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CDPH Weekly Update on Number of Zika Infections in California June 10, 2016 The following table provides the number of travel-associated infections with Zika virus in California residents in 2015 and 2016. CDPH is following CDC testing guidelines. This table is updated every Friday. As of June 10, 2016, there have been 57 travel-associated Zika virus infections in California.  Total infections: 57  Cumulative number of infections in pregnant women: 15*  Cumulative number of infections due to sexual transmission: 1 Zika virus infections in California, 2015-2016§ (as of June 10, 2016) County Travel-associated ¥ Locally acquired † Alameda 5 0 Contra Costa 4 0 Los Angeles 17 0 Marin 1 0 Napa 1 0 Orange 2 0 San Bernardino 3 0 San Diego 13** 0 San Francisco 2 0 San Joaquin 2 0 San Mateo 2 0 Santa Clara 1 0 Solano 1 0 Sonoma 1 0 Yolo 2 0 Total 57 0 *Local Health Departments and CDPH are monitoring all pregnant women and their infants §Total number includes laboratory-confirmed and probable infections as defined by the CSTE Position Statement ¥ Persons exposed through travel to an affected area or contact with a traveler † Presumed local mosquito-borne transmission **Includes one non-resident https://www.cdph.ca.gov/HealthInfo/discond/Documents/TravelAssociatedCasesofZikaVirusinCA.pdf

Delaware health officials Friday announced a fourth confirmed case of the Zika virus in the state, once again caused by an individual traveling abroad and acquiring the disease via a mosquito bite. The fourth case is a man in Kent County who traveled abroad in May. That is all Division of Public Health officials would release on the matter. Two women and a man, all from New Castle County, were the first cases, confirmed in February and March. Officials said there have been no confirmed cases in the state of a mosquito biting an infected individual and then transferring Zika to another individual. The virus can also be spread by men via oral, vaginal, and anal sex. http://www.wdel.com/story/75515-health-officials-announce-4th-confirmed-zika-case-in-delaware

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June. 10, 2016 Department of Health Daily Zika UpdateThree New Travel-Related Cases TodayContact: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. Yesterday, 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. There are three new travel related cases today including two in Miami-Dade and one in Pasco counties. Of the cases confirmed in Florida, eight 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 38, with 9 having met the previous CDC case definition. County Number of Cases (all travel related) Alachua 4 Brevard 3 Broward 19 Clay 2 Collier 2 Escambia 1 Hillsborough 4 Lee 5 Martin 1 Miami-Dade 53 Orange 11 Osceola 6 Palm Beach 8 Pasco 2 Pinellas 4 Polk 3 Santa Rosa 1 Seminole 4 St. Johns 2 Volusia 2 Total cases not involving pregnant women 137 Cases involving pregnant women regardless of symptoms* 38 *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 2,009 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 20 counties included in the declaration– Alachua, Brevard, Broward, Clay, Collier, Escambia, Hillsborough, Lee, Martin, Miami-Dade, 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.Florida currently has the capacity to test 5,987 people for active Zika virus and 1,732 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.Based on CDC guidance released, DOH will now report pregnant women with evidence of Zika virus regardless of symptoms. Prior to new guidance, CDC guidance was only to report cases of Zika if the pregnant women was symptomatic.For more information on Zika virus, click here. About the Florida Department of Health The department 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. http://www.floridahealth.gov/newsroom/2016/06/061016-zika-update.html

County Number of Cases (all travel related) Alachua 4 Brevard 3 Broward 19 Clay 2 Collier 2 Escambia 1 Hillsborough 4 Lee 5 Martin 1 Miami-Dade 53 Orange 11 Osceola 6 Palm Beach 8 Pasco 2 Pinellas 4 Polk 3 Santa Rosa 1 Seminole 4 St. Johns 2 Volusia 2 Total cases not involving pregnant women 137 Cases involving pregnant women regardless of symptoms* 38 *Counties of pregnant women will not be shared.

As of June 10, 2016 there is one confirmed travel-associated case of Zika virus in South Carolina.

Allegheny County Residents Approved for Zika Testing: 109 CDC Confirmed Cases: 4(as of June 9)

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Zika Cases in New Jersey New Jersey County Confirmed Travel-Related Cases Bergen 7 Passaic 4 Burlington 3 Union 3 Monmouth 2 Morris 2 Middlesex 2 Camden 1 Essex 1 Hudson 1 Hunterdon 1 TOTAL 27 Last Updated: June 10, 2016 http://www.nj.gov/health/cd/zika/case_count.shtml

Zika Cases in New Jersey New Jersey County Confirmed Travel-Related Cases Bergen 7 Passaic 4 Burlington 3 Union 3 Monmouth 2 Morris 2 Middlesex 2 Camden 1 Essex 1 Hudson 1 Hunterdon 1 TOTAL 27 Last Updated: June 10, 2016

Zika Virus New Hampshire Summary Report January 11, 2016 – June 8, 2016 Note: Number of testing results and number of people tested may not match because some people may have submitted more than one sample or more than one test may have been performed. Note: Number of positive results and number of cases may not match because some people may have submitted more than one sample or may not be a NH resident and therefore not counted as a NH case. For Questions about this report: The general public or healthcare providers with questions about this report should call 603-271-0273. Members of the media with questions about this report should call 603-271-9391. Additional information on Zika virus is available at: http://www.dhhs.nh.gov/dphs/cdcs/zika/index.htm http://www.cdc.gov/zika/index.html All the data in this report are based upon information provided to the New Hampshire Department of Health and Human Services under specific legislative authority (RSA 141-C). The numbers reported may represent an underestimate of the true absolute number and incidence rate of cases in the state. The department is not responsible for any duplication or misrepresentation of surveillance data released in this report. Report prepared by Carolyn Fredette, MPH, 603-271-0273, [email protected] on 6/8/2016 at 11:00am. ZIKA VIRUS TESTING SUMMARY Number of people tested 206 Total # of pending results 6 Total # of negative results 274 Total # of positive results 4 ZIKA VIRUS CASE SUMMARY Female Pregnant Female Not pregnant Male TOTAL Number of Zika Virus Cases in NH 2 1 1 4

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As of June 9, 201619 confirmed travel-related Zika cases in Georgia http://dph.georgia.gov/

As of June 9, 201619 confirmed travel-related Zika cases in Georgia

Zika Virus – June 10, 2016. Texas has had 41 reported cases of Zika virus disease. Of those, 40 were in travelers who were infected abroad and diagnosed after they returned home; one of those travelers was a pregnant woman. One case involved a Dallas County resident who had sexual contact with someone who acquired the Zika infection while traveling abroad. Texas Zika Cases by County: CountyCasesBexar6Collin1Dallas6Denton2Ellis1Fort Bend2Grayson1Harris13Tarrant4Travis2Val Verde1Williamson1Wise1Total41

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Cape Verde with three cases of microcephaly due to zikaby RFIPublished on 05.06.2016 Changed 05/06/2016 at 19:19Aedes Aegyptis, the mosquito that transmits the virus zika, who made the first infected victim in the United States.REUTERS / Daniel Becerril / FilesThe Minister of Cape Verde Health, Arlindo Rosario, revealed that three children were born with microcephaly under zika virus, one in March and two in May. The three children born with microcephaly were resgistas on the islands of Santiago and Maio. The last two cases of microcephaly because of zika virus happened last month. The revelation was made to the press by the Minister of Health and Social Security, Arlindo of the Rosary , which ensured that children and families are being followed. This time according to the Minister of Health and Social Security are 394 pregnant women suspected of being infected with zika, but all have specialized monitoring. Arlindo Rosario also said that, since 25 April, there is no record of any case of zika infection and mosquitoes analyzed are not infected. The first cases of zika were recorded on the islands of Fogo, Santiago and Maio in September 2015 and amounted to health authorities last April 7,580 suspected cases as in reports our correspondent in Cape Verde, Odair Santos. http://pt.rfi.fr/cabo-verde/20160605-cabo-verde-com-tres-casos-de-microcefalia-devido-zika?ref=tw_i&dlvrit=1888439

Table 3. Countries, territories and areas reporting microcephaly and /or CNS malformation cases potentially associated with Zika virus infection Reporting country or territory Number of microcephaly and /or CNS malformation cases suggestive of congenital infections or potentially associated with a Zika virus infection Probable location of infection Brazil 15516 Brazil Cabo Verde 6 Cabo Verde Colombia 7 Colombia French Polynesia 8 French Polynesia Marshall Islands 1 Marshall Islands Martinique 4 7 Martinique Panama 5 Panama Puerto Rico 1 Puerto Rico Slovenia8 1 Brazil Spain 1 Colombia United States of America9,10 2 Brazil; Mexico, Belize or Guatemala (undetermined) http://apps.who.int/iris/bitstream/10665/208877/1/zikasitrep_9Jun2016_eng.pdf

WHO raises idea of delaying pregnancy in Zika-affected areasFELIPE DANA/AP Marcia Maria, who is seven months pregnant, waits to be examined at a hospital in Recife, Brazil. By HELEN BRANSWELL @HelenBranswell JUNE 9, 2016 TwitterFacebookLinkedInEmailPrint The World Health Organization appears to be trying to steer women toward delaying pregnancy if they live in countries where the Zika virus is spreading. The global health organization had previously avoided issuing that type of advice, suggesting women in Zika-affected countries speak to their doctors about the issue. But in its most recent guidance, the Geneva-based agency has suggested that people of reproductive age living in affected areas “be informed and orientated to consider delaying pregnancy.” In January, El Salvador made headlines around the globe when its deputy health minister urged women to hold off getting pregnant for the next two years. Most other governments have refrained from going that far, suggesting the decision to try to become pregnant is a personal one. ARTICLE CONTINUES AFTER ADVERTISEMENT SPONSOR CONTENTAnalysis: Improving health and pharmacy care through research & advocacyLearn how CVS Health is helping to improve health and pharmacy care through scientific research, analysis, collaborations and advocacy.Sponsor Content by CVS Health The guidance from the Centers for Disease Control and Prevention, for instance, notes pregnancy involves “very complex, deeply personal decisions” and advises doctors to talk to women and their partners about pregnancy planning and strategies to avoid unintended pregnancies. “As part of their pregnancy planning and counseling with their health care providers, some women and their partners residing in areas with active Zika virus transmission might decide to delay pregnancy,” the agency said Thursday in a brief statement about the WHO’s revised position. READ MOREZika in 30 seconds: What you need to know todayThe WHO systematically reviews new evidence and revises its advice as needed, spokeswoman Nyka Alexander told STAT by email. Expert meetings were held in mid-March, she said. “These updates are a result of those meetings and further input from experts in the editing process.” Subscribe to our Zika updates Alexander stressed the importance of the way the advice is worded: “It is a matter of ensuring people are given information about delay as an option for them to consider.” The revised guidance was published online on May 30, Alexander said. The press release issued at the time did not flag the change. Infectious diseases expert Michael Osterholm said it makes sense for people living in places where Zika is spreading to delay pregnancy, if they can. Osterholm, the director of the University of Minnesota’s Center for Infectious Diseases Research and Policy, said while the risk from Zika is high now, it will likely subside. If the pattern of spread of related diseases can be used to predict what will happen with Zika, this period of explosive transmission will ebb in a year or two. “We’re going to see this likely peak in the next 12 to 18 months in terms of the number of new infections. And then as more people become infected, and recover, the transmission dynamics will drop,” he said. But Lawrence Gostin, a professor of global health law at Georgetown University, was not so sure the WHO’s revised guidance will help women living in Zika-affected places. READ MOREThe world is alarmed by the Zika outbreak. No one is paying to deal with it“The problem with suggesting that women postpone pregnancy is that many Latin-American countries have the most restrictive contraception and abortion laws in the world. Even though WHO recommended access to emergency contraception, there is literally no assurance that governments would comply,” Gostin said. Some babies born to mothers infected with Zika have been found to have a host of birth defects, including microcephaly, a condition in which newborns have abnormally small heads. Studies have suggested that 1 in 100 women infected in pregnancy might have a child with microcephaly— though one paper said the figure might be as high as 13 percent. Other studies have suggested microcephaly is the tip of the iceberg when it comes to Zika-related birth defects. Some babies that were infected in the womb are born with visual and hearing impairments; others have other forms of brain damage. Helen Branswell can be reached at [email protected] Follow Helen on Twitter @HelenBranswell https://www.statnews.com/2016/06/09/zika-who-pregnancy-delay/

More pregnant women in American Samoa with Zika11:07 am on 10 June 2016 Share on Twitter Share on Facebook Share on Google Plus Share on Reddit Share on Linked In Share via emailThe number of pregnant women In American Samoa confirmed to have contracted the Zika virus has jumped to 12 after holding steady at six for about two months. The latest report from Department of Health epidemiologist Scott Anesi shows there are now 654 suspectedcases and 23 confirmed cases of Zika. The worst hit area is the Ituau district with 16 percent of the population suspected to have the virus. Teams from the US Centers for Disease Control and Prevention are working with the Department of Health in response, prevention and the distribution of Zika kits to pregnant mothers. http://www.radionz.co.nz/international/pacific-news/306062/more-pregnant-women-in-american-samoa-with-zika