 isolate 2014-R1153, complete genome 11095 11095 100% 0.0 97% KT280497.1 Select seq gb|KT711086.1| Enterovirus D68 isolate TW-02512-2014, complete genome 11090 11090 100% 0.0 97% KT711086.1 Select seq gb|KT280499.1| Enterovirus D68 isolate 2014-R970, complete genome 11086 11086 100% 0.0 97% KT280499.1 Select seq gb|KT280498.1| Enterovirus D68 isolate 2014-R1011, complete genome 11086 11086 100% 0.0 97% KT280498.1 Select seq gb|KT803592.1| Enterovirus D68 isolate CHN/CQ7188/2014 polyprotein gene, partial cds 11003 11003 98% 0.0 98% KT803592.1 Select seq gb|KT803590.1| Enterovirus D68 isolate CHN/CQ5571/2013 polyprotein gene, partial cds 11003 11003 98% 0.0 98% KT803590.1 Select seq gb|KT803598.1| Enterovirus D68 isolate CHN/CQ7174/2014 polyprotein gene, partial cds 10994 10994 98% 0.0 98% KT803598.1 Select seq gb|KT803595.1| Enterovirus D68 isolate CHN/CQ7280/2014 polyprotein gene, partial cds 10962 10962 98% 0.0 98% KT803595.1 Select seq gb|KT803594.1| Enterovirus D68 isolate CHN/CQ7214/2014 polyprotein gene, partial cds 10962 10962 98% 0.0 98% KT803594.1 Select seq gb|KU982561.1| Enterovirus D68 isolate EVD68/SZ04/CHN/2015, complete genome 10954 10954 100% 0.0 97% KU982561.1 Select seq gb|KT803596.1| Enterovirus D68 isolate CHN/CQ7226/2014 polyprotein gene, partial cds 10953 10953 98% 0.0 98% KT803596.1 Select seq gb|KT803597.1| Enterovirus D68 isolate CHN/CQ7233/2014 polyprotein gene, partial cds 10949 10949 98% 0.0 98% KT803597.1 Select seq gb|KT803593.1| Enterovirus D68 isolate CHN/CQ7208/2014 polyprotein gene, partial cds 10949 10949 98% 0.0 98% KT803593.1 Select seq gb|KT803599.1| Enterovirus D68 isolate CHN/CQ7225/2014 polyprotein gene, partial cds 10935 10935 98% 0.0 97% KT803599.1 Select seq gb|KT803600.1| Enterovirus D68 isolate CHN/CQ7360/2014 polyprotein gene, partial cds 10926 10926 98% 0.0 97% KT803600.1 Select seq gb|KT803591.1| Enterovirus D68 isolate CHN/CQ7170/2014 polyprotein gene, partial cds 10922 10922 98% 0.0 97% KT803591.1 Select seq gb|KP114664.1| Enterovirus D68 isolate EV68_Alberta2985_2014 polyprotein gene, partial cds 10888 10888 97% 0.0 98% KP114664.1 Select seq gb|KM892501.1| Enterovirus D68 isolate CA/AFP/11-1767, complete genome 10819 10819 100% 0.0 97% KM892501.1 Select seq gb|KT285320.1| Enterovirus D68 isolate 2011-21282, complete genome 10792 10792 100% 0.0 96% KT285320.1 Select seq gb|KT280503.1| Enterovirus D68 isolate 2011-21186, complete genome 10761 10761 100% 0.0 96% KT280503.1 Select seq gb|KX255370.1| Enterovirus D68 strain EV-D68/Homo sapiens/USA/U4470/2012, complete genome 10729 10729 100% 0.0 96% KX255370.1 Select seq gb|KX255356.1| Enterovirus D68 strain EV-D68/Homo sapiens/USA/U4489/2012, complete genome 10725 10725 100% 0.0 96% KX255356.1 Select seq gb|KX255399.1| Enterovirus D68 strain EV-D68/Homo sapiens/USA/U4486/2012, complete genome 10716 10716 100% 0.0 96% KX255399.1 Select seq gb|KX255365.1| Enterovirus D68 strain EV-D68/Homo sapiens/USA/O466a/2012, complete genome 10716 10716 100% 0.0 96% KX255365.1 Select seq gb|KX255377.1| Enterovirus D68 strain EV-D68/Homo sapiens/USA/O774a/2012, complete genome 10711 10711 100% 0.0 96% KX255377.1 Select seq gb|KX255414.1| Enterovirus D68 strain EV-D68/Homo sapiens/USA/O775a/2012, complete genome 10698 10698 100% 0.0 96% KX255414.1 Select seq gb|KX255383.1| Enterovirus D68 strain EV-D68/Homo sapiens/USA/O810a/2012, complete genome 10680 10680 100% 0.0 96% KX255383.1 Select seq gb|KM361523.1| Enterovirus sp. isolate CU134 polyprotein gene, partial cds 10671 10671 98% 0.0 97% KM361523.1 Select seq gb|KT318494.1| Enterovirus D68 isolate 1-I8/TW/2008, complete genome 10648 10648 100% 0.0 96% KT318494.1 Select seq gb|KX255406.1| Enterovirus D68 strain EV-D68/Homo sapiens/USA/O4415/2013, complete genome 10630 10630 100% 0.0 96% KX255406.1 Select seq gb|KX255384.1| Enterovirus D68 strain EV-D68/Homo sapiens/USA/O4413/2013, complete genome 10630 10630 100% 0.0 96% KX255384.1 Select seq gb|KX255368.1| Enterovirus D68 strain EV-D68/Homo sapiens/USA/O4417/2013, complete genome 10626 10626 100% 0.0 96% KX255368.1 Select seq gb|KM361524.1| Enterovirus sp. isolate CU171 polyprotein gene, partial cds 10626 10626 98% 0.0 96% KM361524.1 Select seq gb|KX433165.1| Enterovirus D68 strain EV-D68/Homo sapiens/USA/O4444/2013, complete genome 10621 10621 100% 0.0 96% KX433165.1 Select seq gb|KX255398.1| Enterovirus D68 strain EV-D68/Homo sapiens/USA/O4446/2013, complete genome 10621 10621 100% 0.0 96% KX255398.1 Select seq gb|KX255387.1| Enterovirus D68 strain EV-D68/Homo sapiens/USA/O4445/2013, complete genome 10621 10621 100% 0.0 96% KX255387.1 Select seq gb|KT803589.1| Enterovirus D68 isolate CHN/CQ2860/2012 polyprotein gene, partial cds 10610 10610 98% 0.0 96% KT803589.1 Select seq gb|KX255403.1| Enterovirus D68 strain EV-D68/Homo sapiens/USA/C7716/2014, complete genome 10608 10608 100% 0.0 96% KX255403.1 Select seq gb|KX255390.1| Enterovirus D68 strain EV-D68/Homo sapiens/USA/C7714/2014, complete genome 10608 10608 100% 0.0 96% KX255390.1 Select seq gb|KX255362.1| Enterovirus D68 strain EV-D68/Homo sapiens/USA/C7715/2014, complete genome 10608 10608 100% 0.0 96% KX255362.1 Select seq gb|KT280504.1| Enterovirus D68 isolate 2013-0720-6, complete genome 10608 10608 100% 0.0 96% KT280504.1 Select seq gb|KT347254.1| Enterovirus D68 strain EVD68/Homo sapiens/USA/MO33/2014, complete genome 10603 10603 100% 0.0 96% KT347254.1 Select seq gb|KP100794.1| Enterovirus D68 strain US/CO/13-60 polyprotein gene, complete cds 10599 10599 100% 0.0 96% KP100794.1 Select seq gb|KX255378.1| Enterovirus D68 strain EV-D68/Homo sapiens/USA/C7729/2014, complete genome 10590 10590 100% 0.0 96% KX255378.1 Select seq gb|KT347258.1| Enterovirus D68 strain EVD68/Homo sapiens/USA/MO12/2014, complete genome 10581 10581 100% 0.0 96% KT347258.1 Select seq gb|KT347252.1| Enterovirus D68 strain EVD68/Homo sapiens/USA/MO51/2014, complete genome 10581 10581 100% 0.0 96% KT347252.1 Select seq gb|KX351812.1| Enterovirus D strain EV-D68/Homo sapiens/USA/SSENT10/2014, complete genome 10576 10576 100% 0.0 96% KX351812.1 Select seq gb|KX351801.1| Enterovirus D strain EV-D68/Homo sapiens/USA/SSENT37/2014, complete genome 10576 10576 100% 0.0 96% KX351801.1 Select seq gb|KX255385.1| Enterovirus D68 strain EV-D68/Homo sapiens/USA/C7733/2014, complete genome 10576 10576 100% 0.0 96% KX255385.1 Select seq gb|KX255379.1| Enterovirus D68 strain EV-D68/Homo sapiens/USA/C7793/2014, complete genome 10576 10576 100% 0.0 96% KX255379.1 Select seq gb|KX351794.1| Enterovirus D strain EV-D68/Homo sapiens/USA/SSENT29/2014, complete genome 10572 10572 100% 0.0 96% KX351794.1 Select seq gb|KX255354.1| Enterovirus D68 strain EV-D68/Homo sapiens/USA/C7731/2014, complete genome 10572 10572 100% 0.0 96% KX255354.1 Select seq gb|KT347233.1| Enterovirus D68 strain EVD68/Homo sapiens/USA/MO19/2014, complete genome 10572 10572 100% 0.0 96% KT347233.1 Select seq gb|KX351820.1| Enterovirus D strain EV-D68/Homo sapiens/USA/SSENT07/2014, complete genome 10567 10567 100% 0.0 96% KX351820.1 Select seq gb|KX351796.1| Enterovirus D strain EV-D68/Homo sapiens/USA/SSENT21/2014, complete genome 10567 10567 100% 0.0 96% KX351796.1 Select seq gb|KX255415.1| Enterovirus D68 strain EV-D68/Homo sapiens/USA/C7721/2014, complete genome 10567 10567 100% 0.0 96% KX255415.1 Select seq gb|KX255411.1| Enterovirus D68 strain EV-D68/Homo sapiens/USA/C7730/2014, complete genome 10567 10567 100% 0.0 96% KX255411.1 Select seq gb|KX255352.1| Enterovirus D68 strain EV-D68/Homo sapiens/USA/C7720/2014, complete genome 10567 10567 100% 0.0 96% KX255352.1 Select seq gb|KT835407.1| Enterovirus D68 strain EV68/Ontario/C818710/2014, partial genome 10567 10567 100% 0.0 96% KT835407.1 Select seq gb|KT347276.1| Enterovirus D68 strain EVD68/Homo sapiens/USA/MO21/2014, complete genome 10567 10567 100% 0.0 96% KT347276.1 Select seq gb|KX351830.1| Enterovirus D strain EV-D68/Homo sapiens/USA/SSENT24/2014, complete genome 10563 10563 100% 0.0 96% KX351830.1 Select seq gb|KT347278.1| Enterovirus D68 strain EVD68/Homo sapiens/USA/MO8/2014, complete genome 10563 10563 100% 0.0 96% KT347278.1 Select seq gb|KT347275.1| Enterovirus D68 strain EVD68/Homo sapiens/USA/MO35/2014, complete genome 10563 10563 100% 0.0 96% KT347275.1 Select seq gb|KT347248.1| Enterovirus D68 strain EVD68/Homo sapiens/USA/MO13/2014, complete genome 10558 10558 100% 0.0 96% KT347248.1 Select seq gb|KP745758.1| Enterovirus D68 isolate NY263 polyprotein gene, complete cds 10558 10558 100% 0.0 96% KP745758.1 Select seq gb|KP745754.1| Enterovirus D68 isolate NY130 polyprotein gene, complete cds 10558 10558 100% 0.0 96% KP745754.1 Select seq gb|KM851228.1| Enterovirus D68 strain US/MO/14-18950, partial genome 10558 10558 100% 0.0 96% KM851228.1 Select seq gb|KX433167.1| Enterovirus D68 strain EV-D68/Homo sapiens/USA/U797/2007, complete genome 10554 10554 100% 0.0 96% KX433167.1 Select seq gb|KX433161.1| Enterovirus D68 strain EV-D68/Homo sapiens/USA/C7791/2014, complete genome 10554 10554 100% 0.0 96% KX433161.1 Select seq gb|KX255407.1| Enterovirus D68 strain EV-D68/Homo sapiens/USA/C7743/2014, complete genome 10554 10554 100% 0.0 96% KX255407.1 Select seq gb|KT347266.1| Enterovirus D68 strain EVD68/Homo sapiens/USA/MO27/2014, complete genome 10549 10549 100% 0.0 96% KT347266.1 Select seq gb|KT347264.1| Enterovirus D68 strain EVD68/Homo sapiens/USA/MO22/2014, complete genome 10549 10549 100% 0.0 96% KT347264.1 Select seq gb|KT455430.1| Enterovirus D68 isolate NYS14_32368, partial genome 10545 10545 100% 0.0 96% KT455430.1 Select seq gb|KT455421.1| Enterovirus D68 isolate NYS14-27898, partial genome 10545 10609 100% 0.0 96% KT455421.1 Select seq gb|KX351811.1| Enterovirus D strain EV-D68/Homo sapiens/USA/SSENT08/2014, complete genome 10545 10545 100% 0.0 96% KX351811.1 Select seq gb|KT835408.1| Enterovirus D68 strain EV68/Ontario/C818712/2014, partial genome 10545 10545 100% 0.0 96% KT835408.1 Select seq gb|KT347249.1| Enterovirus D68 strain EVD68/Homo sapiens/USA/MO16/2014, complete genome 10545 10545 100% 0.0 96% KT347249.1 Select seq gb|KT347241.1| Enterovirus D68 strain EVD68/Homo sapiens/USA/MO18/2014, complete genome 10545 10545 100% 0.0 96% KT347241.1 Select seq gb|KP745770.1| Enterovirus D68 isolate NY77 polyprotein gene, complete cds 10545 10545 100% 0.0 96% KP745770.1 Select seq gb|KP745751.1| Enterovirus D68 isolate NY120, complete genome 10545 10545 100% 0.0 96% KP745751.1 Select seq gb|KX351795.1| Enterovirus D strain EV-D68/Homo sapiens/USA/SSENT27/2014, complete genome 10540 10540 100% 0.0 96% KX351795.1

LOCUS KX675261 7333 bp RNA linear VRL 16-AUG-2016 DEFINITION Enterovirus D68 strain USA/FL/2016-19504, complete genome. ACCESSION KX675261 VERSION KX675261.1 GI:1050796057 DBLINK BioProject: PRJNA322324 KEYWORDS . SOURCE Enterovirus D68 (EV-D68) ORGANISM Enterovirus D68 Viruses; ssRNA viruses; ssRNA positive-strand viruses, no DNA stage; Picornavirales; Picornaviridae; Enterovirus; Enterovirus D. REFERENCE 1 (bases 1 to 7333) AUTHORS Ng,T.F.F., Montmayeur,A., Castro,C.J., Rogers,S.L., Chern,S.-W., Maher,K., Magana,L., Marine,R., Lamson,D., St. George,K., Oberste,M.S. and Nix,W.A. TITLE Detection and Genomic Characterization of Enterovirus D68 in Respiratory Samples from Three Acute Flaccid Myelitis Cases in 2016 JOURNAL Unpublished REFERENCE 2 (bases 1 to 7333) AUTHORS Ng,T.F.F., Montmayeur,A., Castro,C.J., Rogers,S.L., Chern,S.-W., Maher,K., Magana,L., Marine,R., Lamson,D., St. George,K., Oberste,M.S. and Nix,W.A. TITLE Direct Submission JOURNAL Submitted (09-AUG-2016) Polio and Picornavirus Laboratory Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA 30329, USA COMMENT ##Assembly-Data-START## Assembly Method :: Geneious v. R9 Sequencing Technology :: Illumina ##Assembly-Data-END## FEATURES Location/Qualifiers source 1..7333 /organism="Enterovirus D68" /mol_type="genomic RNA" /strain="USA/FL/2016-19504" /isolation_source="nasal swab" /host="Homo sapiens" /db_xref="taxon:42789" /country="USA: FL" /collection_date="31-Mar-2016" CDS 700..7266 /codon_start=1 /product="polyprotein" /protein_id="ANZ79242.1" /db_xref="GI:1050796058" /translation="MGAQVTRQQTGTHENANVATNGSHITYNQINFYKDSYAASASKQ DFSQDPSKFTEPVVEGLKAGAPVLKSPSAEACGYSDRVLQLKLGNSAIVTQEAANYCC AYGEWPNYLPDHEAVAIDKPTQPETATDRFYTLRSVKWEATSTGWWWKLPDALNNIGM FGQNVQHHYLYRSGFLIHVQCNATKFHQGALLVVAIPEHQRGAHNTTTSPGFDDIMKG EAGGTFNHPYVLDDGTSLACATIFPHQWINLRTNNSATIVLPWMNAAPMDFPLRHNQW TLAIIPVVPLGTRTMSSMVPITVSIAPMCCEFNGLRHAITQGVPTYLLPGSGQFLTTD DHSSAPVLPCFNPTPEMHIPGQVRNMLEVVQVESMMEINNTESAVGMERLKVDISALT DVDQLLFNIPLDIQLDGPLRNTLVGNISRYYTHWSGSLEMTFMFCGSFMATGKLILCY TPPGGSCPTTRETAMLGTHIVWDFGLQSSITLIIPWISGSHYRMFNNDAKSTNANVGY VTCFMQTNLIVPSESSDTCSLIGFIAAKDDFSLRLMRDSPDIGQLDHLHGAEAAYQIE GIIKTATDTVKSEINAELGVVPSLNAVETGATSNTEPEEAIQTRTVINQHGVSETLVE NFLSRAALVSKRSFEYKDHTSSAAQADKNFFKWTINTRSFVQLRRKLELFTYLRFDAE ITILTTVAVNGSSNNTYVGLPDLTLQAMFVPTGALTPEKQDSFHWQSGSNASVFFKIS DPPARMTIPFMCINSAYSVFYDGFAGFEKTGLYGINPADTIGNLCVRIVNEHQPVGFT VTVRVYMKPKHIKAWAPRPPRTLPYMSIANANYKGKERAPNALNAIIGNRDSVKTMPH NIVTTGPGFGGVFVGSFKIINYHLATTEERQSAIYVDWQSDILVTPIAAHGRHQIARC KCNTGVYYCRHKDRSYPICFEGPGIQWIEQNEYYPARYQTNVLLAVGPAEAGDCGGLL VCPHGVIGLLTAGGGGIVAFTDIRNLLWLDTDAMEQGITDYIQNLGNAFGAGFTETIS NKAKEVQDMLIGESSLLEKLLKALIKIISALVIVIRNSEDLVTVTATLALLGCHDSPW SYLKQKVCSYLGIPYVPRQSESWLKKFTEACNALRGLDWLSQKIDKFINWLKTKILPE AREKYEFVQRLKQLPVIENQVSTIEHSCPTTEQQQALFNNVQYYSHYCRKYAPLYAVE AKRVMALEKKINNYIQFKSKSRIEPVCLIIHGSPGTGKSVASNLIARAITEKLGGDIY SLPPDPKYFDGYKQQTVVLMDDLMQNPDGNDISMFCQMVSTVDFIPPMASLEEKGTLY TSPFLIATTNAGSIHAPTVSDSKALSRRFKFDVDIEVTDSYKDSNKLDMSRAVEMCKP DGCAPANYKRCCPLICGKAIQFRDRRTNARSTIDMLVTDIIKEYRTRNSTQDKLEALF QGPPQFKEIKISVTPDTPAPDAINDLLRSVDSQEVRDYCQKKGWIVIHPSNELLVEKH ISRAFITLQAIATFVSIAGVVYVIYKLFAGIQGPYTGIPNPKPKVPSLRTAKVQGPGF DFAQAIMKKNTVIARTEKGEFTMLGVYDRVAVIPTHASVGETIYIDDVETRVLDACAL RDLTDTNLEITIVKLDRNQKFRDIRHFLPRYEDDYNDAVLSVHTSKFPNMYIPVGQVT NYGFLNLGGTPTHRILMYNFPTRAGQCGGVVTTTGKVIGIHVGGNGAQGFAAMLLHSY FTDTQGEIVSSEKSGVCINAPAKTKLQPSVFHQVFEGSKEPAVLNPKDPRLKTDFEEA IFSKYTGNKIMLMDEYMEEAVDHYVGCLEPLDISVDPIPLESAMYGMDGLEALDLTTS AGFPYLLQGKKKRDIFNRHTRDTSEMTKMLEKYGVDLPFVTFVKDELRSREKVEKGKS RLIEASSLNDSVAMRVAFGNLYATFHNNPGTATGSAVGCDPDIFWSKIPILLDGEIFA FDYTGYDASLSPVWFACLKKVLIKLGYTHQTSFIDYLCHSVHLYKDRKYIVNGGMPSG SSGTSIFNTMINNIIIRTLLIRVYKGIDLDQFKMIAYGDDVIASYPHKIDPGLLAEAG KHYGLVMTPADKGTSFVDTNWENVTFLKRYFRADDQYPFLIHPVMPMKEIHESIRWTK DPRNTQDHVRSLCYLAWHNGEEAYNEFCRKIRSVPVGRALTLPAYSSLRRKWLDSF" mat_peptide 700..906 /product="VP4" mat_peptide 907..1650 /product="VP2" mat_peptide 1651..2355 /product="VP3" mat_peptide 2356..3282 /product="VP1" mat_peptide 3283..3723 /product="p2A" mat_peptide 3724..4020 /product="p2B" mat_peptide 4021..5010 /product="p2C" mat_peptide 5011..5277 /product="p3A" mat_peptide 5278..5343 /product="p3B" mat_peptide 5344..5892 /product="p3C" mat_peptide 5893..7263 /product="p3D" ORIGIN 1 ttaaaacagc tttggggttg ttcccactcc aagggcccac gtggcggcta gtactctggt 61 acttcggtac ctttgtacgc ctgttttatc tcccttccca atgtaattta gaagctctta 121 aatcaaggct caataggtgg ggcgcaaacc agcgctctca tgagcaagca ctcctgtctc 181 cccggtgtgg ttgtataaac tgttcccacg gttgaaaaca acctatccgt tatccgctat 241 agtacttcga gaaacctagt atcacctttg gattgttgac gcgttgcgct cagcacacta 301 acccgtgtgt agcttgggtc gatgagtctg gacatacccc actggcgaca gtggtccagg 361 ctgcgttggc ggcctactca tggtgaaaac catgagacgc tagacatgaa caaggtgtga 421 agagtctatt gagctactat agagtcctcc ggcccctgaa tgcggctaat cctaaccatg 481 gagcaagtgc tcacaggcca gtgagttgct tgtcgtaatg cgcaagtccg tggcggaacc 541 gactactttg ggtgtccgtg tttcactttt tacttttatg actgcttatg gtgacaattt 601 gatattgtta ccatttagct tgtcaaatta attgcaaaag atcctaaatc ttacttacca 661 acttgcattt tgacaacctt gatttgaaaa tttttaataa tgggagctca ggtcactaga 721 caacaaactg gcactcacga aaatgccaat gttgccacaa atggatctca tatcacatac 781 aatcagataa acttttataa ggatagttat gcagcttcag ccagcaagca ggatttttca 841 caggacccat cgaaattcac tgaaccagta gtggaaggtt tgaaagcagg agcgccagtt 901 ttgaaatctc ctagtgctga ggcgtgtggc tacagtgata gagtgctaca gcttaaatta 961 ggtaattcag ctatcgtcac ccaggaagca gcaaactact gctgtgctta tggtgaatgg 1021 cccaattact taccagacca tgaagcagta gccattgaca aacccacaca accagaaact 1081 gctacagata gattctacac tttgaggtca gtcaaatggg aggctacaag cacaggatgg 1141 tggtggaaac tacccgatgc actaaataat ataggcatgt ttgggcagaa tgtacagcat 1201 cactacctat atagatctgg tttcttgatt catgtgcagt gtaatgccac aaaattccat 1261 cagggtgcct tattagtggt agcaattcca gaacatcaga ggggagcgca caacactacc 1321 actagtccag ggtttgatga catcatgaaa ggtgaagcag gagggacctt caatcatcca 1381 tatgtccttg atgatggaac gtcattggct tgtgcgacga tatttccaca tcagtggata 1441 aatctgagaa ctaacaattc agcaacaatt gttcttccct ggatgaatgc tgctccaatg 1501 gacttcccac ttagacataa tcagtggaca ctagcaataa taccagtggt gccattaggc 1561 acgcgtacaa tgtcaagcat ggtcccaata acagtttcaa ttgctccaat gtgttgtgag 1621 tttaatggac tcagacacgc cattactcaa ggtgtcccaa catacctttt accaggctcg 1681 ggacaattcc taacaactga tgatcatagc tctgcaccgg ttctcccgtg tttcaaccca 1741 actccagaga tgcacattcc agggcaggtc cgtaatatgc tagaagtggt ccaagtggaa 1801 tcaatgatgg agatcaacaa cacagaaagt gcggttggta tggagcgtct caaggttgac 1861 atatcagcat tgacagatgt cgatcaattg ttattcaaca ttccactgga tatacaattg 1921 gatgggccac ttagaaacac tttagtagga aacatatcta gatactatac tcattggtct 1981 ggatccctag aaatgacatt tatgttttgt ggcagcttta tggcgacagg aaaattaatc 2041 ctgtgctata ctcctccagg tgggtcatgc ccgacaacca gagagaccgc catgttaggt 2101 acacatattg tttgggattt tggactacaa tctagtataa ccctgataat accttggatt 2161 agtggatccc actacaggat gttcaataat gatgctaagt caactaatgc taacgttggc 2221 tatgtcactt gtttcatgca gaccaatctg atagtcccca gtgaatcctc tgacacatgt 2281 tccttgatag ggttcatagc agcaaaagat gatttctccc tcaggttaat gagagacagc 2341 cctgacattg gacaattaga ccacttacat ggagcagagg cagcctacca gatcgagggc 2401 atcattaaaa cagcaactga taccgtgaaa agtgagatta acgctgaact tggtgtggtc 2461 cctagcttaa atgcagttga aacaggtgca acatctaaca ctgaaccaga agaagctata 2521 caaactcgca cagtgataaa tcaacacggt gtatccgaaa ctctagtgga gaattttctc 2581 agtagagcag ctttggtgtc aaagagaagt ttcgaataca aagaccatac ttcgtctgca 2641 gcacaagcag ataagaactt tttcaaatgg acaattaaca ccaggtcctt cgtacagcta 2701 agaagaaagt tagaattatt cacatacctt agattcgatg ctgagatcac tatactcaca 2761 actgtagcag tgaatggcag tagtaataat acatatgtgg gtcttcctga cttgacactg 2821 caggcaatgt ttgtacccac tggtgccctt accccagaaa agcaagactc attccactgg 2881 cagtcaggta gtaatgctag tgtattcttt aaaatctctg accccccagc cagaatgacc 2941 atacctttta tgtgtattaa ttcagcatac tcagtttttt atgatggctt tgccggattt 3001 gagaaaactg gtctgtatgg aataaatcca gctgacacta ttggtaactt gtgtgttaga 3061 atagtgaatg aacaccaacc agttggtttc acagtgactg ttagggttta catgaagcct 3121 aaacacataa aagcgtgggc accacgacca ccacgaaccc tgccatacat gagtattgca 3181 aatgcaaatt acaaaggtaa agaaagagca ccaaatgcgc tcaatgctat aattggcaat 3241 agagacagtg ttaaaaccat gcctcataat atagtgacta ctggtccagg cttcggagga 3301 gtttttgtag gatctttcaa aataattaac tatcacttag ccaccacaga ggagagacag 3361 tcagccatct acgtggattg gcaatcagac atcttggtta cccccattgc tgctcatgga 3421 agacaccaaa tagcaagatg caagtgcaac acaggggttt actattgtag acacaaagac 3481 agaagttacc caatttgctt tgaaggccca gggattcaat ggattgaaca aaatgaatat 3541 tacccagcaa ggtaccagac caatgtactt ttagcagttg gccctgcaga agcaggagat 3601 tgcggtggtt tactagtctg tccacatggg gtaatcggtc ttcttacagc aggagggggt 3661 ggaattgtag ctttcaccga tatcagaaac ttgctatggt tagatactga tgctatggaa 3721 caaggcatta ctgattacat tcaaaatctt ggcaatgcct ttggagcagg gttcacagaa 3781 acaatctcta ataaagccaa ggaagtgcaa gatatgctaa ttggagagag ttcactatta 3841 gaaaaattgc taaaagctct aatcaaaatc atatcagcat tagtaattgt aatcagaaat 3901 tcagaagact tagttacagt cacagctaca ctagcattac tggggtgcca cgattcacca 3961 tggagctact tgaaacagaa ggtatgttca tacttaggta ttccttatgt acctagacag 4021 agtgaatcgt ggcttaagaa gttcacagaa gcatgcaatg ctctcagagg tctagattgg 4081 ctatcacaaa agatagataa attcatcaac tggcttaaaa ccaaaatatt accggaagct 4141 agggagaaat atgagtttgt gcaaagacta aagcagttac cggtaataga aaaccaagtt 4201 agcacaatcg agcatagctg cccaacaaca gaacaacagc aggccttatt caataatgtc 4261 cagtactatt cacattactg tagaaagtac gcaccacttt acgcagtgga agcaaagagg 4321 gtaatggctc tcgaaaagaa aataaacaac tacatccagt tcaagtccaa atctcgcatt 4381 gaaccggttt gtttaataat acatggctct ccaggaactg gcaagtcagt ggcctcaaat 4441 ttaattgcca gggctatcac agaaaaattg ggaggggaca tttattcctt gcccccagac 4501 cctaaatatt ttgatggata caaacagcaa acggtagtcc tcatggatga tttaatgcaa 4561 aatccagatg ggaatgacat atctatgttc tgccaaatgg tctctactgt ggattttata 4621 cccccaatgg ctagcttgga ggaaaaagga actttgtaca ccagtccatt tttaatagct 4681 actactaatg ctggctcaat acatgcacca actgtgtcag actcaaaggc tttgtcacgc 4741 aggtttaaat ttgatgtaga tattgaggtc acagattcat acaaagactc aaacaaattg 4801 gacatgtcaa gagcagtcga gatgtgcaaa ccagacggct gtgcccccgc caattacaaa 4861 agatgctgcc cattgatttg tggaaaggct attcaattca gagatcgtag aactaatgca 4921 agatccacta ttgatatgct agtaactgat atcatcaagg agtatagaac cagaaacagt 4981 acacaggata aactggaagc tctatttcag ggacctccac agtttaaaga gatcaaaatt 5041 tcagtcaccc cagatacacc agctcctgat gctataaatg accttcttag gtcagtggat 5101 tctcaagaag ttagggatta ttgccaaaag aagggatgga ttgtaataca cccatcaaat 5161 gaactactag tagaaaaaca catcagcaga gcttttatta ctctgcaagc cattgccacc 5221 tttgtatcaa tagctggtgt agtttatgtt atatataaac tttttgctgg cattcagggt 5281 ccatacacag ggatccccaa tcctaaaccc aaagtaccct ctctcagaac agctaaagtg 5341 caaggaccag ggttcgattt tgcacaagcc ataatgaaga aaaataccgt cattgcgagg 5401 actgaaaagg gtgagttcac catgttgggt gtatatgata gggtagcggt catccccaca 5461 cacgcgtctg ttggggaaac catttacatt gatgatgtag agactagagt tttagatgcg 5521 tgtgcactta gagacttgac tgatacaaac ttagagataa ccatagtcaa attggaccgt 5581 aatcaaaagt tcagagatat cagacatttt ctgcccaggt acgaggatga ttacaatgat 5641 gctgtgctta gcgtacacac atcaaaattc ccaaatatgt atattccagt tggacaagtc 5701 accaattatg gcttcttgaa cctaggtggt acaccgacac accgcatttt aatgtataac 5761 ttcccaacaa gagctggcca gtgtggtggt gtggtgacaa ctacaggtaa ggtgatagga 5821 atacatgtag gtggaaatgg agctcaagga tttgcagcaa tgctactgca ctcttacttt 5881 accgacacac aaggtgagat agttagtagt gagaagagtg gggtgtgcat taatgcacca 5941 gcaaaaacta aactccaacc cagtgttttc catcaagttt ttgaaggttc aaaggaacca 6001 gcagttctca atccaaaaga tcctaggctt aaaacagatt ttgaggaagc cattttctca 6061 aaatatacag gtaacaaaat tatgttaatg gatgagtaca tggaagaggc agtggatcat 6121 tatgtggggt gcttagaacc attagatatc agtgtggatc ccatacccct ggaaagtgcc 6181 atgtatggaa tggatggtct tgaggcatta gacttaacca ccagtgcagg attcccatac 6241 ttactacaag ggaagaagaa aagggatata tttaatagac acactagaga caccagtgaa 6301 atgacaaaga tgttagaaaa atatggagtt gacctaccct ttgtaacctt tgtaaaagat 6361 gaacttagat caagagaaaa agttgaaaaa gggaaatcac gcctgattga ggccagttcc 6421 ttgaatgact cagttgctat gagggttgcc tttgggaacc tttacgccac atttcacaac 6481 aatccaggta cagcaaccgg tagtgcagtt ggttgtgacc cagatatatt ttggtcaaaa 6541 atccctattt tattagatgg agaaatcttt gcttttgatt acactggcta tgatgctagt 6601 ttgtcaccag tgtggtttgc ctgtttaaag aaagttctaa ttaagttagg ttacacacat 6661 caaacatcct ttatagatta tttgtgtcac tcggtacatt tatataagga cagaaaatac 6721 atagttaatg gtgggatgcc ctctggttct tcaggtacca gcatattcaa cactatgatc 6781 aataatataa tcataagaac tctattaatt agggtctaca aaggcattga cttggaccag 6841 ttcaaaatga ttgcctatgg ggatgatgtt attgctagct acccacataa aattgatcca 6901 ggtttactag cggaagcagg caaacattat ggattagtaa tgacaccagc agacaaagga 6961 accagttttg ttgacacaaa ttgggaaaac gtaactttct taaaaagata tttcagagca 7021 gatgatcaat acccctttct catacatcca gtgatgccaa tgaaggagat acatgaatct 7081 attagatgga ctaaagatcc cagaaacaca caggatcatg ttaggtcttt gtgctacctc 7141 gcatggcata atggagagga ggcttacaat gaattttgta gaaaaatcag aagtgtgcct 7201 gtgggaaggg cattgacact acctgcatac tctagtctca gacggaaatg gttagattcg 7261 ttttagacaa ctctaattga aacccaagtt atagtcactt tcatttagag gtaaattttg 7321 gtcacttggg ggc

32. Enterovirus D68 strain USA/FL/2016-19504, complete genome 7,333 bp linear RNA Accession: KX675261.1 GI: 1050796057 GenBankFASTAGraphics Select item 105079605933. Enterovirus D68 strain USA/NY/2016-19505, complete genome 7,319 bp linear RNA Accession: KX675262.1 GI: 1050796059 GenBankFASTAGraphics Select item 105079606134. Enterovirus D68 strain USA/TX/2016-19506, complete genome 7,310 bp linear RNA Accession: KX675263.1 GI: 1050796061 GenBankFASTAGraphics

CDC has released 3 full D68 enterovirus sequences from US acute flaccid myelitis cases.

Zika Clusters Case notified on 22 Sep 2016 (as at 3pm) 1 E-week 35 (28 Aug - 3 Sep 2016) E-week 36 (4 Sep - 10 Sep 2016) E-week 37 (11 Sep 2016 - 17 Sep 2016) E-week 38 (18 Sep 2016 - 22 Sep 2016 as at 3pm) 215 103 62 5 Location of Active Zika Clusters (Map data is updated at 1am. Kindly clear your internet browser cache after each visit, in order to view the latest information.) As of 22 Sep 2016 S/N Locality 1 Aljunied Cres (Blk 95,97,98,99,101,102,103,104,105,106,107,108,109,110,111,112) / Aljunied Rd / Aljunied Rd (Blk 125) / Circuit Rd (Blk 61,85) / Geylang East Ave 1 (Blk 126) / Geylang East Ctrl (Blk 1 22) / Lor 21A,23,25 Geylang / Paya Lebar Way (Blk 91,120,121,122,123) / Pipit Rd (Blk 56, 92A) / Sims Dr (Blk 42A,43,44) / Sims Pl (Blk 52,53) (291 cases as of 22 Sep 2016, of which 14 cases with onset in the last 2 weeks) 2 Bedok Nth Ave 2 (Blk 514) / Bedok Nth Ave 3 (404,405,507) / Bedok Nth St 3 (Blk 525) (5 cases as of 22 Sep 2016, of which 1 case with onset in the last 2 weeks) 3 Joo Seng Rd (Blk 17, 18, 21) / Vernon Pk (4 cases as of 22 Sep 2016, of which 1 case with onset in the last 2 weeks) 4 Bishan St 12 (Blk 122, 123, 134) (5 cases as of 22 Sep 2016, of which 0 cases with onset in the last 2 weeks) 5 Elite Ter / Fidelio St / Jln Tua Kong (Park East) / Tua Kong Green / Siglap Rd (Flamingo Valley) (13 cases as of 22 Sep 2016, of which 4 cases with onset in the last 2 weeks) 6 Ubi Ave 1, Cres (4 cases as of 22 Sep 2016, of which 1 case with onset in the last 2 weeks) 7 Balam Rd (Blk 29) / Circuit Rd (Blk 35) / Jln Raya (3 cases as of 22 Sep 2016, of which 1 case with onset in the last 2 weeks) 8 Sengkang Ctrl (Blk 272C) / Sengkang East Ave (Blk 279C) (2 cases as of 22 Sep 2016, of which 1 case with onset in the last 2 weeks) 9 Hougang Ave 7 (Blk 325) (2 cases as of 22 Sep 2016, of which 1 case with onset in the last 2 weeks)

Case notified on 22 Sep 2016 (as at 3pm) 1 E-week 35 (28 Aug - 3 Sep 2016) E-week 36 (4 Sep - 10 Sep 2016) E-week 37 (11 Sep 2016 - 17 Sep 2016) E-week 38 (18 Sep 2016 - 22 Sep 2016 as at 3pm) 215 103 62 5 http://www.nea.gov.sg/public-health/vector-control/overview/zika-clusters

TABLE I. Provisional cases of selected* infrequently reported notifiable diseases (<1,000 cases reported during the preceding year), United States, week ending September 17, 2016 (WEEK 37)† Disease Total cases reported for previous years Current week Cum 2016 5-year weekly average§ 2015 2014 2013 2012 2011 States reporting cases during current week (No.37) Anthrax - - 0 - - - - 1 Arboviral diseases ¶,**: Chikungunya virus †† - 76 3 896 NN NN NN NN Eastern equine encephalitis virus - 1 1 6 8 8 15 4 Jamestown Canyon virus §§ - 1 - 11 11 22 2 3 La Crosse virus §§ - 10 2 55 80 85 78 130 Powassan virus - 4 0 7 8 12 7 16 St. Louis encephalitis virus - 4 0 23 10 1 3 6 Western equine encephalitis virus - - - - - - - - Botulism, total - 121 3 195 161 152 168 153 foodborne - 29 0 37 15 4 27 24 infant - 78 2 138 127 136 123 97 other(wound & unspecified) - 14 0 20 19 12 18 32 Brucellosis 2 82 2 126 92 99 114 79 MO (1 ), TX (1 ) Chancroid 1 9 0 11 - - 15 8 CO (1 ) Cholera - 1 0 2 5 14 17 40 Cyclosporiasis ** 7 362 6 645 388 784 123 151 NY (2 ), NYC (5 ) Diphtheria - - - - 1 - 1 - Haemophilus influenzae, invasive disease (age <5 yrs) ¶¶: serotype b - 13 1 29 40 31 30 14 nontypeable serotype - 100 2 175 128 141 115 93 other serotype 1 85 2 135 266 233 263 230 TN (1 ) unknown serotype 4 144 3 167 39 34 37 48 NY (1 ), NYC (1 ), VA (1 ), OK (1 ) Hansen's disease ** 2 32 1 89 88 81 82 82 NYC (2 ) Hantavirus Infections **: Hantavirus infection (non-HPS) †† - 2 - 1 NN NN NN NN Hantavirus pulmonary syndrome (HPS) - 11 0 17 32 21 30 23 Hemolytic uremic syndrome, post-diarrheal ** 2 156 8 274 250 329 274 290 ID (1 ), OR (1 ) Hepatitis B, virus infection perinatal 1 17 1 37 47 48 40 NP PA (1 ) Influenza-associated pediatric mortality **, *** - 79 1 130 141 160 52 118 Leptospirosis ** - 27 1 40 38 NN NN NN Listeriosis 9 422 24 766 769 735 727 870 MA (1 ), NY (3 ), OH (2 ), MD (1 ), VA (1 ), FL (1 ) Measles ††† - 52 2 188 667 187 55 220 Meningococcal disease, invasive §§§: serogroup ACWY - 64 2 120 123 142 161 257 serogroup B - 51 1 111 89 99 110 159 other serogroup 1 13 0 21 25 17 20 20 TX (1 ) unknown serogroup 1 129 4 120 196 298 260 323 MD (1 ) Novel influenza A virus infections ¶¶¶ - 21 2 6 3 21 313 14 Plague - - 0 13 10 4 4 3 Poliomyelitis, paralytic - - - - - 1 - - Polio virus infection, nonparalytic ** - - - - - - - - Psittacosis ** 1 4 0 4 8 6 2 2 MD (1 ) Q fever total **: 1 84 3 156 168 170 135 134 acute - 69 2 122 132 137 113 110 chronic 1 15 1 34 36 33 22 24 TX (1 ) Rabies, human - - 0 1 1 2 1 6 SARS CoV - - - - - - - - Smallpox - - - - - - - - Streptococcal toxic shock syndrome ** - 176 3 335 259 224 194 168 Syphilis, congenital **** - 258 8 492 458 348 322 360 Toxic shock syndrome (staphylococcal) ** - 19 2 64 59 71 65 78 Trichinellosis ** - 8 0 11 14 22 18 15 Tularemia 1 134 5 314 180 203 149 166 NE (1 ) Typhoid fever 5 216 9 367 349 338 354 390 NY (1 ), NYC (1 ), OH (1 ), FL (2 ) Vancomycin-intermediate Staphylococcus aureus ** 1 74 4 183 212 248 134 82 NYC (1 ) Vancomycin-resistant Staphylococcus aureus** - - - 1 - - 2 - Viral hemorrhagic Fevers ††††: Crimean-Congo hemorrhagic fever - - - - NP NP NP NP Ebola hemorrhagic fever - - - - 4 NP NP NP Guanarito hemorrhagic fever - - - - NP NP NP NP Junin hemorrhagic fever - - - - NP NP NP NP Lassa fever - - - - 1 NP NP NP Lujo virus - - - - NP NP NP NP Machupo hemorrhagic fever - - - - NP NP NP NP Marburg fever - - - - NP NP NP NP Sabia-associated hemorrhagic fever - - - - NP NP NP NP Yellow fever - - - - - - - - Zika ††,§§§§ Zika virus congenital infection NA NA NA NN NN NN NN NN Zika virus disease, non-congenital infection 3 3,291 - NN NN NN NN NN NYC (1 ), DE (1 ), MD (1 ) [ Export This Table ] [ Next Part ] [ NNDSS Interactive Tables ] [ Mortality Interactive Tables ] -: No reported cases N: Not reportable. NA: Not Available NN: Not Nationally Notifiable. NP: Nationally notifiable but not published. Cum: Cumulative year-to-date counts. * Case counts for reporting years 2015 and 2016 are provisional and subject to change. Data for years 2011 through 2014 are finalized. For further information on interpretation of these data, seehttp://wwwn.cdc.gov/nndss/document/ProvisionalNationaNotifiableDiseasesSurveillanceData20100927.pdf. † This table does not include cases from the U.S. territories. Three low incidence conditions, rubella, rubella congenital, and tetanus, are in Table II to facilitate case count verification with reporting jurisdictions. § Calculated by summing the incidence counts for the current week, the 2 weeks preceding the current week, and the 2 weeks following the current week, for a total of 5 preceding years. Additional information is available athttp://wwwn.cdc.gov/nndss/document/5yearweeklyaverage.pdf. ¶ Includes both neuroinvasive and nonneuroinvasive. Updated weekly reports from the Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (ArboNET Surveillance). Data for West Nile virus are available in Table II. ** Not reportable in all reporting jurisdictions. Data from states where the condition is not reportable are excluded from this table, except for the arboviral diseases and influenza-associated pediatric mortality. Reporting exceptions are available athttp://wwwn.cdc.gov/nndss/downloads.html. †† Office of Management and Budget approval of the NNDSS Revision #0920-0728 on January 21, 2016, authorized CDC to receive data for these conditions. CDC is in the process of soliciting data for these conditions (except Zika virus, congenital infection). CDC and the U.S. states are still modifying the technical infrastructure needed to collect and transmit data for Zika virus congenital infections. §§ Jamestown Canyon virus and Lacrosse virus have replaced California serogroup diseases. ¶¶ Data for Haemophilus influenzae (all ages, all serotypes) are available in Table II. *** Please refer to the MMWR publication for weekly updates to the footnote for this condition. ††† Please refer to the MMWR publication for weekly updates to the footnote for this condition. §§§ Data for meningococcal disease (all serogroups) are available in Table II. ¶¶¶ Please refer to the MMWR publication for weekly updates to the footnote for this condition. **** Updated weekly from reports to the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. †††† Please refer to the MMWR publication for weekly updates to the footnote for this condition. §§§§ All cases reported have occurred in travelers returning from affected areas, with their sexual contacts, or infants infected in utero. National Notifiable Diseases Surveillance System (NNDSS) MMWR web application provided by CDC WONDER, http://wonder.cdc.gov

Zika ††,§§§§ Zika virus congenital infection NA NA NA NN NN NN NN NN Zika virus disease, non-congenital infection 3 3,291 - NN NN NN NN NN NYC (1 ), DE (1 ), MD (1 ) http://wonder.cdc.gov/mmwr/mmwr_2016.asp?mmwr_year=2016&mmwr_week=37&mmwr_table=1&request=Submit&mmwr_location=

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: 10 Miami-Dade County: 6 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 1,034 40 991 3 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 – 4 Investigations Total # of Samples Collected Positive Negative Pending Results 1 0 0 1 Pinellas County – 1 Investigation Total # of Samples Collected Positive Negative Pending Results 67 0 66 1 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 10 Data as of Sep. 21, 2016 - 2:00pm ET http://www.floridahealth.gov/diseases-and-conditions/zika-virus/index.html?utm_source=flhealthIndex&utm_source=PR&PDF

Miami Beach Zika sequences http://recombinomics.co/thedrnimanshow/2016/09/091916.mp3

mp3 discussing Miami Beach Zika sequences http://recombinomics.co/thedrnimanshow/2016/09/091916.mp3

mp3 discussing Miami Beach Zika sequences http://recombinomics.co/thedrnimanshow/2016/09/091916.mp3

mp3 discussing Miami Beach Zika sequences http://recombinomics.co/thedrnimanshow/2016/09/091916.mp3

mp3 discussing Zika sequences http://recombinomics.co/thedrnimanshow/2016/09/091916.mp3

September 21, 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 nine new travel-related cases today with two in Broward, two in Miami-Dade, two in Orange, one in Brevard and two involving pregnant women. Please visit our website to see the full list of travel-related cases. There is one new non-travel related case today 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 678 Non-Travel Related Infections of Zika 89 Infections Involving Pregnant Women 90 Out of State Cases (not Florida Residents) 10 Total 867 The department is currently conducting 10 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 7,853 people statewide. Florida currently has the capacity to test 6,831 people for active Zika virus and 7,996 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 89. 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 6,426 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.

Map Update https://www.google.com/maps/d/edit?hl=en&hl=en&authuser=0&authuser=0&mid=1FlIB7hHnVgGD9TlbSx5HwAj-PEQ

Map Update https://www.google.com/maps/d/edit?hl=en&hl=en&authuser=0&authuser=0&mid=1FlIB7hHnVgGD9TlbSx5HwAj-PEQ

September 21, 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 nine new travel-related cases today with two in Broward, two in Miami-Dade, two in Orange, one in Brevard and two involving pregnant women. Please visit our website to see the full list of travel-related cases. There is one new non-travel related case today 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 678 Non-Travel Related Infections of Zika 89 Infections Involving Pregnant Women 90 Out of State Cases (not Florida Residents) 10 Total 867 The department is currently conducting 10 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 7,853 people statewide. Florida currently has the capacity to test 6,831 people for active Zika virus and 7,996 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 89. 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 6,426 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 21, 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 nine new travel-related cases today with two in Broward, two in Miami-Dade, two in Orange, one in Brevard and two involving pregnant women. Please visit our website to see the full list of travel-related cases. There is one new non-travel related case today 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 678 Non-Travel Related Infections of Zika 89 Infections Involving Pregnant Women 90 Out of State Cases (not Florida Residents) 10 Total 867 The department is currently conducting 10 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 7,853 people statewide. Florida currently has the capacity to test 6,831 people for active Zika virus and 7,996 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 89. 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 6,426 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 nine new travel-related cases today with two in Broward, two in Miami-Dade, two in Orange, one in Brevard and two involving pregnant women. Please visit our website to see the full list of travel-related cases. There is one new non-travel related case today associated with the Miami Beach investigation.

There is one new non-travel related case today associated with the Miami Beach investigation.

Infection Type Infection Count Travel-Related Infections of Zika 678 Non-Travel Related Infections of Zika 89 Infections Involving Pregnant Women 90 Out of State Cases (not Florida Residents) 10 Total 867 http://www.floridahealth.gov/newsroom/2016/09/092116-zika-update.html

Infection Type Infection Count Travel-Related Infections of Zika 678 Non-Travel Related Infections of Zika 89 Infections Involving Pregnant Women 90 Out of State Cases (not Florida Residents) 10 Total 867 http://www.floridahealth.gov/newsroom/2016/09/092116-zika-update.html