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Pregnancy Outcomes in the United States and the District of ColumbiaLiveborn infants with birth defects*12Includes aggregated data reported to the US Zika Pregnancy Registry as of July 14, 2016 Pregnancy losses with birth defects**6Includes aggregated data reported to the US Zika Pregnancy Registry as of July 7, 2016 http://www.cdc.gov/zika/geo/pregnancy-outcomes.html

Pregnant Women with Any Laboratory Evidence of Possible Zika Virus Infection in the United States and Territories, 2016Language:EnglishEspañolPortuguêsRecommend on FacebookTweet Pregnant Women with Any Laboratory Evidence of Possible Zika Virus InfectionUS States and the District of Columbia*400*Includes aggregated data reported to the US Zika Pregnancy Registry as of July 14, 2016 US Territories**378**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 14, 2016

As of July 20, 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 20, 2016.US States Locally acquired mosquito-borne cases reported: 0Travel-associated cases reported: 1,403Laboratory acquired cases reported: 1Total: 1,404Sexually transmitted: 15Guillain-Barré syndrome: 5US Territories Locally acquired cases reported: 3,815Travel-associated cases reported: 12Total: 3,827*Guillain-Barré syndrome: 14*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 20, 2016) StatesTravel-associated cases* No. (% of cases in states) (N=1,404)Locally acquired cases† No. (% of cases in states) (N=0)Alabama8 (1)0 (0)Arizona7 (<1)0 (0)Arkansas5 (<1)0 (0)California69 (5)0 (0)Colorado17 (1)0 (0)Connecticut30 (2)0 (0)Delaware10 (1)0 (0)District of Columbia9 (1)0 (0)Florida270 (19)0 (0)Georgia39 (3)0 (0)Hawaii10 (1)0 (0)Illinois23 (2)0 (0)Indiana13 (1)0 (0)Iowa9 (1)0 (0)Kansas5 (<1)0 (0)Kentucky9 (1)0 (0)Louisiana8 (1)0 (0)Maine7 (<1)0 (0)Maryland36 (3)0 (0)Massachusetts49 (3)0 (0)Michigan13 (1)0 (0)Minnesota21 (1)0 (0)Mississippi9 (1)0 (0)Missouri8 (1)0 (0)Montana1 (<1)0 (0)Nebraska3 (<1)0 (0)Nevada9 (1)0 (0)New Hampshire5 (<1)0 (0)New Jersey50 (4)0 (0)New Mexico3 (<1)0 (0)New York345 (25)0 (0)North Carolina18 (1)0 (0)North Dakota1 (<1)0 (0)Ohio26 (2)0 (0)Oklahoma12 (1)0 (0)Oregon12 (1)0 (0)Pennsylvania††42 (3)0 (0)Rhode Island17 (1)0 (0)South Carolina13 (1)0 (0)Tennessee14 (1)0 (0)Texas69 (5)0 (0)Utah6 (<1)0 (0)Vermont3 (<1)0 (0)Virginia40 (3)0 (0)Washington13 (<1)0 (0)West Virginia7 (<1)0 (0)Wisconsin11 (1)0 (0) TerritoriesTravel-associated cases* No. (% of cases in territories) (N=12)Locally acquired cases† No. (% of cases in territories) (N=3,815)American Samoa2 (17)42 (1)Puerto Rico9 (75)3,752 (98)US Virgin Islands1 (8)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 21, 2016

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Current as of July 20, 2016 Table: Travel History of Patients with Positive Test Results byZika Affected Country or Territory Visited - Connecticut, February 15 - July 20, 2016 http://www.ct.gov/dph/cwp/view.asp?a=3136&pm=1&Q=580282 Countries/Territories VisitedZika Positive Flavivirus Positive* Total Aruba 11 Belize1 1 Brazil 11 Colombia213 Dominican Republic16117 El Salvador 11 Guatemala 11 Haiti134 Honduras112 Jamaica2 2 Mexico 11 Nicaragua1 1 Puerto Rico628 St. Lucia1 1Total 31 1344

Current as of July 20, 2016 Table: Travel History of Patients with Positive Test Results byZika Affected Country or Territory Visited - Connecticut, February 15 - July 20, 2016 Countries/Territories VisitedZika Positive Flavivirus Positive* Total Aruba 11 Belize1 1 Brazil 11 Colombia213 Dominican Republic16117 El Salvador 11 Guatemala 11 Haiti134 Honduras112 Jamaica2 2 Mexico 11 Nicaragua1 1 Puerto Rico628 St. Lucia1 1Total 31 1344 *Test results unable to distinguish between Zika virus, a single-stranded RNA virus in the genusFlavivirus, and others that are closely related including dengue, West Nile, Japanese encephalitis, and yellow fever viruses1. A positive test may mean infection with any of these viruses. Figure: Number of Patients with Positive Zika Virus Test Result by Test Type and Month of Specimen Collection - Connecticut, February 15 - July 20, 2016 Tests Performed for Diagnosis of Zika Virus Infection

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Arizona's First Zika Case Recorded in Traveler, read the news releaseTravel-associated Zika cases confirmed in Arizona: 10http://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: 10Arizona Arboviral Handbook for Chikungunya, Dengue, & Zika Viruses

Zika Virus – July 21, 2016. Texas has had 69 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: CountyCasesBell1Bexar6Collin2Dallas15Denton2Ellis1Fort Bend3Gray1Grayson1Hamilton1Harris20Lubbock1Medina1Tarrant9Travis2Val Verde1Williamson1Wise1Total69

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As of July 20, 2016 in South Carolina: Travel-associated cases reported: 21Pregnant women: 0Sexually transmitted: 1*Locally acquired vector-borne cases reported: 0Total cases: 21http://www.scdhec.gov/Health/DiseasesandConditions/InfectiousDiseases/InsectAnimalBorne/ZikaVirus/

10 PM Tonight EDT Dr. Henry L. Niman, PhDZika Update

As of July 20, 2016 in South Carolina: Travel-associated cases reported: 21Pregnant women: 0Sexually transmitted: 1*Locally acquired vector-borne cases reported: 0Total cases: 21South Carolina has had 21 travel-associated cases of Zika virus. Of those, 20 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.

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Reported Cases of Zika in New York City as of 7/15/2016 [Español (PDF)]http://www1.nyc.gov/site/doh/health/health-topics/zika-virus.page Case TypeNumber of CasesLocally acquired mosquito-borne reported†0Travel-associated*346Sexually transmitted: 4Guillain-Barre syndrome: 3Laboratory acquired0Total346GenderFemale249 Pregnant: 41Male97AgeAverage Age (Range)39 (1-74)Borough BreakdownBoroughNumber of CasesBronx139Manhattan74Queens69Brooklyn62Staten Island1Unknown1Most Common Countries VisitedCountryNumber of CasesDominican Republic207Puerto Rico27Jamaica20Guyana16Colombia9Saint Lucia6 †Presumed local mosquito-borne transmission *Travelers returning from affected areas, their sexual contacts, or infants infected in utero

Reported Cases of Zika in New York City as of 7/15/2016 [Español (PDF)] Case TypeNumber of CasesLocally acquired mosquito-borne reported†0Travel-associated*346Sexually transmitted: 4Guillain-Barre syndrome: 3Laboratory acquired0Total346GenderFemale249 Pregnant: 41Male97AgeAverage Age (Range)39 (1-74)Borough BreakdownBoroughNumber of CasesBronx139Manhattan74Queens69Brooklyn62Staten Island1Unknown1Most Common Countries VisitedCountryNumber of CasesDominican Republic207Puerto Rico27Jamaica20Guyana16Colombia9Saint Lucia6 †Presumed local mosquito-borne transmission *Travelers returning from affected areas, their sexual contacts, or infants infected in utero

Local transmission suspected in Florida Zika caseFiled Under: Chikungunya; ZikaLisa Schnirring | News Editor | CIDRAP News | Jul 20, 2016Share Tweet LinkedIn Email Print & PDFpregnantrepellentuse.jpgHighwaystarz-Photography/ iStockAn investigation is under way to confirm if a recent Zika infection reported from Florida 's Miami-Dade County was contracted from local mosquitoes, which would make it the first such case in the continental United States, health officials announced yesterday. The Centers for Disease Control and Prevention (CDC) has warned that limited local spread of Zika virus is likely in some parts of the southern United States where Aedes aegypti mosquitoes are present. Though detection of a local case on the mainland wouldn't be surprising, the discovery would trigger additional response steps. Limited local spread of chikungunya, another mosquito-borne disease, was seen in 2014, with the nation's first two locally transmitted cases reported from two Florida counties, one of them Miami-Dade. Texas was the only other state to report a local chikungunya case, in an individual who got sick in November 2015 and whose infection was confirmed in January. In March, a Zika risk map for the continental United States issued by two atmospheric research teams pinpointed Miami as the most vulnerable area, followed by several other cities in Florida and along the southeastern coasts. Local response stepsThe CDC is collaborating on the probe, and in a statement yesterday the Florida Department of Health said mosquito control authorities are already conducting reduction and prevention activities near the area where the case was detected. The Associated Press (AP) today, citing an unnamed source familiar with the case, said the patient is an adult woman. Florida Health said in its statement that it would share more details when available. Also, Florida Health said it is distributing Zika prevention kits and repellent for pregnant women in the affected area and is making them available for pickup at its Miami-Dade office. In its daily Zika update today, Florida officials said 284 travel-related Zika infections have been reported in the state, with the largest number of them (89 cases) from Miami-Dade County. The state is monitoring 43 pregnant women with evidence of Zika infection, regardless of symptoms, including 12 that meet the CDC's case definition. Case confirmation would step up CDC response phaseAccording to the CDC draft Zika response plan for the continental United States, unveiled in June, confirmation of a locally acquired case or cases clustered in a single household would raise the level to phase 2. Because state environmental factors vary widely, the agency doesn't have a formula to trigger specific response activities, and it said a starting point for defining local transmission is two or more cases not linked to travel or sexual transmission in nonhousehold members occurring in a 1-mile diameter over the course of 1 month. The CDC has said it would reach out to states reporting local Zika cases to offer support with incident management activities and is standing by with CDC emergency response teams (CERTs), which can be deployed to help with technical and epidemiologic tasks and assist with risk communication, vector control, and response logistics. Part of CDC's assistance involves help investigating the timing and source of infection, interviewing contacts and health providers, and facilitating testing of close contacts. Other developmentsThe CDC and the American Academy of Pediatrics are hosting a 2-day live webcast meeting, starting tomorrow, to review the clinical evaluation and management of babies with congenital Zika infections. The session tomorrow begins at 8:30 a.m. EST and will cover what's known about the science. Then on Jul 22 the group will air recommendations from the previous day's small-group discussions. The US Food and Drug Administration (FDA) yesterday issued an emergency use authorization (EUA) for a real-time reverse-transcriptase polymerase chain reaction (RT-PCR) Zika test from Viracor-IBT Laboratories. The test is designed to detect Zika RNA in human serum, plasma, or urine when collect alongside patient-matched serum of plasma specimens in patients who meet clinical or epidemiological criteria for the disease. The EUA only applies to testing at Viracor-IBT's lab in Lee's Summit, Mo., or at labs certified to perform high complexity tests. French researchers today described Zika virus RNA in the semen of a 27-year-old man 93 days after symptom onset shortly returning from Thailand, where he had been bitten by mosquitoes. They reported their findings today in the August issue of Lancet Infectious Diseases. The virus was found during testing as part of French protocols for men undergoing fertility preservation methods in advance of medical procedures, such as chemotherapy or radiological treatment. The patient was about to undergo aggressive treatment for a monophasic grade 2 synovial cell sarcoma. The researchers noted that people infected from nonepidemic areas such as Thailand can be infected with Zika virus and that prolonged shedding should be considered before taking steps to preserve fertility in advance of certain reproductive fertility measures.See also: Jul 19 Florida Health statement Jul 20 AP story CDC draft Zika response plan Jul 20 Florida Health daily Zika update Mar 16 CIDRAP News story "Cuba, Dominica report local Zika; study estimates US risk" http://www.cidrap.umn.edu/news-perspective/2016/07/local-transmission-suspected-florida-zika-case

Fla. mosquitoes being tested for Zika to confirm caseJennifer Kay, Associated Press6:27 a.m. EDT July 21, 2016 (Photo: Rick Bowmer / AP) Miami — Florida health officials have trapped mosquitoes in an area of Miami-Dade County and are testing them for Zika to confirm whether a woman with the virus could be the first person infected directly by a mosquito bite in the continental United States. Florida’s Department of Health and the U.S. Centers for Disease Control and Prevention did not immediately respond to questions about their investigation, but health officials said the case had no apparent connection to travel outside the country. The patient is a woman who lives in Miami-Dade County, according to a health official familiar with the case who wasn’t authorized to reveal details beyond the statements of the agencies involved, and thus spoke on condition of anonymity. “Mosquitos have been trapped in the area of investigation and are being tested,” Health Department spokeswoman Mara Gambineri said in an email Wednesday to The Associated Press. More than 1,300 Zika infections have been reported in the U.S., none involving bites from local mosquitoes; 14 of these were sexually transmitted, and one lab worker was stuck with a contaminated needle. Health officials predicted that would change this summer once the virus reaches U.S. mosquitoes and have mobilized to keep Zika from spreading beyond isolated clusters of cases. Miami-Dade County has the most confirmed infections in Florida — 89 — but so far all have involved someone who traveled outside the U.S. mainland to areas with Zika outbreaks, such as Latin America and the Caribbean. The White House said in a news release Wednesday that President Barack Obama had spoken by phone with Florida Gov. Rick Scott regarding the new Zika case. The president noted during the call that besides the $2 million the CDC already provided to Florida, the agency anticipates awarding Florida another $5.6 million in Zika funding through a grant this week. According to a CDC response plan, health officials would want to see more than just one unexplained case before declaring that someone has been infected by a mosquito bite in the continental United States. The plan suggests there should be two or more cases within a 1-mile area in people who do not live together, who did not have sex with Zika-infected people and who did not recently travel to countries with Zika outbreaks. Evidence of the virus in mosquitoes captured in the same areas also might help investigators declare Zika is spreading, but short of that, it might be difficult to determine with certainty that mosquito transmission has occurred. Mosquito control inspectors in Miami have been going door-to-door in the area of investigation since health authorities alerted them late last week to the woman’s infection. They’ve been spraying to kill mosquitoes and emptying containers of the water mosquitoes need to breed. If the virus is there, they want to prevent its spread. “We’re constantly in the area. We’re doing hand-held spraying, and we’ll do more truck spraying Thursday,” said Gayle Love, a spokeswoman for Miami-Dade County Solid Waste Management. Crews in Utah, meanwhile, are setting traps in old tires and junkyards and dumping mosquito-eating fish into ponds and abandoned pools after a man who cared for his dying father was infected with Zika as well. Since that case doesn’t involve travel or sex, it has raised more questions about how the virus might spread. “Our best option is to try to find these mosquitoes quickly so that way we can eliminate them prior to their establishment,” said Ary Faraji, manager of the Salt Lake City Mosquito Abatement District. “Once they become established, it is extremely difficult to get rid of those species.” There is no vaccine for Zika. The main defense is to avoid mosquito bites. Zika also can spread through unprotected sex with someone who is infected. In most people, Zika causes only a mild and brief illness, but it can provoke fetal death and severe brain defects in the children of women infected during pregnancy. Health officials worldwide have advised people preparing to have children not to travel to areas where the risk of Zika is high. But these and other warnings have applied to countries and regions where outbreaks have spread far and wide. It remains to be seen how many Zika infections would have to be confirmed in an area before state or federal officials issue similar warnings for parts of the U.S. mainland. http://www.detroitnews.com/story/news/nation/2016/07/21/zika-florida/87377008/?utm_source=twitterfeed&utm_medium=twitter

The White HouseOffice of the Press SecretaryFor Immediate ReleaseJuly 20, 2016Readout of the President’s Call with Governor Rick Scott of FloridaThe President spoke by phone today with Governor Rick Scott of Florida regarding the suspected case of mosquito transmission of Zika announced by the Florida Department of Health. This case would be the first documented Zika infection caused by a mosquito in the Continental United States. The President recognized Florida's strong record of responding aggressively to local outbreaks of mosquito-borne viruses like Zika, and offered Federal support and technical assistance for Florida's ongoing case investigation and mosquito control efforts. He acknowledged Florida's close coordination with the Department of Health and Human Services and the CDC for Zika preparedness. The President also noted during the call that in addition to the $2 million that CDC has provided to Florida for Zika preparedness, CDC is anticipating it will award Florida $5.6 million in Zika funding through a CDC grant to be awarded this week. https://www.whitehouse.gov/the-press-office/2016/07/20/readout-presidents-call-governor-rick-scott-florida

AUTHOR: SARAH ZHANG.SARAH ZHANG SCIENCE DATE OF PUBLICATION: 07.20.16.07.20.16 TIME OF PUBLICATION: 6:23 PM.6:23 PMFLORIDA MAY HAVE ITS FIRST CASE OF ZIKA FROM LOCAL MOSQUITOESClick to Open Overlay GalleryDelfina Tirado, an inspector with Miami-Dade County's Mosquito Control Division, collects larvae of the Aedes aegypti mosquito in Miami, March 17, 2016.MAX REED/THE NEW YORK TIMES/REDUXTHE FIRST CASE of a mosquito giving Zika to someone in the US was always going to be a matter of when, not if. That “when” may be now. The Florida Department of Public Health announced late yesterday that it is investigating a case of non-travel related Zika in Miami-Dade County, at the very southeastern tip of the state. A key part of the investigation will be testing if mosquitoes around the patient’s home carry Zika. The county had set out a type of mosquito trap, baited with carbon dioxide, that preferentially attracts the Zika-carrying mosquito species:Aedes egypti and Aedes albopictus. It’s now sent those mosquitoes to a lab at Florida Gulf Coast University to look for Zika virus. “We don’t have any results to report yet,” says Sharon Irsen, who co-leads the Florida Gulf Coast University lab with Scott Michael. The university lab had been testing Miami-Dade’s mosquitoes for other tropical viruses, like dengue and yellow fever, for the past several years. Earlier this summer, they added Zika virus to their repertoire. The protocol is similar. “The mosquitoes are shipped in vials. We homogenize—basically mush up the mosquitoes—and extract the genome,” says Isern. Then they look for Zika’s genetic signature. The whole process takes about a week, but can go faster if necessary. The Florida Department of Public Health did not specifically rule out sexual transmission of Zika and did not provide any additional details about the case. But sexual transmission is generally easier to prove, as long as you can test the partner. When Dallas found the first case of sexual transmission in the US back in February, they came out and said it. This week also saw a mysterious Zika case in Utah, which does not appear to be associated with mosquitoes, travel, or sexual contact. If the Zika case in Miami-Dade is indeed traced back to local mosquitoes, it could herald more endemic infections to come. “It’s not a small story,” says Michael. “The mosquitoes that can transmit are all up and down the east coast and the Gulf coast.” Still, it is unlikely to ignite a full-blown epidemic like that seen in Brazil. Take the case of dengue, a similar virus spread by the same mosquito species that spread Zika. Florida has seen sporadic breakouts of dengue, but public health officials were able to contain them by containing the insects. Zika has made residents more wary of mosquitoes. Miami-Dade county’s mosquito control has responded to 5,549 mosquito control requests from residents between October and July 7, compared to 4,408 for all of the previous year, according to county spokesperson Gayle Love. When mosquito control gets these requests, officials go out to drain any small pools of standing water in yards and spray bigger ones with larvicide. They’ll also check a few neighboring yards, because the Aedes mosquitoes can only fly so far. This has been, and will continue to be, the core strategy behind containing Zika. The best way to prevent mosquitoes from transmitting Zika is to prevent mosquitoes in the first place. http://www.wired.com/2016/07/florida-investigating-possible-first-case-zika-mosquitoes/?mbid=social_twitter

Zika in Florida: Possible Mosquito to Human Infection Eyed as First US Case of Local TransmissionBy GILLIAN MOHNEYJul 20, 2016, 10:30 AM ET William Volcov/LatinContent/Getty ImagesWATCH Possible Homegrown Case of Zika Investigated in US267SHARES EmailThe Florida Health Department is investigating whether a Zika virusinfection in Miami-Dade County could be the first time the virus has been transmitted within the continental U.S. through infected mosquitoes. The department is working with the U.S. Centers for Disease Control and Prevention to understand how the infected person could have been exposed to the virus in Miami. If confirmed to be a case of local virus transmission via an infected mosquito, it would be the first such case reported for the continental U.S. The unnamed patient had not traveled to any country with ongoing-Zika infections, the health department said. Puerto Rico has already been battling a widespread outbreak of the virus that is being locally transmitted. There have been more than 1,300 people diagnosed with Zika in the U.S., but virtually all were infections contracted while abroad. A small number of cases were transmitted via sexual contact with partners who were infected abroad, according to health officials. In order to be classified as a case of ongoing local Zika transmission there needs to be two cases of Zika infection within a one-mile diameter within a month that are both unrelated to travel or sexual transmission, according to the CDC. Fighting Zika With GMO Mosquitoes Could Be the Future of Mosquito Control Mosquito-Born Zika Virus Linked to Birth Defects Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center, said if the case is confirmed as a local transmission of the virus through infected mosquitoes, it would not be surprising. "Everyone has said from the beginning is that there will likely be introductions and then subsequent local spread that is going to be very limited," of Zika virus, Schaffer said. "This sounds as though this may be the first instance of that." Schaffner pointed out that to stop any possible outbreak, the health department will ask the infected patients to remain indoors so that they cannot infect mosquitoes that might bite them -- potentially leading to other infections. The CDC and Miami-Dade Department of health are also distributing Zika prevention kits and working with mosquito control to reduce the mosquito population in the area. http://abcnews.go.com/Health/florida-investigates-us-case-local-zika-virus-transmission/story?id=40728735

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--- PRESS RELEASE ---For Immediate Release DCHHS Reports 16th Zika Virus Case in Dallas County DALLAS (July 20, 2016) – Dallas County Health and Human Services (DCHHS) is reporting the 16th case of Zika virus in Dallas County in 2016. The case was confirmed through testing in the DCHHS lab. DCHHS has submitted the case for review to the Texas Department of State Health Services. The 49-year-old patient is a resident of Dallas who was infected with the virus during recent travel to Mexico. 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)