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Summary:From 1 January 2007 to 20 April 2016, Zika virus transmission was documented in a total of 66 countries and territories. Mosquito-borne transmission: 42 countries are experiencing a first outbreak of Zika virus since 2015, with no previous evidence of circulation, and with ongoing transmission by mosquitos.17 countries have reported evidence of Zika virus transmission prior to 2015, with or without ongoing transmission or have reported an outbreak since 2015 that is now over.Person-to-person transmission: Eight countries have now reported evidence of person-to-person transmission of Zika virus, other than mosquito-borne transmission (Argentina, Chile, France, Italy, New Zealand, Peru, Portugal and the United States of America).In the week to 20 April, no additional countries have reported mosquito-borne Zika virus transmission. Peru and Portugal are the latest countries to report person-to-person transmission. Microcephaly and other fetal malformations potentially associated with Zika virus infection or suggestive of congenital infection have been reported in six countries (Brazil, Cabo Verde, Colombia, French Polynesia, Martinique and Panama). Two cases, each linked to a stay in Brazil, were detected in Slovenia and the United States of America. A further case, linked to a brief stay in Mexico, Guatemala and Belize, was detected in a pregnant woman in the United States of America. Click to enlarge image

Zika situation report21 April 2016http://www.who.int/emergencies/zika-virus/situation-report/21-april-2016/en/ Zika virus, Microcephaly and Guillain-Barré syndrome Read the full situation report Click to enlarge image

LOCAL CLINIC CONFIRMS FIRST PREGNANT ZIKA PATIENT An Aedes aegypti mosquito is photographed through a microscope at the Fiocruz institute in Recife, Pernambuco state, Brazil, Wednesday, Jan. 27, 2016. (AP Photo/Felipe Dana) Updated 1 hr 31 mins agoHOUSTON (KTRK) --A local clinic has confirmed their first pregnant Zika virus patient. Legacy Community Health Services released a statement on their website that read, in part, "The woman had lived in El Salvador, where the virus is widespread, prior to coming to the U.S. earlier this year, but it's not clear whether she contracted the virus directly through a mosquito bite in El Salvador or through sexual transmission with a male partner. Either way, the Centers for Disease Control has said definitively the virus can cause severe birth defects. "We are closely monitoring the patient through her pregnancy and hope for the best for mom and baby," said Dr. Natalie Vanek, a Legacy Community Health infectious disease specialist. "Today we are re-issuing our advisory to pregnant women not to travel down to the Central and South American countries where the virus is rampant, and want to make the broader Houston community aware the virus can be transmitted sexually. We are focused on prevention, not panic." Common symptoms of the Zika virus include fever, rash, joint pain and conjunctivitis, according to the CDC. Approximately one in five people infected with the virus show symptoms. Severe complications from the virus that require hospitalization are rare, according to the CDC. The virus has been associated with a rise of microcephaly, a type of birth defect. It has affected more than 4,000 babies in Brazil. EMBED Health officials discourage pregnant women from traveling to Central or South America. If you must, they suggest wearing clothing and bug spray with DEET which will protect you. They are also urging you to eliminate any standing water around your home or workplace in order to limit the number of places in which mosquitos can breed. EMBED EMBEDZika symptoms diagnosis and treatment from the CDC Symptoms About 1 in 5 people infected with Zika virus become ill (i.e., develop Zika). The most common symptoms of Zika are fever, rash, joint pain, or conjunctivitis (red eyes). Other common symptoms include muscle pain and headache. The incubation period (the time from exposure to symptoms) for Zika virus disease is not known, but is likely to be a few days to a week. The illness is usually mild with symptoms lasting for several days to a week. Zika virus usually remains in the blood of an infected person for a few days but it can be found longer in some people. Severe disease requiring hospitalization is uncommon. Deaths are rare. Diagnosis The symptoms of Zika are similar to those of dengue and chikungunya, diseases spread through the same mosquitoes that transmit Zika. See your healthcare provider if you develop the symptoms described above and have visited an area where Zika is found. If you have recently traveled, tell your healthcare provider when and where you traveled. Your healthcare provider may order blood tests to look for Zika or other similar viruses like dengue or chikungunya. Treatment No vaccine or medications are available to prevent or treat Zika infections. Treat the symptoms: Get plenty of rest Drink fluids to prevent dehydration Take medicines, such as acetaminophen or paracetamol, to relieve fever and pain Do not take aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and naproxen. Aspirin and NSAIDs should be avoided until dengue can be ruled out to reduce the risk of hemorrhage (bleeding). If you are taking medicine for another medical condition, talk to your healthcare provider before taking additional medication. If you have Zika, avoid mosquito bites for the first week of your illness. During the first week of infection, Zika virus can be found in the blood and passed from an infected person to another mosquito through mosquito bites. Keep checking back on this page to get real-time updates as this story unfolds. To get alerts for breaking news, download the ABC-13 news app for iPhone or Android. You can also get breaking news alerts sent to you by email. http://abc13.com/health/local-clinic-confirms-first-pregnant-zika-patient/1302234/

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First Legacy Patient Tests Positive for Zika as Houston Flooding Sure to Boost Mosquito PopulationCATEGORY: Adult Primary Care, Family Medicine, Public Affairs,Public Health, Vaccination & ImmunizationHealth center re-issues advisory to its patients. And to Congress. HOUSTON – Legacy Community Health, one of the nation’s largest community health centers, today announced its first patient, a pregnant woman, testing positive for Zika virus. The woman had lived in El Salvador, where the virus is widespread, prior to coming to the U.S. earlier this year, but it’s not clear whether she contracted the virus directly through a mosquito bite in El Salvador or through sexual transmission with a male partner. Either way, the Centers for Disease Control has said definitively the virus can cause severe birth defects. “We are closely monitoring the patient through her pregnancy and hope for the best for mom and baby,” said Dr. Natalie Vanek, a Legacy Community Health infectious disease specialist. “Today we are re-issuing our advisory to pregnant women not to travel down to the Central and South American countries where the virus is rampant, and want to make the broader Houston community aware the virus can be transmitted sexually. We are focused on prevention, not panic.” Last week, the CDC said sexual transmission “might contribute to more illness than was anticipated when the outbreak was first recognized.” The guidance comes after a couple in Dallas County–now known to be two men – became infected with Zika in January. It was the first report of transmission by men having sex with men, while previous sexual transmission focused on heterosexual couples. Still, the focus remains on pregnant women. About 700 cases of Zika virus have been reported in the United States, including almost 70 pregnant women, according to the CDC. Legacy Community Health sees about 300 pregnant women a day, some of whom travel regularly to Latin America. The political debate over Zika involves federal funding for prevention measures and fast-tracking a vaccine. Congress has met the Obama Administration’s emergency funding request for $1.9 billion for Zika with inaction. “Washington needs to quickly find common ground on this growing public health situation,” said Legacy CEO Katy Caldwell. “The virus will likely get worse along the Gulf Coast in weeks, not months, given this week’s major flooding that will increase the area’s mosquito population. We are hopeful the health and well-being of the American people is the top priority of lawmakers, even in an election year.” Zika symptoms include fever, rash, joint pain, or red eyes. The best prevention methods are avoiding mosquito bites by using insect repellant, wearing additional clothing, staying in air-conditioned spaces, and using condoms during sexual activity.

Legacy Community Health, one of the nation’s largest community health centers, today announced its first patient, a pregnant woman, testing positive for Zika virus. The woman had lived in El Salvador, where the virus is widespread, prior to coming to the U.S. earlier this year, but it’s not clear whether she contracted the virus directly through a mosquito bite in El Salvador or through sexual transmission with a male partner. Either way, the Centers for Disease Control has said definitively the virus can cause severe birth defects. http://www.legacycommunityhealth.org/newsroom/first-legacy-patient-tests-positive-for-zika-as-houston-flooding-sure-to-boost-mosquito-population/

Tuesday, April 19, 2016 The Houston Health Department was notified by the Texas Department of Health Services that a clerical error wrongly identified a confirmed case of Zika. The case count for The City of Houston is six. 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 Positive

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CDCStatesStatesStatesStatesCDCStatesStatesStatesStatesStatesStates6-Apr7-Apr8-Apr11-Apr12-Apr13-Apr13-Apr14-Apr15-Apr18-Apr19-Apr20-Apr233332333333122222222222111111111111293033333329333334343434222222222222111111111111333333333333333333333333788284858582858788889191111111111111111111131313577775777777101010101010101010131313666666666666444444444444111111111111333333333333444444444444666667788888777777777777122221222222222222222222121212121212121212121212233333333333233333333333111111111111888889999999222222222222222222222222555558888888011110111111222332344444556666666654696969737377999999999999333333333344610101010610101010101012121212121212121215151500000000001112222222222227282828282731313232323222222222222289999891111111111000000001111233332333333555555555555346378383385385358396402406418423427

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At A Glance - Zika in the U.S.(as of Apr 20, 2016) North CarolinaTravel-associated Zika virus disease cases reported: 10Locally acquired vectorborne cases reported: 0 http://epi.publichealth.nc.gov/zika/

At A Glance - Zika in the U.S.(as of Apr 20, 2016) North CarolinaTravel-associated Zika virus disease cases reported: 10Locally acquired vectorborne cases reported: 0 U.S. StatesTravel-associated Zika virus disease cases reported: 358Locally acquired vectorborne cases reported: 0 U.S. TerritoriesTravel-associated cases reported: 4Locally acquired vectorborne cases reported: 471

Zika virus NS5 gene, partial cds.PopSet: 1016884666 GenBank FASTA Sequences in this data setKX059014.1Zika virus isolate Haiti/1230/2014 NS5 gene, partial cdsKX059013.1Zika virus isolate Haiti/1227/2014 NS5 gene, partial cdshttp://www.ncbi.nlm.nih.gov/popset?DbFrom=nuccore&Cmd=Link&LinkName=nuccore_popset&IdsFromResult=1016884668

Zika virus envelope protein gene, partial cds.PopSet: 1018266330 GenBank FASTA Go to:Study DetailsEnvelope protein gene sequences of two different Zika virus isolates from blood drawn in 2014 from Haitian children.Lednicky,J.A., Morris,J.G. Jr., Beau De Rochars,V.M., Elbadry,M.A., Okech,B.A. and Loeb,J.C. Go to:Sequences in this data setKX062045.1Zika virus isolate Haiti/1230/2014 envelope protein gene, partial cdsKX062044.1Zika virus isolate Haiti/1227/2014 envelope protein gene, partial cdshttp://www.ncbi.nlm.nih.gov/popset?DbFrom=nuccore&Cmd=Link&LinkName=nuccore_popset&IdsFromResult=1018266330

Zika virus envelope protein gene, partial cds.PopSet: 1018266330 GenBank FASTA Go to:Study DetailsEnvelope protein gene sequences of two different Zika virus isolates from blood drawn in 2014 from Haitian children.Lednicky,J.A., Morris,J.G. Jr., Beau De Rochars,V.M., Elbadry,M.A., Okech,B.A. and Loeb,J.C. Go to:Sequences in this data setKX062045.1Zika virus isolate Haiti/1230/2014 envelope protein gene, partial cdsKX062044.1Zika virus isolate Haiti/1227/2014 envelope protein gene, partial cdshttp://www.ncbi.nlm.nih.gov/popset?DbFrom=nuccore&Cmd=Link&LinkName=nuccore_popset&IdsFromResult=1018266330

Weekly updates http://portalsaude.saude.gov.br/index.php/o-ministerio/principal/leia-mais-o-ministerio/197-secretaria-svs/20799-microcefalia

April 20, 2016 DEPARTMENT OF HEALTH DAILY ZIKA UPDATE: NO NEW 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 no new cases today. Of the cases confirmed in Florida, three 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, five 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 13 Clay 1 Collier 1 Hillsborough 3 Lee 4 Miami-Dade 39 Orange 5 Osceola 4 Palm Beach 4 Polk 3 Santa Rosa 1 Seminole 1 St. Johns 1 Cases involving pregnant women* 5 Total 91 *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 1,478 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 15 counties included in the declaration– Alachua, Brevard, Broward, Clay, Collier, Hillsborough, Lee, Miami-Dade, Orange, Osceola, Palm Beach, 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 6,674 people for active Zika virus and 1,499 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/2016/04/042016-zika-update.html

TABLE I. Provisional* cases of selected† infrequently reported notifiable diseases (<1,000 cases reported during the preceding year), United States, week ending April 16, 2016 (WEEK 15)http://wonder.cdc.gov/mmwr/mmwr_2016.asp?mmwr_year=2016&mmwr_week=15&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.15) Anthrax-------1 Arboviral diseases ¶,**: Chikungunya virus ††-212805NNNNNNNN Eastern equine encephalitis virus---688154 Jamestown Canyon virus §§---8112223 La Crosse virus §§---55808578130 Powassan virus---7812716 St. Louis encephalitis virus--01910136 Western equine encephalitis virus-------- Zika virus ¶¶1346042NNNNNNNNMD (1 )

Zika virus ¶¶1346042NNNNNNNNMD (1 )

Zika Virus – April 20, 2016. Texas has had 31 confirmed cases of Zika virus disease. Of those, 30 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 – 3Dallas – 6Denton – 1Fort Bend – 2Grayson – 1Harris – 12Tarrant – 3Travis – 2Wise – 1

Brain scans show full horror of Zika defects, Seattle expert saysOriginally published April 20, 2016 at 6:00 am Updated April 20, 2016 at 6:51 amDr. William Dobyns, who works at Seattle Children’s Research Institute, explains brain scans of babies infected with Zika virus in Brazil, highlighting evidence of severe brain destruction. (Bettina Hansen & Katie G. Cotterill / The Seattle Times)Zika virus is causing birth defects rarely seen before, including collapsed brains and skulls, according to Dr. William Dobyns, a Seattle Children’s hospital expert in genetics and pediatric neurology. SECTION SPONSORShare storyBy JoNel Aleccia Seattle Times health reporterZika virus infections are causing birth defects so severe that the babies’ brains shrink and their skulls collapse inside the womb, according to a Seattle expert who is monitoring the epidemic sweeping across Latin America and the Caribbean — and approaching the U.S. mainland. At least half of 40 brain scans from Brazil that Dr. William Dobyns has examined meet criteria for a rare condition known as fetal brain disruption sequence, a previously rare and highly destructive condition, according to the Seattle Children’s hospital medical geneticist and pediatric neurologist. “The brain in a fetus is growing and growing and growing,” he explained. “Then something really bad happens. The brain shrinks and the skull collapses.” It’s a condition much more severe than the microcephaly linked to Zika early on, a disorder in which babies are born with smaller-than-normal heads, Dobyns said. The growing cases are more evidence that the largely mosquito-borne virus leads to far more devastating defects than originally thought. They also underscore the need for greater awareness and preparation as the virus approaches the continental U.S., Dobyns said. “Where is Zika now? It’s in southern Mexico,” he said. “It’s coming and it’s not good.” Dobyns’ observations come a week after the Centers for Disease Control and Prevention (CDC) confirmed Zika virus is the cause of increased cases of severe microcephaly and other birth defects seen in thousands of babies in Brazil starting last fall. CDC officials, writing in the New England Journal of Medicine, said that limited data showed some infants infected with Zika virus had signs of fetal brain disruption sequence. A separate study of 23 Zika-affected infants, published last week in the journal BMJ, also found evidence of the disorder, which previously had been documented in just 20 cases. More on the Zika virusZika test backlog leaves scores of Washington residents anxious for answersUW doctor quietly warns pregnant women about Zika risk in U.S.Local blood supply dips after shipments sent to help Zika-hit Puerto RicoWHO: Sexual transmission of Zika more common than thoughtWoman in Spokane infected with Zika during pregnancy, but delivered healthy babyMason County man who traveled to South Pacific is Washington’s first Zika case“Everybody is seeing the same thing,” said Dobyns, who has been consulting with experts in Brazil and at the CDC. Babies with the condition have severe microcephaly, overlapping skull plates and a prominent occipital bone, which is located at the back of the skull. The infants also have excess folds of scalp skin that remain loose when the skull collapses, Dobyns said. They’re likely to have severe neurological and developmental delays and may not be able to walk, talk or feed themselves. Many will die shortly after birth, he added. Data so far seem to show that infections during the first and second trimesters of pregnancy cause what’s now being called congenital Zika syndrome. As more cases emerge, it’s clear they share certain characteristics, Dobyns said. Other viruses, including cytomegalovirus (CMV), have been associated with microcephaly in the past. But this is very different, Dobyns said. “I think I can tell the difference between Zika and CMV on brain scans,” he said. 1 of 2Dr. William Dobyns, of Seattle Children’s, is a leading expert on Zika virus in pregnancy. After examining scans from Brazil, Dobyns urges people to prepare now and protect themselves. (Bettina Hansen/The Seattle Times) Officials with the CDC and the National Institutes of Health have said transmission of Zika virus by mosquitoes may occur in the United States later this spring and summer, particularly in the Southeast. Two types of mosquitoes, the Aedes aegypti and Aedes albopictus, are known to spread Zika. So far, U.S. states have reported only travel-related cases, in which the virus was spread by someone who got sick abroad, then infected someone back home. Nationwide, 358 cases of travel-related Zika have been reported in the U.S., including 31 in pregnant women. In Washington state, two cases of Zika virusinfection have been confirmed in local residents. Two other cases were confirmed in international travelers. Most Read Stories Nordstrom layoffs respond to sagging profits, rising competitionCharges: Girl posed with victim’s gun after Seattle slayingBrothers sought in Arlington slayings may be headed to MexicoFormer neighbor, now wanted by police, threatened to shoot missing Arlington couple, records sayTrain hits, kills man along Edmonds waterfrontSubscribe now. Four weeks for just $1.At the same time, nearly 500 cases have been reported in U.S. territories, including Puerto Rico, the U.S. Virgin Islands and American Samoa. In addition to birth defects, Zika virus infections have been associated with cases of Guillain-Barré syndrome, which causes muscle weakness and paralysis. Dobyns joined a growing chorus of critics, including Senate Democrats, in urging Congress to approve the Obama administration’s request for $1.9 billion in emergency funds to fight the Zika threat. Federal officials this month shifted $589 million allocated for Ebola to cover Zika costs. Health experts say Zika virus isn’t expected to hit the U.S. as hard as places such as Brazil, largely because of mosquito control and the ability of many people to avoid insect bites. Any outbreak isn’t likely to be widespread, experts say. Still, cases are likely to occur. “Everybody expects that we’re going to have affected kids in the U.S.,” Dobyns said. When that happens, it will likely galvanize public alarm, but Dobyns said he’d like people to prepare now by knowing about places where Zika is likely to spread and taking action to protect themselves. That includes wearing protective clothing and using insect repellent to prevent mosquito bites — and understanding that Zika can spread through sexual transmission. Couples contemplating pregnancy after Zika exposure should be especially concerned. Dobyns said they might consider postponing pregnancy until the crisis clears. “This is a big deal,” he said. “This is not something anybody should ignore.” JoNel Aleccia: 206-464-2906 or [email protected]. On Twitter@JoNel_Aleccia