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Pregnant Women with Possible Zika Infection m 1 2 0 0 1 0 1 12 http://www.dallascounty.org/department/hhs/documents/DCHHSEpiWNVWeeklyReport_7_25_2016.pdf

Zika Virus – July 26, 2016. Texas has had 76 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: CountyCasesBell1Bexar6Collin2Dallas17Denton3Ellis1Fort Bend3Frio1Gray1Grayson1Hamilton1Harris21Lubbock1Medina1Tarrant11Travis2Val Verde1Williamson1Wise1Total76

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Arizona's First Zika Case Recorded in Traveler, read the news releaseTravel-associated Zika cases confirmed in Arizona: 11http://www.azdhs.gov/preparedness/epidemiology-disease-control/mosquito-borne/index.php#zika-home

Arizona's First Zika Case Recorded in Traveler, read the news releaseTravel-associated Zika cases confirmed in Arizona: 11Arizona Arboviral Handbook for Chikungunya, Dengue, & Zika Viruses

Allegheny County Residents Approved for Zika Testing: 136 CDC Confirmed Cases: 6(as of July 25)

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http://msdh.ms.gov/msdhsite/_static/resources/6754.pdf

The Mississippi State Department of Health is reporting two new cases of the Zika virus. This brings the total of Zika cases found in the state this year up to 11. In both new cases, the patients had recently traveled to the Caribbean, according to the MSDH. An Oktibbeha County resident had traveled to St. Lucia, and a resident of Neshoba County went to Jamaica. http://wreg.com/2016/07/25/2-new-cases-of-zika-reported-in-mississippi/

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DESOTO COUNTY, MS (WMC) - The Mississippi State Department of Health confirmed one person in DeSoto County has the Zika virus. MSDH said the infected person traveled to Jamaica recently. Zika is a virus that is transmitted between people by mosquitoes. If contracted during pregnancy, it can cause serious birth defects. In healthy adults, it can cause a mild illness with symptoms like fever and pain lasting for several days to a week. However, some patients have no symptoms at all. http://meredithaz.worldnow.com/story/32380366/case-of-zika-virus-confirmed-in-desoto-county

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Number of cases reportedCounty/Area TodayYear to Date (7/22-25/16)Albany03Broome01Clinton01Dutchess05Erie14Lewis01Monroe25Nassau127Niagara01Oneida02Onondaga05Ontario03Orange02Otsego01Putnam01Rockland16St Lawrence01Schenectady01Suffolk029Tompkins12Westchester012NYS (ex NYC)6113NYC21383NYS Total Confirmed27496NYS Pregnant Registry025NYS Total27521

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Travel*9Locally**0_______________________________________________________________*: Case became infected with Zika Virus while traveling outside of West Virginia. For more information on Zika-affected areas, click here.**: Case became infected with Zika virus in West Virginia.***: Counts updated: 7/21/2016 3:41 PM (EST)http://www.dhhr.wv.gov/oeps/disease/zoonosis/mosquito/documents/zika/zika-main.html

Travel*9Locally**0_______________________________________________________________*: Case became infected with Zika Virus while traveling outside of West Virginia. For more information on Zika-affected areas, click here.**: Case became infected with Zika virus in West Virginia.***: Counts updated: 7/21/2016 3:41 PM (EST)

> Media Statement> > Embargoed until 11:00 a.m. ET> Monday, July 25, 2016> > Contact: CDC Media Relations> 404-639-3286 > > > CDC Issues Updated Zika Recommendations: Interim Guidance for healthcare providers caring for pregnant women with possible exposure to Zika virus; Interim Guidance for the prevention of sexually transmitted Zika virus> > CDC today issued updated guidance and information to prevent Zika virus transmission and health effects:> > · Updated interim guidance for healthcare providers caring for pregnant women with possible exposure to Zika virus; and> · Updated interim guidance for the prevention of sexually transmitted Zika virus.> CDC updates its interim guidance related to Zika virus transmission and related health effects based on the accumulating evidence, expert opinion, and knowledge about the risk associated with other viral infections. CDC will continue to update this guidance as new information becomes available.> Article 1: Updated interim guidance for healthcare providers caring for pregnant women with possible exposure to Zika virus> Because the diagnosis of Zika infection can be complicated, the updated guidance expands the timeframe, up to 14 days, that testing for Zika virus particles in the blood of pregnant women can be offered. This expansion will provide a definite diagnosis for more pregnant women infected with for Zika virus.> > Many people infected with Zika virus won’t have symptoms or will only have mild symptoms. Up until now, scientists thought that if a person becomes sick after being infected with Zika, the virus stays in the person’s blood for about a week after symptoms started. So the first week of illness was thought to be the best time to find evidence of the virus in blood using a Zika-specific test. But not everyone will see a health care provider while they are sick with Zika and many will not have symptoms. For those who visited a health care provider more than a week after symptoms started, that is, after the virus has cleared from the blood, and those who were possibly exposed to Zika but never developed symptoms, healthcare providers could order a different test to look for evidence that the body is fighting a virus in the family of viruses that includes Zika. The results of the latter test are more difficult to interpret because the body’s reaction to Zika virus can resemble the reaction to similar viruses; therefore, this test may not provide a definite diagnosis.> > New information has indicated that some infected pregnant women can have evidence of Zika virus in their blood for longer than the previously recommended seven-day window for testing after symptoms begin, and that even pregnant women without symptoms can have evidence of the virus in their blood and urine. Therefore, the updated guidance expands the Zika-specific blood testing for a longer period, up to 14 days, in pregnant women with symptoms and advises that pregnant women with possible Zika exposure but no symptoms receive this testing as well. In addition, if pregnant women visit their healthcare provider after the 14 day testing window and test positive with the less-specific test, the Zika-specific blood testing can now be offered potentially to provide a definite diagnosis for pregnant women with Zika virus infection. Expanding the use of the Zika-specific test could provide more women with Zika virus infection a definite diagnosis and help direct medical evaluation and care. In addition, the CDC’s new guidance includes recommendations to help healthcare providers better care for their pregnant patients with confirmed or possible Zika infection.> > Article 2: Updated recommendations for the prevention of sexually transmitted Zika virus to include the possibility of sexual transmission from an infected woman> This expanded guidance is based on a recently reported case of female-to-male sexual transmission in New York City and limited human and non-human primate data indicating Zika virus RNA can be detected in vaginal secretions. It expands CDC’s definition of sexual exposure to Zika to include sex without a barrier method (including male or female condoms, among other methods) with any person-- male or female-- who has traveled to or lives in an area with Zika. The updated recommendations for pregnant couples, include pregnant women with female sex partners who are potentially infected with Zika. They also give advice for potentially infected women about how to reduce their risk of sexually transmitting the virus to partners.> > Although transmission of Zika from a woman to her sex partners is believed to be uncommon and (as with the majority of Zika infections) unlikely to result serious side effects, it could present a risk for pregnant women with female sex partners who may be infected with Zika. For this reason, CDC recommends that all pregnant women with sex partners (male or female) who live in or traveled to an area with Zika use condoms during sex or abstain from sex for the remainder of their pregnancy. All other couples in which a partner (male or female) has been in an area with Zika can also reduce the risk of sexual transmission by using condoms or abstaining from sex. Sex includes vaginal, anal and oral sex, and may also include the sharing of sex toys. Health care providers should test all pregnant women who may have been exposed to Zika sexually. Health care providers should also test any patients for Zika if they develop symptoms of Zika and report potential sexual exposure to a partner who lives in or traveled to an area with Zika. CDC encourages local and state health department to report potential cases of sexually transmitted Zika virus infection.> > CDC will continue to update its guidance related to Zika virus transmission and related health effects based on the accumulating evidence, expert opinion, and knowledge about the risk associated with other viral infections. For updates, visit:http://www.cdc.gov/zika/index.html.

> Media Statement> > Embargoed until 11:00 a.m. ET> Monday, July 25, 2016> > Contact: CDC Media Relations> 404-639-3286 > > > CDC Issues Updated Zika Recommendations: Interim Guidance for healthcare providers caring for pregnant women with possible exposure to Zika virus; Interim Guidance for the prevention of sexually transmitted Zika virus> > CDC today issued updated guidance and information to prevent Zika virus transmission and health effects:> > · Updated interim guidance for healthcare providers caring for pregnant women with possible exposure to Zika virus; and> · Updated interim guidance for the prevention of sexually transmitted Zika virus.> CDC updates its interim guidance related to Zika virus transmission and related health effects based on the accumulating evidence, expert opinion, and knowledge about the risk associated with other viral infections. CDC will continue to update this guidance as new information becomes available.> Article 1: Updated interim guidance for healthcare providers caring for pregnant women with possible exposure to Zika virus> Because the diagnosis of Zika infection can be complicated, the updated guidance expands the timeframe, up to 14 days, that testing for Zika virus particles in the blood of pregnant women can be offered. This expansion will provide a definite diagnosis for more pregnant women infected with for Zika virus.> > Many people infected with Zika virus won’t have symptoms or will only have mild symptoms. Up until now, scientists thought that if a person becomes sick after being infected with Zika, the virus stays in the person’s blood for about a week after symptoms started. So the first week of illness was thought to be the best time to find evidence of the virus in blood using a Zika-specific test. But not everyone will see a health care provider while they are sick with Zika and many will not have symptoms. For those who visited a health care provider more than a week after symptoms started, that is, after the virus has cleared from the blood, and those who were possibly exposed to Zika but never developed symptoms, healthcare providers could order a different test to look for evidence that the body is fighting a virus in the family of viruses that includes Zika. The results of the latter test are more difficult to interpret because the body’s reaction to Zika virus can resemble the reaction to similar viruses; therefore, this test may not provide a definite diagnosis.> > New information has indicated that some infected pregnant women can have evidence of Zika virus in their blood for longer than the previously recommended seven-day window for testing after symptoms begin, and that even pregnant women without symptoms can have evidence of the virus in their blood and urine. Therefore, the updated guidance expands the Zika-specific blood testing for a longer period, up to 14 days, in pregnant women with symptoms and advises that pregnant women with possible Zika exposure but no symptoms receive this testing as well. In addition, if pregnant women visit their healthcare provider after the 14 day testing window and test positive with the less-specific test, the Zika-specific blood testing can now be offered potentially to provide a definite diagnosis for pregnant women with Zika virus infection. Expanding the use of the Zika-specific test could provide more women with Zika virus infection a definite diagnosis and help direct medical evaluation and care. In addition, the CDC’s new guidance includes recommendations to help healthcare providers better care for their pregnant patients with confirmed or possible Zika infection.> > Article 2: Updated recommendations for the prevention of sexually transmitted Zika virus to include the possibility of sexual transmission from an infected woman> This expanded guidance is based on a recently reported case of female-to-male sexual transmission in New York City and limited human and non-human primate data indicating Zika virus RNA can be detected in vaginal secretions. It expands CDC’s definition of sexual exposure to Zika to include sex without a barrier method (including male or female condoms, among other methods) with any person-- male or female-- who has traveled to or lives in an area with Zika. The updated recommendations for pregnant couples, include pregnant women with female sex partners who are potentially infected with Zika. They also give advice for potentially infected women about how to reduce their risk of sexually transmitting the virus to partners.> > Although transmission of Zika from a woman to her sex partners is believed to be uncommon and (as with the majority of Zika infections) unlikely to result serious side effects, it could present a risk for pregnant women with female sex partners who may be infected with Zika. For this reason, CDC recommends that all pregnant women with sex partners (male or female) who live in or traveled to an area with Zika use condoms during sex or abstain from sex for the remainder of their pregnancy. All other couples in which a partner (male or female) has been in an area with Zika can also reduce the risk of sexual transmission by using condoms or abstaining from sex. Sex includes vaginal, anal and oral sex, and may also include the sharing of sex toys. Health care providers should test all pregnant women who may have been exposed to Zika sexually. Health care providers should also test any patients for Zika if they develop symptoms of Zika and report potential sexual exposure to a partner who lives in or traveled to an area with Zika. CDC encourages local and state health department to report potential cases of sexually transmitted Zika virus infection.> > CDC will continue to update its guidance related to Zika virus transmission and related health effects based on the accumulating evidence, expert opinion, and knowledge about the risk associated with other viral infections. For updates, visit:http://www.cdc.gov/zika/index.html.

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--- PRESS RELEASE ---For Immediate Release DCHHS Reports the 19th and 20th Zika Virus Cases in Dallas County DALLAS (July 25, 2016) – Dallas County Health and Human Services (DCHHS) is reporting the 19th and 20th cases of Zika virus in Dallas County in 2016. The cases were confirmed through testing in the DCHHS lab. DCHHS has submitted the cases for review to the Texas Department of State Health Services. The 26 and 23-year-old patients are residents of Dallas who were infected with the virus during recent travel to Jamaica and the British Virgin Islands, respectively. 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)

Dallas County Health and Human Services (DCHHS) is reporting the 19th and 20th cases of Zika virus in Dallas County in 2016. The cases were confirmed through testing in the DCHHS lab. DCHHS has submitted the cases for review to the Texas Department of State Health Services. The 26 and 23-year-old patients are residents of Dallas who were infected with the virus during recent travel to Jamaica and the British Virgin Islands,

ReferencesRasmussen SA, Jamieson DJ, Honein MA, Petersen LR. Zika virus and birth defects—reviewing the evidence for causality. N Engl J Med 2016;374:1981–7. CrossRef PubMedMeaney-Delman D, Rasmussen SA, Staples JE, et al. Zika virus and pregnancy: what obstetric health care providers need to know. Obstet Gynecol 2016;127:642–8. CrossRef PubMedSimeone RM, Shapiro-Mendoza CK, Meaney-Delman D, et al. ; Zika and Pregnancy Working Group. Possible Zika virus infection among pregnant women—United States and Territories, May 2016. MMWR Morb Mortal Wkly Rep 2016;65:514–9. CrossRef PubMedBocanegra C, Sulleiro E, Soriano-Arandes A, et al. Zika virus infection in pregnant women in Barcelona, Spain. Clin Microbiol Infect . In press 2016.Driggers RW, Ho CY, Korhonen EM, et al. Zika virus infection with prolonged maternal viremia and fetal brain abnormalities. N Engl J Med 2016;374:2142–51. CrossRef PubMedPacheco O, Beltrán M, Nelson CA, et al. Zika virus disease in Colombia—preliminary report. N Engl J Med 2016;NEJMoa1604037. CrossRefPubMedMeaney-Delman D, Oduyebo T, Polen KND, et al. Prolonged detection of Zika virus RNA in pregnant women. Obstet Gynecol In press 2016.Rabe IB, Staples JE, Villanueva J, et al. . Interim guidance for interpretation of Zika virus antibody test results. MMWR Morb Mortal Wkly Rep 2016;65:543–6. CrossRef PubMedOduyebo T, Petersen EE, Rasmussen SA, et al. Update: interim guidelines for health care providers caring for pregnant women and women of reproductive age with possible Zika virus exposure—United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65:122–7. CrossRef PubMedPetersen EE, Staples JE, Meaney-Delman D, et al. Interim guidelines for pregnant women during a Zika virus outbreak—United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65:30–3. CrossRef PubMedOster AM, Russell K, Stryker JE, et al. Update: interim guidance for prevention of sexual transmission of Zika virus—United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65:323–5. CrossRef PubMedCDC. CDC Recommendations for subsequent Zika IgM antibody testing. Atlanta, GA: US Department of Health and Human Services, CDC; 2016.http://emergency.cdc.gov/han/han00392.aspPetersen EE, Polen KN, Meaney-Delman D, et al. Update: interim guidance for health care providers caring for women of reproductive age with possible Zika virus exposure—United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65:315–22. CrossRef PubMedFranca GV, Schuler-Faccini L, Oliveira WK, et al. Congenital Zika virus syndrome in Brazil: a case series of the first 1501 livebirths with complete investigation. Lancet 2016. Epub June 29, 2016. http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)30902-3.pdfMeaney-Delman D, Hills SL, Williams C, et al. Zika Virus infection among U.S. pregnant travelers—August 2015–February 2016. MMWR Morb Mortal Wkly Rep 2016;65:211–4. CrossRef PubMedFleming-Dutra KE, Nelson JM, Fischer M, et al. Update: interim guidelines for health care providers caring for infants and children with possible Zika virus infection—United States, February 2016. MMWR Morb Mortal Wkly Rep 2016;65:182–7. CrossRef PubMedLo YM, Lo ES, Watson N, et al. Two-way cell traffic between mother and fetus: biologic and clinical implications. Blood 1996;88:4390–5. PubMedMasuzaki H, Miura K, Miura S, et al. Labor increases maternal DNA contamination in cord blood. Clin Chem 2004;50:1709–11. CrossRef PubMedChhabra RS, Brion LP, Castro M, Freundlich L, Glaser JH. Comparison of maternal sera, cord blood, and neonatal sera for detecting presumptive congenital syphilis: relationship with maternal treatment. Pediatrics 1993;91:88–91. PubMedWorkowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015;64(RR-03). PubMedMartines RB, Bhatnagar J, de Oliveira Ramos AM, et al. Pathology of congenital Zika syndrome in Brazil: a case series. Lancet 2016. Epub June 29, 2016.http://thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)30883-2.pdf Top * Sex is specifically defined as vaginal sex (penis-to-vagina sex), anal sex (penis-to-anus sex), oral sex (mouth-to-penis sex or mouth-to-vagina sex), and the sharing of sex toys. † Barrier methods include male or female condoms for vaginal or anal sex, male condoms for oral sex (mouth-to-penis), and male condoms cut to create a flat barrier or dental dams for oral sex (mouth-to-vagina). § Zika virus disease is defined as having at least one of the following signs or symptoms: acute onset of fever, rash, arthralgia, conjunctivitis, and laboratory confirmation of Zika virus infection. ¶ http://www.cdc.gov/zika/geo/active-countries.html. ** http://www.cdc.gov/zika/hc-providers/registry.html. †† http://www.cdc.gov/zika/public-health-partners/zapss.html. §§ https://www.cdc.gov/zika/geo/pregwomen-uscases.html. ¶¶ http://wwwnc.cdc.gov/travel/page/avoid-bug-bites. *** http://www.cdc.gov/zika/laboratories/test-specimens-tissues.html.

TABLE. Clinical management of a pregnant woman with suspected Zika virus infectionInterpretation of laboratory results*Prenatal managementPostnatal managementRecent Zika virus infectionConsider serial ultrasounds every 3–4 weeks to assess fetal anatomy and growth.† Decisions regarding amniocentesis should be individualized for each clinical circumstance.§Live births: Cord blood and infant serum should be tested for Zika virus by rRT-PCR, and for Zika IgM and dengue virus IgM antibodies. If CSF is obtained for other reasons, it can also be tested. Zika virus rRT-PCR and IHC staining of umbilical cord and placenta are recommended.¶ Fetal losses: Zika virus rRT-PCR and IHC staining of fetal tissues are recommended.¶Recent flavivirus infection; specific virus cannot be identifiedPresumptive recent Zika virus infection**Consider serial ultrasounds every 3–4 weeks to assess fetal anatomy and growth.† Amniocentesis might be considered; decisions should be individualized for each clinical circumstance.Live births: Cord blood and infant serum should be tested for Zika virus by rRT-PCR, and for Zika virus IgM and dengue virus IgM antibodies. If CSF is obtained for other reasons, it can also be tested. Zika virus rRT-PCR and IHC staining of umbilical cord and placenta should be considered.¶ Fetal losses: Zika virus rRT-PCR and IHC staining of fetal tissues should be considered.¶Presumptive recent flavivirus infection**Recent dengue virus infectionClinical management in accordance with existing guidelines.††No evidence of Zika virus or dengue virus infectionPrenatal ultrasound to evaluate for fetal abnormalities consistent with congenital Zika virus syndrome.† Fetal abnormalities present: repeat Zika virus rRT-PCR and IgM test; base clinical management on corresponding laboratory results. Fetal abnormalities absent: base obstetric care on the ongoing risk for Zika virus exposure risk to the pregnant woman.Abbreviations: CSF = cerebrospinal fluid; IgM = immunoglobulin M; IHC = immunohistochemical; PRNT = plaque reduction neutralization test; rRT-PCR = real-time reverse transcription–polymerase chain reaction. * Refer to the previously published guidance for testing interpretation (http://www.cdc.gov/mmwr/volumes/65/wr/mm6521e1.htm). † Fetal abnormalities consistent with congenital Zika virus syndrome include microcephaly, intracranial calcifications, and brain and eye abnormalities. § Health care providers should discuss risks and benefits of amniocentesis with their patients. It is not known how sensitive or specific rRT-PCR testing of amniotic fluid is for congenital Zika virus infection, whether a positive result is predictive of a subsequent fetal abnormality, and if it is predictive, what proportion of infants born after infection will have abnormalities. ¶ Refer to pathology guidance for collection and submission of fetal tissues for Zika virus testing for detailed information on recommended specimen types (http://www.cdc.gov/zika/laboratories/test-specimens-tissues.html). ** rRT-PCR or PRNT should be performed for positive or equivocal IgM results as indicated. PRNT results that indicate recent flavivirus infection should be interpreted in the context of the currently circulating flaviviruses. Refer to the laboratory guidance for updated testing recommendations (http://www.cdc.gov/zika/laboratories/lab-guidance.html). Because of the overlap of symptoms and areas where other viral illnesses are endemic, evaluate for possible dengue or chikungunya virus infection. †† http://apps.who.int/iris/bitstream/10665/44188/1/9789241547871_eng.pdf.