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Additional Materials:Highlights Page: (PDF, 1 page)Full Report: (PDF, 30 pages)Contact:Timothy M. Persons, Ph.D. (202) 512- 6412 [email protected] Office of Public Affairs (202) 512-4800 [email protected] What GAO FoundWhile several countries have reported outbreaks of Zika virus disease—which appear to be primarily transmitted to humans by mosquitos—unanswered questions remain regarding the epidemiology and transmission of the disease. Many factors—including a large number of asymptomatic patients and patients with mild symptoms, and a lack of a consistent international case definition of Zika virus disease—complicate understanding of the virus and may hinder responses to the current outbreak. For example, an estimated 80 percent of individuals infected with the Zika virus may not manifest clinical symptoms. As a result, incidence of the infection may be underestimated. Questions also remain regarding the strength of the association between Zika virus infection and two other conditions: microcephaly and Guillain-Barré syndrome. A lack of validated diagnostic tests, consistent international case definitions, and trend information may also contribute to difficulty in estimating the prevalence of the virus. The United States uses two diagnostic tests for Zika, and according to the U.S. Centers for Disease Control and Prevention (CDC), while there are no commercially-available diagnostic tests for Zika, an antibody-based test for Zika virus was recently authorized for Emergency Use by the U.S. Food and Drug Administration. Diagnosing Zika virus infection is also complicated because it is difficult to differentiate it from other similar diseases, such as dengue or yellow fever. For example, a person previously infected with dengue could be falsely identified as also having been exposed to the Zika virus (and vice-versa). Moreover, the World Health Organization has acknowledged the need for a consistent case definition—that is, a set of uniform criteria to define the disease for public health surveillance and to determine who is included in the count and who is excluded. Additionally, a lack of pattern and trend data has made surveillance challenging. Because Zika virus disease cannot yet be prevented by drugs or vaccines, vector (mosquito) control remains a critical factor in preventing and mitigating the occurrence of this disease. There are three methods for mosquito control: (1) standing water treatment, (2) insecticides, and (3) emerging technologies. Mosquito control has been achieved in some locations by methods such as reducing or chemically-treating water sources where mosquitoes breed or mature, or by insecticide dispersal. Emerging technologies, including biological control methods—such as infecting mosquitoes with bacteria— genetically-modified mosquitoes, and auto-dissemination traps, show some promise but are still in development and testing phases. The National Institutes of Health (NIH) and the CDC have identified several high priority areas of research. Research priorities include basic research to understand viral replication, pathogenesis, and transmission, as well as the biology of the mosquito vectors; potential interactions with co-infections such as dengue and yellow fever viruses; linkages between Zika and the birth defect microcephaly; improving diagnostic tests; vaccine development; and novel vector control methods. These efforts are ambitious, and agencies may face challenges in implementing this agenda. Why GAO Did This StudyEmerging infectious diseases constitute a clear and persistent threat to the health and well-being of people and animals around the world. The Zika virus, which at present appears to be primarily transmitted to humans by infected mosquitos, can cause symptoms including fever, rash, and joint pain. A large ongoing outbreak is occurring in Brazil that started in May 2015. As of February 24, 2016, over 100 cases of U.S. travel-associated Zika virus disease cases have been reported. Due to concerns about its potential impact, you asked GAO to present preliminary observations on the Zika virus. This statement addresses (1) the epidemiology and transmission of the Zika virus disease, including reporting on the incidence of disease and what is known about its link to microcephaly; (2) detection and testing methods; (3) methods for mosquito control; and (4) the proposed federal research agenda as it relates to the Zika virus and Zika virus disease. To report on these questions, GAO reviewed relevant peer-reviewed scientific literature, epidemiological alerts, agency documents, and prior GAO work from 2003-2016 on related topics; consulted experts in the fields of virology, infectious diseases, and vector control, including industry representatives; and interviewed officials of the CDC and NIH. What GAO RecommendsGAO is not making recommendations at this time. For more information, contact Timothy Persons at or [email protected].

EMERGING INFECTIOUS DISEASES:Preliminary Observations on the Zika Virus OutbreakGAO-16-470T: Published: Mar 2, 2016. Publicly Released: Mar 2, 2016.http://www.gao.gov/products/GAO-16-470T?utm_medium=email&utm_source=govdelivery

Mar. 2, 2016 Surgeon General Dr. John Armstrong’s Daily Zika Update - No New Cases Todayhttp://www.floridahealth.gov/newsroom/2016/03/030216-zika-update.html

MEXICO CITY The Ministry of Health federal recorded 121 cases of zika in the country until 26 February. 11 relate to pregnant women . Through a statement, the Department of Epidemiology of that agency explained that the state sickest zika is Chiapas with 57 cases, followed by Oaxaca with 52, Nuevo Leon with four and Guerrero three . the rest of the entities recorded cases of the disease in Jalisco, Michoacan, Sinaloa, Veracruz and Yucatan, with one case each. Chiapas is the onethat has eight confirmed cases of zika in pregnant women, while in Oaxaca and Veracruz two and one case respectively.

Mexico update 121 confirmed Zika cases http://www.aztecanoticias.com.mx/notas/salud/245095/121-casos-de-zika-en-todo-el-pais-salud

Starting

pahopin: Media briefing Zika DEberwine: Testing Paola: Testing medpage: tsting DEberwine: We will begin shortly DEberwine: The moderator is Leticia Linn, PAHO communication advisor DEberwine: Speakers (in order of presentation) are: DEberwine: Marcos Espinal, Director of the Department of Communicable Diseases and Health Analysis, PAHO/WHO DEberwine: Paulo Buss, Director, Global Health Center, Oswaldo Cruz Foundation (Fiocruz), Brazil DEberwine: Amadou Sall, Scientific Director, Pasteur Institute in Dakar, Senegal FabioBrazil: Test DEberwine: Lyle Petersen, Director, Division of Vector-Borne Diseasses, National Center for Emerging and Zoonotic Diseases, U.S. Centers for Disease Control and Prevention (CDC) Anne Gulland: When is this press conference going to start? Tianna: Will the phone call number become live? We can only hear one another, not the speakers DEberwine: Pretty soon. Will check on the phone line now Tianna: Thank you

Starting at 1:00 PM ET

Zika Virus InformationAs of March 2, 2016 there are no confirmed cases of Zika virus in South Carolina.

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

Latest Facts and Advisories as of 3/2/2016 [ Español (PDF)]Reported cases of Zika in New York City: 9 One of the nine cases was a pregnant woman;All cases contracted Zika while visiting other countries; andAll patients have recovered.

NY NY Zika cases increase to 9 http://www1.nyc.gov/site/doh/health/health-topics/zika-virus.page

Latest Facts and Advisories as of 3/2/2016 [ Español (PDF)]Reported cases of Zika in New York City: 9 One of the nine cases was a pregnant woman;All cases contracted Zika while visiting other countries; andAll patients have recovered.

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

As of March 1, 2016, the Illinois Department of Public Health is reporting six cases of Zika virus disease statewide.**Please note that all numbers are provisional and may be subject to change**

Illinois Zika confirmed cases increases to six (travel status not noted) http://www.dph.illinois.gov/topics-services/diseases-and-conditions/zika

As of March 1, 2016, the Illinois Department of Public Health is reporting six cases of Zika virus disease statewide.**Please note that all numbers are provisional and may be subject to change**

Zika Virus – March 2, 2016 Texas has had 14 confirmed cases of Zika virus disease. 13 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 County – 3Dallas County – 2Harris County – 7Travis County - 2

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