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How common is GBS?An estimated 3,000 to 6,000 people, or 1-2 cases for every 100,000 people, develop GBS each year in the US. Most cases of GBS tend to occur for no known reason, and true “clusters” of cases of GBS are very unusual. If you have concerns about the number of GBS cases in your area, notify the state or local health department in the state where the cases happen. CDC collaborates with state and local health departments to investigate reports of possibly unusually large numbers or “clusters” of GBS cases. http://www.cdc.gov/zika/qa/gbs-qa.html

Zika Virus Linked to Paralysis Disorder in U.S., CDC SaysAlexandra Sifferlin @acsifferlin 4:59 PM ET There are two cases of Guillain-Barré syndrome linked to Zika in the United States, the CDC saysTwo confirmed cases of Guillain-Barré syndrome (GBS) linked to the Zika virus have been reported in the United States, U.S. health authorities told TIME on Thursday. The link between Zika and the birth defect microcephaly has received much attention. But health experts are also concerned about the link between the virus and GBS, a condition where the immune system starts attacking the body’s nerves, which leads to weakness that can eventually result in temporary paralysis. In some cases, the disorder can interfere with breathing. The CDC confirmed to TIME that there have been two cases of GBS in the United States in people who also tested positive for Zika virus. “I think we can say that the link between Zika and Guillain-Barre looks strong and would not be at all surprising,” says Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention (CDC). “We’ve seen similar post-infection complications after many different infections, including some that are quite similar to Zika. That is a link that’s getting stronger.” One reported GBS case has been linked to Zika in Puerto Rico, which the CDC described in a recent report. In that case, a 37-year-old man developed a rash that was followed by symptoms of weakness. It was confirmed he had GBS and tested positive for the Zika virus. The CDC has not released details about the two people with GBS linked to Zika in the continental U.S. Like microcephaly, the link between GBS and Zika appears strong, but is it not yet confirmed. More research is needed to understand the link. So far, there are 84 travel-associated cases of Zika in the United States, and Puerto Rico has reported more than two dozen locally transmitted cases. “We really do expect that there will be hundreds, if not thousands, of travel-associated cases in the U.S.,” says Frieden. “There are more than 40 million travelers in the U.S. to Zika affected countries every year—that’s a lot of people.” The CDC says it is aware of pregnant U.S. women who became infected with Zika while traveling. As TIME previously reported, the CDC recently completed the initial stages of a study looking at the possible connection between GBS and Zika in Brazil. The investigation was launched after the Brazil Ministry of Health reported higher than normal cases of GBS amid the Zika outbreak. The researchers at the CDC knew to be on the lookout for possible cases of GBS, since a similar pattern was observed during a 2013 Zika outbreak in the South Pacific. While the findings from the study are still very preliminary, the lead researcher told TIME that while it’s normally rare to see the disease in young people, the CDC researchers in Brazil found a high number of cases among people in their 20s, 30s and 40s who were otherwise healthy.

Media reports cite GBS in two US Zika cases. http://time.com/4229778/cdc-zika-virus-guillain-barre-syndrome/

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Zika Virus Basics: Zika virus is a virus spread to people through mosquito bites of Aedes species mosquitoes. Aedes mosquitoes also spread dengue and chikungunya viruses. Outbreaks of Zika virus disease have occurred in Africa, Southeast Asia, and the Pacific Islands. Zika virus is not currently found in the continental United States. The most common symptoms of Zika virus disease are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting from several days to a week. Severe disease requiring hospitalization is uncommon. In May 2015, Zika virus was identified in Brazil and has resulted in a large outbreak in that country. There have been reports in Brazil of pregnant women with poor pregnancy outcomes, including giving birth to babies with a condition called microcephaly. Microcephaly is a birth defect where a baby’s head is smaller than expected when compared to babies of the same sex and age. In response, CDC has issued a travel alert (Level 2-Practice Enhanced Precautions) for people traveling to regions and certain countries where Zika virus transmission is ongoing. There have also been reports of a potential association between Zika virus infection and Guillain-Barre syndrome, a neurological disease that can affect children and adults. Limited Zika virus transmission has been reported in certain areas of the United States; however, no transmission has been identified in Maryland at this time. Zika virus has been detected in Maryland residents who traveled to countries with ongoing Zika transmission. Maryland Confirmed Zika Virus Infections (As of February 17, 2016) Travel-AssociatedLocally AcquiredTotal202

Maryland Confirmed Zika Virus Infections (As of February 17, 2016) Travel-AssociatedLocally AcquiredTotal202 http://phpa.dhmh.maryland.gov/Pages/Zika.aspx

Tonight at 10 PM ET Dr. Henry L. Niman, PhDZika Virus Moving Fast

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eb. 18, 2016 Surgeon General Dr. John Armstrong’S Daily Zika Update - Two New Cases Confirmed in Miami-Dade CountyContact: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. As of today, two new Zika cases have been confirmed in Miami-Dade County. County Number of Cases (all travel related) Alachua 1 Brevard 1 Broward 4 Hillsborough 3 Lee 3 Miami-Dade 9 Osceola 1 Santa Rosa 1 St. Johns 1 Total 24 Last week, Governor Rick 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 498 callers since Friday. 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. None of the confirmed cases involve pregnant women. 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 eight effected counties – Alachua, Brevard, Broward, Hillsborough, Lee, Miami-Dade, Osceola, Santa Rosa 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 4,923 people for active Zika virus and 1,317 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.This week, 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 websitehere.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/2016/02/021816-zika-update-11.html As of today, two new Zika cases have been confirmed in Miami-Dade County. County Number of Cases (all travel related) Alachua 1 Brevard 1 Broward 4 Hillsborough 3 Lee 3 Miami-Dade 9 Osceola 1 Santa Rosa 1 St. Johns 1 Total 24

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3 cases of Zika confirmed in VirginiaWRIC NewsroomPublished: February 18, 2016, 12:59 pm Updated: February 18, 2016, 1:01 pmClick to share on Twitter (Opens in new window) Click to share on Google+ (Opens in new window) Share on Facebook (Opens in new window) Click to share on Pinterest (Opens in new window) RICHMOND, Va. (WRIC) — The Virginia Department of Health says there are now three cases of Zika here in the Commonwealth. Testing by the Centers for Disease Control and Prevention confirmed the cases. All of those infected have traveled to countries where the virus is known to be spread. Currently no local mosquito-borne Zika cases have been reported in U.S. states, but several cases have been reported in U.S. territories, including Puerto Rico, the U.S. Virgin Islands and American Samoa. Zika usually is transmitted through bites from a mosquito species that can be found in Florida, along the Gulf Coast and in states that border Mexico, among other regions. The virus is spreading rapidly through Latin America. While most people experience either mild or no symptoms, Zika is suspected of causing a devastating birth defect — babies born with abnormally small heads — and pregnant Americans are urged to avoid travel to affected areas. Officials say that if you are planning a trip, you should learn how to protect yourself before you go. A few of those precaution include: Wearing bug repellent,Wearing long pants and long-sleeved shirts to prevent mosquito bites andStaying inside as much as possible.Meanwhile, many airlines and cruise companies are offering refunds for trips to Zika-affected areas. The Associated Press contributed to this report. http://wric.com/2016/02/18/3-cases-of-zika-confirmed-in-virginia/

VDH has confirmed Zika virus disease (via laboratory testing provided through the CDC) in three (3) adult residents of Virginia (1 in Northwest Region, 1 in Northern Region, 1 in Eastern Region). All are travel associated. CDC has issued a travel alert (Level 2-Practice Enhanced Precautions) for people traveling to regions and certain countries where Zika virus transmission is ongoing.

A Zika cases has been confirmed in Virginia's Northern Region http://www.vdh.virginia.gov/

Number of Zika cases in Ireland rises to three, HSE saysVirus contracted during travel in Colombia and Barbados before patients returned hereabout 2 hours agoPaul CullenThe Zika virus, which is spread primarily by mosquitoes, has been linked to thousands of birth defects in Brazil. File photograph: Marvin Recinos/AFP/Getty Images The number of people diagnosed with the Zika virus in Ireland has risen to three, according to the HSE. Two of the cases relate to people who picked up the virus in Colombia and were diagnosed on their return to Ireland. The third case originated inBarbados. The first case resulted from travel in Colombia last year but the other two cases relate to travel this year, the HSE’s Health Protection Surveillance Centre (HPSC) says. It has already said the first two cases were unrelated to each other and both patients are well. The individuals, neither of whom was pregnant, had a history of travel to Zika affected countries. According to the HSE, the diagnosis of Zika cases in Ireland is “not an unexpected event” as many other European countries have reported cases as a result of people travelling to affected areas. Zika, which has been declared a global emergency by the World Health Organisation, has now spread to 30 countries. The disease, which is spread primarily by mosquitoes, has been linked to thousands of birth defects in Brazil, which has recorded almost 5,000 cases of the virus. Health chiefs have urged Irish people who fall ill within two weeks of returning from an affected area to seek medical help. Mild illnessFor most people, Zika causes only a mild illness, usually without symptoms. However, infection has been strongly linked with a serious birth condition called microcephaly. Microcephaly means a baby born with an unusually small head. In these cases, the baby’s brain may not have formed properly during pregnancy. Only one case of possible person-to-person spread, through sex, has been reported. The HPSC says further evidence is needed to confirm if sex is a way of spreading Zika. http://www.irishtimes.com/news/health/number-of-zika-cases-in-ireland-rises-to-three-hse-says-1.2539825

Zika Virus – Feb. 18, 2016 Texas has 12 cases of Zika virus disease. 11 are travelers who were infected abroad and diagnosed after they returned home. One case involves 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 – 7 http://www.texaszika.org/

Zika virus: Study supports link to microcephalyBy Smitha MundasadHealth reporter18 February 2016 From the sectionHealthImage copyrightAPImage captionA 10-year-old Brazilian boy holds his two-month-old brother, who was born with microcephalyZika virusZika outbreak: What you need to knowZika outbreak: Travel adviceMothers' fears amid Zika outbreakVideo How mums-to-be are tackling ZikaScientists say a study involving pregnant women in Brazil "strengthens" the theory that Zika is linked to microcephaly birth defects in babies. The research confirmed the presence of Zika virus in the amniotic fluid of two women who had had Zika-like symptoms during their pregnancies. Brazilian experts say this suggests the virus can infect the foetus. But WHO experts caution the link is not proven and expect to release more information in the next few weeks. Urgent investigationsBrazil has seen a rise in microcephaly - babies born with abnormally small heads and, in some cases, problems with brain development - in the last year, at the same time as a rise in the number of people infected with Zika virus. This has led to a number of studies investigating whether the virus is behind the rise. The research, published in the journal Lancet Infectious Diseases, involved two women who had fever, rash and muscle aches during their pregnancies. After ultrasound scans revealed their developing foetuses had microcephaly, scientists ran further amniocentesis checks. This involved taking a small sample of the amniotic fluid that surrounds the foetus in the womb. Genetic analysis of this fluid confirmed the presence of Zika virus - discounting similar viruses that may have been responsible. Lead scientist, Dr Ana de Filippis, from the Oswaldo Cruz Institute in Rio de Janeiro, Brazil, said: "This study reports details of the Zika virus being identified directly in the amniotic fluid of a woman during her pregnancy, suggesting the virus could cross the placental barrier and potentially infect the foetus." She added: "This study cannot determine whether the Zika virus identified in these two cases was the cause of microcephaly in the babies. "Until we understand the biological mechanism linking Zika to microcephaly we cannot be certain that one causes the other, and further research is urgently needed." Prof Jimmy Whitworth, at the London School of Hygiene and Tropical Medicine added that while the research cannot prove the link: "This study does strengthen the body of evidence that Zika virus is the cause of foetal microcephaly in Brazil." Separately the paper suggests that the virus looks genetically very similar to the Zika virus circulating in French Polynesia in 2013. But scientists say despite growing research, a lot remains unknown and a number of questions still need urgent answers - including how big the risk of microcephaly is if a woman has Zika virus infection in pregnancy and whether the timing of the infection makes a difference. Brazil, the country hardest-hit by Zika, has about 508 confirmed cases of microcephaly and is investigating about 3,935 suspected cases. The ministry said last week that 41 of the confirmed cases of microcephaly had shown links to Zika infection. Microcephaly can be caused by a range of factors, including genetic conditions, infections and drugs. Experts say women who are pregnant are most at risk from mosquito-borne Zika and should try to protect themselves from mosquito bites. http://www.bbc.com/news/health-35597465

PDF http://apps.who.int/iris/bitstream/10665/204421/1/WHO_ZIKV_MOC_16.1_eng.pdf?ua=1

OverviewThis guidance has been developed to provide advice on the prevention of potential sexual transmission of Zika virus. The primary transmission route of Zika virus is via the Aedesmosquito. However, sexual transmission of Zika virus may also be possible, with limited evidence recorded in a few cases. This is of concern due to an association between Zika virus infection and potential complications, including microcephaly and Guillain-Barré syndrome. The current evidence base on Zika virus remains extremely limited. This guidance will be reviewed and the recommendations updated as new evidence emerges. Related linksAll publications, technical guidances on Zika virusMicrocephaly/Zika virus

Prevention of potential sexual transmission of Zika virus, interim guidance Share PrintAuthors: World Health Organization Publication detailsNumber of pages: 2 Publication date: 18 February 2016 Languages: English ISBN: WHO/ZIKV/MOC/16.1 http://www.who.int/csr/resources/publications/zika/sexual-transmission-prevention/en/

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