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Zika and Birth Defects: The Evidence MountsPosted on March 15, 2016 by Dr. Francis CollinsCaption: Human neural progenitor cells (gray) infected with Zika virus (green) increased the enzyme caspase-3 (red), suggesting increased cell death. Credit: Sarah C. Ogden, Florida State University, Tallahassee Recently, public health officials have raised major concerns over the disturbing spread of the mosquito-borne Zika virus among people living in and traveling to many parts of Central and South America [1]. While the symptoms of Zika infection are typically mild, grave concerns have arisen about its potential impact during pregnancy. The concerns stem from the unusual number of births of children with microcephaly, a very serious condition characterized by a small head and damaged brain, coinciding with the spread of Zika virus. Now, two new studies strengthen the connection between Zika and an array of birth defects, including, but not limited to, microcephaly. In the first study, NIH-funded laboratory researchers show that Zika virus can infect and kill human neural progenitor cells [2]. Those progenitor cells give rise to the cerebral cortex, a portion of the brain often affected in children with microcephaly. The second study, involving a small cohort of women diagnosed with Zika virus during their pregnancies in Rio de Janeiro, Brazil, suggests that the attack rate is disturbingly high, and microcephaly is just one of many risks to the developing fetus. [3] The NIH-supported study, described in a recent issue of Cell Stem Cell, was led by Guo-li Ming and Hongjun Song of Johns Hopkins University School of Medicine, Baltimore, and Hengli Tang of Florida State University, Tallahassee. Their research teams turned to human induced pluripotent stem (iPS) cells, derived from skin biopsies, to produce human neural progenitor cells (hNPCs). These cells are readily found in the developing brain and are capable of becoming neurons in the cerebral cortex. The researchers found that Zika virus could readily infect those neural progenitors in lab dishes. In fact, within three days of inoculation, the virus had infected 65 to 90 percent of the cells. The infection also led to a 30 percent reduction in viable hNPCs, as some cells died and others grew more slowly. In another important experiment, the group discovered that, once infected, a neural progenitor cell turns into “a virus factory.” In other words, the virus exploits the cell’s own machinery to produce and release more Zika to infect more cells. While these findings will need to be confirmed in clinical studies, they suggest for the first time that Zika virus can directly target these essential neural cells. They also help to explain how Zika infection could cause harm to the developing brain, providing a possible link to microcephaly. Unfortunately, it now appears that microcephaly isn’t the only cause for worry about children exposed to Zika virus in the womb. In the second study, reported recently inThe New England Journal of Medicine, a team of U.S. and Brazilian researchers enrolled 88 healthy pregnant Brazilian women who within the past five days had developed a red skin rash, one of the symptoms associated with Zika infection. Seventy-two of these women were later confirmed by blood and/or urine tests to have Zika virus, and 42 of those agreed to undergo an abdominal ultrasound. Of the Zika-infected women, almost a third had developing babies that showed signs of very serious abnormalities by ultrasound. Five babies showed growth restrictions with or without microcephaly. Seven had other abnormalities of the central nervous system. Seven babies showed abnormally low levels of amniotic fluid or blood flow to the brain or umbilical cord. Doctors delivered one of the babies by emergency C-section due to a dangerous lack of amniotic fluid. Two babies in the study were stillborn just weeks before their due dates. None of the 16 Zika-uninfected women had pregnancies with fetal abnormalities. These preliminary findings suggest that exposure to Zika virus is risky at any stage of pregnancy—even for developing babies that don’t appear to have microcephaly or other malformations. Further research is urgently needed, and these researchers have now enrolled a total of 280 Brazilian women into their ongoing study. They’ll also continue to follow the outcomes for these women and their children over the coming months. Taken together, these studies strengthen the case that the Zika virus may well be behind the deeply troubling rise in microcephaly in Brazil. These new developments raise the question of why the ability of Zika virus to cause birth defects wasn’t previously known—after all, this virus has been around for a long time (it was originally described in 1947 in the Zika forest in Uganda). One possibility is that in endemic areas nearly all individuals are infected as children, have a mild illness, and then develop lifelong immunity. Only in the situation where a previously unexposed population encounters the virus in adulthood is the risk of active infection in pregnancy, and subsequent birth defects in the offspring, possible. (Scholars of virology will recognize this phenomenon as having similarities to rubella, or “German measles.”) The NIH is now working aggressively to develop a vaccine. But there are still many steps in development and testing before a vaccine could be made available to vulnerable populations. Meanwhile, CDC recommendations for travelers should be scrutinized by everyone. References: [1] Zika virus disease in the United States, 2015-2016. Centers for Disease Control and Prevention. 2016 Mar 9. [2] Zika virus infects human cortical neural progenitors and attenuates their growth. Tang H, Hammack C, Ogden SC, Wen Z, Qian X, Li Y, Yao B, Shin J, Zhang F, Lee EM, Christian KM, Didier RA, Jin P, Song H, Ming G. Cell Stem Cell. 2016 Mar 4. [Epub ahead of print] [3] Zika Virus Infection in Pregnant Women in Rio de Janeiro – Preliminary Report. Brasil P, Pereira JP Jr, Raja Gabaglia C, Damasceno L, Wakimoto M, Ribeiro Nogueira RM, Carvalho de Sequeira P, Machado Siqueira A, Abreu de Carvalho LM, Cotrim da Cunha D, Calvet GA, Neves ES, Moreira ME, Rodrigues Baião AE, Nassar de Carvalho PR, Janzen C, Valderramos SG, Cherry JD, Bispo de Filippis AM, Nielsen-Saines K. N Engl J Med. 2016 Mar 4. [Epub ahead of print] Links: Zika Virus (National Institute of Allergy and Infectious Diseases/NIH) Microcephaly Information Page (National Institute of Neurological Disorders and Stroke/NIH) Hongjun Song (Johns Hopkins University, Baltimore) Hengli Tang (Florida State University, Tallahassee) NIH Support: National Institute of Allergy and Infectious Diseases; National Institute of Neurological Disorders and Stroke http://directorsblog.nih.gov/2016/03/15/zika-and-birth-defects-the-evidence-mounts/

Zika and Birth Defects: The Evidence MountsPosted on March 15, 2016 by Dr. Francis CollinsCaption: Human neural progenitor cells (gray) infected with Zika virus (green) increased the enzyme caspase-3 (red), suggesting increased cell death. Credit: Sarah C. Ogden, Florida State University, Tallahassee Recently, public health officials have raised major concerns over the disturbing spread of the mosquito-borne Zika virus among people living in and traveling to many parts of Central and South America [1]. While the symptoms of Zika infection are typically mild, grave concerns have arisen about its potential impact during pregnancy. The concerns stem from the unusual number of births of children with microcephaly, a very serious condition characterized by a small head and damaged brain, coinciding with the spread of Zika virus. Now, two new studies strengthen the connection between Zika and an array of birth defects, including, but not limited to, microcephaly. In the first study, NIH-funded laboratory researchers show that Zika virus can infect and kill human neural progenitor cells [2]. Those progenitor cells give rise to the cerebral cortex, a portion of the brain often affected in children with microcephaly. The second study, involving a small cohort of women diagnosed with Zika virus during their pregnancies in Rio de Janeiro, Brazil, suggests that the attack rate is disturbingly high, and microcephaly is just one of many risks to the developing fetus. [3] The NIH-supported study, described in a recent issue of Cell Stem Cell, was led by Guo-li Ming and Hongjun Song of Johns Hopkins University School of Medicine, Baltimore, and Hengli Tang of Florida State University, Tallahassee. Their research teams turned to human induced pluripotent stem (iPS) cells, derived from skin biopsies, to produce human neural progenitor cells (hNPCs). These cells are readily found in the developing brain and are capable of becoming neurons in the cerebral cortex. The researchers found that Zika virus could readily infect those neural progenitors in lab dishes. In fact, within three days of inoculation, the virus had infected 65 to 90 percent of the cells. The infection also led to a 30 percent reduction in viable hNPCs, as some cells died and others grew more slowly. In another important experiment, the group discovered that, once infected, a neural progenitor cell turns into “a virus factory.” In other words, the virus exploits the cell’s own machinery to produce and release more Zika to infect more cells. While these findings will need to be confirmed in clinical studies, they suggest for the first time that Zika virus can directly target these essential neural cells. They also help to explain how Zika infection could cause harm to the developing brain, providing a possible link to microcephaly. Unfortunately, it now appears that microcephaly isn’t the only cause for worry about children exposed to Zika virus in the womb. In the second study, reported recently inThe New England Journal of Medicine, a team of U.S. and Brazilian researchers enrolled 88 healthy pregnant Brazilian women who within the past five days had developed a red skin rash, one of the symptoms associated with Zika infection. Seventy-two of these women were later confirmed by blood and/or urine tests to have Zika virus, and 42 of those agreed to undergo an abdominal ultrasound. Of the Zika-infected women, almost a third had developing babies that showed signs of very serious abnormalities by ultrasound. Five babies showed growth restrictions with or without microcephaly. Seven had other abnormalities of the central nervous system. Seven babies showed abnormally low levels of amniotic fluid or blood flow to the brain or umbilical cord. Doctors delivered one of the babies by emergency C-section due to a dangerous lack of amniotic fluid. Two babies in the study were stillborn just weeks before their due dates. None of the 16 Zika-uninfected women had pregnancies with fetal abnormalities. These preliminary findings suggest that exposure to Zika virus is risky at any stage of pregnancy—even for developing babies that don’t appear to have microcephaly or other malformations. Further research is urgently needed, and these researchers have now enrolled a total of 280 Brazilian women into their ongoing study. They’ll also continue to follow the outcomes for these women and their children over the coming months. Taken together, these studies strengthen the case that the Zika virus may well be behind the deeply troubling rise in microcephaly in Brazil. These new developments raise the question of why the ability of Zika virus to cause birth defects wasn’t previously known—after all, this virus has been around for a long time (it was originally described in 1947 in the Zika forest in Uganda). One possibility is that in endemic areas nearly all individuals are infected as children, have a mild illness, and then develop lifelong immunity. Only in the situation where a previously unexposed population encounters the virus in adulthood is the risk of active infection in pregnancy, and subsequent birth defects in the offspring, possible. (Scholars of virology will recognize this phenomenon as having similarities to rubella, or “German measles.”) The NIH is now working aggressively to develop a vaccine. But there are still many steps in development and testing before a vaccine could be made available to vulnerable populations. Meanwhile, CDC recommendations for travelers should be scrutinized by everyone. References: [1] Zika virus disease in the United States, 2015-2016. Centers for Disease Control and Prevention. 2016 Mar 9. [2] Zika virus infects human cortical neural progenitors and attenuates their growth. Tang H, Hammack C, Ogden SC, Wen Z, Qian X, Li Y, Yao B, Shin J, Zhang F, Lee EM, Christian KM, Didier RA, Jin P, Song H, Ming G. Cell Stem Cell. 2016 Mar 4. [Epub ahead of print] [3] Zika Virus Infection in Pregnant Women in Rio de Janeiro – Preliminary Report. Brasil P, Pereira JP Jr, Raja Gabaglia C, Damasceno L, Wakimoto M, Ribeiro Nogueira RM, Carvalho de Sequeira P, Machado Siqueira A, Abreu de Carvalho LM, Cotrim da Cunha D, Calvet GA, Neves ES, Moreira ME, Rodrigues Baião AE, Nassar de Carvalho PR, Janzen C, Valderramos SG, Cherry JD, Bispo de Filippis AM, Nielsen-Saines K. N Engl J Med. 2016 Mar 4. [Epub ahead of print] Links: Zika Virus (National Institute of Allergy and Infectious Diseases/NIH) Microcephaly Information Page (National Institute of Neurological Disorders and Stroke/NIH) Hongjun Song (Johns Hopkins University, Baltimore) Hengli Tang (Florida State University, Tallahassee) NIH Support: National Institute of Allergy and Infectious Diseases; National Institute of Neurological Disorders and Stroke http://directorsblog.nih.gov/2016/03/15/zika-and-birth-defects-the-evidence-mounts/

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

TABLE I. Provisional* cases of selected† infrequently reported notifiable diseases (<1,000 cases reported during the preceding year), United States, week ending March 19, 2016 (WEEK 11) Disease Total cases reported for previous years Current weekCum 20165-year weekly average§20152014201320122011States reporting cases during current week (No.11) Anthrax-------1 Arboviral diseases ¶,**: Chikungunya virus ††-11-793NNNNNNNN Eastern equine encephalitis virus--0688154 Jamestown Canyon virus §§---8112223 La Crosse virus §§---53808578130 Powassan virus---7812716 St. Louis encephalitis virus---1910136 Western equine encephalitis virus-------- Zika virus ¶¶-240033NNNNNNNN

Zika virus ¶¶-240033NNNNNNNN ¶¶ This table does not include cases from the U.S. territories. There may be some delay between identification of a case and reporting to CDC. All cases reported are travel related. Office of Management and Budget approval of the NNDSS Revision #0920-0728 on January 21, 2016, authorized CDC to receive data for these conditions. CDC is in the process of soliciting data for these conditions. http://wonder.cdc.gov/mmwr/mmwr_2016.asp?mmwr_year=2016&mmwr_week=11&mmwr_table=1&request=Submit&mmwr_location=

Zika Virus – March 23, 2016 Texas has had 25 confirmed cases of Zika virus disease. Of those, 24 were in travelers who were infected abroad and diagnosed after they returned home. 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 – 3 Dallas – 4 Fort Bend - 2 Harris – 10 Tarrant - 3 Travis - 2 Wise – 1

Concerns grow over care of patients with serious Zika complicationsFiled Under: ZikaLisa Schnirring | News Editor | CIDRAP News | Mar 22, 2016Share Tweet LinkedIn Email Print & PDFpreemie.jpgPixelistanbul / iStockAs the evidence linking maternal Zika virus infections with microcephaly and other birth defects continues to grow—along with the number of countries and territories reporting cases—a shift in focus is needed away from individual cases and toward building health system capacities to care for affected patients and families, World Health Organization (WHO) Director-General Margaret Chan, MD, MPH, said today. Martinique is the latest area to report its first suspected microcephaly case, according to an Agence France-Presse (AFP) report citing France's health minister. The development comes just days after Panama announced its first such case and as a WHO-led joint mission is investigating the first report in Cape Verde of microcephaly, which manifests as babies born with small heads and brain defects. In other developments, the WHO marked the first suspected Zika-linked instances of Guillain-Barre syndrome (GBS) outside the outbreak area, a pair of cases from the United States, both in people who had been in Zika-hit areas. Earlier reports have already described a few Zika-linked microcephaly cases in countries outside the outbreak area, all involving women with a history of travel to affected areas. Funding gap undermines careMicrocephaly and other reported serious neurologic complications—especially GBS, but with case reports also hinting at meningitis and myelitis—can be expected to take a toll on health systems, Chan said. Though in mid February the WHO said $56 million was needed for the response and to help countries strengthen their health systems to care for patients, member countries have donated only $3 million, with discussions under way for $4 million more. US health officials are also facing a lukewarm response from Congress to President Obama's $1.8 billion emergency fund request, and have warned that representatives and senators are having to shift funds from other important health initiatives such as dengue and HIV. Chan told reporters that the WHO is also facing a situation of having to borrow from other health activities. "We will not allow money to stand in the way of doing the right thing," she said, adding that resources have already been tapped to send experts, lab testing materials, and equipment to the outbreak area. US reports pair of Zika-associated GBS casesUS health officials recently notified the WHO about the Zika-linked GBS cases, according to a statement yesterday. The WHO said they are the first Zika-linked GBS cases to be reported outside of a Zika transmission area, but it added that both cases are still under investigation to determine of they meet the Brighton Collaboration case definition for GBS. One of the patients is an older man who got sick with a febrile illness after returning from Central America and was hospitalized in January with progressive extremity weakness and diminished reflexes. The patient's polymerase chain reaction test was positive for Zika virus. The man's condition improved with treatment, but he experienced a brain aneurysm and died before his discharge from the hospital. The other patient is a man from Haiti who sought medical care in the United States after experiencing symptoms consistent with GBS in early January, with no earlier illness reported. A serology test was positive for past Zika infection. The man's illness improved with intravenous immunoglobulin therapy, and he was discharged from the hospital. Though the WHO said the cases add more evidence for the link between Zika virus and GBS, more research is needed to explore a possible role for earlier dengue infection along with Zika infection in GBS development. The agency added that it's crucial to assess if increases of GBS reported in countries with local Zika transmission reflect a real change or enhanced surveillance. CDC updates, research newsThough Zika transmission to healthcare workers and patients from exposure to body fluids in healthcare settings hasn't been documented, the US Centers for Disease Control and Prevention (CDC) today addressed the possible threat and the importance of implementing standard precautions in labor and delivery settings. In an early Morbidity and Mortality Weekly Report (MMWR) release, the CDC said use of standard precautions is especially important in labor and delivery, because of exposure to large volumes of body fluids and the sometimes unpredictable and fast-paced nature of obstetric care. The CDC today added Dominica to its level 2 travel alert for pregnant women and those considering getting pregnant. The development comes just a few days after the CDC added Cuba to the list of travel destinations reporting local Zika virus spread. The University of Manchester yesterday announced that one of its research teams has received about $252,000 in funding to develop and test a Zika virus vaccine based on a pre-existing smallpox vaccine model. In a statement, the UK university said study results are due within 18 months and that the funding is part of a request for proposals as part of a $5.7 million rapid response initiative announced in early February from the Medical Research Council, the Wellcome Trust, and the Newton Fund. Health officials in Bangladesh shared more details about a retrospective Zika virus case detected from a blood sample collected in 2014, Xinhua reported today. The WHO briefly mentioned the finding in its Mar 17 Zika situation update. The patient is a man in his 60s, and his blood sample was part of a group collected in 2013 and 2014 in patients with diseases such as dengue fever. Samples from 159 of the man's close contacts were negative for the virus.See also: Mar 22 AFP report Mar 21 WHO statement on US GBS cases http://www.cidrap.umn.edu/news-perspective/2016/03/concerns-grow-over-care-patients-serious-zika-complications

Birth Defects Tied to Zika in PanamaBy SABRINA TAVERNISEMARCH 22, 2016 Continue reading the main storyShare This PageShareTweetEmailMoreSavePhoto A health worker fumigated in Veracruz on the outskirts of Panama City last month. CreditCarlos Jasso/ReutersWASHINGTON — Panama has reported its first case of birth defectsassociated with the Zika virus, the World Health Organization said on Tuesday — new evidence of the epidemic’s potentially dangerous effects spreading throughout the region. Dr. Margaret Chan, the director general of W.H.O., said a baby with an unusually small head and brain damage — a condition called microcephaly— was born at 30 weeks’ gestation in Panama and died a few hours later. Local investigators found evidence of the Zika virus in the umbilical cord. Dr. Chan was providing an update on the Zika virus and its spread in the Americas. Scientists around the world are waiting to see whether more pregnant women who become infected eventually give birth to babies withmicrocephaly. Photo Dr. Margaret Chan, the director general of W.H.O., at a news conference in Geneva on Tuesday.CreditFabrice Coffrini/Agence France-Presse — Getty Images“The knowledge base is building very rapidly,” Dr. Chan said. “The more we know, the worse things look.” So far, a surge of cases has been documented only in Brazil. In most other countries where Zika infections have spread, pregnant women who might have been exposed have yet to give birth. The virus is circulating in 38 countries and territories, Dr. Chan said. “No one can predict whether the virus will spread to other parts of the world,” she added. Brazil and Panama are the only countries that have documented microcephaly cases linked to Zika infection from mosquito bites, Dr. Chan said, but Colombia is investigating several cases with a possible connection. Officials have said that if there is a link, as most scientists believe, they expect to start seeing birth defects in Colombia in June. Dr. Chan said Colombia had set up “a very robust mechanism” to determine whether microcephaly in newborns there was linked to Zika infection. Cape Verde, a small nation of islands off the coast of Senegal, reported a case of suspected microcephaly last week, and Dr. Chan said W.H.O. has sent investigators to help analyze it. The team includes epidemiologists, laboratory experts, maternal health specialists and communication staff members. W.H.O. said last week that there had been 7,490 suspected cases of infection with the Zika virus reported in Cape Verde from Oct. 21 to March 6, and that 165 were in pregnant women. Officials said 44 women had given birth without any abnormalities. In Brazil, the numbers still lack clarity. Dr. Anthony Costello, the director of the maternal, newborn, child and adolescent health department at W.H.O., estimated that 39 percent of the approximately 2,200 suspected microcephaly cases that were carefully investigated, including with brain scans, were eventually confirmed. Using that ratio and the current count of about 6,500 suspected cases, Dr. Costello said he would expect a total of about 2,500 confirmed cases. “Given the rapid spread of this,” he added, “we must expect that burden to increase substantially.” Dr. Chan said funding to address the Zika outbreak had been slow in coming. The organization has received about $3 million out of a requested $25 million, and officials are in “active discussion” over $4 million more. “The situation is still pretty serious in terms of lack of funding,” she said. http://www.nytimes.com/2016/03/23/health/zika-colombia-microcephaly-world-health-organization.html?_r=0

Birth Defects Tied to Zika in PanamaBy SABRINA TAVERNISEMARCH 22, 2016 Continue reading the main storyShare This PageShareTweetEmailMoreSavePhoto A health worker fumigated in Veracruz on the outskirts of Panama City last month. CreditCarlos Jasso/ReutersWASHINGTON — Panama has reported its first case of birth defectsassociated with the Zika virus, the World Health Organization said on Tuesday — new evidence of the epidemic’s potentially dangerous effects spreading throughout the region. Dr. Margaret Chan, the director general of W.H.O., said a baby with an unusually small head and brain damage — a condition called microcephaly— was born at 30 weeks’ gestation in Panama and died a few hours later. Local investigators found evidence of the Zika virus in the umbilical cord. Dr. Chan was providing an update on the Zika virus and its spread in the Americas. Scientists around the world are waiting to see whether more pregnant women who become infected eventually give birth to babies withmicrocephaly. Photo Dr. Margaret Chan, the director general of W.H.O., at a news conference in Geneva on Tuesday.CreditFabrice Coffrini/Agence France-Presse — Getty Images“The knowledge base is building very rapidly,” Dr. Chan said. “The more we know, the worse things look.” So far, a surge of cases has been documented only in Brazil. In most other countries where Zika infections have spread, pregnant women who might have been exposed have yet to give birth. The virus is circulating in 38 countries and territories, Dr. Chan said. “No one can predict whether the virus will spread to other parts of the world,” she added. Brazil and Panama are the only countries that have documented microcephaly cases linked to Zika infection from mosquito bites, Dr. Chan said, but Colombia is investigating several cases with a possible connection. Officials have said that if there is a link, as most scientists believe, they expect to start seeing birth defects in Colombia in June. Dr. Chan said Colombia had set up “a very robust mechanism” to determine whether microcephaly in newborns there was linked to Zika infection. Cape Verde, a small nation of islands off the coast of Senegal, reported a case of suspected microcephaly last week, and Dr. Chan said W.H.O. has sent investigators to help analyze it. The team includes epidemiologists, laboratory experts, maternal health specialists and communication staff members. W.H.O. said last week that there had been 7,490 suspected cases of infection with the Zika virus reported in Cape Verde from Oct. 21 to March 6, and that 165 were in pregnant women. Officials said 44 women had given birth without any abnormalities. In Brazil, the numbers still lack clarity. Dr. Anthony Costello, the director of the maternal, newborn, child and adolescent health department at W.H.O., estimated that 39 percent of the approximately 2,200 suspected microcephaly cases that were carefully investigated, including with brain scans, were eventually confirmed. Using that ratio and the current count of about 6,500 suspected cases, Dr. Costello said he would expect a total of about 2,500 confirmed cases. “Given the rapid spread of this,” he added, “we must expect that burden to increase substantially.” Dr. Chan said funding to address the Zika outbreak had been slow in coming. The organization has received about $3 million out of a requested $25 million, and officials are in “active discussion” over $4 million more. “The situation is still pretty serious in terms of lack of funding,” she said. http://www.nytimes.com/2016/03/23/health/zika-colombia-microcephaly-world-health-organization.html?_r=0

Australian A Zika infection after returning from Vietnam07:45 PM - 03/23/2016 Youth OnlineDepartment of Preventive Medicine Zika virus doubts have emerged in VietnamFACEBOOKGOOGLE+TWITTEREMAILLien ChauSAME CATEGORYSaigon as separate sidewalks for pedestrians: Cleared, safetyGreen moss covered picturesque, people flock to despite the dangersSaigon Railway absent: Seeing Me Me but more road traffic supportSaigon installation separators, pedestrian sidewalk ownTragicomic story in Saigon Bridge - United 3: ... between city oasisTOP NEWS'Brothers in the industry' challenge the police: 'He does very good test'Ming Snow: Ha Phuong and rich does not mean I need to rely Cam Ly'He Stork' livelihood wandering Phung Ngoc Phu Quoc23.3 pm, Department of Preventive Health (MOH) announced emergency service raised the alert level due to Zika virus in Vietnam, when an Australian who had just returned from Vietnam about this virus infected water.RELATED NEWSTri Nguyen Island breeding mosquitoes in the room capable of Zika virusNot detect dengue virus associated with ZikaZika suspected cause paralysis"The Health Ministry raised the alert by Australia noted a case Zika virus after returning from Vietnam. Instead of preventing intrusion cases like last, we can face the appearance of the virus in domestic Zika, "said Tran Dac Phu, Director of Preventive Health (MOH) said .According to his wife, the national lead agency implementing the International Health Charter (IHR) of Vietnam has received information to the World Health Organization (WHO) said 22.3 days, cases of Zika virus say in Vietnam to date 02/26/2016 and 03/06/2016 exit of Australia day; Date 08/03/2016 people have symptoms Zika virus infection such as fever, rash, headache, muscle aches, conjunctivitis, nausea. During his stay in Vietnam, cases of Zika has traveled to many places: City, Lam Dong, Khanh Hoa and Binh Thuan. However, the identity and sex of the Australian cases have not been notified. Immediately after receiving information from WHO focal agency of the Ministry of Health has established an emergency mission by the Deputy Minister Nguyen Thanh Long as head of the delegation and leaders of relevant units of the Ministry of Health to the provinces Khanh Hoa, Binh Thuan People's Committee and work with departments and agencies of the provinces to direct the monitoring, verification and implementation of activities to prevent diseases caused by Zika virus. http://thanhnien.vn/doi-song/mot-nguoi-uc-nhiem-zika-sau-khi-ve-tu-viet-nam-684327.html

Authorities confirmed 15 cases of zika in BoliviaNationalGovernor Ruben Costas involved in the cleanup campaign in Santa Cruz. | David Moreno CMKSPosted on 23.03.2016 at 3:30 0 Santa Cruz | The Times A new case of zika occurred in the city of Santa Cruz, bringing to 15 registered since December last year. This is a grown woman of 41 years of the Villa Rosario, west of the city, the downtown area network, the director of the Departmental Health Service (Headquarters), Joaquin Monasterio said. He said that the woman is stable, in good health, restored, although medical care to ensure complete cure. In December 2015 two cases and this year, from January to date, 13 were recorded, of which six are from the eastern capital, five of the city of Portachuelo and the other four were imported. So far, the mosquito Aedes aegypti has infected 563 people with chikungunya, dengue and 380 to 15 with zika. The authorities, both the Government and the municipalities and the Ministry of Health, are working together and coordinated to be more effective and eliminate mosquito breeding sites in Santa Cruz, both in the capital and in the provinces. Bell Yesterday, in the 7th district, near the Villa Primero de Mayo, a general cleaning was performed and extermination breeding mosquito larvae involving medical program My Health, Ministry of Health, the Early Warning Unit the local municipality and officials of the Government Headquarters. It is mobilizing 180 people sanearán 300 apple trees until 29 March. useless objects such as buckets, bottles, tires and others that can store water and moisture, where the female mosquito lays her eggs collected. - See more at: http://www.lostiempos.com/actualidad/nacional/20160323/autoridades-confirman-15-casos-zika-bolivia#sthash.PhPJJUcS.dpuf

Zika cases increase in Mexico; Chiapas and Oaxaca states most affectedPhoto of a mosquito Aedes aegypti, suspected of causing zika virus under a microscope in the Fiocruz Institute of Recife, state of Pernambuco, Brazil. Photo taken on Jan. 27, 2016. (AP Photo / Felipe Dana, File) (Felipe Dana / AP)Zika cases increase in Mexico; Chiapas and Oaxaca states most affected Until 18 March have confirmed 160 indigenous cases of Zika virus infection in Mexico, 30 of them in pregnant women, according to the latest report from the Department of Epidemiology. From 11 to 18 March, total cases increased from 151 to 160 and infections in pregnant women increased from 25 to 30. Chiapas and Oaxaca account for 88 percent of cases, with 82 confirmed and 59, respectively infections. Guerrero have been reported in seven cases, in Nuevo Leon and Jalisco four two; entities that have submitted only one case are Michoacan, Nayarit, Sinaloa, Tabasco, Veracruz and Yucatan. Of infected pregnant women, 24 reside in Chiapas, five in Oaxaca and Veracruz. The incubation period of the virus is 3 to 12 days and the symptoms can last between 4 and 7 days. A person infected with Zika virus may have a fever, headache, conjunctivitis, skin rash, muscle and joint pain, yet only one in four infected people develop symptoms. Since the Zika virus is transmitted by the Aedes aegypti mosquito and there is no vaccine, the Health Department recommends placing screens on doors and windows, use repellent and clothing that covers extremities and remove water containers that can serve as breeding grounds for the insect. According to the latest epidemiological report of the WHO in 33 countries of America have indigenous cases of Zika and most of the infections has occurred in the age group of 20-49 years. http://www.hoylosangeles.com/noticias/mexico/hoyla-mex-aumentan-los-casos-de-zika-en-mxico-chiapas-y-oaxaca-los-estados-ms-afectados-20160323-story.html

Brazil confirms 907 Zika-linked microcephaly cases, 198 deaths Published March 23, 2016 9:55amBrazil has confirmed 907 cases of microcephaly and 198 babies with the birth defect who have died since the Zika virus outbreak started in October, authorities said Tuesday. Health officials are still working on 4,293 suspicious cases, the Health Ministry said. Scientists in Brazil say the increase in microcephaly -- in which a baby is born with an abnormally small head and often incomplete brain development -- is linked to an explosion of the mosquito-transmitted Zika virus, with an estimated 1.5 million people infected. The World Health Organization is studying the possible connection and calls the Zika outbreak an international health emergency. Brazil typically reports 150 cases of microcephaly per year. The birth defect is also associated with mothers who contract syphilis, rubella or toxoplasmosis during pregnancy. —Agence France-Presse http://www.gmanetwork.com/news/story/560114/news/world/brazil-confirms-907-zika-linked-microcephaly-cases-198-deaths - See more at: http://www.gmanetwork.com/news/story/560114/news/world/brazil-confirms-907-zika-linked-microcephaly-cases-198-deaths#sthash.AITaiYOT.dpuf

REPORT CARD Ministry of Health investigated 4,293 cases of microcephaly It has been confirmed 907 cases of microcephaly and other nervous system disorders, suggestive of congenital infection. Other 1,471 cases were disposedThe Ministry of Health is investigating 4,293 suspected cases of microcephaly and other nervous system disorders, suggestive of congenital infection. Cases already analyzed, 907 were confirmed and 1,471 discarded. Since the beginning of the investigation have been reported 6,671 suspected cases of microcephaly. Data from epidemiological report from the Ministry of Health are sent weekly by the state departments of Health and were closed on Saturday, March 19th. The 907 confirmed cases occurred in 348 municipalities located in 19 Brazilian states: Alagoas, Bahia, Ceará , Maranhão, Paraíba, Pernambuco, Piauí, Rio Grande do Norte, Sergipe, Espírito Santo, Minas Gerais, Rio de Janeiro, Pará, Rondônia, Distrito Federal, Goiás, Mato Grosso, Mato Grosso do Sul and Rio Grande do Sul. 1,471 discarded cases were classified because they have normal exams, or submit microcefalias and / or changes in the central nervous system by an infectious causes. the 6,671 cases reported since the beginning of the investigation, are distributed in 1,266 municipalities, from all regions of the country. Most were registered in the Northeast (5,270 cases, which corresponds to 79%), the State of Pernambuco the Federation Unit with the largest number of cases are still being investigated (1,210). Next are Bahia (670), Paraíba (417), Rio de Janeiro (308), Rio Grande do Norte (290) and Ceará (249). It should be noted that the Ministry of Health is investigating all cases of microcephaly and other changes in the central nervous system, informed by the states, and the possible relationship with the Zika virus and other congenital infections. Microcephaly can be caused byvarious infectious agents beyond Zika as Syphilis, Toxoplasmosis, Other Infectious Agents, Rubella, Cytomegalovirus and Herpes Viral. Until March 19, there were 198 suspected deaths of microcephaly and / or alteration of the nervous system central after childbirth or during pregnancy (miscarriage or stillbirth). Of these, 46 were confirmed to microcephaly and / or alteration of the central nervous system. Another 130 are still under investigation and 22 were dropped. Of the total confirmed cases of microcephaly, 122 tested positive for Zika. In these cases, specific laboratory test was used to Zika virus. However, the Ministry of Health points out that this figure does not represent adequately the total number of cases related to the virus. . That is, the folder considers that there was infection Zika most of the mothers who had babies with a final diagnosis of microcephaly To date, signaled to the Ministry of Health of the virus indigenous movement Zika 23 Brazilian states: Goiás, Minas Gerais, Federal district, Mato Grosso do Sul, Roraima, Amazonas, Pará, Rondônia, Mato Grosso, Tocantins, Maranhao, Piaui, Ceara, Rio Grande do Norte, Paraiba, Pernambuco, Alagoas, Bahia, Sergipe, Espírito Santo, Rio de Janeiro, São Paulo and Paraná. The Ministry of Health advises pregnant women to adopt measures to reduce the presence of Aedes aegypti, with the elimination of breeding sites , and protect themselves from mosquito exposure, keeping doors and closed or screened windows, wear pants and long-sleeved shirt and use repellents allowed to pregnant women. Distribution of reported cases of microcephaly by UF until March 19, 2016 Regions and Federative UnitsMicrocephaly cases and / or malformations suggestive of congenital infection Total acumulado1 of reported cases from 2015 to 2016 research confirmed discarded Brazil 4,293 907 1,471 6671 Alagoas 103 41 106 250 Bahia 670 170 120 960 Ceará 249 68 100 417 Maranhão 146 53 31 230 Paraíba 417 91 334 842 Pernambuco 1,210 268 341 1,819 Piauí 52 62 31 145 large northern river 290 81 35 406 Sergipe 161 26 14 201 Northeast 3,298 860 1,112 5,270 Holy Spirit 85 4 18 107 Minas Gerais 29 two 44 75 Rio de Janeiro 308 9 20 337 Sao Paulo 150 0 60 210 Southeast region 572 15 142 729 Acre 28 0 1 29 Amapá No registry No registry No registry No registry Amazon 9 0 1 10 For 20 1 0 21 Rondônia 4 3 4 11 Roraima 16 0 0 16 Tocantins 117 0 17 134 North region 194 4 23 221 Federal district 3 3 31 37 Goiás 83 9 26 118 Mato Grosso 110 13 71 194 Mato Grosso do Sul 4 two 11 17 Midwest region 200 27 139 366 Paraná 4 0 24 28 Santa Catarina 1 0 two 3 Rio Grande do Sul 24 1 29 54 South region 29 1 55 85 Source: Health Departments of the States and the Federal District (updated data until 19/03/2016). http://combateaedes.saude.gov.br/noticias/454-ministerio-da-saude-investiga-4-293-casos-de-microcefalia-no-pais

Latest press briefings22 March 2016: WHO Director-General briefs the media on the Zika situationDr Margaret Chan, WHO Director-General Dr. Florence Fouque, Unit Leader, Vectors, Environment & Society; Tropical Diseases Research Dr. Anthony Costello, Director, Maternal, Newborn, Child and Adolescent Health Department Dr. Bernadette Murgue, Project Manager, Health Systems and Innovation Dr. Tarun Dua, Coordinator, Evidence, Research, Action on Mental & Brain Disorders Dr. Chris Dye, Director, Strategy, Policy and Information Audio recording of the briefing Duration: 50 minWatch the live broadcastWHO Director-General briefs the media on the Zika situation

Audio http://terrance.who.int/mediacentre/presser/WHO-RUSH_Zika_virus_update_presser_22MAR2016.mp3?ua=1

WHO Director-General briefs the media on the Zika situationWHO statement 22 March 2016 Ladies and gentlemen, I welcome this opportunity to update you on developments in science and the Zika evidence base that have built up since 1 February. The world was alerted to the first appearance of Zika in the Western Hemisphere on 7 May 2015, when Brazil confirmed that a mysterious outbreak of thousands of cases of mild disease with rash was caused by the Zika virus. The appearance of an infectious disease with epidemic potential in a new part of the world is always cause for concern. The absence of population immunity gives the virus license to spread rapidly and behave in possibly unexpected ways. At the time of the May announcement, the disease looked reassuringly mild, with no hospitalizations or deaths reported. Past experience has taught us to expect more from emerging viruses than what is initially observed. This came from Brazil in July with a reported increase in cases of Guillain-Barré syndrome, followed by an unusual increase in microcephaly among newborns, reported to WHO in late October. The possibility that a mosquito bite could be linked to severe fetal malformations alarmed the public and astonished scientists. The association with Guillain-Barré syndrome and other severe disorders of the central nervous system has expanded the risk group well beyond women of child-bearing age. We now know that sexual transmission of the virus occurs. In less than a year, the status of Zika has changed from a mild medical curiosity to a disease with severe public health implications. The knowledge base is building very rapidly. I want to thank all countries and their scientists who have worked so hard in helping WHO build up the evidence base. The more we know the worse things look. A pattern has emerged in which initial detection of virus circulation is followed, within about three weeks, by an unusual increase in cases of Guillain-Barré syndrome. Detection of microcephaly and other fetal malformations comes later, as pregnancies of infected women come to term. In the current outbreak, Brazil and Panama have reported microcephaly. Colombia is investigating several cases of microcephaly for a possible link to Zika. In other countries and territories, the virus has not been circulating long enough for pregnancies to come to term. A WHO team is currently in Cabo Verde to investigate the country’s first reported case of microcephaly. To date, 12 countries and territories have now reported an increased incidence of Guillain-Barré syndrome or laboratory confirmation of Zika infection among GBS cases. Additional effects on the central nervous system have been documented, notably inflammation of the spinal cord and inflammation of the brain and its membranes. The virus is currently circulating in 38 countries and territories. On present knowledge, no one can predict whether the virus will spread to other parts of the world and cause a similar pattern of fetal malformations and neurological disorders. If this pattern is confirmed beyond Latin America and the Caribbean, the world will face a severe public health crisis. Ladies and gentlemen, We need to build the knowledge base quickly, very quickly. Since 1 February, WHO has convened seven international meetings and published 15 documents that translate the latest research into interim practical guidance to support countries as they respond to this outbreak and its neurological complicatoins. Over the past two weeks, WHO convened three high-level meetings to look at the science, the convention and new tools for mosquito control, and what we know about the management of complications, including microcephaly and Guillain-Barré syndrome. These meetings help answer pressing scientific questions and gather advice on the best ways to respond to a situation that is rapidly evolving. The science meeting looked at the evidence linking Zika infection with fetal malformations and neurological disorders. Though the association is not yet scientifically proven, the meeting concluded that there is now scientific consensus that Zika virus is implicated in these neurological disorders. The kind of urgent action called for by this public health emergency should not wait for definitive proof. In terms of new medical products, the experts agreed that a reliable, point-of-care diagnostic test is the most urgent priority. At present, more than 30 companies are working on, or have developed, potential new diagnostic tests. For vaccines, 23 projects are being worked on by 14 vaccine developers in the US, France, Brazil, India, and Austria. As the vaccine will be used to protect pregnant women or women of child-bearing age, it must meet an extremely high standard of safety. WHO estimates that at least some of the projects will move into clinical trials before the end of this year, but several years may be needed before a fully tested and licensed vaccine is ready for use. Several scientists warned that the first explosive wave of spread may be over before a vaccine is available. However, all agreed that development of a vaccine is imperative. More than half of the world’s population lives in an area where the Aedes aegypti mosquito is present. During the meeting on mosquito control, the experts concluded that well-implemented control programmes using existing tools and strategies are effective in reducing the transmission of Aedes-borne diseases, including Zika. However, they also identified a number or challenges in implementing these tools. The experts evaluated the potential impact of five new tools for mosquito control. None was judged ready for full-scale implementation. While investigations of all five should continue, the experts recommended carefully planned pilot deployment of two: namely, microbial control, using Wolbachia bacteria, of human pathogens in adult mosquitoes, and the use of genetic manipulation to reduce mosquito populations. The third meeting looked at the management of complications, including fetal malformations and neurological disorders, and the heavy burden this places on health systems. Evidence supports the likelihood that Zika infection during pregnancy will have a broad range of effects on the developing fetus, beyond microcephaly. As the experts concluded, a shift in thinking is needed, away from the management of individual cases and towards the longer-term building of capacities to cope with these added burdens. Fetal malformations place a heart-breaking strain on families and communities as well as systems for health care and social support. Neurological disorders like Guillain-Barré syndrome call for added capacity to provide life-saving intensive care. Thank you. http://www.who.int/mediacentre/news/statements/2016/zika-update-3-16/en/

ReferencesBrasil P, Pereira JP , Raja Gabaglia C, et al. Zika virus infection in pregnant women in Rio de Janeiro—preliminary report. N Engl J Med 2016;NEJMoa1602412. Published online March 4, 2016. CrossRefCao-Lormeau VM, Blake A, Mons S, et al. Guillain-Barré syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study. Lancet 2016;0140-6736(16)00562-6. Published online February 29, 2016. CrossRefHills SL, Russell K, Hennessey M, et al. Transmission of Zika virus through sexual contact with travelers to areas of ongoing transmission—continental United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65:215–6. CrossRef PubMedBarzon L, Pacenti M, Berto A, et al. Isolation of infectious Zika virus from saliva and prolonged viral RNA shedding in a traveller returning from the Dominican Republic to Italy, January 2016. Euro Surveill 2016;21:30159. CrossRef PubMedMusso D, Nhan T, Robin E, et al. Potential for Zika virus transmission through blood transfusion demonstrated during an outbreak in French Polynesia, November 2013 to February 2014. Euro Surveill 2014;19:20761. CrossRef PubMedSiegel JD, Rhinehart E, Jackson M, Chiarello L; Healthcare Infection Control Practices Advisory Committee. 2007 guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings. http://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.htmlLikis FE, Sathe NA, Morgans AK, et al. Management of postpartum hemorrhage. Comparative effectiveness review. No. 151. Rockville, MD: Agency for Healthcare Research and Quality; 2015. https://www.effectivehealthcare.ahrq.gov/ehc/products/552/2077/hemorrhage-postpartum-executive-150427.pdfSandlin AT, Ounpraseuth ST, Spencer HJ, Sick CL, Lang PM, Magann EF. Amniotic fluid volume in normal singleton pregnancies: modeling with quantile regression. Arch Gynecol Obstet 2014;289:967–72. CrossRef PubMedKouri DL, Ernest JM. Incidence of perceived and actual face shield contamination during vaginal and cesarean delivery. Am J Obstet Gynecol 1993;169:312–6. CrossRef PubMedMischke C, Verbeek JH, Saarto A, Lavoie MC, Pahwa M, Ijaz S. Gloves, extra gloves or special types of gloves for preventing percutaneous exposure injuries in healthcare personnel. Cochrane Database Syst Rev 2014;3:CD009573. CrossRef PubMedGammon J, Morgan-Samuel H, Gould D. A review of the evidence for suboptimal compliance of healthcare practitioners to standard/universal infection control precautions. J Clin Nurs 2008;17:157–67. PubMed Top * http://www.cdc.gov/zika/geo/active-countries.html.

Importance of Ongoing Education and TrainingStandard Precautions represent the minimum infection prevention expectations for safe care across all health care settings. Ongoing education and training of all health care personnel in a facility, including those employed by outside entities, on the principles and rationale for use of Standard Precautions and use of specific PPE help ensure that infection control policies and procedures are understood and followed (6). These educational efforts should emphasize that infection prevention strategies enhance the quality of patient care and do not alter the relationship between provider and patient. Barriers (e.g., cost and lack of standardized protocols in facilities) to implementation of Standard Precautions and use of PPE should be addressed as soon as they are recognized. Facility, nursing, and obstetric leadership is critical for instituting infection prevention policies and promoting routine use of and adherence to Standard Precautions (6). Infectious disease outbreaks, such as the current Zika virus disease outbreak, provide an opportunity to emphasize the importance of adherence to published infection prevention strategies to prevent transmission of infectious diseases in all health care settings, including labor and delivery units.

Use of Standard Precautions in Labor and Delivery SettingsPregnant women lose an average of 500 mL of blood during uncomplicated vaginal deliveries, with higher losses during complicated vaginal deliveries and cesarean deliveries (7). Amniotic fluid volume at the time of full-term delivery typically exceeds 500 mL (8). Eye protection used during deliveries has been demonstrated to be contaminated with blood and body fluids (9), and when double layers of gloves are used for procedures and surgeries, the outer layers often have significant perforations, whereas the inner layers are intact or have many fewer perforations (10). Although health care personnel in these settings are at substantial risk for exposure to blood and body fluids, varying levels of adherence to Standard Precautions have been reported in health care settings, including in labor and delivery units (11). Numerous barriers to the appropriate use of PPE have been cited, including the perception that PPE is uncomfortable and limits dexterity, fogging of goggles or face masks, the misperception that prescription eyeglasses provide adequate eye protection, lack of available PPE, forgetting to use PPE, lack of time in urgent clinical situations to don appropriate PPE, the perception that the patient poses minimal risk, and concerns about interference with patient care (11). Given the theoretic risk for transmission of Zika virus through contact with body fluids in a health care setting in which female health care personnel might be pregnant, or male or female health care personnel might be trying to conceive a pregnancy, the outbreak of Zika virus disease provides an opportunity to emphasize the importance of maintaining appropriate infection control. The goals of Standard Precautions include 1) preventing contact between a patient’s body fluids and health care personnel’s mucous membranes (including conjunctivae), skin, and clothing; 2) preventing health care personnel from carrying potentially infectious material from one patient to another; and 3) avoiding unnecessary exposure to contaminated sharp implements. Health care personnel must assess the likelihood of body fluid exposure, based on the type of contact and the nature of the procedure or activity, and use appropriate PPE. For example, because the risk for splashes to areas of the body other than the hands is small when performing vaginal examinations of pregnant women with minimal cervical dilation and intact membranes, only gloves are required. Placement of a fetal scalp electrode when membranes have already been ruptured or handling newborns before blood and amniotic fluid have been removed from the newborn’s skin require protection of health care personnel’s skin and clothing using gloves and an impermeable gown. In contrast, when performing procedures where exposure to body fluids is anticipated, such as an amniotomy or placement of an intrauterine pressure catheter, protection of mucous membranes, skin, and clothing are recommended, with a mask and eye protection, in addition to gloves and an impermeable gown. Anesthesia providers in the labor and delivery setting should adhere to Standard Precautions and wear sterile gloves and a surgical mask when placing a catheter or administering intrathecal injections; additional PPE should be worn based on anticipated exposure to body fluids (6). Double gloves might minimize the risk for percutaneous injury when sharps are handled. Patient body fluids also should not come into direct contact with health care personnel clothing or footwear. When performing procedures including vaginal deliveries, manual placenta removal, bimanual uterine massage, and repair of vaginal lacerations, PPE should include (in addition to mucous membrane and skin protection) impermeable gowns and knee-high impermeable shoe covers. Clothing, skin, and mucous membrane protections should be maintained for procedures performed in operating room settings. Health care personnel should assess their risk for exposure and select PPE appropriate for the situation, and all personnel on a team involved in the same procedures should use the same level of PPE. All health care personnel should be trained in the correct use and disposal of PPE and be able to demonstrate the ability to don PPE quickly in urgent situations and remove it safely. Non–health care personnel in attendance should be positioned away from areas of exposure risk or adequately protected. Any occupational exposures, including mucous membrane exposure following splash of body fluids, sustained by health care personnel should be reported as soon as possible to the facility’s occupational health clinic to ensure appropriate assessment of health care personnel, and so that any systemic safety risks can be addressed. In addition to use of PPE by health care personnel, placement of disposable absorbent material on the floor around the procedure and delivery area to absorb fluid can reduce the risk for splash exposure to body fluids. Infection control supplies should be available and accessible in all patient care areas where they will be needed. Standard cleaning and disinfection procedures for environmental surfaces, using Environmental Protection Agency-registered hospital disinfectants, should be followed.

Use of Standard Precautions in Health Care SettingsHealth care personnel should adhere to Standard Precautions in every health care setting. Standard Precautions are designed to protect health care personnel and to prevent them from spreading infections to patients. They are based on the premise that all blood, body fluids, secretions, excretions (except sweat), nonintact skin, and mucous membranes might contain transmissible infectious agents and include 1) hand hygiene, 2) use of personal protective equipment (PPE), 3) respiratory hygiene and cough etiquette, 4) safe injection practices, and 5) safe handling of potentially contaminated equipment or surfaces in the patient environment (6). Because patients with Zika virus infection might be asymptomatic, Standard Precautions should be in place at all times, regardless of whether the infection is suspected or confirmed. Health care personnel should assess the potential for exposure to potentially infectious material during health care delivery and protect themselves accordingly, based on the level of clinical interaction with the patient and the physical distance at which care is provided (6). In addition, health care providers should use soap and water or alcohol-based products (gels, rinses, foams), at a minimum, before and after a patient contact and after removing PPE, including gloves (6).

Zika virus transmission was detected in the Region of the Americas (Americas) in Brazil in May 2015, and as of March 21, 2016, local mosquito-borne transmission of Zika virus had been reported in 32 countries and territories in the Americas, including Puerto Rico and the U.S. Virgin Islands.* Most persons infected with Zika virus have a mild illness or are asymptomatic. However, increasing evidence supports a link between Zika virus infection during pregnancy and adverse pregnancy and birth outcomes (1), and a possible association between recent Zika virus infection and Guillain-Barré syndrome has been reported (2). Although Zika virus is primarily transmitted through the bite of Aedes species of mosquitoes, sexual transmission also has been documented (3). Zika virus RNA has been detected in a number of body fluids, including blood, urine, saliva, and amniotic fluid (3–5), and whereas transmission associated with occupational exposure to these body fluids is theoretically possible, it has not been documented. Although there are no reports of transmission of Zika virus from infected patients to health care personnel or other patients, minimizing exposures to body fluids is important to reduce the possibility of such transmission. CDC recommends Standard Precautions in all health care settings to protect both health care personnel and patients from infection with Zika virus as well as from blood-borne pathogens (e.g., human immunodeficiency virus [HIV] and hepatitis C virus [HCV]) (6). Because of the potential for exposure to large volumes of body fluids during the labor and delivery process and the sometimes unpredictable and fast-paced nature of obstetrical care, the use of Standard Precautions in these settings is essential to prevent possible transmission of Zika virus from patients to health care personnel.

Christine K. Olson, MD1; Martha Iwamoto, MD2; Kiran M. Perkins, MD3; Kara N.D. Polen, MPH4; Jeffrey Hageman, MHS3; Dana Meaney-Delman, MD5; Irogue I. Igbinosa, MD6; Sumaiya Khan, MPH7; Margaret A. Honein, PhD4; Michael Bell, MD3; Sonja A. Rasmussen, MD8; Denise J. Jamieson, MD1 Corresponding author: Christine K. Olson, [email protected], 770-488-7100. 1Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC; 2Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC; 3Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC; 4Division of Congenital and Developmental Disorders, National Center for Birth Defects and Developmental Disabilities, CDC; 5Office of the Director, National Center for Emerging and Zoonotic Infectious Diseases, CDC; 6Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, CDC; 7Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC; 8Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC.