niman

Zika Virus – March 29, 2016. Texas has had 27 confirmed cases of Zika virus disease. Of those, 26 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 – 4Fort Bend – 2Grayson – 1Harris – 11Tarrant – 3Travis – 2Wise – 1

ReferencesBrazilian Ministry of Health. Epidemiological bulletin with Zika virus data [in Portuguese] [cited 2015 Nov 30].http://portalsaude.saude.gov.br/images/pdf/2015/novembro/26/2015-dengue-SE45.pdfZanluca C, Melo VC, Mosimann ALP, Santos GI, Santos CN, Luz K. First report of autochthonous transmission of Zika virus in Brazil. Mem Inst Oswaldo Cruz. 2015;110:569–72 . DOIPubMedBrazilian Ministry of Health. Ministry of Health confirms relationship between Zika virus and microcephaly [in Portuguese] [cited 2015 Nov 30]. http://portalsaude.saude.gov.br/index.php/o-ministerio/principal/secretarias/svs/noticias-svs/21016-ministerio-da-saude-confirma-relacao-entre-virus-zika-e-microcefaliaBrazilian Ministry of Health. Protocol for monitoring and response to microcephaly occurrence relating to ZikaV infection [in Portuguese] [cited 2015 Dec 9].http://portalsaude.saude.gov.br/images/pdf/2015/dezembro/09/Microcefalia-Protocolo-de-vigil-ncia-e-resposta-vers-o-1-09dez2015-8h.pdfMlakar J, Korva M, Tul N, Popović M, Poljšak-Prijatelj M, Mraz J, Zika virus associated with microcephaly. N Engl J Med. 2016;374:951–8 .DOIPubMedPan American Health Organization. Neurological syndrome, congenital malformations, and Zika virus infection. Implications for public health in the Americas. Epidemiological Alert [cited 2015 Dec 1].http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&Itemid=270&gid=32405&lang=enBrazilian Ministry of Health. Epidemiological bulletin. Ministry of Health updated microcephaly numbers related to Zika virus [in Portuguese] [cited 2015 Dec 15]. http://portalsaude.saude.gov.br/index.php/cidadao/principal/agencia-saude/21254-ministerio-da-saude-atualiza-numeros-de-microcefalia-relacionados-ao-zikaFenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants.BMC Pediatr. 2013;13:59. DOIPubMedPereira AP, Leal MC, da Gama SG, Domingues RM, Schilithz AO, Bastos MH. Determining gestational age based on information from the Birth in Brazil study. Cad Saude Publica. 2014;30(Suppl 1):S1–12 .PubMedMiranda-Filho DB, Martelli CM, Ximenes RA, Araújo TV, Rocha MA, Ramos RC, Initial description of the presumed congenital Zika syndrome. Am J Public Health. 2016;106:598–600. DOIPubMedKleber de Oliveira W, Cortez-Escalante J, De Oliveira WT, do Carmo GM, Henriques CM, Coelho GE, Increase in peported prevalence of microcephaly in infants born to women living in areas with confirmed Zika virus transmission during the first trimester of pregnancy—Brazil, 2015. MMWR Morb Mortal Wkly Rep. 2016;65:242–7 .DOIPubMedNeu N, Duchon J, Zachariah P. TORCH infections. [viii. ]. Clin Perinatol. 2015;42:77–103. DOIPubMedTrimm F, Quiñonez JM. Congenital toxoplasmosis and congenital cytomegalovirus infection. Pediatr Mod.2004;2:1–12.FiguresFigure 1. Microcephaly cases (based on Fenton growth chart criteria) at 2 referral hospitals, by week of birth, Pernambuco State, Brazil, 2015 (N = 104).Figure 2. Microcephaly, Pernambuco State, Brazil, 2015. A) Two newborns in whom microcephaly was diagnosed during the epidemic. B) Brain computed tomography scan of a 43-day-old infant showing cerebellar hypoplasia, parenchymal...TableTable. Characteristics of 104 newborns with microcephaly seen at 2 referral hospitals, Pernambuco State, Brazil, August–December 2015Technical AppendixTechnical Appendix. 140 KB Suggested citation for this article: Microcephaly Epidemic Group. Microcephaly in infants, Pernambuco State, Brazil, 2015. Emerg Infect Dis. 2016 Jun [date cited]. http://dx.doi.org/10.32032/eid2206.160062 DOI: 10.3201/eid2206.160062 1Members of the Microcephaly Epidemic Group who contributed data are listed at the end of this article. Table of Contents – Volume 22, Number 6—June 2016

ConclusionsMicrocephaly among the 104 newborns peaked in October 2015 and demonstrated severe central nervous system abnormalities with brain dysgenesis and intracranial calcifications consistent with an intrauterine infection. Although we initially lacked Zika virus testing and completed only partial testing for ToRCHeS infections, the timing on the microcephaly and the history of rash in more than half of the pregnant mothers suggest an outbreak of congenital microcephaly caused by a congenital infection. Since our study was completed, less clinically detailed and more surveillance-oriented data have been published from the national reporting system (11). These data include the case-infants reported here and the reported occurrence of the 2015–2016 microcephaly cases, especially in Pernambuco. They highlight the temporal relationship between the preceding Zika virus transmission and the abrupt increase in prevalence of microcephaly at birth. Our study focused on the clinical findings of 1 cohort, demonstrating a high proportion of calcifications and malformations of cortical development in infants with microcephaly and with severe microcephaly. Such malformations have commonly been observed in cases of intrauterine infections caused by cytomegalovirus and toxoplasmosis (12); more severe anomalies (e.g., lissencephaly) occur in infants whose mothers were infected before weeks 16–18 of pregnancy (13). The finding of intracranial calcifications predominantly in the cortical/subcortical parenchyma suggests a scan pattern distinct from that of other congenital infections, although further studies including comprehensive diagnostic testing for Zika virus and other known infectious causes of congenital central nervous system defects are needed to confirm this pattern. Our study had several limitations. First, as previously noted, this study was preliminary, and Zika virus testing was not yet available. Second, personnel and laboratory resources were insufficient for ToRCHeS testing of more than half of the case-infants reported here; however, we collected blood and cerebrospinal fluid samples for future testing. Third, limited resources restricted the number of brain scans to slightly more than half of these infants. Fourth, the data on rash during pregnancy was collected postpartum and could be subject to recall bias. Nevertheless, a case–control study has been under way in Pernambuco since December 2015, supported by the Brazilian Ministry of Health and the Pan American Health Organization, to establish an association between microcephaly and Zika virus (primary hypothesis) and explore other infectious or noninfectious causes. Although the ToRCHeS testing was incomplete, our findings suggest an outbreak of severe microcephaly in Pernambuco that peaked in October 2015. Our data, in conjunction with recent surveillance summaries from Brazil (11), are consistent with the timing of the Zika virus epidemic. Our findings illustrate the most severe end of the spectrum of defects affecting newborns. Other manifestations and complications in infants born to mothers infected with Zika virus during pregnancy will be described through close follow-up of these children. The government of Brazil plans to expand the support system for affected children. Further studies will define the proportion of congenital defects according to the gestational age of infection and describe the clinical outcomes. The Microcephaly Epidemic Research Group comprises experts from several institutions in response to the public health emergency. The main goals of the group are research development and epidemiologic data analysis. AcknowledgmentsWe are thankful for the support of the Brazilian Ministry of Health, Pernambuco State Health Department and Pan American Health Organization for their support. The authors received partial support from the Conselho Nacional de Desenvolvimento Científico e Tecnológico (scholarship 306489/2010-4 to C.M.T.M., 308311/2009-4 to RAAX, 308590/2013-9 to D.B.M.F., 301779/2009-0 to M.F.P.M.A., 304174/2014-9 to C.B., and 306222/2013-2 to W.V.S. Members of the Microcephaly Epidemic Group who contributed data to this article: Maria de Fátima P.M. Albuquerque, Thalia V.B. Araújo, Andreza Barkokebas, Luciana Caroline A. Bezerra, Cynthia Braga, Sinval P. Brandão-Filho, Carlos Alexandre A. Brito, Renata G. Cabral, Adriana R. Carneiro, Maria Durce C.G. Carvalho, Marli T. Cordeiro, Iran Costa-Jr, Adriana S.C. Cunha, Danielle D.C.S. Cruz, Rafael Dhalia, Adriano N. Hazin, Leticia Katz, Ernesto T.A. Marques, Celina Maria T. Martelli, Demócrito B. Miranda-Filho, Monica Maria C. Moraes, Cristina Mota, Vanessa V.D.L. Mota, Regina C.F. Ramos, Maria Angela W. Rocha, Paula Fabiana S. Silva, Wayner V. Souza, Ana Van Der Linden, Ricardo A.A. Ximenes (Recife, Brazil); Joanna d’Arc L. Batista, Enrique Vazquez (Chapeco, Brazil); Giovanini E. Coelho, Juan J. Cortez-Escalante, Elisete Duarte, Cláudio M.P. Henriques, Carlos Frederico C.A. Melo, Wanderson K. Oliveira (Brasilia, Brazil); Lavínia Schüler-Faccini (Porto Alegre, Brazil); Sylvain Aldighieri, Maria Almiron, Jairo Mendez-Rico, Pilar Ramon-Pardo (Washington, DC, USA); Laura C. Rodrigues (London, UK).

The StudyIn August 2015, we began systematically collecting data prospectively and retrospectively (by reviewing hospital records dating to April 2015) on infants suspected to have microcephaly and referred to us. We defined microcephaly as head circumference below the third percentile for gestational age and sex using the Fenton growth chart (8). Our routine protocol for reviewing suspected microcephaly cases involved collecting data on maternal age and infant sex, gestational age, and birthweight. Laboratory testing was performed for 6 pathogens: serologic testing for dengue virus; and a nontreponemal test for toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, and syphilis (collectively referred to in Brazil as ToRCHeS agents). Zika virus testing was not available at the time of the study. Brain imaging was performed when available by using computed tomography (CT) scans, magnetic resonance imaging, or transfontanellar ultrasonography. Hearing was assessed by using otoacoustic emission testing, and retinae were examined by using handheld fundoscopy. We asked mothers about rash during pregnancy, but no data were collected on the timing of the rash, other clinical symptoms, or environmental exposures. We excluded patients with suspected microcephaly who had a head circumference greater than the third percentile (40 infants), were missing chart data for head circumference (6 infants) or gestational age (4 infants), or tested positive for a congenital infection known to cause microcephaly (1 infant positive for cytomegalovirus identified by PCR). We plotted included cases by week of birth and compared variables of infants with microcephaly (head circumference 30–32 cm) and those with severe microcephaly (circumference <30 cm). We conducted this investigation as part of our routine clinical practice; it did not require human subject approvals. Figure 1. Microcephaly cases (based on Fenton growth chart criteria) at 2 referral hospitals, by week of birth, Pernambuco State, Brazil, 2015 (N = 104). Figure 2. Microcephaly, Pernambuco State, Brazil, 2015. A) Two newborns in whom microcephaly was diagnosed during the epidemic. B) Brain computed tomography scan of a 43-day-old infant showing cerebellar hypoplasia, parenchymal calcifications, ventriculomegaly,... Our final study comprised 104 infants with microcephaly. Cases increased from epidemiologic week 37 (mid-September) and peaked during weeks 40–43 (late October) (Figure 1). Seventy infants had severe microcephaly (Table; Figure 2, panel A) and a mean head circumference of 29 cm. Only 10% of case-infants were born prematurely, which was lower than the national estimates of the prevalence of premature birth (9). Mothers were a mean of 25 (range 15–43) years of age. Of the 100 mothers interviewed, 59 recalled having a rash during pregnancy. Testing for dengue and ToRCHeS was incomplete for more than half of the case-infants; the number tested for each of the 6 pathogens varied because of limited laboratory resources at the beginning of the epidemic (Table). Three infants tested positive for syphilis, 2 for dengue, and 1 for herpes simplex virus, but they also shared common features with the epidemic of congenital microcephaly (10). As of January, 13, 2016, a total of 58 of the 104 infants had been investigated (54 by CT scan, 3 by magnetic resonance imaging, 1 by both). All 58 infants showed radiologic abnormalities, including calcifications (93%), mainly in the cortical/subcortical junction but also in the periventricular region, basal ganglia, thalamus, midbrain, and cerebellum. Sixty-nine percent showed evidence of malformations of cortical development, including lissencephaly (relative smoothness of the brain surface) associated with pachygyria (poorly formed, broad cortical folds), agyria (no cortical folds), or both (Figure 2, panel B). Sixty-six percent had ventriculomegaly, an enlargement of the ventricles that can occur for several reasons, such as loss of brain volume or impaired outflow or absorption of cerebrospinal fluid from the ventricles. Of the 15 children with pending CT scans who had undergone ultrasonography, 14 had abnormalities, such as calcifications and brain atrophy. The child (at term) with a normal ultrasound had a head circumference of 30 cm, and the mother reported a rash during pregnancy.

In April 2015, Zika virus was identified in Brazil (1,2). In August, an increased incidence of microcephaly was detected in Pernambuco State. In November, the Brazilian Ministry of Health declared a relationship between the microcephaly epidemic and Zika virus infection during pregnancy (3) on the basis of accumulating evidence (Technical Appendix[PDF - 140 KB - 2 pages]). Since then, several reports of Zika virus–associated microcephaly have been published (4–6). As of December 12, 2015, a total of 2,401 suspected cases of microcephaly had been reported (including 29 stillbirths) in 549 municipalities in 20 states in Brazil; Pernambuco reported the most (874 cases) (7). In comparison, an annual mean of 156 microcephaly cases were reported in Brazil (through the routine birth notification system) during 2010–2014, including 9 in Pernambuco (7). We describe preliminary findings of 104 microcephaly cases in Pernambuco from the 2 hospitals to which infants with suspected cases were referred.

AbstractWe studied the clinical characteristics for 104 infants born with microcephaly in the delivery hospitals of Pernambuco State, Brazil, during 2015. Testing is ongoing to exclude known infectious causes. However, microcephaly peaked in October and demonstrated central nervous system abnormalities with brain dysgenesis and intracranial calcifications consistent with an intrauterine infection.

Volume 22, Number 6—June 2016DispatchMicrocephaly in Infants, Pernambuco State, Brazil, 2015Microcephaly Epidemic Group http://wwwnc.cdc.gov/eid/article/22/6/16-0062_article

https://www.google.com/maps/d/edit?hl=en&hl=en&authuser=0&authuser=0&mid=zv94AJqgUct4.kT4qLMXp3SLU CDCStatesStatesStatesStates 23-Mar23-Mar24-Mar25-Mar28-MarAL23333AR11111AZ00001CA1717172222CO22222CT11111DE33333DC33333FL7072737575GA77777HI57777IL99999IN44444IA44444KS11111KY22222LA22222MD55555MA33333ME01111MI23333MN99999MO11111MS00122MT11111NC77799NE22222NH22222NJ22222NM01111NV00112NY4353535353OH88889OK33333OR610101010PA888811TN11111TX2328282828UT01111VA77777WA23333WV55555 273302305315321

Map Update https://www.google.com/maps/d/edit?hl=en&hl=en&authuser=0&authuser=0&mid=zv94AJqgUct4.kT4qLMXp3SLU

News ReleaseFor Immediate Release: March 28, 2016Media Contact:Holly Ward, ADHS: [email protected], 602-542-1094Courtney Kreuzwiesner, MCDPH: [email protected], 602-540-5473Johnny Diloné, MCESD: [email protected], 602-506-6611 Arizona’s first Zika case recorded in travelerRisk of virus spread throughout state is low PHOENIX — The Arizona Department of Health Services and the Maricopa County Department of Public Health confirmed today the state’s first case of Zika virus in a Maricopa County resident. The older adult woman traveled outside of the United States to a Zika affected area before developing symptoms of illness. "We have been expecting a travel associated case of Zika virus and we believe more infections are likely as people travel to and from areas where the disease is currently being transmitted," said Cara Christ, MD, MS, director of the Arizona Department of Health Services. "While this is a first, the risk of this virus spreading throughout Arizona is very low. Arizona’s public health system has a plan in place and we are ready to rapidly respond." Zika virus is a type of flavivirus that is primarily transmitted by the bite of an infected mosquito. A link has been identified between the virus and birth defects among infants of infected mothers. "As soon as public health became aware of the suspect case, the individual was contacted to ensure she stayed indoors and avoided being bitten by mosquitoes to prevent further spread of the virus," said Bob England, MD, MPH, director of MCDPH. Most people infected with the Zika virus do not become ill, and those who do become ill have symptoms that may include fever, rash, joint pain, and conjunctivitis. Severe illness and hospitalization due to Zika virus is rare. "We strongly recommend those who travel to Zika affected areas wear insect-repellant and take precautions to avoid mosquito bites for at least a week when they return, even if they have no signs of illness, not just to protect themselves but to protect their families and the community," said Dr. England. Maricopa County Department of Environmental Services, in collaboration with MCDPH, initiated their response plan to any suspect case of mosquito-borne disease that is not yet circulating in Maricopa County. This plan includes enhanced surveillance for mosquitoes and humans with appropriate vector control measures to ensure the disease does not spread locally. "Our Vector Control technicians survey Maricopa County year-round and set traps to monitor and treat areas that have routinely been mosquito breeding sites to help minimize the risks of mosquito-borne diseases," said Steven Goode, Maricopa County Environmental Services Department Director. "Our Vector Control Lab has also recently received the most current guidelines from CDC for conducting testing for the Zika and Dengue viruses; and we are in the process of acquiring all the materials needed to begin testing mosquitoes for Zika." Zika virus can be transmitted by several Aedes species mosquitoes, and Arizona is home to one of these – Aedes aegypti. Although the mosquito is found in many parts of the state, there is no evidence of Zika transmission within Arizona. Arizona communities typically experience mosquito activity in the warmer months, with highest mosquito activity during monsoon season from June through September. The Arizona Department of Health Services is working with local and federal agencies to coordinate Zika preparedness and response plans. Preventing mosquito bites, both at home and when traveling, is important to prevent disease spread. "When you look for a mosquito repellant, look for DEET on the label," said Dr. England. "At home, drain and remove containers of water, even small ones, which provide a good breeding ground for those mosquito eggs. It’s important to not only get rid of the water but also wipe the inside of the container to make sure the eggs aren’t stuck to the side, waiting for their next drink of water." Unlike other mosquitoes that come out at dawn and dusk, the Aedes aegypti mosquito can be out during all times of the day or night. "Fight the bite, day or night," said Dr. Christ. For more information on Zika in Arizona, please visit http://azhealth.gov/zika. # # # B-roll of Zika testing performed in the ADHS State Laboratory is available via the following Dropbox folder:http://1.azdhs.gov/1pUCDJG. The video shows laboratory testing of bodily fluids to detect if Zika virus is present. The ADHS State Laboratory was one of the first three state health labs in the nation to be validated by the Centers for Disease Control and Prevention for Zika testing.

The Arizona Department of Health Services and the Maricopa County Department of Public Health confirmed today the state’s first case of Zika virus in a Maricopa County resident. The older adult woman traveled outside of the United States to a Zika affected area before developing symptoms of illness. http://www.azdhs.gov/director/public-information-office/index.php#news-release-032816

LOCUS JN860885 10269 bp RNA linear VRL 19-MAR-2012 DEFINITION Zika virus isolate FSS13025 polyprotein gene, partial cds. ACCESSION JN860885 VERSION JN860885.1 GI:380036385 KEYWORDS . SOURCE Zika virus ORGANISM Zika virus Viruses; ssRNA viruses; ssRNA positive-strand viruses, no DNA stage; Flaviviridae; Flavivirus. REFERENCE 1 (bases 1 to 10269) AUTHORS Haddow,A.D., Schuh,A.J., Yasuda,C.Y., Kasper,M.R., Heang,V., Huy,R., Guzman,H., Tesh,R.B. and Weaver,S.C. TITLE Genetic characterization of zika virus strains: geographic expansion of the asian lineage JOURNAL PLoS Negl Trop Dis 6 (2), E1477 (2012) PUBMED 22389730 REMARK Publication Status: Online-Only REFERENCE 2 (bases 1 to 10269) AUTHORS Haddow,A.D. and Schuh,A.J. TITLE Direct Submission JOURNAL Submitted (17-OCT-2011) Department of Pathology, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA FEATURES Location/Qualifiers source 1..10269 /organism="Zika virus" /mol_type="genomic RNA" /isolate="FSS13025" /host="Homo sapiens" /db_xref="taxon:64320" /country="Cambodia" /collection_date="2010" /note="Passage History: Vero African green monkey kidney cells 1 time; serogroup: Spondweni"http://www.ncbi.nlm.nih.gov/nuccore/JN860885

PUBLIC RELEASE: 28-MAR-2016New mouse model for Zika virus to enable immediate screening of potential drugs and vaccinesResearch in American Journal of Tropical Medicine and Hygiene describes first new Zika animal model in decades BURNESS COMMUNICATIONS SHARE PRINT E-MAILOakbrook Terrace, Ill. (March 28, 2016)-- Efforts to combat the rapid spread of Zika virus got a boost this week as researchers at the University of Texas Medical Branch, Galveston (UTMB) announced the first peer-reviewed publication of a mouse model for Zika infection reported in decades. Several research institutions and companies have vaccine and drug candidates nearly ready to test, but until now a mouse model - a critical stage in preclinical testing - has not been available. The study, published in the American Journal of Tropical Medicine and Hygiene (AJTMH), removes a bottleneck that was delaying treatment screening. "There is a huge demand to screen antivirals that have been backlogged because we haven't had a good way to test them," said Shannan Rossi, PhD, a UTMB virologist and lead author of the study. "Without this model, we were really stagnant in our efforts to find new treatments. You can look for efficacy in cell cultures, but that tells you almost nothing about what's going to happen when you test in a mouse or a human. This will help get those drug and vaccine candidates moving through the pipeline." Rossi and UTMB colleague Scott Weaver, PhD, a virologist and vector biologist, have been on the forefront of investigations into the meteoric rise in Zika virus infection raging through Central and South America. Weaver, an expert in mosquito-borne viruses in the family that includes Zika, dengue, West Nile and yellow fever, warned as early as 2009 that Zika presented a threat in the Americas. With an epidemic underway, the race is on to rapidly develop new treatments. "Normally, creating a mouse model like this would take us several months, but the urgency of the situation propelled us into this rapid response, and we were able to put together our results in just three weeks," Rossi said. Using funding from a grant to the World Reference Center for Emerging Viruses and Arboviruses (WRCEVA) at UTMB, Rossi injected several genetically distinct varieties of laboratory mice with Zika virus isolated in Asia in 2010. The current epidemic in South America can be traced to the Asian Zika virus lineage, of which this strain is a member. Normal mice did not develop disease after infection with Zika virus, the research team reported. Only when researchers injected mice that had been genetically altered to have a deficient innate immune response did the animals develop detectible disease. Young mice of these strains are highly susceptible to infection. These mice became lethargic, lost weight and died within six days after infection. Older mice became ill, but did not always develop infection, and they ultimately recovered. The mouse model is available immediately for testing of antivirals, and Weaver said that preliminary testing is already underway with an antiviral developed by another member of the UTMB team, Pei-Yong Shi, PhD, to treat dengue fever. Since so little is known about how Zika virus behaves once inside the body, researchers also searched for evidence of viral infection in the animals' organs. They found viral particles in most of the major organ systems, with the highest levels found in the spleen, brain and testes. While the results are preliminary, the findings corroborate evidence that the virus can be sexually transmitted. The finding of virus in the brain could also be important, since the most devastating impact of the current outbreak in Brazil appears to be children of infected mothers born with microcephaly - abnormally small heads and, in some cases, incomplete brain development. While the mouse study does not prove a direct connection between Zika infection and microcephaly, Rossi said, it does underscore the urgent need for effective animal models to further study the course of disease and its transmission. The mice described in the current report were developed for testing of drug and vaccine candidates and may not be good models for human transmission, said Weaver. Understanding human transmission will likely require non-human primate models and UTMB is also working on that research, he added, although all of these studies are in the early stages. He emphasized that the bulk of research on Zika virus was published in the 1950s and 1960s. And until media attention surged recently, there had been little interest or research funding available to study Zika virus. Thus, there is limited knowledge about the extent and mechanisms of transmission during the current outbreak in the Americas and even less about how the virus is circulating in Asia. The difficulty in tracking Zika stems from the fact that most people who become infected show no symptoms at all, and those who do become ill have signs and symptoms that overlap with more common viral infections, such as dengue and chikungunya. Further, current serologic tests often can't distinguish between related flavivirus infections in dengue-endemic regions. Ongoing, long-term funding is necessary to be better prepared for these types of outbreaks, he said. The Aedes aegypti mosquitoes that are believed to spread Zika virus can be found all over the southern United States. With the rainy season approaching in Central America and the Caribbean, Weaver said transmission is likely to pick up, and more travel-related cases may be reported in the United States. "There's a risk from every one of those travel-related cases," said Weaver. "Most of them will not lead to local transmission, but our experience with dengue and chikungunya tells us that some of them probably will." "This research team's dedication and previous research on dengue and other arboviruses enabled them to quickly develop this model for Zika virus, an important first step to enable testing of candidate vaccine and therapeutics," said Stephen Higgs, PhD, the president of the American Society of Tropical Medicine and Hygiene. "The lack of research on Zika virus in the decades since it was discovered and the current epidemic reveals our vulnerability to these poorly understood viruses and demonstrates the need for smart and, more importantly, sustained investments to support basic and applied research." ### About the American Society of Tropical Medicine and Hygiene The American Society of Tropical Medicine and Hygiene, founded in 1903, is the largest international scientific organization of experts dedicated to reducing the worldwide burden of tropical infectious diseases and improving global health. We accomplish this through generating and sharing scientific evidence, informing health policies and practices, fostering career development, recognizing excellence, and advocating for investment in tropical medicine/global health research. For more information, visit http://www.astmh.org About the American Journal of Tropical Medicine and Hygiene Continuously published since 1921, AJTMH is the peer-reviewed journal of the American Society of Tropical Medicine and Hygiene, and the world's leading voice in the fields of tropical medicine and global health. AJTMH disseminates new knowledge in fundamental, translational, clinical and public health sciences focusing on improving global health. http://www.eurekalert.org/pub_releases/2016-03/bc-nmm032316.php

AbstractThe mosquito-borne Zika virus (ZIKV) is responsible for an explosive ongoing outbreak of febrile illness across the Americas. ZIKV was previously thought to cause only a mild, flu-like illness, but during the current outbreak, an association with Guillain–Barré syndrome and microcephaly in neonates has been detected. A previous study showed that ZIKV requires murine adaptation to generate reproducible murine disease. In our study, a low-passage Cambodian isolate caused disease and mortality in mice lacking the interferon (IFN) alpha receptor (A129 mice) in an age-dependent manner, but not in similarly aged immunocompetent mice. In A129 mice, viremia peaked at ∼107plaque-forming units/mL by day 2 postinfection (PI) and reached high titers in the spleen by day 1. ZIKV was detected in the brain on day 3 PI and caused signs of neurologic disease, including tremors, by day 6. Robust replication was also noted in the testis. In this model, all mice infected at the youngest age (3 weeks) succumbed to illness by day 7 PI. Older mice (11 weeks) showed signs of illness, viremia, and weight loss but recovered starting on day 8. In addition, AG129 mice, which lack both type I and II IFN responses, supported similar infection kinetics to A129 mice, but with exaggerated disease signs. This characterization of an Asian lineage ZIKV strain in a murine model, and one of the few studies reporting a model of Zika disease and demonstrating age-dependent morbidity and mortality, could provide a platform for testing the efficacy of antivirals and vaccines.

Shannan L. Rossi*, Robert B. Tesh, Sasha R. Azar, Antonio E. Muruato,Kathryn A. Hanley, Albert J. Auguste, Rose M. Langsjoen, Slobodan Paessler,Nikos Vasilakis and Scott C. Weaver-Author Affiliations Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas; Department of Pathology, University of Texas Medical Branch, Galveston, Texas; Institute for Translational Science, University of Texas Medical Branch, Galveston, Texas; Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas; Sealy Center for Vaccine Development, University of Texas Medical Branch, Galveston, Texas; Department of Biology, New Mexico State University, Las Cruces, New Mexico-Author Notes Authors' addresses: Shannan L. Rossi, Robert B. Tesh, Albert J. Auguste, Slobodan Paessler, and Nikos Vasilakis, Institute of Human Infection and Immunity University of Texas Medical Branch, Galveston, TX, and Department of Pathology, University of Texas Medical Branch, Galveston, TX, E-mails: [email protected],[email protected], [email protected], [email protected], [email protected]. Sasha R. Azar and Rose M. Langsjoen, Institute for Translational Studies, University of Texas Medical Branch, Galveston, TX, E-mails: [email protected] and [email protected]. Antonio E. Muruato, Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, E-mail:[email protected]. Kathryn A. Hanley, Department of Biology, New Mexico State University, Las Cruces, NM, E-mail:[email protected]. Scott C. Weaver, Institute of Human Infection and Immunity, University of Texas Medical Branch, Galveston, TX, Sealy Center for Vaccine Development, University of Texas Medical Branch, Galveston, TX, and Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, E-mail: [email protected]. ↵* Address correspondence to Shannan L. Rossi, Department of Pathology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0609. E-mail: [email protected]

Characterization of a Novel Murine Model to Study Zika Virushttp://www.ajtmh.org/content/early/2016/03/24/ajtmh.16-0111.full.pdf+html

In Antioquia six cases of microcephaly associated with zika studied Written by: NotiMedellin ,March 28, 2016According to the latest epidemiological report by the National Institute of Health, in Antioquia are six cases of microcephaly, apparently associated with the Zika virus. Health officials in the department confirmed that three cases are reported in Medellin, two in Urrao and one in Guarne. Public health manager in Antioquia, Castrillón Ricardo Quintero, said it is premature to say that cases of microcephaly are related to Zika virus. However, he clarified that mothers and their babies were conducted laboratory tests and are awaiting the results. Castrillón Quintero recalled that the municipalities of Turbo and Apartadó in Urabá and Caucasia in Bajo Cauca, are the most likely areas of contracting the virus Zika and stressed that the department has slowed by 30 percent endemic process the illness. According to the National Institute of Health, in total, Colombia reported 58,000 cases of zika 838 since the start of the circulation of the virus. In Antioquia, so far, are 99 confirmed cases of the virus Zika./RCN R http://notimedellin.com/en-antioquia-se-estudian-seis-casos-de-microcefalia-asociados-con-zika/

Map Update https://www.google.com/maps/d/edit?hl=en&hl=en&authuser=0&authuser=0&mid=zv94AJqgUct4.kT4qLMXp3SLU

FOR IMMEDIATE RELEASE: March 28, 2016 Southern Nevada Health District reports second Zika case LAS VEGAS — The Southern Nevada Health District is reporting the second confirmed case of Zika virus in a Clark County resident. The patient is an adult female who recently traveled to Brazil. "The Health District continues to test people in keeping with guidelines from the Centers for Disease Control and Prevention (CDC). We do expect that we will report more positive cases in the future. However, it is important for the public to continue to understand that to date these cases have all been acquired outside of the United States," said Dr. Joe Iser, Chief Health Officer for the Southern Nevada Health District. The Health District continues to stress the Zika virus is primarily spread though the bite of an infected Aedes species mosquito. This species of mosquito has not currently been identified in Southern Nevada. The Health District's Vector Control Program is equipped to trap and identify this specific species, as it has been found in neighboring states. The most common symptoms of Zika virus disease are fever, rash, joint pain, and conjunctivitis (red eyes). Additional symptoms can include muscle pain and headache. The virus is usually mild, and four out of five people infected will not know they have the disease. Patients usually don't require hospitalization, and Zika rarely results in death. People traveling to areas where Zika is known to be spreading should take precautions to protect themselves from mosquito bites. Additionally, the CDC is recommending that all travelers returning from an area with Zika take steps to prevent mosquito bites for up to three weeks, even if they do not feel sick. Men returning from areas with Zika, even without symptoms, are advised that if they have pregnant partners they should wear condoms theright way every time they have sex during the pregnancy, and with all partners. The Health District advises anyone who is concerned they may have been exposed to Zika virus, and who has traveled to an area where the virus is circulating to consult with a health care provider. A Zika virus diagnosis is based on travel history, clinical signs and symptoms, and laboratory blood tests. Currently, there is no vaccine to prevent Zika virus disease, and no specific treatment for the infection. In addition to mosquito bites, Zika can be passed from a mother to her baby during pregnancy, and it can spread during sex from a man to his partners. Spread of the virus through blood transfusion has also been reported and is being investigated. The CDC continues to investigate a potential link to pregnant women who are infected with the virus and an increase in birth defects. The CDC is recommending special precautions for pregnant women, women who are trying to get pregnant, and their partners. Up to date CDC recommendations and travel advisories are available on the CDC website. Access information about the Southern Nevada Health District on its website:www.SNHD.info. Follow the Health District on Facebook:www.facebook.com/SouthernNevadaHealthDistrict, YouTube:www.youtube.com/SNHealthDistrict, and Twitter: www.twitter.com/SNHDinfo. The Health District is available in Spanish on Twitter: www.twitter.com/TuSNHD. Don't have a Twitter account? Follow the Health District on your phone by texting "follow SNHDinfo" to 40404. Additional information and data can be accessed through the Healthy Southern Nevada website: www.HealthySouthernNevada.org.

The Southern Nevada Health District is reporting the second confirmed case of Zika virus in a Clark County resident. The patient is an adult female who recently traveled to Brazil. http://southernnevadahealthdistrict.org/news16/20160328-southern-nevada-health-district-reports-second-zika-case.php

REPORTED TWO CASES OF MICROCEPHALY ASSOCIATED WITH ZIKA IN BARRANQUILLAMARCH 28, 2016 AGENDADENOTICIASBQ LEAVE A COMMENTPhoto: Press mayor of BarranquillaHealth authorities in Barranquilla are monitoring two possible cases of microcephaly . The Health Secretary Alma Solano, said there have been 40 births in this year of women who have had zika . " There are two possible cases of microcephaly, which would associated with zika, but we await confirmation from the National Institute of Health , "said Solano. he added that newborns do not have neurological problems . from October 2015 to March 2016 there have been more than 4,000 cases of zika in the city. From Guillán Barré, associated with zika, there have been 60 cases .

Health authorities in Barranquilla are monitoring two possible cases of microcephaly . The Health Secretary Alma Solano, said there have been 40 births in this year of women who have had zika . " There are two possible cases of microcephaly, which would associated with zika, but we await confirmation from the National Institute of Health , https://agendadenoticiasbq.wordpress.com/2016/03/28/reportan-dos-posibles-casos-de-microcefalia-asociados-a-zika-en-barranquilla/

March 28, 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, four 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, four 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 11 Clay 1 Collier 1 Hillsborough 3 Lee 3 Miami-Dade 32 Orange 5 Osceola 4 Polk 2 Santa Rosa 1 Seminole 1 St. Johns 1 Cases involving pregnant women* 4 Total 75 *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 1,177 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.The Declaration currently includes the 14 affected counties – Alachua, Brevard, Broward, Clay, Collier, Hillsborough, Lee, Miami-Dade, Orange, Osceola, 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.Florida currently has the capacity to test 4,079 people for active Zika virus and 1,727 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 are examining a possible link between the virus and harm to unborn babies exposed during pregnancy.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 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/2016/03/032816-zika-update.html

Map Update https://www.google.com/maps/d/edit?hl=en&hl=en&authuser=0&authuser=0&mid=zv94AJqgUct4.kT4qLMXp3SLU