niman

Findings Between Jan 15, 2016, and May 2, 2016, we prospectively recruited 32 cases and 62 controls. 24 (80%) of 30 mothers of cases had Zika virus infection compared with 39 (64%) of 61 mothers of controls (p=0·12). 13 (41%) of 32 cases and none of 62 controls had laboratory-confirmed Zika virus infection; crude overall OR 55·5 (95% CI 8·6–∞); OR 113·3 (95% CI 14·5–∞) for seven cases with brain abnormalities; and OR 24·7 (95% CI 2·9–∞) for four cases without brain abnormalities.

Methods We did this case-control study in eight public hospitals in Recife, Brazil. Cases were neonates with microcephaly. Two controls (neonates without microcephaly), matched by expected date of delivery and area of residence, were selected for each case. Serum samples of cases and controls and cerebrospinal fluid samples of cases were tested for Zika virus-specific IgM and by quantitative RT-PCR. Laboratory-confirmed Zika virus infection during pregnancy was defined as detection of Zika virus-specific IgM or a positive RT-PCR result in neonates. Maternal serum samples were tested by plaque reduction neutralisation assay for Zika virus and dengue virus. We estimated crude odds ratios (ORs) and 95% CIs using a median unbiased estimator for binary data in an unconditional logistic regression model. We estimated ORs separately for cases with and without radiological evidence of brain abnormalities.

Background The microcephaly epidemic, which started in Brazil in 2015, was declared a Public Health Emergency of International Concern by WHO in 2016. We report the preliminary results of a case-control study investigating the association between microcephaly and Zika virus infection during pregnancy.

Dr Thalia Velho Barreto de Araújo, PhDPress enter key for correspondence informationPress enter key to Email the author , Prof Laura Cunha Rodrigues, PhD , Prof Ricardo Arraes de Alencar Ximenes, PhD , Demócrito de Barros Miranda-Filho, PhD , Ulisses Ramos Montarroyos, PhD , Ana Paula Lopes de Melo, MSc , Sandra Valongueiro, PhD , Maria de Fátima Pessoa Militão de Albuquerque, PhD , Wayner Vieira Souza, PhD , Cynthia Braga, PhD , Sinval Pinto Brandão Filho, PhD , Marli Tenório Cordeiro, PhD , Enrique Vazquez, PhD , Danielle Di Cavalcanti Souza Cruz, MD , Cláudio Maierovitch Pessanha Henriques, MSc , Luciana Caroline Albuquerque Bezerra, MSc , Priscila Mayrelle da Silva Castanha, PhD , Rafael Dhalia, PhD , Ernesto Torres Azevedo Marques-Júnior, PhD , Prof Celina Maria Turchi Martelli, PhD on behalf of investigators from the Microcephaly Epidemic Research Group the Brazilian Ministry of Health the Pan American Health Organization Instituto de Medicina Integral Professor Fernando Figueirathe State Health Department of Pernambuco† †Investigators contributing on behalf of these organisations are listed at the end of the report Contributors TVBA, CMTM, LCR, RAAX, and DBM-F participated in all phases of the study. All other authors participated in data interpretation and critical revision of the manuscript. All authors approved the final version and agree to be accountable for all aspects of the work. Declaration of interests We declare no competing interests. Contributing investigators Microcephaly Epidemic Research Group: Sergio Souza da Cunha, Carmen Dhalia, Marcela Santos, Fanny Cortes, Marcus K Eder Brazilian Ministry of Health: Wanderson Kleber de Oliveira, Giovanini Evelim Coelho Pan American Health Organization: Juan Jose Cortez-Escalante, Carlos Frederico Campelo de Albuquerque de Melo, Pilar Ramón-Pardo, Sylvain Aldighieri, Jairo Méndez-Rico, Marcos Espinal Instituto de Medicina Integral Professor Fernando Figueira: Leuridan Torres, Adriano Nassri Hazin, Ana Van der Linden, Mônica Coentro State Health Department of Pernambuco: George Santiago Dimech, Romildo Siqueira de Assunção, Patricia Ismael de Carvalho, Valdete Felix Oliveira For further details please see the appendix.

Association between Zika virus infection and microcephaly in Brazil, January to May, 2016: preliminary report of a case-control study http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(16)30318-8/fulltext

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

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 Galveston 6 Gray 1 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 195 Dallas Pregnant Registry 18 Texas Preg Reg excl Dallas 28 Total 241

Zika Virus – September 16, 2016. Texas has had 195 reported cases of Zika virus disease. All the cases were associated with travel to an area where Zika is being spread. This count includes 11 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 6 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 195

Zika Clusters Cases notified on 16 Sep 2016 (as at 3pm) 14 E-week 35 (28 Aug - 3 Sep 2016) E-week 36 (4 Sep - 10 Sep 2016) E-week 37 (11 Sep 2016 - 16 Sep 2016 as at 3pm) 215 103 51 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 16 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 120,121,122,123) / Pipit Rd (Blk 56, 92A) / Sims Dr (Blk 42A,43,44) / Sims Pl (Blk 52,53) (283 cases as of 16 Sep 2016, of which 39 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 16 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 16 Sep 2016, of which 2 cases with onset in the last 2 weeks) 4 Bishan St 12 (Blk 122, 123, 134) (5 cases as of 16 Sep 2016, of which 4 cases with onset in the last 2 weeks) 5 Elite Ter / Fidelio St / Jln Tua Kong (Park East) / Tua Kong Green / Siglap Road (Flamingo Valley) (11 cases as of 16 Sep 2016, of which 9 cases with onset in the last 2 weeks) 6 Ubi Ave 1, Cres (4 cases as of 16 Sep 2016, of which 3 cases with onset in the last 2 weeks) 7 Balam Rd (Blk 29) / Circuit Rd (Blk 35) / Jln Raya (3 cases as of 16 Sep 2016, of which 2 cases with onset in the last 2 weeks) 8 Sengkang Ctrl (Blk 272C) / Sengkang East Ave (Blk 279C) (2 cases as of 16 Sep 2016, of which 2 cases with onset in the last 2 weeks) http://www.nea.gov.sg/public-health/vector-control/overview/zika-clusters

Cases notified on 16 Sep 2016 (as at 3pm) 14 E-week 35 (28 Aug - 3 Sep 2016) E-week 36 (4 Sep - 10 Sep 2016) E-week 37 (11 Sep 2016 - 16 Sep 2016 as at 3pm) 215 103 51 http://www.nea.gov.sg/public-health/vector-control/overview/zika-clusters

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Tonight at 10 PM THURSDAY Dr. Henry L. Niman, PhD Zika Spreading Fast

As of Thursday, *September 15, 2016, VDH has reported 82 cases of Zika virus disease in Virginia residents to the CDC ( 8 in Northwest Region, 41 in Northern Region, 9 in Eastern Region, 13 in Central Region and 11 in Southwest Region). All Virginia cases are associated with travel to a Zika-affected area. http://www.vdh.virginia.gov/zika/zika-virus-update/

As of Thursday, *September 15, 2016, VDH has reported 82 cases of Zika virus disease in Virginia residents to the CDC ( 8 in Northwest Region, 41 in Northern Region, 9 in Eastern Region, 13 in Central Region and 11 in Southwest Region). All Virginia cases are associated with travel to a Zika-affected area.

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

County Cases Angelina 1 Bell 6 Bexar 11 Brazos 3 Burnet 1 Collin 5 Dallas 35 Denton 6 El Paso 3 Ellis 1 Fort Bend 7 Frio 1 Galveston 6 Gray 1 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 192 Dallas Pregnant Registry 18 Texas Preg Reg excl Dallas 28 Total 238

Zika Virus – September 15, 2016. Texas has had 192 reported cases of Zika virus disease. All the cases were associated with travel to an area where Zika is being spread. This count includes 11 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 11 Brazos 3 Burnet 1 Collin 5 Dallas 35 Denton 6 El Paso 3 Ellis 1 Fort Bend 7 Frio 1 Gray 1 Galveston 6 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 192

ACTIVE INVESTIGATIONS The department is conducting 20 active investigations, including 16 in Miami-Dade, one in Pinellas and three in Palm Beach counties. The department 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. The department has closed out seven investigations including five in Miami-Dade County, one in Broward County and one in Palm Beach County. These cases were determined to be single cases with no additional transmission or linkage to areas of active transmission. Data as of Sep. 15, 2016 - 3:30pm ET http://www.floridahealth.gov/diseases-and-conditions/zika-virus/index.html?utm_source=flhealthIndex

September 15, 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 11 new travel-related cases today including eight in Miami-Dade, two in Flagler and one in Lee. This is Flagler County’s first case and the Declaration of Public Health Emergency has been amended to include the county. Please visit our website to see the full list of travel-related cases. There are seven new non-travel related cases today including six in Miami-Dade and one in Palm Beach County. Three individuals are associated with the Miami Beach investigation. Two individuals are in Miami-Dade County and the department is investigating to determine where exposure occurred. One case is a Palm Beach resident, however the individual was likely infected in Miami-Dade County. The department is investigating the case. One individual is an out-of-state visitor who was likely infected in Miami-Dade County and the department is investigating 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 small identified areas in Wynwood and Miami Beach in Miami-Dade County, see maps 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 650 Non-Travel Related Infections of Zika 77 Infections Involving Pregnant Women 86 Out of State Cases (not Florida Residents) 10 Total 823 The department is currently conducting 20 active investigations. The department has closed seven 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 7,117 people statewide. Florida currently has the capacity to test 5,094 people for active Zika virus and 8,516 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 86. 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 6,141 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. State of Florida Miami-Dade County 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 15, 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 11 new travel-related cases today including eight in Miami-Dade, two in Flagler and one in Lee. This is Flagler County’s first case and the Declaration of Public Health Emergency has been amended to include the county. Please visit our website to see the full list of travel-related cases. There are seven new non-travel related cases today including six in Miami-Dade and one in Palm Beach County. Three individuals are associated with the Miami Beach investigation. Two individuals are in Miami-Dade County and the department is investigating to determine where exposure occurred. One case is a Palm Beach resident, however the individual was likely infected in Miami-Dade County. The department is investigating the case. One individual is an out-of-state visitor who was likely infected in Miami-Dade County and the department is investigating 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 small identified areas in Wynwood and Miami Beach in Miami-Dade County, see maps 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 650 Non-Travel Related Infections of Zika 77 Infections Involving Pregnant Women 86 Out of State Cases (not Florida Residents) 10 Total 823 The department is currently conducting 20 active investigations. The department has closed seven 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 7,117 people statewide. Florida currently has the capacity to test 5,094 people for active Zika virus and 8,516 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 86. 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 6,141 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. State of Florida Miami-Dade County 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 15, 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 11 new travel-related cases today including eight in Miami-Dade, two in Flagler and one in Lee. This is Flagler County’s first case and the Declaration of Public Health Emergency has been amended to include the county. Please visit our website to see the full list of travel-related cases. There are seven new non-travel related cases today including six in Miami-Dade and one in Palm Beach County. Three individuals are associated with the Miami Beach investigation. Two individuals are in Miami-Dade County and the department is investigating to determine where exposure occurred. One case is a Palm Beach resident, however the individual was likely infected in Miami-Dade County. The department is investigating the case. One individual is an out-of-state visitor who was likely infected in Miami-Dade County and the department is investigating 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 small identified areas in Wynwood and Miami Beach in Miami-Dade County, see maps 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 650 Non-Travel Related Infections of Zika 77 Infections Involving Pregnant Women 86 Out of State Cases (not Florida Residents) 10 Total 823 The department is currently conducting 20 active investigations. The department has closed seven 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 7,117 people statewide. Florida currently has the capacity to test 5,094 people for active Zika virus and 8,516 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 86. 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 6,141 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. State of Florida Miami-Dade County 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.

One individual is an out-of-state visitor who was likely infected in Miami-Dade County and the department is investigating to determine where exposure occurred.

There are 11 new travel-related cases today including eight in Miami-Dade, two in Flagler and one in Lee.

There are seven new non-travel related cases today including six in Miami-Dade and one in Palm Beach County. Three individuals are associated with the Miami Beach investigation. Two individuals are in Miami-Dade County and the department is investigating to determine where exposure occurred. One case is a Palm Beach resident, however the individual was likely infected in Miami-Dade County. The department is investigating the case. One individual is an out-of-state visitor who was likely infected in Miami-Dade County and the department is investigating to determine where exposure occurred.