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10 more people likely contracted Zika from mosquitoes Governor Rick Scott asks CDC to activate Emergency Response Team By Stacey Readout - Executive producer of digital strategy Posted: 11:17 AM, August 01, 2016Updated: 11:17 AM, August 01, 2016 4 4 TALLAHASSEE, Fla. - Governor Rick Scott confirmed Monday morning that 10 additional people in Florida with the Zika virus likely contracted it through a mosquito bite. This brings the total number of people with locally transmitted Zika to 14. The Florida Department of Health believes that active transmissions of the Zika virus are still only occurring in a small area of Miami-Dade County, just north of downtown, that was announced on Friday. Among the 10 new patients announced Monday, six are asymptomatic and were identified from the door-to-door community survey that DOH is conducting. “Following today’s announcement, I have requested that the CDC activate their Emergency Response Team to assist DOH in their investigation, research and sample collection efforts," said Governor Scott. "Their team will consist of public health experts whose role is to augment our response efforts to confirmed local transmissions of the Zika virus." DOH has conducted testing for the Zika virus for more than 2,300 people statewide. Since DOH began its investigation into possible local transmissions of Zika on July 7th, more than 200 individuals in Miami-Dade and Broward counties have been tested for the virus who live or work near the individuals that have already been confirmed with likely mosquito-borne transmissions. Of the 14 individuals identified, two are women and 12 are men. http://www.news4jax.com/news/florida/10-more-people-likely-contracted-zika-from-mosquitoes

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

Gov. Scott: Florida Calls on CDC to Activate Emergency Response Team Following Confirmed Mosquito-Borne Transmissions On August 1, 2016, in News Releases, by Staff ST. PETERSBURG, Fla. – Today, Governor Rick Scott announced that the Florida Department of Health (DOH) has identified 10 additional people in Florida with the Zika virus who likely contracted it through a mosquito bite. This brings the total number of people with locally transmitted Zika to 14. DOH believes that active transmissions of the Zika virus are still only occurring in the one small area in Miami-Dade County, just north of downtown, that was announced on Friday (see map below). This remains the only area of the state where DOH has confirmed there are ongoing local transmissions of Zika. Among the 10 new individuals announced today, six are asymptomatic and were identified from the door-to-door community survey that DOH is conducting. Following today’s announcement, Governor Scott has called upon the Centers for Disease Control and Prevention (CDC) to activate a CDC Emergency Response Team (CERT) to assist the Florida Department of Health and other partners in their investigation, sample collection, and mosquito control efforts. Governor Scott said, “Today, DOH has confirmed that 10 additional people have contracted the Zika virus locally, likely through a mosquito bite. DOH has been testing individuals in three locations in Miami-Dade and Broward Counties for possible local transmissions through mosquito bites. Based on DOH’s investigations, two locations have been ruled out for possible local transmissions of the Zika virus. DOH believes local transmissions are still only occurring in the same square mile area of Miami. “Following today’s announcement, I have requested that the CDC activate their Emergency Response Team to assist DOH in their investigation, research and sample collection efforts. Their team will consist of public health experts whose role is to augment our response efforts to confirmed local transmissions of the Zika virus. “While we continue to learn more about this virus each day, we know that it is most harmful to pregnant women and their babies. For women who live or work in the impacted area and are either pregnant or thinking of becoming pregnant, I urge you to contact your OB/GYN for guidance and to receive a Zika prevention kit. “Florida has a proven track record of success when it comes to managing similar mosquito-borne viruses. We will continue to keep our residents and visitors safe utilizing constant surveillance and aggressive strategies, such as increased mosquito spraying, that have allowed our state to fight similar viruses. While I encourage all residents and visitors to continue to use precaution by draining standing water and wearing bug spray, Florida remains safe and open for business. This year, we have already welcomed a record 30 million tourists and we look forward to welcoming more visitors to Florida this summer.” DOH has conducted testing for the Zika virus for more than 2,300 people statewide. Since DOH began their investigation into possible local transmissions of Zika on July 7th, more than 200 individuals in Miami-Dade and Broward counties have been tested for the virus who live or work near the individuals that have already been confirmed with likely mosquito-borne transmissions. Of the 14 individuals identified, two are women and 12 are men. The CDC has now issued a notice to women who are pregnant or thinking of becoming pregnant to avoid unnecessary travel to the impacted area that is just north of downtown Miami (see map below of the one square mile area). As directed by Governor Scott last week, DOH has activated the Joint Information Center (JIC) within the State Emergency Operations Center to ensure the impacted area has coordinated access to information and resources. DOH has also begun the process to contract with commercial pest control companies to enhance and expand mosquito mitigation and abatement, including increased spraying, in the impacted area. On February 12th, 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 number for the Zika Virus Information Hotline is 1-855-622-6735. The exact location of where DOH believes there are active transmissions of the Zika virus is within the boundaries of the following area: NW 5th Avenue to the west, US 1 to the east, NW/NE 38thStreet to the north and NW/NE 20th Street to the south. This area is about one square mile and a map is below to detail the area. ###

Today, Governor Rick Scott announced that the Florida Department of Health (DOH) has identified 10 additional people in Florida with the Zika virus who likely contracted it through a mosquito bite. This brings the total number of people with locally transmitted Zika to 14. http://www.flgov.com/2016/08/01/gov-scott-florida-calls-on-cdc-to-activate-emergency-response-team-following-confirmed-mosquito-borne-transmissions/

Press Briefing Transcript Friday, July 29, 2016, at 1:30 P.M. EST Audio recording[MP3, 6.14 MB] Please Note:This transcript is not edited and may contain errors. OPERATOR: thank you for standing by. Today’s conference be begin shortly. Again, thank you for standing by. Today’s conference will begin shortly. OPERATOR: Thank you all for standing by. The conference will begin momentarily as we wait for more to join the conference. Again, today's conference will begin shortly. >>> Thank you for standing by. The conference begins momentarily as we await more participants to join. Again, today's conference will begin shortly. >>> Welcome, and thank you for standing by. Welcome to the Zika conference. You’re in listen only mode until the question and answer session. If you have a question then, press star 1. Today’s update is recorded. if an objection, disconnect at this time. we have the chief media branch, and thank you, ma'am, you may begin. KATHY HARBEN: thank you, holly, and thank you for joining us today for a briefing on Zika. We have Dr. Tom Frieden joining us, director of the CDC and Dr. Marc and that's m-a-r-c, Fischer, f-i-s-c-h-e-r. He’s a Medical officer in CDC’s Arboviral Disease Branch and He’s currently deployed to assist Florida in their Zika investigation. TOM FRIEDEN: Hello, everybody, and apologies for the delayed start. We had a lot of interest in the call so it took a while to get everyone joined in. Thank you for joining. As you know, Governor Rick Scott and the Florida health department announced four cases of Zika infection that are the result of local mosquito-borne transmission, these are first cases reported in the continental United States. We’re working closely with Florida and we've been impressed by the comprehensiveness of their investigation. These cases are not unexpected. At CDC, we've been saying for months based on experience with Chikungunya and Dengue which are viruses spread by the same mosquito that spreads Zika, that individual cases and potentially small clusters of Zika are possible in the U.S. As we have anticipated, Zika is now here. We are proceeding as though the cases are confirmed local Mosquito-borne transmission. To be clear about this because it can be confusing, confirming mosquito-borne transmission is not as easy as confirming infection in a person. Our best evidence would be if we found Zika in one of the Aedes aegypti mosquitos in the area where there are cases reported. But that is very difficult to do, it is like finding a needle in a hay stack. Whether -- if infected mosquitos are not found, that doesn’t imply that it's not spreading by mosquitoes. If they are found that’s highly suggestive. But it’s not expected that we would find infected mosquitoes even if there is spread by mosquitos in that area. The Zika cases are in both Miami-Dade and Broward counties. The Florida Health Department has focused on one small area several blocks just north of downtown Miami where active transmission of Zika appears to have occurred in early July. All the evidence we've seen indicates that this is mosquito-borne transmission that occurred several weeks ago. Importantly, since these infections were diagnosed, Florida has implemented aggressive mosquito control as they do for all the travel associated cases there, of which they have had close to 400. Florida is aggressively working to reduce mosquitos in the area of the reported cases. They’ve been going door-to-door to reduce standing water. They are spraying by truck and backpack both for adult mosquitos and larva mosquitos, and we're coordinating closely with Florida and will continue to support efforts to assess the situation on a daily basis. We at CDC continue to recommend everyone in areas where mosquitos are present, especially pregnant women, take steps to avoid mosquito bites. That means applying Deet repellent every day to exposed areas of skin, on arms, legs, neck, and face. Wearing long sleeves and pants. And staying indoors or in screened areas as often as possible. We at CDC offered Florida supported laboratory testing and vector control as well as other aspects of the investigation and response and we are clear that we are ready to go as soon as they ask. We would not be surprised if additional individual cases are reported. In fact, there may well be more cases we're not aware of right now because most people infected with Zika do not have symptoms. People infected weeks ago may have infections diagnosed as we do, as Florida does, community surveys in the area. If, however, we were to see cases in this area in people infected after the mosquito control efforts were undertaken, this would be a concern and warrant further advice and action. We will continue to update you with what we know, when we know it, and in the meantime, everyone all over the states where Aedes aegypti mosquitos are present, especially pregnant women, should take steps to avoid mosquito bites. We understand that people want more information. We understand that Zika is scary, especially for pregnant women. We wish we had all of the answers, and we know that Florida's working hard to reduce the risk of Zika and protect pregnant women. The bottom line, again, is that Zika is now here. It’s particularly important for pregnant women to avoid mosquito bites in all areas where the Aedes aegypti mosquito is present by using Deet, wearing long sleeves, and avoiding mosquito bites to protect themselves. We’ll now open this up for questions. OPERATOR: Thank you. If you'd like to ask a question press star followed by the number 1 and record your first and last name when prompted so i can introduce your question. one moment, please, for incoming questions. Our first question is from Mike Stobbe with the Associated Press. Go ahead, your line is open. MIKE STOBBE: Hi. Thank you for taking my question. I was wondering a couple of things. Are there plans now to do more active surveillance for cases? i -- please correct me if I’m wrong, but I was under the impression these four cases were identified through past surveillance so will Florida health officials or anyone be going into clinics, hospitals doing more blood testing and I was wondering if you could say more about what areas had this active mosquito eradication, in the Wynnwood area or other areas? Also, do you have any advice for women in the Miami area who are considering conceiving? Should they put that off for some amount of time, or what's your advice? TOM FRIEDEN: thank you. Well, first in terms of active case findings, there are several things that the Florida health department is doing. The first is encouraging doctors to think Zika. People have symptoms that may be consistent with Zika. second in the areas where local mosquito-borne transmission is considered, the Florida health department with CDC input and dr. fischer's presence with the Florida team have done community surveys, knocking on doors, not only to eliminate standing water, but also to ask people to participate in the survey so we might be able to identify if there were other infections through testing there. So that's a form of active surveillance or active monitoring that could help define the area of concern or the extent of the problem. In terms of decisions about whether and when to become pregnant is a highly personal decision. Right now, the area that we're concerned about is a several block area in North Miami and for that area, my understanding is that the Florida health department will recommend that women who are pregnant consider getting a test for Zika even though the odds are low of infection. Always better safe than sorry, always good to be prudent, and I’m sure people want to have that information. They will then have access to it. We provided Florida with test kits and are available if there is a surge in testing requirements to support the needs of people who want to get tested there. Next question. OPERATOR: Our next question is from Eben Brown from Fox News, go ahead, your line is open. EBEN BROWN: Thank you very much for taking the call. We kind of all had known this would happen, and I’m remembering back to the original press call we did about Zika which if I remember was hastily called on a Friday night. Did this happen sooner than was expected, or was everyone ready, sitting around waiting for the first transmission? TOM FRIEDEN: Well, while we can't predict the future, this is really the time when we would expect to see cases. It's the upswing of mosquito season, it’s similar to times when we’ve seen Dengue and Chikungunya in the past and in July and August, so this is the time Frame that we thought would be most likely. EBEN BROWN: Thank you. TOM FRIEDEN: Next question. OPERATOR: Next question from Betsy McKay from the "Wall Street Journal," your line is open. BETSY MCKAY: I had a couple questions. One is, I was wondering if you can shed light why the focus is on the one mile square area, is this a place of residence for the four people? One from Broward county, so they don't live there, but I’m wondering how much time they spent in the area. Second question is, one of the four is a woman. Is she pregnant? TOM FRIEDEN: So for the details of that, I have to refer you to Florida and for situations like, whether someone's pregnant or not, confidentiality often prevents us from discussing that in either direction. The investigations have been of multiple cases that have occurred. Which may represent local transmission on more than one occasion. what's concerning about this particular area is that more than one of the cases were associated with it, and it was their only association and the investigations there identified significant number of mosquitos that can spread Zika. Those conditions were rapidly abated. But that’s why it appears that this is an area where there was some local transmission in early July. BETSY MCKAY: Thanks. TOM FRIEDEN: Thank you. TOM FRIEDEN: Next question. TOM FRIEDEN: Operator next question, please. OPERATOR: Our next question comes from Jon Cohen from Science Magazine. Go ahead, your line is open. JON COHEN: I wanted to follow-up with what Betsy was asking. The -- I think we're very confused when we're told that there were reports of it being both Miami and Miami-Dade and Broward and now just Miami. We have to clarify that or we'll misreport it. i also think it's unusual for us to be told of a restricted area like this for a mosquito-borne virus; regardless of whether it was the Florida department of Health. What does the CDC think of the Florida Department of Health issuing this restricted area in a map? TOM FRIEDEN: Thank you. so first off, residences are in both Miami-Dade and Broward; however, where it appears transmission occurred is in this several block area in Miami, and we are fully in agreement with outlining the area providing it so that there's transparency and people can know and people in the area can help with mosquito abatement, getting rid of standing water, for example, but there’s a very important point here, and I don't know if it's behind your question. There’s a huge difference with mosquito -- between mosquito control for West Nile, which many of you are familiar with, and mosquito control for Zika. With Zika, it's a very focal disease. The Aedes aegypti mosquito does not travel more than about 150 meters in its lifetime – and often quite a bit less than that. In contrast, with West Nile, you have virus circulation within a bird, mosquito population that can cover a large area. That’s a totally different situation from what we have with Zika where it's a focal in areas like this where it's a focal problem that needs to be addressed focally. Does that answer your question? JON COHEN: Well, it's still confusing why a resident in one county would be assumed to have been affected in another county. TOM FRIEDEN: The epidemiologic analysis strongly suggests that the exposure and the infection occurred around the workplace because of the connections between people who don't have other connections. So the Florida investigation identified in the course of their interviewing of patients and assessment of environments, that this location was likely to have been the source for more than one case of Zika spread locally. JON COHEN: Thank you. TOM FRIEDEN: Next question, please. OPERATOR: our next question comes from Dr. John LaPook. Go ahead, your line is open. DR. JOHN LAPOOK: Yeah. Hi, Tom. I have a question. I know that local blood donations have been suspended, but there's a window between when the active infection occurs, several weeks ago and now. So during that window, there was potential for somebody to donate blood and for it to be infected. Have people gone back to look at the blood supply and look at whether there's any evidence of infection? TOM FRIEDEN: Well, first off, my understanding is that the blood bank for the area is beginning testing of blood as of today. In terms of past transfusions, I would have to refer you to the FDA because they have regulatory authority over that. DR. JOHN LAPOOK. Okay, thanks, Tom. TOM FRIEDEN: Thank you. Next question. OPERATOR: Our next question from Elliot Rodriguez with WFOR Miami. Go ahead, your line is open. ELLIOT RODRIGUEZ: Hi, thank you for taking my question. I’m here in Miami, you can imagine how concerned people are about this. I wanted to clear up, you said residences are in Miami-Dade and Broward but these people were infected in Wynnwood –were they at the same place, workplace, I’m fuzzy on that. And also, Wynnwood is a popular restaurant and entertainment district in Miami. Would you recommend people stay away or pregnant women stay away? TOM FRIEDEN: Thank you. The investigation identified more than one individual who appeared to have been infected near each other in that location. In terms of travel into the locations, we don't currently see a situation where we would advise people not to travel there or advise pregnant women not to travel there. If, however, cases were to continue in the area, even after the mosquito control activities had been undertaken, that would be a very different situation, and so at present, we understand that some people may decide not to go there, and that's an individual decision, that they are free to make and they have the information from the Florida Health Department about where the investigation is taking place and where the intensive mosquito control activities are undertaken, but at this point, we do not see an indication to advise people or pregnant women not to travel there. However, anyone there, anyone in Miami, anyone in any city or state where the Aedes aegypti mosquito is present, especially pregnant women, should use Deet, use long sleeves, long pants, and avoid mosquito bites. For pregnant women, that may involve staying indoors, air-conditioning as possible or screened space for as much time as practical. Next question, please. OPERATOR: Our next question comes from Nancy cook with "Politico." Go ahead, your line is open. NANCY COOK: Thank you so much for taking my question. My question on two parts. one, I’m curious about what the delay was, you know, both the press release and you just said Florida has known about this since early July wondering if you could explain to me why we're just now having confirmation of local transmission. And then Two, more broadly, does CDC have a sense of what the time frame that Zika will remain in the U.S. is? is it just a problem for the summer, or do you think it will be a problem that extends into 2017? Thank you. TOM FRIEDEN: So on the first -- let me really clarify this. The individuals appear to have gotten infected in early July. They got sick about a week later. They got diagnosed a couple days later. Immediately after that, Florida did what they do for all of the Zika cases including travel associated. They went to the area, and they began killing mosquitos. That’s the right thing to do. They also, for all of the nearly 400 cases they have had, do a thorough investigation to see, did that person travel, have sexual contact with someone who might have had Zika? Is there another explanation for their Zika infection, and in the cases that Governor Scott mentioned today, they concluded that there was no other explanation except local transmission of Zika, and that conclusion is not simple to make. There’s no simple test for that. Mosquito pools are rarely positive, if they are it’s very helpful, but they’re rarely positive. I think this is a complex investigation, and we'll certainly continue to share information as soon as we have it. In terms of the future, I think every indication is that Zika will continue to spread in parts of Latin America and the Caribbean in future years. It may spread at a different level, it may become more of an endemic than an epidemic situation, but only time will tell. That’s why it's so important we strengthen systems to monitoring for Zika, inform people how to protect themselves, and continue to develop new and better tools to diagnose it and prevent it. Next question. OPERATOR: our next question comes from Pam Belluck with the New York Times. Go ahead, your line is open. PAM BELLUCK: Hi, thanks for taking my question. Just to clarify, you said just a few minutes ago that all the people appeared to have been infected near each other in that location, which I think you were referring to the work place, right? They were all infected near each other? In or near a particular workplace, is that the right way to think of this? TOM FRIEDEN: So, there are details of the investigation to refer you to Florida to address. There are multiple cases that are consistent with local mosquito-borne transmission. Of those cases, at least some of them are associated with the area in the map from the Florida Health Department where there were at least two individuals who were nearby each other and who developed Zika. PAM BELLUCK: And nearby each other as coworkers? TOM FRIEDEN: No. They were in different work sites but close by. PAM BELLUCK: Okay, okay, okay. So the four people are not all related? TOM FRIEDEN: Correct. PAM BELLUCK: Okay. Okay. Thank you. TOM FRIEDEN: Thank you, next question. OPERATOR: Our next question comes from Donald McNeil with The New York Times. Go ahead, your line is open. DONALD MCNEIL: Hi. Back in January when there was local transmission like this, the CDC issued advice saying pregnant women should stay away from entire countries with transmission, and now you're not telling people to stay away from one square mile? This does not seem consistent, and so it looks like bowing into pressure from the Florida tourism industry. why not issue a travel advisory as you did last time? TOM FRIEDEN: it is completely consistent. we issued guidance for Puerto Rico because we anticipated and predicted what has occurred since we predicted it, that there would be widespread explosive spread of Zika in Puerto Rico. what we also said at that time was that there are likely to be isolated cases in the u.s., and there may be occasional clusters in the u.s. we don't expect widespread transmission in the continental u.s. if, however, we were to see continuing spread in this area or somewhere else, or explosive spread, then we would absolutely issue travel guidance. That's not the situation that we're in today, but we will reassess that every single day, and based on what we know now, we are not issuing travel guidance, but that could change depending on events as they occur here and elsewhere in the u.s. We are applying exactly the same standards within the u.s. and outside the u.s. DONALD MCNEIL: well, when is it a precaution just because you don't know if the mosquito killing is effective or not. TOM FRIEDEN>> you know, by that reasoning, donald, you could issue a precaution for all 30 states where the mosquitoes are present because four out of five diagnoses are asymptomatic. we don't know where it's spreading. we are taking a pragmatic approach to support the community and the state and protecting people by providing information and reminding everyone, especially pregnant women, whether or not Zika has been diagnosed in your community, just use insect repellent, wear long sleeves, and avoid mosquito bites. next question, please. >> the next question comes from lena sun from the washington post. go ahead, your line is open. LENA SUN hi. i was wondering if you could elaborate on something. you said that there are multiple cases that are consistent with local mosquito born transmission, and at least some of them were infected in the area on the map, so that -- that's before what governor scot talk about, but how many more cases are we talking about that are locally transmitted? TOM FRIEDEN>> well, as per governor scott's announcement, they identified and confirmed as of today, four cases that are locally transmitted. for details of the investigation, i refer you to Florida, but let me emphasize something. Again, remember that four out of five Zika infections are asymptomatic. So if we find a singleton case of locally transmitted Zika in community X, that doesn't necessarily imply that that community is at any higher risk of Zika than all of the other communities with the mosquitos present because four out of five of them won't be found. as we look back to the other viruses—dengue/chikungunya, the vast majority, nine out of ten or more of the introductions of that virus have been dead ends. They've only infected one person and not resulted in the cluster. We have a small number of clusters identified and investigated in the past in Key West and a couple of communities in texas. Generally, when cases come in, they dead end after infecting one person. that's partly because our environment is not that conducive to mosquitos, partly because people use screens and air-conditioning. For whatever the reason, we don't generally see clusters. here, we are seeing at least two cases associated with a location where there's large number of mosquitos present, mosquito abatement was done immediately after cases were diagnosed even before they were confirmed to be locally transmitted, and the thing we're looking at very carefully here is: is there anyone there who gets Zika after that mosquito control intervention? in that case, it's a different situation. >> okay. thank you. >> thank you, next question. OPERATOR comes from megan rosen with science news. go ahead, your line is open. MEGHAN ROSEN: > thank you for taking my question. you just touch on this a little, but i'm wondering if you can talk about the risk of larger outbreaks given what we already known about local transmission in Florida. TOM FRIEDEN: We’ve learned a lot in recent years about control. there are some environmental situations making it more difficult than others, so in some environments where there's lots of standing water and people don't have screens and air-conditioning, it's much harder to control, especially if people are close together. in other situations, the mosquito is in what is for it a marginal environment where it's harder to survive and easier for us to knock down populations with mosquito control intervention, so this is why we said we believe that widespread transmission in the continental u.s. is unlikely, but it's not impossible. that's why we're aggressively keeping our guard up and investigating every possible incident that may represent widespread transmission. >> thank you. >> next question. OPERATOR: >> kimberly leonard from u.s. news and world report. go ahead, your line is open. KIMBERLY LEONARD: yes, hi, thank you for taking my call. could you explain pretty well for me the needle in the hay stack and how it was difficult to confirm 100% that it was local transmission, but the language in a lot of the releases says likely transmission. does it seem to be it's confirmed? if it's not, are we still considering that Zika might have another mode of transmission, and that's why we use the term "likely"? TOM FRIEDEN: everything we've seen so far indicates this is mosquito-borne transmission. there's not a test to confirm that unless we're lucky enough to find Zika in a mosquito. we are considering this and proceeding as though it is confirmed local mosquito-borne transmission. next question. >> next question from michael with npr.org. your line is open. MICHAELEEN DOUCLEF yeah. I'm wondering if you can talk about the blood supply and testing. do you know if there's enough kits available in the county to test the blood supply, and are counties asking for them? TOM FRIEDEN: there are two kinds of tests here. one is a test of the blood supply, and there are ample tests available to screen blood. The FDA indicated that blood should be screened scene the blood bank that covers the area is, as we understand, has said they will start that today. there's no shortage of kits for blood screening, and the food and drug administration would be the place to go for any follow-up questions about the blood supply. For testing kits, generally, testing people who may have Zika, there's also ample supply for people who are pregnant, have symptoms, or are in the area and have concerns. the tests are provided by CDC or developed by laboratories including the Florida health department and are available through health departments and through clinician offices. we've worked closely with four different commercial laboratories to get a range of tests available in private laboratories to make it easier for patients to get tested, and we hope that in the next few weeks, they'll be able to get that testing started in the commercial laboratories as well. MICHAELEEN DOUCLEF: so right now, the tests are only available through the health department -- TOM FRIEDEN: >> no. People can get tested if they have an indication for testing at any doctor's office. Their doctor's office coordinates with the health department to get the samples sent to where it needs to go to be tested. >> next question, please. >> our next question comes from dan childs. go ahead, your line is open. DAN CHILDS: thank you so much for holding this call. a two-part question. given, as you said, that four and five people who are infected show no symptoms. are there any projections on how many other cases right now there might be that we have not detected, and then, also, the second part of the question is, how close are we to knowing asymptomatic people infected can be receivers of the disease. are there any ongoing studies to help tell us this? TOM FRIEDEN>> so a couple things there. we don't have projections, but, again, we believe that about four out of five people with Zika infection don't have symptoms, so we anticipate there's going to be other infections. after all, individuals who got the infection ultimately got it from a mosquito who got it from another other who had Zika because they traveled somewhere where Zika was spreading. we do know with certainty that people with asymptomatic infections with Zika, women with asymptomatic infections of Zika, can give it to the fetus that can get microcephaly from that asymptomatic infection. We also know with certainty that asymptomatic infection also has virus in the blood and also can result in the spread of Zika through mosquitos. we're not yet certain whether that also holds for the sexual transmission of Zika, which may require a larger inoculant, but we're just not sure. we don't have any reason to think it doesn't, and so we say anyone who traveled to an area where Zika is spreading like latin america and parts of the caribbean, should use a condom until the end of the pregnancy if their partner is pregnant. time for two more questions. >> your line is open. DAN VERGANO>> thank you, can you talk about the status of funding for CDCZika efforts right now, how much cash do you have? when does it run out? how are you doing, basically? TOM FRIEDEN:>> we are doing the best we can with the resources we have available to us, and the authorities available to us. if we had more resources, we would be able to mount a more robust response, and this is certainly an example of why it's so important that as proposed by both houses of congress, both parties, that there be an infectious disease rapid response funds for resources and authorities for rapid action. last question, please. TOM FRIEDEN:>> thank you. so i'll just wrap up here. i do want to correct one thing i said earlier. it is now confirmed that asymptomatic infection can result in sexual spread of Zika from a male partner to a female or to a sexual partner, so that has now been confirmed. we've said from day one that we are learning more about Zika literally every day. we do everything we can to inform the public about that as soon as we learn it. the bottom line here is that Zika is now present in the continental united states. we identified, the Florida health department has identified a small cluster of cases in a several block area just north of downtown Miami. the transmission there appears to have occurred in early july. by mid-july, the health department had already conducted aggressive mosquito control activities there. we continue to monitor the situation on a daily basis, and everyone, particularly pregnant women, anywhere, where the aedes aegypti mosquito is present, should protect themselves against mosquito bites by applying insect repellent, wearing long sleeve shirts and long pants, using or repairing screens on windows and doors, using air-conditioning when available and removing standing water where mosquitos can lay eggs. thank you all very much for joining us today. KATHY HARBEN:>> thank you, doctor Frieden, and also, thank you reporters for joining us. if you have follow-up questions, you can call the press office at 404-639-3286 or you can e-mail us at [email protected]. thank you for joining us. this concludes the call. http://www.cdc.gov/media/releases/2016/t0729-zika-update.html

MC Map Update https://www.google.com/maps/d/u/0/edit?mid=1RcVTrkYW6hax_iITjKUkEcBCVeI

Pregnancy Outcomes in the United States and the District of Columbia Liveborn infants with birth defects* 13 Includes aggregated data reported to the US Zika Pregnancy Registry as of July 21, 2016 Pregnancy losses with birth defects** 6 Includes aggregated data reported to the US Zika Pregnancy Registry as of July 21, 2016 http://www.cdc.gov/zika/geo/pregnancy-outcomes.html

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Zika virus cases in Canada, as of July 29, 2016 Country Acquired through sexual transmission Mother to child transmission Travel-related Canada 1 1 168 http://www.healthycanadians.gc.ca/diseases-conditions-maladies-affections/disease-maladie/zika-virus/surveillance-eng.php?id=zikacases#s1

Zika virus cases in Canada, as of July 29, 2016 Country Acquired through sexual transmission Mother to child transmission Travel-related Canada 1 1 168

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Laboratory-confirmed travel-related cases of Zika virus in Ontario^ as of July 26, 2016 Number of laboratory-confirmed*cases Countries of Travel§ 100* Aruba, Barbados, Brazil, Columbia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Guatemala, Grenada, Guyana, Haiti, Honduras, Jamaica, Martinique, French West Indies, Mexico, Nicaragua, Panama, South Caribbean, Venezuela *Note: One of the 100 laboratory-confirmed cases of Zika virus in Ontario is non-travel related. http://health.gov.on.ca/en/public/publications/disease/zika.aspx

Laboratory-confirmed travel-related cases of Zika virus in Ontario^ as of July 26, 2016 Number of laboratory-confirmed*cases Countries of Travel§ 100* Aruba, Barbados, Brazil, Columbia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Guatemala, Grenada, Guyana, Haiti, Honduras, Jamaica, Martinique, French West Indies, Mexico, Nicaragua, Panama, South Caribbean, Venezuela *Note: One of the 100 laboratory-confirmed cases of Zika virus in Ontario is non-travel related. *Laboratory testing is currently being performed by the National Microbiology Laboratory. §The countries listed are based on the travel history provided by the person tested. In some instances, a person may have travelled to multiple countries prior to infection. The countries listed are based on the travel history provided by cases, however, this listing does not reflect the risk of acquisition of Zika virus. The World Health Organization and the Pan American Health Organization currently list the following countries as having local transmission of Zika virus: American Samoa, Aruba, Barbados, Bolivia (Plurinational State of), Bonaire, Brazil, Cabo Verde, Cambodia, Colombia, Costa Rica, Cuba, Curaçao, Dominica, Dominican Republic, Ecuador, El Salvador, Fiji, French Guiana, French Polynesia, Gabon, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Indonesia, Jamaica, Lao People, Maldives, Marshall Islands, Martinique, Mexico, Nicaragua, Panama, Paraguay, Philippines, Puerto Rico, Saint Martin, Saint Vincent and the Grenadines, Samoa, Saint Maarten, Solomon Islands, Suriname, Thailand, Tonga, Trinidad & Tobago, Vanuatu, Venezuela (Bolivarian Republic of). ^Please note, the ministry will be updating this website each week on Wednesday.

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As of July 29, 2016 in South Carolina: Travel-associated cases reported: 26 Pregnant women: 0 Sexually transmitted: 1* Locally acquired vector-borne cases reported: 0 Total cases: 26 South Carolina has had 26 travel-associated cases of Zika virus. Of those, 25 were in travelers who were infected abroad and diagnosed after they returned home. *One case involved a South Carolina resident who had sexual contact with someone who acquired the Zika infection while traveling abroad. Due to federal privacy restrictions, DHEC is unable to provide additional information concerning any individual, including details about physical condition, hospitalization, age, sex, and residence. http://www.scdhec.gov/Health/DiseasesandConditions/InfectiousDiseases/InsectAnimalBorne/ZikaVirus/

As of July 29, 2016 in South Carolina: Travel-associated cases reported: 26 Pregnant women: 0 Sexually transmitted: 1* Locally acquired vector-borne cases reported: 0 Total cases: 26 South Carolina has had 26 travel-associated cases of Zika virus. Of those, 25 were in travelers who were infected abroad and diagnosed after they returned home. *One case involved a South Carolina resident who had sexual contact with someone who acquired the Zika infection while traveling abroad. Due to federal privacy restrictions, DHEC is unable to provide additional information concerning any individual, including details about physical condition, hospitalization, age, sex, and residence.

Mosquitoes likely transmitted Zika to people in this Miami neighborhood, according to the Florida health department. Florida Department of Health Zika has gained a foothold in Florida but is unlikely to become widespread in the United StatesBy Jon CohenJul. 29, 2016 , 3:00 PM It’s little surprise that the Florida Department of Health confirmed this morning that there’s a “high likelihood” that local transmission of Zika has occurred in the United States for the first time, says Anthony Fauci, head of the U.S. National Institute of Allergy and Infectious Diseases in Bethesda, Maryland. “I can tell you right here today I’m almost certain that we’re going to see more,” Fauci said this morning at an event held by the Bipartisan Policy Center in Washington, D.C. “The critical issue is how do you respond to that.” The four cases appear to have been infected in early July just north of downtown Miami in an area of about 2.5 square kilometers, the Florida health department reported after doing intensive investigations to rule out the possibility that the patients were infected by traveling to affected countries or via sex with infected people. The department released a map featuring a rectangle where transmission has likely occurred—an area whose boundaries are "NW 5th Avenue to the west, US 1 to the east, NW/NE 38th Street to the north and NW/NE 20th Street to the south," the department says. At a press conference held by the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta later in the day, CDC Director Tom Frieden explained that the area had high levels of the Aedes aegypti mosquito, a species known to spread the Zika virus, although no infected mosquitoes have yet been found. The four infected live in both Miami-Dade and Broward counties, but Frieden noted that at least two worked in the area inside the rectangle. He went further than the Florida health department when asked about his level of certainty that these cases are truly local transmission. “We consider this and are proceeding as though it is confirmed local, mosquito-borne transmission,” he said. Scientists had predicted that Zika would gain a foothold in Florida this year, based on the heavy volume of travel from Latin America and the presence of A. aegyptimosquitoes that can transmit the virus. There have already been nearly 400 cases of travel-related, or "imported" Zika in Florida, which increased the odds that a mosquito would bite an infected person and transmit it to others. Indeed, imported cases were increasing at such a fast clip that “I had to revise my slide twice a day,” Fauci said. (Another city that scientists say is likely to see local Zika transmission is Brownsville, Texas, which also has large populations of A. aegypti and a very busy border crossing with Mexico.) Models suggest that the cases don't forebode a big epidemic in the United States. Other viral diseases spread by the same mosquitoes—including dengue and chikungunya—that have caused massive epidemics south of the U.S. border have triggered only small outbreaks in the United States. Scientists cite a variety of factors for the marked difference, including lower mosquito densities and the fact that people spend more time inside. “Very aggressive mosquito abatement” in Florida and other states will also help make it “unlikely” that the continental United States would see a big epidemic, Fauci said. “That doesn’t mean we should relax and be cavalier,” he added. “We’ve got to be very aggressive about the things that you do to prevent mosquito transmission. You get rid of the mosquitoes, you get rid of their breeding place, and you have the population—particularly pregnant women if they’re living in that area—to protect themselves against mosquitoes.” The four Zika cases in Miami have triggered far more attention than the cases of local dengue and chikungunya transmission, Fauci says. “Hardly anybody paid any attention to it,” he said. “I bet nobody even remembers reading major stories about dengue in Florida or chikungunya in Florida or Texas, but it happened.” Frieden noted that blood banks in the affected area have started to screen for Zika virus infection. He stressed that pregnant women in particular should take precautions, including using insect repellant and long clothing. So far, Congress has not heeded the White House’s call for emergency funding to respond to Zika. “If we had more resources we’d be able to mount a more robust response,” Frieden said. If new money does not surface soon, Fauci warned that human trials of Zika vaccines might be delayed. “I have moved a fair amount of money from other accounts to do what I think is a very proactive, full-court press on the research,” he said. “Nothing has substantially slowed—yet. I am preciously close to the point where I don’t have any money and things are going to start slowing.” Posted in: HealthDOI: 10.1126/science.aag0710 http://www.sciencemag.org/news/2016/07/zika-has-gained-foothold-florida-unlikely-become-widespread-united-states?utm_source=newsfromscience&utm_medium=twitter&utm_campaign=zikafoothold-6153

CDPH Weekly Update on Number of Zika Virus Infections in California July 29, 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 July 29, 2016, there have been 114 travel-associated Zika virus infections in California.  Total infections: 114  Cumulative number of infections in pregnant women: 21*  Cumulative number of infections due to sexual transmission: 1 Zika virus infections in California, 2015-2016§ (as of July 29, 2016) County Travel-associated ¥ Locally acquired † Alameda 9 0 Contra Costa 6 0 Fresno 1 0 Los Angeles 24 0 Marin 1 0 Merced 2 0 Monterey 1 0 Napa 2 0 Orange 9 0 Riverside 1 0 San Bernardino 6 0 San Diego 23** 0 San Francisco 8 0 San Joaquin 3 0 San Mateo 2 0 Santa Clara 7 0 Solano 1 0 Sonoma 2 0 Stanislaus 2 0 Tulare 1 0 Yolo 2 0 Yuba 1 0 Total 114 0 *Local Health Departments and CDPH are monitoring all pregnant women and their infants §Total number includes laboratory-confirmed and probable infections as defined by the CSTE Position Statement ¥Persons exposed through travel to an affected area or contact with a traveler †Presumed local mosquito-borne transmission **Includes one non-resident https://www.cdph.ca.gov/HealthInfo/discond/Documents/TravelAssociatedCasesofZikaVirusinCA.pdf

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--- PRESS RELEASE ---For Immediate Release DCHHS Reports the 21st Zika Virus Case in Dallas County DALLAS (July 29, 2016) – Dallas County Health and Human Services (DCHHS) is reporting the 21st case of Zika virus in Dallas County in 2016. The case was confirmed through testing in the DCHHS lab. DCHHS has submitted the cases for review to the Texas Department of State Health Services. The 29 year-old patient is a resident of Addison who was infected with the virus during recent travel to the Dominican Republic. For medical confidentiality and personal privacy reasons, DCHHS does not provide additional identifying information. While sexual transmission of Zika virus is possible, it is primarily transmitted to people by Aedes species mosquitoes. The most common symptoms of Zika virus are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting several days to a week. DCHHS advises individuals with symptoms to see a healthcare provider if they visited an area where Zika virus is present or had sexual contact with a person who traveled to an area where Zika virus is present. There is no specific medication available to treat Zika virus and there is not a vaccine. The best ways to avoid Zika virus are to avoid mosquito bites and sexual contact with a person who has Zika virus. There are currently no reports of Zika virus being locally-transmitted by mosquitoes in Dallas County. However, imported cases make local spread by mosquitoes possible because the mosquitoes that can transmit the virus are found locally. DCHHS advises recent travelers with Zika virus symptoms as well as individuals diagnosed with the virus to protect themselves from further mosquito bites. # For additional information, contact: YaMonica Sadberry, Administrative [email protected] 214.819.6070 (office) Zachary Thompson, Director 214.755.9299 (cell)

The 29 year-old patient is a resident of Addison who was infected with the virus during recent travel to the Dominican Republic.

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July 29, 2016 DEPARTMENT OF HEALTH RESPONDS TO LOCAL ZIKA CASES http://www.floridahealth.gov/newsroom/2016/07/072916-local-zika.htmlContact:Communications [email protected](850) 245-4111 Tallahassee, Fla.—The Florida Department of Health has gathered enough information as part of its ongoing investigation into non-travel related cases of Zika in Miami-Dade and Broward counties to conclude that a high likelihood exists that four cases are the result of local transmission. At this time, the department believes that active transmission of the Zika virus are occurring in one small area in Miami-Dade County, just north of downtown. The exact location is within the boundaries of the following area: NW 5th Avenue to the west, US 1 to the east, NW/NE 38th Street to the north and NW/NE 20th Street to the south. This area is about 1 square mile and a map is below to detail the area. While no mosquitoes trapped tested positive for the Zika virus, the department believes these cases were likely transmitted through infected mosquitoes in this area. The department is actively conducting door-to-door outreach and urine sample collection in the impacted area and will share more details as they become available. The results from these efforts will help department determine the number of people affected. These local cases were identified by clinicians who brought them to the attention of the department. In addition, blood banks in the area are currently excluding donations from impacted areas until screening protocols are in place. In an effort to keep Florida residents and visitors safe and aware about the status of the Zika virus, the department will continue to issue a Zika virus update each week day at 2 p.m. Updates will include a CDC-confirmed Zika case count by county and information to better keep Floridians prepared. There are three new travel-related cases today in Miami-Dade County. According to CDC, symptoms associated with the Zika virus last between seven to 10 days. CDC recommends that women who are pregnant or thinking of becoming pregnant postpone travel to areas with widespread Zika infection. Florida’s small case cluster is not considered widespread transmission.According to CDC guidance, providers should consider testing all pregnant women with a history of travel to a Zika affected area for the virus. CDC recommends that a pregnant woman with a history of Zika virus and her provider should consider additional ultrasounds. Florida has been monitoring pregnant women with evidence of Zika regardless of symptoms since January. The total number of pregnant women who have been monitored is 55, with 18 having met the previous CDC case definition. The Council of State and Territorial Epidemiologists and CDC released a new case definition for Zika that now includes reporting both asymptomatic and symptomatic cases of Zika. Prior to this change, states reported only symptomatic non-pregnant cases and pregnant cases regardless of symptoms. This change comes as a result of increased availability for testing in commercial laboratories. County Number of Cases (all travel related) Alachua 5 Brevard 8 Broward 55 Charlotte 1 Citrus 2 Clay 3 Collier 4 Duval 6 Escambia 2 Highlands 1 Hillsborough 10 Lake 1 Lee 6 Manatee 1 Martin 1 Miami-Dade 99 Okaloosa 2 Okeechobee 1 Orange 40 Osceola 18 Palm Beach 18 Pasco 6 Pinellas 7 Polk 12 Santa Rosa 1 Seminole 12 St. Johns 3 St. Lucie 1 Volusia 5 Total cases not involving pregnant women 331 Cases involving pregnant women regardless of symptoms* 55 *Counties of pregnant women will not be shared. 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 2,421 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. More Information on DOH action on Zika: On Feb. 3, Governor Scott directed the State Surgeon General to issue a Declaration of Public Health Emergency for the counties of residents with travel-associated cases of Zika.There have been 29 counties included in the declaration– Alachua, Brevard, Broward, Charlotte, Citrus, Clay, Collier, Duval, Escambia, Highlands, Hillsborough, Lake, Lee, Manatee, Martin, Miami-Dade, Okaloosa, Okeechobee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Santa Rosa, Seminole, St. Johns, St. Lucie and Volusia – and will be updated as needed. DOH encourages Florida residents and visitors to protect themselves from all mosquito-borne illnesses by draining standing water; covering their clothing and bare skin with repellent; and covering windows with screens.DOH has a robust mosquito-borne illness surveillance system and is working with CDC, the Florida Department of Agriculture and Consumer Services and local county mosquito control boards to ensure that the proper precautions are being taken to protect Florida residents and visitors.On April 6, Governor Scott and Interim State Surgeon General Dr. Celeste Philip hosted a conference call with Florida Mosquito Control Districts to discuss ongoing preparations to fight the possible spread of the Zika virus in Florida. There were 74 attendees on the call.On May 11, Governor Scott met with federal leaders on the importance of preparing for Zika as we would a hurricane. Governor Scott requested 5,000 Zika preparedness kits from HHS Secretary Sylvia Burwell as well as a plan from FEMA on how resources will be allocated to states in the event an emergency is declared.On June 1, Governor Scott requested for President Obama to provide preparedness items needed in order to increase Florida’s capacity to be ready when Zika becomes mosquito-borne in our state.On June 9, Governor Scott spoke with Health and Human Services Secretary Sylvia Burwell and CDC Director Dr. Tom Frieden on Zika preparedness and reiterated the requests that he has continued to make to the federal government to prepare for the Zika virus once it becomes mosquito-borne in Florida. Governor Scott also requested that the CDC provide an additional 1,300 Zika antibody tests to Florida to allow individuals, especially pregnant women and new mothers, to see if they ever had the Zika virus.On June 23, Governor Scott announced that he will use his emergency executive authority to allocate $26.2 million in state funds for Zika preparedness, prevention and response in Florida.On June 28, the department announced the first confirmed case of microcephaly in an infant born in Florida whose mother had a travel-related case of Zika. The mother of the infant contracted Zika while in Haiti. Following the confirmation of this case, Governor Scott called on CDC to host a call with Florida medical professionals, including OBGYNs and physicians specializing in family medicine, to discuss the neurological impacts of Zika and what precautions new and expecting mothers should take.On July 1, CDC hosted a call with Florida medical professionals, including OB/GYNs, pediatricians and physicians specializing in family medicine, to discuss the neurological impacts of Zika and what precautions new and expecting mothers should take. More than 120 clinicians participated.Florida currently has the capacity to test 6,609 people for active Zika virus and 2,059 for Zika antibodies.Federal Guidance on Zika: According to CDC, Zika illness is generally mild with a rash, fever and joint pain. CDC researchers have concluded that Zika virus is a cause of microcephaly and other birth defects.The FDA released guidance regarding donor screening, deferral and product management to reduce the risk of transfusion-transmission of Zika virus. Additional information is available on the FDA website here.CDC has put out guidance related to the sexual transmission of the Zika virus. This includes CDC recommendation that if you have traveled to a country with local transmission of Zika you should abstain from unprotected sex.For more information on Zika virus, click here. 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.

4 Local Cases + County Number of Cases (all travel related) Alachua 5 Brevard 8 Broward 55 Charlotte 1 Citrus 2 Clay 3 Collier 4 Duval 6 Escambia 2 Highlands 1 Hillsborough 10 Lake 1 Lee 6 Manatee 1 Martin 1 Miami-Dade 99 Okaloosa 2 Okeechobee 1 Orange 40 Osceola 18 Palm Beach 18 Pasco 6 Pinellas 7 Polk 12 Santa Rosa 1 Seminole 12 St. Johns 3 St. Lucie 1 Volusia 5 Total cases not involving pregnant women 331 Cases involving pregnant women regardless of symptoms* 55 *Counties of pregnant women will not be shared