niman

Isolate name: A/Stavropol/11/2016 Isolate ID: EPI_ISL_209017 Passage details/history: c1/c2 Type: A / H1N1 Lineage:pdm09 Sample information Collection date: 2016-01-18 Host Human Additional host information: Zip code: Patient status: Deceased Last vaccinated: In-vivo pathogenicity test: Location: Russian Federation / Stavropol Krai Additional location information: Stavropol Patient age: 27 Year(s) Gender: Male Outbreak: Treatment: Specimen source: Tissue post-mortem Institute information Originating lab: Sample ID given by the sample provider: Address: Submitting lab: State Research Center of Virology and Biotechnology Vector Sample ID given by the submitting laboratory: Authors: Ivan,Susloparov; Natalya,Goncharova; Natalya,Kolosova; Alexander,Durymanov; Tatyana,Ilyicheva; Alexander,Ryzhikov Address: State Research Center of Virology and Biotechnology Vector Emerging Zoonotic Diseases and Influenza Novosibirsk Region 630559 Koltsovo Russian Federation PublicationPublication In vivo antiviral resistance PhenotypeGenotypeUnspecifiedAntiviral resistance tested by experimental procedures Adamantanes: Unknown Oseltamivir: Unknown Zanamivir: Unknown Peramivir: Unknown Other: Unknown Additional informationAntigenic characterization: Note: Sequence segmentidentifierlengthaccession #INSDCSequence HA A/Stavropol/11/2016 1786 EPI704030 NA A/Stavropol/11/2016 1439 EPI704031 NS A/Stavropol/11/2016 890 EPI704032 Submitter information Submitter: Susloparov, Ivan Submission Date: 2016-02-06 Last modifier: Susloparov, Ivan Last modified: 2016-02-06

State Research Center of Virology and Biotechnology Vector has released sequences from a deceased H1N1pdm09 case,27M. The H1 frompost-mortum tissue had D225G.

Sequences producing significant alignments:Select:AllNone Selected:0 AlignmentsDownloadGenBankGraphicsDistance tree of resultsShow/hide columns of the table presenting sequences producing significant alignmentsSequences producing significant alignments:Select for downloading or viewing reportsDescriptionMax scoreTotal scoreQuery coverE valueIdentAccessionSelect seq gb|KU321639.1|Zika virus strain ZikaSPH2015, complete genome13781378100%0.099%KU321639.1Select seq gb|KM078936.1|Zika virus strain CHI1410214 NS5 protein gene, partial cds13781378100%0.099%KM078936.1Select seq gb|KJ776791.1|Zika virus strain H/PF/2013 polyprotein gene, complete cds13781378100%0.099%KJ776791.1Select seq gb|KM078961.1|Zika virus strain CHI2612114 NS5 protein gene, partial cds13751375100%0.099%KM078961.1Select seq gb|KU365780.1|Zika virus strain BeH815744 polyprotein gene, complete cds13731373100%0.099%KU365780.1Select seq gb|KU365779.1|Zika virus strain BeH819966 polyprotein gene, complete cds13731373100%0.099%KU365779.1Select seq gb|KU365777.1|Zika virus strain BeH818995 polyprotein gene, complete cds13731373100%0.099%KU365777.1Select seq gb|KM078930.1|Zika virus strain CHI2283714 NS5 protein gene, partial cds13731373100%0.099%KM078930.1Select seq gb|KM078971.1|Zika virus strain CHI2613014 NS5 protein gene, partial cds13691369100%0.099%KM078971.1Select seq gb|KM078970.1|Zika virus strain CHI2490414 NS5 protein gene, partial cds13691369100%0.099%KM078970.1Select seq gb|KM078933.1|Zika virus strain CHI1058514 NS5 protein gene, partial cds13691369100%0.099%KM078933.1Select seq gb|KU365778.1|Zika virus strain BeH819015 polyprotein gene, complete cds13671367100%0.099%KU365778.1Select seq gb|KU312312.1|Zika virus isolate Z1106033 polyprotein gene, complete cds13671367100%0.099%KU312312.1Select seq gb|KM078929.1|Zika virus strain CHI1805214 NS5 protein gene, partial cds13671367100%0.099%KM078929.1Select seq gb|KF993678.1|Zika virus strain PLCal_ZV from Canada polyprotein gene, partial cds13511351100%0.099%KF993678.1Select seq gb|KJ873160.1|Zika virus isolate NC14-03042014-3481 nonstructural protein 5 gene, partial cds1347134797%0.099%KJ873160.1Select seq gb|JN860885.1|Zika virus isolate FSS13025 polyprotein gene, partial cds13171317100%0.098%JN860885.1Select seq gb|EU545988.1|Zika virus polyprotein gene, complete cds13121312100%0.098%EU545988.1Select seq gb|KJ873161.1|Zika virus isolate NC14-02042014-3220 nonstructural protein 5 gene, partial cds1266126691%0.099%KJ873161.1Select seq gb|HQ234499.1|Zika virus isolate P6-740 polyprotein gene, partial cds1140114099%0.094%HQ234499.1Select seq gb|KM851039.1|Zika virus strain SV0127/14 nonstructural protein 5 gene, partial cds1051105177%0.099%KM851039.1Select seq gb|KM851038.1|Zika virus strain CPC-0740 nonstructural protein 5 gene, partial cds1013101377%0.098%KM851038.1

LOCUS KU556802 749 bp RNA linear VRL 02-FEB-2016 DEFINITION Zika virus isolate MEX/InDRE/14/2015 NS5 protein gene, partial cds. ACCESSION KU556802 VERSION KU556802.1 GI:984943318 KEYWORDS . SOURCE Zika virus ORGANISM Zika virus Viruses; ssRNA viruses; ssRNA positive-strand viruses, no DNA stage; Flaviviridae; Flavivirus; Spondweni virus group. REFERENCE 1 (bases 1 to 749) AUTHORS Diaz-Quinonez,J.A., Vazquez-Pichardo,M., Nunez-Leon,A., Torres-Rodriguez,M.L., Escobar-Escamilla,N., Wong-Arambula,C., Torres-Longoria,B., Lopez-Martinez,I., Ruiz-Matus,C., Kuri-Morales,P.A. and Ramirez-Gonzalez,J.E. TITLE Identification of Zika Virus in Mexico JOURNAL Unpublished REFERENCE 2 (bases 1 to 749) AUTHORS Vazquez-Pichardo,M., Nunez-Leon,A., Torres-Rodriguez,M.L., Rosales-Jimenez,C., Torres-Olmos,Y.A., Perez-Meza,R., Aparicio-Antonio,A.M., Herrera-Bautista,R.M., Wong-Arambula,C., Rodriguez-Maldonado,A.P., Escobar-Escamilla,N., Torres-Longoria,B., Lopez-Martinez,I., Ramirez-Gonzalez,J.E. and Diaz-Quinonez,J.A. TITLE Direct Submission JOURNAL Submitted (18-JAN-2016) Biologia Molecular y Validacion de Tecnicas, Instituto de Diagnostico y Referencia Epidemiologicos (InDRE), Francisco de P. Miranda 177 Col. Lomas de Plateros, Mexico, DF 01480, Mexico COMMENT ##Assembly-Data-START## Sequencing Technology :: Sanger dideoxy sequencing ##Assembly-Data-END## FEATURES Location/Qualifiers source 1..749 /organism="Zika virus" /mol_type="genomic RNA" /isolate="MEX/InDRE/14/2015" /isolation_source="serum" /host="Homo sapiens; 26 years old male" /db_xref="taxon:64320" /country="Mexico: Queretaro" /collection_date="22-Oct-2015" CDS <1..>749 /codon_start=1 /product="NS5 protein" /protein_id="AMC39589.1" /db_xref="GI:984943319" /translation="FEALGFLNEDHWMGRENSGGGVEGLGLQRLGYVLEEMSRIPGGR MYADDTAGWDTRISRFDLENEALITNQMEKGHRALALAIIKYTYQNKVVKVLRPAEKG KTVMDIISRQDQRGSGQVVTYALNTFTNLVVQLIRNMEAEEVLEMQDLWLLRRSEKVT NWLQSNGWDRLKRMAVSGDDCVVKPIDDRFAHALRFLNDMGKVRKDTQEWKPSTGWDN WEEVPFCSHHFNKLHLKDGRSIVVPCRHQDEL" ORIGIN 1 ttcgaagccc ttggattctt gaacgaggat cactggatgg ggagagagaa ctcaggaggt 61 ggtgttgaag ggctgggatt acaaagactc ggatatgtcc tagaagagat gagtcgcata 121 ccaggaggaa ggatgtatgc agatgacact gctggctggg acacccgcat cagcaggttt 181 gatctggaga atgaagctct aatcaccaac caaatggaga aagggcacag ggccttggca 241 ttggccataa tcaagtacac ataccaaaac aaagtggtaa aggtccttag accagctgaa 301 aaagggaaaa cagttatgga cattatttcg agacaagacc aaagggggag cggacaagtt 361 gtcacttacg ctcttaacac atttaccaac ctagtggtgc aactcattcg gaatatggag 421 gctgaggaag ttctagagat gcaagacttg tggctgctgc ggaggtcaga gaaagtgacc 481 aactggttgc agagcaacgg atgggatagg ctcaaacgaa tggcagtcag tggagatgat 541 tgcgttgtga agccaattga tgataggttt gcacatgccc tcaggttctt gaatgatatg 601 ggaaaagtta ggaaggacac acaagagtgg aaaccctcaa ctggatggga caactgggaa 661 gaagttccgt tttgctccca ccacttcaac aagctccatc tcaaggacgg gaggtccatt 721 gtggttccct gccgccacca agatgaact

InDRE released a partial Zika sequences collected in October 2015 in Queretaro from a 26M. http://www.ncbi.nlm.nih.gov/nuccore/KU556802.1

Sequences producing significant alignments:Select:AllNone Selected:0 AlignmentsDownloadGenBankGraphicsDistance tree of resultsShow/hide columns of the table presenting sequences producing significant alignmentsSequences producing significant alignments:Select for downloading or viewing reportsDescriptionMax scoreTotal scoreQuery coverE valueIdentAccessionSelect seq gb|KU321639.1|Zika virus strain ZikaSPH2015, complete genome1923019230100%0.099%KU321639.1Select seq gb|KU365779.1|Zika virus strain BeH819966 polyprotein gene, complete cds190981909899%0.099%KU365779.1Select seq gb|KU365780.1|Zika virus strain BeH815744 polyprotein gene, complete cds190891908999%0.099%KU365780.1Select seq gb|KU365777.1|Zika virus strain BeH818995 polyprotein gene, complete cds190801908099%0.099%KU365777.1Select seq gb|KU365778.1|Zika virus strain BeH819015 polyprotein gene, complete cds190641906499%0.099%KU365778.1Select seq gb|KJ776791.1|Zika virus strain H/PF/2013 polyprotein gene, complete cds190571905799%0.099%KJ776791.1Select seq gb|KU312312.1|Zika virus isolate Z1106033 polyprotein gene, complete cds185651856597%0.099%KU312312.1Select seq gb|JN860885.1|Zika virus isolate FSS13025 polyprotein gene, partial cds177981779896%0.098%JN860885.1Select seq gb|KF993678.1|Zika virus strain PLCal_ZV from Canada polyprotein gene, partial cds177511775194%0.099%KF993678.1Select seq gb|EU545988.1|Zika virus polyprotein gene, complete cds176431764396%0.098%EU545988.1Select seq gb|HQ234499.1|Zika virus isolate P6-740 polyprotein gene, partial cds164661646696%0.096%HQ234499.1

LOCUS KU509998 10676 bp RNA linear VRL 02-FEB-2016 DEFINITION Zika virus strain Haiti/1225/2014, complete genome. ACCESSION KU509998 VERSION KU509998.1 GI:983657312 KEYWORDS . SOURCE Zika virus ORGANISM Zika virus Viruses; ssRNA viruses; ssRNA positive-strand viruses, no DNA stage; Flaviviridae; Flavivirus; Spondweni virus group. REFERENCE 1 (bases 1 to 10676) AUTHORS Lednicky,J.A., Morris,J.G. Jr., Beau De Rochars,V.M., Elbadry,M.A., Okech,B.A. and Loeb,J.C. TITLE Zika virus from a Haitian, December 2014 JOURNAL Unpublished REFERENCE 2 (bases 1 to 10676) AUTHORS Lednicky,J.A., Morris,J.G. Jr., Beau De Rochars,V.M., Elbadry,M.A., Okech,B.A. and Loeb,J.C. TITLE Direct Submission JOURNAL Submitted (10-JAN-2016) Environmental and Global Health, University of Florida - Gainesville, 1225 Center Drive, Room 4155, Gainesville, FL 32610, USA COMMENT ##Assembly-Data-START## Sequencing Technology :: Sanger dideoxy sequencing ##Assembly-Data-END## FEATURES Location/Qualifiers source 1..10676 /organism="Zika virus" /mol_type="genomic RNA" /strain="Haiti/1225/2014" /isolation_source="plasma" /host="Homo sapiens" /db_xref="taxon:64320" /country="Haiti" /collection_date="12-Dec-2014" /note="genotype: Asian" 5'UTR 1..105 CDS 106..10377 /note="contains structural and non-structural proteins" /codon_start=1 /product="polyprotein" /protein_id="AMB37295.1" /db_xref="GI:983657313" /translation="MKNPKKKSGGFRIVNMLKRGVARVSPFGGLKRLPAGLLLGHGPI RMVLAILAFLRFTAIKPSLGLINRWGSVGKKEAMEIIKKFKKDLAAMLRIINARKEKK RRGADTSVGIVGLLLTTAMAAEVTRRGSAYYMYLDRNDAGEAISFPTTLGMNKCYIQI MDLGHMCDATMSYECPMLDEGVEPDDVDCWCNTTSTWVVYGTCHHKKGEARRSRRAVT LPSHSTRKLQTRSQTWLESREYTKHLIRVENWIFRNPGFALAAAAIAWLLGSSTSQKV IYLVMILLIAPAYSIRCIGVSNRDFVEGMSGGTWVDVVLEHGGCVTVMAQDKPTVDIE LVTTTVSNMAEVRSYCYEASISDMASDSRCPTQGEAYLDKQSDTQYVCKRTLVDRGWG NGCGLFGKGSLVTCAKFACSKKMTGKSIQPENLEYRIMLSVHGSQHSGMIVNDTGHET DENRAKVEITPNSPRAEATLGGFGSLGLDCEPRTGLDFSDLYYLTMNNKHWLVHKEWF HDIPLPWHAGADTGTPHWNNKEALVEFKDAHAKRQTVVVLGSQEGAVHTALAGALEAE MDGAKGRLSSGHLKCRLKMDKLRLKGVSYSLCTAAFTFTKIPAETLHGTVTVEVQYAG TDGPCKVPAQMAVDMQTLTPVGRLITANPVITESTENSKMMLELDPPFGDSYIVIGVG EKKITHHWHRSGSTIGKAFEATVRGAKRMAVLGDTAWDFGSVGGALNSLGKGIHQIFG AAFKSLFGGMSWFSQILIGTLLMWLGLNTKNGSISLMCLALGGVLIFLSTAVSADVGC SVDFSKKETRCGTGVFVYNDVEAWRDRYKYHPDSPRRLAAAVKQAWEDGICGISSVSR MENIMWRSVEGELNAILEENGVQLTVVVGSVKNPMWRGPQRLPVPVNELPHGWKAWGK SHFVRAAKTNNSFVVDGDTLKECPLKHRAWNSFLVEDHGFGVFHTSVWLKVREDYSLE CDPAVIGTAVKGKEAVHSDLGYWIESEKNDTWRLKRAHLIEMKTCEWPKSHTLWTDGI EESDLIIPKSLAGPLSHHNTREGYRTQMKGPWHSEELEIRFEECPGTKVHVEETCGTR GPSLRSTTASGRVIEEWCCRECTMPPLSFRAKDGCWYGMEIRPRKEPESNLVRSMVTA GSTDHMDHFSLGVLVILLMVQEGLKKRMTTKIIISTSMAVLVAMILGGFSMSDLAKLA ILMGATFAEMNTGGDVAHLALIAAFKVRPALLVSFIFRANWTPRESMLLALASCLLQT AISALEGDLMVLINGFALAWLAIRAMVVPRTDNITLAILAALTPLARGTLLVAWRAGL ATCGGFMLLSLKGKGSVKKNLPFVMALGLTAVRLVDPINVVGLLLLTRSGKRSWPPSE VLTAVGLICALAGGFAKADIEMAGPMAAVGLLIVSYVVSGKSVDMYIERAGDITWEKD AEVTGNSPRLDVALDESGDFSLVEDDGPPMREIILKVVLMTICGMNPIAIPFAAGAWY VYVKTGKRSGALWDVPAPKEVKKGETTDGVYRVMTRRLLGSTQVGVGVMQEGVFHTMW HVTKGSALRSGEGRLDPYWGDVKQDLVSYCGPWKLDAAWDGHSEVQLLAVPPGERARN IQTLPGIFKTKDGDIGAVALDYPAGTSGSPILDKCGRVIGLYGNGVVIKNGSYVSAIT QGRREEETPVECFEPSMLKKKQLTVLDLHPGAGKTRRVLPEIVREAIKTRLRTVILAP TRVVAAEMEEALRGLPVRYMTTAVNVTHSGTEIVDLMCHATFTSRLLQPIRVPNYNLY IMDEAHFTDPSSIAARGYISTRVEMGEAAAIFMTATPPGTRDAFPDSNSPIMDTEVEV PERAWSSGFDWVTDYSGKTVWFVPSVRNGNEIAACLTKAGKRVIQLSRKTFETEFQKT KHQEWDFVVTTDISEMGANFKADRVIDSRRCLKPVILDGERVILAGPMPVTHASAAQR RGRIGRNPNKPGDEYLYGGGCAETDEDHAHWLEARMLLDNIYLQDGLIASLYRPEADK VAAIEGEFKLRTEQRKTFVELMKRGDLPVWLAYQVASAGITYTDRRWCFDGTTNNTIM EDSVPAEVWTRHGEKRVLKPRWMDARVCSDHAALKSFKEFAAGKRGAAFGVMEALGTL PGHMTERFQEAIDNLAVLMRAETGSRPYKAAAAQLPETLETIMLLGLLGTVSLGIFFV LMRNKGIGKMGFGMVTLGASAWLMWLSEIEPARIACVLIVVFLLLVVLIPEPEKQRSP QDNQMAIIIMVAVGLLGLITANELGWLERTKSDLSHLMGRREEGATMGFSMDIDLRPA SAWAIYAALTTFITPAVQHAVTTSYNNYSLMAMATQAGVLFGMGKGMPFYAWDFGVPL LMIGCYSQLTPLTLIVAIILLVAHYMYLIPGLQAAAARAAQKRTAAGIMKNPVVDGIV VTDIDTMTIDPQVEKKMGQVLLMAVAVSSAILSRTAWGWGEAGALITAATSTLWEGSP NKYWNSSTATSLCNIFRGSYLAGASLIYTVTRNAGLVKRRGGGTGETLGEKWKARLNQ MSALEFYSYKKSGITEVCREEARRALKDGVATGGHAVSRGSAKLRWLVERGYLQPYGK VIDLGCGRGGWSYYAATIRKVQEVKGYTKGGPGHEEPVLVQSYGWNIVRLKSGVDVFH MAAEPCDTLLCDIGESSSSPEVEEARTLRVLSMVGDWLEKRPGAFCIKVLCPYTSTMM ETLERLQRRYGGGLVRVPLSRNSTHEMYWVSGAKSNTIKSVSTTSQLLLGRMDGPRRP VKYEEDVNLGSGTRAVVSCAEAPNMKIIGNRIERIRSEHAETWFFDENHPYRTWAYHG SYEAPTQGSASSLINGVVRLLSKPWDVVTGVTGIAMTDTTPYGQQRVFKEKVDTRVPD PQEGTRQVMSMVSSWLWKELGKHKRPRVCTKEEFINKVRSNAALGAIFEEEKEWKTAV EAVNDPRFWALVDKEREHHLRGECQSCVYNMMGKREKKQGEFGKAKGSRAIWYMWLGA RFLEFEALGFLNEDHWMGRENSGGGVEGLGLQRLGYVLEEMSRIPGGRMYADDTAGWD TRISRFDLENEALITNQMEKGHRALALAIIKYTYQNKVVKVLRPAEKGKTVMDIISRQ DQRGSGQVVTYALNTFTNLVVQLIRNMEAEEVLEMQDLWLLRRSEKVTNWLQSNGWDR LKRMAVSGDDCVVKPIDDRFAHALRFLNDMGKVRKDTQEWKPSTGWDNWEEVPFCSHH FNKLHLKDGRSIVVPCRHQDELIGRARVSPGAGWSIRETACLAKSYAQMWQLLYFHRR DLRLMANAICSSVPVDWVPTGRTTWSIHGKGEWMTTEDMLVVWNRVWIEENDHMEDKT PVTKWTDIPYLGKREDLWCGSLIGHRPRTTWAENIKNTVNMVRRIIGDEEKYMDYLST QVRYLGEEGSTPGVL" mat_peptide 106..480 /product="capsid protein" mat_peptide 481..750 /product="propeptide" mat_peptide 751..975 /product="membrane protein" mat_peptide 2491..3576 /product="NS1" mat_peptide 3577..4230 /product="NS2A" mat_peptide 4231..4662 /product="NS2B" mat_peptide 4663..6471 /product="NS3" mat_peptide 6472..6912 /product="NS4A" mat_peptide 6913..8418 /product="NS4B" mat_peptide 8419..10374 /product="NS5" 3'UTR 10378..10676 ORIGIN 1 gttgttactg ttgctgactc agactgcgac agttcgagtt tgaagcgaaa gctagcaaca 61 gtatcaacag gttttatttg gatttggaaa cgagagtttc tggtcatgaa aaacccaaaa 121 aagaaatccg gaggattccg gattgtcaat atgctaaaac gcggagtagc ccgtgtgagc 181 ccctttgggg gcttgaagag gctgccagcc ggacttctgc tgggtcatgg gcccatcagg 241 atggtcttgg caattctagc ctttttgaga ttcacggcaa tcaagccatc actgggtctc 301 atcaatagat ggggttcagt ggggaaaaaa gaggctatgg aaataataaa gaagttcaag 361 aaagatctgg ctgccatgct gagaataatc aatgctagga aggagaagaa gagacgaggc 421 gcagatacta gtgtcggaat tgttggcctc ctgctgacca cagctatggc agcggaggtc 481 actagacgtg ggagtgcata ctatatgtac ttggacagaa acgatgctgg ggaggccata 541 tcttttccaa ccacattggg gatgaataag tgttatatac agatcatgga tcttggacac 601 atgtgtgatg ccaccatgag ctatgaatgc cctatgctgg atgagggggt ggaaccagat 661 gacgtcgatt gttggtgcaa cacgacgtca acttgggttg tgtacggaac ctgccatcac 721 aaaaaaggtg aagcacggag atctagaaga gctgtgacgc tcccctccca ttccactagg 781 aagctgcaaa cgcggtcgca aacctggttg gaatcaagag aatacacaaa gcacttgatt 841 agagtcgaaa attggatatt caggaaccct ggcttcgcgt tagcagcagc tgccatcgct 901 tggcttttgg gaagctcaac gagccaaaaa gtcatatact tggtcatgat actgctgatt 961 gccccggcat acagcatcag gtgcatagga gtcagcaata gggactttgt ggaaggtatg 1021 tcaggtggga cttgggttga tgttgtcttg gaacatggag gttgtgtcac cgtaatggca 1081 caggacaaac cgactgtcga catagagctg gttacaacaa cagtcagcaa catggcggag 1141 gtaagatcct actgctatga ggcatcaata tcagacatgg cttcggacag ccgctgccca 1201 acacaaggtg aagcctacct tgacaagcaa tcagacactc aatatgtctg caaaagaacg 1261 ttagtggaca gaggctgggg aaatggatgt ggactttttg gcaaagggag tctggtgaca 1321 tgcgctaagt ttgcatgctc caagaaaatg accgggaaga gcatccagcc agagaatctg 1381 gagtaccgga taatgctgtc agttcatggc tcccagcaca gtgggatgat cgttaatgac 1441 acaggacatg aaactgatga gaatagagcg aaggttgaga taacgcccaa ttcaccaaga 1501 gccgaagcca ccctgggggg ttttggaagc ctaggacttg attgtgaacc gaggacaggc 1561 cttgactttt cagatttgta ttacttgact atgaataaca agcactggtt ggttcacaag 1621 gagtggttcc acgacattcc attaccttgg cacgctgggg cagacaccgg aactccacac 1681 tggaacaaca aagaagcact ggtagagttc aaggacgcac atgccaaaag gcaaactgtc 1741 gtggttctag ggagtcaaga aggagcagtt cacacggccc ttgctggagc tctggaggct 1801 gagatggatg gtgcaaaggg aaggctgtcc tctggccact tgaaatgtcg cctgaaaatg 1861 gataaactta gattgaaggg cgtgtcatac tccttgtgta ccgcagcgtt cacattcacc 1921 aagatcccgg ctgaaacact gcacgggaca gtcacagtgg aggtacagta cgcagggaca 1981 gatggacctt gcaaggttcc agctcagatg gcggtggaca tgcaaactct gaccccagtt 2041 gggaggttga taaccgctaa ccccgtaatc actgaaagca ctgagaactc taagatgatg 2101 ctggaacttg atccaccatt tggggactct tacattgtca taggagtcgg ggagaagaag 2161 atcacccacc actggcacag gagtggcagc accattggaa aagcatttga agccactgtg 2221 agaggtgcca agagaatggc agtcttggga gacacagcct gggactttgg atcagttgga 2281 ggcgctctca actcattggg caagggcatc catcaaattt ttggagcagc tttcaaatca 2341 ttgtttggag gaatgtcctg gttctcacaa attctcattg gaacgttgct gatgtggttg 2401 ggtctgaaca caaagaatgg atctatttcc cttatgtgct tggccttagg gggagtgttg 2461 atcttcttat ccacagccgt ctctgctgat gtggggtgct cggtggactt ctcaaagaag 2521 gagacgagat gcggtacagg ggtgttcgtc tataacgacg ttgaagcctg gagggacagg 2581 tacaagtacc atcctgactc cccccgtaga ttggcagcag cagtcaagca agcctgggaa 2641 gatggtatct gcgggatctc ctctgtttca agaatggaaa acatcatgtg gagatcagta 2701 gaaggggagc tcaacgcaat cctggaagag aatggagttc aactgacggt cgttgtggga 2761 tctgtaaaaa accccatgtg gagaggtcca cagagattgc ccgtgcctgt gaacgagctg 2821 ccccacggct ggaaggcttg ggggaaatcg cacttcgtca gagcagcaaa gacaaataac 2881 agctttgtcg tggatggtga cacactgaag gaatgcccac tcaaacatag agcatggaac 2941 agctttcttg tggaggatca tgggttcggg gtatttcaca ctagtgtctg gctcaaggtt 3001 agagaagatt attcattaga gtgtgatcca gccgttattg gaacagctgt taagggaaag 3061 gaggctgtac acagtgatct aggctactgg attgagagtg agaagaatga cacatggagg 3121 ctgaagaggg cccatctgat cgagatgaaa acatgtgaat ggccaaagtc ccacacattg 3181 tggacagatg gaatagaaga gagtgatctg atcataccca agtctttagc tgggccactc 3241 agccatcaca ataccagaga gggctacagg acccaaatga aagggccatg gcacagtgaa 3301 gagcttgaaa ttcggtttga ggaatgccca ggcactaagg tccacgtgga ggaaacatgt 3361 ggaacaagag gaccatctct gagatcaacc actgcaagcg gaagggtgat cgaggaatgg 3421 tgctgcaggg agtgcacaat gcccccactg tcgttccggg ctaaagatgg ctgttggtat 3481 ggaatggaga taaggcccag gaaagaacca gaaagcaact tagtaaggtc aatggtgact 3541 gcaggatcaa ctgatcacat ggatcacttc tcccttggag tgcttgtgat tctgctcatg 3601 gtgcaggaag ggctgaagaa gagaatgacc acaaagatca tcataagcac atcaatggca 3661 gtgctggtag ctatgatcct gggaggattt tcaatgagtg acctggctaa gcttgcaatt 3721 ttgatgggtg ccaccttcgc ggaaatgaac actggaggag atgtagctca tctggcgctg 3781 atagcggcat tcaaagtcag accagcgttg ctggtatctt tcatcttcag agctaattgg 3841 acaccccgtg aaagcatgct gctggccttg gcctcgtgtc ttttgcaaac tgcgatctcc 3901 gccttggaag gcgacctgat ggttctcatc aatggttttg ctttggcctg gttggcaata 3961 cgagcgatgg ttgttccacg cactgataac atcaccttgg caatcctggc tgctctgaca 4021 ccactggccc ggggcacact gcttgtggcg tggagagcag gccttgctac ttgcgggggg 4081 tttatgctcc tctctctgaa gggaaaaggc agtgtgaaga agaacttacc atttgtcatg 4141 gccctgggac taaccgctgt gaggctggtc gaccccatca acgtggtggg gctgctgttg 4201 ctcacaagga gtgggaagcg gagctggccc cctagcgaag tactcacagc tgttggcctg 4261 atatgcgcat tggctggagg gttcgccaag gcagatatag agatggctgg gcccatggcc 4321 gcggtcggtc tgctaattgt cagttacgtg gtctcaggaa agagtgtgga catgtacatt 4381 gaaagagcag gtgacatcac atgggaaaaa gatgcggaag tcactggaaa cagtccccgg 4441 ctcgatgtgg cgctagatga gagtggtgat ttctccctgg tggaggatga cggtcccccc 4501 atgagagaga tcatactcaa ggtggtcctg atgaccatct gtggcatgaa cccaatagcc 4561 ataccctttg cagctggagc gtggtacgta tacgtgaaga ctggaaaaag gagtggtgct 4621 ctatgggatg tgcctgctcc caaggaagta aaaaaggggg agaccacaga tggagtgtac 4681 agagtaatga ctcgtagact gctaggttca acacaagttg gagtgggagt tatgcaagag 4741 ggggtctttc acactatgtg gcacgtcaca aaaggatccg cgctgagaag cggtgaaggg 4801 agacttgatc catactgggg agatgtcaag caggatctgg tgtcatactg tggtccatgg 4861 aagctagatg ccgcctggga cgggcacagc gaggtgcagc tcttggccgt gccccccgga 4921 gagagagcga ggaacatcca gactctgccc ggaatattta agacaaagga tggggacatt 4981 ggagcggttg cgctggatta cccagcagga acttcaggat ctccaatcct agacaagtgt 5041 gggagagtga taggacttta tggcaatggg gtcgtgatca aaaatgggag ttatgttagt 5101 gccatcaccc aagggaggag ggaggaagag actcctgttg agtgcttcga gccttcgatg 5161 ctgaagaaga agcagctaac tgtcttagac ttgcatcctg gagctgggaa aaccaggaga 5221 gttcttcctg aaatagtccg tgaagccata aaaacaagac tccgtactgt gatcttagct 5281 ccaaccaggg ttgtcgctgc tgaaatggag gaagccctta gagggcttcc agtgcgttat 5341 atgacaacag cagtcaatgt cacccactct ggaacagaaa tcgtcgactt aatgtgccat 5401 gccaccttca cttcacgtct actacagcca atcagagtcc ccaactataa tctgtatatt 5461 atggatgagg cccacttcac agatccctca agtatagcag caagaggata catttcaaca 5521 agggttgaga tgggcgaggc ggctgccatc ttcatgaccg ccacgccacc aggaacccgt 5581 gacgcatttc cggactccaa ctcaccaatt atggacaccg aagtggaagt cccagagaga 5641 gcctggagct caggctttga ttgggtgacg gattattctg gaaaaacagt ttggtttgtt 5701 ccaagcgtga ggaacggcaa tgagatcgca gcttgtctga caaaggctgg aaaacgggtc 5761 atacagctca gcagaaagac ttttgagaca gagttccaga aaacaaaaca tcaagagtgg 5821 gactttgtcg tgacaactga catttcagag atgggcgcca actttaaagc tgaccgtgtc 5881 atagattcca ggagatgcct aaagccggtc atacttgatg gcgagagagt cattctggct 5941 ggacccatgc ctgtcacaca tgccagcgct gcccagagga gggggcgcat aggcaggaat 6001 cccaacaaac ctggagatga gtatctgtat ggaggtgggt gcgcagagac tgacgaagac 6061 catgcacact ggcttgaagc aagaatgctc cttgacaata tttacctcca agatggcctc 6121 atagcctcgc tctatcgacc tgaggccgac aaagtagcag ccattgaggg agagttcaag 6181 cttaggacgg agcaaaggaa gacctttgtg gaactcatga aaagaggaga tcttcctgtt 6241 tggctggcct atcaggttgc atctgccgga ataacctaca cagatagaag atggtgcttt 6301 gatggcacga ccaacaacac cataatggaa gacagtgtgc cggcagaggt gtggaccaga 6361 cacggagaga aaagagtgct caaaccgagg tggatggacg ccagagtttg ttcagatcat 6421 gcggccctga agtcattcaa ggagtttgcc gctgggaaaa gaggagcggc ttttggagtg 6481 atggaagccc tgggaacact gccaggacac atgacagaga gattccagga agccattgac 6541 aacctcgctg tgctcatgcg ggcagagact ggaagcaggc cttacaaagc cgcggcggcc 6601 caattgccgg agaccctaga gaccattatg cttttggggt tgctgggaac agtctcgctg 6661 ggaatctttt tcgtcttgat gaggaacaag ggcataggga agatgggctt tggaatggtg 6721 actcttgggg ccagcgcatg gctcatgtgg ctctcggaaa ttgagccagc cagaattgca 6781 tgtgtcctca ttgttgtgtt cctattgctg gtggtgctca tacctgagcc agaaaagcaa 6841 agatctcccc aggacaacca aatggcaatc atcatcatgg tagcagtagg tcttctgggc 6901 ttgattaccg ccaatgaact cggatggttg gagagaacaa agagtgacct aagccatcta 6961 atgggaagga gagaggaggg ggcaaccatg ggattctcaa tggacattga cctgcggcca 7021 gcctcagctt gggccatcta tgctgccttg acaactttca ttaccccagc cgtccaacat 7081 gcagtgacca cttcatacaa caactactcc ttaatggcga tggccacgca agctggagtg 7141 ttgtttggta tgggcaaagg gatgccattc tacgcatggg actttggagt cccgctgcta 7201 atgataggtt gctactcaca attaacgccc ctgaccctaa tagtggccat cattttgctc 7261 gtggcgcact acatgtactt gatcccaggg ctgcaggcag cagctgcgcg tgctgcccag 7321 aagagaacgg cagctggcat catgaagaac cctgttgtgg atggaatagt ggtgactgac 7381 attgacacaa tgacaattga cccccaagtg gagaaaaaga tgggacaggt gctactcatg 7441 gcagtagccg tctccagcgc catactgtcg cggaccgcct gggggtgggg ggaggctggg 7501 gccctgatca cagccgcaac ttccactttg tgggaaggct ctccgaacaa gtactggaac 7561 tcctctacag ccacttcact gtgtaacatt tttaggggaa gttacttggc tggagcttct 7621 ctaatctaca cagtaacaag aaacgctggc ttggtcaaga gacgtggggg tggaacagga 7681 gagaccctgg gagagaaatg gaaggcccgc ttgaaccaga tgtcggccct ggagttctac 7741 tcctacaaaa agtcaggcat caccgaggtg tgcagagaag aggcccgccg cgccctcaag 7801 gacggtgtgg caacgggagg ccatgctgtg tcccgaggaa gtgcaaagct gagatggttg 7861 gtggagcggg gatacctgca gccctatgga aaggtcattg atcttggatg tggcagaggg 7921 ggctggagtt actacgccgc caccatccgc aaagttcaag aagtgaaagg atacacaaaa 7981 ggaggccctg gtcatgaaga acccgtgttg gtgcaaagct atgggtggaa catagtccgt 8041 cttaagagtg gggtggacgt ctttcatatg gcggctgagc cgtgtgacac gttgctgtgt 8101 gacataggtg agtcatcatc tagtcctgaa gtggaagaag cacggacgct cagagtcctc 8161 tccatggtgg gggattggct tgaaaaaaga ccaggagcct tttgtataaa agtgttgtgc 8221 ccatacacca gcactatgat ggaaaccctg gagcgactgc agcgtaggta tgggggagga 8281 ctggtcagag tgccactctc ccgcaactct acacatgaga tgtactgggt ctctggagcg 8341 aaaagcaaca ccataaaaag tgtgtccacc acgagccagc tcctcttggg gcgcatggac 8401 gggcctagga ggccagtgaa atatgaggag gatgtgaatc tcggctctgg cacgcgggct 8461 gtggtaagct gcgctgaagc tcccaacatg aagatcattg gtaaccgcat tgaaaggatc 8521 cgcagtgagc acgcggaaac gtggttcttt gacgagaacc acccatatag gacatgggct 8581 taccatggaa gctatgaggc ccccacacaa gggtcagcgt cctctctaat aaacggggtt 8641 gtcaggctcc tgtcaaaacc ctgggatgtg gtgactggag tcacaggaat agccatgacc 8701 gacaccacac cgtatggtca gcaaagagtt ttcaaggaaa aagtggacac tagggtgcca 8761 gacccccaag aaggcactcg tcaggttatg agcatggtct cttcctggtt gtggaaagag 8821 ctaggcaaac acaaacggcc acgagtctgt accaaagaag agttcatcaa caaggttcgt 8881 agcaatgcag cattaggggc aatatttgaa gaggaaaaag agtggaagac tgcagtggaa 8941 gctgtgaacg atccaaggtt ctgggctcta gtggacaagg aaagagagca ccacctgaga 9001 ggagagtgcc agagttgtgt gtacaacatg atgggaaaaa gagaaaagaa acaaggggaa 9061 tttggaaagg ccaagggcag ccgcgccatc tggtatatgt ggctaggggc tagatttcta 9121 gagttcgaag cccttggatt cttgaacgag gatcactgga tggggagaga gaactcagga 9181 ggtggtgttg aagggctggg attacaaaga ctcggatatg tcctagaaga gatgagtcgc 9241 ataccaggag gaaggatgta tgcagatgac actgctggct gggacacccg catcagcagg 9301 tttgatctgg agaatgaagc tctaatcacc aaccaaatgg agaaagggca cagggccttg 9361 gcattggcca taatcaagta cacataccaa aacaaagtgg taaaggtcct tagaccagct 9421 gaaaaaggga agacagttat ggacattatt tcgagacaag accaaagggg gagcggacaa 9481 gttgtcactt acgctcttaa cacatttacc aacctagtgg tgcaactcat tcggaatatg 9541 gaggctgagg aagttctaga gatgcaagac ttgtggctgc tgcggaggtc agagaaagtg 9601 accaactggt tgcagagcaa cggatgggat aggctcaaac gaatggcagt cagtggagat 9661 gattgcgttg tgaagccaat tgatgatagg tttgcacatg ccctcaggtt cttgaatgat 9721 atgggaaaag ttaggaagga cacacaagag tggaaaccct caactggatg ggacaactgg 9781 gaagaagttc cgttttgctc ccaccacttc aacaagctcc atctcaagga cgggaggtcc 9841 attgtggttc cctgccgcca ccaagatgaa ctgattggcc gggcccgcgt ctctccaggg 9901 gcgggatgga gcatccggga gactgcttgc ctagcaaaat catatgcgca aatgtggcag 9961 ctcctttatt tccacagaag ggacctccga ctgatggcca atgccatttg ttcatctgtg 10021 ccagttgact gggttccaac tgggagaact acctggtcaa tccatggaaa gggagaatgg 10081 atgaccactg aagacatgct tgtggtgtgg aacagagtgt ggattgagga gaacgaccac 10141 atggaagaca agaccccagt tacgaaatgg acagacattc cctatttggg aaaaagggaa 10201 gacttgtggt gtggatctct catagggcac agaccgcgca ccacctgggc tgagaacatt 10261 aaaaacacag tcaacatggt gcgcaggatc ataggtgatg aagaaaagta catggactac 10321 ctatccaccc aagttcgcta cttgggtgaa gaagggtcta cacctggagt gctgtaagca 10381 ccaatcttaa tgttgtcagg cctgctagtc agccacagct tggggaaagc tgtgcagcct 10441 gtgacccccc caggagaagc tgggaaacca agcctatagt caggccgaga acgccatggc 10501 acggaagaag ccatgctgcc tgtgagcccc tcagaggaca ctgagtcaaa aaaccccacg 10561 cgcttggagg cgcaggatgg gaaaagaagg tggcgacctt ccccaccctt caatctgggg 10621 cctgaactgg agatcagctg tggatctcca gaagagggac tagtggttag aggaga

University of Florida has released a full Zika sequence from a December 2014 Haiti outbreak, which is virtually identical to the 2015 sequence from Brazil, ZikaSPH2015. http://www.ncbi.nlm.nih.gov/nuccore/KU509998.1

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

Surgeon General Dr. John Armstrong’s Daily Zika UpdateBy Florida Department of Health, Office of Communications February 05, 2016 Press ReleaseSHARE THIS PAGEFacebookTwitter Feb. 5, 2016 SURGEON GENERAL DR. JOHN ARMSTRONG'S DAILY ZIKA UPDATE 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 Zika virus, beginning this Monday, State Surgeon General and Secretary of Health Dr. John Armstrong will issue a daily Zika update at 2 p.m. each day. Updates will include a CDC-confirmed Zika case count by county and information to better keep Floridians prepared. County Number of Cases (all travel related) Hillsborough 3 Miami-Dade 5 Lee 2 Santa Rosa 1 Broward 1 St. Johns 1 Osceola 1 Total 14 All cases are travel-associated. There have been no locally-acquired cases of Zika virus in Florida. None of the confirmed cases involve pregnant women. For more information on Zika virus, click here. State Surgeon General and Secretary of Health Dr. John Armstrong urges Floridians to drain standing water, no matter how seemingly small. A couple drops of water in a bottle cap can be a breeding location for mosquitoes. More Information on DOH action on Zika: According to the CDC, Zika fever illness is generally mild with a rash, fever and joint pain. CDC researchers are examining a possible link between the virus and unborn babies exposed during pregnancy.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.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; covering windows with screens; and other basic precautions.Yesterday, Governor Scott asked:The CDC to provide at least 1,000 Zika antibody tests so the state can test individuals, especially pregnant women and new mothers, who have traveled to affected areas and had symptoms of Zika. The antibody test allows the state to see if individuals ever had the Zika virus. Florida currently has the capacity to test only 475 people.The CDC to conduct a conference call within the next two weeks to help train Florida hospital workers - especially OBGYN doctors and those who work with pregnant women - on how Zika is spread, its symptoms, treatments and proper precautions.The CDC has yet to fulfill either request.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.

Florida Health cites new Zika cases in St Johns and Osceola Co travelers. http://www.floridahealth.gov/newsroom/2016/02/020516-zika-update.html

The best test for the babies is an antibody test on the CSF (cerebral spinal fluid),which involves an invasive procedure. Doing an invasive procedure on a normal baby, which is not beneficial to the baby, is problematic.

Fri Feb 5, 2016 12:53pm EST Related: HEALTHPuerto Rico declares public health emergency over Zika virusBY MEGAN DAVIES AND LUC COHENPuerto Rico Governor Alejandro Garcia Padilla on Friday declared a public health emergency because of the mosquito-borne Zika virus, a government statement said. Puerto Rican health officials have confirmed 22 cases, including a pregnant woman and a man with Zika who developed Guillain-Barre syndrome, a separate government statement said. Guillain-Barre is a rare disorder in which the body's immune system attacks the nerves. Health authorities would track the Zika cases and report results weekly, the government said. The virus is having an impact on tourism, with some tourist groups canceling reservations, particularly weddings in hotels on the Caribbean island. There were no reports of conventions being canceled, the statement said. Puerto Rico reported its first case of Zika in December, the virus having emerged at a difficult time for the U.S. territory as it tries to resolve an economic and fiscal crisis. The island, struggling to restructure its debt, will run out of fiscal emergency measures by June, the Government Development Bank president said on Friday. (Additional reporting by a contributor in San Juan) http://www.reuters.com/article/us-health-zika-puertorico-idUSKCN0VE250

DCHHS Advises Dallas County Residents to Follow CDC Zika Virus Guidance DALLAS (Feb. 5, 2016) – Dallas County Health and Human Services (DCHHS) is advising Dallas County residents to be aware of new guidelines from the Centers for Disease Control and Prevention (CDC) regarding Zika virus. “DCHHS is staying in constant communication with local, state, and federal partners to ensure we have the most current information,” said Zachary Thompson, DCHHS director. “In addition to the usual recommendations we have been giving Dallas County residents, we encourage them to be aware of and follow CDC guidance as well to protect themselves and their loved ones from all mosquito-borne viruses, including Zika.” DCHHS recommends everyone use the 4Ds to reduce the chance of being bitten by a mosquito: · DEET All Day, Every Day: Whenever you’re outside, use insect repellents that contain DEET or other EPA approved repellents and follow instructions. · Dress: Wear long, loose, and light-colored clothing outside. · Drain: Drain or treat all standing water in and around your home or workplace. · Dusk & Dawn: Limit outdoor activities during dusk and dawn when mosquitoes are most active. Standing water can be treated with EPA-approved larvicides that are available for retail purchase. Larvicides are products used to kill immature mosquitoes before they become adults. Larvicides are applied directly to water sources that hold mosquito eggs, larvae, or pupae. When used well, larvicides can help reduce the overall mosquito burden by limiting the number of mosquitoes that are produced, according to the CDC. Travelers can protect themselves further by doing the following:· Choose a hotel or lodging with air conditioning or screens on windows or doors.· Sleep under a mosquito bed net if you are outside or in a room that is not well-screened. Dr. Christopher Perkins, DCHHS medical director/health authority, said in addition to DCHHS’ traditional recommendations for preventing mosquito-borne viruses, the latest CDC guidance is important in helping prevent transmission and spread of Zika virus locally, and to pregnant women and women planning to become pregnant. “Pregnant women, those planning to become pregnant, and their partners traveling to or from areas where Zika virus is active should follow guidance from CDC,” said Perkins. “Furthermore, pregnant women should use condoms for the duration of their pregnancy or abstain from sexual activity altogether.” DCHHS plans to make updates on Zika virus as more information becomes available. Click here to see: CDC issues Interim Guidelines for Preventing Sexual Transmission of Zika Virus and Updated Interim Guidelines for Health Care Providers Caring for Pregnant Women and Women of Reproductive Age with Possible Zika Virus Exposure

DCHHS Advises Dallas County Residents to Follow CDC Zika Virus Guidance DALLAS (Feb. 5, 2016) – Dallas County Health and Human Services (DCHHS) is advising Dallas County residents to be aware of new guidelines from the Centers for Disease Control and Prevention (CDC) regarding Zika virus. “DCHHS is staying in constant communication with local, state, and federal partners to ensure we have the most current information,” said Zachary Thompson, DCHHS director. “In addition to the usual recommendations we have been giving Dallas County residents, we encourage them to be aware of and follow CDC guidance as well to protect themselves and their loved ones from all mosquito-borne viruses, including Zika.” DCHHS recommends everyone use the 4Ds to reduce the chance of being bitten by a mosquito: · DEET All Day, Every Day: Whenever you’re outside, use insect repellents that contain DEET or other EPA approved repellents and follow instructions. · Dress: Wear long, loose, and light-colored clothing outside. · Drain: Drain or treat all standing water in and around your home or workplace. · Dusk & Dawn: Limit outdoor activities during dusk and dawn when mosquitoes are most active. Standing water can be treated with EPA-approved larvicides that are available for retail purchase. Larvicides are products used to kill immature mosquitoes before they become adults. Larvicides are applied directly to water sources that hold mosquito eggs, larvae, or pupae. When used well, larvicides can help reduce the overall mosquito burden by limiting the number of mosquitoes that are produced, according to the CDC. Travelers can protect themselves further by doing the following:· Choose a hotel or lodging with air conditioning or screens on windows or doors.· Sleep under a mosquito bed net if you are outside or in a room that is not well-screened. Dr. Christopher Perkins, DCHHS medical director/health authority, said in addition to DCHHS’ traditional recommendations for preventing mosquito-borne viruses, the latest CDC guidance is important in helping prevent transmission and spread of Zika virus locally, and to pregnant women and women planning to become pregnant. “Pregnant women, those planning to become pregnant, and their partners traveling to or from areas where Zika virus is active should follow guidance from CDC,” said Perkins. “Furthermore, pregnant women should use condoms for the duration of their pregnancy or abstain from sexual activity altogether.” DCHHS plans to make updates on Zika virus as more information becomes available. Click here to see: CDC issues Interim Guidelines for Preventing Sexual Transmission of Zika Virus and Updated Interim Guidelines for Health Care Providers Caring for Pregnant Women and Women of Reproductive Age with Possible Zika Virus Exposure

Update: Interim Guidelines for Health Care Providers Caring for Pregnant Women and Women of Reproductive Age with Possible Zika Virus Exposure — United States, 2016Early Release / February 5, 2016 / 65(05);1–6 Format:Select onePDF [396 KB]Recommend on FacebookTweetTitilope Oduyebo, MD1,2; Emily E. Petersen, MD2; Sonja A. Rasmussen, MD3; Paul S. Mead, MD4; Dana Meaney-Delman, MD5; Christina M. Renquist, MPH6; Sascha R. Ellington, MSPH2; Marc Fischer, MD4; J. Erin Staples, MD, PhD4; Ann M. Powers, PhD4; Julie Villanueva, PhD4; Romeo R. Galang, MD1,7; Ada Dieke, DrPH1,2; Jorge L. Muñoz, PhD4; Margaret A. Honein, PhD6; Denise J. Jamieson, MD2 (View author affiliations) View suggested citation CDC has updated its interim guidelines for U.S. health care providers caring for pregnant women during a Zika virus outbreak (1). Updated guidelines include a new recommendation to offer serologic testing to asymptomatic pregnant women (women who do not report clinical illness consistent with Zika virus disease) who have traveled to areas with ongoing Zika virus transmission. Testing can be offered 2–12 weeks after pregnant women return from travel. This update also expands guidance to women who reside in areas with ongoing Zika virus transmission, and includes recommendations for screening, testing, and management of pregnant women and recommendations for counseling women of reproductive age (15–44 years). Pregnant women who reside in areas with ongoing Zika virus transmission have an ongoing risk for infection throughout their pregnancy. For pregnant women with clinical illness consistent with Zika virus disease,* testing is recommended during the first week of illness. For asymptomatic pregnant women residing in areas with ongoing Zika virus transmission, testing is recommended at the initiation of prenatal care with follow-up testing mid-second trimester. Local health officials should determine when to implement testing of asymptomatic pregnant women based on information about levels of Zika virus transmission and laboratory capacity. Health care providers should discuss reproductive life plans, including pregnancy intention and timing, with women of reproductive age in the context of the potential risks associated with Zika virus infection. Zika virus is primarily transmitted by Aedes aegypti mosquitoes, which are found throughout much of the region of the Americas, including parts of the United States (2,3). These mosquitoes can also transmit dengue and chikungunya viruses (4). The Zika virus outbreak continues to spread (http://www.cdc.gov/zika/geo/index.html), with ongoing Zika virus transmission recently reported in U.S. territories. Evidence suggesting an association of Zika virus infection with an increased risk for congenital microcephaly and other abnormalities of the brain and eye (5) prompted the World Health Organization to declare the Zika virus outbreak a Public Health Emergency of International Concern on February 1, 2016 (http://www.who.int/mediacentre/news/statements/2016/1st-emergency-committee-zika/en/). There is currently no vaccine or medication to prevent Zika virus infection. All travelers to or residents of areas with ongoing Zika virus transmission should be advised to strictly follow steps to avoid mosquito bites because of the potential for exposure to Zika, dengue, and chikungunya viruses (6). Aedes vector mosquitoes bite mostly during daylight hours; thus, protection from mosquito bites is required throughout the day (7). Prevention of mosquito bites includes wearing long-sleeved shirts, pants, permethrin-treated clothing, and using United States Environmental Protection Agency (EPA)-registered insect repellents. Insect repellents containing ingredients such as DEET, picaridin, and IR3535 are safe for use during pregnancy when used in accordance with the product label (6). To prevent human-to-mosquito-to-human transmission, persons infected with Zika, dengue, or chikungunya virus should protect themselves from mosquito exposure during the first week of illness. The number of mosquitoes in and around homes can be reduced by emptying standing water from containers, installing or repairing screens on windows and doors, and using air conditioning if available. Further information on preventing mosquito bites is available online (http://www.cdc.gov/features/stopmosquitoes/). Antiviral treatment is not currently available for Zika virus disease; treatment is supportive and includes rest, fluids, and analgesic and antipyretic medications. Aspirin and other nonsteroidal anti-inflammatory medications should be avoided until dengue virus infection can be ruled out (8). Dengue virus infection can cause serious complications, including hemorrhage and death, which might be substantially reduced by early recognition and supportive treatment (4,8). Pregnant women with fever should be treated with acetaminophen (9). Top Updated Recommendations for Testing Pregnant Women with a History of Travel to Areas with Ongoing Zika Virus TransmissionRecommendations for Zika virus testing of pregnant women who have a clinical illness consistent with Zika virus disease during or within 2 weeks of travel to areas with ongoing Zika virus transmission are unchanged from CDC recommendations released January 19, 2016 (1). Zika virus testing of maternal serum includes reverse transcription-polymerase chain reaction (RT-PCR) testing for symptomatic patients with onset of symptoms during the previous week; immunoglobulin M (IgM) and plaque-reduction neutralizing antibody testing should be performed on specimens collected ≥4 days after onset of symptoms (Figure 1) (1,10). Serologic testing for Zika virus can be offered to asymptomatic pregnant women who traveled to an area with ongoing Zika virus transmission (Figure 1); however, interpretation of results is complex. Because of cross-reactivity among related flaviviruses, such as dengue, yellow fever, and West Nile viruses, a positive IgM result can be difficult to interpret. Plaque-reduction neutralization testing (PRNT) can be performed to measure virus-specific neutralizing antibodies to Zika virus and other flaviviruses. The levels of neutralizing antibodies can then be compared between flaviviruses, but these tests might also be difficult to interpret in persons who were previously infected with or vaccinated against flaviviruses. However, a negative IgM result obtained 2–12 weeks after travel would suggest that a recent infection did not occur and could obviate the need for serial ultrasounds. Based on experience with other flaviviruses, IgM antibodies will be expected to be present at least 2 weeks after virus exposure and persist for up to 12 weeks (11–14). Information about the performance of serologic testing of asymptomatic persons is limited; a negative serologic test result obtained 2–12 weeks after travel cannot definitively rule out Zika virus infection. Given these challenges in interpreting serologic test results, health care providers should contact their state, local, or territorial health department for assistance with arranging testing and interpreting results. CDC is working with health departments and other organizations to rapidly increase the availability of testing for Zika virus. Top Guidelines for Pregnant Women Residing in Areas with Ongoing Zika Virus TransmissionPregnant women who reside in areas with ongoing Zika virus transmission should be evaluated for symptoms of Zika virus disease. For women who report clinical illness consistent with Zika virus disease, testing by RT-PCR should be performed on serum collected within 7 days of symptom onset. Because viremia decreases over time, a negative RT-PCR result from serum collected 5–7 days after symptom onset does not exclude Zika virus infection, and serologic testing should be performed. (http://www.aphl.org/Materials/CDCMemo_Zika_Chik_Deng_Testing_011916.pdf). A false positive IgM result is more likely among women residing in areas with ongoing Zika virus transmission than among travelers because of a higher likelihood of previous exposure to a related flavivirus. Pregnant women who do not report clinical illness consistent with Zika virus disease can be offered IgM testing upon initiation of prenatal care; among women with negative IgM results, repeat testing can be considered in the mid-second trimester because of the ongoing risk for Zika virus exposure and infection throughout pregnancy (Figure 2). Pregnant women with negative Zika virus IgM testing should receive routine prenatal care, including an assessment of pregnancy dating and an ultrasound at 18–20 weeks of gestation to assess fetal anatomy (15). The ultrasound should include careful evaluation of the fetus for brain anomalies, including microcephaly and intracranial calcifications. Because fetal microcephaly is most easily detected in the late second and early third trimesters of pregnancy (16), and because of ongoing potential exposure to Zika virus, health care providers might consider an additional fetal ultrasound later in pregnancy. Findings of fetal microcephaly or intracranial calcifications on prenatal ultrasound should prompt health care providers to repeat maternal IgM testing and consider amniocentesis, depending on gestational age. Zika virus testing can be performed on amniotic fluid using RT-PCR to inform clinical management (5). Based on experience with other congenital infections and a small number of prenatally-diagnosed fetal Zika virus infections (5,17), amniocentesis can be used to diagnose intrauterine infections (18). However, the performance of RT-PCR testing of amniotic fluid for Zika virus infection has not been evaluated. Furthermore, the risk for microcephaly or other anomalies when Zika virus RNA is detected in amniotic fluid is not known. Serial fetal ultrasounds should be considered to monitor fetal anatomy and growth every 3–4 weeks in pregnant women with positive or inconclusive Zika virus test results, and referral to a maternal-fetal medicine specialist is recommended. Testing is recommended at the time of delivery, including histopathologic examination of the placenta and umbilical cord, testing of frozen placental tissue and cord tissue for Zika virus RNA, and testing of cord serum (1,19). Guidelines for infants whose mothers have possible Zika virus infection are available (19). If a pregnant woman with Zika virus disease experiences a fetal loss, Zika virus RT-PCR and immunohistochemical staining should be performed on fetal tissues, including umbilical cord and placenta (1). Sexual transmission of Zika virus can occur, although there is limited data about the risk (20). The risk for sexual transmission of Zika virus can be eliminated by abstinence and reduced by correct and consistent use of condoms (21). Given the potential risks of maternal Zika virus infection, pregnant women whose male partners have or are at risk for Zika virus infection should consider using condoms or abstaining from sexual intercourse (21). Additional studies are needed to characterize the risk for sexual transmission of Zika virus; recommendations will be updated as more information becomes available. Top Special Considerations for Women of Reproductive Age Residing in Areas of Ongoing Zika Virus TransmissionCDC recommends that health care providers discuss pregnancy intention and reproductive options with women of reproductive age. Decisions regarding the timing of pregnancies are personal and complex; reproductive life plans can assist in making these decisions (22). Patient age, fertility, reproductive and medical history, as well as the values and preferences of the woman and her partner should be considered during discussions regarding pregnancy intentions and timing. In the context of the ongoing Zika virus transmission, preconception care should include a discussion of the signs and symptoms and the potential risks associated with Zika virus infection. Health care providers should discuss strategies to prevent unintended pregnancy with women who do not want to become pregnant; these strategies should include counseling on family planning and use of contraceptive methods. Safety, effectiveness, availability, and acceptability should be considered when selecting a contraceptive method (23). Approximately half of U.S. pregnancies each year are unintended (24); patients should be counseled to use the most effective contraceptive method that can be used correctly and consistently. For women desiring highly effective contraception, long acting reversible contraception, including contraceptive implants and intrauterine devices, might be the best choice (http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/PDF/Contraceptive_methods_508.pdf). When choosing a contraceptive method, the risk for sexually transmitted infections should also be considered; correct and consistent use of condoms reduces the risk for sexually transmitted infections. Strategies to prevent mosquito bites should be emphasized for women living in areas with ongoing Zika virus transmission who want to become pregnant. These strategies, including wearing pants and long-sleeved shirts, using FDA-approved insect repellents, ensuring that windows and doors have screens, and staying inside air conditioned spaces when possible, can reduce the risk for Zika virus infection and other vector-borne diseases. During preconception counseling visits, the potential risks of Zika virus infection acquired during pregnancy should be discussed. Women of reproductive age with current or previous laboratory-confirmed Zika virus infection should be counseled that there is no evidence that prior Zika virus infection poses a risk for birth defects in future pregnancies (7). This is because the viremia is expected to last approximately 1 week in patients with clinical illness (2,25). There is no current evidence to suggest that a fetus conceived after maternal viremia has resolved would be at risk for fetal infection (7). Top Corresponding author: Denise Jamieson, [email protected], 770-488-6377. Top 1Epidemic Intelligence Service, CDC; 2Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC; 3Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC; 4Arboviral Diseases Branch, National Center for Emerging and Zoonotic Infectious Diseases, CDC;5Office of the Director, National Center for Emerging and Zoonotic Infectious Diseases, CDC; 6Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, CDC; 7Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention, CDC. Top ReferencesPetersen EE, Staples JE, Meaney-Delman D, et al. Interim guidelines for pregnant women during a Zika virus outbreak—United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65:30–3. CrossRef PubMedHayes EB. Zika virus outside Africa. Emerg Infect Dis 2009;15:1347–50. CrossRef PubMedCDC. Chikungunya virus. Atlanta, GA: US Department of Health and Human Services, CDC; 2015. http://www.cdc.gov/chikungunya/hc/clinicalevaluation.html.World Health Organization. Dengue: guidelines for diagnosis, treatment, prevention and control. Geneva, Switzerland: World Health Organization; 2009.http://apps.who.int/iris/bitstream/10665/44188/1/9789241547871_eng.pdf.Oliveira Melo AS, Malinger G, Ximenes R, Szejnfeld PO, Alves Sampaio S, Bispo de Filippis AM. Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg? Ultrasound Obstet Gynecol 2016;47:6–7. CrossRef PubMedCDC. West Nile virus: insect repellent use & safety. Atlanta, GA: US Department of Health and Human Services, CDC; 2015. http://www.cdc.gov/westnile/faq/repellent.html.CDC. Zika virus. Atlanta, GA: US Department of Health and Human Services, CDC; 2015. http://www.cdc.gov/zika/index.html.CDC. Dengue virus. Atlanta, GA: US Department of Health and Human Services, CDC; 2009. http://www.cdc.gov/Dengue/.Rasmussen SA, Kissin DM, Yeung LF, et al. ; Pandemic Influenza and Pregnancy Working Group. Preparing for influenza after 2009 H1N1: special considerations for pregnant women and newborns. Am J Obstet Gynecol 2011;204(Suppl 1):S13–20. CrossRef PubMedDivision of Vector-Borne Diseases. Arboviral Diseases and Dengue Branches. Updated diagnostic testing for Zika, chikungunya, and dengue viruses in US Public Health Laboratories. Atlanta, GA: US Department of Health and Human Services, CDC; 2016. http://www.aphl.org/Materials/CDCMemo_Zika_Chik_Deng_Testing_011916.pdf.Babaliche P, Doshi D. Catching dengue early: clinical features and laboratory markers of dengue virus infection. J Assoc Physicians India 2015;63:38–41. PubMedWahala WMPB, de Silva AM. The human antibody response to dengue virus infection. Viruses 2011;3:2374–95. CrossRef PubMedGibney KB, Edupuganti S, Panella AJ, et al. Detection of anti-yellow fever virus immunoglobulin m antibodies at 3–4 years following yellow fever vaccination. Am J Trop Med Hyg 2012;87:1112–5. CrossRef PubMedRoehrig JT, Nash D, Maldin B, et al. Persistence of virus-reactive serum immunoglobulin m antibody in confirmed west nile virus encephalitis cases. Emerg Infect Dis 2003;9:376–9. CrossRefPubMedAmerican Academy of Pediatrics/American College of Obstetricians and Gynecologists. Guidelines for perinatal care. 7th ed. Elk Grove Village, IL: American Academy of Pediatrics/American College of Obstetricians and Gynecologists; 2012.Bromley B, Benacerraf BR. Difficulties in the prenatal diagnosis of microcephaly. J Ultrasound Med 1995;14:303–6. PubMedAmerican College of Obstetricians and Gynecologists. Practice bulletin no. 151: Cytomegalovirus, parvovirus B19, varicella zoster, and toxoplasmosis in pregnancy. Obstet Gynecol 2015;125:1510–25. CrossRef PubMedPicone O, Costa JM, Leruez-Ville M, Ernault P, Olivi M, Ville Y. Cytomegalovirus (CMV) glycoprotein B genotype and CMV DNA load in the amniotic fluid of infected fetuses. Prenat Diagn 2004;24:1001–6. CrossRef PubMedStaples JE, Dziuban EJ, Fischer M, et al. Interim guidelines for the evaluation and testing of infants with possible congenital Zika virus infection—United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65:63–7. CrossRef PubMedFoy BD, Kobylinski KC, Foy JLC, et al. Probable non-vector-borne transmission of Zika virus, Colorado, USA. Emerg Infect Dis 2011;17:880–2. CrossRef PubMedOster AM, Brooks JT, Stryker JE, et al. Interim guidelines for prevention of sexual transmission of Zika virus—United States, 2016. MMWR Morb Mortal Wkly Rep 2015;65(5).CDC. Reproductive life plan tool for health professionals. Atlanta, GA: US Department of Health and Human Services, CDC; 2014. http://www.cdc.gov/preconception/rlptool.html.Division of Reproductive Health. National Center for Chronic Disease Prevention. U.S. Selected Practice Recommendations for Contraceptive Use, 2013: adapted from the World Health Organization selected practice recommendations for contraceptive use, 2nd edition. MMWR Recomm Rep 2013;62(RR-05).Finer LB, Zolna MR. Shifts in intended and unintended pregnancies in the United States, 2001–2008. Am J Public Health 2014;104(Suppl 1):S43–8. CrossRef PubMedLanciotti RS, Kosoy OL, Laven JJ, et al. Genetic and serologic properties of Zika virus associated with an epidemic, Yap State, Micronesia, 2007. Emerg Infect Dis 2008;14:1232–9. CrossRefPubMed Top * Clinical illness consistent with Zika virus disease is defined as two or more of the following signs or symptoms: acute onset of fever, maculopapular rash, arthralgia, or conjunctivitis. Top FIGURE 1. Updated Interim guidance: testing algorithm*,†,§,¶,** for a pregnant woman with history of travel to an area with ongoing Zika virus transmission* Testing is recommended for pregnant women with clinical illness consistent with Zika virus disease, which includes two or more of the following signs or symptoms: acute onset of fever, maculopapular rash, arthralgia, or conjunctivitis during or within 2 weeks of travel. Testing includes Zika virus reverse transcription-polymerase chain reaction (RT-PCR), and Zika virus immunoglobulin M (IgM) and neutralizing antibodies on serum specimens (http://www.aphl.org/Materials/CDCMemo_Zika_Chik_Deng_Testing_011916.pdf). Because of the overlap of symptoms and areas where other viral illnesses are endemic, evaluation for dengue or chikungunya virus infection is also recommended. † Testing can be offered to pregnant women without clinical illness consistent with Zika virus disease. If performed, testing should include Zika virus IgM, and if IgM test result is positive or indeterminate, neutralizing antibodies on serum specimens. Testing should be performed 2–12 weeks after travel. § Laboratory evidence of maternal Zika virus infection: 1) Zika virus RNA detected by RT-PCR in any clinical specimen; or 2) positive Zika virus IgM with confirmatory neutralizing antibody titers that are ≥4-fold higher than dengue virus neutralizing antibody titers in serum. Testing is considered inconclusive if Zika virus neutralizing antibody titers are <4-fold higher than dengue virus neutralizing antibody titers. ¶ Fetal ultrasounds might not detect microcephaly or intracranial calcifications until the late second or early third trimester of pregnancy. ** Amniocentesis is not recommended until after 15 weeks of gestation. Amniotic fluid should be tested for Zika virus RNA by RT-PCR. The sensitivity and specificity of RT-PCR testing on amniotic fluid are not known. Top FIGURE 2. Interim guidance: testing algorithm*,†,§,¶,** for a pregnant woman residing in an area with ongoing Zika virus transmission,†† with or without clinical illness consistent with Zika virus disease§§* Tests for pregnant women with clinical illness consistent with Zika virus disease include Zika virus reverse transcription-polymerase chain reaction (RT-PCR), and Zika virus immunoglobulin M (IgM) and neutralizing antibodies on serum specimens (http://www.aphl.org/Materials/CDCMemo_Zika_Chik_Deng_Testing_011916.pdf). Because of the overlap of symptoms and areas where other viral illnesses are endemic, evaluation for dengue or chikungunya virus infection is also recommended. If chikungunya or dengue virus RNA is detected, treat in accordance with existing guidelines. Timely recognition and supportive treatment for dengue virus infections can substantially lower the risk of medical complications and death. Repeat Zika virus testing during pregnancy is warranted if clinical illness consistent with Zika virus disease develops later in pregnancy. † Testing can be offered to pregnant women without clinical illness consistent with Zika virus disease. If performed, testing should include Zika virus IgM, and if IgM test result is positive or indeterminate, neutralizing antibodies on serum specimens. Results from serologic testing are challenging to interpret in areas where residents have had previous exposure to other flaviviruses (e.g., dengue, yellow fever). § Laboratory evidence of maternal Zika virus infection: 1) Zika virus RNA detected by RT-PCR in any clinical specimen; or 2) positive Zika virus IgM with confirmatory neutralizing antibody titers that are ≥4-fold higher than dengue virus neutralizing antibody titers in serum. Testing is considered inconclusive if Zika virus neutralizing antibody titers are <4-fold higher than dengue virus neutralizing antibody titer. ¶ Amniocentesis is not recommended until after 15 weeks gestation. Amniotic fluid should be tested for Zika virus RNA by RT-PCR. The sensitivity and specificity of RT-PCR testing on amniotic fluid are not known. ** Fetal ultrasounds might not detect microcephaly or intracranial calcifications until the late second or early third trimester of pregnancy. †† Local health officials should determine when to implement testing of asymptomatic pregnant women based on information about levels of Zika virus transmission and laboratory capacity. §§ Clinical illness consistent with Zika virus disease is defined as two or more of the following signs or symptoms: acute onset of fever, maculopapular rash, arthralgia, or conjunctivitis. Top Suggested citation for this article: Oduyebo T, Petersen EE, Rasmussen SA, et al. Update: Interim Guidelines for Health Care Providers Caring for Pregnant Women and Women of Reproductive Age with Possible Zika Virus Exposure — United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65(Early Release):1–6. DOI:http://dx.doi.org/10.15585/mmwr.mm6505e2er. http://www.cdc.gov/mmwr/volumes/65/wr/mm6505e2er.htm?s_cid=mm6505e2er.htm_w

Interim Guidelines for Prevention of Sexual Transmission of Zika Virus — United States, 2016Early Release / February 5, 2016 / 65(5);1–2 Format:Select onePDF [765 KB]Recommend on FacebookTweetAlexandra M. Oster, MD1; John T. Brooks, MD1; Jo Ellen Stryker, PhD1; Rachel E. Kachur2; Paul Mead, MD3; Nicki T. Pesik, MD4; Lyle R. Petersen, MD3 (View author affiliations) View suggested citation Zika virus is a mosquito-borne flavivirus primarily transmitted by Aedes aegypti mosquitoes (1,2). Infection with Zika virus is asymptomatic in an estimated 80% of cases (2,3), and when Zika virus does cause illness, symptoms are generally mild and self-limited. Recent evidence suggests a possible association between maternal Zika virus infection and adverse fetal outcomes, such as congenital microcephaly (4,5), as well as a possible association with Guillain-Barré syndrome. Currently, no vaccine or medication exists to prevent or treat Zika virus infection. Persons residing in or traveling to areas of active Zika virus transmission should take steps to prevent Zika virus infection through prevention of mosquito bites (http://www.cdc.gov/zika/prevention/). Sexual transmission of Zika virus is possible, and is of particular concern during pregnancy. Current information about possible sexual transmission of Zika is based on reports of three cases. The first was probable sexual transmission of Zika virus from a man to a woman (6), in which sexual contact occurred a few days before the man’s symptom onset. The second is a case of sexual transmission currently under investigation (unpublished data, 2016, Dallas County Health and Human Services). The third is a single report of replication-competent Zika virus isolated from semen at least 2 weeks and possibly up to 10 weeks after illness onset; reverse transcriptase-polymerase chain reaction testing of blood plasma specimens collected at the same time as the semen specimens did not detect Zika virus (7). The man had no sexual contacts. Because no further testing was conducted, the duration of persistence of Zika virus in semen remains unknown. In all three cases, the men developed symptomatic illness. Whether infected men who never develop symptoms can transmit Zika virus to their sex partners is unknown. Sexual transmission of Zika virus from infected women to their sex partners has not been reported. Sexual transmission of many infections, including those caused by other viruses, is reduced by consistent and correct use of latex condoms. The following recommendations, which apply to men who reside in or have traveled to areas with active Zika virus transmission (http://wwwnc.cdc.gov/travel/notices/) and their sex partners, will be revised as more information becomes available. Top Recommendations for men and their pregnant partnersMen who reside in or have traveled to an area of active Zika virus transmission who have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sex (i.e., vaginal intercourse, anal intercourse, or fellatio) for the duration of the pregnancy. Pregnant women should discuss their male partner’s potential exposures to mosquitoes and history of Zika-like illness (http://www.cdc.gov/zika/symptoms) with their health care provider; providers can consult CDC’s guidelines for evaluation and testing of pregnant women (8). Top Recommendations for men and their nonpregnant sex partnersMen who reside in or have traveled to an area of active Zika virus transmission who are concerned about sexual transmission of Zika virus might consider abstaining from sexual activity or using condoms consistently and correctly during sex. Couples considering this personal decision should take several factors into account. Most infections are asymptomatic, and when illness does occur, it is usually mild with symptoms lasting from several days to a week; severe disease requiring hospitalization is uncommon. The risk for acquiring vector-borne Zika virus in areas of active transmission depends on the duration and extent of exposure to infected mosquitoes and the steps taken to prevent mosquito bites (http://www.cdc.gov/zika/prevention). After infection, Zika virus might persist in semen when it is no longer detectable in blood. Zika virus testing has been recommended to establish a diagnosis of infection in some groups, such as pregnant women (8). At present, Zika virus testing for the assessment of risk for sexual transmission is of uncertain value, because current understanding of the incidence and duration of shedding in the male genitourinary tract is limited to one case report in which Zika virus persisted longer than in blood (7). At this time, testing of men for the purpose of assessing risk for sexual transmission is not recommended. As we learn more about the incidence and duration of seminal shedding from infected men and the utility and availability of testing in this context, recommendations to prevent sexual transmission of Zika virus will be updated. Top AcknowledgmentsBrian Foy, Colorado State University, Ft. Collins, Colorado; Joel Gallant, Southwest CARE Center, Santa Fe, New Mexico; King Holmes, University of Washington, Seattle, Washington; Tom Quinn, Johns Hopkins University, Baltimore, Maryland; Wendy Chung, Dallas County Health and Human Services, Dallas Texas. Top Corresponding author: John T. Brooks, [email protected], 404-639-3894. Top 1Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC; 2Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC; 3Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC; 4Office of the Director, National Center for Emerging and Zoonotic Infectious Diseases, CDC. Top ReferencesHayes EB. Zika virus outside Africa. Emerg Infect Dis 2009;15:1347–50. CrossRef PubMedCDC. Zika virus. Atlanta, GA: US Department of Health and Human Services, CDC; 2016. http://www.cdc.gov/zika/index.html.Duffy MR, Chen TH, Hancock WT, et al. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med 2009;360:2536–43. CrossRef PubMedEuropean Centre for Disease Prevention and Control. Rapid risk assessment: Zika virus epidemic in the Americas: potential association with microcephaly and Guillain-Barré syndrome. Stockholm, Sweden: European Centre for Disease Prevention and Control; 2015. http://ecdc.europa.eu/en/publications/Publications/zika-virus-americas-association-with-microcephaly-rapid-risk-assessment.pdf.Oliveira Melo AS, Malinger G, Ximenes R, Szejnfeld PO, Alves Sampaio S, Bispo de Filippis AM. Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg? Ultrasound Obstet Gynecol 2016;47:6–7. CrossRef PubMedFoy BD, Kobylinski KC, Chilson Foy JL, et al. Probable non-vector-borne transmission of Zika virus, Colorado, USA. Emerg Infect Dis 2011;17:880–2. CrossRef PubMedMusso D, Roche C, Robin E, Nhan T, Teissier A, Cao-Lormeau VM. Potential sexual transmission of Zika virus. Emerg Infect Dis 2015;21:359–61. CrossRef PubMedOduyebo T, Petersen EE, Rasmussen SA, et al. Update: interim guidelines for health care providers caring for pregnant women and women of reproductive age with possible Zika virus exposure—United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65. Top Suggested citation for this article: Oster AM, Brooks JT, Stryker JE, et al. Interim Guidelines for Prevention of Sexual Transmission of Zika Virus — United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65(Early Release):1–2. DOI: http://dx.doi.org/10.15585/mmwr.mm6505e1er. Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services. References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication. All HTML versions of MMWR articles are generated from final proofs through an automated process. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version (http://www.cdc.gov/mmwr) and/or the original MMWR paper copy for printable versions of official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices. Questions or messages regarding errors in formatting should be addressed to [email protected]. http://www.cdc.gov/mmwr/volumes/65/wr/mm6505e1er.htm?s_cid=mm6505e1.htm_w

Zika Virus – Feb. 5, 2016Texas has 10 cases of Zika virus disease. Nine 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: Harris County – 7 Bexar County – 1 Dallas County – 2 Zika is primarily a mosquito-borne virus that can cause fever, rash, muscle and joint aches and pinkeye. Symptoms are usually mild, and most people exposed to Zika virus won’t develop any symptoms at all. There have been reports of microcephaly and other poor pregnancy outcomes in babies of mothers who were infected with Zika virus while pregnant. The Texas Department of State Health Services is encouraging people to follow travel precautions for regions and certain countries where Zika virus transmission is ongoing. DSHS recommends travelers avoid mosquito bites while abroad and for seven days after returning, in case they have been exposed to Zika virus. People can protect themselves from mosquito bites by: Wearing long-sleeved shirts and long pantsUsing EPA-registered insect repellentsUsing permethrin-treated clothing and gear Staying and sleeping in screened-in or air-conditioned roomsAvoiding or limiting outdoor activities during peak mosquito timesNote: Zika case data for Texas will be updated weekdays by 11 a.m. Texas Zika Virus DSHS News Releases CDC Zika Virus http://www.dshs.state.tx.us/news/updates.shtm

CDC has issued new interim guidance on preventing sexual transmission of Zika virus after confirming through laboratory testing, in collaboration with Dallas County Health and Human Services, the first case of Zika virus infection in a non-traveler in the continental United States during this outbreak. Although sexual transmission of Zika virus infection is possible, mosquito bites remain the primary way that Zika virus is transmitted. Because there currently is no vaccine or treatment for Zika virus, the best way to avoid Zika virus infection is to prevent mosquito bites. Based on what we know now, CDC is issuing interim recommendations to prevent sexual transmission of Zika virus. To date, there have been no reports of sexual transmission of Zika virus from infected women to their sex partners. CDC expects to update its interim guidance as new information becomes available. New recommendations for pregnant women, and men with pregnant sex partners who live in or have traveled to Zika-affected areas: Pregnant women and their male sex partners should discuss the male partner’s potential exposures and history of Zika-like illness with the pregnant woman’s health care provider (http://www.cdc.gov/zika/symptoms/). Providers should consult CDC’s guidelines for evaluation and testing of pregnant women.Men with a pregnant sex partner who reside in or have traveled to an area of active Zika virus transmission and their pregnant sex partners should consistently and correctly use condoms during sex (vaginal, anal, or oral) or abstain from sexual activity for the duration of the pregnancy. Consistent and correct use of latex condoms reduces the risk of sexual transmission of many infections, including those caused by other viruses.New recommendations for non-pregnant women, and men with non-pregnant sexual partners who live in or have traveled to Zika-affected areas: Couples in which a man resides in or has traveled to an area of active Zika virus transmission who are concerned about sexual transmission of Zika virus may consider using condoms consistently and correctly during sex or abstaining from sexual activity. Couples may consider several factors when making this complex and personal decision to abstain or use condoms:Zika virus illness is usually mild. An estimated 4 out of 5 people infected never have symptoms; when symptoms occur they may last from several days to one week.The risk of Zika infection depends on how long and how much a person has been exposed to infected mosquitoes, and the steps taken to prevent mosquito bites while in an affected area.The science is not clear on how long the risk should be avoided. Research is now underway to answer this question as soon as possible. If you are trying to get pregnant, you may consider testing in discussion with your health care provider.Updated interim guidelines for healthcare providers CDC also has updated its interim guidance for healthcare providers in the United States caring for pregnant women and women of reproductive age with possible Zika virus exposure. The updated guidelines recommend that pregnant women without symptoms of Zika virus disease can be offered testing 2 to 12 weeks after returning from areas with ongoing Zika virus transmission. New recommendations for women who reside in areas with ongoing Zika virus transmission, both pregnant women and women of reproductive age, include the following: For pregnant women experiencing symptoms consistent with Zika virus disease, testing is recommended at the time of illness.For pregnant women not experiencing symptoms consistent with Zika virus disease, testing is recommended when women begin prenatal care. Follow-up testing around the middle of the second trimester of pregnancy is also recommended, because of an ongoing risk of Zika virus exposure. Pregnant women should receive routine prenatal care, including an ultrasound during the second trimester of pregnancy. An additional ultrasound may be performed at the discretion of the health care provider.For women of reproductive age, healthcare providers should discuss strategies to prevent unintended pregnancy, including counseling on family planning and the correct and consistent use of effective contraceptive methods, in the context of the potential risks of Zika virus transmission.Local health officials will need to determine when to implement testing recommendations for pregnant women without symptoms based on information about local levels of Zika virus transmission and local laboratory capacity.All travelers to or residents of areas with ongoing Zika virus transmission should strictly follow measures to prevent mosquito bites. CDC continues to work with other public health officials to monitor for ongoing Zika virus‎ transmission. CDC has issued travel alerts (Level 2-Practice Enhanced Precautions) for people traveling to regions and certain countries where Zika virus transmission is ongoing. For a full list of affected countries/regions, check this site regularly: http://www.cdc.gov/zika/geo/index.html. CDC guidance on Zika virus, its transmission, treatment, and response to the outbreak will continue to be updated as more becomes known.

CDC issues Interim Guidelines for Preventing Sexual Transmission of Zika Virus and Updated Interim Guidelines for Health Care Providers Caring for Pregnant Women and Women of Reproductive Age with Possible Zika Virus Exposure Recommend on FacebookTweetMedia StatementEmbargoed Until: Friday, February 5, 2016, 11:00am EST Contact: Media Relations, (404) 639-3286 http://www.cdc.gov/media/releases/2016/s0205-zika-interim-guidelines.html

43 minutes ago From the sectionHealthImage copyrightGetty ImagesZika virusZika outbreak: What you need to knowZika outbreak: Travel adviceZika outbreak: The perfect mosquitoVideo How mums-to-be are tackling ZikaActive Zika virus has been detected in the saliva and urine of patients, Brazilian scientists say. The finding does not mean the virus can be readily transmitted through the bodily fluids. The main method of infection is via mosquito bites, but scientists are investigating all other possibilities. While Zika infection is normally mild, it has been linked to thousands of suspected birth defects. Traces of Zika have been detected in saliva and urine during the 2013 outbreak in French Polynesia, but the Brazilian authorities say this is the first time "active" virus has been detected. Paulo Gadelha, the head of the Fiocruz Institute which is part of the Ministry of Health, said: "The presence of the active Zika virus has been found in saliva and urine. "But that does not mean there is a capacity for transmission through saliva and urine." The potential risk of transmission through bodily fluids was highlighted in the US where the Centers for Disease Control believe a case was spread through sex. However, there have been only two suspected cases of sexual transmission of Zika. More on the Zika crisis:What you need to know Key questions answered about the virus and its spread Key unanswered questions The many things we do not know about Zika Travel advice Countries affected and what you should do The mosquito behind spread of virus What we know about the insect Abortion dilemma Laws and practices in Catholic Latin America Prof Jonathan Ball, a virologist at the University of Nottingham, told the BBC: "Because we can detect a virus in a particular body fluid it does not mean that it will become an important source of virus for transmission to humans. "At the peak of virus replication in the blood, virus can often be detected in other body fluids, but the levels of virus are often much lower and there is no obvious or efficient means for the virus to get from that bodily fluid into another person's bloodstream." The risks of different modes of infection are still unclear. But experts say that the million-plus suspected cases in the Americas have been contained to areas where the mosquito is found, suggesting it does not spread easily through other means. Brazil has seen 4,783 suspected cases of babies born with small brains, although only 404 have been confirmed, 709 have been rejected and 3,670 are still being investigated. Follow James on Twitter.

Active Zika found in saliva and urineBy James GallagherHealth editor, BBC News websitehttp://www.bbc.com/news/health-35501491

ReferencesDick GW, Kitchen SF, Haddow AJ. Zika virus isolations and serological specificity. Trans R Soc Trop Med Hyg. 1952;46:509–20 . DOIPubMedLanciotti RS, Kosoy OL, Laven JJ, Velez JO, Lambert AJ, Johnson AJ, Genetic and serologic properties of Zika virus associated with an epidemic, Yap State, Micronesia, 2007. Emerg Infect Dis. 2008;14:1232–9. DOIPubMedCao-Lormeau VM, Roche C, Teissier A, Robin E, Berry AL, Mallet HP, Zika virus, French Polynesia, South Pacific, 2013. Emerg Infect Dis.2014;20:1085–6. DOIPubMedMusso D, Nilles EJ, Cao-Lormeau VM. Rapid spread of emerging Zika virus in the Pacific area. Clin Microbiol Infect. 2014;20:O595–6.DOIPubMedFaye O, Freire CC, Iamarino A, Faye O, de Oliveira JV, Diallo M, Molecular evolution of Zika virus during its emergence in the 20th century. PLoS Negl Trop Dis. 2014;8:e2636 . DOIPubMedZanluca C, de Melo VC, Mosimann AL, Dos Santos GI, Dos Santos CN, Luz K. First report of autochthonous transmission of Zika virus in Brazil. Mem Inst Oswaldo Cruz. 2015;110:569–72. DOIPubMedHaddow AD, Schuh AJ, Yasuda CY, Kasper MR, Heang V, Huy R, Genetic characterization of Zika virus strains: geographic expansion of the Asian lineage. PLoS Negl Trop Dis. 2012;6:e1477. DOIPubMedMusso D, Cao-Lormeau VM, Gubler DJ. Zika virus: following the path of dengue and chikungunya? Lancet. 2015;386:243–4. DOIPubMedVolk SM, Chen R, Tsetsarkin KA, Adams AP, Garcia TI, Sall AA, Genome-scale phylogenetic analyses of chikungunya virus reveal independent emergences of recent epidemics and various evolutionary rates. J Virol. 2010;84:6497–504. DOIPubMedLanciotti RS, Lambert AJ. Phylogenetic analysis of chikungunya virus strains circulating in the Western Hemisphere. Am J Trop Med Hyg. 2016. In press.

Figure Figure. Phylogenetic tree of Zika virus isolates identified from Guatemala and Puerto Rico in December 2015 (indicated in boldface) compared with reference isolates obtained from GenBank. The isolates from Guatemala and Puerto Rico grouped with other Asian genotype viruses. The tree was derived by neighbor-joining methods (bootstrapped 1,000 times) using complete-genome sequences. Location, year identified, and GenBank strain identification for the viruses used in tree construction are shown. Scale bar indicates number of nucleotide substitutions per site. GenBank accession nos.: KU321639 (Brazil 2015 SPH2015), KJ776791 (French Polynesia H/PF/2013), KF383115 (Central African Republic ARB1362), KF383116 (Senegal 1968 ArD7117), KF383117 (Senegal 1997 ArD128000), KF383118 (Senegal 2001 ArD157995), KF383119 (Senegal 2001 ArD158084), KF268948 (CAR 1979 ARB13565), KF268949 (CAR 1980 ARB15076), KF268950 (CAR 1976 ARB7701), EU545988 (Yap 2007), KF993678 (Thailand 2013 PLCal_ZV), JN860885 (Cambodia 2010 FSS13025), HQ234499 (Malaysia 1966 P6-740), HQ234501 (Senegal 1984 ArD41519), HQ234500 (Nigeria 1968 IbH 30656), LC002520 (Uganda 1947 MR766), KU501215 (Puerto Rico PRVABC59), KU501216 (Guatemala 8375), and KU501217 (Guatemala 103344).

To the Editor: Zika virus (ZIKV) belongs to the genus Flavivirus, family Flaviviridae, and is transmitted by Aedesspp. mosquitoes. Clinical signs and symptoms of human infection with ZIKV include fever, headache, malaise, maculopapular rash, and conjunctivitis. ZIKV was first isolated in 1947 from the blood of a febrile sentinel rhesus monkey during a study of yellow fever in the Zika Forest of Uganda (1). During the next 20 years, ZIKV isolates were obtained primarily from East and West Africa during arbovirus surveillance studies in the absence of epidemics. During those 20 years, cases of ZIKV infection were detected sporadically; however, given the clinical similarity of ZIKV and dengue virus infections and the extensive cross-reactivity of ZIKV antibodies with dengue viruses, it is possible that ZIKV was associated with epidemics that were incorrectly attributed to dengue viruses. Beginning in 2007, substantial ZIKV outbreaks were reported first in Yap Island (Federated States of Micronesia), then in French Polynesia, and then in other Pacific Islands (2–4). Genetic studies have revealed that ZIKV has evolved into 3 distinct genotypes: West African (Nigerian cluster), East African (MR766 prototype cluster), and Asian. It has been postulated that the virus originated in East Africa and then spread into both West Africa and Asia ≈50–100 years ago (5). In early 2015, cases of ZIKV infection were detected in Rio Grande State, northern Brazil, and limited sequence analyses revealed that the virus was most closely related to a 2013 ZIKV from French Polynesia, within the Asian clade (6). Figure. Phylogenetic tree of Zika virus isolates identified from Guatemala and Puerto Rico in December 2015 (indicated in boldface) compared with reference isolates obtained from GenBank. The isolates from Guatemala and Puerto... In December 2015, the Centers for Disease Control and Prevention Arbovirus Diagnostic Laboratory detected ZIKV in serum specimens collected from persons in Guatemala and Puerto Rico. The complete nucleotide sequence of ZIKV was derived directly from 3 of these serum specimens by using next-generation sequencing on the Ion Torrent (Thermo Fisher Scientific, Waltham, MA, USA) platform. The raw sequence reads were analyzed and assembled by using the CLC bio Genomics Workbench (CLC bio, Waltham, MA, USA) and Lasergene NextGen (DNAStar, Madison, WI, USA). The complete genome sequences were aligned by using ClustalW (http://www.megasoftware.net/) with all available full-length ZIKV sequences from GenBank representing the 3 genotypes. Nearly identical phylogenetic trees were generated by using several methods (minimum-evolution, maximum-likelihood, neighbor-joining), and a neighbor-joining tree was generated and analyzed with 1,000 replicates for bootstrap testing (Figure). GenBank accession numbers for ZIKV sequences presented in this article are KU501215 (Puerto Rico PRVABC59), KU501216 (Guatemala 8375), and KU501217 (Guatemala 103344). In agreement with the initial sequencing of samples from Brazil conducted by Zanluca et al. (6), the 3 newly sequenced ZIKVs from Guatemala and Puerto Rico are all within the Asian genotype and most closely related to strains recently isolated from Brazil (2015) and French Polynesia (2013). The tree topology confirms previous findings and indicates that Asian genotype viruses have been gradually evolving and spreading geographically throughout Asia and the Pacific Islands since at least 1966; the tree suggests that the Malaysia 1966 ZIKV is representative of an ancestral genotype (7). The percent nucleotide identity among all the Western Hemisphere ZIKVs is >99%, and as a group, these Western Hemisphere viruses are ≈89% identical (96% aa) to viruses of the East African and West African genotypes. As reported by Musso et al. (8), the phylogeny and movement of ZIKV and chikungunya virus are strikingly similar. Each virus is grouped into 3 genotypes of very similar geographic distribution: East Africa, West Africa, and Asia. For both viruses, it also seems that viruses from East Africa moved into Asia ≈50–100 years ago and evolved into a unique Asian genotype (9,10). In addition, the similarity with respect to the recent movement of these viruses from Asia into the Pacific Islands and then into the New World (9) is noteworthy. It seems that similar ecologic and/or human social factors might be responsible for the movement of chikungunya virus and ZIKV into the New World at approximately the same time. Further studies might elucidate the exact mechanism of this transcontinental movement, leading to effective prevention strategies.