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University of Padua has released full Zika sequences (Dominican Republic/2016/PD1 & Dominican Republic/2016/PD2) collected Feb 1, 2016 from urine and saliva from Padua Italy traveler who returned from Dominican Republic http://www.ncbi.nlm.nih.gov/nuccore/KU853012 http://www.ncbi.nlm.nih.gov/nuccore/KU853013

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San Bernardino County confirms first Zika virus caseThis 2006 photo provided by the Centers for Disease Control and Prevention shows a female Aedes aegypti mosquito in the process of acquiring a blood meal from a human host.James Gathany/Centers for Disease Control and Prevention via APBy Jim Steinberg, The Sun POSTED: 03/11/16, 3:13 PM PST | UPDATED: 2 HRS AGO 0 COMMENTS SAN BERNARDINO >> Public health officials announced Friday that San Bernardino County has reported its first Zika virus case. As with all 20 confirmed cases in California, this victim, a woman in her 60s, was infected while traveling outside of the country, officials said. She did not develop complications from the virus, Strong said. The city where the resident lived and the county in South America where she is believed to have contracted the virus were not immediately known, said Susan Strong, communicable disease program many for the county’s health department. Zika cases have also been reported in Orange and Los Angeles counties. One of the Los Angeles County victims was a pregnant woman. Medical experts believe there is “a possible association” between Zika and microcephaly, an abnormally small head and brain, says the California Department of Public Health website. The Zika virus is transmitted by two non-native mosquito varieties that have been found in Los Angeles, Pico Rivera, several cities in Orange County, across much of east Los Angeles County, Montclair, Colton and Upland, parts of San Diego County and in much of Imperial County, according to the state health department’s website. But the virus has not been detected in these domestic populations, officials say. Most people infected with the virus have no symptoms. If symptoms develop, they usually begin with fever, rash, joint pain and/or red eyes. Symptoms begin three to seven days after the bite. These varieties of mosquitoes are daytime bitters, so Strong and other health officials urge people to take precautions during daylight hours. Zika normally occurs in many tropical and subtropical areas of the world, particularly Africa, Southeast Asia and Islands in the Pacific Ocean. Recent outbreaks have occurred in Latin America and the Caribbean. There is no specific treatment for Zika. Most people feel better after about a week, says the state health department’s website. Eleven of the state’s 20 Zika cases were confirmed this year, officials say

Public health officials announced Friday that San Bernardino County has reported its first Zika virus case. As with all 20 confirmed cases in California, this victim, a woman in her 60s, was infected while traveling outside of the country, officials said. She did not develop complications from the virus, Strong said. The city where the resident lived and the county in South America where she is believed to have contracted the virus were not immediately known, said Susan Strong, communicable disease program many for the county’s health department. http://www.sbsun.com/health/20160311/san-bernardino-county-confirms-first-zika-virus-case

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StateCDCStates States 9-Mar10-Mar11-MarAL112AR111CA131416CO222DE111DC333FL495859GA577HI566IL777IN333IA334KS001KY011LA222MD444MA333ME011MI233MN666MO111MT111NE222NH111NJ222NY254040NC556OH667OK233OR599PA666TN111TX192626UT011VA666WA133WV011 193239247

Friday, March 11, 2016 GenderAge RangeTravel HistoryTravel MonthConfirmation DateCase Status by CDCFemale60-64Colombia11/1512/22/2015Confirmed PositiveMale35-39Honduras12/1501/28/2016Confirmed PositiveFemale40-45Honduras12/151/29/2016Confirmed PositiveFemale0-10Honduras1/162/22/2016Confirmed PositiveFemale45-50Guatemala1/162/25/2016Confirmed PositiveFemale60-64El Salvador11/152/26/2016Confirmed Positive

11 March 2016CHP notified of additional imported case of Zika Virus Infection on Mainland The Centre for Health Protection (CHP) of the Department of Health (DH) today (March 11) received notification of an additional imported case of Zika Virus Infection on the Mainland from the National Health and Family Planning Commission and the Health and Family Planning Commission of Guangdong Province. The CHP again urged the public to adopt strict anti-mosquito measures during travel. Pregnant women and those planning pregnancy should consider deferring their trip to the affected areas. The case involves a 19-year-old man who lives in Venezuela. He arrived at Hong Kong International Airport on February 29 and shortly later on the same day travelled to Enping, Jiangmen, Guangdong, by bus via Shenzhen Bay Control Point. He remained afebrile during his travel. He developed a rash on March 9 and subsequently was laboratory confirmed to be an imported case of Zika Virus Infection by the Health and Family Planning Commission of Guangdong Province. The patient is now hospitalised for isolation and management and is in stable condition. To date, 13 imported cases of Zika Virus Infection have been notified on the Mainland. The DH's Port Health Office has stepped up inspections at the Boundary Control Points (BCPs) and airport to maintain strict environmental hygiene with effective mosquito control. Port Health Inspectors have reinforced training for contractors of BCPs, including the airport, harbour ports and ground crossings, on port hygiene and pest control for effective vector prevention. Health promotion in BCPs has been enhanced through pamphlets and posters to alert travellers to necessary measures against Zika. "Routine health surveillance on the body temperature of inbound travellers at all boundary control points is ongoing. Suspected cases will be referred to healthcare facilities for follow-up. However, at present, around 70 to 80 per cent of infected people are asymptomatic and most can recover fully. Therefore, we again urge those arriving from Zika-affected areas to apply insect repellent for 14 days upon arrival to reduce the risk of transmission," the spokesman for the DH said. The DH has been working closely with the travel industry and stakeholders, especially agents operating tours in Zika-affected areas and personnel receiving travellers in those areas (particularly pregnant women), to regularly update them on the latest disease information and health advice. As long as there is international travel, there is always a risk of the introduction of the Zika virus to Hong Kong. As asymptomatic infection is very common and the potential vector, Aedes albopictus, is present locally, there is also the risk of local spread if Zika is introduced to Hong Kong. The public should pay special attention to the countries/areas with reports/indications of autochthonous Zika virus transmission announced earlier by the World Health Organization (WHO). The DH has been maintaining close liaison with the WHO as well as overseas, neighbouring and Mainland health authorities to closely monitor the latest developments of Zika. Locally, no human Zika cases have been reported to the CHP to date. To prevent Zika virus Infection, in addition to general anti-mosquito measures, the DH draws the public's attention to the special notes below: A. Travelling abroad * If going to areas with ongoing Zika transmission (affected areas), travellers, especially those with immune disorders or severe chronic illnesses, should arrange consultation with a doctor at least six weeks before the trip, and take extra preventive measures to avoid mosquito bites;* Those arriving from affected areas should apply insect repellent for 14 days upon arrival. If feeling unwell, e.g. having fever, they should seek medical advice as soon as possible, and provide travel details to a doctor; B. Pregnant women and those preparing for pregnancy * Pregnant women and those preparing for pregnancy should consider deferring their trip to affected areas. Those who must travel should seek medical advice from their doctor before the trip, adopt contraception if appropriate, strictly follow steps to avoid mosquito bites during the trip, and consult and reveal their travel history to their doctor if symptoms develop after the trip. Women preparing for pregnancy are advised to continue to adopt contraception for 28 days after returning from these areas; and C. Special notes for prevention of sexual transmission regarding potential adverse pregnancy outcomes * Pregnant women should not have sex with male partners who have travelled to areas with ongoing Zika virus transmission, or else condoms should be used throughout the pregnancy;* Any male traveller returning from affected areas should:(i) abstain from sex with his pregnant partner, or else use condoms throughout the pregnancy; and(ii) use a condom for at least six months if his female partner may get pregnant. The public may visit the pages below for more disease information and health advice: * The CHP's Zika page (www.chp.gov.hk/en/view_content/43086.html);* The Zika page of the DH's Travel Health Service (www.travelhealth.gov.hk/english/popup/popup_zika.html);* The Outbound Travel Alert page of the Security Bureau (www.sb.gov.hk/eng/ota); and* Anti-mosquito precautions for women (www.fhs.gov.hk/english/health_info/woman/30014.html). Ends/Friday, March 11, 2016

The case involves a 19-year-old man who lives in Venezuela. He arrived at Hong Kong International Airport on February 29 and shortly later on the same day travelled to Enping, Jiangmen, Guangdong, by bus via Shenzhen Bay Control Point. He remained afebrile during his travel. He developed a rash on March 9 and subsequently was laboratory confirmed to be an imported case of Zika Virus Infection by the Health and Family Planning Commission of Guangdong Province. The patient is now hospitalised for isolation and management and is in stable condition. To date, 13 imported cases of Zika Virus Infection have been notified on the Mainland. http://www.chp.gov.hk/en/content/116/43864.html

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March 11, 2016 SURGEON GENERAL DR. JOHN ARMSTRONG'S DAILY ZIKA UPDATE: ONE NEW CASE IN ORANGE 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, State Surgeon General and Secretary of Health Dr. John Armstrong 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 case today in Orange County. Of the cases confirmed in Florida, five 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 1 Brevard 1 Broward 8 Hillsborough 3 Lee 3 Miami-Dade 27 Orange 4 Osceola 3 Polk 2 Santa Rosa 1 Seminole 1 St. Johns 1 Cases involving pregnant women* 4 Total 59 *Counties of pregnant women will not be shared. This week, following news of the first confirmation of a sexually transmitted Zika case in Polk County from an individual who traveled out of the country, Governor Rick Scott asked the CDC to host another conference call with Florida healthcare workers on how Zika is spread, its symptoms, treatments and proper precautions. On Feb. 12, Governor Scott directed State Surgeon General Dr. John Armstrong 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 1,012 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. State Surgeon General and Secretary of Health Dr. John Armstrong 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 State Surgeon General and Secretary of Health Dr. John Armstrong 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 4,408 people for active Zika virus and 1,396 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.

County Number of Cases (all travel related) Alachua 1 Brevard 1 Broward 8 Hillsborough 3 Lee 3 Miami-Dade 27 Orange 4 Osceola 3 Polk 2 Santa Rosa 1 Seminole 1 St. Johns 1 Cases involving pregnant women* 4 Total 59 *Counties of pregnant women will not be shared. http://www.floridahealth.gov/newsroom/2016/03/031116-zika-update.html

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First Confirmed Travel-Related Case of Zika VirusPosted on 3/11/2016 by Yalonda Galloway Winston Salem, NC – This week, the Forsyth County Department of Public Health (FCDPH) confirmed the first case of Zika virus infection in a Forsyth County patient who had recently travelled to a country with ongoing Zika virus transmission. To protect patient confidentiality no additional details on this patient will be provided. “The FCDPH is working closely with North Carolina Division of Public Health, providers and the Centers for Disease Control and Prevention (CDC) to help with diagnosis testing in persons returning from areas with active mosquito-borne transmission of the Zika virus,” said Marlon Hunter, Health Director. At this time, no cases of the disease are known to have been acquired in Forsyth County or elsewhere in North Carolina. As of March 9, 2016, the Centers for Disease Control and Prevention reported five travel-related Zika virus infections in North Carolina. Forsyth County Health Department is home to one of several Vector Control Programs across the state and has already started its regular mosquito control activities around the county. Zika virus is transmitted through the bite of an infectious mosquito, although cases of transmission through sexual contact and blood transfusion have also been reported. Symptoms can include rash, red eyes, fever and joint pain. Only about one in five people infected with Zika virus will show symptoms. A pregnant woman infected with Zika virus can pass the virus to her unborn baby. A serious birth defect of the brain called microcephaly and other adverse pregnancy outcomes have been reported in some infants born to mothers who were infected with Zika virus while pregnant. FCDPH is in constant communication with health providers, including obstetricians and gynecologists, to ensure they have the latest information, as well as access to guidance and testing from state health officials. While the primary mosquitoes that carry Zika virus are not believed to be widespread in North Carolina, individuals are always encouraged, as a routine precaution, to take steps to prevent mosquito bites, such as: Eliminating potential breeding sites in their own yards on a weekly basis: draining water from garbage cans, house gutters, pool covers, coolers, toys, flower pots or any other container where sprinkler or rain water has collected.Discarding any items, however small, that may collect water. Remember to clean bird baths and pet water bowls twice a week.Wearing shoes, socks, long pants and long sleeves, and apply mosquito repellent to bare skin and clothing.Always use an EPA registered insect repellent according to the label. Repellents with DEET, picardin, oil of lemon eucalyptus, and IR3535 are effective.The Centers for Disease Control and Prevention has issued a travel advisory recommending pregnant women consider postponing travel to any area with active Zika virus transmission. Women who are trying to become pregnant should talk to their doctors about the risk of Zika virus infection before traveling. For additional information about Zika please visit http://www.forsyth.cc/PublicHealth/ or call Forsyth County Department of Public Health-Division of Environmental Health at 336-703-3225.

This week, the Forsyth County Department of Public Health (FCDPH) confirmed the first case of Zika virus infection in a Forsyth County patient who had recently travelled to a country with ongoing Zika virus transmission. http://www.forsyth.cc/PublicHealth/?StoryID=21133

Zika virus cases in Ohio:

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Alabama Residents Tested for Zika Virus as of March 10, 2016http://www.adph.org/mosquito/index.asp?id=7427 Number Tested PositiveNumber of SubmissionsNumber with Results Pending2 38 33

Alabama Residents Tested for Zika Virus as of March 10, 2016 Number Tested PositiveNumber of SubmissionsNumber with Results Pending2 38 33

ReferencesChouin-Carneiro T, Vega-Rua A, Vazeille M, et al. Differential susceptibilities of Aedes aegypti and Aedes albopictus from the Americas to Zika virus. PLoS Negl Trop Dis 2016;10:e0004543.CrossRef PubMedPan American Health Organization. Epidemiological alert: Zika virus infection. 2015 May 7. Washington, DC: Pan American Health Organization, World Health Organization; 2015.http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&Itemid=270&gid=30075Brady OJ, Golding N, Pigott DM, et al. Global temperature constraints on Aedes aegypti and Ae. albopictus persistence and competence for dengue virus transmission. Parasit Vectors 2014;7:338. CrossRef PubMedGarnham PC. Malaria epidemics at exceptionally high altitudes. BMJ 1945;2:45–7. CrossRef PubMedLozano-Fuentes S, Hayden MH, Welsh-Rodriguez C, et al. The dengue virus mosquito vector Aedes aegypti at high elevation in Mexico. Am J Trop Med Hyg 2012;87:902–9. CrossRefPubMedDhimal M, Gautam I, Joshi HD, O’Hara RB, Ahrens B, Kuch U. Risk factors for the presence of chikungunya and dengue vectors (Aedes aegypti and Aedes albopictus), their altitudinal distribution and climatic determinants of their abundance in central Nepal. PLoS Negl Trop Dis 2015;9:e0003545. CrossRef PubMedKraemer MU, Sinka ME, Duda KA, et al. The global distribution of the arbovirus vectors Aedes aegypti and Ae. albopictus. eLife 2015;4:e08347. CrossRef PubMedLandScan. 2014. High resolution global population data set copyrighted by UT-Battelle, LLC, operator of Oak Ridge National Laboratory under contract no. DE-AC05–00OR22725 [dataset]. 2014. http://web.ornl.gov/sci/landscan/Messina JP, Brady OJ, Pigott DM, Brownstein JS, Hoen AG, Hay SI. A global compendium of human dengue virus occurrence. Sci Data 2014;1:140004. CrossRef PubMedDanielson JJ, Gesch DB. Global multi-resolution terrain elevation data 2010 (GMTED2010): US Geological Survey Open-File Report. Washington, DC: US Department of the Interior, US Geological Survey; 2011. http://pubs.usgs.gov/of/2011/1073/pdf/of2011-1073.pdf Top * CDC provides updated travel information on areas with ongoing Zika virus transmission. http://wwwnc.cdc.gov/travel/notices. † American Samoa, Aruba, Barbados, Bolivia, Bonaire, Brazil, Cape Verde, Colombia, Costa Rica, Curacao, Dominican Republic, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Jamaica, Marshall Islands, Martinique, Mexico, New Caledonia, Nicaragua, Panama, Paraguay, Puerto Rico, Saint Martin, Saint Vincent and Grenadines, Samoa, Sint Maarten, Suriname, Tonga, Trinidad and Tobago, U.S. Virgin Islands, and Venezuela. § CDC provides updated travel notice maps for areas with ongoing Zika virus transmission, including Bolivia, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Guatemala,Guyana, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Panama, and Venezuela. http://wwwnc.cdc.gov/travel/page/zika-travel-information. ¶ http://wwwnc.cdc.gov/travel/page/avoid-bug-bites. ** The low oxygen levels found at high elevations can cause problems for travelers who are going to elevations above 2,400 m (8,000 ft). The best way to prevent altitude illness is to ascend slowly and take time to get used to the lower oxygen levels. Pregnant women should avoid strenuous activities at high elevations, and some doctors recommend that pregnant women not spend the night at altitudes above 3,650 m (12,000 ft). Pregnant women should also consider whether they will have access to medical care at a high-elevation destination.

Martin Cetron, MD1 (View author affiliations) View suggested citationSince May 2015, when Zika virus, a flavivirus transmitted primarily by Aedes aegypti mosquitoes, was reported in Brazil, the virus has rapidly spread across the Region of the Americas and the Caribbean. The association between maternal Zika virus infection and adverse fetal and reproductive outcomes, including microcephaly, prompted CDC to issue a Level 2 alert travel notice* for the 37 countries and U.S. territories (at the national and territorial level) that have reported recent Zika virus transmission as of March 11, 2016. In addition to mosquito bite precautions for all travelers, CDC advises that pregnant women postpone travel to affected countries and U.S. territories. Within a nation’s borders, ecologic characteristics, which determine the distribution of mosquito vectors, can vary considerably. CDC conducted a spatial analysis, focusing on the probability of occurrence of Ae. aegypti, to support the demarcation for subnational travel alerts. Based on results of this analysis, travel that is limited to elevations higher than 2,000 m (6,562 ft) above sea level is considered to have minimal (approximately 1%) likelihood for mosquito-borne Zika virus transmission, even within countries reporting active transmission. Women who are pregnant should avoid travel to elevations <2,000 m in countries with active Zika virus transmission. Zika virus is a flavivirus primarily transmitted by Aedes species mosquitoes (1). In May 2015, the Pan American Health Organization (PAHO) issued an alert regarding the first confirmed Zika virus infections in Brazil (2). Currently, outbreaks of Zika virus disease are occurring in many countries and U.S. territories, and as of March 11, 2016, CDC had issued 37 Level 2 travel notices for areas with ongoing Zika virus transmission.† Currently, when laboratory-confirmed local Zika virus transmission is first reported, travel notices are issued for the entire country or U.S. territory. Establishing more precisely defined areas of Zika virus risk in a country or U.S. territory is complicated by incomplete surveillance data on the disease and the presence of the mosquito vector. In an effort to develop more precise guidance for travelers, CDC evaluated whether subnational travel notices could be based on an ecologic indicator of the probable absence of the predominant Zika virus mosquito vector, Ae. aegypti. Within a nation’s borders, ecologic factors, such as temperature, precipitation, vegetation, and human population density, that define suitable habitats forAedes species vary. Where habitat is unsuitable, the mosquito vector is likely to be absent, and risk for mosquito-borne Zika virus transmission is likely to be negligible. The first step in developing subnational travel notices required identification of a single, easily quantifiable ecologic variable that could be used as a substitute for the likely absence of Ae. aegypti. Of the many ecologic factors affecting habitat suitability and Ae. aegypti survival as a vector for Zika virus, temperature has been the most frequently investigated and rigorously quantified (3); however, temperature varies widely and is difficult to predict locally and over the long term. Historically, elevation has served as a reasonable proxy for temperature. Because it is static and relatively easy to measure (4), elevation was selected for further investigation. Previous reports from various global regions suggest that Ae. aegypti is present, but rare, between elevations of 1,700–2,100 m (5,6). Therefore, this analysis was restricted to countries and U.S. territories that have 1) ongoing Zika virus transmission and 2) areas with high elevations (starting at >1,500 m). Sixteen countries, including Bolivia, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Panama, and Venezuela have areas which fit these criteria.§ No U.S. territories had elevations at that level. Spatial analyses were conducted using multiple data sets: global data on predicted probabilities of the presence of Ae. aegypti based on 20,000 observed occurrences during 1960–2014 (7); remotely sensed data on human population density (8); global geographic data on human dengue cases during 1960–2012 (9); and a digital elevation model (10); zonal statistics were used to relate the data sets. Within each of the 16 countries, the area of land suitable for Ae. aegypti, and the human population counts within each area were quantified. The quantification was done in 100-m elevation segments for elevations between 0 m and 2,500 m. Across all 16 countries, at elevations >2,000 m, Ae. aegypti was predicted to be largely absent. Because of sparse current geographic data on Zika virus cases, cases of dengue, another vector-borne viral disease spread primarily by Ae. aegypti, were examined as a proxy for Zika cases. Only 1.1% (28/2,682) of dengue cases in the global data set (9) were reported to have occurred at elevations >2,000 m in the 16 countries. A CDC Zika virus travel notice is currently applied to an entire country or U.S. territory when transmission is confirmed by a local public health authority. However, Ae. aegypti might not be uniformly present because of differences in ecologic suitability. Recent advances in scientific modeling have allowed for more precision in geospatial analyses. CDC applied these approaches to previously published and rigorously evaluated data to determine if more precise guidance to travelers and persons living in affected regions could be established. The results from the spatial analyses of 16 countries with ongoing Zika virus transmission and elevation points >1,500 m indicate that Ae. aegypti is unlikely to be found at elevations >2,000 m because of unsuitable ecologic factors, including but not limited to, low temperatures. Consequently, at elevations above 2,000 m, the risk for mosquito-borne exposure to Zika virus is considered to be minimal. These findings support revising the Zika travel notice to reflect enhanced geographic precision regarding the likelihood of Zika virus presence at certain elevations. With this revision, CDC recommends that women who are pregnant should postpone travel to areas that are at elevations <2,000 m above sea level in countries and U.S. territories with ongoing Zika virus transmission. Because Zika virus is primarily spread by mosquitoes, CDC recommends that travelers protect themselves from mosquito bites.¶ Travel that is entirely limited to elevations >2,000 m is considered to pose minimal likelihood for mosquito-borne Zika virus transmission.** As additional geographic data specific to Zika virus cases in relation to elevation become available, these recommendations will be reviewed and revised as needed. Top Corresponding author: Martin Cetron, [email protected], 770-488-7100. Top 1Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC.

Revision to CDC’s Zika Travel Notices: Minimal Likelihood for Mosquito-Borne Zika Virus Transmission at Elevations Above 2,000 MetersEarly Release / March 11, 2016 / 65 http://www.cdc.gov/mmwr/volumes/65/wr/mm6510e1er.htm?s_cid=mm6510e1er_w

Puerto Rico reports 201 confirmed Zika casesBy ASSOCIATED PRESS PUBLISHED: 12:36 EST, 11 March 2016 | UPDATED: 12:36 EST, 11 March 2016 SAN JUAN, Puerto Rico (AP) — Puerto Rico's Health Department is reporting 201 confirmed Zika cases amid warnings the U.S. territory could face an epidemic of the mosquito-borne virus. Officials said Friday that 21 of those cases involve pregnant women. This concerns health authorities because Zika may be linked to microcephaly, which causes babies to have unusually small heads and brain damage. The director of the U.S. Centers for Disease Control and Prevention visited the island on Tuesday as federal officials stepped up efforts to help prevent the spread of Zika in Puerto Rico. Health officials say they expect thousands of pregnant women in Puerto Rico to become infected. They also warn that more than 20 percent of the island's 3.5 million people overall could be affected. Read more: http://www.dailymail.co.uk/wires/ap/article-3488065/Puerto-Rico-reports-201-confirmed-Zika-cases.html#ixzz42cUxNUL1 Follow us: @MailOnline on Twitter | DailyMail on Facebook

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