Presser Updates on CDC’s Zika virus response efforts Feb 26

niman · February 26, 2016

For Immediate Release
Friday, February 26, 2016

Contact: CDC Media Relations
404-639-3286

CDC Telebriefing: Updates on CDC’s Zika virus response efforts

WHAT:           Updates on CDC’s Zika virus response efforts.

WHO:             Tom Frieden, M.D., M.P.H., CDC Director

Denise J. Jamieson, MD, MPH, CAPT, USPHS, Co-Lead, Pregnancy and Birth Defects Team, CDC Zika Virus Response Team

Jennifer H. McQuiston, DVM, MS, CAPT, USPHS, Deputy Incident Manager, CDC Zika Virus Response Team

Julie Villanueva, PhD, Laboratory Team Lead, CDC Zika Virus Response Team

WHEN:            1:30pm EST, Friday, February 26, 2016

DIAL-IN:        Media:    888-946-3811
Non-Media: 800-369-3122
International: 1-630-395-0174
Passcode: CDC Media

* Please dial in 10 to 15 minutes before the start of the press conference.

Important Instructions
If you would like to ask a question during the call, press *1 on your touchtone phone. Press *2 to withdraw your question.
You may queue up at any time. You will hear a tone to indicate your question is pending.

TRANSCRIPT
A transcript of this media briefing will be available following the briefing at CDC’s web site: www.cdc.gov/media.

Admin · February 26, 2016

Please Note: This transcript is not edited and may contain errors.

OPERATOR: Welcome and thank you for standing by. All participants will be in a listen mode only. This conference is being recorded. We’ll be conducting a question and answer session today. If you would like to ask a question press star then 1. I would now like to turn the conference over to Kathy Harben with the CDC Office of Communication. Thank you, you may begin.

KATHY HARBEN: Thank you, Karen. Thank you all for joining us for an update on the Zika virus outbreak. With us today are the director of CDC Dr. Tom Frieden as well as Dr. Denise J. Jamieson, Dr. Paul Mead. And Dr. Julie Villanueva. We are also joined by Dr. Luciana Borio and she's with us from FDA, and now I’ll turn the call over to Dr. Frieden for opening remarks.

TOM FRIEDEN: Good afternoon. Today it's been six weeks to the day from CDC's first announcement and travel briefing about Zika. In these past six weeks we've done a lot and we've learned a lot about this unprecedented situation. In fact, we're literally learning more about Zika every day. In this briefing we have a lot of information to cover so please bear with us. We’re going to outline new findings and developments. For the American public, the bottom line hasn't changed from the time of our initial announcement. If you're pregnant, avoid travel to a place where Zika is spreading. If you're in a place such as Puerto Rico where Zika is spreading, do everything you can to avoid mosquito bites. The most severe risk is to pregnant women.

There’s two anticipated developments and one unanticipated development. First, we anticipated that there would be continued rapid spread of the Zika virus in places where the mosquito species that spread it lives, including Puerto Rico and, in fact, that's what we've seen. Second, we anticipated that there would be many, possibly hundreds or even thousands of American travelers returning from Zika affected areas and this too is what we're seeing. We did not, however, anticipate that we would see this many sexually transmitted cases of Zika. When sexual transmission in the current outbreak was first documented, we issued guidance indicating that men who live in or who have returned from a Zika affected area use a condom if they have sex with a woman who is pregnant. Today’s report underscores the importance of that recommendation.

As of today, 147 cases have been reported to CDC. Of these, 107 are travel related cases in 24 states and the District of Columbia. The other 40 are mostly locally acquired infections in U.S. Territories. Puerto Rico is by far the most affected area. It makes the numbers a little confusing but I would like to indicate that today after closure of the CDC number that I just mentioned for the whole country including Puerto Rico from this past week, Puerto Rico posted their latest information which indicates that they have so far 117 known diagnosed cases. CDC's response and that of other parts of the federal government as well as other countries is extensive. Today’s briefing covers just a few aspects of this.

One critical aspect is increasing access to diagnosis of infection with the virus. There are fundamentally two different types of tests for Zika. One testsfor active infection. Another tests for infection at least a week and up to several months after that infection. The CDC laboratory has developed tests for both of these and is rolling them out to laboratories in the CDC laboratory response network or LRN over the next several weeks. The tests for active infection can already be performed by more than 20 laboratories around the U.S. using CDC materials. These labs cover most of the returning at risk travelers and returning travelers in other parts of the country can have their specimens sent to CDC. We’ll hear more about testing shortly but first we'll hear from Dr. Denise Jamieson about today's article, Zika virus infection among U.S. pregnant travelers August 2015 to February 2016. This is important information and even though the numbers are small, they are of considerable interest. We understand that the occurrence of fetal malformation, fetal loss or a child with a birth defect is something that can be devastating to a family. That’s why we're working so hard to understand more what's happening and how it can be prevented. Dr. Jamieson?

DENISE JAMIESON: thank you, Dr. Frieden. Good afternoon. After reports of microcephaly, CDC issued a travel alert on January 15th, 2016. This advisory recommended that pregnant women consider postponing travel to areas with ongoing Zika virus transmission. Shortly thereafter on January 19th CDC released guidelines for U.S. health care providers who care for pregnant women who traveled to an affected area. We updated those guidelines on February 5th to include women residing in those areas with Zika transmission and expanded our recommendations to offer testing to asymptomatic women. As of February 17th, 2016, nine U.S. pregnant travelers with Zika virus infection had been reported to CDC. Among these women, there were no Zika virus related hospitalizations or deaths. Among the six women with Zika virus disease who experienced symptoms during the first trimester two women experienced spontaneous pregnancy losses, two terminated and one pregnancy is continuing without complications. Two women with Zika virus disease were exposed during the second trimester of pregnancy. One delivered a healthy infant and the other pregnancy is continuing. The one confirmed case of Zika virus disease in a woman who was exposed during the third trimester of pregnancy resulted in the delivery of a healthy infant. All of the confirmed cases were among U.S. women who had traveled to areas with local Zika virus transmission, including American Samoa, Brazil, El Salvador, Guatemala, Haiti, Mexico, Puerto Rico and Samoa. To better understand, CDC has established the U.S. pregnancy registry for Zika virus infection. This registry will provide information about the effects of Zika virus on pregnant women and their children. Information about the registry will soon be available on the CDC website. In addition, CDC maintains a 24/7 consultation service for health care officials and health care providers caring for pregnant women with possible Zika virus infection. To contact the service call 1-800-CDC-info or e-mail ZikaMCH @CDC.gov. Now Dr. Paul Mead will share the latest information about what we know about sexual transmission.

DR. PAUL MEAD: Thank you, Dr. Jamieson. Good afternoon. Today we released a report about transmission of Zika virus through sexual contact with travelers to areas of active transmission. After we published CDC's interim guidance to help prevent sexual transmission of Zika virus on February 5th, 2016, we and state health departments have received new reports of additional instances of possible sexual transmission of Zika virus. During February 6th through 22nd, 2016, roughly the two weeks after our recommendation, we received numerous reports of possible sexual transmission of Zika virus from multiple states. In conjunction with state and local health doctors, nurses, laboratory experts and disease control specialists, we are investigating each of these reports. These investigations take time, not only to interview the patients for detailed information, but also to obtain laboratory samples and test them for Zika. The test that is most able to confirm the diagnosis of Zika requires actual growth of the virus in the laboratory, something which takes about a week. At this point we're reporting on the six most advanced investigations. Two laboratory confirmed cases and four probable cases of Zika virus disease in women who had not traveled themselves and whose only known risk factor was sexual contact with a symptomatic known partner who traveled to an area with ongoing Zika transmission. All the cases occurred in women. Median patient age was 22 years. In all cases where type of sexual contact was documented, the contact included vaginal intercourse without a condom and occurred when the male partner was symptomatic or shortly after symptoms resolved.

We’re not releasing details of pregnancy status, age, state of residence of these patients out of respect for patient privacy and confidentiality and we trust you in the media will respect patient privacy. While these investigations are being completed, CDC encourages state and local public health departments, clinicians and the public to be aware of and to follow our recommendations for preventing sexual transmission of Zika virus. This is particularly important for men who have pregnant partners or for pregnant women.

These recommendations advise pregnant women who have partners who live in or who have traveled to Zika affected areas to discuss the male partner’s potential exposure and any history of Zika like illness with their health care provider. Providers should consult CDC's guidelines for evaluation and testing of pregnant women which are available on CDC's webpage. Men who reside in or have traveled to an area of active Zika virus transmission and who have a pregnant sex partner should use a condom during sex the right way, every time, or consider not having sex during the partner's pregnancy. Using latex condoms the right way every time reduces the risk of sexual transmission of many infections and including those caused by other viruses. Of note, all the women who were confirmed or likely to have transmitted Zika in our investigations – excuse me, all the men who were confirmed and likely to have transmitted Zika in our investigations so far have done so when they were ill or shortly after their illness resolved. This does not mean that transmission later on is impossible. It may be that we simply haven't seen this yet because spread of Zika is relatively recent. Studies to determine how long Zika remains in semen after illness are not completed. CDC will update its guidance as more information becomes available.

DR. FRIEDEN: Thank you Dr. Jamieson and Dr. Mead. And now Dr. Julie Villanueva will provide information on the diagnostic test.

DR. JULIE VILLANUEVA: The CDC Zika IgM Antibody Capture Enzyme-Linked Immunosorbent Assay (Zika MAC-ELISA) can detect proteins called antibodies that the human body makes to fight Zika virus infection. These antibodies appear in the blood in a person affected with Zika virus beginning as early as four days after the start of illness and can last for several weeks. The Zika can help determine whether a person may have been recently infected with Zika virus. This new test will be available in qualified U.S. public health laboratories through the LRN. The CDC was able to make the test available quickly because we worked very closely with our colleagues at the Food and Drug Administration using a special expedited process to authorize its use called an emergency use authorization or EUA. An EUA is a tool that FDA can use to allow the use of certain medical products for emergencies based on scientific data. The U.S. secretary of Health and Human Services has declared that circumstances exist to allow the emergency use of authorized diagnostic tests for Zika virus infections such as the CDC Zika. We’re fortunate enough to have Dr. Borio from the FDA on the phone today to be available to answer any other questions you may have about the emergency use authorization process. Dr. Frieden?

DR. FRIEDEN: thank you very much. And I want to particularly thank Secretary Burwell of HHS and FDA and our own lab team for having worked so hard to make this lab test available. This is a test that has been developed over years in the CDC laboratory and over a question of just weeks we've been able to scale up production, with the support of the secretary, secretary Burwell and the FDA, get through regulatory approvals and we're rolling this test out to laboratories throughout the United States. It will take time before it's widely available, and we've completed all of the quality assurance checks with all of the laboratories that are doing it but it's an encouraging step forward. Before we take questions I would like to just spend a moment summarizing what we know now, what we don't know, and what we're doing. We know that Zika is spreading widely in parts of the world where the particular mosquito species is present and we know it's associated with potentially devastating fetal malformation microcephaly. We know while at least while men are symptomatic they can spread Zika to their sexual partners. We know Zika and microcephaly are associated although we do not yet have definitive proof that Zika infection alone is the cause of microcephaly. Although the evidence for this is getting stronger by the day. We know that Guillain-Barre' Syndrome is triggered by Zika in a small proportion of infections as it is after a variety of other infections and we know that, unfortunately, the mosquitos that spread Zika are very hard to get rid of.

The key is reducing the risk to pregnant women. That means reducing travel of pregnant women to areas where Zika is spreading. That means reducing the risk of sexual transmission of Zika. And that means trying to reduce the mosquito population in areas where Zika is spreading and this last is the hardest. Because the particular mosquito that spreads Zika has been referred to as the cock roach of mosquitos. It lives indoors in dark places, hard to get rid of and efforts to do so have often been frustrated by the sheer numbers of the mosquito and the difficulty in getting rid of it. There are also many things we wish we knew and are working hard to find out. We don't know for sure that Zika infection causes microcephaly and if it does whether there are co-factors that make it more likely to do so. We don't know whether there's any phase of pregnancy in which infection is at lower or no risk for the fetus. We don't know if infants born without microcephaly will have any other health problems and unfortunately this is something we may not know for many years. We don't know if the prior findings that 80% of infections are asymptomatic will hold true in this outbreak. CDC's commitment to protecting Americans from health threats is absolute. It’s why we're here. It’s what makes the thousands of doctors, lab experts, disease control experts and other scientists come to work every day. In Atlanta and throughout the U.S. including in Puerto Rico and the other affected U.S. Territories, more than 600 CDC staff are working to continue to learn more and do more to protect people. CDC is one part of the U.S. Government’s overall response to Zika. our friends at NIH are working hard on vaccines. FDA is doing tremendous work to get approvals quickly for diagnostic tests and other urgent tools. The president has asked congress for $1.9 billion in emergency funding to enable us to further prepare for and respond to the Zika virus outbreak both domestically and internationally. Of this $828 million is intended for use by the CDC to allow us to do more, including increasing lab capacities throughout the country. Establishing rapid response teams to limit potential clusters of cases in the U.S. Expanding monitoring systems so we can track what's happening including Guillain-Barre' syndrome, birth defects in the U.S. and our territories. Increasing research and the link between Zika, microcephaly and other health outcomes. Providing targeted information for people who need it most including pregnant women and health care providers and most importantly figuring out ways to reduce the risk of Zika. We’re continuing to inform people about Zika and to learn more about the links between Zika and health outcomes. CDC has deployed 25 staff to assist in Puerto Rico in addition to the 50 staff who work there year round in our dengue branch.

They are providing support including investigation and monitoring for other Zika cases, assessing mosquito populations for their susceptibility. CDC is helping local teams in any way we can. We’re also working closely with public health teams in Brazil, tracking the spread of Zika virus and studying the links between Zika and microcephaly and other adverse birth outcomes. An HHS delegation just returned from Brazil and another team of CDC experts is working in close partnership with Brazil on research and evaluation. Team members in Colombia are working to develop a detailed study of pregnant women who have been infected by the Zika virus. This is an important way for us to learn more over time. In addition we're continuing work to help prevent Zika infection in places with ongoing transmission. Because there's no vaccine to prevent Zika the best way to prevent it is to protect yourself and your family from mosquito bites and sexual transmission. That’s particularly relevant in areas where Zika is spreading and in the U.S. that's currently only Puerto Rico, American Samoa and U.S. Virgin Islands as far as information available to date. This is a challenge for some people right now and for that reason CDC has worked with the CDC foundation to develop Zika prevention kits or ZPKs. The ZPKs inform women about the Zika virus, its risks and how to avoid infection. The kits provide pregnant women with an initial supply of prevention tools. The kits are not intended to take them through the entire pregnancy. kits contain educational materials, mosquito repellents, condoms, a thermometer, tablets that can be put into standing water, that is water that can't be eliminated and prevent mosquitos from multiplying. Kits are being provided to women who need them. We’ll be rolling out the distribution of these kits over the next several weeks. And they will help women in areas of local Zika transmission learn more and do more to protect themselves and their pregnancy.

KATHY HARBEN: thank you very much, Dr. Frieden and our other speakers. Karen, we're now ready for questions.

OPERATOR: Thank you. At this time we'll start the question and answer session. If you want to ask a question please press star then 1. Our first question comes from STAT News.

KAREN WEINTRAUB: I was wondering is there a line, a moment when we can say yes Zika does cause microcephaly or Guillain-Barre', something you're looking for or waiting for to make that decision?

TOM FRIEDEN: Well, let's take them separately. In both cases we have additional studies under way. In terms of Guillain-Barre' we may be learning more in the coming days and weeks. Microcephaly is more complicated because the question isn't only is there an association, there's clearly an association. The question is also is it absolutely causal and are there any co-factors. What point in the pregnancy is the highest risk period? Whether obviously affected children have any health effects. So there's a lot more we still will be learning over the coming days, weeks and months, and some of it will simply take time. For example, as women who are exposed more recently, deliver infants, we may tragically find out that microcephaly is present in some of those infants.

KAREN WEINTRAUB: and Guillain-Barre', is there something that specifically you need to know in order to declare that causal?

TOM FRIEDEN: there are studies under way including one we did with Brazil and when the laboratory work from that comes back, we may have more definitive information. But i would emphasize it's really important to think of these two conditions differently. Guillain-Barre' is something that we see after many different infections, including west Nile virus which is related to Zika. So we would not be the least bit surprised if Guillain-Barre' is definitely associated with Zika and given the time course of clusters of Guillain-Barre' after peak Zika virus infection i think most epidemiologists would say it's certainly related. In the case of microcephaly it's much more complicated. This is an extraordinarily unusual occurrence. It has been more than 50 years since a pathogen causing microcephaly or other serious birth defects has been identified. And, in fact, we're not aware of any previous documentation of a mosquito borne cause of an infection that can cause a severe birth defect such as microcephaly. So I think things do develop over time and part of science is uncovering information step by step and trying to be sure to not overstate what the data shows, but also as soon as we have information as we're doing today to share that openly with the public.

KAREN WEINTRAUB: Thank you.

OPERATOR: Yes, sir. Our next question comes from Maggie Fox of NBC News. ma'am, your line is open.

MAGGIE FOX: thanks very much. We’re very confused about some of the numbers here. Can we go through some of the cases that we have already known about and reported on and what are new among the nine pregnancies that you're reporting on? For instance, I believe the one case the baby born with severe microcephaly must be referring to the case in Hawaii, and a couple of the miscarriages is this linked to Zika.

DR. DENISE JAMIESON: In our report today we're not linking any of the cases to specific states. We’re just reporting that there were nine pregnant travelers with Zika infection and then reporting on those cases by trimester.

MAGGIE FOX: you can understand why we might be confused and where the numbers start to get conflated. For purpose of clarity can we say one case delivered is one we knew about and that the cases that were either aborted or miscarried has been described before?

DR. DENISE JAMIESON: Perhaps the confusion is this the first time we reported on U.S. pregnant travelers. The prior cases that CDC reported on were in Brazil.

MAGGIE FOX: Thank you.

OPERATOR: our next question comes from Mike Stobbe from the associated press. Your line is open.

MIKE STOBBE: Okay. Thanks for taking the call. I share Maggie’s confusion and desire for clarity but let me ask. Of the nine pregnant women, were all U.S. citizens and then i also have a question about the tests. Are you all saying that these this now is going to be available in commercial labs and what are the rates of false positives and false negatives for this test?

TOM FRIEDEN: All right. That was a few questions. Let me first clarify the previous answer. So, to Maggie Fox's question. A previous MMWR reported on two early infant deaths, infants who died in the first 24 hours of life with severe microcephaly and on two miscarriages. That was a prior MMWR. All four of those were in Brazil, in Brazilian women. None of those four are reported in today's set of nine. CDC has not previously reported any of the nine; some may have been in news media in various places. The diagnostic tests are currently going to be made available through the Laboratory Response Network. We are in conversation with several commercial entities about providing a non-exclusive license agreement to them to develop the test and we are open to providing materials and information and technology transfer to other parts of the private-sector but our first priority is that public health departments throughout the United States have access to the test. I’ll ask Dr. Villanueva to say anything more about the distribution of the virus as well as false positives and false negatives.

DR. JULIE VILLANUEVA: Thank you. With any diagnostic assay there's a risk of a false positive and a false negative. When the FDA does post our instructions for use on their website you'll be able to look at the performance characteristics of this test. If you have a positive result with the Zika test, it's likely you were recently infected with Zika virus but there is a chance the test can give a false positive result. That’s incorrect. This is because there are very -- there are other very closely related viruses such as dengue virus that can cause a positive result. So those positive specimens will be sent to CDC or a laboratory designated by CDC for further confirmation.

TOM FRIEDEN: Thank you. Next question.

OPERATOR: Thank you. Our next question is coming from Betsy McKay of the Wall Street Journal. Your line is open.

BETSY MCKAY: Thanks. Just to clarify, I’m following up on Maggie and Mike, Dr. Frieden I think what you were saying is this is the first time that CDC has reported on any pregnant travelers, right? All of the nine include all cases that have been reported to CDC whether they were reported in the media elsewhere first.

TOM FRIEDEN: correct.

BETSY MCKAY: Okay. Good. Thank you. Then I just wanted to ask a couple of questions or two about the pregnant, the cases. Could you maybe Dr. Jamieson describe for us where Zika was found in the cases, in the pregnancies of patients a and b. In other words was it an amniotic fluid or placenta or elsewhere, you said it was in products of conception, i think and then lastly is CDC looking into the possibility that previous infection with dengue might be a factor for these women who also had Zika and have had babies born with microcephaly? Thanks. Sorry, lots of questions.

DR. DENISE JAMIESON: So, in the early spontaneous abortion or early fetal loss the product of conception were positive by PCR. In the infant case, the placenta was positive by PCR.

BETSY MCKAY: But what is products of conception. Can you describe what that means for us?

DR. DENISE JAMIESON: Well early in gestation sometimes hard to differentiate what the different products are. In some cases the fetus hasn't even begun developing. So just in general the products from the conception were positive by PCR. But we're not specifically stating which part of that early pregnancy loss was positive.

TOM FRIEDEN: does that answer your question?

TOM FRIEDEN: Next question.

OPERATOR: our next question comes from Sabrina Tavernise of the "New York Times." Your line is open.

SABRINA TAVERNISE: Hi, everybody. Thank you. In plain English how would one render that product?

TOM FRIEDEN: Let’s just be clear here. There are now a series of miscarriages among women who have been infected with Zika. As we did report earlier in the patients from Brazil, our laboratory identified Zika in the placental tissues there. That’s suggestive that Zika may have caused the miscarriage but it's important to note that I believe 10% to 20% of all pregnancies may end in a spontaneous miscarriage. The fact that it's present doesn't necessarily mean it is what caused them. However its presence in the placenta is it terminated.

SABRINA TAVERNISE: Do we know why terminated?

DR. DENISE JAMIESON: We don't have that information. There were brain abnormalities noted on ultrasound and on MRI. In the case of termination.

OPERATOR: thank you. Our next question comes from Dan Childs of ABC news.

DAN CHILDS: this addresses something we heard often about this virus infection is only present in terms of symptoms in 20% of people, four out of five people affected may be asymptomatic. Do you intend to study if asymptomatic men can pass the infection and if asymptomatic women could still give birth to a child with microcephaly?

TOM FRIEDEN: We wish we knew the answer to those questions and we're studying that. It’s quite difficult to study because you then have to test a large number of people without symptoms to identify the moment when infection may be present. So, yes, those are very important questions. Yes we're investigating them. But no we don't have answers as of today and it may take some time before we have answers.

DAN CHILDS: Just one quick follow-up.

TOM FRIEDEN: No one is more impatient than we are to get answers to these questions.

DAN CHILDS: How would such a study be conducted hypothetically?

TOM FRIEDEN: For example, what we have done with chikungunya in Puerto Rico is to get blood from people who are donating blood and tested for the chikungunya virus and that's how we determine that it spread extremely quickly in Puerto Rico. That within just eight or nine months about a quarter of the adult population have become infected with the virus. And if you combine that with asking about symptoms that you can then know how much asymptomatic infection you would know or have a record of it. For the issue of asymptomatic women having a risk of transfer to fetus, studies we're doing in Colombia have a good chance of identifying that since we have whom of a definitive infection with Zika. The problem is they are all asymptomatic. Dr. Jamieson you want to say anything more?

DR. DENISE JAMIESON: That’s right. You have to enroll a cohort of pregnant women who were not asymptomatic and follow them throughout their pregnancy and test them every month.

TOM FRIEDEN: The further complexity, just to give you a sense of the challenges that our teams are working with is that in the areas where Zika spread, dengue and chikungunya is also presents and there's a lot of cross reactivity even with the best tests in the world that may make it difficult to differentiate one infection from the other. These are very challenging studies to do and something that we continue to work hard on.

OPERATOR: Thank you.

OPERATOR: Our next question comes from Brady Dennis of "the Washington post." Your line is open.

BRADY DENNIS: Hi. Thank you guys for holding the call today. I’m sorry if i missed but i heard an earlier question asked about whether the nine pregnant women with Zika were all U.S. Citizens or not and if there was an answer i missed it so I just wanted to ask again. Also I’m curious if you can talk a little bit about given the worries of pregnant women in this situation what we know and don't know about how early in pregnancy you might be able to detect brain abnormalities and other problems. What are we learning about that? Thank you.

DR. DENISE JAMIESON: Regarding the nine pregnant women they were all U.S. travelers. So I can't comment on their citizenship but they were all women who reside in the U.S. and traveled to a place with ongoing Zika virus transmission.

BRADY DENNIS: Its okay to say they are all U.S. residents, essentially.

DR. DENISE JAMIESON: that's true.

BRADY DENNIS They all live here. Got it.

DR. DENISE JAMIESON: In terms of how soon we can detect these abnormalities, in terms of microcephaly, microcephaly is hard to detect early on. But it's not very reliable for picking up these abnormalities early on. The later in pregnancy, the easier it is to see the abnormalities of the skull and brain. however, it's not clear whether these abnormalities developed later on and that's why you don't see them at 18 to 20 weeks when many women receive a routine screening ultrasound or whether we're just not very good at picking them up earlier on. so there's still a lot we don't know about when Zika has an effect and when we can first detect these effects and we are studying these issues.

BRADY DENNIS: I’m sorry. That was Denise?

DR. DENISE JAMIESON: Yes.

BRADY DENNIS thanks so much.

OPERATOR: Thank you. Our next question comes from Amy Birnbaum of CBS News. Your line is open.

AMY BIRNBAUM: To clarify a couple of things. You note brain abnormality noted on the ultrasound and it was terminated. The case report just as one. That’s one question. Then I also wanted to ask about sexual transmission. You mentioned a few cases of sexual transmission for women who are pregnant. Did you give a number? And then finally i want to ask the FDA about progress on a test for the blood supply. Thank you very much.

DR. DENISE JAMIESON: To the first question regarding terminations, we only reported the results for one of the terminations that, again, had the brain abnormalities on mri and ultrasound. No additional details about the other termination.

TOM FRIEDEN: We’re about 45 minutes into this call and i believe FDA had to drop-off the call.

AMY BIRNBAUM: okay.

TOM FRIEDEN: So I’ll refer you to their office for further questions.

AMY BIRNBAUM Thank you. And then if you can just clarify the sexual transmission and pregnancy.

DR. PAUL MEAD: I assume you're referring to the number of cases. Several of the patients were pregnant however we're not releasing the details of those again out of respect for patient confidentiality.

AMY BIRNBAUM okay. Thank you.

OPERATOR: thank you. Our next question comes from Maryn McKenna of National Geographic. Your line is open.

MARYN MCKENNA: This is another request for a little more clarity in the numbers, please. so in the discussion of pregnancies you have nine lab confirmed pregnancies among travelers, you have ten additional reports of pregnancies you're following up on and you also have -- we have a separate set of cases of confirmed or probable sexual transmission. Did those two sets of patients overlap? In other words are some of those pregnancies that you are investigating cases of sexual transmission?

DR. DENISE JAMIESON: No, because the first -- the case series of pregnant women are just travelers. Women who traveled and were exposed in those countries or areas with ongoing Zika virus transmission. So they do not include pregnant women who were exposed sexually. They are not overlapping.

MARYN MCKENNA: That includes the time you're following up because you said ten pregnant women not ten travelers.

DR. DENISE JAMIESON: That’s correct.

MARYN MCKENNA: okay. All right. Thank you very much.

OPERATOR: Thank you. Our next question comes from Robert Lowes, from MedScape Medical News. Sir your line is open.

ROBERT LOWES thanks for take my call. I see a news report that the Oregon health authority says Oregon has its first case of the Zika virus that was spread by sexual transmission. Is this occasion part of what has been reported today or is this an additional case?

DR. PAUL MEAD: Yeah. Again, this is Paul Mead. I need to refer you to Oregon for that information. I think our approach here is to respect the states that have asked us to keep that sort of information private for now. Thank you.

OPERATOR: Thank you. Our next question comes from Lynn Peterson. Your line is open.

LYNN PETERSON thank you. So given that the Brazilians apparently markedly undercounted microcephaly before 2015, how much does the current observed rate of cases exceed the expected number because i think there are cases of microcephaly without Zika and so given the birth rate and the known rates of microcephaly elsewhere, is the number really excessive? And what about here in the U.S. As well.

DR. DENISE JAMIESON: The numbers here are small in the United States, so we do have good baseline data here for the rate of microcephaly. And microcephaly does occur for lots of different reasons. But we did not expect to see these brain abnormalities in this small case series of U.S. Pregnant travelers. It is unexpected and greater than we would have expected.

TOM FRIEDEN: Thank you. We’ll take one more question.

OPERATOR: Thank you. Our next question comes from Dan Vergano of buzz feed news. Your line southern plains.

Dan Vergano thanks, folks. I was wondering can you do a little more to put that in perspective. If we report to people that you had nine pregnant travelers, and two miscarriages, two terminations with brain abnormalities, a case of microcephaly on delivery, that's like five out of nine. Should people take that as the rate of problems after a Zika infection in pregnancy if not tell us and put it in perspective.

TOM FRIEDEN: No. We just don't know. It’s too soon to say. We’re providing information as it becomes available and there is important information in this case series. For example, if you look at the numbers of women known to have been infected in the first trimester of pregnancy two had miscarriages and one had a child with microcephaly and one has an ongoing pregnancy and two had voluntary termination of pregnancy. First trimester we expect from rubella a parallel experience might be a period of higher risk but what proportion of all women infected develop, have their fetus develop a problem that can only to be done with large scale studies such as those that we have teams on the ground doing today in both Brazil and Colombia.

TOM FRIEDEN So i want to first thank everyone for participating in this briefing and i want to recap and mention a couple of the really key issues. I want to close by come back to the bottom line. For most people in the U.S. the bottom line is that pregnant women should postpone travel to Zika affected areas. As we get more reports of confirmed sexual transmission of the Zika virus we strongly encourage pregnant women and their male partner who has traveled to or lives in an area where Zika is spreading to use protection with condoms if they have sex. Third, pregnant women who themselves have traveled to an area where Zika has been spreading should and can now be tested for the virus between two and 12 weeks after return. We continue to learn more about Zika every day. And we're developing new tools to help diagnose it. There’s something that everyone can do. Pregnant women can deter travel or if they live in a Zika affected area do their best to avoid mosquito bites. Communities can reduce mosquito populations by mosquito control and investing in effective mosquito control strategies. We at CDC and throughout HHS and the rest of the federal government are working 24/7 to scale up testing for Zika, track the virus, implement the best ways we have today to protect people and figure out better ways to kill mosquitos, and prevent Zika. We are committed to telling people what we know, when we know it and as always when we learn more we'll share it. So Americans can decide best how to protect their own health. Thank you very much.

KATHY HARBEN: Thank you to all of our speakers and to Karen our operator. This concludes our telebriefing. A transcript of this call will be posted to the CDC newsroom as soon as possible. If you need additional information or have other questions, please call the CDC press office at 404-639-3286, or e-mail us at [email protected]. You can also find information in the two MMWR articles that were published today. Thank you very much.

Admin · February 27, 2016

CDC: Zika infections confirmed in 9 pregnant women in US

By MIKE STOBBE

Feb. 26, 2016 5:50 PM EST

1 photo

This 2006 photo provided by the Centers for Disease Control and Prevention shows a female Aedes... Read more

NEW YORK (AP) — Zika infections have been confirmed in nine pregnant women in the United States, including one who gave birth to a baby with a rare birth defect, health officials said Friday.

All got the virus while visiting or living in places with Zika outbreaks.

The Centers for Disease Control and Prevention said it is also investigating 10 more reports of pregnant travelers with Zika.

The U.S. cases add to reports out of Brazil. Officials there are exploring a possible link to babies born with unusually small heads, a rare birth defect called microcephaly that can signal underlying brain damage.

CDC Confirms 9 U.S. Pregnancies With Zika, Investigates 10 More

by MAGGIE FOX

In this Dec. 22, 2015 photo, Angelica Pereira, right, holds her daughter Luiza Felipe Dana / AP

Health officials said Friday they have confirmed nine cases of Zika virus among pregnant women in the U.S., and say they are investigating 10 more suspected cases.

The numbers have surprised the Centers for Disease Control and Prevention, which has been on the lookout for pregnant travelers affected by Zika. Five of the nine affected babies or fetuses have either miscarried or shown evidence of birth defects.

Two of the pregnancies with the virus, which is suspected of causing severe birth defects, have ended in miscarriage, two more were aborted, and one baby was born with severe microcephaly. Two babies were born healthy, the CDC reported, and two women are still pregnant with apparently healthy babies.

"We did not expect to see these brain abnormalities in this small case series of U.S. pregnant travelers," Dr. Denise Jamieson, who's helping lead CDC's Zika response, told reporters in a conference call. "It is unexpected and greater than what we would have expected."

And CDC officials also said they'd been surprised at how many sexual transmissions of the virus have been seen so far.

Brazil has reported more than 5,600 cases of microcephaly, a severe birth brain defect, since October, the World Health Organization announced separately Friday. WHO said it has not yet been proven Zika is causing any of them, but says the evidence is strengthening.

And both WHO and CDC said it was becoming increasingly apparent that Zika could cause Guillain-Barre syndrome, a usually rare complication of infections of various kinds.

All of the 19 pregnant women eyed by CDC were U.S. residents who had traveled to Zika-affected areas, the CDC said. With more than 30 million Americans traveling to Central and South America and the Caribbean every year, the CDC expects many travelers to bring home infections.

The case of the baby born with microcephaly had been reported by state health officials in Hawaii but CDC said it would not identify any of the women by state.

"Approximately half a million pregnant women are estimated to travel to the United States annually from the 32 Zika-affected countries and U.S. territories with active transmission of Zika virus," the CDC said.

These nine early cases may indicate that the first trimester of pregnancy may be the most dangerous time for a woman to become infected with the virus, although it is not 100 percent certain yet that Zika is causing the birth defects.

Doctors say the evidence is building, with several miscarried or aborted fetuses showing evidence of the virus in their brains, along with severe damage to the brain tissue.

CDC has warned pregnant women to avoid travel to Zika-affected areas.

"All nine women reported at least one of the four most commonly observed symptoms (fever, rash, conjunctivitis, or arthralgia), all women reported rash, and all but one woman had at least two symptoms," CDC said. Arthralgia is a medical term for joint pain.

"Among two women with Zika virus infection who had symptoms during the second trimester of pregnancy, one apparently healthy infant has been born and one pregnancy is continuing. One pregnant woman reported symptoms of Zika virus infection in the third trimester of pregnancy, and she delivered a healthy infant," CDC added.

"For the American public, the bottom line hasn't changed," CDC Director Dr. Tom Frieden told reporters. "If you are pregnant, avoid travel to a place where Zika is spreading." Women in affected U.S. territories, such as American Samoa and Puerto Rico, should protect themselves from mosquito bites as well as they can.

Image: Zika Prevention Kits — CDC, in collaboration with the CDC Foundation, has assembled more than 5,000 Zika prevention kits for pregnant women in Puerto Rico, with an additional 45,000 planned. If Zika is reported in the United States the kits will also be distributed to pregnant women in affected areas. The ZPK provides pregnant women with an initial supply of prevention tools including repellent, products that kill mosquito larvae, and condoms to prevent sexual transmission.CDC

CDC said it was distributing Zika prevention kits for pregnant women in Puerto Rico.

"There is the potential for hundreds of thousands of cases of Zika in Puerto Rico and unfortunately, tragically, affected pregnancies as well," Frieden said.

CDC has also cautioned men coming back from affected areas to be careful, as it's becoming clear the virus can be transmitted sexually. CDC reported 14 suspected or confirmed cases of sexual transmission in the U.S. but says two of those have now turned out not to be sexually transmitted Zika infections.

CDC gave some details of some of the cases, including a pregnant woman in her 30s who traveled to a Zika-affected area early in her pregnancy.

"One day after returning from travel, she developed fever, eye pain, and myalgia (muscle ache). The next day, she developed a rash," the CDC team said. A blood test confirmed she had Zika.

When she was 20 weeks pregnant, am ultrasound showed the fetus had severe brain damage. An amniocentesis test showed virus in the amniotic fluid, which indicates the fetus was infected.

"After discussion with her health care providers, the patient elected to terminate her pregnancy," CDC said.

CDC said it was rushing tests out to states so that pregnant women who suspect they are infected can be tested for Zika. So far, it's tested 257 pregnant women and just 3 percent of them have turned out to have had Zika.

CDC also detailed several cases of sexual transmission of Zika. All involved a man who had traveled to a Zika-affected area and had unprotected sex with a woman while he had symptoms, such as a rash or fever.

"We know that, at least while men are symptomatic, they can spread Zika to their sexual partners," Frieden said.

"Health care providers should now consider any person who has had condomless sex (i.e., vaginal intercourse, anal intercourse, or fellatio) with a male partner who has traveled to an area of ongoing Zika virus transmission and who has had symptoms of Zika virus disease during travel or within two weeks of return as potentially exposed," the CDC advised.

Zika's a mosquito-borne virus, spread as female Aedes mosquitos sip blood from one person after another, often in the same room. Other viruses are spread this way, too: yellow fever, dengue, West Nile and chikungunya.

With Zika, right now the only way the virus is getting to unaffected countries like the U.S. is in the bodies of travelers. So the cases of sexual transmission stand out. CDC says 30 million to 40 million Americans fly to Latin America and the Caribbean every year and even more go by land.

http://www.nbcnews.com/health/health-news/cdc-confirms-9-u-s-pregnancies-zika-investigates-10-more-n526726

Admin · February 27, 2016

Zika Virus Infection Confirmed or Being Investigated in 19 Pregnant Women in US, CDC Says

By GILLIAN MOHNEY

Feb 26, 2016, 2:01 PM ET

PHOTO: An Aedes Aegypti mosquito is photographed on human skin in a lab of the International Training and Medical Research Training Center (CIDEIM) on Jan. 25, 2016, in Cali, Colombia. — WATCH 5 Things You Need to Know About Zika Virus

Zika virus infections have been either confirmed or are being investigated in 19 pregnant women in the U.S., the Centers of Disease Control and Prevention said today.

Nine women have been confirmed to have had the Zika virus in the U.S., according to a new report from the CDC, which also note that of these pregnancies, two ended in miscarriage, two were electively terminated, one infant had microcephaly and two infants were born healthy. The last two pregnancies are ongoing without known complications, according to the CDC.

Ten other reports of pregnant women with Zika-like symptoms are being investigated, the CDC said. All of these women are believed to have been infected with the Zika virus while traveling outside the U.S.

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The Zika virus usually results in mild symptoms, including fever, rash, joint pain and conjunctivitis, according to the CDC. Approximately one in five people infected with the virus show symptoms. However, the virus has also been associated with a rise of microcephaly birth defect cases. The birth defect is characterized by a malformed or smaller head and brain and can result in significant developmental delays.

The CDC also released more information about cases of sexually transmitted Zika virus. The agency said after they received 14 reports of possible sexually transmitted Zika virus, they confirmed two cases of this transmission in the lab. Another four probably cases were identified and six investigations are ongoing. In all of these cases, sexual contact occurred shortly before a male partner became symptomatic, according to the CDC.

http://abcnews.go.com/Health/zika-virus-infection-confirmed-investigated-19-pregnant-women/story?id=37227077

Admin · February 27, 2016

Life | Fri Feb 26, 2016 6:54pm EST

U.S. study of nine pregnant travelers raises new worries about Zika

CHICAGO | BY JULIE STEENHUYSEN

A study of nine pregnant women from the United States who traveled to countries where the Zika virus was circulating shows

a greater-than-expected number of fetal infections and brain abnormalities, U.S. health officials said on Friday.

Two of the women had miscarriages, two had abortions, two had apparently healthy children, and one child was born with severe microcephaly, the U.S. Centers for Disease Control and Prevention said.

Doctors are still following the two remaining pregnancies, which so far appear to be progressing without complications, the CDC said.

"We did not expect to see these brain abnormalities in this small case series of U.S. pregnant travelers," said Dr. Denise Jamieson, a birth defects expert serving on CDC's Zika Virus Response Team.

She said it was "greater than we would have expected."

Brazil is investigating thousands of cases of babies born with abnormally small heads thought to be linked with Zika, a mosquito-borne virus circulating in Latin America and the Caribbean.

In the nine U.S. cases, Zika virus infection during pregnancy was associated with a range of outcomes, including early pregnancy losses, congenital microcephaly, and apparently healthy infants, the CDC said. Microcephaly is a birth defect associated with undersized heads and developmental problems.

More information will be available in the future from a new CDC registry for U.S. pregnant women with confirmed Zika virus infection and their infants.

An analysis of some cases showed the virus had crossed the placenta and affected the fetuses.

In one, a woman traveled to a Zika-affected area when she was five weeks pregnant. Antibody testing confirmed a recent

Zika infection. The mother miscarried at eight weeks, and an analysis of the fetus detected Zika virus.

"Our lab identified Zika in the placental tissues. That is suggestive that Zika may have caused the miscarriage," CDC Director Dr. Thomas Frieden told reporters on a conference call. But he cautioned that 10 percent to 20 percent of all pregnancies end up in miscarriage, so it was not certain that Zika was to blame.

In another case, a woman in her 30s had traveled to a Zika-affected area when she was about 12 weeks pregnant. Shortly after her return, she developed a fever, eye pain, body aches and a rash. Testing confirmed a recent Zika infection.

The woman got a routine ultrasound at about 20 weeks gestation, and doctors noted that the fetus was missing its corpus callosum, tissue that connects both halves of the brain. It also had fluid in the brain and there was evidence the brain had shrunk in size. The Zika virus was detected in the amniotic fluid. The woman chose to abort the fetus.

In another case, a woman who had lived in Brazil gave birth to an infant with severe microcephaly. The CDC did not release details on where the baby was born. In January, a CDC spokesman confirmed that a U.S. woman who had lived in Brazil gave birth to a microcephalic baby in Hawaii.

"It's more evidence to me that this association is continuing to look stronger and stronger," said Dr. Richard Beigi, president of The Infectious Diseases Society for Obstetrics and Gynecology, who had seen the reports.

"We want to be cautious because it's a small group of women, but from what I saw, it is suggestive that the effects look to be more severe in the early part of pregnancy," said Beigi, an obstetrician at the University of Pittsburgh Medical Center.

The CDC is also investigating another 10 cases of Zika infection in pregnant travelers. On Jan. 15, the CDC issued an advisory telling pregnant women to consider postponing travel to areas with active transmission of Zika virus.

On the conference call, the CDC said it has developed a diagnostic test that it plans to distribute to U.S. public health laboratories to speed the diagnosis of Zika, which currently takes about a week.

It is not yet clear that Zika virus actually causes microcephaly in babies, but experts say the evidence of a link is growing.

Brazil has confirmed more than 580 cases of microcephaly, and considers most of them to be related to Zika infections in the mothers. Brazil is investigating an additional 4,100 suspected cases of microcephaly.

The CDC said it has deployed 25 staff to help with the investigation. That was in addition to the 50 CDC staff members in Brazil studying dengue, a related virus.

(Reporting by Julie Steenhuysen; Editing by David Gregorio)

http://www.reuters.com/article/us-health-zika-usa-study-idUSKCN0VZ2NU

Admin · February 27, 2016

CDC: 9 pregnant U.S. travelers infected with Zika

Liz Szabo, USA TODAY3:25 p.m. EST February 26, 2016

Nine pregnant U.S. travelers have been diagnosed with Zika, and one gave birth to a baby with microcephaly, the Centers for Disease Control and Prevention announced Friday.

Of the eight other women, two miscarried, two had abortions, two gave birth to healthy babies and two are still pregnant. Health officials previously reported an American woman who traveled to Brazil gave birth in Hawaii to a baby with microcephaly, a birth defect where babies are born with abnormally small heads.

None of the women were hospitalized. Health officials are investigating 10 additional possible Zika infections in pregnant women in the U.S.

All of the women are U.S. residents who traveled to countries with Zika outbreaks, according to the CDC. The agency has tested blood from 257 women with potential exposure to the virus and established a voluntary pregnancy registry to gather more information from across the U.S.

In addition, the CDC reported 14 cases of suspected sexual transmission of Zika, including two confirmed cases in pregnant women and four more "probable" cases involving pregnancies.

Jose Wesley, who screams uncontrollably for long stretches, is attended to in Bonito, Pernambuco state, Brazil. Felipe Dana, AP

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Doctors believe Zika could be most dangerous in early pregnancy, an important period for brain development. Six of the pregnant women developed symptoms of the virus in their first trimester. Of those women, two miscarried, two had abortions and one had a baby with microcephaly, the CDC said.

Zika symptoms include fever, rash and joint pain, although four of five people infected with the virus have no symptoms.

It's unclear if these women's cases are typical, Frieden said.

The CDC provided details on four of the nine pregnancies:

One of the women who had an abortion traveled to a Zika-affected area when she was 11 to 12 weeks pregnant. A typical pregnancy lasts 40 weeks. One day after returning home, she developed fever, eye pain and muscle pain. The next day, she developed a rash. An ultrasound performed in the 20th week of her pregnancy suggested a number of problems. The fetus' brain had atrophied, or worn away, and it lacked a corpus callosum, the broad band of nerve fibers joining the two hemispheres of the brain. Genetic material from the Zika virus was detected in amniotic fluid.
One of the women who miscarried traveled to an area with a Zika outbreak five weeks into her pregnancy. A week or two later, she felt sick and developed a fever, rash, joint pain and muscle pain. A blood test confirmed her Zika infection. She miscarried around the eighth week of pregnancy. Genetic material from the Zika virus was detected in the miscarriage.
The woman whose baby was born with microcephaly lived in Brazil until her 12th week of pregnancy. She developed a headache, fever, rash and joint pain about seven to eight weeks into pregnancy. Tests found Zika in her blood and in the baby's placenta. The baby's head was smaller than 97% of babies of the same gestational age. In addition to microcephaly, the baby had weak muscle tone, difficulty swallowing and seizures. Tests also found eye inflammation. The baby's optic nerve, which carries messages from the eye to the brain, was pale, a symptom that can indicate optic atrophy, which can cause vision problems. Doctors sent the baby home with a feeding tube.
One of the women with a healthy baby visited to a Zika-affected area when she was 15 weeks pregnant. She developed a fever, rash, joint pain and headache when she was 17 to 18 weeks pregnant, and tested positive for the Zika virus. She delivered a full-term baby with no reported abnormalities.

The World Health Organization says while there is not yet definitive proof Zika causes microcephaly, the virus should be presumed "guilty until proven innocent" for now.Microcephaly cases have increased after Zika outbreaks in Brazil and French Polynesia.

Doctors don't yet know if Zika causes miscarriages, said Frieden, noting that 10% to 20% of pregnancies end in miscarriage. So, it's possible the miscarriages were coincidence.

Brazil reported 5,640 cases of microcephaly or malformations of the central nervous system, which includes the brain and spinal cord, between Oct. 22 and Feb. 20, according to the WHO. About 120 of those infants died. Brazil normally reports an average of 163 microcephaly cases each year. Only 583 of the microcephaly cases were confirmed and 4,107 remain under investigation.

USA TODAY

Zika Q&A: What you need to know about sex, saliva, sperm banks

Health officials in eight countries with Zika outbreaks have seen increases in Guillain-Barre syndrome, a nerve condition that can cause paralysis and death, according to the WHO. Guillain-Barre cases often occur after an infection, including West Nile virus, a disease spread by the same species of mosquito that transmits Zika.

Men appear able to spread Zika through semen when they have symptoms of the disease, said CDC director Thomas Frieden. Doctors don't yet know if men can spread the infection sexually when they don't have symptoms.

The CDC recommends men who have traveled to a place with a Zika outbreak and who have a pregnant sexual partner to either abstain from sex or use condoms for the duration of the pregnancy. Doctors don't know how long Zika can survive in semen. Tests have found viral genetic material in semen up to 62 days after illness, although those tests did not find infectious viruses, according to the CDC.

USA TODAY

Full coverage

Pregnant women should avoid travel to places with Zika outbreaks. People who live in areas with Zika outbreaks, such as Puerto Rico, should do everything they can to prevent mosquito bites, such as using mosquito repellent and clearing up trash that can collect standing water. The mosquitoes that spread Zika breed in standing water and often lay eggs in containers, such as flower pots.

More than 30 countries and territories in the Americas are experiencing Zika outbreaks.

Puerto Rico, where local mosquitoes are already spreading Zika virus, could see hundreds of thousands of Zika cases, Frieden said. The CDC is sending Zika prevention kits for pregnant women to territories where Zika is spreading: Puerto Rico, the U.S. Virgin Islands and American Samoa.

The CDC developed a test for Zika and is sending it out to public health labs across the USA, Frieden said.

Scientists discovered Zika in Uganda in 1947. The virus caused only sporadic cases in humans until 2007, when it caused an epidemic in the Pacific nation of Micronesia.

French Polynesia experienced a large Zika outbreak in 2013-2014. Health officials first diagnosed the virus in the Western Hemisphere in May, when it struck Brazil.

http://www.usatoday.com/story/news/2016/02/26/cdc-2-sexually-transmitted-zika-cases-confirmed-pregnant-women-4-more-probably/80990058/

Admin · February 27, 2016

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