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Zika Cases in New Jersey New Jersey County Confirmed Travel-Related Cases Bergen 13 Passaic 11 Middlesex 6 Burlington 5 Hudson 5 Essex 5 Union 5 Camden 3 Morris 3 Monmouth 2 Ocean 1 Hunterdon 1 Mercer 1 TOTAL 61 Last Updated: July 19, 2016

Zika Virus – July 19, 2016. Texas has had 68 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 Bend3Grayson1Hamilton1Harris20Lubbock1Medina1Tarrant9Travis2Val Verde1Williamson1Wise1Total68

ReferencesFauci, AS and Morens, DM. Zika virus in the Americas - yet another arbovirus threat. N Engl J Med.2016; 374: 601–604View in Article | Crossref | PubMed | Scopus (44)Heymann, DL, Hodgson, A, Sall, AA et al. Zika virus and microcephaly: why is this situation a PHEIC?. Lancet. 2016; 387: 719–721View in Article | Summary | Full Text | Full Text PDF | PubMed | Scopus (19)Rodriguez-Morales, AJ. Zika: the new arbovirus threat for Latin America. J Infect Dev Ctries. 2015; 9:684–685View in Article | Crossref | PubMed | Scopus (17)Arzusa-Ortega, L, Polo, A, Pérez-Tatis, G et al. Fatal Zika virus infection in girl with sickle cell disease, Colombia. Emerg Infect Dis. 2016; 22View in Article PAHO. Neurological syndrome, congenital malformations, and Zika virus infection. Implications for public health in the Americas – Epidemiological Alert. http://www.paho.org/hq/index.php?option=com_content&view=category&layout=blog&id=1218&Itemid=2291; 2015. ((accessed Feb 13, 2016).)View in Article

Zika virus infection has emerged in Latin America as an important threat due to its association with Guillain-Barré syndrome, which can lead to deaths, and microcephaly in newborn babies.1, 2, 3 Cases of fatal Zika virus infection are rare and misunderstood. The spectrum of clinical disease remains uncertain and considering the rapidly evolving epidemics of this new arbovirus in Latin America, it deserves further detailed assessment.1, 2, 3, 4 Here, we describe four well documented fatal cases of Zika virus infection in Tolima, Colombia. Between Oct 2 and Oct 22, 2015, four febrile patients attended Tolima's Hospitals in the central region of Colombia. Patients were a 2-year-old girl, a 30-year-old woman, a 61-year-old man, and a 72-year-old woman, with 2–6 previous days with fever. The infant girl also had dehydration, somnolence, hepatomegaly, mucosa haemorrhage, and thrombocytopenia, evolving to respiratory distress, disseminated intravascular coagulation, and shock. The 30-year-old woman had exanthema in upper and lower limbs, severe thrombocytopenia, and leukopenia, evolving in 10 days to intracerebral and subarachnoid haemorrhages, sepsis, acute respiratory failure, seizures, and shock. The older man had myalgias and arthralgias, with dehydration, mucosa haemorrhage, also evolving to respiratory distress, acute coronary syndrome, and shock. This patient's history included high blood pressure under medication control. The older woman presented with abdominal pain, vomiting, dehydration, somnolence, and thrombocytopenia, evolving to acute respiratory failure and shock. This patient's history included diabetes mellitus type 2 under control with insulin. In all four patients, giving the endemicity of the zone, dengue fever or chikungunya were suspected. All patients presented with anaemia (haemoglobin range 90–120 g/L), three of them with leukopenia. The 30-year-old woman had leukocytosis, and all but the older man had severe thrombocytopenia (<14 000 platelets per mL). Despite medical management at the intensive care unit, all of four patients died. The infant girl died 24 h after admission (5 days after symptoms began); the 30-year-old woman died after 10 days (12 days after symptoms began); the 61-year-old man at 24 h (7 days after symptoms begun), and the 72-year-old woman in less than 24 h (48 h after symptoms began). In all these cases, RT-PCR for dengue (including tissues), anti-dengue IgM, and NS1 ELISA and western-blot tests were negative. In the 61-year-old man, IgM for chikungunya was positive. IgM for Leptospiraspp was negative in all cases. Finally, in all patients RT-PCR for Zika virus was positive, confirmed at the Colombia national reference laboratory. In the infant girl and 30-year-old woman, necropsy revealed probable acute leukaemias (lymphoblastic and myeloid, respectively). In the 61 year-old man, necropsy showed ischaemic lesions in the brain with areas of necrosis in the liver and of systemic inflammatory response in the spleen. In this patient, RT-PCR of tissues was positive for Zika virus. In the 72-year-old woman, necropsy showed oedema and ischemic lesions in brain. From Sept 22, 2015, to March 19, 2016, there were 58 838 cases of Zika virus infection in Colombia (2361 laboratory-confirmed, 49 211 diagnosed by clinical criteria, and 7266 suspected); nevertheless before the current report, only one previous fatal case has been described, from our group in Colombia.4 Before the current outbreak in Latin America, Zika virus was not linked to deaths,1, 3, 4 but as of Nov 28, 2015, the Brazil Ministry of Health has also reported three deaths associated with Zika virus infection (two in adults and one in a newborn baby).5 These cases call attention to the need for evidence-based guidelines for clinical management of Zika, as well as the possible occurrence of atypical and severe cases (including possibly congenitally-related microcephaly).2, 3, 5 Based in our first case report,4 such guidelines have been considered and suggested by the European Centre for Disease Control in its recent Rapid Risk Assessment. We declare no competing interests.

Andrea Sarmiento-Ospina, Heriberto Vásquez-Serna, Carlos E Jimenez-Canizales, Wilmer E Villamil-Gómez, Alfonso J Rodriguez-MoralesPublished Online: 07 April 2016DOI: http://dx.doi.org/10.1016/S1473-3099(16)30006-8

Volume 16, No. 5, p523–524, May 2016CorrespondenceZika virus associated deaths in Colombiahttp://www.thelancet.com/journals/laninf/article/PIIS1473-3099(16)30006-8/fulltext?rss=yes

Live stream https://www.youtube.com/watch?v=2GAJCzKs1XY&feature=youtu.be

First US death linked to Zika reported from Puerto RicoMARIO TAMA/GETTY IMAGES An Aedes aegypti mosquito is seen through a microscope. By HELEN BRANSWELL @HelenBranswell APRIL 29, 2016 TwitterFacebookLinkedInEmailRepublishPrint An elderly man in Puerto Rico who contracted the Zika virus has died of the infection, according to the US Centers for Disease Control and Prevention. The man in his 70s developed a severe case of a condition calledthrombocytopenia — a blood clotting problem that can lead to internal bleeding. This is the first Zika-related death reported among the more than 1,000 cases that have been diagnosed in the United States and US territories. ARTICLE CONTINUES AFTER ADVERTISEMENT “It is a rare outcome,” said Tyler Sharp, acting head epidemiologist at the CDC’s dengue branch, which is based in the Puerto Rican capital of San Juan. READ MOREMedical sleuths descend on Puerto Rico to unearth mysteries of ZikaMost people who contract Zika have either no symptoms or quite mild illness. “But there are some manifestations of Zika virus infection that are associated with potentially fatal outcomes,” Sharp noted — including birth defects like microcephaly, neurological disorders like Guillain-Barré syndrome, and blood problems like those suffered by the man who died. CDC officials reported the case Friday in the agency’s Morbidity and Mortality Weekly Review. Sharp said the man had appeared to recover from his infection, but then developed a particular type of thrombocytopenia called immune thrombocytopenic purpura, or ITP, in which the man’s immune system attacked the platelets in his blood, leading to a clotting disorder. Dutch researchers in February reported a very similar fatal case in a 54-year-old woman who was infected by Zika in Suriname. In Colombia, health officials have also reported four deaths, three of which involved thrombocytopenia. But there aren’t enough details of those cases in the medical literature to know if they were the same kind of the condition suffered by the man in Puerto Rico, Sharp said. The deaths in Colombia crossed the age spectrum, involving a 2-year-old girl, a 30-year-old woman, a 61-year-old man, and a 72-year-old woman. READ MORE‘I can’t move’: In Colombia, families cope with creeping paralysis tied to ZikaSharp said the Zika virus continues to surprise researchers who are studying its impact. “Certainly the association with the autoimmune condition Guillain-Barré syndrome was surprising. And now we appear to be seeing an association with another autoimmune condition, ITP, that is also a little bit surprising,” he said. “So each day that goes by we continue to learn more about Zika and better understand it so we can best combat it and provide the appropriate medical interventions for infected individuals.’’ Puerto Rico, which is expected to be hard hit by the Zika virus, has diagnosed707 cases of Zika infection so far. Of those, 89 are among pregnant women, according to the territory’s Department of Health. READ MOREIn Puerto Rico, no one fears mosquitoes. With Zika, that’s a problemSo far, none of the women who contracted Zika during pregnancy have been diagnosed as carrying a fetus with microcephaly, according to Sharp. A total of 19 people in Puerto Rico have been hospitalized with complications caused by Zika infection. There have also been five reported cases of Zika-related Guillain-Barré. In the 50 states, 426 Zika cases have been diagnosed, 36 of them pregnant women. All the cases were people infected abroad or who were infected byhaving sex with someone who had returned to the United States infected with Zika. https://www.statnews.com/2016/04/29/zika-death-puerto-rico/

First US death linked to Zika reported from Puerto RicoMARIO TAMA/GETTY IMAGES An Aedes aegypti mosquito is seen through a microscope. By HELEN BRANSWELL @HelenBranswell APRIL 29, 2016 TwitterFacebookLinkedInEmailRepublishPrint An elderly man in Puerto Rico who contracted the Zika virus has died of the infection, according to the US Centers for Disease Control and Prevention. The man in his 70s developed a severe case of a condition calledthrombocytopenia — a blood clotting problem that can lead to internal bleeding. This is the first Zika-related death reported among the more than 1,000 cases that have been diagnosed in the United States and US territories. ARTICLE CONTINUES AFTER ADVERTISEMENT “It is a rare outcome,” said Tyler Sharp, acting head epidemiologist at the CDC’s dengue branch, which is based in the Puerto Rican capital of San Juan. READ MOREMedical sleuths descend on Puerto Rico to unearth mysteries of ZikaMost people who contract Zika have either no symptoms or quite mild illness. “But there are some manifestations of Zika virus infection that are associated with potentially fatal outcomes,” Sharp noted — including birth defects like microcephaly, neurological disorders like Guillain-Barré syndrome, and blood problems like those suffered by the man who died. CDC officials reported the case Friday in the agency’s Morbidity and Mortality Weekly Review. Sharp said the man had appeared to recover from his infection, but then developed a particular type of thrombocytopenia called immune thrombocytopenic purpura, or ITP, in which the man’s immune system attacked the platelets in his blood, leading to a clotting disorder. Dutch researchers in February reported a very similar fatal case in a 54-year-old woman who was infected by Zika in Suriname. In Colombia, health officials have also reported four deaths, three of which involved thrombocytopenia. But there aren’t enough details of those cases in the medical literature to know if they were the same kind of the condition suffered by the man in Puerto Rico, Sharp said. The deaths in Colombia crossed the age spectrum, involving a 2-year-old girl, a 30-year-old woman, a 61-year-old man, and a 72-year-old woman. READ MORE‘I can’t move’: In Colombia, families cope with creeping paralysis tied to ZikaSharp said the Zika virus continues to surprise researchers who are studying its impact. “Certainly the association with the autoimmune condition Guillain-Barré syndrome was surprising. And now we appear to be seeing an association with another autoimmune condition, ITP, that is also a little bit surprising,” he said. “So each day that goes by we continue to learn more about Zika and better understand it so we can best combat it and provide the appropriate medical interventions for infected individuals.’’ Puerto Rico, which is expected to be hard hit by the Zika virus, has diagnosed707 cases of Zika infection so far. Of those, 89 are among pregnant women, according to the territory’s Department of Health. READ MOREIn Puerto Rico, no one fears mosquitoes. With Zika, that’s a problemSo far, none of the women who contracted Zika during pregnancy have been diagnosed as carrying a fetus with microcephaly, according to Sharp. A total of 19 people in Puerto Rico have been hospitalized with complications caused by Zika infection. There have also been five reported cases of Zika-related Guillain-Barré. In the 50 states, 426 Zika cases have been diagnosed, 36 of them pregnant women. All the cases were people infected abroad or who were infected byhaving sex with someone who had returned to the United States infected with Zika. https://www.statnews.com/2016/04/29/zika-death-puerto-rico/

ReferencesGoorhuis, A, von Eije, KJ, Douma, RA et al. Zika virus and the risk of imported infection in returned travelers: implications for clinical care. Travel Med Infect Dis. 2016;DOI: http://dx.doi.org/10.1016/j.tmaid.2016.01.008(published online Jan 27.)View in Article | Summary | Full Text | Full Text PDF | PubMed | Scopus (5)Enfissi, A, Codrington, J, Roosblad, J, Kazanji, M, and Rousset, D. Zika virus genome from the Americas. Lancet. 2016; 387: 227–228View in Article | Summary | Full Text | Full Text PDF | PubMed | Scopus (32)Zammarichi, L, Stella, G, Mantella, A et al. Zika virus infections imported to Italy: clinical, immunological and virological findings, and public health implications. J Clin Virol. 2015; 63: 32–35View in Article | Summary | Full Text | Full Text PDF | PubMed | Scopus (26)Balm, MN, Lee, CK, Lee, HK et al. A diagnostic polymerase chain reaction assay for Zika virus. J Med Virol. 2012; 84: 1501–1505View in Article | Crossref | PubMed | Scopus (21)Overbosch, FW, van den Hoek, A, Schinkel, J, and Sonder, GJ. High prevalence of previous dengue virus infection among first-generation Surinamese immigrants in the Netherlands. BMC Infect Dis.2014; 14: 493View in Article | Crossref | PubMed | Scopus (1)

FigureSkin and tissue symptoms (A) Swelling of the hand and wrists, and (B) skin rash during acute illness (day 2). Photos courtesy of the patient. (C,D) Subcutaneous haematomas on day 18, when the patient was recovering from acute illness. Photos taken at the Academic Medical Center, Amsterdam, Netherlands. View Large Image | View Hi-Res Image | Download PowerPoint SlidePCR analysis, at the Academic Hospital of Paramaribo, of a blood sample taken on day 2 of her illness was positive for Zika virus. The patient treated herself symptomatically with paracetamol 1000 mg three times a day from day 0 to day 2, and no concomitant medication, particularly no aspirin, was taken. On day 10, she developed watery diarrhoea, vomited twice without any visible traces of blood, and had subcutaneous haematomas on both arms and legs without preceding trauma (figure). On first examination in our clinic on day 17, 3 days after her return to the Netherlands, she had several haematomas on both arms and legs. The haematomas varied from 2 cm to 6 cm in diameter, and two fresh ones developed on the day of presentation, with no evidence of petechial bleedings. Physical examination was otherwise normal. Our differential diagnosis included complications of acute Zika virus infection, concomitant dengue virus infection, and post-infectious immune thrombocytopenia. Laboratory examination showed slight microcytic anaemia (haemoglobin concentration 7·2 mmol/L) but a normal haematocrit, and a profound thrombocytopenia of 20 × 109 platelets per L, with normal coagulation parameters. A watch-and-wait decision was made. On day 29, she developed gum bleeding, at a thrombocyte count of 10 × 109 platelets per L. At this point, we decided to treat her presumed immune-mediated thrombocytopenia with intravenous immunoglobulins, upon which her thrombocyte count increased to 80 × 109 platelets per L within a few days. Concentrations of thrombocyte antibodies and thrombopoietin have been measured, and results are still pending. In follow-up PCR analyses at the AMC on days 17 and 18, her blood sample was negative for Zika virus and her urine sample was positive. Dengue serology (Panbio Dengue Duo Cassette, Alere, Tilburg, Netherlands) was positive for IgG and weakly positive for IgM. A rapid immunochromatographic dengue antigen test (Bio-Rad, Veenendaal, Netherlands) on blood and urine samples was also negative. Additionally, PCR analysis of all dengue virus serotypes was negative on urine samples. The patient did not recall a previous disease episode that was suggestive of dengue infection. She had received her latest yellow fever vaccination in 2000. Zika virus is a Flavivirus transmitted to human beings primarily through the bites of Aedes spp. The present outbreak in the Americas is spreading quickly, causing an increase in Zika virus infections among travellers returning from endemic areas.1, 2 As of Feb 7, 2016, 410 cases have been confirmed in Suriname, with many more suspected or unconfirmed cases (Codrington J, unpublished). The clinical syndrome is usually mild and self-limiting, and lasts for 4–7 days after an incubation period of a maximum of 2 weeks. Mild thrombocytopenia (139 × 109 platelets per L) has been described only once in the past;3 however, unconfirmed preliminary clinical reports from the ongoing outbreak suggest moderate thrombocytopenia as an infrequent, but not uncommon, finding (Vreden SGS, unpublished). The positive dengue virus IgG suggests the presence of high titres against the virus, since the test is designed to detect secondary dengue virus infection. Whether a primary Zika virus infection can induce high-titre cross-reactivity is unknown, but cross-reactivity in Flavivirus serology is a well known occurrence, which might also explain the weakly positive dengue IgM.4 Furthermore, positive dengue serology is a very frequent finding in first-generation Surinamese immigrants in the Netherlands.5 The absence in urine of dengue virus antigen and RNA, which are known to remain detectable for up to 3–4 weeks, makes concomitant dengue virus infection less likely. The presumed immune-mediated thrombocytopenia is therefore most likely related to Zika virus monoinfection, with probable dengue virus infection in the past. In summary, we report a patient with Zika virus infection that was related to clinically relevant thrombocytopenia and subcutaneous haematomas. Experience from the field and heightened vigilance among returned travellers are necessary to understand the clinical significance of this complication. We declare no competing interests. We thank our patient for agreeing to the publication of her case report and Richard Molenkamp (Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands) for setting up the Zika PCR assay. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00502-X/fulltext?rss%3Dyes

Ouafae Karimi, Abraham Goorhuis, Janke Schinkel, John Codrington, Stephen Gerold S Vreden, Joost S Vermaat,Cornelis Stijnis, Martin Peter GrobuschPublished Online: 19 February 2016DOI: http://dx.doi.org/10.1016/S0140-6736(16)00502-X

Volume 387, No. 10022, p939–940, 5 March 2016Correspondence Thrombocytopenia and subcutaneous bleedings in a patient with Zika virus infectionhttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00502-X/fulltext?rss%3Dyes

AbstractWe report two patients who developed severe thrombocytopenia after Zika virus infection. The first had 1,000 platelets/mm3, and died following multiple hemorrhages. The second had 2,000 platelets/mm3, melena, ecchymoses, and recovered after receiving intravenous immunoglobulin. Physicians should be aware that Zika virus may be associated with immune-mediated severe thrombocytopenia.

Tyler M. Sharp1,*, Jorge Muñoz-Jordán1, Janice Perez-Padilla1, Melissa I. Bello-Pagán2,Aidsa Rivera1, Daniel M. Pastula3,4, Jorge L. Salinas5, Jose H. Martínez Mendez6,Mónica Méndez7, Ann M. Powers8, Stephen Waterman1, and Brenda Rivera-García2+Author Affiliations 1Centers for Disease Control and Prevention, Dengue Branch2Puerto Rico Department of Health3University of Colorado Denver4Centers for Disease Control and Prevention, Division of Vector-Borne Diseases5Centers for Disease Control and Prevention, Epidemic Intelligence Service6San Juan City Hospital7Hospital HIMA San Pablo – Bayamón8Centers for Disease Control and Prevention, Arboviral Diseases Branch↵*corresponding author: 1324 Calle Cañada, San Juan, PR 00920, Email: [email protected] corresponding author: Brenda Rivera-Garcia, [email protected], 787.274.6831, Phone: 787.706.2245

Zika Virus Infection Associated with Severe ThrombocytopeniaClin Infect Dis. (2016)doi: 10.1093/cid/ciw476First published online: July 14, 2016

Clinical Infectious Diseases paper describes severe thrombocytopenia in two patients in Puerto Rico, including a fatal case. http://cid.oxfordjournals.org/content/early/2016/07/13/cid.ciw476.abstract

GERMINATION Strange New Case Might Change What We Know About Zika A caregiver in Utah didn't contract Zika from a mosquito or sex, leading health officials to investigate a new route to transmission. By Maryn McKennaPUBLISHED JULY 18, 2016 Zika virus infection appears to have passed from one member of a Utah family to another, but not by any of the known paths of transmission: sex, pregnancy, or mosquito bite. The case, announced Monday by the Utah Department of Health and the Centers for Disease Control and Prevention, reveals that the risks posed by the novel, fast-moving virus are still not understood. The agencies said in back-to-back press conferences that a “family contact” of an elderly man who died in June—and who was discovered after his death to have been the first Zika-related death in the continental U.S.—has also come down with the disease. That person, who helped care for the ailing man, experienced mild Zika symptoms of rash and fever and has recovered, the officials said. (The agencies declined to identify the family member; the Wall Street Journal reports it was his son.) The first patient, the elderly man, traveled to a place where Zika is circulating and was probably infected there, the officials said. But trapping and testing by Utah mosquito-control teams, which operate in warm-weather months to search for West Nile virus, haves not uncovered either of the mosquito species believed to transmit Zika—meaning it is unlikely the dead man passed the virus to a mosquito which then passed it back to a human. Gary Edwards, a health officer in the Salt Lake County Health Department, said in the Utah press conference: “This case is unusual. The individual does not have any of the known risk factors we’ve seen thus far with Zika.” 'Uniquely High Amounts' of VirusThe lack of other explanations poses the possibility that the family member became infected in a manner that scientists have not yet documented, possibly by exposure to bodily fluids. The virus has been found in blood, semen, urine, saliva, cervical mucus, breast milk, and the fluid inside the eyeball. The CDC has been warning blood banks to act as though Zika can be transmitted by transfusion, though there have been no transfusion cases identified so far. “We are trying to determine if the contact between the very sick, elderly patient and the person played a role in how the person got sick,” Satish Pillai, a physician involved in the CDC’s Zika response, said during the press briefing. “We don’t have all the answers right now.” The elderly man had an underlying health condition that officials have not described; when he died, officials were careful to say his demise was associated with Zika but not necessarily caused by it. The investigation into his death revealed that he had what the CDC called “uniquely high amounts” of virus in his blood, 100,000 times higher than has been recorded in other cases that have been analyzed. That could indicate that the man’s blood, and possibly other bodily fluids, was uniquely infectious, because it carried so much more virus than usual. But federal officials said Monday that it’s not yet possible to know whether it was his underlying illness or a genetic factor or even the strain of Zika infecting him that allowed the virus to replicate to such high numbers in his system. “A high viral load is something we take very seriously, and it is not something about which we have a very long experience,” Michael Bell, a physician and deputy director of the CDC division that handles infection prevention in hospitals, told reporters. “Someone who is extremely ill and debilitated from another disease process could have a diminished immune system that doesn’t fight the virus as well. On the other hand, someone with a high viral load could be more sick as a result of the actual viral infection.” A Preexisting Link?Before his death, the elderly man experienced thrombocytopenia, a disorder that can be triggered by infections and causes bleeding in internal organs, in the mouth and nose, and from nicks and cuts. Last week, physicians in Puerto Rico reported that two Zika patients there also developed thrombocytopenia, and one “died following multiple hemorrhages.” That person, a 72-year-old man with high blood pressure, was the first person in the greater U.S. to die from a syndrome related to Zika. Other cases and deaths from blood disorders linked to Zika have been reported in Colombia, Suriname, and Polynesia. The physicians who treated the Puerto Rico patients warned this is something to be wary of—especially since both men were misdiagnosed with dengue and not identified as having Zika until the bleeding disorder began. Asked whether an association between Zika infection and body fluids would be any cause for alarm, CDC officials pointed out that there have been 1,306 known cases of Zika in the U.S. so far, and only a few have involved person-to-person transmission. (That includes the revelation last Friday that Zika can be passed not only from male sexual partners to women, but from women to men as well.) Bell, from the CDC, said that hospital workers should already be protected because healthcare institutions all practice the “standard precautions” against body-fluid contact that have existed since the start of the AIDS epidemic. “Currently we are not altering PPE [personal protective equipment] instructions,” the CDC’s Bell said. “What this highlights is the fact that when you have an infection like Zika, wherein a good percentage of patients don’t actually have symptoms, it means it is as important as ever to stick with good adherence to standard precautions … It is a great example of why we should never take chances.” Equally, there’s no reason the general public should feel at risk, Pillai said: “We don’t have evidence right now that Zika can be passed by sneezing or coughing, routine touching, kissing, hugging, or sharing utensils. While we still don’t know exactly how this family contact became sick, what we do know is the primary mechanism of transmission is mosquito-borne. So we feel that should provide reassurance to the public.” http://news.nationalgeographic.com/2016/07/mysterious-new-zika-transmission-utah/ Maryn McKenna, author of Superbug and Beating Back the Devil, is an internationally published journalist who writes about public health, global health, and food policy. Follow Maryntwitter

Unique Zika Case of Utah Caregiver Under InvestigationA person who cared for a Zika-infected relative in Utah has contracted the disease, marking the first case in the continental U.S. in a patient who didn't travel to an affected area or have sex with an infected person, health officials said.July 19, 2016, at 2:56 a.m. MOREUnique Zika Case of Utah Caregiver Under InvestigationMORELeft to right, Dr. Angela Dunn, deputy state epidemiologist at the Utah Department of Health; Gary Edwards, executive director, Salt Lake County Health Department; Dr. J. Erin Staples, Medical Epidemiologist, Centers for Disease Control and Prevention,and Dr. Edward Clark Associate Vice President Clinical Affairs University of Utah speak during a news conference on Monday. RICK BOWMER/AP By LINDSAY WHITEHURST, Associated Press SALT LAKE CITY (AP) — Health authorities in Utah are investigating a unique case of Zika found in a person who had been caring for a relative who had an unusually high level of the virus in his blood. Exactly how the disease was transmitted is still a mystery, though the person has since recovered. [RELATED: Mysterious Zika Spread in Utah Suggests New Mode of Transmission] The elderly relative who died after contracting Zika abroad had amounts of the virus in his blood more than 100,000 times higher than other samples of infected people, according to the Centers for Disease Control and Prevention. Though the tropical mosquito that mainly spreads Zika isn't typically found in Utah, officials haven't ruled out the possibility that the man brought a mosquito back with him from an area where he caught the virus, perhaps in a suitcase, according to the Centers for Disease Control and Prevention. "The new case in Utah is a surprise, showing that we still have more to learn about Zika," CDC medical epidemiologist Dr. Erin Staples said. Authorities did not give further details about either patient, citing health privacy laws. The new case was discovered after a doctor noticed the caregiver's Zika-like symptoms, which include rash, fever and pink eye, officials said. He or she had cared for the older man both at home and in the hospital. That man died in late June and was the first death of a Zika-infected in the continental U.S. His age and another health condition made his exact cause of death unclear. The caregiver did not travel to an affected area. Health workers are testing other people who had contact with the first patient. Officials are trapping mosquitoes in Utah to test them, though the species that spread the disease don't usually live in the state's high altitude and cold winters. The CDC did not immediately revise its advice to health care workers or caregivers after the new case emerged. "Based on what we know so far about this case, there is no evidence that there is any risk of Zika virus transmission among the general public in Utah," said Dr. Angela Dunn, deputy state epidemiologist at the Utah Department of Health. Signs of Zika have been found in blood, urine, semen and saliva. There's no evidence yet that the Zika infection in this case is an unusual mutation, but researchers are exploring that possibility through genomic analysis. Editorial cartoons on Zika EXPAND GALLERY The virus causes only a mild illness in most people. But during recent outbreaks in Latin America, scientists discovered that infection during pregnancy has led to severe brain-related birth defects. No cases of mosquito-spread Zika have been reported in the continental United States, according to the CDC. Health experts think mosquito transmission probably will occur in the U.S., but the expectation is that it will be in low-elevation, sweltering places where the insect has been a steady problem — such as southern Florida or southern Texas. More than 1,300 Zika illnesses have been reported in the 50 states and the District of Columbia, including eight in Utah, according to health officials. Almost all were people who had traveled to Zika outbreak countries and caught the virus there. Fourteen were people who had not traveled to Zika zones but had sex with someone who had. The CDC has also been tracking pregnant women infected with Zika, and says they have five reports of pregnancy losses because of miscarriage, stillbirth or abortion. ___ Associated Press Medical Writer Mike Stobbe in New York and contributed to this report. http://www.usnews.com/news/news/articles/2016-07-19/unique-zika-case-of-utah-caregiver-under-investigation

Unusual US Zika virus case baffles experts2 hours ago From the sectionHealthShareImage copyrightSPLZika virusZika outbreak: What you need to knowZika outbreak: Travel adviceMothers' fears amid Zika outbreakVideo How mums-to-be are tackling ZikaExperts are trying to work out exactly how a US carer has caught Zika after tending to a dying elderly man with the virus. Until now it was thought that only mosquitoes and sex spread Zika, as well as the risk of mother-to-child transmission in the womb. The carer, from Utah, did not have any of these known risk factors. US officials say they are monitoring the situation carefully and carrying out more tests. They stress that the chance of spread from one person to another without sexual contact is still very unlikely or rare. Zika outbreak: What you need to know The Centres for Disease Control says the patient, who died in June, had travelled to an area where Zika-infected mosquitoes are present. Lab tests showed he had uniquely high amounts of the virus - more than 100,000 times higher than seen in other samples from infected people - in his blood. The CDC has sent out an emergency response team to investigate. They will be interviewing and testing family members of the carer and any health care workers who may have had contact with the deceased man. Gary Edwards, director of the Salt Lake County Health Department, said the infected individual was a family contact of the man who died. "We know that the patient had contact with the deceased patient while the deceased patient was very ill," he said. "The exact nature of that contact, we are still investigating." The investigators also plan to trap and test local mosquitoes to check that they are not carrying and spreading the virus. Tom Hudachko, from the Utah Department of Health, said state officials were not aware of any mosquitoes known to carry the Zika virus within Utah. He said there had been a few Aedes aegypti mosquitoes - the kind that carry Zika - discovered in traps in the south-western parts of the state several years ago, but there had not been any since. CDC expert Dr Erin Staples said: "The new case in Utah is a surprise, showing that we still have more to learn about Zika. "Fortunately, the patient recovered quickly, and from what we have seen with more than 1,300 travel-associated cases of Zika in the continental United States and Hawaii, non-sexual spread from one person to another does not appear to be common." How Zika can spreadBites from mosquitoes that carry the virusMaternal transmission from mother to baby in the wombUnprotected vaginal, oral or anal sexual intercourse - although rare, the virus can persist in semenZika virus has been found in other bodily fluids, including saliva and urine, but it is unknown whether it can spread through these routesBlood transfusion - very likely but not confirmedhttp://www.bbc.com/news/health-36833321

Is There a New Way to Get Zika?By Brenda Goodman, MA WebMD Health NewsReviewed by Brunilda Nazario, MD July 18, 2016 -- The CDC is investigating a Zika mystery: how a Utah resident got the virus without traveling or sexual contact. The new case is a relative and caregiver of an elderly Zika patient who died in late June. The deceased man had traveled to an area where Zika is spreading, and lab tests showed he had high amounts of the virus in his blood -- more than 100,000 times higher than those seen in other samples of infected people, according to the CDC. He also had a medical condition, which has not been disclosed. The new patient developed mild symptoms and rapidly recovered, said CDC officials in a news conference. Neither patient was identified. “The new case in Utah is a surprise, showing that we still have more to learn about Zika,” said Erin Staples, MD, PhD, the CDC’s medical epidemiologist on the ground in Utah, in a news release. Doctors don’t know if the virus was passed directly from nonsexual contact with bodily fluids like saliva or urine or whether it might have been spread indirectly, through the bite of an infected mosquito. Scientists have found the Zika virus in human blood, semen, saliva, urine, breast milk, swabs from the genital tract, and in fluid in the eye. If it was passed through a mosquito bite, it would be the first case of local transmission documented in the U.S., but that possibility seems unlikely because Utah isn’t known to have the kinds of mosquitoes that are known to carry Zika. “Right now we’re assessing whether any other kind of transmission could be occurring,” said Michael Bell, MD, a medical epidemiologist with the CDC. An estimated 80% of people infected with Zika don’t show symptoms. The others may have a fever, joint pain, and red eyes (known asconjunctivitis). But Zika can wreak havoc on the unborn, causing devastating birth defects including microcephaly, in which babies have unusually small heads and brain damage. As of July 7, nine babies with birth defects linked to Zika have been reported in the U.S., according to the CDC. Six other pregnancy losses with birth defects were linked to the virus. In a statement issued last week, Ary Faraji, PhD, manager of the Salt Lake City Mosquito Abatement District, said that neither of the two mosquito species that are known to transmit the virus have ever been found in Utah. Casual contact seems unlikely also, Staples said. “From what we have seen with more than 1,300 travel-associated cases of Zika in the continental United States and Hawaii, non-sexual spread from one person to another does not appear to be common.” CDC investigators are trapping mosquitoes in Utah in the communities where the family lives. Robert Wirtz, PhD, an entomologist with the CDC, says that so far, the number of mosquitoes that have been trapped in Utah are low and they are mostly culex mosquitoes, which primarily feed on birds. Aedes aegypti and Aedes albopictus mosquitoes are believed to be the carriers in the Zika outbreak spreading through the Americas. “As has been said, in our line of work, we never take anything off the table, but right now, we feel like transmission by aedes mosquitoes is highly unlikely,” he says. Public health officials are interviewing the patient and other family members to learn what kind of contact they had with the deceased man. They are also collecting samples for testing from family members and others who had contact with the deceased patient to see if anyone else was infected, according to a news release from the Utah Department of Health. “Based on what we know so far about this case, there is no evidence that there is any risk of Zika virus transmission among the general public in Utah,” says Angela Dunn, MD, deputy state epidemiologist at the Utah Department of Health. As of July 13, 1,306 cases of Zika have been reported in the continental United States and Hawaii; none of these has been the result of local spread by mosquitoes. These cases include 14 believed to be the result of sexual transmission and one that was the result of a laboratory exposure. http://www.webmd.com/news/20160718/cdc-investigates-mystery-zika-transmission

D-brief « We Won’t Finish Discovering New Trees in the Amazon for 300 YearsZika Virus Case in Utah Raises New Questions for ScientistsBy Nathaniel Scharping | July 18, 2016 4:07 pm (Credit: Tacio Philip Sansonovski/Shutterstock) Scientists from the Centers for Disease Control and Prevention (CDC) are scrambling to figure out how a Utah caregiver became ill with Zika. The virus is overwhelmingly transmitted via bites from infected mosquitoes, but can also spread through sexual contact. The case in Utah seems to be the result of something completely different, however, say state officials. Scientists aren’t exactly sure how the person became infected, but they working to figure what’s behind this latest twist in the ongoing epidemic. Patient Had Contact with ZikaAccording to the Wall Street Journal, the patient was caring for their elderly father, who became infected with the virus after traveling to an area with Zika. The elderly man eventually passed away, although it isn’t known how Zika factored into his death as he had other health complications as well. That man was the first person with Zika to die in the continental U.S. and his case was notable for the extremely high levels of the virus found in his blood — more than 100,000 times the level of people infected with the disease, according to the CDC. The caregiver was briefly ill, but has since recovered, authorities say, and caution that this was likely an isolated case and should not be cause for alarm. It’s not known what kinds of bodily fluids the caregiver came into contact with while caring for their father, hinting that there could be a previously unknown means by which the disease spreads. Public health investigators in Utah are interviewing family members to learn more about the interactions the person had with their father while providing care. New Method of Transmission?In addition to mosquito bites, the disease can be transmitted through sexual contact, blood and urine, as well as from pregnant mothers to their fetuses. It is not known if any other bodily fluids, such as saliva, could also serve as vectors for the disease. Mosquito bites are the most common form of transmission, but the species of mosquito that carry the virus, Aedes aegyptiand Aedes albopictus are not found in Utah, although they are present in neighboring states. The caregiver had not traveled to any areas with a high Zika risk either, officials say. The CDC researchers say that they are casting a wide net in their search for the method of transmission, and say that it is still too early to rule out any possibilities. “The new case in Utah is a surprise, showing that we still have more to learn about Zika,” said Erin Staples, an epidemiologist with the CDC in Utah, in a press release. The CDC team is testing family members and acquaintances who may have had contact with the deceased patient in order to find out if the disease spread to anyone else. They are also conducting a survey of mosquitos in the area to see if any are carrying the virus. “This is a unique situation,” said CDC director Tom Frieden, speaking to theWashington Post. He says that this is first documented instance of the disease spreading between two people without sexual contact. The CDC is also conducting genomic tests to see if this strain displays any mutations that could allow it to be transmitted differently, according to Frieden. There have been 1,306 cases of Zika reported in the U.S. as of July 13, although only two resulted in deaths, but no reported instances of transmission via mosquito bites in the U.S. as of yet — the majority of cases resulted from travelers returning from infected areas. In addition, 14 cases likely resulted from the sexual transmission of the disease and one was the result of exposure in the laboratory, says the CDC. http://blogs.discovermagazine.com/d-brief/2016/07/18/zika-virus-case-in-utah-perplexes-scientists/#.V44G5rgrJ-Q

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July 18, 2016 JACKSON, Miss. – Today the Mississippi State Department of Health (MSDH) reports one new case of Zika virus, bringing the 2016 total to nine in Mississippi. The case was a resident from Rankin County who recently traveled to Guatemala. Zika is a mosquito-borne virus that causes severe birth defects in a developing fetus – including brain damage, hearing and vision loss, and impaired growth – if the mother is infected during pregnancy. Zika virus infection can cause a mild illness with symptoms (fever, joint pain, conjunctivitis or rash) lasting for several days to a week, but 80 percent of those infected have mild symptoms or no symptoms at all. Death is very rare. The MSDH strongly advises pregnant women not to travel to countries where Zika is actively being transmitted. “It’s important to remember that all nine of our cases that have been reported in Mississippi are travel-related,” said MSDH State Epidemiologist Dr. Thomas Dobbs. “It is crucial that pregnant women not travel to countries where Zika is actively being transmitted.” Zika has been seen in parts of Africa, Southeast Asia, and some Pacific islands for years, but has recently been reported in approximately 30 countries, mostly in the Caribbean, Central and South America. The breed of mosquito that is spreading Zika – Aedes aegypti – has not been detected in Mississippi since the early 1990s. The MSDH is currently conducting surveillance for Aedes mosquito populations in every county in the state. The MSDH suggests the following precautions to protect yourself and your environment from mosquito-borne illnesses: Use an EPA-registered mosquito repellent that contains DEET while you are outdoors.Remove all sources of standing water around your home and yard to prevent mosquito breeding.Wear loose, light-colored, long clothing to cover the arms and legs when outdoors.Avoid areas where mosquitoes are prevalent.For more information on mosquito-borne illnesses, visit the MSDH website at HealthyMS.com/westnile and HealthyMs.com/zika. Follow MSDH by e-mail and social media at HealthyMS.com/connect. Follow MSDH by e-mail and social media at HealthyMS.com/connect.