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Maryland Confirmed Zika Virus Infections (As of September 7, 2016) Region No. of Confirmed Zika Cases Baltimore Metropolitan (Anne Arundel County, Baltimore City, Baltimore County, Carroll County, Harford County, Howard County) 38 Eastern Shore (Caroline County, Cecil County, Dorchester County, Kent County, Queen Anne's County, Somerset County, Talbot County, Wicomico County, Worcester County) 0 National Capital (Frederick County, Montgomery County, Prince George's County) 45 Southern (Calvert County, Charles County, St. Mary's County) 3 Western (Allegany County, Garrett County, Washington County) 3 TOTAL 89

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The Illinois Department of Public Health is currently reporting 60 cases of Zika virus disease statewide. * http://www.dph.illinois.gov/topics-services/diseases-and-conditions/zikavirus

The Illinois Department of Public Health is currently reporting 60 cases of Zika virus disease statewide. *

Zika Clusters Cases notified on 8 Sep 2016 as at 3pm 9 E-week 35 (28 Aug - 3 Sep 2016) E-week 36 (4 Sep - 8 Sep 2016 at 3pm) 215 77 Number of reported Zika cases will be updated daily when cases are notified. Zika Clusters as of 8 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 / 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) / Sims Dr (Blk 42A,43,44) / Sims Pl (Blk 52,53) (252 cases as of 8 Sep 2016, of which 164 cases with onset in the last 2 weeks) 2 Bedok Nth Ave 2 (Blk 514) / Bedok Nth Ave 3 (404,507) / Bedok Nth St 3 (Blk 525) (4 cases as of 8 Sep 2016, of which 3 cases with onset in the last 2 weeks) 3 Joo Seng Rd (Blk 17, 18, 21) (3 cases as of 8 Sep 2016, of which 3 cases with onset in the last 2 weeks) 4 Bishan St 12 (Blk 122, 123) (4 Cases as of 8 Sep 2016, of which 4 cases with onset in the last 2 weeks) 5 Elite Ter (3 Cases as of 8 Sep 2016, of which 3 cases with onset in the last 2 weeks) 6 Ubi Ave 1, Cres (3 Cases as of 8 Sep 2016, of which 3 cases with onset in the last 2 weeks) http://www.nea.gov.sg/public-health/vector-control/overview/zika-clusters

Joint MOH-NEA statement (9 Sep 2016) Tags: News Highlights Joint MOH-NEA statement (9 September) 1. As of 12pm, 9 September, MOH has confirmed 12 new cases of locally transmitted Zika virus infection in Singapore. Of these, 10 cases are linked to the Aljunied Crescent/ Sims Drive/ Kallang Way/ Paya Lebar Way cluster and one case is linked to the Elite Terrace cluster. The other new case has no known links to any existing cluster. Vector Control Update 2. NEA is continuing with vector control operations and outreach efforts in the cluster areas at Aljunied Crescent/ Sims Drive/ Paya Lebar Way/ Kallang Way/ Circuit Road/ Geylang East Central/ Geylang East Avenue 1; Bedok North Avenue 2/ Bedok North Avenue 3/ Bedok North Street 3; Joo Seng Road; Bishan Street 12; Elite Terrace and Ubi Crescent. As of 8 September 2016, a total of 183 breeding habitats have been found and destroyed in the cluster areas, of which 114 are from homes, and 69 from common areas/other premises. 3. As a continuation from last weekend, outreach activities supporting the Mozzie Wipeout Movement Against Zika will be conducted all over Singapore this weekend to urge all residents to join in the collective effort in the fight against Zika by doing the 5-step Mozzie Wipeout, removing stagnant water and not littering. 4. Members of the public can obtain updated information on Zika and details on current clusters at NEA’s website: www.nea.gov.sg/zika andwww.nea.gov.sg/zika-clusters. 5. Aligned to our dengue control approach, NEA will continue to work with stakeholders and the community to reduce mosquito breeding, as vector control is key to reducing the transmission of Zika in the community. https://www.moh.gov.sg/content/moh_web/home/pressRoom/pressRoomItemRelease/2016/joint-moh-nea-statement--9-sep-2016-.html

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As of Sept. 7, 2016 78 confirmed travel-related Zika cases in Georgia http://dph.georgia.gov/ Confirmed travel-related Zika cases in Georgia (by county) since January 2016 County Number of Travel-Related Zika Cases Barrow < 5 Bibb < 5 Bulloch < 5 Camden < 5 Carroll < 5 Chatham < 5 Cherokee < 5 Clarke < 5 Clayton < 5 Cobb <5 Columbia < 5 DeKalb 10-14 Douglas < 5 Forsyth < 5 Fulton 10-14 Gwinnett 10-14 Hart < 5 Henry < 5 Liberty < 5 Long < 5 Lowndes < 5 Muscogee < 5 Richmond < 5 Rockdale < 5 Thomas < 5 Toombs < 5 Walker < 5 Walton < 5

As of Sept. 7, 2016 78 confirmed travel-related Zika cases in Georgia Confirmed travel-related Zika cases in Georgia (by county) since January 2016 County Number of Travel-Related Zika Cases Barrow < 5 Bibb < 5 Bulloch < 5 Camden < 5 Carroll < 5 Chatham < 5 Cherokee < 5 Clarke < 5 Clayton < 5 Cobb <5 Columbia < 5 DeKalb 10-14 Douglas < 5 Forsyth < 5 Fulton 10-14 Gwinnett 10-14 Hart < 5 Henry < 5 Liberty < 5 Long < 5 Lowndes < 5 Muscogee < 5 Richmond < 5 Rockdale < 5 Thomas < 5 Toombs < 5 Walker < 5 Walton < 5

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http://msdh.ms.gov/msdhsite/_static/resources/6754.pdf Chickasaw 1 DeSoto 1 Harrison 2 Hinds 1 LaFayette 2 Lamar 1 Madison 3 Neshoba 1 Noxubee 1 Oktibbeha 2 Panola 2 Prentiss 1 Rankin 2 Warren 1 21

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County Cases Bell 5 Bexar 10 Brazos 2 Collin 5 Dallas 34 Denton 4 El Paso 3 Ellis 1 Fort Bend 7 Frio 1 Galveston 3 Gray 1 Grayson 1 Gregg 1 Hamilton 1 Harris 49 Jefferson 2 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 168 Dallas Pregnant Registry 18 Texas Preg Reg excl Dallas 28 Total 214

Zika Virus – September 8, 2016. Texas has had 168 reported cases of Zika virus disease. This count includes six 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 5 Bexar 10 Brazos 2 Collin 5 Dallas 34 Denton 4 El Paso 3 Ellis 1 Fort Bend 7 Frio 1 Gray 1 Galveston 3 Grayson 1 Gregg 1 Hamilton 1 Harris 49 Jefferson 2 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 168

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September 8, 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 12 new travel related cases today including three in Miami-Dade, two in Alachua, one in Marion, one in Orange, one in Palm Beach and four involving pregnant women. 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 604 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. The department now has enough information to close the first Palm Beach County investigation. There were no additional infections related to this case. 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 6,321 people statewide. Florida currently has the capacity to test 5,510 people for active Zika virus and 6,340 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 5,702 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 604 Non-Travel Related Infections of Zika 56 Infections Involving Pregnant Women 84 http://www.floridahealth.gov/newsroom/2016/09/090816-zika-update.html

As of September 7, 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 7, 2016. US States Locally acquired mosquito-borne cases reported: 43 Travel-associated cases reported: 2,920 Laboratory acquired cases reported: 1 Total: 2,964 Sexually transmitted: 24 Guillain-Barré syndrome: 7 MAPS OF ZIKA IN THE US More US Territories Locally acquired cases reported: 15,809 Travel-associated cases reported: 60 Total: 15,869* Guillain-Barré syndrome: 31 *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 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) Vermont 7 (<1) 0 (0) Virginia 78 (3) 0 (0) Washington 28 (1) 0 (0) West Virginia 11 (<1) 0 (0) Wisconsin 24 (1) 0 (0) Territories Travel-associated cases* No. (% of cases in territories) (N=60) Locally acquired cases† No. (% of cases in territories) (N=15,809) American Samoa 0 (0) 47 (<1) Puerto Rico 59 (98) 15,541** (98) US Virgin Islands 1 (2) 221 (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 **The Puerto Rico Department of Health is retroactively reporting cases, resulting in larger than normal increases in cases in recent weeks. Page last reviewed: February 4, 2016 Page last updated: September 8, 2016

regnant Women with Any Laboratory Evidence of Possible Zika Virus Infection US States and the District of Columbia* 671 *Includes aggregated data reported to the US Zika Pregnancy Registry as of September 1, 2016 US Territories** 1,080 **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 1, 2016

Pregnancy Outcomes in the United States and the District of Columbia Liveborn infants with birth defects* 17 Includes aggregated data reported to the US Zika Pregnancy Registry as of September 1, 2016 Pregnancy losses with birth defects** 5 Includes aggregated data reported to the US Zika Pregnancy Registry as of September 1, 2016 http://www.cdc.gov/zika/geo/pregnancy-outcomes.html

Reported Cases of Zika in New York City as of 9/2/2016 [Español (PDF)] Positive NYC Residents Case Type Number of Cases Locally acquired mosquito-borne reported† 0 Travel-associated* 510 Sexually transmitted: 5 Guillain-Barre syndrome: 3 Infants with birth defects: 1 Laboratory acquired 0 Pending Verification of Travel 40 Total 550 Gender Number of Cases Female 388 Pregnant: 58 Male 161 Age Average Age (Range) 38 (1-78) Positive NYC Resident by Borough Number of Cases Bronx 193 Brooklyn 135 Manhattan 113 Queens 105 Staten Island 4 Unknown 0 Most Common Countries Visited Number of Cases Dominican Republic 278 Puerto Rico 49 Jamaica 47 Guyana 19 Trinidad and Tobago 18 Grenada 14 Saint Lucia 11 Colombia 10 Saint Vincent and the Grenadines 10 Barbados 8 Mexico 7 Honduras 6 Nicaragua 6 US Virgin Islands 6 †Presumed local mosquito-borne transmission *Travelers returning from affected areas, their sexual contacts, or infants infected in utero

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Current as of September 7, 2016 Table: Travel History of Patients with Positive Test Results by Zika Affected Country or Territory Visited - Connecticut, February 15 - September 7, 2016 Countries/Territories Visited Zika Positive Flavivirus Positive* Total Aruba 1 1 Belize 2 2 Brazil 1 1 Colombia 2 1 3 Dominican Republic 24 4 28 El Salvador 1 1 Guatemala 1 3 4 Haiti 1 3 4 Honduras 2 2 4 Jamaica 8 1 9 Mexico 2 1 3 Nicaragua 2 2 Puerto Rico 23 1 24 St. Lucia 2 2 Trinidad and Tobago 2 2 U.S. Virgin Islands 1 1 Venezuela 1 3 4 Total 73 22 95 *Test results unable to distinguish between Zika virus, a single-stranded RNA virus in the genusFlavivirus, and others that are closely related including dengue, West Nile, Japanese encephalitis, and yellow fever viruses1. A positive test may mean infection with any of these viruses. http://www.ct.gov/dph/cwp/view.asp?a=3136&pm=1&Q=580282

Current as of September 7, 2016 Table: Travel History of Patients with Positive Test Results by Zika Affected Country or Territory Visited - Connecticut, February 15 - September 7, 2016 Countries/Territories Visited Zika Positive Flavivirus Positive* Total Aruba 1 1 Belize 2 2 Brazil 1 1 Colombia 2 1 3 Dominican Republic 24 4 28 El Salvador 1 1 Guatemala 1 3 4 Haiti 1 3 4 Honduras 2 2 4 Jamaica 8 1 9 Mexico 2 1 3 Nicaragua 2 2 Puerto Rico 23 1 24 St. Lucia 2 2 Trinidad and Tobago 2 2 U.S. Virgin Islands 1 1 Venezuela 1 3 4 Total 73 22 95 *Test results unable to distinguish between Zika virus, a single-stranded RNA virus in the genusFlavivirus, and others that are closely related including dengue, West Nile, Japanese encephalitis, and yellow fever viruses1. A positive test may mean infection with any of these viruses. Figure: Number of Patients with Positive Zika Virus Test Result by Test Type and Month of Specimen Collection - Connecticut, February 15 - September 6, 2016