niman

Zika Virus – May 11, 2016. Texas has had 33 confirmed cases of Zika virus disease. Of those, 32 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. Case counts by county: Bexar – 3Collin – 1Dallas – 6Denton – 1Fort Bend – 2Grayson – 1Harris – 12Tarrant – 3Travis – 2Val Verde – 1 Wise – 1

Map Update https://www.google.com/maps/d/u/0/edit?hl=en&hl=en&authuser=0&authuser=0&mid=1FlIB7hHnVgGD9TlbSx5HwAj-PEQ

As of today, there is one confirmed travel-related case of Zika virus in Williamson County. http://www.wcchd.org/news/press_releases/docs/Williamson County and Cities Health District Urges Precaution Against Mosquito Bites.pdf

Map Update https://www.google.com/maps/d/u/0/edit?hl=en&hl=en&authuser=0&authuser=0&mid=1FlIB7hHnVgGD9TlbSx5HwAj-PEQ

For Immediate Release May 10, 2016 Marin County Confirms Case of Zika VirusSan Rafael, CA – Today, the Marin County Department of Health and Human Services (HHS) confirmed Marin’s first Zika virus infection. The disease was contracted by an individual who was in Central America recently. The spread of the Zika virus occurs primarily through infected Aedes mosquitoes, which have not been detected in Marin. Due to privacy concerns and because this case does not represent any risk to the community, HHS will not release any identifying information regarding the infected individual. HHS will continue to provide updates on Zika onwww.marinhhs.org, through news releases and with social media posts. There have been Zika virus outbreaks in Africa, Asia, the Pacific Islands, Central America, and South America. You are at risk of getting Zika if: you live in or recently traveled to a Zika outbreak area and if you were bitten by mosquitos while there, or;you have had unprotected sex (no condom) with a male who lives in or recently traveled to a Zika outbreak area.Also, unborn babies may be at risk if a woman is infected with Zika while pregnant. The virus may cause microcephaly (small head syndrome) in babies born to women who are infected while pregnant. More studies are being done to learn about how Zika affects unborn babies. “Although currently there is no risk for local transmission, our residents could be exposed to Zika virus through travel or sexual contact with anyone infected with Zika,” said Marin County Deputy Health Officer, Dr. Lisa Santora. It is hard to diagnose the Zika virus because many other illnesses have the same symptoms. Four out of five infected people will not have any symptoms. Common symptoms of the Zika virus are fever, eye redness, achy joints, and a skin rash. Almost all people with Zika get better without any special treatment, and most do not get very sick or require hospitalization. There is no vaccine to prevent Zika. The best way to prevent Zika is to avoid mosquito bites. Everyone should follow travel guidelines from the Centers for Disease Control and Prevention (CDC). Pregnant women should delay travel to a Zika outbreak area, if possible. Men who have a pregnant sexual partner and who may have been exposed to Zika should abstain from sexual activity or use condoms consistently and correctly during sex. Marin HHS is working with local health care providers to test for the Zika virus. In addition, County staff is coordinating with the Marin/Sonoma Mosquito & Vector Control District on education and response plans. The Vector Control District has a mosquito surveillance program for the detection of invasive Aedes mosquitoes. What can a Marin resident do to reduce the risk of Zika? Mosquito season has arrived, so residents should maintain, manage or eliminate all types of outdoor standing water on a regular basis. Report mosquito problems, especially aggressive daytime biting mosquitoes, to the Vector Control District at 1-800-231-3236 or online atwww.msmosquito.com. The list of countries with active Zika spread is changing each week, so visit the CDC’s website for the most updated information.

Today, the Marin County Department of Health and Human Services (HHS) confirmed Marin’s first Zika virus infection. The disease was contracted by an individual who was in Central America recently. The spread of the Zika virus occurs primarily through infected Aedes mosquitoes, which have not been detected in Marin. Due to privacy concerns and because this case does not represent any risk to the community, HHS will not release any identifying information regarding the infected individual. HHS will continue to provide updates on Zika onwww.marinhhs.org, through news releases and with social media posts. http://www.marincounty.org/main/county-press-releases/press-releases/2016/hhs-zika-051016

Map Update https://www.google.com/maps/d/u/0/edit?hl=en&hl=en&authuser=0&authuser=0&mid=1FlIB7hHnVgGD9TlbSx5HwAj-PEQ

May 10, 2016 DEPARTMENT OF HEALTH DAILY ZIKA UPDATE: TWO NEW TRAVEL-RELATED CASES TODAY IN MIAMI-DADE COUNTY 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 two new travel-related cases today in Miami-Dade County. Of the cases confirmed in Florida, six cases are still exhibiting symptoms. According to the CDC, symptoms associated with the Zika virus last between seven to 10 days. Based on CDC guidance, several pregnant women who have traveled to countries with local-transmission of Zika have received antibody testing, and of those, seven have tested positive for the Zika virus. The CDC recommends that a pregnant woman with a history of Zika virus and her provider should consider additional ultrasounds. It is recommended that women who are pregnant or thinking of becoming pregnant postpone travel to Zika affected areas. County Number of Cases (all travel related) Alachua 4 Brevard 2 Broward 15 Clay 1 Collier 1 Hillsborough 3 Lee 4 Martin 1 Miami-Dade 44 Orange 7 Osceola 4 Palm Beach 7 Pasco 1 Pinellas 1 Polk 3 Santa Rosa 1 Seminole 2 St. Johns 1 Cases involving pregnant women* 7 Total 109 *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 1,653 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 18 counties included in the declaration– Alachua, Brevard, Broward, Clay, Collier, Hillsborough, Lee, Martin, Miami-Dade, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Santa Rosa, Seminole and St. Johns – 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 the 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.Florida currently has the capacity to test 6,458 people for active Zika virus and 2,079 for Zika antibodies.Federal Guidance on Zika: According to the 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.The CDC has put out guidance related to the sexual transmission of the Zika virus. This includes the 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. http://www.floridahealth.gov/newsroom/2016/05/051016-zika-update.html

County Number of Cases (all travel related) Alachua 4 Brevard 2 Broward 15 Clay 1 Collier 1 Hillsborough 3 Lee 4 Martin 1 Miami-Dade 44 Orange 7 Osceola 4 Palm Beach 7 Pasco 1 Pinellas 1 Polk 3 Santa Rosa 1 Seminole 2 St. Johns 1 Cases involving pregnant women* 7 Total 109

ReferencesCouncil of State and Territorial Epidemiologists. Zika virus disease and congenital Zika virus infection interim case definition and addition to the nationally notifiable disease list. Atlanta, GA: Council of State and Territorial Epidemiologists; 2016.https://www.cste2.org/docs/Zika_Virus_Disease_and_Congenital_Zika_Virus_Infection_Interim.pdfGourinat AC, O’Connor O, Calvez E, Goarant C, Dupont-Rouzeyrol M. Detection of Zika virus in urine. Emerg Infect Dis 2015;21:84–6. CrossRefPubMedRozé B, Najioullah F, Fergé JL, et al. ; GBS Zika Working Group. Zika virus detection in urine from patients with Guillain-Barré syndrome on Martinique, January 2016. Euro Surveill 2016;21:30154. CrossRef PubMedMusso D, Roche C, Nhan TX, Robin E, Teissier A, Cao-Lormeau VM. Detection of Zika virus in saliva. J Clin Virol 2015;68:53–5. CrossRef PubMedAtkinson B, Hearn P, Afrough B, et al. Detection of Zika virus in semen [letter]. Emerg Infect Dis. Epub May 16. CrossRefMusso D, Roche C, Robin E, Nhan T, Teissier A, Cao-Lormeau V-M. Potential sexual transmission of Zika virus. Emerg Infect Dis 2015;21:359–61.CrossRef PubMedLanciotti RS, Kosoy OL, Laven JJ, et al. Genetic and serologic properties of Zika virus associated with an epidemic, Yap State, Micronesia, 2007. Emerg Infect Dis 2008;14:1232–9. CrossRef PubMedFood and Drug Administration. Zika virus emergency use authorization. Emergency use authorizations. Silver Spring, MD: US Department of Health and Human Resources, Food and Drug Administration; 2016.http://www.fda.gov/downloads/MedicalDevices/Safety/EmergencySituations/UCM491592.pdfMartin DA, Muth DA, Brown T, Johnson AJ, Karabatsos N, Roehrig JT. Standardization of immunoglobulin M capture enzyme-linked immunosorbent assays for routine diagnosis of arboviral infections. J Clin Microbiol 2000;38:1823–6. PubMed

TABLE 2. Results of RT-PCR testing of urine, saliva, and serum specimens for Zika virus RNA, by days after symptom onset for 53 travel-associated cases of Zika virus disease — Florida, 2016Days after onsetUrine No. positive/No. tested (%)Saliva No. positive/No. tested (%)Serum No. positive/No. tested (%)17/7 (100)7/7 (100)6/7 (86)29/9 (100)9/9 (100)6/9 (67)39/9 (100)8/9 (89)4/9 (44)49/9 (100)8/9 (89)7/9 (78)510/12 (83)9/12 (75)4/12 (33)61/1 (100)0/1 (0)0/1 (0)72/3 (67)0/3 (0)0/3 (0)91/1 (100)1/1 (100)0/1 (0)140/1 (0)0/1 (0)0/1 (0)201/1 (100)1/1 (100)0/1 (0)Abbreviation: RT-PCR = real time reverse-transcription polymerase chain reaction. Top Suggested citation for this article: Bingham AM, Cone M, Mock V, et al. Comparison of Test Results for Zika Virus RNA in Urine, Serum, and Saliva Specimens from Persons with Travel-Associated Zika Virus Disease — Florida, 2016. MMWR Morb Mortal Wkly Rep. ePub: 10 May 2016. DOI:http://dx.doi.org/10.15585/mmwr.mm6518e2.

TABLE 1. Results of Zika virus IgM antibody testing of serum specimens and RT-PCR testing of serum and urine specimens for Zika virus RNA, by days after symptom onset for 66 persons with travel-associated Zika virus disease – Florida, 2016Days after onsetSerum IgM No. positive/No. tested (%)Serum RT-PCR No. positive/No. tested (%)Urine RT-PCR No. positive/No. tested (%)00/1 (0)0/1 (0)1/1 (100)12/7 (29)6/7 (85)7/7 (100)23/12 (25)8/12 (67)11/12 (92)35/10 (50)4/10 (40)10/10 (100)43/12 (25)8/12 (67)12/12 (100)59/13 (69)5/13 (38)11/13 (85)62/2 (100)0/2 (0)2/2 (100)74/4 (100)0/4 (0)3/4 (75)92/3 (67)0/3 (0)3/3 (100)141/1 (100)0/1 (0)0/1 (0)201/1 (100)0/1 (0)1/1 (100)Range of days0–522/55 (40)31/55 (56)*52/55 (95)*6–108/9 (89)0/9 (0)*8/9 (89)*11–151/1 (100)0/1 (0)0/1 (0)16–201/1 (100)0/1 (0)1/1 (100)Abbreviations: IgM = immunoglobulin M; RT-PCR = real time reverse-transcription polymerase chain reaction. *Statistically significant difference in proportion RT-PCR positive in serum specimens versus urine specimens, by exact McNemar’s test (0–5 days, p<0.001; 6–10 days, p<0.01).

FIGURE. Results of RT-PCR testing for Zika virus RNA in urine specimens of 70 persons with travel-associated Zika virus disease, by number of days after onset of symptoms — Florida, 2016* Abbreviation: RT-PCR = reverse transcription-polymerase chain reaction. * Four persons included in figure did not contribute to the 66 persons with urine and serum specimens collected on the same day; each of these four persons had Zika virus RNA detected in their urine specimens, which were collected on days 3, 7, 12, and 13, respectively.

DiscussionResults of testing conducted at BPHL suggest that urine might be the preferred specimen type to identify acute Zika virus disease. Rates of detection from urine were higher than from serum, even during the first few days after symptom onset and continuing after day five, when no serum specimens tested in this evaluation had detectable RNA. Assays used for diagnostic purposes need to be validated for the specific specimen type being tested. The ability to confirm that a recent illness is caused by Zika virus and not another flavivirus by detection of Zika virus RNA in a clinical specimen is important, given the limitations in interpretation of results from serology testing in persons who have had previous flavivirus infection or vaccination. Among pregnant women, this ability to confirm Zika virus is important because close monitoring during pregnancy is recommended for women with confirmed Zika virus disease. The ease of collection of urine specimens is an additional advantage. This report also demonstrates that saliva specimens (another specimen that is easily obtained) can also yield a higher rate of RNA detection than serum even during the first 5 days; the detection rate in saliva also approaches the detection rate in urine. However, no cases were identified through saliva testing alone. The findings in this report are subject to at least four limitations. First, eight patients from the group with serum and urine tested by RT-PCR who had RNA detected in their urine specimen but not in their serum specimen did not have Zika virus IgM antibodies detected in their serum to provide an independent confirmation of Zika virus infection. However, five of these eight patients had a saliva specimen available, and all five had viral RNA detected in saliva. The lack of IgM antibodies in some of the cases might be explained by the early timing of the serum collection; Zika virus IgM antibody might be detectable in serum specimens collected as early as 4–5 days after symptom onset, and is usually present by 7 days after symptom onset (7). However, convalescent serum specimens were not obtained to help confirm Zika virus disease by serology. Second, only five urine specimens came from patients >7 days after symptom onset; therefore the RNA detection rate in urine specimens from this period is not well characterized. However, the limited data available demonstrate that testing of some specimens can have positive results as far out as 20 days. Third, date of symptom onset can be difficult to ascertain, particularly in symptoms with mild symptoms. Therefore, the absolute rate of RNA detection for a particular day after symptom onset might be imprecise, but the relative detection rate across specimen types should not be impacted by this limitation. Finally, real-time RT-PCR results should be carefully interpreted to account for the possibility of false-negative and false-positive results, particularly at the lower limits of detection of the assay, when reproducibility is low and results are not confirmed with both primer/probe sets in replicate tests. Top AcknowledgmentsFlorida Department of Health laboratory and epidemiology personnel.

In May 2015, Zika virus was reported to be circulating in Brazil. This was the first identified introduction of the virus in the Region of the Americas. Since that time, Zika virus has rapidly spread throughout the region. As of April 20, 2016, the Florida Department of Health Bureau of Public Health Laboratories (BPHL) has tested specimens from 913 persons who met state criteria for Zika virus testing. Among these 913 persons, 91 met confirmed or probable Zika virus disease case criteria and all cases were travel-associated (1). On the basis of previous small case studies reporting real time reverse-transcription polymerase chain reaction (RT-PCR) detection of Zika virus RNA in urine, saliva, and semen (2–6), the Florida Department of Health collected multiple specimen types from persons with suspected Zika virus disease. Test results were evaluated by specimen type and number of days after symptom onset to determine the most sensitive and efficient testing algorithm for acute Zika virus disease. Urine specimens were collected from 70 patients with suspected Zika virus disease from zero to 20 days after symptom onset. Of these, 65 (93%) tested positive for Zika virus RNA by RT-PCR. Results for 95% (52/55) of urine specimens collected from persons within 5 days of symptom onset tested positive by RT-PCR; only 56% (31/55) of serum specimens collected on the same date tested positive by RT-PCR. Results for 82% (9/11) of urine specimens collected >5 days after symptom onset tested positive by RT-PCR; none of the RT-PCR tests for serum specimens were positive. No cases had results that were exclusively positive by RT-PCR testing of saliva. BPHL testing results suggest urine might be the preferred specimen type to identify acute Zika virus disease. Criteria for Zika virus testing included persons who experienced two or more of the following symptoms: rash, fever, arthralgia or conjunctivitis during or within 2 weeks of return from an area with Zika virus activity, or who had an epidemiologic link to a Zika virus–infected traveler (sexual partner, household member, etc.). RT-PCR was routinely performed on urine, serum, or saliva specimens collected within 21 days of symptom onset. Clinicians were informed that only the serum RT-PCR and antibody tests were to be used for diagnostic purposes. Urine and saliva RT-PCR tests were only used for surveillance purposes. Serologic testing was performed on all serum specimens included in this analysis. The probable case definition criteria for Zika virus disease, based on serology, required Zika virus–specific IgM antibodies and no dengue virus–specific IgM antibodies detected in serum or cerebrospinal fluid. Zika virus RT-PCR was performed at BPHL using a laboratory-developed test based on a previously published protocol using two RT-PCR targets (7) (this is not the CDC Trioplex rRT-PCR assay authorized for emergency use by the Food and Drug Administration (8)). Specimens were tested in a primary assay, in duplicate in the same run, with a primer and probe set that detects all known genotypes of Zika virus, ZIKV 1086/1162c/1107FAM (later renamed ZIKV 1087/1163c/1108FAM). If detected in at least one of the duplicates, the same extract was tested with a secondary assay, in duplicate in the same run, with a primer and probe set that detects the Asian genotype currently circulating in the Western Hemisphere, ZIKV 4481/4552c/4507cFAM (unpublished Zika real time RT-PCR protocol, RS Lanciotti, Division of Vector-Borne Infectious Diseases, CDC. Fort Collins, Colorado, updated January 14, 2016). Specimens reported as positive had cycle threshold (Ct) values ≤38 for at least one of the replicates in both the primary and secondary RT-PCR assays. Specimens reported as equivocal had a Ct value ≤38 in the primary assay, but not the secondary assay. For the purpose of this analysis, equivocal specimens were considered as negative. Specimens reported as negative had Ct values >38 in the primary assay and were not tested further. Zika virus and dengue virus IgM antibody testing was performed at BPHL using a laboratory-developed IgM antibody capture enzyme-linked immunosorbent assay (MAC-ELISA) based on a CDC flavivirus MAC-ELISA protocol (9). In March 2016, BPHL transitioned to the Food and Drug Administration’s Emergency Use Authorization Zika MAC-ELISA developed by CDC (8). Zika virus antigen and positive control material were provided by CDC. A positive/negative (P/N) ratio was calculated from results of the MAC-ELISA for each specimen tested and was interpreted as the following: P/N ratios <2 were reported as negative, P/N ratios 2–<3 were reported as equivocal, and P/N ratios ≥3 were reported as presumptive positive, as defined in the emergency use authorization. As of April 20, 2016, 91 cases of travel-associated Zika virus disease had been reported in Florida. Urine specimens were collected from a total of 70 persons with Zika virus disease, and in 65 (93%) of the cases, the urine specimen was positive by RT-PCR (Figure). The five specimens that were negative by RT-PCR testing were collected on days 2, 5, 5, 7, and 14 after symptom onset. Viral RNA was detectable in urine as early as the 1st day of symptoms and as late as 20 days after onset of symptoms. Ten of 12 urine specimens (83%) collected 7–20 days after symptom onset were positive. Among 62 of the 65 cases with positive urine specimens by RT-PCR testing, both primer and probe sets were positive in duplicate reactions. For two of the three remaining cases, a saliva specimen also tested positive by RT-PCR. In 66 cases, persons had urine and serum specimens collected on the same day. The majority of these persons were female (64%), white (77%), and Hispanic (71%), with a median age of 46 years (range = 23–76 years). In two cases, female patients were pregnant. Approximately twice as many persons had RT-PCR positive test results for Zika virus RNA in urine specimens compared with serum specimens, 61 persons (92%) versus 31 (47%), respectively. One person had positive test results in serum alone (2 days after symptom onset) and 31 persons had positive test results only for urine specimens. Among the 55 persons with urine and serum specimens collected within the first 5 days of symptom onset, 52 (95%) had urine specimens that tested positive for Zika virus RNA by RT-PCR testing and 31 (56%) had serum specimens that tested positive (Table 1). Forty percent (22/55) of the serum specimens had detectable Zika virus IgM antibodies, including two specimens collected 1 day after symptom onset. Among the 11 cases with specimens collected >5 days after symptom onset, nine persons (82%) had urine specimens that tested positive by RT-PCR; none had serum specimens that tested positive (Table 1). Three specimen types collected on the same day were available for 53 of the 66 cases and were tested by RT-PCR: 92% of urine specimens, 81% of saliva specimens, and 51% of serum specimens tested positive. Viral RNA was detected in saliva as early as 1 day and as late as 20 days after symptom onset (Table 2). All cases with saliva specimens that tested positive for Zika virus RNA by RT-PCR testing also had at least one other specimen type that tested positive by RT-PCR testing. Of the 66 serum specimens that also had paired urine specimens, five (8%) tested positive for both Zika virus RNA and IgM antibody (the five specimens were collected 1, 2, 3, 5, and 5 days after symptom onset) (Table 1). Among the 31 cases in which urine specimens tested positive by RT-PCR, but serum specimens tested negative, Zika virus IgM antibody was detected in serum in 23 (74%). Of the remaining eight cases in which neither IgM antibodies nor viral RNA were detected in serum, Zika virus RNA was detected in saliva as well as urine in five cases (the five cases had all three specimens collected on days 2, 3, 4, 5, and 9 after symptom onset, respectively), and in three cases (serum and urine specimens collected days 0, 2, and 3, respectively) saliva specimens were not collected for testing. Overall, Zika virus IgM antibodies were detectable in the serum specimens from 48% of the 66 cases. Four of the 66 cases had serum and urine specimens that tested negative by RT-PCR testing, but positive (serum specimens only) by IgM antibody testing (specimens collected 5, 5, 7, and 14 days after symptom onset, respectively).

SummaryWhat is already known about this topic? Limited data suggest Zika virus is excreted in multiple body fluids, including urine and saliva. Urine and saliva might be appropriate specimens for evaluating Zika virus disease. What is added by this report? A comparison of reverse-transcription polymerase chain reaction (RT-PCR) test results for urine and serum specimens from 66 persons with Zika virus disease with both specimens collected on the same date indicated that approximately twice as many urine specimens (61) than serum specimens (31) tested positive. No results from RT-PCR testing of serum specimens were positive >5 days after symptom onset; results from testing nine of 11 urine specimens were positive. A further comparison of 53 persons with Zika virus disease with urine, saliva, and serum specimens collected on the same date found positive results from testing in 49 (92%) urine specimens, 43 (81%) saliva specimens, and 27 (51%) serum specimens. What are the implications for public health practice? These results suggest urine might be a useful specimen for identifying acute Zika virus disease.

Andrea M. Bingham, PhD1; Marshall Cone, MPH1; Valerie Mock1; Lea Heberlein-Larson, MPH1; Danielle Stanek, DVM1; Carina Blackmore, PhD1; Anna Likos, MD1 Corresponding author: Andrea M Bingham, [email protected], 850-245-4401. Top 1Florida Department of Health.

Comparison of Test Results for Zika Virus RNA in Urine, Serum, and Saliva Specimens from Persons with Travel-Associated Zika Virus Disease — Florida, 2016Early Release / May 10, 2016 / 65 http://www.cdc.gov/mmwr/volumes/65/wr/mm6518e2.htm?s_cid=mm6518e2_w

Comparison of Zika virus testing in serum, urine and saliva specimens from travel-associated Zika virus disease cases–Florida, 2016> > As of April 20, 2016, Florida Department of Health Bureau of Public Health Laboratories (BPHL) has tested 913 people who met state and national criteria for Zika virus testing. Of these individuals, 91 met confirmed or probable Zika virus disease case criteria. Based on previous small case studies reporting real time reverse-transcriptase polymerase chain reaction (RT-PCR) detection of Zika virus in urine, saliva, and semen, Florida Department of Health collected multiple specimen types from people with suspected acute Zika virus disease. Test results were evaluated by sample type and date of sample collection related to symptom onset in an effort to determine the most sensitive and efficient testing algorithm for acute Zika virus disease. Overall, urine samples from 65 of 70 cases (93%) collected from 1-20 days post-onset were RT-PCR positive. Of the 55 cases with samples collected on the same date and within 5 days of onset, 95% were urine RT-PCR positive, while only 56% were serum RT-PCR positive. Eighty-two percent (9/11) of urine samples collected more than 5 days after symptom onset were RT-PCR positive but none of the serum samples were positive. No cases had saliva as the only RT-PCR positive specimen type. BPHL testing results suggest urine might be the preferred sample type to diagnose acute Zika virus infections.

Press Contacts> > > May 10, 2016> > Up Comparison of Zika virus testing in serum, urine and saliva specimens from travel-associated Zika virus disease cases–Florida, 2016> > CDC Media Relations> 404-639-3286> > Interim guidance for Zika virus testing on urine ― United States, 2016> > CDC Media Relations> 404-639-3286> > Reduced Prevalence of Chikungunya Virus Infection in Communities with Ongoing Aedes Aegypti Mosquito Trap Intervention Studies – Salinas and Guayama, Puerto Rico, November 2015–February 2016> > CDC Media Relations> 404-639-3286> > > > The MMWR is embargoed until 1:00 PM ET May 10, 2016> > > > > > > Synopsis for May 10, 2016> > > > Comparison of Zika virus testing in serum, urine and saliva specimens from travel-associated Zika virus disease cases–Florida, 2016> > As of April 20, 2016, Florida Department of Health Bureau of Public Health Laboratories (BPHL) has tested 913 people who met state and national criteria for Zika virus testing. Of these individuals, 91 met confirmed or probable Zika virus disease case criteria. Based on previous small case studies reporting real time reverse-transcriptase polymerase chain reaction (RT-PCR) detection of Zika virus in urine, saliva, and semen, Florida Department of Health collected multiple specimen types from people with suspected acute Zika virus disease. Test results were evaluated by sample type and date of sample collection related to symptom onset in an effort to determine the most sensitive and efficient testing algorithm for acute Zika virus disease. Overall, urine samples from 65 of 70 cases (93%) collected from 1-20 days post-onset were RT-PCR positive. Of the 55 cases with samples collected on the same date and within 5 days of onset, 95% were urine RT-PCR positive, while only 56% were serum RT-PCR positive. Eighty-two percent (9/11) of urine samples collected more than 5 days after symptom onset were RT-PCR positive but none of the serum samples were positive. No cases had saliva as the only RT-PCR positive specimen type. BPHL testing results suggest urine might be the preferred sample type to diagnose acute Zika virus infections.> > Interim guidance for Zika virus testing on urine ― United States, 2016> > Diagnostic testing for Zika virus infection can be accomplished using both molecular and serological methods. Real-time reverse transcription-polymerase chain reaction (RT-PCR) is the preferred test for Zika virus infection because it can be performed rapidly and is very specific. However, in most patients, Zika virus RNA is unlikely to be detected in serum after the first week of illness. Recent reports suggest that Zika virus RNA can be detected for longer duration in urine than in serum. Based on newly available data, CDC recommends that Zika virus RT-PCR be performed on urine collected less than 14 days after illness onset in patients with suspected Zika virus disease.> > Reduced Prevalence of Chikungunya Virus Infection in Communities with Ongoing Aedes Aegypti Mosquito Trap Intervention Studies – Salinas and Guayama, Puerto Rico, November 2015–February 2016> > Aedes species mosquitoes transmit chikungunya virus, as well as dengue and Zika viruses. Puerto Rico reported its first laboratory-positive chikungunya case in May 2014 and subsequently identified more than 29,000 suspected cases throughout the island by the end of 2015. Conventional vector control approaches have failed to result in effective and sustainable prevention of infection with viruses transmitted by Aedes mosquitoes. As a tool for surveillance and control, CDC developed an Autocidal Gravid Ovitrap (AGO) to attract and capture the female Ae. aegypti mosquitoes responsible for transmission of infectious agents to humans. AGO traps are simple, low-cost devices that require no use of pesticides and no servicing for an extended period. Since 2012, four communities in southern Puerto Rico have participated in an ongoing field trial of AGO traps to control Ae. aegypti mosquitoes. Two intervention communities used AGO traps and two non-intervention communities used only surveillance traps to monitor mosquito population densities. With three AGO traps per home placed around ~85% of homes in intervention communities (in addition to randomly distributed surveillance traps), captures of adult Ae. aegypti mosquitos fell tenfold compared with non-intervention communities. The introduction of chikungunya virus into the previously unexposed population of Puerto Rico provided a unique opportunity to assess whether the use of AGO traps was associated with reduced incidence of chikungunya virus infection in these communities. Preliminary results from data collection during November 2015 – February 2016 found that the prevalence of anti-chikungunya virus antibody among participants from the two intervention communities was half that of participants from non-intervention communities. AGO traps might reduce arbovirus transmission by reducing mosquito density. CDC produces AGO traps in limited numbers. To increase the availability of AGO traps for control of Ae. aegypti mosquitoes, efforts are underway by private sector companies to mass produce AGO traps of similar quality.>

About forty babies at risk of being born with microcephalyThe danger increases if women acquire the virus in its first quarter zika 0002Women who are pregnant should not miss appointments for any reason, authorities say.04/14/2016Tegucigalpa, Honduras About forty young who are still in the womb could be affected with microcephaly. In the country there are 219 pregnant women who have or had the virus zika in the first trimester of pregnancy. The dean of the Faculty of Medical Sciences of the National Autonomous University of Honduras (UNAH) , Marco Tulio Medina says that this is the time for women to consider family planning to prevent pregnancy. "There are several studies that have found the increased risk of the presence of congenital malformations associated virus zika, especially the brain. One says there is a risk that 20% of women who had zika in the first quarter may give birth to a child with microcephaly, "said neurologist. It is noteworthy that the Center for Disease Control (CDC) in the United States on Wednesday confirmed the link between the virus and birth defects zika as microcephaly. According to Medina, the risk of a baby being born with the disease decreases if the mother was infected after three months of gestation. No guard down President Juan Orlando Hernández urged this week to all Hondurans to remain vigilant against the disease precisely because that relationship with congenital disease. "Do not lose heart; will continue, we raise the tone even more to this campaign, because we did not want it confirmed it is practically confirmed, which is the zika relationship with microcephaly, blind, with other difficult consequences, "he said. Microcephaly is a neurological disorder in which the circumference of the head is smaller than the average circumference for the child's age. So far the country has not registered any cases of microcephaly associated with the disease. One would appear from July, as indicated. http://www.elheraldo.hn/pais/950195-466/unos-cuarenta-bebés-en-riesgo-de-nacer-con-microcefalia

Microcephaly first case investigated by zika in Honduras MAY 9, 2016 - 24:23 The Health Ministry is investigating the case of a pregnant woman whose baby could present the first case would microcephaly associated with the Zika virus. Deputy Health Minister, Francis Contreras said that "we are currently not able to secure 100 percent since prenatal diagnosis ends up being different from post-natal diagnosis." Contreras explained that in Brazil several cases of pregnant women report microcephaly, whom he underwent several ultrasounds during gestation period presented. "But at the moment of birth, head circumference was below normal levels, but did not reach microcephaly." A woman will have been several ultrasounds in which doctors have detected abnormalities in the fetus. The official said the woman is a resident of Tegucigalpa and has more than five months pregnant, but did not disclose further details to protect the identity of the mother. "We are monitoring the health of both mother and baby, we expect negative result, but we have a strong suspicion, which could be a case of microcephaly" expanded Contreras. However, he stressed that both the woman and the baby are getting all the necessary care and it is expected that this is not a case microcephaly. http://www.latribuna.hn/2016/05/09/investigan-primer-caso-microcefalia-zika-honduras/

Mon May 9, 2016 11:55pm BSTRelated: HEALTHHonduras suspects first case of microcephaly in pregnant Zika patient The Central American nation of Honduras "strongly suspects" it has detected its first case of an unborn child with microcephaly in a pregnant woman infected with the Zika virus, the country's deputy health minister Francis Contreras said on Monday. The mother is five months pregnant, and Contreras warned it would not be certain her child had developed microcephaly, a birth defect marked by small head size that can lead to severe developmental problems in babies, until she gave birth. "We strongly suspect that we could be facing a case of microcephaly," Contreras told local radio. U.S. health officials have concluded that Zika infections in pregnant women can cause microcephaly. The World Health Organization has said there is strong scientific consensus that Zika can also cause Guillain-Barre, a rare neurological syndrome that causes temporary paralysis in adults. The connection between Zika and microcephaly first came to light last autumn in Brazil, which has now confirmed more than 1,100 cases of microcephaly that it considers to be related to Zika infections in the mothers. Zika is carried by mosquitoes, which transmit the virus to humans. A small number of cases of sexual transmission have been reported in the United States and elsewhere. A case of suspected transmission through a blood transfusion in Brazil have raised questions about other ways that Zika may spread. The Zika outbreak is affecting large parts of Latin America and the Caribbean, with Brazil the hardest hit so far. Honduras is the Central American country with the highest number of Zika cases, with 19,000 infections, and 238 pregnant women infected. So far, it has detected 78 Guillain-Barre cases. In Panama, where there are 264 people infected with the Zika virus, at least four babies have been born with microcephaly whose mothers were infected with Zika. (Reporting by Gabriel Stargardter; Editing by Bill Rigby) http://uk.reuters.com/article/us-health-zika-honduras-idUKKCN0Y02L1

Pregnant Connecticut teen shocked to learn she has ZikaWTSP 8:27 PM. EST May 09, 2016 (Photo: SARA MUJICA VIA AP) CONNECT TWEET PINTERESTA Connecticut teenager says she was shocked she tested positive for the Zika virus after learning she was pregnant. Sara Mujica, 17, of Danbury, said she found out she was pregnant in March while she was visiting Victor Cruz, her fiance and the baby's father, in Honduras. At the time of the pregnancy test, she said she was getting over an illness that gave her rashes, headaches and neck aches. She thought it was related to fish she had eaten, not Zika. She said she returned to Connecticut on March 30 and went to Danbury Hospital to get tested for Zika -- just in case. She said she learned of the positive Zika results during a phone call from her crying mother last week, after she had returned to Honduras. "I was in a state of shock honestly," Mujica told The Associated Press by phone Monday. "I didn't really know what to say. I didn't know what to do. I just started getting teary eyed and almost crying. I was just trying to stay strong." Mosquito-borne Zika has become epidemic in Latin America and the Caribbean. It can cause microcephaly, a severe birth defect in which babies are born with abnormally small heads and brain damage. Researchers don't yet know the rate at which infected women have babies with birth defects. The virus is mainly spread to humans through bites of infected mosquitoes, but the CDC reports it can also be sexually transmitted through semen. There is no vaccine or specific treatment available for Zika virus. Mujica, who is Catholic, said she weighed her risks and decided to keep the baby. "This is my blessing. This is my miracle," she said. "I have a cousin who has Down syndrome and he is so smart and l love him so much. I would never give up a Down syndrome child or a child with birth defects." Officials at the state Department of Public Health and Danbury Hospital declined to comment Monday on whether Mujica tested positive for Zika. Last week, the department revealed that a Connecticut resident who had traveled to Central America and became pregnant had been diagnosed with Zika. They didn't identify her. Mujica said she believes she contracted Zika from a mosquito bite -- and not sexual contact -- while in Honduras, where Cruz lives in the city of Choloma. She is among 44 pregnant women across the U.S. who have tested positive for Zika, according to the federal Centers for Disease Control and Prevention. Tests have confirmed Zika in a total of 472 people in the U.S., with all the infections associated with travel to Zika-infected areas in other countries, according to the CDC. Connecticut officials say four people in the state have tested positive. Mujica is hoping that Cruz can come live with her in Connecticut. As the weather warms and mosquito season arrives in the Gulf states, U.S. officials are bracing for more cases of Zika. While they do not anticipate a wide-scale outbreak like the one seen in Latin America, they say local transmission is likely. Federal, state, and local health officials are working on strategies to curb Zika infections in the U.S., including improved mosquito control, increased availability of Zika testing, and increased public awareness efforts on how the public can protect themselves. The CDC recommends the following advice to avoid mosquito bites: Cover exposed skin by wearing long-sleeved shirts and long pants.Use an insect repellent approved by the Environmental Protection Agency as directed.Higher percentages of active ingredients provide longer protection. Use products with the following active ingredients: DEET, Picaridin, oil of lemon eucalyptus (OLE), IR3535.Use permethrin-treated clothing and gear, such as boots, pants, socks, and tents. You can buy pre-treated clothing and gear or treat them yourself.Stay and sleep in screened-in or air-conditioned rooms.Use a bed net if the area where you are sleeping is exposed to the outdoors.http://www.wtsp.com/news/health/pregnant-connecticut-teen-shocked-to-learn-she-has-zika/183367611