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Harris County Public Health (HCPH) has confirmed the first Zika related microcephaly case in Harris County and in the State of Texas. HCPH received a positive Zika test result for an infant who has been diagnosed with microcephaly at birth. The mother, who traveled from Latin America, was tested for Zika, but had received inconclusive test results. Since the infant received a definitive positive lab result for Zika, it is suspected that the mother probably carried the virus while pregnant, and presumably was infected in Latin America. http://publichealth.harriscountytx.gov/Portals/27/Documents/News/Zika_Micro_Press_7-13-16_.pdf?ver=2016-07-13-130439-127

Harris County Public Health (HCPH) has confirmed the first Zika related microcephaly case in Harris County and in the State of Texas. HCPH received a positive Zika test result for an infant who has been diagnosed with microcephaly at birth. The mother, who traveled from Latin America, was tested for Zika, but had received inconclusive test results. Since the infant received a definitive positive lab result for Zika, it is suspected that the mother probably carried the virus while pregnant, and presumably was infected in Latin America. http://publichealth.harriscountytx.gov/Portals/27/Documents/News/Zika_Micro_Press_7-13-16_.pdf?ver=2016-07-13-130439-127

July 13, 2016 DEPARTMENT OF HEALTH DAILY ZIKA UPDATE: 11 NEW TRAVEL-RELATED CASES TODAY http://www.floridahealth.gov/newsroom/2016/07/071316-zika-update.htmlContact:Communications [email protected](850) 245-4111 Tallahassee, Fla.—In an effort to keep Florida residents and visitors safe and aware about the status of the Zika virus, the Florida Department of Health will issue a Zika virus update each week day at 2 p.m. Updates will include a CDC-confirmed Zika case count by county and information to better keep Floridians prepared. There are 11 new travel-related cases today with two in Broward, one in Collier, one in Duval, three in Miami-Dade, two in Orange, one in Pasco and one in Pinellas counties. According to CDC, symptoms associated with the Zika virus last between seven to 10 days. CDC recommends that women who are pregnant or thinking of becoming pregnant postpone travel to Zika affected areas. According to CDC guidance, providers should consider testing all pregnant women with a history of travel to a Zika affected area for the virus. CDC recommends that a pregnant woman with a history of Zika virus and her provider should consider additional ultrasounds. Florida has been monitoring pregnant women with evidence of Zika regardless of symptoms since January. The total number of pregnant women who have been monitored is 43, with 12 having met the previous CDC case definition. The Council of State and Territorial Epidemiologists and CDC released a new case definition for Zika that now includes reporting both asymptomatic and symptomatic cases of Zika. Prior to this change, states reported only symptomatic non-pregnant cases and pregnant cases regardless of symptoms. This change comes as a result of increased availability for testing in commercial laboratories. County Number of Cases (all travel related) Alachua 5 Brevard 6 Broward 43 Charlotte 1 Citrus 2 Clay 3 Collier 4 Duval 6 Escambia 1 Highlands 1 Hillsborough 6 Lake 1 Lee 6 Martin 1 Miami-Dade 78 Okaloosa 1 Orange 25 Osceola 12 Palm Beach 13 Pasco 5 Pinellas 7 Polk 8 Santa Rosa 1 Seminole 9 St. Johns 2 St. Lucie 1 Volusia 2 Total cases not involving pregnant women 250 Cases involving pregnant women regardless of symptoms* 43 *Counties of pregnant women will not be shared. On Feb. 12, Governor Scott directed the State Surgeon General to activate a Zika Virus Information Hotline for current Florida residents and visitors, as well as anyone planning on traveling to Florida in the near future. The hotline, managed by the Department of Health, has assisted 2,270 callers since it launched. The number for the Zika Virus Information Hotline is 1-855-622-6735. All cases are travel-associated. There have been no locally-acquired cases of Zika in Florida. For more information on the Zika virus, click here. The department urges Floridians to drain standing water weekly, no matter how seemingly small. A couple drops of water in a bottle cap can be a breeding location for mosquitoes. Residents and visitors also need to use repellents when enjoying the Florida outdoors. More Information on DOH action on Zika: On Feb. 3, Governor Scott directed the State Surgeon General to issue a Declaration of Public Health Emergency for the counties of residents with travel-associated cases of Zika.There have been 27 counties included in the declaration– Alachua, Brevard, Broward, Charlotte, Citrus, Clay, Collier, Duval, Escambia, Highlands, Hillsborough, Lake, Lee, Martin, Miami-Dade, Okaloosa, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Santa Rosa, Seminole, St. Johns, St. Lucie and Volusia – and will be updated as needed. DOH encourages Florida residents and visitors to protect themselves from all mosquito-borne illnesses by draining standing water; covering their skin with repellent and clothing; and covering windows with screens.DOH has a robust mosquito-borne illness surveillance system and is working with CDC, the Florida Department of Agriculture and Consumer Services and local county mosquito control boards to ensure that the proper precautions are being taken to protect Florida residents and visitors.On April 6, Governor Scott and Interim State Surgeon General Dr. Celeste Philip hosted a conference call with Florida Mosquito Control Districts to discuss ongoing preparations to fight the possible spread of the Zika virus in Florida. There were 74 attendees on the call.On May 11, Governor Scott met with federal leaders on the importance of preparing for Zika as we would a hurricane. Governor Scott requested 5,000 Zika preparedness kits from HHS Secretary Sylvia Burwell as well as a plan from FEMA on how resources will be allocated to states in the event an emergency is declared.On June 1, Governor Scott requested for President Obama to provide preparedness items needed in order to increase Florida’s capacity to be ready when Zika becomes mosquito-borne in our state.On June 9, Governor Scott spoke with Health and Human Services Secretary Sylvia Burwell and CDC Director Dr. Tom Frieden on Zika preparedness and reiterated the requests that he has continued to make to the federal government to prepare for the Zika virus once it becomes mosquito-borne in Florida. Governor Scott also requested that the CDC provide an additional 1,300 Zika antibody tests to Florida to allow individuals, especially pregnant women and new mothers, to see if they ever had the Zika virus.On June 23, Governor Scott announced that he will use his emergency executive authority to allocate $26.2 million in state funds for Zika preparedness, prevention and response in Florida.On June 28, the department announced the first confirmed case of microcephaly in an infant born in Florida whose mother had a travel-related case of Zika. The mother of the infant contracted Zika while in Haiti. Following the confirmation of this case, Governor Scott called on CDC to host a call with Florida medical professionals, including OBGYNs and physicians specializing in family medicine, to discuss the neurological impacts of Zika and what precautions new and expecting mothers should take.On July 1, CDC hosted a call with Florida medical professionals, including OBGYNs and physicians specializing in family medicine, to discuss the neurological impacts of Zika and what precautions new and expecting mothers should take. More than 120 clinicians participated.Florida currently has the capacity to test 5,188 people for active Zika virus and 1,676 for Zika antibodies.Federal Guidance on Zika: According to CDC, Zika illness is generally mild with a rash, fever and joint pain. CDC researchers have concluded that Zika virus is a cause of microcephaly and other birth defects.The FDA released guidance regarding donor screening, deferral and product management to reduce the risk of transfusion-transmission of Zika virus. Additional information is available on the FDA website here.CDC has put out guidance related to the sexual transmission of the Zika virus. This includes CDC recommendation that if you have traveled to a country with local transmission of Zika you should abstain from unprotected sex.For more information on Zika virus, click here. About the Florida Department of Health The department, nationally accredited by the Public Health Accreditation Board, works to protect, promote and improve the health of all people in Florida through integrated state, county and community efforts. Follow us on Twitter at @HealthyFla and on Facebook. For more information about the Florida Department of Health, please visit www.FloridaHealth.gov.

July 13, 2016 DEPARTMENT OF HEALTH DAILY ZIKA UPDATE: 11 NEW TRAVEL-RELATED CASES TODAY Contact:Communications [email protected](850) 245-4111 Tallahassee, Fla.—In an effort to keep Florida residents and visitors safe and aware about the status of the Zika virus, the Florida Department of Health will issue a Zika virus update each week day at 2 p.m. Updates will include a CDC-confirmed Zika case count by county and information to better keep Floridians prepared. There are 11 new travel-related cases today with two in Broward, one in Collier, one in Duval, three in Miami-Dade, two in Orange, one in Pasco and one in Pinellas counties. According to CDC, symptoms associated with the Zika virus last between seven to 10 days. CDC recommends that women who are pregnant or thinking of becoming pregnant postpone travel to Zika affected areas. According to CDC guidance, providers should consider testing all pregnant women with a history of travel to a Zika affected area for the virus. CDC recommends that a pregnant woman with a history of Zika virus and her provider should consider additional ultrasounds. Florida has been monitoring pregnant women with evidence of Zika regardless of symptoms since January. The total number of pregnant women who have been monitored is 43, with 12 having met the previous CDC case definition. The Council of State and Territorial Epidemiologists and CDC released a new case definition for Zika that now includes reporting both asymptomatic and symptomatic cases of Zika. Prior to this change, states reported only symptomatic non-pregnant cases and pregnant cases regardless of symptoms. This change comes as a result of increased availability for testing in commercial laboratories. County Number of Cases (all travel related) Alachua 5 Brevard 6 Broward 43 Charlotte 1 Citrus 2 Clay 3 Collier 4 Duval 6 Escambia 1 Highlands 1 Hillsborough 6 Lake 1 Lee 6 Martin 1 Miami-Dade 78 Okaloosa 1 Orange 25 Osceola 12 Palm Beach 13 Pasco 5 Pinellas 7 Polk 8 Santa Rosa 1 Seminole 9 St. Johns 2 St. Lucie 1 Volusia 2 Total cases not involving pregnant women 250 Cases involving pregnant women regardless of symptoms* 43 *Counties of pregnant women will not be shared.

Current as of July 12, 2016 Table: Travel History of Patients with Positive Test Results byZika Affected Country or Territory Visited - Connecticut, February 15 - July 12, 2016 Countries/Territories VisitedZika Positive Flavivirus Positive* Total Aruba 11 Brazil 11 Colombia213 Dominican Republic16117 El Salvador 11 Guatemala 11 Haiti134 Honduras112 Jamaica2 2 Mexico 11 Puerto Rico415 St. Lucia1 1Total 27 1239 *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 12, 2016 Tests Performed for Diagnosis of Zika Virus Infection

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Zika Cases in New Jersey New Jersey County Confirmed Travel-Related Cases Bergen 12 Passaic 10 Middlesex 5 Burlington 5 Union 5 Essex 4 Hudson 3 Morris 3 Camden 3 Monmouth 2 Mercer 1 Hunterdon 1 TOTAL 54 Last Updated: July 12, 2016 http://www.nj.gov/health/cd/zika/case_count.shtml

Zika Cases in New Jersey New Jersey County Confirmed Travel-Related Cases Bergen 12 Passaic 10 Middlesex 5 Burlington 5 Union 5 Essex 4 Hudson 3 Morris 3 Camden 3 Monmouth 2 Mercer 1 Hunterdon 1 TOTAL 54 Last Updated: July 12, 2016

TABLE I. Provisional cases of selected* infrequently reported notifiable diseases (<1,000 cases reported during the preceding year), United States, week ending July 9, 2016 (WEEK 27)†http://wonder.cdc.gov/mmwr/mmwr_2016.asp?mmwr_year=2016&mmwr_week=27&mmwr_table=1&request=Submit&mmwr_location= Disease Total cases reported for previous years Current weekCum 20165-year weekly average§20152014201320122011States reporting cases during current week (No.27) Anthrax-------1 Arboviral diseases ¶,**: Chikungunya virus ††-528896NNNNNNNN Eastern equine encephalitis virus--0688154 Jamestown Canyon virus §§--011112223 La Crosse virus §§-2155808578130 Powassan virus-217812716 St. Louis encephalitis virus--12310136 Western equine encephalitis virus-------- Botulism, total-864195161152168153 foodborne-220371542724 infant-57313812713612397 other(wound & unspecified)-702019121832 Brucellosis1492126929911479MO (1 ) Chancroid17011--158SC (1 ) Cholera--025141740 Cyclosporiasis **106534645388784123151NYC (3 ), IA (1 ), NE (4 ), FL (2 ) Diphtheria----1-1- Haemophilus influenzae, invasive disease (age <5 yrs) ¶¶: serotype b-902940313014 nontypeable serotype-85317412814111593 other serotype-641135266233263230 unknown serotype3113316739343748NY (1 ), FL (1 ), CO (1 ) Hansen's disease **-2228988818282 Hantavirus Infections **: Hantavirus infection (non-HPS) ††-2-1NNNNNNNN Hantavirus pulmonary syndrome (HPS)-911732213023 Hemolytic uremic syndrome, post-diarrheal **1858275250329274290TN (1 ) Hepatitis B, virus infection perinatal115137474840NPNY (1 ) Influenza-associated pediatric mortality **, ***276113014116052118AZ (1 ), TX (1 ) Leptospirosis **-1704038NNNNNN Listeriosis624318766769735727870MA (1 ), NY (2 ), OH (2 ), VA (1 ) Measles †††-46518866718755220 Meningococcal disease, invasive §§§: serogroup ACWY-563120123142161257 serogroup B-4111118999110159 other serogroup1902125172020OK (1 ) unknown serogroup2974120196298260323FL (1 ), CA (1 ) Novel influenza A virus infections ¶¶¶-31632131314 Plague--01310443 Poliomyelitis, paralytic--0--1-- Polio virus infection, nonparalytic **-------- Psittacosis **-3-48622 Q fever total **:-513158168170135134 acute-432123132137113110 chronic-803536332224 Rabies, human--011216 SARS CoV-------- Smallpox-------- Streptococcal toxic shock syndrome **11454335259224194168ID (1 ) Syphilis, congenital ****-1608490458348322360 Toxic shock syndrome (staphylococcal) **-1516659716578 Trichinellosis **-401114221815 Tularemia1579314180203149166MO (1 ) Typhoid fever-1327367349338354390 Vancomycin-intermediate Staphylococcus aureus **-52318321224813482 Vancomycin-resistant Staphylococcus aureus **--01--2- Viral hemorrhagic Fevers ††††: Crimean-Congo hemorrhagic fever----NPNPNPNP Ebola hemorrhagic fever----4NPNPNP Guanarito hemorrhagic fever----NPNPNPNP Junin hemorrhagic fever----NPNPNPNP Lassa fever----1NPNPNP Lujo virus----NPNPNPNP Machupo hemorrhagic fever----NPNPNPNP Marburg fever----NPNPNPNP Sabia-associated hemorrhagic fever----NPNPNPNP Yellow fever-------- Zika ††,§§§§ Zika virus congenital infectionNANANANNNNNNNNNN Zika virus disease, non-congenital infection71,2470NNNNNNNNNNMA (1 ), OH (1 ), VA (1 ), SC (1 ), FL (1 ), TN (1 ), MS (1 )[ Export This Table ] [ Next Part ] [ NNDSS Interactive Tables ] [ Mortality Interactive Tables ] -: No reported cases N: Not reportable. NA: Not Available NN: Not Nationally Notifiable. NP: Nationally notifiable but not published. Cum: Cumulative year-to-date counts. * Case counts for reporting years 2015 and 2016 are provisional and subject to change. Data for years 2011 through 2014 are finalized. For further information on interpretation of these data, seehttp://wwwn.cdc.gov/nndss/document/ProvisionalNationaNotifiableDiseasesSurveillanceData20100927.pdf. † This table does not include cases from the U.S. territories. Three low incidence conditions, rubella, rubella congenital, and tetanus, are in Table II to facilitate case count verification with reporting jurisdictions. § Calculated by summing the incidence counts for the current week, the 2 weeks preceding the current week, and the 2 weeks following the current week, for a total of 5 preceding years. Additional information is available athttp://wwwn.cdc.gov/nndss/document/5yearweeklyaverage.pdf. ¶ Includes both neuroinvasive and nonneuroinvasive. Updated weekly reports from the Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (ArboNET Surveillance). Data for West Nile virus are available in Table II. ** Not reportable in all reporting jurisdictions. Data from states where the condition is not reportable are excluded from this table, except for the arboviral diseases and influenza-associated pediatric mortality. Reporting exceptions are available athttp://wwwn.cdc.gov/nndss/downloads.html. †† Office of Management and Budget approval of the NNDSS Revision #0920-0728 on January 21, 2016, authorized CDC to receive data for these conditions. CDC is in the process of soliciting data for these conditions (except Zika virus, congenital infection). CDC and the U.S. states are still modifying the technical infrastructure needed to collect and transmit data for Zika virus congenital infections. §§ Jamestown Canyon virus and Lacrosse virus have replaced California serogroup diseases. ¶¶ Data for Haemophilus influenzae (all ages, all serotypes) are available in Table II. *** Please refer to the MMWR publication for weekly updates to the footnote for this condition. ††† Please refer to the MMWR publication for weekly updates to the footnote for this condition. §§§ Data for meningococcal disease (all serogroups) are available in Table II. ¶¶¶ Please refer to the MMWR publication for weekly updates to the footnote for this condition. **** Updated weekly from reports to the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. †††† Please refer to the MMWR publication for weekly updates to the footnote for this condition. §§§§ All cases reported have occurred in travelers returning from affected areas, with their sexual contacts, or infants infected in utero.National Notifiable Diseases Surveillance System (NNDSS) MMWR web application provided by CDC WONDER, http://wonder.cdc.gov

58 cases in 2015 Zika ††,§§§§ Zika virus congenital infectionNANANANNNNNNNNNN Zika virus disease, non-congenital infection71,2470NNNNNNNNNNMA (1 ), OH (1 ), VA (1 ), SC (1 ), FL (1 ), TN (1 ), MS (1 )

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As of July 13, 2016 in South Carolina: Travel-associated cases reported: 17Pregnant women: 0Sexually transmitted: 1*Locally acquired vector-borne cases reported: 0Total cases: 17South Carolina has had 17 travel-associated cases of Zika virus. Of those, 16 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. http://www.scdhec.gov/Health/DiseasesandConditions/InfectiousDiseases/InsectAnimalBorne/ZikaVirus/

As of July 13, 2016 in South Carolina: Travel-associated cases reported: 17Pregnant women: 0Sexually transmitted: 1*Locally acquired vector-borne cases reported: 0Total cases: 17South Carolina has had 17 travel-associated cases of Zika virus. Of those, 16 were in travelers who were infected abroad and diagnosed after they returned home. *One case involved a South Carolina resident who had sexual contact with someone who acquired the Zika infection while traveling abroad. Due to federal privacy restrictions, DHEC is unable to provide additional information concerning any individual, including details about physical condition, hospitalization, age, sex, and residence.

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

weekconfdiscarduntestedtotalweekly increase2618641121941325135611218117241151102164272365081137192264369118232164148957205265788719526508191852443721417521325881642026506154182244111421516330

Among the epidemiological weeks 01 to 26, 2016 have beeneighteen confirmed cases of microcephaly associated virusZika, 64 cases were dismissed, and 112 cases are under consideration.Special monitoring of Neurological Syndromes withhistory of illness compatible with infectionZika virus http://www.ins.gov.co/boletin-epidemiologico/Boletn Epidemiolgico/2016 Boletín epidemiológico semana 26.pdf

The number of microcephaly cases reported in week 26 rose to 194 (from 181 in week 25). In the past 5 weeks, the number of cases have increased by 99 (well above the expected background level of 15 = 3 per week).

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

Among the epidemiological weeks 01 to 26, 2016 have beeneighteen confirmed cases of microcephaly associated virusZika, 64 cases were dismissed, and 112 cases are under consideration.Special monitoring of Neurological Syndromes withhistory of illness compatible with infectionZika virus http://www.ins.gov.co/boletin-epidemiologico/Boletn Epidemiolgico/2016 Boletín epidemiológico semana 26.pdf

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

intensified surveillance of microcephalyReview July 1, 2016Among the epidemiological weeks 01 to 25, 2016 have beenthirteen confirmed cases of microcephaly associated virusZika, 56 cases were dismissed, and 112 cases are under consideration. http://www.ins.gov.co/boletin-epidemiologico/Boletn Epidemiolgico/2016 Boletín epidemiológico semana 25.pdf

Microcephaly map update https://www.google.com/maps/d/u/0/edit?mid=1RcVTrkYW6hax_iITjKUkEcBCVeI

Among the epidemiological weeks 01 to 26, 2016 have been eighteen confirmed cases of microcephaly associated virus Zika, 64 cases were dismissed, and 112 cases are under consideration. Special monitoring of Neurological Syndromes with history of illness compatible with infection Zika virus http://www.ins.gov.co/boletin-epidemiologico/Boletn Epidemiolgico/2016 Boletín epidemiológico semana 26.pdf

Number of cases reportedCounty/Area TodayYear to Date (7/12/16) Albany03Broome11Clinton01Dutchess05Erie02Lewis01Monroe03Nassau020Niagara01Oneida02Onondaga04Ontario02Orange01Putnam01Rockland05St Lawrence01Schenectady01Suffolk127Tompkins01Westchester18NYS (ex NYC)390NYC4307NYS Total Confirmed7397NYS Pregnant Registry022NYS Total7419