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Preventing Transmission of Zika Virus in Labor and Delivery Settings Through Implementation of Standard Precautions — United States, 2016Early Release / March 22, 2016 / 65 http://www.cdc.gov/mmwr/volumes/65/wr/mm6511e3er.htm?s_cid=mm6511e3er_w

--- PRESS RELEASE ---For Immediate Release DCHHS Hosts Dallas County Zika Virus Outbreak Exercise DCHHS Prepares Cities for Locally-Acquired Cases DALLAS (March 22, 2016) – Dallas County Health and Human Services (DCHHS) today hosted a Zika virus outbreak tabletop exercise for Dallas County municipalities, emergency managers and other response partners. DCHHS officials demonstrated and tested several capabilities necessary to respond to an outbreak. Attendees were able to participate to ensure their city’s preparedness. “It is likely Dallas County will receive more confirmed cases of Zika virus as we enter into mosquito season,” said Zachary Thompson, DCHHS director. “This exercise gave us the opportunity to provide our response partners with the information and resources they need in a real-life scenario.” Exercise objectives included information and open discussion on investigating an outbreak, communication procedures, specimen collection and testing, and mosquito control measures. This event was another component of DCHHS’ Zika virus campaign, which began Jan. 27, before the first Zika virus case was confirmed in Dallas County. Since then, the campaign has spread widely, including sharing information with other counties and door hanger distribution in high risk zip codes. To date, Dallas County confirmed four cases of Zika virus. Three were imported and one was sexually transmitted from an imported case. While there are currently no reports of Zika virus being locally-transmitted by mosquitoes in Dallas County, imported cases make local spread by mosquitoes possible because the mosquitoes that can transmit the virus are found in Dallas County. “We continue to push education to citizens informing them how to reduce the chance of spreading Zika virus into the local mosquito population,” Thompson said. “But it still remains a very real possibility that local transmission could happen at any time.” Dr. Christopher Perkins, DCHHS medical director/health authority, said any time DCHHS can work cooperatively with response partners and connect directly with citizens proves better in preventing public health outbreaks. “Everyone plays a role in protecting public health,” Perkins said. “That’s why it is important for everyone to be informed so we’re all on the same page.” DCHHS will continue its campaign throughout mosquito season, which begins in May. Campaign materials are available for the public at www.dallascounty.org/hhs. Attendees sign in to participate in the exercise.DCHHS Director Zachary Thompson and Medical Director/Health Authority Dr. Christopher Perkins welcome attendees.Officials from several Dallas County municipalities attended the exercise.Response partners discuss what their city will need to do during a Zika virus outbreak.Representatives give a report of their group discussion and conclusions for communication and mosquito control during a Zika virus outbreak.DCHHS Director Zachary Thompson and Medical Director/Health Authority Dr. Christopher Perkins speak with U.S. HHS Regional Health Administrator Rear Admiral Epi Elizondo and Senior Public Health Advisor Capt. James Dickens, who both attended the Zika virus outbreak exercise.Scott Sawlis, DCHHS entomologist, discusses the difference in flight patterns among mosquitoes that can carry Zika virus and those that transmit West Nile.Tammara Scroggins, DCHHS assistant director public health communicable disease, offers closing remarks.# For additional information, contact: Erikka D. Neroes, Public Information [email protected] 214.819.6329 (office) 214.394.8109 (cell) Zachary Thompson, Director 214.755.9299 (cell)

Confirmed Zika Cases in Oregon, 2016As of 3/22/2016 Travel-associated cases: 6 Oregon mosquito-acquired cases: 0 Total: 6

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

Zika Virus – March 22, 2016 Texas has had 25 confirmed cases of Zika virus disease. 22 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 http://www.dshs.state.tx.us/news/updates.shtm

Zika Virus – March 22, 2016 Texas has had 25 confirmed cases of Zika virus disease. 22 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

Zika: More than 2,500 babies born with microcephaly in Brazil, WHO predicts Resize Text Print Article Comments 2 Book mark article Read later list Saved to Reading List By Lena H. Sun March 22 at 1:44 PM General Director of the World Health Organization (WHO), Margaret Chan, gives an update on the Zika virus in Geneva, Switzerland. (EPA/Salvatore Di Nolfi)The World Health Organization said Tuesday that it expects Brazil will have more than 2,500 babies born with a severe birth defect known as microcephaly if current trends continue in the Zika virus outbreak. Data from Brazil, the epicenter of an epidemic that has hit more than three dozen countries and territories in the Americas, show that about 39 percent of 2,212 investigated cases of microcephaly are already confirmed for the rare congenital condition. To date, that's 863 babies born with the characteristic abnormally small heads and underdeveloped brains, WHO detailed at a news conference in Geneva. [The agonizing wait of an expectant mother with Zika] Get Zika news by email We will update you when news breaks about the virus. Sign up "If that rate continues, we expect more than 2,500 cases will emerge of babies with brain damage and clinical signs of microcephaly," said Anthony Costello, who heads WHO's department of maternal, newborn, child and adolescent health. WHO Director-General Margaret Chan said new evidence is becoming clear daily about the mosquito-borne virus. A pattern seems to be emerging: Initial detection of Zika is followed within about three weeks by an unusual increase of Guillain-Barré syndrome, a rare condition that can cause paralysis and sometimes death. Detection of microcephaly and other fetal abnormalities typically comes about six months later, WHO officials said, as pregnancies of infected women come to term. How countries are combating the Zika virusView PhotosThe mosquito-borne disease suspected of causing serious birth defects is expected to spread to all countries in the Americas except Canada and Chile, according to the World Health Organization.Brazil and Panama are now reporting cases of microcephaly -- including 6,480 suspected cases in Brazil. Panama has one reported case. Colombia is investigating many cases for a possible link. A WHO team is currently in Cape Verde to investigate that country's first reported case of microcephaly, Chan said. A total of 12 countries and territories have now seen an increase in the incidence of Guillain-Barré or actual lab confirmation of Zika among cases with the syndrome, she said. Although Zika has hit countries in Latin America and the Caribbean the hardest, Chan warned that no one can predict if it will spread to other parts of the world and trigger the same pattern of health complications. In other affected countries, the virus has not been circulating long enough for pregnancies to come to term, she said. "If this pattern is confirmed beyond Latin America and the Caribbean, the world will face a severe public health crisis," she said. Chan said the Zika virus initially looked "reassuringly mild," with no hospitalizations or deaths reported when it first showed up in Brazil last May. In Brazil, single mothers face reality of microcephaly Play Video1:57 These three mothers in the Brazilian city of Recife all have children with microcephaly. Brazil has seen an outbreak of thousands of suspected cases of the birth defect. The mothers impacted mostly come from poorer families and are now dealing with the difficult reality of caring for children with special needs. (Dom Phillips,Jason Aldag/The Washington Post)But in less than a year, she said, "the status of Zika has changed from a mild medical curiosity to a disease with severe public health implications." The possibility that a mosquito bite could be linked to severe fetal abnormalities "alarmed the public and astonished scientists," she said. The world community needs to shift thinking and preparations for the long term, she said. Countries need to build health capacity and social support to help families cope with the "heartbreaking strain" from caring for such babies. [Zika outbreak: 'The more we learn the worse things seem to get'] The Cape Verde archipelago off West Africa has more than than 7,000 Zika infections, including its first case last week of a newborn with microcephaly. Although the link between Zika and fetal abnormalities has not been proven, "the circumstantial evidence is now overwhelming," she said. Urgent action should not wait for definitive proof, she added. Recent studies have detailed how the pathogen could attack fetal brain development as well as trigger complications at any stage of pregnancy. In a study published last week the Lancet medical journal, researchers analyzed a 2013-2014 Zika outbreak in French Polynesia and said the risk of microcephaly is about one for every 100 women infected with the virus during the first trimester of pregnancy. The research, based on statistical and mathematical models, was conducted after the outbreak was over. Researchers cautioned, however, that outbreaks differ, and the risk will depend on how the virus spreads and the makeup of the affected population. WHO officials said they don't have enough information yet to say what the risk of microcephaly is for pregnant women in Brazil or elsewhere. Between 2001 and 2014, Brazil had, on average, about 163 cases of microcephaly a year. The global health agency has convened three meetings in recent weeks to receive updates on the science, mosquito control tools and management of health complications. Chan said the most urgently needed medical priority is a reliable diagnostic test for Zika. More than 30 companies are working on, or have developed potential new tests for the virus. The U.S. Food and Drug Administration last week approved a tool developed by the Centers for Disease Control and Prevention that can test for Zika and two related viruses carried by the same mosquito -- dengue and chikungunya. Hundreds of those test kits are being shipped to labs in affected countries and around the United States. [The research from this lab is helping to fight Zika around the world] For vaccines, there are more than 23 projects underway by 14 vaccine developers in the United States, France, Brazil, India and Austria, WHO officials said. Although clinical trials might start before the end of the year, including one underway at the National Institutes of Health, health authorities have said it will be several years at least before a fully tested, licensed Zika vaccine is ready. Although the "first explosive wave" of Zika's spread may be over before a vaccine is available, Chan said there will continue to be need for a vaccine in the years ahead."We expect it to be a long haul," she said. https://www.washingtonpost.com/news/to-your-health/wp/2016/03/22/zika-in-brazil-more-than-2500-births-with-microcephaly-who-predicts/

WHO: Zika virus 'implicated' in large numbers of brain-damaged babiesDirector general says necessary to shift from looking at individual cases to planning for impact of thousands of babies requiring care Margaret Chan gives a press conference on Zika virus at the WHO headquarters in Geneva. Photograph: Fabrice Coffrini/AFP/Getty ImagesSarah Boseley Health editor Tuesday 22 March 2016 13.31 EDTLast modified on Tuesday 22 March 201614.46 EDT Share on PinterestShare on LinkedInShare on Google+Shares22 Save for laterZika virus is now “implicated” in the large numbers of brain-damaged babies in Brazil and the increase in the nerve disorder Guillan-Barré syndrome, according to experts at the World Health Organisation, who say urgent action is needed to deal with a growing crisis. WHO’s director general, Margaret Chan, said on Tuesday the association was still not officially scientifically proven but a shift was needed from looking at individual cases to planning for the possible impact on health systems of the birth of many thousands of babies who will need care, treatment and support for life. Speaking in Geneva, Chan said nobody could predict how far the Zika virus would spread, causing more and more cases of Guillan-Barré and microcephaly, but “if this pattern is confirmed in and beyond Latin America and the Caribbean, the world will face a severe public health crisis”. Zika threatens Honduras, already one of the world's most dangerous countries – in pictures View galleryA substantial proportion of the babies diagnosed with microcephaly because of their small head circumference in north-east Brazil, whose mothers had been infected by the Zika virus, are being confirmed by CT scans as brain-damaged, said Anthony Costello, WHO’s director of maternal and child health. Out of 6,480 suspected cases in Brazil, most of them in the north-east, 2,212 have been fully investigated and 863 confirmed with brain abnormalities, a rate of 39%. “If that rate continues, we would expect just over 2,500 cases will emerge of babies with brain damage and the clinical signs of microcephaly,” said Costello. More and more suspect cases will be reported as time goes on. “We must expect the burden to increase substantially.” The proportion of pregnant women infected with Zika giving birth to a baby with microcephaly is much lower – a study in French Polynesia estimated it at 1%. That study, however, looked only at women infected in the first three months of pregnancy and microcephaly only defined as a small head circumference. “There is a changing pattern of defects in Brazil,” said Costello. “Children are born with unusual brain scans as well as microcephaly and hearing and visual defects.” Analysis Zika's spread in Brazil continues, but where else is in danger?As the epidemic in Latin America shows no signs of abating, concern grows over potential of a spread to impoverished countries in Africa and Asia Read moreChan has asked member states for $56m (£39m) to help WHO tackle the crisis, but only $3m has so far been handed over to the Pan-American Health Organisation, the regional division which deals with Latin America. She said she was in discussions over $4m more. If necessary, she said, she would borrow from other WHO departments and repay them later. The implications for health systems in affected countries are severe, she said. “We need a whole systems approach and a much longer term approach [to help] countries to prepare the capacity to deal with it. It would be very difficult to estimate what would be the funding requirement.” More than half the world’s population lives in countries where the Aedes aegyptimosquito, which transmits the virus, breeds. WHO’s experts say there are effective tools against mosquitoes, but are recommending “carefully planned” pilot studies of two of the most novel approaches. One is infecting mosquitoes with Wolbachia, a bacteria that lives only in insect cells and impairs the mosquito’s ability to transmit infections such as dengue and Zika. The other is the use of genetic manipulation to reduce the populations of mosquitoes. http://www.theguardian.com/world/2016/mar/22/who-zika-virus-implicated-in-large-numbers-of-brain-damaged-babies

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

March 22, 2016 DEPARTMENT OF HEALTH DAILY ZIKA UPDATE: ONE NEW TRAVEL-RELATED CASE IN BROWARD COUNTY Contact:Communications [email protected](850) 245-4111 Tallahassee, Fla.—In an effort to keep Florida residents and visitors safe and aware about the status of the Zika virus, the Florida Department of Health will issue a Zika virus update each week day at 2 p.m. Updates will include a CDC-confirmed Zika case count by county and information to better keep Floridians prepared. There is one new travel-related case in Broward County.Of the cases confirmed in Florida, eight 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 Hillsborough 3 Lee 3 Miami-Dade 32 Orange 4 Osceola 4 Polk 2 Santa Rosa 1 Seminole 1 St. Johns 1 Cases involving pregnant women* 4 Total 72 *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 1,126 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 12 affected counties – Alachua, Brevard, Broward, 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 4,199 people for active Zika virus and 1,767 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/2016/03/032216-zika-update.html County Number of Cases (all travel related) Alachua 4 Brevard 2 Broward 11 Hillsborough 3 Lee 3 Miami-Dade 32 Orange 4 Osceola 4 Polk 2 Santa Rosa 1 Seminole 1 St. Johns 1 Cases involving pregnant women* 4 Total 72

Panama has reported microcephaly to WHO. 30 weeks gestation and umbilical cord PCR confirmed Zika.

Definitive data lacking on Zika origin of outbreak on Cape Verde.

NE Brazil has a 39% confirmation (radiological evidence of infection) of suspect microcephaly in Brazil (largely in the NE) projecting 2500 confirmations.

Within a year status changed to disease with a significant health risk due to GBS and microcephaly. Brazil and Panama reported Zika linked microcephaly. Colombia investigating reports.

Western Hemisphere of Zika first notice to WHO was May 7, 2015 in report from Brazil.

Transcript and audio files will be available at http://www.who.int/mediacentre

Zika virus polyprotein gene, partial cds.PopSet: 1006592943 GenBank FASTA Go to:Study DetailsZika virus in Israeli travelers: Asia, Central and South AmericaLustig,Y., Meltzer,E., Leshem,E., Koren,R., Levy,R., Hindiyeh,M., Mendelson,E. and Schwartz,E. Go to:Sequences in this data setKU926326.1Zika virus isolate Zika 2235 Israel ex Colombia 2015 polyprotein gene, partial cdsKU926325.1Zika virus isolate Zika 356 Israel ex Mexico 2016 polyprotein gene, partial cdsKU926324.1Zika virus isolate Zika 352 Israel ex Vietnam 2016 polyprotein gene, partial cdsKU926323.1Zika virus isolate Zika 269 Israel ex Colombia 2016 polyprotein gene, partial cds

Zika virus polyprotein gene, partial cds.PopSet: 1006592943 GenBank FASTA Go to:Study DetailsZika virus in Israeli travelers: Asia, Central and South AmericaLustig,Y., Meltzer,E., Leshem,E., Koren,R., Levy,R., Hindiyeh,M., Mendelson,E. and Schwartz,E. Go to:Sequences in this data setKU926326.1Zika virus isolate Zika 2235 Israel ex Colombia 2015 polyprotein gene, partial cdsKU926325.1Zika virus isolate Zika 356 Israel ex Mexico 2016 polyprotein gene, partial cdsKU926324.1Zika virus isolate Zika 352 Israel ex Vietnam 2016 polyprotein gene, partial cdsKU926323.1Zika virus isolate Zika 269 Israel ex Colombia 2016 polyprotein gene, partial cds

Zika virus polyprotein gene, partial cds.PopSet: 1006592943 GenBank FASTA Go to:Study DetailsZika virus in Israeli travelers: Asia, Central and South AmericaLustig,Y., Meltzer,E., Leshem,E., Koren,R., Levy,R., Hindiyeh,M., Mendelson,E. and Schwartz,E. Go to:Sequences in this data setKU926326.1Zika virus isolate Zika 2235 Israel ex Colombia 2015 polyprotein gene, partial cdsKU926325.1Zika virus isolate Zika 356 Israel ex Mexico 2016 polyprotein gene, partial cdsKU926324.1Zika virus isolate Zika 352 Israel ex Vietnam 2016 polyprotein gene, partial cdsKU926323.1Zika virus isolate Zika 269 Israel ex Colombia 2016 polyprotein gene, partial cds

Zika virus polyprotein gene, partial cds.PopSet: 1006592943 GenBank FASTA Go to:Study DetailsZika virus in Israeli travelers: Asia, Central and South AmericaLustig,Y., Meltzer,E., Leshem,E., Koren,R., Levy,R., Hindiyeh,M., Mendelson,E. and Schwartz,E. Go to:Sequences in this data setKU926326.1Zika virus isolate Zika 2235 Israel ex Colombia 2015 polyprotein gene, partial cdsKU926325.1Zika virus isolate Zika 356 Israel ex Mexico 2016 polyprotein gene, partial cdsKU926324.1Zika virus isolate Zika 352 Israel ex Vietnam 2016 polyprotein gene, partial cdsKU926323.1Zika virus isolate Zika 269 Israel ex Colombia 2016 polyprotein gene, partial cds

ZIKA: FIRST SUSPECTED CASE OF MICROCEPHALY IN MARTINIQUEmagictr | March 22, 2016 | Health | o CommentsMarisol Touraine said this morning that tests are underway to determine if the baby of a pregnant woman in Martinique suffers from microcephaly following infection Zika virus.While 130 pregnant women have currently been identified as infected with Zika West Indies and French Guiana since the beginning of the current epidemic, the Health Minister Marisol Touraine said Tuesday on RMC that for a of them, the evidence suggests that her baby is diagnosed with a directly linked to microcephaly Zika virus.“I do not want to say definitively because we are awaiting the results of final exams, but all the evidence we have going in that direction today,” cautiously added the minister, who also said that “the virus was transmitted by the mosquito a priori.” If the results are positive, this case of microcephaly would be the first in France to the current outbreak. This defect, which is characterized by abnormally small size of the cranium of the fetus, causes mental retardation more or less profound, irreversible disorders of varying intensity development or even death depending on the seriousness of the infringement, according to a document circulated by the French health authorities. “All you have asked to know about ZikaThe existence of a link between Zika and microcephaly fetus has been established scientifically for the first time in a study published March 4 in the journal Cell Stem Cell . Researchers at the Johns Hopkins University (Baltimore, STATES) and Florida State University have shown that the virus selectively infects the stem cells that form the cerebral cortex, preventing them from dividing normally to form new cells, resulting in their destruction .Furthermore, another study published last week in the medical journal The Lancet and conducted by Simon Cauchemez, mathematical modeling of infectious diseases researcher at the Pasteur Institute (Paris), for the first time quantified the risk in case of microcephaly infection Zika. Based on data from the previous outbreak of Zika, held in French Polynesia in 2013 and 2014, scientists estimated at a hundred the risk to a mother infected with the virus during the first trimester of pregnancy to have a baby with microcephaly. Normally, this risk is only 0.02%. It is thus multiplied by 50 outbreak.Zika virus is transmitted between people through an Aedes mosquito, including Aedes aegypti and Aedes albopictus (tiger mosquito). Sexual transmission is possible, although it is rare. For now, the virus has already affected more than 15,000 people in the Caribbean and Guyana, according to Marisol Touraine. In most cases, the symptoms caused by the virus are mild and transient (proud, headache, body aches).The World Health Organization (WHO) estimated at the beginning of February that a possible link between Zika and explosion cases of microcephaly was “a public health emergency of international concern”. In Brazil, the country most affected, 745 infants are suffering from microcephaly -or five times more than the average annually and 157 babies died because of this malformation since the beginning of the epidemic in October 2015, according to a report Official 10 March. http://sivertimes.com/zika-first-suspected-case-of-microcephaly-in-martinique/18795?utm_source=twitterfeed&utm_medium=twitter

The first case is an elderly male resident of the United States with recent travel to Central America. He developed an acute febrile illness shortly after returning to the U.S. and was subsequently hospitalized in January with progressive ascending weakness of the extremities and diminished reflexes. The patient tested positive for Zika virus infection by polymerase chain reaction (PCR). He improved following treatment and was ready to be discharged. However, he experienced a sudden subarachnoid haemorrhage due to a ruptured aneurysm and died.

The WHO DON report on GBS (Guillain-Barré syndrome) in a US resident (Zika confirmed ex-Central America) led to death from a subarachnoid haemorrhage due to a ruptured aneurysm. http://www.who.int/csr/don/21-march-2016-gbs-usa/en/

WHO adviceWHO recommends Member States affected or susceptible to Zika virus outbreaks to: monitor the incidence and trends of neurological disorders, especially GBS, to identify variations against their expected baseline values;develop and implement sufficient patient management protocols to manage the additional burden on health care facilities generated by a sudden increase in patients with Guillain-Barre Syndrome;raise awareness among health care workers and establish and/or strengthen links between public health services and clinicians in the public and private sectors.The proximity of mosquito vector breeding sites to human habitation is a significant risk factor for Zika virus infection. Prevention and control relies on reducing the breeding of mosquitoes through source reduction (removal and modification of breeding sites) and reducing contact between mosquitoes and people. This can be achieved by reducing the number of natural and artificial water-filled habitats that support mosquito larvae, reducing the adult mosquito populations around at-risk communities and by using barriers such as insect screens, closed doors and windows, long clothing and repellents. Since the Aedes mosquitoes (the primary vector for transmission) are day-biting mosquitoes, it is recommended that those who sleep during the daytime, particularly young children, the sick or elderly, should rest under mosquito nets (bed nets), treated with or without insecticide to provide protection. During outbreaks, space spraying of insecticides may be carried out following the technical orientation provided by WHO to kill flying mosquitoes. Suitable insecticides (recommended by the WHO Pesticide Evaluation Scheme) may also be used as larvicides to treat relatively large water containers, when this is technically indicated. Basic precautions for protection from mosquito bites should be taken by people traveling to high risk areas, especially pregnant women. These include use of repellents, wearing light colored, long sleeved shirts and pants and ensuring rooms are fitted with screens to prevent mosquitoes from entering. Based on the current available information, WHO does not recommend any travel or trade restrictions to the United States of America.