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MIAMI (September 09, 2016) — Today, the Florida Department of Agriculture and Consumer Services announced that it has detected a fourth Zika-positive mosquito pool in the 1.5-square-mile area of Miami Beach where three pools had previously tested positive for Zika. http://www.miamidade.gov/releases/2016-09-09-mayor-statement-miami-beach.asp

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Zika situation report http://who.int/emergencies/zika-virus/situation-report/8-september-2016/en/ 8 September 2016 Zika virus, Microcephaly and Guillain-Barré syndrome Read the full situation report Download the map png, 663kb List of countries and territories reporting mosquito-borne Zika virus transmission (Table 1.) png, 49kb Key updates Countries and territories reporting mosquito-borne Zika virus infections for the first time in the past week: None Malaysia has reported one locally acquired mosquito-borne Zika infection in the past week. Prior to this, the only evidence of Zika in Malaysia had been a scientific publication that had reported a case of Zika infection identified in Germany in an individual with travel history to Malaysia. Countries and territories reporting microcephaly and other central nervous system (CNS) malformations potentially associated with Zika virus infection for the first time in the past week: None Countries and territories reporting Guillain-Barré syndrome (GBS) cases associated with Zika virus infection for the first time in the past week: None The Netherlands reported evidence of person-to-person transmission of Zika virus (probably via a sexual route) for the first time in the past week. Operational updates from the WHO Regional Office for the Americas: WHO convened a workshop in Barbados on clinical management of neurological complications. A technical mission to Brazil by WHO/PAHO for laboratory assessment and strengthening of Zika diagnostic capacity of State laboratories was completed in August. WHO facilitated two meetings in Panama for updating the strategic plan for vector surveillance and control. WHO/PAHO carried out missions to Colombia and El Salvador to organize and help launch “Mosquito Awareness Week”. In Haiti, WHO and the Ministry of Public Health and Population’s Division of Epidemiology, Laboratory and Research (DELR) held three train-the-trainer workshops on epidemiological surveillance of Zika and its complications in August. The results from the sequencing analysis of Zika virus cases in Singapore indicate that the virus belongs to the Asian lineage and likely evolved from the strain that was previously circulating in Southeast Asia. The recent cases in Singapore do not appear to be the result of imported virus from South America. The 2016 Summer Paralympic Games opened in Rio de Janeiro, Brazil, on 7 September. WHO continues to provide technical support to the Ministry of Health to ensure the 2016 Summer Paralympic Games are as safe as possible for all athletes, volunteers, visitors and residents. There is a low, but not zero, risk of Zika transmission in this setting. All persons should continue to follow guidance on avoiding Zika infection. The fourth meeting of the Emergency Committee was held on 1 September 2016. Having considered the evidence presented, the Committee agreed that due to continuing geographic expansion and considerable gaps in understanding of the virus and its consequences, Zika virus infection and its associated congenital and other neurological disorders continues to be a Public Health Emergency of International Concern. Based on a systematic review of the literature, WHO has concluded that Zika virus infection during pregnancy is a cause of congenital brain abnormalities, including microcephaly, and that Zika virus is a trigger of GBS. Revised guidance on the prevention of sexual transmission was published on 6 September 2016.

September 9, 2016 http://www.floridahealth.gov/newsroom/2016/09/090916-zika-update.html 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 12 new travel-related cases today including seven in Miami-Dade, two in Broward, one in Hillsborough, one in Okaloosa and one in Orange. Please visit our website to see the full list of travel-related cases. There are no new non-travel related cases today. 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 616 Non-Travel Related Infections of Zika 56 Infections Involving Pregnant Women 84 The department is currently conducting 13 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 6,507 people statewide. Florida currently has the capacity to test 5,414 people for active Zika virus and 6,208 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 84. 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 5,791 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.

Infection Type Infection Count Travel-Related Infections of Zika 616 Non-Travel Related Infections of Zika 56 Infections Involving Pregnant Women 84

CDPH Weekly Update on Number of Zika Virus Infections in California September 9, 2016 The following table provides the number of travel-associated infections with Zika virus in California residents in 2015 and 2016. CDPH is following CDC testing guidelines. This table is updated every Friday. As of September 9, 2016, there have been 260 travel-associated Zika virus infections in California. • Total infections: 260 • New infections reported this week: 19 • Cumulative number of infections due to sexual transmission: 2 • Cumulative number of infections in pregnant women: 35a o Liveborn infants with birth defects: 2b o Pregnancy losses with birth defects: 0c Zika virus infections in California, 2015-2016d (as of September 9, 2016) County Travel-associated e Locally acquired f Alameda (City of Berkeley) 18g (2) 0 Contra Costa 12 0 Fresno 1 0 Humboldt 1 0 Kern 3 0 Lake 1 0 Los Angeles (City of Long Beach) 68h (1) 0 Marin 4 0 Merced 3 0 Monterey 2 0 Napa 2 0 Orange 18 0 Riverside 7 0 Sacramento 4 0 San Bernardino 9 0 San Diego 36i 0 San Francisco 21 0 San Joaquin 5 0 San Mateo 6 0 Santa Barbara 2 0 Santa Clara 16 0 Santa Cruz 2 0 Solano 1 0 Sonoma 5 0 Stanislaus 2 0 Tulare 3 0 Ventura 3 0 Yolo 4 0 Yuba 1 0 Total 260 0 a Local Health Departments and CDPH are monitoring all pregnant women and their infants b Includes microcephaly, calcium deposits in the brain indicating possible brain damage, excess fluid in the brain cavities and surrounding the brain, absent or poorly formed brain structures, abnormal eye development, or other problems resulting from damage to the brain that affects nerves, muscles and bones, such as clubfoot or inflexible joints. c Includes miscarriage, stillbirths, and terminations with evidence of the birth defects mentioned above d Total number includes laboratory-confirmed and probable infections as defined by the CSTE Position Statement e Persons exposed through travel to an affected area or contact with a traveler f Presumed local mosquito-borne transmission g Includes two residents of the City of Berkeley h Includes one resident of the City of Long Beach I Includes one non-resident https://www.cdph.ca.gov/HealthInfo/discond/Documents/TravelAssociatedCasesofZikaVirusinCA.pdf

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Pennsylvania Blood Tests Submitted for Zika TestingInformation updated Mondays at 2 p.m. Confirmed Infections: 100 Pending Test Results: 59 Last update: 09/05/2016 http://www.health.pa.gov/My Health/Diseases and Conditions/U-Z/Zikavirus/Pages/ZikaVirusHomePage.aspx#.V9L_C5grJgJ

Pennsylvania Blood Tests Submitted for Zika TestingInformation updated Mondays at 2 p.m. Confirmed Infections: 100 Pending Test Results: 59 Last update: 09/05/2016

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Arizona's First Zika Case Recorded in Traveler, read the news release Travel-associated Zika cases confirmed in Arizona: 30 http://www.azdhs.gov/preparedness/epidemiology-disease-control/mosquito-borne/index.php#zika-home

Arizona's First Zika Case Recorded in Traveler, read the news release Travel-associated Zika cases confirmed in Arizona: 30

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States CDC States States States CDC States 1-Sep 1-Sep 2-Sep 6-Sep 7-Sep 8-Sep 8-Sep 1 0 1 1 1 0 1 AK 30 24 31 32 32 24 32 AL 9 9 9 9 9 9 9 AR 26 20 28 28 28 22 28 AZ 189 152 241 241 241 210 241 CA 27 27 27 27 27 27 27 CO 85 52 85 85 85 58 90 CT 12 11 12 12 12 11 12 DE 18 11 22 24 24 11 24 DC 705 507 711 713 732 571 744 FL 69 69 72 77 77 75 78 GA 11 11 11 11 11 11 11 HI 2 2 2 2 2 2 2 ID 59 51 59 59 59 51 65 IL 32 31 32 34 34 32 34 IN 14 14 15 15 15 15 15 IA 15 13 15 15 15 13 15 KS 20 20 20 20 20 20 20 KY 26 26 26 26 26 26 26 LA 85 85 85 85 85 89 89 MD 65 65 65 65 65 67 67 MA 11 11 11 11 11 11 11 ME 43 43 43 43 43 45 45 MI 40 40 40 40 40 39 40 MN 23 23 23 23 23 26 26 MO 18 18 18 18 18 20 21 MS 7 7 7 7 7 7 7 MT 49 48 49 49 49 52 52 NC 3 1 3 3 3 1 3 ND 8 8 8 8 8 8 8 NE 8 8 8 8 8 8 8 NH 120 91 120 122 122 91 122 NJ 3 3 3 3 3 4 4 NM 13 13 13 13 13 14 13 NV 737 625 737 759 759 661 759 NY 42 33 43 43 43 36 43 OH 20 20 20 20 20 20 20 OK 27 19 30 30 32 19 32 OR 95 90 95 95 95 95 95 PA 28 28 28 28 28 29 29 RI 33 31 46 46 46 31 46 SC 1 1 1 1 1 1 1 SD 37 37 37 37 37 38 38 TN 203 136 203 206 206 161 214 TX 10 10 10 10 10 12 12 UT 75 75 75 75 75 78 80 VA 7 7 7 7 7 7 7 VT 36 26 36 36 36 28 37 WA 31 24 37 37 37 24 40 WI 11 11 11 11 11 11 11 WV 3238 2687 3330 3369 3390 2921 3453

County Cases Bell 6 Bexar 10 Brazos 2 Collin 5 Dallas 35 Denton 5 El Paso 3 Ellis 1 Fort Bend 7 Frio 1 Galveston 3 Gray 1 Grayson 1 Gregg 1 Hamilton 1 Harris 51 Jefferson 2 Lee 1 Lubbock 1 Matagorda 1 Medina 1 Midland 1 Montgomery 1 Palo Pinto 1 Randall 1 Tarrant 19 Travis 3 Upshur 1 Val Verde 1 Walker 1 Williamson 5 Wise 1 Total 174 Dallas Pregnant Registry 18 Texas Preg Reg excl Dallas 28 Total 220

Zika Virus – September 9, 2016. Texas has had 174 reported cases of Zika virus disease. This count includes 11 pregnant women, two infants infected before birth, and one person who had sexual contact with a traveler. Texas Zika Cases by County: County Cases Bell 6 Bexar 10 Brazos 2 Collin 5 Dallas 35 Denton 5 El Paso 3 Ellis 1 Fort Bend 7 Frio 1 Gray 1 Galveston 3 Grayson 1 Gregg 1 Hamilton 1 Harris 51 Jefferson 2 Lee 1 Lubbock 1 Matagorda 1 Medina 1 Midland 1 Montgomery 1 Palo Pinto 1 Randall 1 Tarrant 19 Travis 3 Upshur 1 Val Verde 1 Walker 1 Williamson 5 Wise 1 Total 174

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Laboratory-confirmed Zika virus disease cases reported to ArboNET by state or territory — United States, 2015–2016 (as of September 7, 2016)§ States Travel-associated cases* No. (% of cases in states) (N=2,921) Locally acquired cases† No. (% of cases in states) (N=43) Alabama 24 (1) 0 (0) Arizona 22 (1) 0 (0) Arkansas 9 (<1) 0 (0) California 210 (7) 0 (0) Colorado 27 (1) 0 (0) Connecticut 58 (2) 0 (0) Delaware 11 (<1) 0 (0) District of Columbia 11 (<1) 0 (0) Florida 571 (20) 43 (100) Georgia 75 (3) 0 (0) Hawaii 11 (<1) 0 (0) Idaho 2 (<1) 0 (0) Illinois 51 (2) 0 (0) Indiana 32 (1) 0 (0) Iowa 15 (1) 0 (0) Kansas 13 (<1) 0 (0) Kentucky 20 (1) 0 (0) Louisiana 26 (1) 0 (0) Maine 11 (<1) 0 (0) Maryland 89 (3) 0 (0) Massachusetts 67 (2) 0 (0) Michigan 45 (2) 0 (0) Minnesota 39 (1) 0 (0) Mississippi 20 (1) 0 (0) Missouri 26 (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 91 (3) 0 (0) New Mexico 4 (<1) 0 (0) New York 661 (23) 0 (0) North Carolina 52 (2) 0 (0) North Dakota 1 (<1) 0 (0) Ohio 36 (1) 0 (0) Oklahoma 20 (1) 0 (0) Oregon 19 (1) 0 (0) Pennsylvania†† 95 (3) 0 (0) Rhode Island 29 (1) 0 (0) South Carolina 31 (1) 0 (0) South Dakota 1 (<1) 0 (0) Tennessee 38 (1) 0 (0) Texas 161 (6) 0 (0) Utah 12 (<1) 0 (0) http://www.cdc.gov/zika/geo/united-states.html

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Laboratory-confirmed Zika virus disease cases reported to ArboNET by state or territory — United States, 2015–2016 (as of September 7, 2016)§ States Travel-associated cases* No. (% of cases in states) (N=2,921) Locally acquired cases† No. (% of cases in states) (N=43) Alabama 24 (1) 0 (0) Arizona 22 (1) 0 (0) Arkansas 9 (<1) 0 (0) California 210 (7) 0 (0) Colorado 27 (1) 0 (0) Connecticut 58 (2) 0 (0) Delaware 11 (<1) 0 (0) District of Columbia 11 (<1) 0 (0) Florida 571 (20) 43 (100) Georgia 75 (3) 0 (0) Hawaii 11 (<1) 0 (0) Idaho 2 (<1) 0 (0) Illinois 51 (2) 0 (0) Indiana 32 (1) 0 (0) Iowa 15 (1) 0 (0) Kansas 13 (<1) 0 (0) Kentucky 20 (1) 0 (0) Louisiana 26 (1) 0 (0) Maine 11 (<1) 0 (0) Maryland 89 (3) 0 (0) Massachusetts 67 (2) 0 (0) Michigan 45 (2) 0 (0) Minnesota 39 (1) 0 (0) Mississippi 20 (1) 0 (0) Missouri 26 (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 91 (3) 0 (0) New Mexico 4 (<1) 0 (0) New York 661 (23) 0 (0) North Carolina 52 (2) 0 (0) North Dakota 1 (<1) 0 (0) Ohio 36 (1) 0 (0) Oklahoma 20 (1) 0 (0) Oregon 19 (1) 0 (0) Pennsylvania†† 95 (3) 0 (0) Rhode Island 29 (1) 0 (0) South Carolina 31 (1) 0 (0) South Dakota 1 (<1) 0 (0) Tennessee 38 (1) 0 (0) http://www.cdc.gov/zika/geo/united-states.html

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Laboratory-confirmed Zika virus disease cases reported to ArboNET by state or territory — United States, 2015–2016 (as of September 7, 2016)§ States Travel-associated cases* No. (% of cases in states) (N=2,921) Locally acquired cases† No. (% of cases in states) (N=43) Alabama 24 (1) 0 (0) Arizona 22 (1) 0 (0) Arkansas 9 (<1) 0 (0) California 210 (7) 0 (0) Colorado 27 (1) 0 (0) Connecticut 58 (2) 0 (0) Delaware 11 (<1) 0 (0) District of Columbia 11 (<1) 0 (0) Florida 571 (20) 43 (100) Georgia 75 (3) 0 (0) Hawaii 11 (<1) 0 (0) Idaho 2 (<1) 0 (0) Illinois 51 (2) 0 (0) Indiana 32 (1) 0 (0) Iowa 15 (1) 0 (0) Kansas 13 (<1) 0 (0) Kentucky 20 (1) 0 (0) Louisiana 26 (1) 0 (0) Maine 11 (<1) 0 (0) Maryland 89 (3) 0 (0) Massachusetts 67 (2) 0 (0) Michigan 45 (2) 0 (0) Minnesota 39 (1) 0 (0) Mississippi 20 (1) 0 (0) Missouri 26 (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 91 (3) 0 (0) New Mexico 4 (<1) 0 (0) New York 661 (23) 0 (0) North Carolina 52 (2) 0 (0) North Dakota 1 (<1) 0 (0) Ohio 36 (1) 0 (0) Oklahoma 20 (1) 0 (0) Oregon 19 (1) 0 (0) Pennsylvania†† 95 (3) 0 (0) Rhode Island 29 (1) 0 (0) http://www.cdc.gov/zika/geo/united-states.html