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July 1, 2016 DEPARTMENT OF HEALTH DAILY ZIKA UPDATE: 10 NEW TRAVEL-RELATED CASES http://www.floridahealth.gov/newsroom/2016/07/070116-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 10 new travel-related cases with two in Pasco, two in Polk, one in Charlotte, one in Citrus, one in Miami-Dade, one in Orange counties and two involving pregnant women. The Declaration of Public Health Emergency has been amended to include Charlotte County Of the cases confirmed in Florida, 25 are still exhibiting symptoms. 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 4 Brevard 4 Broward 33 Charlotte 1 Citrus 2 Clay 2 Collier 3 Duval 3 Escambia 1 Highlands 1 Hillsborough 5 Lee 5 Martin 1 Miami-Dade 69 Okaloosa 1 Orange 18 Osceola 9 Palm Beach 12 Pasco 4 Pinellas 6 Polk 6 Santa Rosa 1 Seminole 8 St. Johns 2 Volusia 2 Total cases not involving pregnant women 203 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 2,189 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 25 counties included in the declaration– Alachua, Brevard, Broward, Charlotte, Citrus, Clay, Collier, Duval, Escambia, Highlands, Hillsborough, Lee, Martin, Miami-Dade, Okaloosa, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Santa Rosa, Seminole, St. Johns 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 Rick 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 Centers for Diseases Control (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 Rick 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 Rick Scott called on the Centers for Disease Control and Prevention (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.Today, the Centers for Disease Control and Prevention (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 5,506 people for active Zika virus and 1,942 for Zika antibodies.Federal Guidance on Zika: According to CDC, Zika illness is generally mild with a rash, fever and joint pain. CDC researchers have concluded that Zika virus is a cause of microcephaly and other birth defects.The FDA released guidance regarding donor screening, deferral and product management to reduce the risk of transfusion-transmission of Zika virus. Additional information is available on the FDA website here.CDC has put out guidance related to the sexual transmission of the Zika virus. This includes CDC recommendation that if you have traveled to a country with local transmission of Zika you should abstain from unprotected sex.For more information on Zika virus, click here. About the Florida Department of Health The department, nationally accredited by the Public Health Accreditation Board, works to protect, promote and improve the health of all people in Florida through integrated state, county and community efforts. Follow us on Twitter at @HealthyFla and on Facebook. For more information about the Florida Department of Health, please visit www.FloridaHealth.gov.

County Number of Cases (all travel related) Alachua 4 Brevard 4 Broward 33 Charlotte 1 Citrus 2 Clay 2 Collier 3 Duval 3 Escambia 1 Highlands 1 Hillsborough 5 Lee 5 Martin 1 Miami-Dade 69 Okaloosa 1 Orange 18 Osceola 9 Palm Beach 12 Pasco 4 Pinellas 6 Polk 6 Santa Rosa 1 Seminole 8 St. Johns 2 Volusia 2 Total cases not involving pregnant women 203 Cases involving pregnant women regardless of symptoms* 43

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Table below does not include most of recent Pregnant Registry cases StatesStatesStatesCDCStatesStatesStatesStatesStatesCDCStates 20-Jun21-Jun22-Jun23-Jun23-Jun24-Jun27-Jun28-Jun29-Jun30-Jun30-JunAL66626666626AR55555555555AZ66636666667CA6060605260626262625562CO55555555588CT23232512525252525130DE55555555559DC66666666666FL199206213162213220223227232182236GA2125252625262626262626HI1010101010101010101010IL1919191619191919231623IN1010101010101010101010IA77777999979KS24424444455KY66666666666LA66677777767MD2525252626262626263131MA2727272828282828283232ME66666666666MI7779999991010MN1919191919191919191919MO66656666656MS33333333333MT11111111111NC1515151615161616181618ND11111111101NE22222222222NH44444444444NJ2829291729353539392139NM33333333333NV77777777777NY265269281198300309324334344236367OH1414161416161616161621OK66666666666OR12121271212121515715PA2424242424242424243131RI8881111111111111515SC11111566666TN44455556688TX6466664266676767674972UT22222222222VA2626262727272727272727VT11111111323WA11111151111111212613WI55527777828WV66666666666 99910191042823107311061125114811729351247

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Zika Cases in New Jerseyhttp://www.nj.gov/health/cd/zika/case_count.shtml New Jersey County Confirmed Travel-Related Cases Bergen 10 Passaic 9 Burlington 5 Middlesex 4 Union 4 Hudson 3 Camden 3 Morris 3 Monmouth 2 Essex 2 Mercer 1 Hunterdon 1 TOTAL 47 Last Updated: July 1, 2016

Zika Cases in New Jersey New Jersey County Confirmed Travel-Related Cases Bergen 10 Passaic 9 Burlington 5 Middlesex 4 Union 4 Hudson 3 Camden 3 Morris 3 Monmouth 2 Essex 2 Mercer 1 Hunterdon 1 TOTAL 47 Last Updated: July 1, 2016

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Number of cases reportedCounty/Area TodayYear to Date (6/30/16) Albany03Dutchess05Erie01Lewis01Monroe03Nassau017Niagara01Oneida02Onondaga04Ontario01Orange01Putnam01Rockland04St Lawrence01Schenectady01Suffolk021Tompkins01Westchester06NYS (ex NYC)074NYC2272NYS Total Confirmed2346NYS Pregnant Registry021NYS Total2367

21 Pregnant Registry cases in New York State not included in table below

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Current as of June 29, 2016 Table: Travel History of Patients with Positive Test Results byZika Affected Country or Territory Visited - Connecticut, February 15 - June 29, 2016 Countries/Territories VisitedZika Positive Flavivirus Positive* Total Aruba 11 Brazil 11 Colombia112 Dominican Republic13 13 El Salvador 11 Guatemala 11 Haiti134 Honduras112 Jamaica1 1 Mexico 11 Puerto Rico 415 St. Lucia1 1Total 22 1133

Surveillance for Zika virus has been ongoing in Connecticut since February 15, 2016. No locally acquired cases have been reported. The following annual statistics are preliminary and are current as of the date shown. Zika Virus Testing, Cumulative Results Current as of June 29, 2016 Table: Travel History of Patients with Positive Test Results byZika Affected Country or Territory Visited - Connecticut, February 15 - June 29, 2016 Countries/Territories VisitedZika Positive Flavivirus Positive* Total Aruba 11 Brazil 11 Colombia112 Dominican Republic13 13 El Salvador 11 Guatemala 11 Haiti134 Honduras112 Jamaica1 1 Mexico 11 Puerto Rico 415 St. Lucia1 1Total 22 1133 *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 - June 29, 2016 Tests Performed for Diagnosis of Zika Virus Infection

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June 30, 2016 5:03 AMFiled Under: cases, confirmed, Local, Mosquitoes, residents, St. Louis, St. Louis County, West Nile Virus, Zika virus (NELSON ALMEIDA/AFP/Getty Images) 6ST. LOUIS (KMOX) – Three confirmed cases of Zika have now turned up in St. Louis County. However, County Health Director Dr. Faizal Khan points out the three cases they have registered were all the result of local residents returning from “endemic” Zika sites such as Mexico, Brazil or the Caribbean. http://stlouis.cbslocal.com/2016/06/30/zika-virus-cases-confirmed-in-st-louis-county/

Zika Virus Cases Confirmed in St. Louis CountyJune 30, 2016 5:03 AMFiled Under: cases, confirmed, Local, Mosquitoes, residents, St. Louis, St. Louis County, West Nile Virus, Zika virus (NELSON ALMEIDA/AFP/Getty Images) 6ST. LOUIS (KMOX) – Three confirmed cases of Zika have now turned up in St. Louis County. However, County Health Director Dr. Faizal Khan points out the three cases they have registered were all the result of local residents returning from “endemic” Zika sites such as Mexico, Brazil or the Caribbean. http://stlouis.cbslocal.com/2016/06/30/zika-virus-cases-confirmed-in-st-louis-county/

Zika virus: 3 more US babies born with birth defectsPublished time: 1 Jul, 2016 03:33Get short URL© Paulo Whitaker / ReutersAddThis Sharing Buttons152The Centers for Disease Control and Prevention have confirmed that three more American babies have been born with birth defects likely linked to Zika virus infections. The agency also said another lost pregnancy was linked to the virus.According to the health agency’s online Zika pregnancies registry, that brings the total to seven babies with microcephaly born in the US, and five lost pregnancies either from miscarriage, stillbirth or termination as of June 23. View image on Twitter The registry compiles laboratory evidence of possible Zika infection from all 50 states and the District of Columbia. View image on Twitter Zika has caused alarm throughout the Americas since numerous cases of the birth defect microcephaly, linked to the mosquito-borne virus Zika, was reported in Brazil, the country hardest hit by the current outbreak. The rare birth defect is marked by unusually small head size and potentially severe developmental problems. More than 1,400 cases of microcephaly in babies have been confirmed in Brazil. “The poor birth outcomes reported include those that have been detected in infants infected with Zika before or during birth, including microcephaly (unusually small head size and severe developmental problems), excess fluid in the brain cavities and surrounding the brain, absent or poorly formed brain structures… or other problems resulting from damage to the brain that affects nerves, muscles and bones such a clubfoot or inflexible joints,” the CDC said in a statement. View image on Twitter More than 900 Zika cases in the US reported so far have all involved people who contracted the virus outside the country in areas with active Zika outbreaks, or otherwise were infected through unprotected sex with an infected partner. View image on Twitter There have not yet been any cases reported of local transmission of the virus in the US, but health experts expect local transmission to occur with the onset of mosquito season, especially in Gulf Coast states such as Florida and Texas. The CDC plans to issue updated reports each Thursday to ensure that information about pregnancy outcomes linked with the Zika virus is publicly available. The issue of providing funding to counter the Zika virus is ongoing in Congress, which is currently in disagreement. Republicans presented a bill earlier this week to propose $1.1 billion in funding, including efforts to develop a vaccine. The bill’s spending would have been offset by $750 million in savings from unused Ebola funding, cuts to administrative funding at the US Department of Health and Human Services and unused money for healthcare exchanges within the Affordable Care Act. View image on Twitter The bill failed Tuesday in a nearly clean party-line vote of 52-48, falling short of 60 votes necessary for passage. Democrats said they could not support the measure, because it was chock full of unrelated measures and funding restrictions for reproductive health, including limits to funding for healthcare providers of birth control, as well as weakened standards for pesticide use near water sources. The White House and Democrats have backed a proposal that would offer $1.9 billion to fight Zika. President Barack Obama said he would veto the Republican funding plan. Republicans accused Democrats for playing politics in the face of a dangerous virus. https://www.rt.com/usa/349083-3-more-zika-babies-us/

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http://www.houstontx.gov/health/Epidemiology/Zika_Virus.html GenderAge RangeTravel HistoryTravel MonthConfirmation DateCase Status by CDCFemale60-64Colombia11/1512/22/2015Confirmed PositiveMale35-39Honduras12/1501/28/2016Confirmed PositiveFemale40-45Honduras12/151/29/2016Confirmed PositiveFemale0-10Honduras1/162/22/2016Confirmed PositiveFemale45-50Guatemala1/162/25/2016Confirmed PositiveFemale60-64El Salvador11/152/26/2016Confirmed PositiveFemale30-34Central America6/166/22/2016Confirmed PositiveFemale25-30Honduras5/165/20/2016Confirmed PositiveMale30-34Puerto Rico6/166/21/2016Confirmed PositiveFemale55-60Venezuelaunknown6/22/2016Confirmed PositiveMale30-34U.S. Virgin Islands6/166/27/2016Confirmed Positive

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HCPH Zika Virus Cases *Please note, these are the most current number of confirmed cases. This list is updated every Thursday by 2pm CST. Number of pregnancy related cases: 0 http://publichealth.harriscountytx.gov/Resources/2016-Zika-Virus Age RangeGenderTravel MonthCountry of TravelStatus< 10M12/2015El SalvadorRecovered40-49F11/2015El SalvadorRecovered20-29M11/2015El SalvadorRecovered40-49F11/2015El SalvadorRecovered30-39M01/2016VenezuelaRecovered40-49M01/2016HondurasRecovered40-49F04/2016HondurasRecovered