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1-Aug asymp 52 contact 26 2-Aug asymp 52 contact 26 3-Aug asymp 52 contact 26 4-Aug asymp 52 contact 26 5-Aug asymp 52 contact 26 Invest date collect negative positive pending MD1 1-Aug 54 54 0 0 B1 1-Aug 70 70 0 0 Wyn 8-Aug 437 418 11 8 #1 9-Aug 455 424 17 14 10-Aug 498 424 16 46 11-Aug 511 480 19 12 12-Aug 517 492 21 4 15-Aug 518 492 22 4 16-Aug 518 492 22 4 17-Aug 518 492 23 4 18-Aug 519 492 23 4 19-Aug 519 492 23 4 22-Aug 519 492 23 4 23-Aug 519 492 29 0 24-Aug 519 492 27 0 25-Aug 519 492 27 0 26-Aug 519 492 26 0 MD2 5-Aug 11 #2 8-Aug 19 16 0 3 9-Aug 19 16 0 3 10-Aug 19 18 0 1 11-Aug 19 18 0 1 12-Aug 19 19 0 0 15-Aug 21 19 0 2 16-Aug 21 19 0 2 17-Aug 21 19 0 2 18-Aug 21 19 0 2 19-Aug 21 19 0 2 22-Aug 21 19 0 2 23-Aug 21 19 0 2 24-Aug 21 19 0 2 25-Aug 21 21 0 0 26-Aug 21 21 0 0 PB1 8-Aug 1 0 0 1 #3 9-Aug 1 0 0 1 10-Aug 3 0 0 3 11-Aug 3 2 0 1 12-Aug 3 3 0 0 15-Aug 3 3 0 0 16-Aug 3 3 0 0 17-Aug 3 3 0 0 18-Aug 3 3 0 0 19-Aug 3 3 0 0 22-Aug 3 3 0 0 23-Aug 3 3 0 0 24-Aug 3 3 0 0 25-Aug 3 3 0 0 26-Aug 3 3 0 0 MD3 17-Aug 0 #4 18-Aug 0 19-Aug 0 22-Aug 0 23-Aug 0 24-Aug 0 25-Aug 0 26-Aug 0 MD4 15-Aug 5 1 0 4 #5 16-Aug 5 1 0 4 17-Aug 6 1 0 5 18-Aug 6 1 0 5 19-Aug 6 1 0 5 22-Aug 6 1 0 5 23-Aug 6 1 0 5 24-Aug 6 1 0 5 25-Aug 6 1 0 5 26-Aug 6 1 0 5 MD5 17-Aug 2 0 0 2 #6 18-Aug 2 0 0 2 19-Aug 2 0 0 2 22-Aug 8 6 0 2 23-Aug 26 6 0 20 24-Aug 27 24 0 3 25-Aug 27 24 0 3 26-Aug 27 24 0 3 MD6 17-Aug 18-Aug 19-Aug 22-Aug comb MD7 18-Aug 0 #7 19-Aug 0 22-Aug 0 23-Aug 0 24-Aug 0 25-Aug 0 26-Aug MD8 18-Aug 19-Aug MB 22-Aug comb 5 #8 23-Aug 0 24-Aug 0 25-Aug 97 0 0 97 26-Aug 97 0 0 97 MD9 19-Aug 22-Aug comb PIN 23-Aug 3 0 0 3 #9 24-Aug 3 0 0 3 25-Aug 3 0 0 3 26-Aug 21 3 0 18 PB2 24-Aug 0 #10 25-Aug 0 26-Aug 5 0 0 5

ACTIVE INVESTIGATIONS The department is currently conducting 10 active investigations. 1) Identified one-square mile in Miami-Dade – Two (2) original cases Total # of Samples Collected Negative Samples Positive Samples Pending Results 519 492 26 0 Door to door outreach and sampling continue. Mosquito abatement and reduction activities are on-going. The department has cleared three portions within the one-square mile as no additional people tested positive in those areas. The CDC continues to monitor the area per their guidelines. 2) First Miami-Dade investigation outside of Wynwood: One (1) case Total # of Samples Collected Negative Samples Positive Samples Pending Results* 21 21 0 0 *Awaiting confirmatory testing from CDC to rule out infection. 3) One (1) case in Palm Beach County: Total # of Samples Collected Negative Samples Positive Samples Pending Results 3 3 0 0 4) Second Miami-Dade investigation outside of Wynwood: One (1) case The investigation is beginning in this area in Miami-Dade County. Mosquito abatement and reduction activities will take place around the area of interest. 5) Third Miami-Dade investigation outside of Wynwood: One (1) case Total # of Samples Collected Negative Samples Positive Samples Pending Results 6 1 0 5 6) Fourth Miami-Dade investigation outside of Wynwood: One (1) case Total # of Samples Collected Negative Samples Positive Samples Pending Results 27 24 0 3 7) Sixth Miami-Dade investigation outside of Wynwood: One (1) case The investigation is beginning in this area in Miami-Dade County. Mosquito abatement and reduction activities will take place around the area of interest 8) Miami-Beach Investigation: Five index cases, 3 are out of state The investigation is beginning in this area in Miami-Dade County. Mosquito abatement and reduction activities will take place around the area of interest Total # of Samples Collected Negative Samples Positive Samples Pending Results 97 0 0 97 9) Pinellas Investigation: One (1) case Total # of Samples Collected Negative Samples Positive Samples Pending Results 21 3 0 18 10) Second Palm Beach County Investigation: One (1) case Total # of Samples Collected Negative Samples Positive Samples Pending Results 5 0 0 5 CLOSED INVESTIGATIONS The department has closed out the investigations into the first cases in Miami-Dade and Broward County (two cases). On Aug. 23, the department had enough information to close two of the ongoing investigations in Miami-Dade County, both were determined to be single cases with no additional transmission or linkage to areas of active transmission. Data as of Aug. 26, 2016 - 3:09pm EST

August 26, 2016 http://www.floridahealth.gov/newsroom/2016/08/082616-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. There are 15 new travel related cases today, three in Broward, three in Pinellas, one in Collier, one in Hillsborough, one in Orange, one in Sarasota and five 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. The department learned from its ongoing investigation that one of the individuals initially classified as a locally acquired case in the Wynwood area, had recent travel outside the U.S. to an area with widespread, ongoing Zika transmission. Therefore, our non-travel related case count has decreased by one, to 42, and our travel-associated case count has increased by one. 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 545 Non-Travel Related Infections of Zika 42 Infections Involving Pregnant Women 75 The department is currently conducting 10 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 4,110 people statewide. Florida currently has the capacity to test 6,253 people for active Zika virus and 2,936 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 75. 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 4,910 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 545 Non-Travel Related Infections of Zika 42 Infections Involving Pregnant Women 75

Note astrisk on pending column ACTIVE INVESTIGATIONS The department is currently conducting 10 active investigations. 1) Identified one-square mile in Miami-Dade – Two (2) original cases Total # of Samples Collected Negative Samples Positive Samples Pending Results 519 492 27 0 Door to door outreach and sampling continue. Mosquito abatement and reduction activities are on-going. The department has cleared three portions within the one-square mile as no additional people tested positive in those areas. The CDC continues to monitor the area per their guidelines. 2) First Miami-Dade investigation outside of Wynwood: One (1) case Total # of Samples Collected Negative Samples Positive Samples Pending Results* 21 21 0 0 *Awaiting confirmatory testing from CDC to rule out infection. 3) One (1) case in Palm Beach County: Total # of Samples Collected Negative Samples Positive Samples Pending Results 3 3 0 0 4) Second Miami-Dade investigation outside of Wynwood: One (1) case The investigation is beginning in this area in Miami-Dade County. Mosquito abatement and reduction activities will take place around the area of interest. 5) Third Miami-Dade investigation outside of Wynwood: One (1) case Total # of Samples Collected Negative Samples Positive Samples Pending Results 6 1 0 5 6) Fourth Miami-Dade investigation outside of Wynwood: One (1) case Total # of Samples Collected Negative Samples Positive Samples Pending Results 27 24 0 3 7) Sixth Miami-Dade investigation outside of Wynwood: One (1) case The investigation is beginning in this area in Miami-Dade County. Mosquito abatement and reduction activities will take place around the area of interest 8) Miami-Beach Investigation: Five index cases, 3 are out of state The investigation is beginning in this area in Miami-Dade County. Mosquito abatement and reduction activities will take place around the area of interest Total # of Samples Collected Negative Samples Positive Samples Pending Results 97 0 0 97 9) Pinellas Investigation: One (1) case Total # of Samples Collected Negative Samples Positive Samples Pending Results 3 0 0 3 10) Second Palm Beach County Investigation: One (1) case The investigation is beginning in Palm Beach County. Mosquito abatement and reduction activities will take place around the area of interest. CLOSED INVESTIGATIONS The department has closed out the investigations into the first cases in Miami-Dade and Broward County (two cases). On Aug. 23, the department had enough information to close two of the ongoing investigations in Miami-Dade County, both were determined to be single cases with no additional transmission or linkage to areas of active transmission. Data as of Aug. 25, 2016 - 6:15pm EST

Zika Virus – August 26, 2016. Texas has had 130 reported cases of Zika virus disease. This count includes three 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 4 Bexar 8 Brazos 1 Collin 3 Dallas 30 Denton 4 El Paso 2 Ellis 1 Fort Bend 6 Frio 1 Gray 1 Galveston 2 Grayson 1 Greg 1 Hamilton 1 Harris 34 Jefferson 1 Lubbock 1 Matagorda 1 Medina 1 Midland 1 Palo Pinto 1 Randall 1 Tarrant 14 Travis 3 Val Verde 1 Walker 1 Williamson 3 Wise 1 Total 130 Note: Zika case data for Texas will be updated each weekday no later than 11 a.m.

FDA Advises Zika Screening for All US Blood Centers By MATTHEW PERRONE, AP HEALTH WRITER WASHINGTON — Aug 26, 2016, 11:14 AM ET ABCNews.com SHARE Email The Food and Drug Administration wants all U.S. blood centers to start screening for Zika, a major expansion intended to protect the nation's blood supply from the mosquito-borne virus. The new advisory means all U.S. states and territories will need to begin testing blood donations for Zika. Previously, the FDA had limited the requirement to Puerto Rico and two Florida counties. "There is still much uncertainty regarding the nature and extent of Zika virus transmission," said Dr. Peter Marks, director of the FDA's biologic products center, in an agency release. "At this time, the recommendation for testing the entire blood supply will help ensure that safe blood is available for all individuals who might need transfusion." Blood collection sites already test donations for HIV, hepatitis, West Nile virus and other blood-borne viruses. FDA officials said Zika testing is already underway in Puerto Rico and parts of Florida, where "it has shown to be beneficial in identifying donations infected with Zika virus." The FDA has authorized use of two experimental blood-screening tests for Zika, one made by Roche and another from Hologic Inc. Several testing sites are already voluntarily using the technology, including blood centers in Texas. The cost of adding Zika testing to the blood screening process is less than $10, according to officials at South Texas Blood and Tissue Center. Since February, U.S. blood centers have been turning away people who have recently traveled to areas with Zika outbreaks, under a previous FDA directive. Zika is spread primarily by mosquito bites, as well as sex. There have been cases of Zika transmission through blood transfusion in Brazil. The FDA works with other federal agencies to set standards for screening, testing and handling blood donations. Last month, blood centers in Miami and Fort Lauderdale had to halt donations until they could begin screening each unit of blood. The order followed now-confirmed reports of local Zika transmission in the Miami area — the first in the continental U.S. Puerto Rico suspended blood donations and imported blood products in March until the island began screening its blood. Friday's announcement follows recent pressure from members of Congress urging the FDA to expand Zika screening. "We must implement widespread universal screening now to prevent any further contamination of the blood supply before it occurs and to pre-empt a widespread shortfall in the blood supply," stated Reps. Lloyd Doggett, D-Texas, Patrick Murphy, D-Fla. and a half-dozen other House members, in a letter to the FDA earlier this month. The Zika virus causes only a mild illness in most people, but scientists have confirmed that infection during pregnancy can lead to severe brain-related birth defects. The tropical mosquito that spreads Zika and other viruses is found in the southern U.S. While health officials have predicted that mosquitoes in the continental U.S. would begin spreading Zika this summer, they also have said they expect only isolated clusters of infections and not widespread outbreaks. So far, there have been about 40 cases of homegrown Zika in Florida. http://abcnews.go.com/US/wireStory/fda-advises-zika-screening-us-blood-centers-41670193

All U.S. Blood Donations Should Be Screened For Zika, FDA Says Facebook Twitter Google+ Email August 26, 201611:06 AM ET JOE NEEL The FDA says that facilities that collect blood donations throughout the United States should be testing donations for Zika within 12 weeks. Toby Talbot/AP The Food and Drug Administration is recommending that blood banks screen all blood donations in the U.S. for the Zika virus. It's a major expansion from a Feb. 16 advisory that limited such screening to areas with active Zika virus transmission. In a statement released Friday, the FDA says all those areas are currently in compliance with blood screening, but that expanded testing is now needed. "As new scientific and epidemiological information regarding Zika virus has become available, it's clear that additional precautionary measures are necessary," the FDA's acting chief scientist, Luciana Borio, said in the statement. The expansion of testing won't happen all at once. The FDA is advising blood establishments in 11 states to begin testing within the next four weeks. Those states include Alabama, Arizona, California, Georgia, Hawaii, Louisiana, Mississippi, New Mexico, New York, South Carolina and Texas. These states are in proximity to areas where Zika is actively spreading via mosquitoes or where there are a significant number of cases related to other exposures, including sexual transmission. Within 12 weeks, blood facilities in all states should be testing donations for Zika, the FDA says. Currently, Zika is being spread by mosquitoes in South Florida, Puerto Rico and the U.S. Virgin Islands, as well as most countries in the Caribbean and Central and South America. There is a total of 2,517 cases of Zika in the U.S. states and D.C., according to the Centers for Disease Control and Prevention, with 9,011 more in U.S. territories. Most of the cases within the U.S. and D.C. are related to travel abroad or sexual transmission. The cases in Puerto Rico and the U.S. Virgin Islands are a mix of travel-related cases and locally acquired infections via mosquitoes or sex. In issuing the new recommendations, the agency noted that 4 out of 5 people infected with Zika virus never develop symptoms. Thus, questions that blood banks routinely ask about the risks of disease might not catch people who have been exposed and who have been infected with the Zika virus. Zika virus infection during pregnancy has caused serious birth defects in a few cases in the U.S. and hundreds of cases in Central and South America where infants have been born with microcephaly, a condition where the brain and skull are malformed. There have been no cases of Zika related to blood transfusions in the U.S., according to the Centers for Disease Control and Prevention. "There is still much uncertainty regarding the nature and extent of Zika virus transmission," says Peter Marks, director of the FDA's Center for Biologics Evaluation and Research. "At this time, the recommendation for testing the entire blood supply will help ensure that safe blood is available for all individuals who might need transfusion." In a news conference Friday, Marks said that there had been one case in Florida where a unit of donated blood was tested and taken out of the blood supply. Other units where Zika is suspected are currently under investigation, he said. http://www.npr.org/sections/health-shots/2016/08/26/491484838/all-u-s-blood-donations-should-be-screened-for-zika-fda-says

FDA recommends screening all blood donations for Zika Doyle Rice, USA TODAY12:05 p.m. EDT August 26, 2016 The FDA recommended expanding the screening process for all blood donations in the U.S.WIBBITZ (Photo: CRISTOBAL HERRERA, EPA) The Food and Drug Administration on Friday recommended expanding the screening process for all blood donations in the U.S. as a precaution against contaminating the blood supply with the mosquito-borne Zika virus. The new recommendation expands the guidance to all U.S. states and territories. Previously, the FDA only advised screening in areas with active Zika cases, such as parts of Florida and throughout Puerto Rico. “At this time, the recommendation for testing the entire blood supply will help ensure that safe blood is available for all individuals who might need transfusion," said Peter Marks, the director of the FDA’s Center for Biologics Evaluation and Research, in a statement. The new order comes in the wake of the first locally acquired Zika cases in the continental U.S. More than 40 people in Miami-Dade and Palm Beach counties in Florida have been diagnosed with the virus since officials announced its appearance there earlier this month. Previously, all cases within the continental U.S. were travel-related. The FDA updated its guidance due to the potential serious health consequences of Zika to pregnant women and children born to women exposed to the virus during pregnancy. The Zika virus is transmitted primarily by the Aedes mosquito but can also be spread by sexual contact. Although most people infected with the virus never develop symptoms, an infection during pregnancy can cause serious birth defects and is associated with other adverse pregnancy outcomes, the FDA warns. Around 2,200 Zika cases have been reported in the continental U.S. and more than 13,000 in Puerto Rico, according to the Centers for Disease Control and Prevention. Most of the cases within the continental U.S. involved individuals who contracted the virus while traveling in another country, while most of the Puerto Rico cases were locally acquired. http://www.usatoday.com/story/news/nation/2016/08/26/fda-blood-donations-zika-virus/89404204/

FDA News Release FDA advises testing for Zika virus in all donated blood and blood components in the US SHARE TWEET LINKEDIN PIN IT EMAIL PRINT For Immediate Release August 26, 2016 Release As a further safety measure against the emerging Zika virus outbreak, today the U.S. Food and Drug Administration issued a revised guidance recommending universal testing of donated Whole Blood and blood components for Zika virus in the U.S. and its territories. “There is still much uncertainty regarding the nature and extent of Zika virus transmission,” said Peter Marks, M.D., Ph.D., director of the FDA’s Center for Biologics Evaluation and Research. “At this time, the recommendation for testing the entire blood supply will help ensure that safe blood is available for all individuals who might need transfusion.” The FDA first issued guidance on Feb. 16 recommending that only areas with active Zika virus transmission screen donated Whole Blood and blood components for Zika virus, use pathogen-reduction devices, or halt blood collection and obtain Whole Blood and blood components from areas of the U.S. without active virus transmission. All areas with active transmission in the U.S. are currently in compliance with this guidance. The revised guidance announced today recommends that all states and U.S. territories screen individual units of donated Whole Blood and blood components with a blood screening test authorized for use by the FDA under an investigational new drug (IND) application, or a licensed test when available. Alternatively, an FDA-approved pathogen-reduction device may be used for plasma and certain platelet products. The FDA is updating its guidance after careful consideration of all available scientific evidence, consultation with other public health agencies, and taking into consideration the potential serious health consequences of Zika virus infection to pregnant women and children born to women exposed to Zika virus during pregnancy. Testing of donated blood is already underway in Florida and Puerto Rico, as well as in other areas, and it has shown to be beneficial in identifying donations infected with Zika virus. Expanded testing will continue to reduce the risk for transmission of Zika virus through the U.S. blood supply and will be in effect until the risk of transfusion transmission of Zika virus is reduced. Zika virus is transmitted primarily by the Aedes mosquito. Zika virus can also be spread by sexual contact. Although 4 out of 5 people infected with Zika virus never develop symptoms, when symptoms do occur they may include fever, arthralgia (joint pain), maculopapular rash (red area with small bumps), and conjunctivitis (red, irritated eyes). In addition, Zika virus infection during pregnancy can cause serious birth defects and is associated with other adverse pregnancy outcomes. “As new scientific and epidemiological information regarding Zika virus has become available, it’s clear that additional precautionary measures are necessary,” said Luciana Borio, M.D., the FDA’s acting chief scientist. “We are issuing revised guidance for immediate implementation in order to help maintain the safety of the U.S. blood supply.” The first local or non-travel related transmission of Zika virus in the U.S. by mosquitoes was reported from Puerto Rico in December 2015; and soon thereafter, local transmission was reported in American Samoa and the U.S. Virgin Islands. In July 2016, the first cases of local or non-travel related transmission of Zika virus in the continental U.S. were reported in Miami-Dade County, Florida. In addition to protecting the nation’s blood supply, the FDA works to protect the safety of our nation’s supply of human cells, tissues, and cellular and tissue-based products; supports the development and availability of diagnostic tests that may be useful for identifying the presence of or prior exposure to the Zika virus; works with commercial and government developers to advance the development of investigational vaccines and therapeutics; and monitors for fraudulent products and false product claims related the Zika virus. The FDA, an agency within the U.S. Department of Health and Human Services, promotes and protects the public health by, among other things, assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

As a further safety measure against the emerging Zika virus outbreak, today the U.S. Food and Drug Administration issued a revised guidance recommending universal testing of donated Whole Blood and blood components for Zika virus in the U.S. and its territories. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm518218.htm

Note "*Awaiting confirmatory testing from CDC to rule out infection" notation on Pending column ACTIVE INVESTIGATIONS The department is currently conducting 10 active investigations. 1) Identified one-square mile in Miami-Dade – Two (2) original cases Total # of Samples Collected Negative Samples Positive Samples Pending Results 519 492 27 0 Door to door outreach and sampling continue. Mosquito abatement and reduction activities are on-going. The department has cleared three portions within the one-square mile as no additional people tested positive in those areas. The CDC continues to monitor the area per their guidelines. 2) First Miami-Dade investigation outside of Wynwood: One (1) case Total # of Samples Collected Negative Samples Positive Samples Pending Results* 21 21 0 0 *Awaiting confirmatory testing from CDC to rule out infection. 3) One (1) case in Palm Beach County: Total # of Samples Collected Negative Samples Positive Samples Pending Results 3 3 0 0 4) Second Miami-Dade investigation outside of Wynwood: One (1) case The investigation is beginning in this area in Miami-Dade County. Mosquito abatement and reduction activities will take place around the area of interest. 5) Third Miami-Dade investigation outside of Wynwood: One (1) case Total # of Samples Collected Negative Samples Positive Samples Pending Results 6 1 0 5 6) Fourth Miami-Dade investigation outside of Wynwood: One (1) case Total # of Samples Collected Negative Samples Positive Samples Pending Results 27 24 0 3 7) Sixth Miami-Dade investigation outside of Wynwood: One (1) case The investigation is beginning in this area in Miami-Dade County. Mosquito abatement and reduction activities will take place around the area of interest 8) Miami-Beach Investigation: Five index cases, 3 are out of state The investigation is beginning in this area in Miami-Dade County. Mosquito abatement and reduction activities will take place around the area of interest Total # of Samples Collected Negative Samples Positive Samples Pending Results 97 0 0 97 9) Pinellas Investigation: One (1) case Total # of Samples Collected Negative Samples Positive Samples Pending Results 3 0 0 3 10) Second Palm Beach County Investigation: One (1) case The investigation is beginning in Palm Beach County. Mosquito abatement and reduction activities will take place around the area of interest. CLOSED INVESTIGATIONS The department has closed out the investigations into the first cases in Miami-Dade and Broward County (two cases). On Aug. 23, the department had enough information to close two of the ongoing investigations in Miami-Dade County, both were determined to be single cases with no additional transmission or linkage to areas of active transmission. http://www.floridahealth.gov/diseases-and-conditions/zika-virus/index.html?utm_source=flhealthIndex Data as of Aug. 25, 2016 - 6:15pm EST

Health officials going door to door in Lake Worth to warn of Zika BY AL PEFLEY THURSDAY, AUGUST 25TH 2016 Zika warning.PNG share now! tweet now! LAKE WORTH (CBS12) — Workers with the Florida Department of Health in Palm Beach County fanned out in a section of Lake Worth Thursday night, to spread the word about a new non-travel related case of zika. The mayor of Lake Worth told CBS12 she’s very concerned about the fact that a Lake Worth woman may have acquired zika from a local mosquito. In the battle to combat Zika, these are the front lines. Workers with the Florida Department of Health are going door to door in a Lake Worth residential neighborhood to warn people about the Zika virus. View image on Twitter View image on Twitter “We just want to let you know the symptoms of Zika. Fever. Red eyes, joint pain,” said one health care worker to a resident. A small army of workers fanned out, trying to reach as many people as possible Thursday night. “We want to make sure that you’re getting rid of all that standing water, like twice a week, okay?” the worker said to a homeowner. At one particular house, they found a place where mosquitoes can breed, a mop bucket partially filled with water in the backyard. So they emptied it. A big part of their job is teaching people about zika. “Zika in itself is kind of a mild illness. But it has very bad effects on pregnant women and their unborn children,” one worker explained to a female resident. “Everybody needs to take precautions not to get bit by mosquitoes,” the worker told her as he handed her some Zika prevention reading material. They’ve come to this neighborhood because it’s not far from where a 24-year-old woman lives who has been confirmed as the second Palm Beach County resident to get Zika through a local mosquito. Some here are taking the zika threat seriously. “I was just talking about it today. I’m very nervous about it actually. With kids especially,” said Amanda Vititoe, a Lake Worth parent of a 2 year old boy. “That’s a very good idea to warn people about zika,” said Ricardo Dyce, Lake Worth resident who lives on the street the Health Department workers visited. “I haven’t been bitten by a mosquito in years. So I myself am not too worried,” said James Malaspino, also a Lake Worth resident. The woman from Lake Worth who has Zika was briefly hospitalized. Health department workers---one city block at a time---want to eliminate the mosquitos here that may be carrying it. View image on Twitter View image on Twitter The Florida Health Department says this was the first night they’ve gone door to door in Lake Worth handing out cans of insect repellent and literature about zika, since the non-travel related case in Lake Worth was announced by the governor Wednesday. They say they’ll be out again Friday and this weekend, depending on what the approaching storm does. http://cbs12.com/news/local/department-of-health-go-door-to-door-in-lake-worth-to-warn-of-zika

Discussion of Lake Worth case and detail on active Florida investigations

1-Aug asymp 52 contact 26 2-Aug asymp 52 contact 26 3-Aug asymp 52 contact 26 4-Aug asymp 52 contact 26 5-Aug asymp 52 contact 26 Invest date collect negative positive pending MD1 1-Aug 54 54 0 0 B1 1-Aug 70 70 0 0 Wyn 8-Aug 437 418 11 8 #1 9-Aug 455 424 17 14 10-Aug 498 424 16 46 11-Aug 511 480 19 12 12-Aug 517 492 21 4 15-Aug 518 492 22 4 16-Aug 518 492 22 4 17-Aug 518 492 23 4 18-Aug 519 492 23 4 19-Aug 519 492 23 4 22-Aug 519 492 23 4 23-Aug 519 492 29 0 24-Aug 519 492 27 0 25-Aug 519 492 27 0 MD2 5-Aug 11 #2 8-Aug 19 16 0 3 9-Aug 19 16 0 3 10-Aug 19 18 0 1 11-Aug 19 18 0 1 12-Aug 19 19 0 0 15-Aug 21 19 0 2 16-Aug 21 19 0 2 17-Aug 21 19 0 2 18-Aug 21 19 0 2 19-Aug 21 19 0 2 22-Aug 21 19 0 2 23-Aug 21 19 0 2 24-Aug 21 19 0 2 25-Aug 21 21 0 0 PB1 8-Aug 1 0 0 1 #3 9-Aug 1 0 0 1 10-Aug 3 0 0 3 11-Aug 3 2 0 1 12-Aug 3 3 0 0 15-Aug 3 3 0 0 16-Aug 3 3 0 0 17-Aug 3 3 0 0 18-Aug 3 3 0 0 19-Aug 3 3 0 0 22-Aug 3 3 0 0 23-Aug 3 3 0 0 24-Aug 3 3 0 0 25-Aug 3 3 0 0 MD3 17-Aug 0 #4 18-Aug 0 19-Aug 0 22-Aug 0 23-Aug 0 24-Aug 0 25-Aug 0 MD4 15-Aug 5 1 0 4 #5 16-Aug 5 1 0 4 17-Aug 6 1 0 5 18-Aug 6 1 0 5 19-Aug 6 1 0 5 22-Aug 6 1 0 5 23-Aug 6 1 0 5 24-Aug 6 1 0 5 25-Aug 6 1 0 5 MD5 17-Aug 2 0 0 2 #6 18-Aug 2 0 0 2 19-Aug 2 0 0 2 22-Aug 8 6 0 2 23-Aug 26 6 0 20 24-Aug 27 24 0 3 25-Aug 27 24 0 3 MD6 17-Aug 18-Aug 19-Aug 22-Aug comb MD7 18-Aug 0 #7 19-Aug 0 22-Aug 0 23-Aug 0 24-Aug 0 25-Aug 0 MD8 18-Aug 19-Aug MB 22-Aug comb 5 #8 23-Aug 0 24-Aug 0 25-Aug 97 0 0 97 MD9 19-Aug 22-Aug comb PIN 23-Aug 3 0 0 3 #9 24-Aug 3 0 0 3 25-Aug 3 0 0 3 PB2 24-Aug 0 #10 25-Aug 0

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

August 25, 2016 Department of Health Daily Zika Update http://www.floridahealth.gov/newsroom/2016/08/Department of Health Daily Zika Update.html 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. There are 11 new travel related cases today, three in Miami-Dade, two in Alachua, two in Orange, one in Duval, one in Monroe, one in Osceola and one in Polk. 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 534 Non-Travel Related Infections of Zika 43 Infections Involving Pregnant Women 70 The department is currently conducting 10 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 4,020 people statewide. Florida currently has the capacity to test 6,381 people for active Zika virus and 3,124 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 70. 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 4,805 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 534 Non-Travel Related Infections of Zika 43 Infections Involving Pregnant Women 70

By Associated Press | Posted: Thu 9:53 AM, Aug 25, 2016 By: Associated Press LAKE WORTH, Fla. (AP) -- Officials say a second person in Palm Beach County, Florida, has contracted the Zika virus through a local mosquito. Florida's Department of Health said in a statement Wednesday that a 24-year-old Lake Worth woman has been confirmed to have contracted the virus. Officials say the woman was hospitalized last week with classic Zika symptoms that included fever, rash, eye redness and joint pain, but a final diagnosis did not come until Tuesday. The woman says she hasn't traveled outside of the county in months. The number of non-travel related cases in Florida now stands at 43, with the majority having occurred in Miami-Dade County. Palm Beach County is north of Miami. Zika causes a mild illness in most people but can lead to severe brain-related birth defects if women are infected during pregnancy. http://www.wctv.tv/content/news/New-case-of-non-travel-related-Zika-in-Palm-Beach-County-391284792.html

GOV. SCOTT: CDC MUST FULLY FULFILL REQUESTS FOR ZIKA RESOURCES On August 24, 2016, in News Releases, by Staff TALLAHASSEE, Fla. – Today, Governor Rick Scott announced that the Florida Department of Health (DOH) is investigating a new non-travel related case of Zika in Palm Beach County. This case is unrelated to the other non-travel related case announced earlier this month in Palm Beach DOH has begun door-to-door outreach and targeted sampling in Palm Beach County and mosquito abatement and reduction activities are also taking place. DOH still believes ongoing active transmission is only taking place within the small identified areas in Wynwood and Miami Beach in Miami-Dade County. More details will be announced when the investigation concludes. http://www.flgov.com/2016/08/24/gov-scott-cdc-must-fully-fulfill-requests-for-zika-resources/

US States and the District of Columbia* 584 *Includes aggregated data reported to the US Zika Pregnancy Registry as of August 18, 2016 US Territories** 812 **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 August 18, 2016

Outcomes of Pregnancies with Laboratory Evidence of Possible Zika Virus Infection in the United States, 2016 Language: English Español Português Recommend on FacebookTweet Pregnancy Outcomes in the United States and the District of Columbia Liveborn infants with birth defects* 16 Includes aggregated data reported to the US Zika Pregnancy Registry as of August 18, 2016 Pregnancy losses with birth defects** 5 Includes aggregated data reported to the US Zika Pregnancy Registry as of August 18, 2016 Pregnancy Outcomes in the United States Territories Liveborn infants with birth defects* 1 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 August 18, 2016 Pregnancy losses with birth defects** 1 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 August 18, 2016 What these numbers show These numbers reflect poor outcomes among pregnancies with laboratory evidence of possible Zika virus infection reported to these systems. Reported numbers may increase or decrease as preliminary information is clarified. The number of live-born infants and pregnancy losses with birth defects are combined for the 50 US states, the District of Columbia, and the US territories. To protect the privacy of the women and children affected by Zika, CDC is not reporting individual state, tribal, territorial or jurisdictional level data. The poor birth outcomes reported include those that have been detected in infants infected with Zika before or during birth, including 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 brain that affects nerves, muscles and bones, such as clubfoot or inflexible joints, and confirmed hearing loss. What these new numbers do not show These numbers are not real time estimates. They will reflect the outcomes of pregnancies reported with any laboratory evidence of possible Zika virus infection as of 12 noon every Thursday the week prior; numbers will be delayed one week. These numbers do not reflect outcomes among ongoing pregnancies. Although these outcomes occurred in pregnancies with laboratory evidence of Zika virus infection, we do not know whether they were caused by Zika virus infection or other factors. Where do these numbers come from? These data reflect pregnancies reported to the US Zika Pregnancy Registry and the Zika Active Pregnancy Surveillance System. CDC, in collaboration with state, local, tribal and territorial health departments, established these systems for comprehensive monitoring of pregnancy and infant outcomes following Zika virus infection. The data collected through these systems will be used to update recommendations for clinical care, to plan for services and support for pregnant women and families affected by Zika virus, and to improve prevention of Zika virus infection during pregnancy. These registries are covered by an assurance of confidentiality. This protection requires us to safeguard the information collected for the pregnant women and infants in the registries. * 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, and confirmed hearing loss. **Includes miscarriage, stillbirths, and terminations with evidence of the birth defects mentioned above Page last reviewed: June 15, 2016 Page last updated: August 24, 2016

As of August 24, 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 – August 24, 2016. US States Locally acquired mosquito-borne cases reported: 29 Travel-associated cases reported: 2,487 Laboratory acquired cases reported: 1 Total: 2,517 Sexually transmitted: 22 Guillain-Barré syndrome: 7 MAPS OF ZIKA IN THE US More US Territories Locally acquired cases reported: 8,968 Travel-associated cases reported: 43 Total: 9,011* Guillain-Barré syndrome: 26 *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 August 24, 2016)§ States Travel-associated cases* No. (% of cases in states) (N=2,488) Locally acquired cases† No. (% of cases in states) (N=29) Alabama 15 (1) 0 (0) Arizona 20 (1) 0 (0) Arkansas 9 (<1) 0 (0) California 152 (6) 0 (0) Colorado 24 (1) 0 (0) Connecticut 50 (2) 0 (0) Delaware 11 (<1) 0 (0) District of Columbia 11 (<1) 0 (0) Florida 471 (19) 29 (100) Georgia 54 (2) 0 (0) Hawaii 11 (<1) 0 (0) Idaho 1 (<1) 0 (0) Illinois 49 (2) 0 (0) Indiana 28 (1) 0 (0) Iowa 13 (1) 0 (0) Kansas 11 (<1) 0 (0) Kentucky 19 (1) 0 (0) Louisiana 25 (1) 0 (0) Maine 10 (<1) 0 (0) Maryland 77 (3) 0 (0) Massachusetts 63 (3) 0 (0) Michigan 31 (1) 0 (0) Minnesota 31 (1) 0 (0) Mississippi 17 (1) 0 (0) Missouri 20 (1) 0 (0) Montana 4 (<1) 0 (0) Nebraska 7 (<1) 0 (0) Nevada 13 (1) 0 (0) New Hampshire 8 (<1) 0 (0) New Jersey 91 (4) 0 (0) New Mexico 3 (<1) 0 (0) New York 601 (24) 0 (0) North Carolina 35 (1) 0 (0) North Dakota 1 (<1) 0 (0) Ohio 33 (1) 0 (0) Oklahoma 20 (1) 0 (0) Oregon 19 (1) 0 (0) Pennsylvania†† 77 (3) 0 (0) Rhode Island 28 (1) 0 (0) South Carolina 31 (1) 0 (0) South Dakota 1 (<1) 0 (0) Tennessee 35 (1) 0 (0) Texas 125 (5) 0 (0) Utah 7 (<1) 0 (0) Vermont 7 (<1) 0 (0) Virginia 66 (3) 0 (0) Washington 21 (1) 0 (0) West Virginia 11 (<1) 0 (0) Wisconsin 21 (1) 0 (0) Territories Travel-associated cases* No. (% of cases in territories) (N=43) Locally acquired cases† No. (% of cases in territories) (N=8,968) American Samoa 0 (0) 46 (1) Puerto Rico 42 (98) 8,746 (98) US Virgin Islands 1 (2) 176 (2) §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 Page last reviewed: February 4, 2016 Page last updated: August 24, 2016

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As of Thursday, *August 25, 2016, VDH has reported 69 cases of Zika virus disease in Virginia residents to the CDC ( 7 in Northwest Region, 36 in Northern Region, 7 in Eastern Region, 11 in Central Region and 8 in Southwest Region). All Virginia cases are associated with travel to a Zika-affected area http://www.vdh.virginia.gov/zika/zika-virus-update/