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By THOMAS M. BURTON [email protected]@wsj.comUpdated July 28, 2016 4:13 p.m. ET2 COMMENTSWASHINGTON—The U.S. Food and Drug Administration is calling on all blood centers in Miami-Dade County and Broward County in Florida to stop collecting blood until they can test all individual donations for the Zika virus. The agency said it is taking this step, at least temporarily and as a precaution, because Florida authorities are investigating four cases of the Zika virus that aren't travel related. And state officials said those may therefore be the first cases of local Zika transmission by mosquitoes in the continental U.S. The FDA recommended the two South Florida counties take this measure until they can test for the Zika virus on each blood donation or until they use a method to inactivate the virus. The FDA also recommended “adjacent and nearby counties” implement those precautions as soon as possible. From the Archives 0:00 / 0:00 New studies have shed light on how the Zika virus -- which can cause serious birth defects -- may be transmitted from infected mother to unborn child. Image: Dr. Indira U. Mysorekar, Dr. Bin Cao/Washington University (Originally published May 17, 2016)Federal health experts have said they expected continental transmission of the virus in the U.S. to hit this summer. There have been 1,658 Zika cases in the U.S. and 4,750 cases in the U.S. territories as of July 27, according to the Centers for Disease Control and Prevention. The U.S. cases are almost all travel-associated; the territories’ cases are almost all locally acquired. U.S. Surgeon General Vivek Murthy on Thursday said the possibility of local transmission in Miami-Dade and Broward counties made it all the more important that pregnant women take precautions to avoid mosquito bites and that women who were considering whether to get pregnant talk directly with their doctor. “We know each person’s situation is unique and requires a one-on-one assessment,” he said. “At this point we are not recommending a travel restriction to South Florida,” he continued. He said the administration was working with Florida health officials to consider implications of the cases there and to watch for additional ones. Zika has been expected to hit Florida in particular. The CDC reports it had learned of 270 cases of Zika associated with travel as of July 20. Zika is spread by mosquitoes and can cause a birth defect in the form of an abnormally small head if women are pregnant while having the virus. It has also been linked to Guillain-Barré syndrome, a disorder that can cause permanent nerve damage. Congress left Washington for the summer without passing legislation to provide funding to combat the spread of Zika. Democrats balked at a $1.1 billion Republican proposal that would have effectively prevented funding from going to a group that partners with Planned Parenthood in Puerto Rico, which has been hard hit by Zika. President Barack Obama in February had requested about $1.9 billion to fight the spread of the virus. —Louise Radnofsky contributed to this article. Write to Thomas M. Burton at [email protected]

FDA Tells Two South Florida Counties to Stop Blood Donations Over ZikaThe move comes as state authorities investigate cases of the virus that aren’t travel relatedhttp://www.wsj.com/articles/fda-tells-two-south-florida-counties-to-stop-blood-donations-over-zika-1469729921

Florida investigates 2 more suspected local Zika cases Liz Szabo, USA TODAY3:38 p.m. EDT July 28, 2016 0:31 1:34 Fla. Official: Possible Local Zika Transmission Mosquito control officials in Miami brace for the first locally aquired Zika virus transmitted by mosquito. AP (Photo: MARVIN RECINOS, AFP/Getty Images) Florida health officials are going door to door to investigate two more Zika infections that may have been spread by local mosquitoes, bringing the total number of suspected local cases to four. Although officials haven't yet confirmed how the infections were contracted, the spread of Zika among native mosquitoes would be a major change in the course of the disease in the continental U.S., where all cases until now have been linked to travel to Zika-affected regions. The four Florida cases under investigation are in Broward or Miami-Dade counties, according to the state health department. Because of the risk of a local Zika outbreak, the Food and Drug Administration has asked all blood donation centers in Miami-Dade, Broward and surrounding areas to stop accepting blood donations until the blood can be tested for the virus. Blood collection centers across the country also shouldn't accept any blood donations from people who have traveled to Miami-Dade and Broward counties within the past four weeks, the FDA added. There's no need to avoid traveling to south Florida, said Surgeon General Vivek Murthy. That would change if Florida experiences a major Zika epidemic. A plan developed by the Centers for Disease Control and Prevention calls for pregnant women to avoid traveling to areas with "widespread, local and continuous transmission" of Zika. About 1,660 people in the continental U.S. have been diagnosed with Zika after traveling or, in 15 cases, having sex with a traveler, according to the CDC. Both men and women can spread the virus sexually, although the vast majority of infections are caused by mosquito bites. Zika, which can cause devastating birth defects, is spreading much more widely inU.S. territories, with nearly 4,700 cases in Puerto Rico alone. More than 430 pregnant women in the continental U.S. have been diagnosed with Zika, along with 422 in the territories. The actual number of infections could be much higher, said Peter Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine in Houston. Only one in five people with Zika develop symptoms, which include rash, fever, muscle aches and headaches, according to the CDC. So most people with the infection don't know it. Public health departments don't have the money or staff to test everyone for Zika, so many cases are never detected, Hotez said. "Remember for every imported case being reported, there are dozens of others not being reported," Hotez said. "The numbers, I believe, are highly unreliable due to under reporting and under testing." Florida public health staff will collect urine samples from residents to test for the virus as a way to gauge how many people are infected. Health officials also are giving out Zika prevention kits and mosquito repellent. Health officials have warned the virus is likely to spread to the continental U.S., although they've said any outbreaks are likely to be relatively small, given Americans' widespread use of air conditioning and window screens. Even without official confirmation of local Zika spread, "we're treating it as if it's real," said Karen Harris, an obstetrician-gynecologist in Gainesville, Fla., and spokeswoman for the American Congress of Obstetricians and Gynecologists. "That's the safest thing we can do for our patients." Harris and her colleagues posted information about Zika in every exam room at their office. They're also advising pregnant women to use condoms for the duration of their pregnancies in order to prevent Zika infections. "We're telling all of our pregnant patients not to leave the house without mosquito repellent," Harris said. Communities in Florida and Texas have been able to control recent outbreaks of dengue, another mosquito-borne tropical disease, by aggressively killing mosquitoes and removing the standing water where they breed, said Amesh Adalja, a senior associate at the Center for Health Security at the University of Pittsburgh Medical Center. If the four Florida cases were spread by local mosquitoes, Adalja said it would "raise the stakes for pregnant women in Florida, who will have to be meticulous in their avoidance of mosquitoes." Although most Zika infections are mild, the disease can cause miscarriages and catastrophic brain damage in fetuses, according to the CDC. Thirteen American women have had babies with Zika-related birth defects. Seven other women have miscarried or terminated pregnancies because of Zika, including one in Puerto Rico. Because there are no vaccines or treatments for Zika, the CDC cautions people to protect themselves from mosquito bites by wearing long pants and insect repellent when outside, and by emptying standing water around their homes. The agency also warned pregnant women to avoid to areas with Zika outbreaks. Hotez said he wonders why Florida officials are taking so long to confirm whether Zika is spreading locally, given that the first suspected case in a non-traveler was announced a week ago. "The investigation should be very straightforward," he said. The process would including interviewing the four infected people and asking whether they'd traveled to a Zika-infected area in the past month or had sex with someone who traveled to such a region in the past one or two months, Hotez added. "This is not difficult," he said. http://www.usatoday.com/story/news/2016/07/28/florida-investigates-two-more-zika-cases-people-who-havent-traveled/87655028/

Zika Virus – July 28, 2016. Texas has had 80 reported cases of Zika virus disease. This count includes three pregnant women, one infant infected before birth, and one person who had sexual contact with a traveler. Texas Zika Cases by County: CountyCasesBell1Bexar6Collin2Dallas18Denton3Ellis1Fort Bend3Frio1Gray1Grayson1Hamilton1Harris24Lubbock1Medina1Tarrant11Travis2Val Verde1Williamson1Wise1Total

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As of July 28, 2016 in South Carolina: Travel-associated cases reported: 25Pregnant women: 0Sexually transmitted: 1*Locally acquired vector-borne cases reported: 0Total cases: 25http://www.scdhec.gov/Health/DiseasesandConditions/InfectiousDiseases/InsectAnimalBorne/ZikaVirus/

As of July 28, 2016 in South Carolina: Travel-associated cases reported: 25Pregnant women: 0Sexually transmitted: 1*Locally acquired vector-borne cases reported: 0Total cases: 25

Confirmed Zika Cases in Oregon, 2016As of 7/26/2016 Travel-associated cases: 15 Oregon mosquito-acquired cases: 0 Total: 15

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At A Glance - Zika in the U.S.(as of July 27, 2016) North CarolinaTravel-associated Zika virus disease cases reported: 25Locally acquired vectorborne cases reported: 0 http://epi.publichealth.nc.gov/zika/

At A Glance - Zika in the U.S.(as of July 27, 2016) North CarolinaTravel-associated Zika virus disease cases reported: 25Locally acquired vectorborne cases reported: 0 U.S. StatesTravel-associated Zika virus disease cases reported: 1,404Locally acquired vectorborne cases reported: 0 U.S. TerritoriesTravel-associated cases reported: 12Locally acquired vectorborne cases reported: 3,815

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July 28, 2016 DEPARTMENT OF HEALTH DAILY ZIKA UPDATE: TWO NEW TRAVEL-RELATED CASES TODAY http://www.floridahealth.gov/newsroom/2016/07/072816-zika-update.htmlContact: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 Florida Department of Health will 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 two new travel-related cases of Zika, both involving pregnant women. According to CDC, symptoms associated with the Zika virus last between seven to 10 days. The department continues its investigations into four possible non-travel related Zika virus cases, with two in Miami-Dade and two Broward counties. Door-to-door outreach and sample collection are ongoing in all cases. The department will share more details as they become available. Residents and visitors are urged to participate in requests for urine samples by the department in the areas of investigation. These results will help the department determine the number of people affected. Zika prevention kits and repellent are being distributed in the areas of investigation, through local OBGYN offices and at both DOH-Broward and DOH-Miami-Dade. Residents and visitors with questions regarding Zika are reminded to call the Zika Virus Information Hotline at 1-855-622-6735. CDC recommends that women who are pregnant or thinking of becoming pregnant postpone travel to Zika affected areas. 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 96 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 328 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. All cases are travel-associated. There have been no locally-acquired cases of Zika in Florida. For more information on the Zika virus, click here. 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 skin with repellent and clothing; 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 OBGYNs, 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 6,658 people for active Zika virus and 2,075 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.

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 96 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 328 Cases involving pregnant women regardless of symptoms* 55 *Counties of pregnant women will not be shared.

The department continues its investigations into four possible non-travel related Zika virus cases, with two in Miami-Dade and two Broward counties. Door-to-door outreach and sample collection are ongoing in all cases. The department will share more details as they become available. Residents and visitors are urged to participate in requests for urine samples by the department in the areas of investigation. These results will help the department determine the number of people affected. http://www.floridahealth.gov/newsroom/2016/07/072816-zika-update.html

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As of Thursday, July 28, 2016, VDH has reported 50 cases of Zika virus disease in Virginia residents to the CDC ( 7 in Northwest Region, 27 in Northern Region, 2 in Eastern Region, 9 in Central Region and 5 in Southwest Region). CDC has issued a travel alert (Level 2-Practice Enhanced Precautions) for people traveling to regions and certain countries where Zika virus transmission is ongoing. http://www.vdh.virginia.gov/zika/zika-virus-update/

As of Thursday, July 28, 2016, VDH has reported 50 cases of Zika virus disease in Virginia residents to the CDC ( 7 in Northwest Region, 27 in Northern Region, 2 in Eastern Region, 9 in Central Region and 5 in Southwest Region). CDC has issued a travel alert (Level 2-Practice Enhanced Precautions) for people traveling to regions and certain countries where Zika virus transmission is ongoing.

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Zika virus cases in Ohio:

As of July 27, 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 – July 27, 2016.US States Locally acquired mosquito-borne cases reported: 0Travel-associated cases reported: 1,657Laboratory acquired cases reported: 1Total: 1,658Sexually transmitted: 15Guillain-Barré syndrome: 5US Territories Locally acquired cases reported: 4,729Travel-associated cases reported: 21Total: 4,750*Guillain-Barré syndrome: 17*Sexually transmitted cases are not reported for areas with local mosquito-borne transmission of Zika virus because 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 July 27, 2016) StatesTravel-associated cases* No. (% of cases in states) (N=1,658)Locally acquired cases† No. (% of cases in states) (N=0)Alabama9 (1)0 (0)Arizona10 (1)0 (0)Arkansas5 (<1)0 (0)California87 (5)0 (0)Colorado18 (1)0 (0)Connecticut38 (2)0 (0)Delaware10 (1)0 (0)District of Columbia10 (1)0 (0)Florida307 (19)0 (0)Georgia41 (2)0 (0)Hawaii10 (1)0 (0)Illinois29 (2)0 (0)Indiana15 (1)0 (0)Iowa9 (1)0 (0)Kansas6 (<1)0 (0)Kentucky10 (1)0 (0)Louisiana9 (1)0 (0)Maine7 (<1)0 (0)Maryland48 (3)0 (0)Massachusetts52 (3)0 (0)Michigan14 (1)0 (0)Minnesota21 (1)0 (0)Mississippi11 (1)0 (0)Missouri8 (<1)0 (0)Montana1 (<1)0 (0)Nebraska4 (<1)0 (0)Nevada11 (1)0 (0)New Hampshire7 (<1)0 (0)New Jersey50 (3)0 (0)New Mexico3 (<1)0 (0)New York449 (27)0 (0)North Carolina21 (1)0 (0)North Dakota1 (<1)0 (0)Ohio26 (2)0 (0)Oklahoma13 (1)0 (0)Oregon12 (1)0 (0)Pennsylvania††48 (3)0 (0)Rhode Island16 (1)0 (0)South Carolina26 (2)0 (0)Tennessee16 (1)0 (0)Texas76 (5)0 (0)Utah6 (<1)0 (0)Vermont6 (<1)0 (0)Virginia48 (3)0 (0)Washington14 (1)0 (0)West Virginia9 (1)0 (0)Wisconsin11 (1)0 (0) TerritoriesTravel-associated cases* No. (% of cases in territories) (N=21)Locally acquired cases† No. (% of cases in territories) (N=4,729)American Samoa2 (10)42 (1)Puerto Rico18 (86)4,666 (99)US Virgin Islands1 (5)21 (<1)*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, 2016Page last updated: July 28, 2016

Pregnancy Outcomes in the United States and the District of ColumbiaLiveborn infants with birth defects*13Includes aggregated data reported to the US Zika Pregnancy Registry as of July 21, 2016 Pregnancy losses with birth defects**6Includes aggregated data reported to the US Zika Pregnancy Registry as of July 21, 2016 Pregnancy Outcomes in the United States TerritoriesLiveborn infants with birth defects*0Includes 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 July 21, 2016 Pregnancy losses with birth defects**1Includes 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 July 21, 2016 What these numbers show These numbers reflect poor outcomes among pregnancies with laboratory evidence of possible Zika virus infection reported to the US Zika Pregnancy Registry.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.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. CDC, in collaboration with state, local, tribal and territorial health departments, established this registry for comprehensive monitoring of pregnancy and infant outcomes following Zika virus infection.The data collected through this system 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. **Includes miscarriage, stillbirths, and terminations with evidence of the birth defects mentioned above

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

Pregnant Women with Any Laboratory Evidence of Possible Zika Virus InfectionUS States and the District of Columbia*433*Includes aggregated data reported to the US Zika Pregnancy Registry as of July 21, 2016 US Territories**422**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 July 21, 2016