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5 References 1 Fauci AS, Morens DM. Zika virus in the Americas — yet another arbovirus threat. N Engl J Med 2016;374:601-604 Free Full Text | Medline 2 Latest Zika virus situation reports. Geneva: World Health Organization, 2016 (http://www.who.int/emergencies/zika-virus/situation-report/en/). 3 Mlakar J, Korva M, Tul N, et al. Zika virus associated with microcephaly. N Engl J Med 2016;374:951-958 Full Text 4 Ioos S, Mallet H-P, Leparc Goffart I, Gauthier V, Cardoso T, Herida M. Current Zika virus epidemiology and recent epidemics. Med Mal Infect 2014;44:302-307 CrossRef | Web of Science | Medline 5 Oehler E, Watrin L, Larre P, et al. Zika virus infection complicated by Guillain-Barre syndrome — case report, French Polynesia, December 2013. Euro Surveill 2014;19 CrossRef

To the Editor:Zika virus (ZIKV) is currently spreading widely, while its clinical spectrum remains a matter of investigation. Evidence of a relationship between ZIKV infection and cerebral birth abnormalities1,2is growing.3 An increased incidence of some peripheral nervous syndromes among adults was reported during outbreaks in French Polynesia4,5 and Brazil,1,2 but no formal link with ZIKV infection was shown. We describe a case of central nervous system infection with ZIKV that was associated with meningoencephalitis in an adult. An 81-year-old man was admitted to the intensive care unit (ICU) 10 days after he had been on a 4-week cruise in the area of New Caledonia, Vanuatu, the Solomon Islands, and New Zealand; he was reported to have been in perfect health during that time. On medical examination, he was febrile (39.1°C) and comatose (Glasgow Coma Scale score of 6 on a scale from 3 to 15, with lower scores indicating a reduced level of consciousness) with hemiplegia of the left side, paresis of the right upper limb, a normal response to tendon reflexes, and a Babinski sign on the left side. The patient’s trachea was intubated and mechanical ventilation begun; a transient rash was observed within the next 48 hours. Magnetic resonance imaging (MRI) of the brain was suggestive of meningoencephalitis. There were asymmetric subcortical white-matter hyperintensities on fluid-attenuated inversion recovery (FLAIR) imaging, multiple punctuated hyperintensities on diffusion-weighted sequences that were evocative of ischemic foci, and a slight hyperintensity of the right rolandic fissure that was evocative of meningitis (Figure 1FIGURE 1Imaging of the Brain.). Computed tomographic angiography revealed an irregular narrowing of the right callosomarginal artery. A lumbar puncture was performed on day 1, and findings on analysis of cerebrospinal fluid (CSF) were suggestive of meningitis: the leukocyte count was 41 per cubic millimeter (with 98% polymorphonuclear leukocytes), the protein level was 76 mg per deciliter, and the ratio of CSF to blood glucose was 0.75. The patient was initially treated with amoxicillin, cefotaxime, gentamicin, and acyclovir, but these antimicrobial agents were stopped on day 5. Investigations in both CSF and blood for other infections were unrevealing (see the Supplementary Appendix, available with the full text of this letter at NEJM.org), except for a positive result for ZIKV on reverse-transcriptase–polymerase-chain-reaction assay of the CSF (cycle threshold, 34). ZIKV was grown in culture from the CSF on a Vero cell line (see the Supplementary Appendix). These findings all support the diagnosis of ZIKV-associated meningoencephalitis. Several electroencephalograms showed no direct signs that were suggestive of epilepsy during levetiracetam therapy (which was administered for the first time in the ICU because seizure had been suspected as one of the mechanisms of the initial consciousness disorder). Spontaneous arousal occurred within 24 hours after intubation, and mechanical ventilation was weaned on day 2. At that time, the patient was awake but had spatial delusion with visual and kinesthetic hallucinations and a persisting weakness (2/5) of the left arm. His neurologic condition continued to improve without specific treatment. He was discharged from the ICU on day 17, and his cognitive function was fully recovered by day 38. He had a residual weakness (4/5) of the left arm. Clinicians should be aware that ZIKV may be associated with meningoencephalitis.

Guillaume Carteaux, M.D., Ph.D. Assistance Publique–Hôpitaux de Paris, Créteil, France [email protected] Marianne Maquart, Ph.D. French Armed Forces Biomedical Research Institute, Marseille, France Armand Mekontso Dessap, M.D., Ph.D. Université Paris Est Créteil, Créteil, France Alexandre Bedet, M.D. Damien Contou, M.D. Pierre Brugières, M.D. Slim Fourati, M.D., Ph.D. Laurent Cleret de Langavant, M.D., Ph.D. Assistance Publique–Hôpitaux de Paris, Créteil, France Thomas de Broucker, M.D. Centre Hospitalier de Saint-Denis, Saint-Denis, France Christian Brun-Buisson, M.D. Assistance Publique–Hôpitaux de Paris, Créteil, France Isabelle Leparc-Goffart, Ph.D. French Armed Forces Biomedical Research Institute, Marseille, France Disclosure forms provided by the authors are available with the full text of this letter at NEJM.org. This letter was published on March 9, 2016, at NEJM.org.

CORRESPONDENCE Zika Virus Associated with MeningoencephalitisMarch 9, 2016DOI: 10.1056/NEJMc1602964 http://www.nejm.org/doi/full/10.1056/NEJMc1602964

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Zika cases in Georgia rise to six 5:22 p.m. Wednesday, March 9, 2016 | Filed in: Local NewsGeorgia now has four new travel-related cases of the Zika virus, bringing the total number of confirmed cases in the state to six. The Georgia Department of Public Health received the test results on Tuesday from the Centers for Disease Control and Prevention for four Georgia travelers. The health department would not identify the men and women in any way other than saying they had visited areas of the Americas where the virus is rampant. Growing evidence suggests Zika is the cause of microcephaly, a devastating birth defect that leaves newborns with underdeveloped brains and unusually small heads. None of the Georgia travelers was pregnant. Mosquitos are the primary transmitters of Zika and other viruses like DengueLast month two other Georgians were confirmed to have had Zika. They contracted the disease while traveling as well. The CDC has issued travel advisories warning pregnant women not to visit countries with active Zika outbreaks, such as Brazil which has been the epicenter of the outbreak in the Americas. The virus can also be transmitted sexually, but is primarily contracted through mosquito bites. There is growing concern that the virus will spread rapidly in the Southern United States as temperatures rise and mosquito populations explode.

The Georgia Department of Public Health received the test results on Tuesday from the Centers for Disease Control and Prevention for four Georgia travelers. The health department would not identify the men and women in any way other than saying they had visited areas of the Americas where the virus is rampant. http://www.ajc.com/news/news/local/zika-cases-in-georgia-rise-to-six/nqg7X/

NYSDOH expands Zika virus testing for pregnant womenBy WBNG News March 9, 2016Updated Mar 9, 2016 at 3:24 PM ESTAlbany, NY (WBNG Binghamton) The NYS Department of Health is taking new steps in the fight against Zika and expanding it's virus testing. Governor Andrew Cuomo (D) announced on Wednesday he has directed the NYSDOH to expand free testing to all pregnant women who had unprotected sex with a partner who traveled to an area with ongoing Zika virus transmission. WBNG E-News - Sign Up For Our Newsletter! The NYSDOH is currently investigating one case of possible sexual transmission of the Zika virus. The federal Centers for Disease Control and Prevention has published reports of increasing numbers of confirmed and probable sexual transmission of Zika virus. NYSDOH’s Wadsworth Center has conducted tests on samples from more than 1,400 patients and 40 have been found to be positive. All of those patients have been returning travelers from countries where the Zika virus is ongoing. One possible case is by sexual transmission. NYSDOH already offers testing to pregnant women who themselves have traveled to an area with ongoing Zika virus transmission during their pregnancy, as well as to non-pregnant women, men or children who developed symptoms of Zika virus within 4 weeks of travel to an area with active Zika virus transmission. Only one in five people infected with Zika virus will get sick, and the symptoms are usually very mild, including fever, rash, joint pain, or conjunctivitis. But there have been reports of increased cases of a birth defect known as microcephaly that may be associated with Zika virus infection among pregnant women. CDC and NYSDOH recommend that, until more is known, males who have traveled to or lived in an area with active Zika virus transmission and are sexual partners of pregnant women, abstain from sex or consistently and correctly use latex condoms for the duration of the pregnancy. NYSDOH Commissioner Dr. Howard Zucker said, “As evidence has emerged that the risk of sexual transmission is greater than previously known, the Department is expanding its testing to include all pregnant women who had unprotected sex with a partner who traveled to an area with active Zika virus transmission. This expansion in testing will provide more pregnant women and clinicians with information to guide their healthcare. Moving forward, we will continue to work closely with the CDC to respond to new data on transmission to determine how we can best limit the spread of Zika virus.” New educational materials on the Zika virus have been sent to local health departments, clinics, hospitals and other healthcare facilities and WIC clinics. NYSDOH is working with local health officials from all of the counties in New York inhabited by a species of mosquito that could potentially carry the Zika virus, to update and implement the New York State Mosquito Surveillance and Response Plan. Healthcare providers must report all potential cases of the Zika virus to their local health department to allow NYSDOH to monitor the occurrence of the disease and ensure a coordinated response. http://www.wbng.com/news/state/NYSDOH-expands-Zika-virus-testing-371552031.html

New York Expands Zika Testing After The Latest "Alarming" News From WHOBY MIRANDA KATZ IN NEWS ON MAR 9, 2016 5:09 PM The Aedes albopictus mosquito, native to NYC, has been known to transmit Zika in other areas. (Wiki commons) The state Department of Health announced today that it will begin offering free testing for the Zika virus to pregnant women whose partners recently traveled to a country with Zika transmission. This comes a day after the World Health Organization announced that there's now substantial evidence of links between Zika and birth defects such as microcephaly, and that the virus can be sexually transmitted more easily than initially thought. "Reports and investigations in several countries strongly suggest that sexual transmission of the virus is more common than previously assumed," WHO Director General Dr. Margaret Chan said yesterday, calling this news "alarming." For the past month, the state DOH has been offering free testing for men and women alike who have traveled to Zika-affected countries and are symptomatic. But with the newly serious risk of contracting the virus through sex with someone who is infected, that coverage is now expanding to any pregnant woman whose partner has been exposed to Zika. In a statement today, state DOH commissioner Dr. Howard Zucker said that "this expansion in testing will provide more pregnant women and clinicians with information to guide their healthcare. Moving forward, we will continue to work closely with the CDC to respond to new data on transmission to determine how we can best limit the spread of Zika virus." The WHO declared Zika virus an international public health emergency in February, which some saw as surprising given that the virus itself is quite mild, especially compared the other three such declarations of emergency: Ebola and polio in 2014, and swine flu in 2009. Just one in five people infected with Zika virus will show symptoms, and those symptoms are usually mild, including a fever or a rash. But there has been some evidence that links Zika virus in pregnant women to birth defects such as microcephaly, which causes babies to be born with abnormally small heads and brains, and Guillain-Barre Syndrome, which can cause temporary paralysis and death. Though there is still no clearly established causation between Zika virus and such conditions, the evidence is mounting, the WHO said yesterday: apparently nine Zika-affected countries have recently reported increases in Guillan-Barre. In slightly better news, a vaccine against the viruscould be ready for human testing as soon as September. There have been 40 confirmed cases of Zika in the state to date, one of which may have been sexually transmitted. In New York City, there have been 15 confirmed cases, DOH spokesperson Christopher Miller said today—quite the leap from last month's count of 5. In all of these cases, except for the one possible sexual transmission, the virus was contracted abroad. Zika virus has been spread in Latin American and Caribbean countries by the Aedes aegypti mosquito, which is not native to New York. However, New York is home to the Aedes albopictus mosquito, which has been known to carry the virus in other areas. Last month, Mayor de Blasio said that he is "very concerned about the onset of the mosquito season at the beginning of April," and that the city is working on a plan for mosquito control. Miller said that there was a roundtable at City Hall today on mosquito control, and that "we continue to update our plans and services for New York City residents based on the best available evidence we have. We will be using information from this meeting to inform our plans moving forward. We are already stepping up our surveillance and testing here in New York City." As of last month, the city was "cautiously optimistic" that New Yorkers won't have to worry about catching Zika from mosquitoes here. But if you think you've been exposed to the virus and want more information about free testing, you can call the state's Zika hotline at 1-888-364-4723. http://gothamist.com/2016/03/09/new_york_expands_zika_testing_after.php

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Zika virus case confirmed in Grayson CountyPosted: Wed 10:58 AM, Mar 09, 2016By: KXII-TVHome / Headlines List / ArticleSHERMAN, Texas -- The Grayson County Health Department confirmed Wednesday that a county resident had tested positive for the Zika virus. The patient is an adult resident of Grayson County and has recently traveled to an area with a known Zika Virus outbreak. According to the Centers for Disease Control, the Zika virus is spread to people primarily through the bite of an infected Aedes species mosquito. The virus can also be spread through sexual contact. Zika virus can be spread from a pregnant woman to her fetus and has been linked to a serious birth defect of the brain called microcephaly in babies of mothers who had Zika virus while pregnant. Microcephaly is a condition in which a baby's head is significantly smaller than expected, often due to abnormal brain development. The most common symptoms of Zika are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting for several days to a week after being bitten by an infected mosquito. People usually don’t get sick enough to go to the hospital, and they very rarely die of Zika. To date no Zika infections resulting from a mosquito bite have been reported in The United States.

The Grayson County Health Department confirmed Wednesday that a county resident had tested positive for the Zika virus. The patient is an adult resident of Grayson County and has recently traveled to an area with a known Zika Virus outbreak. http://www.kxii.com/home/headlines/Zika-virus-case-confirmed-in-Grayson-County-371535091.html

Florida's first sexually transmitted Zika case confirmed in Polk CountyPerson in Polk County contracts virus Posted: 1:41 PM, March 09, 2016Updated: 2:05 PM, March 09, 20160 0POLK COUNTY, Fla. - A person in Polk County has contracted the Zika virus after having sex with someone who recently traveled out of the United States, officials said. Florida Gov. Rick Scott said Wednesday that he has asked the Centers for Disease Control and Prevention to host another conference call with state healthcare workers to discuss how Zika is spread and its symptoms, treatments and proper precautions. More Health HeadlinesCDC provides Florida with 500 extra Zika testsFDA issues guidelines to prevent Zika virus spreadFlorida Surgeon General to testify about ZikaOrlando International Airport seeks to curb Zika virusOneBlood proactive in protecting blood supply from Zika virus"It is imperative that the most up-to-date information is available so we can stay ahead of the possible spread of the Zika virus in Florida," Scott said. "We will continue to do all we can to keep families across our state safe." In February, Scott asked the CDC to conduct a call with Florida healthcare workers, including OBGYNS, doctors and those who work with pregnant women, which the CDC completed on February 11. http://www.news4jax.com/health/floridas-first-sexually-transmitted-zika-case-confirmed

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Mar. 9, 2016 Surgeon General Dr. John Armstrong’s Daily Zika Update - First Sexually Transmitted Case Confirmed in FloridaContact: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 are two new cases today in Polk County – one is travel-associated and one was sexually transmitted from an individual who was traveling outside of the country. The Declaration of Public Health Emergency has been expanded to include Polk County. Of the cases confirmed in Florida, three cases are still exhibiting symptoms. According to the CDC, symptoms associated with the Zika virus last between seven to 10 days. 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. 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. CountyNumber of Cases (all travel related)Alachua1Brevard1Broward7Hillsborough3Lee3Miami-Dade24Orange3Osceola1Polk2Santa Rosa1Seminole1St. Johns1Cases involving pregnant women*4Total52 *Counties of pregnant women will not be shared. Last week, Governor Rick Scott announced that the Centers for Disease Control fulfilled the request he made last week for more antibody tests for the Zika virus and provided an additional 500 tests. 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 959 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 4,512 people for active Zika virus and 1,501 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.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.

There are two new cases today in Polk County – one is travel-associated and one was sexually transmitted from an individual who was traveling outside of the country. http://www.floridahealth.gov/newsroom/2016/03/030916-zika-update.html

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Latest Facts and Advisories as of 3/9/2016 [ Español (PDF)]Reported cases of Zika in New York City: 15 Two of the fifteen cases were pregnant women;All cases contracted Zika while visiting other countries; andAll patients have recovered.http://www1.nyc.gov/site/doh/health/health-topics/zika-virus.page