CDC Action Plan Zika Summit

niman · April 1, 2016

U.S. Zika Action Plan Summit and Press Conference

WHAT: Hosted by CDC, the one-day Zika Action Plan Summit will bring together officials from local, state and federal jurisdictions and non-government organizations to prepare for a coordinated U.S. response to Zika. A press conference will be held to provide updates on the U.S. Zika response; speakers include CDC Director Tom Frieden, M.D., M.P.H.; Nicole Lurie, M.D., Assistant Secretary for Preparedness Health and Response, HHS; and Amy Pope, White House Deputy Homeland Security Advisor & Deputy Assistant to the President. For more information about the ZAP Summit, including the full agenda, visit:http://www.cdc.gov/zap/index.html.

WHEN:

8:00 a.m. to 3:00 p.m. EDT

Friday, April 1, 2016

8:30 to 11:20 a.m.:                  Presentations on the latest science about Zika

12:30 to 1:30 p.m.:                  Press Conference (webcast and in person)

2:00 to 4:00 p.m.:                    Media availability: CDC and key Summit participants

WHY: The United States faces likely local mosquito-borne transmission of Zika virus in some places in the continental United States. The Commonwealth of Puerto Rico, U.S. Virgin Islands, and American Samoa already are experiencing active mosquito-borne transmission. The U.S. government has planned this Summit to help identify gaps in preparedness and provide state and local senior officials with information and tools to improve Zika response within their states and jurisdictions. State and local jurisdictions will leave with comprehensive Zika Readiness Action Plans.

WHO:

·         State and local health officials

·         CDC experts

·         Representatives from multiple federal departments involved in Zika response

·         Representatives from non-government organizations involved in US. Zika response

WHERE: CDC Headquarters, 1600 Clifton Road, Atlanta GA 30329 and by webcast (Satellite coordinates below).

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.

NOTE: Media may also Register to Watch the Summit Webcast remotely. The ZAP Summit will be broadcast live on the web 8:30 a.m. to 3 p.m. EDT, April 1, 2016.

SATELLITE FEED: 1245-1345 ET

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Txp: 16K Ch: Lower

Downlink Frequency: 12011.00 V

Bandwidth: 18.00

FEC: 3/4

Data Rate: 18.295

Symbol Rate: 13.235

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Modulaton Std: QPSK

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Galaxy 17 Ku Intelsat

Txp: 16K Ch: Upper

Downlink Frequency : 12029.00 V

Bandwidth : 18.00

FEC : 3/4

Data Rate : 18.295

Symbol Rate : 13.235

Roll Of :

MPEG : MPEG-2

Modulaton : DVB-S

Modulaton Std : QPSK

Pilot On : No

Chroma Format : 4:2:0

Video Format : NTSC

Encompass GSC / TOC Information Atlanta (ATL): 678.421.6604

Edited April 1, 2016 by niman

niman · April 1, 2016

Friday, April 1, 2016 | 7:00 AM – 5:00 PM

How to join the live webcast?

Register to Watch the Zika Action Plan Summit Live, April 1, 2016, 8:30am-3pm EDT. For those who register, an email reminder will be sent 48 hours prior to the April 1st Zika Action Plan Summit event with a link to watch the Summit Webcast.

8:30 AM – 9:00 AM – Welcome
9:00 – 10:15 AM – Zika Science Plenary
10:15 – 11:15 AM – State and Local Panel: Controlling and Responding to Mosquito-borne Illnesses
11:30 – 12:30 PM – Crisis and Emergency Risk Communication in the context of Zika
12:30 – 1:00 PM – Press conference
2:00 – 3:00 PM – Using Policy to Increase Public Understanding and Enhance State and Community Readiness

7:00 AM – 8:15 AM | Networking Breakfast and Registration

Opening Science Plenary

8:30 AM | Welcome
9:00 AM | Science Plenary – Preparing and Responding to Zika Virus
- Presenters:
  - Tom Frieden, MD, MPH, Director, CDC
  - Denise Jamieson, MD, MPH, Medical Officer, Division of Reproductive Health, CDC
  - Beth Bell, MD, MPH, Director, National Center for Emerging and Zoonotic Infectious Diseases, CDC
  - Lyle Petersen, MD, MPH, Director, Division of Vector-Borne Diseases and Incident Manager for Zika Response, CDC
10:15 AM | State and Local Panel – Controlling and Responding to Mosquito-borne Illnesses
- Moderator: Anne Schuchat, MD, Principal Deputy, CDC and Rear Admiral, US Public Health Service
- Presenters:
  - Carina Blackmore, CB DVM, PhD, Dipl. ACVPM, Deputy State Epidemiologist, Acting Director, Division of Disease Control and Health Protection
  - Daniel Kass, MSPH, Deputy Commissioner for Environmental Health, New York City, New York, Department of Health and Mental Hygiene
  - Umair A. Shah, MD, MPH, Executive Director/Local Health Authority, Harris County, Texas, Public Health and Environmental Services
  - Brenda Rivera-Garcia, DVM, MPH, Territorial Epidemiologist, Puerto Rico Department of Health, San Juan, Puerto Rico
11:15 AM – 11:30 AM | Break
Participants will transition to either the Leadership Planning Track or the Readiness Action Planning
Track during the break.

Leadership Planning Track

This track is intended for Governors or their designee, public information officers, state, tribal, territorial and local leaders, and select U.S. government, non-governmental organization and private sector leaders.

11:30 AM | Crisis and Emergency Risk Communication
- Katherine Lyon Daniel, PhD, Associate Director of Communications, CDC
- Barbara Reynolds, PhD, Senior Advisor, Crisis and Risk Communication, Office of the Director, CDC
- Leonard Marcus, PhD, Co-Director, National Preparedness Leadership Initiative, Harvard University
12:30 PM – 2:00 PM | Networking Lunch
2:00 PM – 2:45 PM | Leadership Track Breakout Sessions

Breakout 1

Using Policy to Increase Public Understanding and Enhance State and Community Readiness

Presenters:
- John Auerbach, MBA, Associate Director for Policy, Acting Director, Office for State, Tribal, Local and Territorial Support, CDC
- Robert Eadie, JD, Health Officer and Administrator, Monroe County Health Department, Monroe County, Florida

Breakout 2

Practicum: Applying Communication Principles in a Zika Response

Crisis and Emergency Risk Communication Trainers:
- Barbara Reynolds, PhD, Senior Advisor, Crisis and Risk Communication, Office of the Director, CDC
- Molly Gaines-McCollum, MPH, CHES, Health Communication Specialist, CDC
- Kate Fowlie, Press Officer, Northrop Grumman
- Bret Atkins, PhD, CCPH, Health Communication Specialist, CDC

2:45 PM – 3:00 PM | Break
3:00 PM – 3:45 PM | Town Hall: Readiness Gaps and Innovative Solutions – Identifying public-private sector collaboration opportunities
- Moderators:
  - Judy Monroe, MD, FAAFP, President and CEO, CDC Foundation
  - Jerry Abramson, Deputy Assistant to the President and Director, Office of Intergovernmental Affairs, The White House

Readiness Action Planning Track

This track is intended for state, tribal, territorial, and local scientific and technical staff.

11:30 AM –12:20 PM | Jurisdiction Zika Action Planning
12:20 PM – 12:40 PM | Break and Pick Up Lunch
12:40 PM – 2:35 PM | Specialized Technical Assistance Workshop and Working Lunch
- 12:40 PM – 1:35 PM | Round 1 – Specialized Technical Assistance Roundtable Discussions
1. Vector Control
2. Diagnostics: Laboratory Capacity and Testing Interpretation
3. Prevention and Care for Pregnant and Reproductive-age Women
4. Health Communications
5. Surveillance to Detect Local Transmission and Monitor Outcomes (GBS) of Zika Infection
6. Surveillance and Services for Children with Birth Defects Associated with Congenital Zika Infection
7. Blood and Tissue Safety
- 1:40 PM – 2:35 PM | Round 2 – Specialized Technical Assistance Roundtable Discussions
1. Vector Control
2. Diagnostics: Laboratory Capacity and Testing Interpretation
3. Prevention and Care for Pregnant and Reproductive-age Women
4. Health Communications
5. Surveillance to Detect Local Transmission and Monitor Outcomes (GBS) of Zika Infection
6. Surveillance and Services for Children with Birth Defects Associated with Congenital Zika Infection
7. Identifying and Preventing Sexual Transmission of Zika Virus
2:35 PM – 2:50 PM | Break
2:50 PM – 3:45 PM | Jurisdiction Zika Action Planning

Closing Plenary

4:00 PM – 4:20 PM | Zika Action Plan Strategy Report Out
- Moderator: Stephen Redd, MD, Director, Office of Public Health Preparedness and Response, CDC and Rear Admiral, US Public Health Service
4:20 PM – 4:45 PM | Final Remarks and Questions and Answers
- Tom Frieden, MD, MPH, Director, CDC
4:45 PM – 5:00 PM | Appreciation and Adjourn
- Tom Frieden, MD, MPH, Director, CDC

PDF version of agenda: Summit Agenda[484 KB, 3 pages] . For more information, visit Zika Action Plan (ZAP) Summit .

niman · April 1, 2016

niman · April 1, 2016

Zika Action Plan Pre Summit Webinar

CDC hosted a webinar to provide guidance for all states on CDC’s recommendations for preparing and responding to the emergence of the Zika virus.

Thursday, March 10, 2016, 3:00 pm EST

Zika Action Plan Summit Webinar: Presentation[867 KB, 40 pages] | Audio[MP4, 14 MB]

Transcript

Coordinator: Welcome and thank you for standing by. At this time, all participants are in a listen only mode until the question and answer session of today’s conference. At that time, you may press star followed by the number 1 to ask a question.

I would like to inform all parties that today’s conference is being recorded. If you have any objections, you may disconnect at this time. Please continue to stand by. The conference will begin momentarily.

Coordinator: You are live in the conference at this time.

Dr. Anne Schuchat: Operator, could you begin the call for us?

Coordinator: Yes, you are live in the conference and you may begin when ready.

Dr. Anne Schuchat: Thank you so much. Good afternoon. This is Anne Schuchat and I really want to welcome everybody to the Zika Action Plan Summit planning call. We’re really glad that you could join us today as we talk about CDC’s recommendations for preparing and responding to the emergence of the Zika virus.

I’m pleased to be here with you today to update you on CDC’s response so far. During the Webinar, we plan to provide you with information on guidelines for a phased response to Zika and considerations as you continue working on your Zika action plans.

We’ll also share details about the Zika action plan Summit itself. Recently the White House invited governors and other leaderships from states to attend the first April 1st Zika action plan summit being hosted at the CDC in Atlanta.

The summit will provide state and senior health officials with information and tools to improve Zika preparedness and response in jurisdictions. The summit will also provide participants with the latest Zika science including modes of transmission and implications for pregnant women.

One housekeeping note - there’s going to be an opportunity to ask questions through the operator at the end of our presentation during a question and answer session.

If you prefer, please feel free to send a question throughout the session using the Q&A tab on your Live Meeting toolbar. We’ll do our best to answer as many questions as we can get to.

What is CDC doing? This winter, CDC began to focus intensively on the Zika virus which had been spreading in the Americas. We dispatched teams to Brazil and elsewhere to work with counterparts on understanding the virus and issued our first travel guidance on January 15th.

On January 22nd, CDC activated its emergency operations center and because emerging data was pointing to clusters of microcephaly and other problems associated with Zika virus, on February 1st the World Health Organization declared a public health emergency of international concern.

On the 8th of February, we elevated our EOC activation to level one, the highest level of response reserved for very critical emergencies. And as you know, on February 8th, the President announced the request for over $1.8 billion in emergency funds.

Zika virus was first discovered in 1947 in a monkey but it has been - probably we have learned more about this virus in the last two or three months than we have in its first 70 years.

Zika is spread primarily through the bite of an Aedes mosquito infected with the virus and most people probably don’t know they have the virus. Symptoms are typically quite mild and last for several days to a week.

The greatest risk is to pregnant women and their infants and we have emerging data about that risk and that is really why the focus of state and local preparedness is so urgent.

Once a pregnant woman is infected with the virus through a mosquito bite or potentially through sexual contact with a male who’s been infected or who has persistent virus, she can pass the virus on to the fetus and there can be a variety of potential complications to the fetus or potentially to the child.

So far, Zika virus and pregnancy has been linked to fetal loss, to congenital infections including microcephaly, eye problems and impaired growth. We don’t have evidence right now that women who deliver a baby who has complications from Zika virus or who loses a pregnancy to Zika virus has any risk for future pregnancies related to her Zika infection.

But we do think that infection during pregnancy can be a real problem. There are many questions right now and we’re working very hard to get answers, but we don’t know for sure if a pregnant woman is exposed to Zika virus, how likely it is that she’ll be infected.

If she’s infected, we don’t know how likely it is that her pregnancy will have problems or that her fetus will have problems. We don’t know if the fetus is infected, how likely it is that there’ll be birth defects or even longer-term developmental problems.

This is a critical set of questions that CDC and our counterparts around the world are actively trying to understand. Identifying a new viral cause of a major birth defect is extremely rare.

We know that certain maternal viruses like rubella and CMV can cause birth defects. The association between microcephaly and Zika is the first association between maternal infection and birth, in fact, to be detected in more than 50 years and we are literally learning more every week.

But the evidence for a causal relationship between Zika virus and microcephaly or other adverse pregnancy outcomes gets stronger by the day. CDC and other scientists are working to collect information about women infected with Zika during pregnancy and their infants to learn more about the impact of Zika during pregnancy.

The information collected will direct public health efforts intended to mitigate the impact of Zika and guide recommendations for the evaluation, testing and management of women infected with Zika during pregnancy.

We’re also very busy in developing and disseminating clinical guidelines that address the issues for pregnant women, infants and children who have possible Zika virus infections.

We’ll be continuing to issue guidance and update guidance as new information becomes available. Before 2015, Zika outbreaks had occurred in Africa, Southeast Asia and the Pacific Islands.

Currently, there are outbreaks occurring in many countries and territories in the Americas. And, as you know, it was last May that Brazil reported the detection of Zika virus and since then, more than 30 countries or territories are reporting it.

I want to caution you before you pay too much attention to the numbers on this next slide, the numbers shown come from (ArboNET). We have made Zika virus reportable and the state and local authorities are doing a great job of reporting cases but these numbers will be reflecting individuals who have been tested, results that our lab confirmed, that get reported and get updated once a week.

And see individuals from the territories are reporting frequently but these numbers will lag behind the actual trajectory of disease and they will only be laboratory confirmed cases.

That said, as of March 9th, 367 cases of Zika virus have been reported to (ArboNET) which is the national arboviral surveillance system managed by CDC and state health departments.

To date, there has been no local mosquito-borne transmission of Zika virus in the US mainland. One-hundred-ninety-three travel associated cases have been reported so far in 31 states and the District of Columbia.

Seventeen of those were pregnant travelers, three were sexually transmitted and one was a congenital transmission. So far, 174 cases of Zika virus have been reported to (ArboNET) from three US territories including 159 cases from Puerto Rico.

The numbers increase every week and we believe this trajectory will continue to increase substantially, particularly in the territories. So what is CDC doing? We’re focused on supporting state, local, tribal and territorial response efforts.

We’re just at the beginning of the response and its rapidly evolving. The priorities shift as we learn more every day but right now we’re working intensively with public health partners and state health departments to monitor the spread of Zika and report cases for public health surveillance, to increase lab capacity for testing and identification of Zika infections, to assist with the development of new or improved tests for the detection of the virus or past infections and working with partners to improve mosquito control efforts.

As you know, we’ve been providing recommendations for prevention and promoting effective health communication strategies. We are very keen to focus on support to state, local, tribal and territorial response efforts.

That is what the Zika action plan summit is all about and I’m pleased now to introduce our next speaker, Dr. Jennifer McQuiston, who is the deputy incident manager for the Zika response. She’s going to discuss guidelines for jurisdictions developing Zika risk-based action plans.

Dr. Jennifer McQuiston: Good afternoon. It’s a pleasure to be here to speak with everybody today. As Dr. Schuchat mentioned, I’m going to be talking about some new guidelines that we have recently shared with states for the development of their own state and local risk-based Zika action plans.

And these are recommendations that states might take into account in consider as they begin to work on their own plans. These guidelines are posted on the CDC Web site and the link is here and they’ve also been shared with state preparedness directors, partners and state health officials yesterday.

When states are beginning to work on their plans, probably a very common question that comes up is what should we do at what time? And the guidelines that we have been working on developing really look at Zika in a phased response.

A lot of states already have (vector) response plans and we know that some states have experienced, not only with the West Nile virus response, but also with chikungunya and dengue outbreaks.

But the Zika response requires some new considerations that are likely not covered in those other response plans including the need to really focus on pregnant women, protecting them from mosquito exposures and also how to incorporate sexual transmission messaging and risk reduction measures in the response plan.

The plan that was shared with states yesterday provides guidance for a phased jurisdictional response based on escalating risk for Zika. This means that states and counties and local jurisdictions might wish to base their response in a very defined geographic area if there’s not widespread transmission of Zika within the state.

And the phased response plan gives states and localities ways to do this. This is intended to serve as the support tool for states as they develop their plans. It is just meant to be guidance and it’s not meant to be policy.

In order for states and local jurisdictions to think about implementing a phased response, though, there are a few key actions that would really be important. The first is that plans that are already in place are reviewed and you prepare them in the context of a Zika response.

And it’s important to do this in advance of Zika transition actually being reported in your state. The vector control piece of the phased plan requires a comprehensive multistep approach and this means that states and jurisdictions should be thinking about how to monitor for Aedes species mosquitoes in their areas, both at the larval and adult stages and think about how to control them and then also how to implement a more urgent response in the event that Zika transmission begins to occur.

A phased response plan also requires that states have a very strong surveillance and diagnostic testing program in order to very quickly diagnose, report and respond to suspected Zika cases.

The phased response plan breaks down a response into four different categories of risk. There’s a preparation phase and this is the time period that’s really now.

It’s pre-mosquito season and that’s meant for states where an Aedes aegypti or an Aedes albopictus mosquito is present or possible in a jurisdiction. The second category is during mosquito season and this means that you’re actually expecting mosquito biting activity and breeding activity from those mosquito species.

The third phase is confirmed local transmission. This would be the first single case or few cases clustered in a single household or community block in a county or jurisdiction.

And then the fourth category of risk is widespread local transmission within a county or jurisdiction. This means that there are multiple locations with Zika virus cases and that there does not appear to be a clear chain of connection between them.

There is actually a fifth category of risk that we’re not going to talk about here and that would be widespread transmission in multiple counties in a region of the states, and that is just because the same recommendations are in effect but they’re scaled in a much greater level.

In each risk category, there are response activities that follow these different targeted areas and we’re going to talk about each of them. In the preparation phase, as states are beginning to think about what they might do in the event of Zika transmission locally, it’s important to think about who’s going to provide the leadership at the state and local levels.

And that would include appointing a senior representative to coordinate response efforts in deciding who will be an incident manager during an emergency.

It’s important that a lot of state and localities coordinate between state public health officials and vector control officials because, in many cases, those are organized differently and they’re not always working in tandem.

But in a situation like this, it’s very, very important for the infectious disease officials in a state to be talking with the maternal child health officials in the state and also to be coordinating with their vector control officials.

This is a good time to review any plans the state already has, what the situation looks like for your state and local mosquito control programs, what capacity they have, what their staffing needs are.

This is also a good time to review the processes that you may need for rapid hiring more contracting of services. For example, if your state or local area does not have a vector control program, what contracts would need to be put in place in order to make sure that that capacity is arranged?

Also in the preparation phase, and he state that has Aedes aegypti and Aedes albopictus will likely need to be thinking about how to communicate messages to the residents of their states and jurisdictions.

And this is a good time to begin to prepare a communication campaign. Pregnant women are one of the most important groups for us to focus on for communications.

The truly are the most vulnerable population and why we’re treating Zika and the possibility of it in the United States with such urgency. But also travelers returning from countries that have active Zika virus transmission and healthcare providers to know what to look for and how to test patients, all of those have communication needs that can be prepared in advance.

It’s important to note here that unlike other vector-borne diseases like chikungunya or West Nile virus, it’s really important to include messaging on sexual transmission and steps for prevention for Zika.

In the preparation phase, enhancing surveillance for travel associated Zika cases is also important. Not only does this give providers a chance to be recognizing what Zika could look like and how to report it, identifying travel associated cases early and making sure that they’re following recommendations to protect themselves from mosquito bites, may actually help prevent local spread of the virus.

This is also a good time to review your laboratory capacity and to determine if your state is able and ready to test specimens for Zika. For vector control, reviewing and conducting mosquito surveillance activities to assess historic distribution maps is important, but it’s also important to note that many of those maps are outdated.

And so as you’re preparing for the beginning of mosquito season, you might be thinking about how to do surveillance as mosquitoes start to come out so that those maps can be updated.

This is also a good time to begin planning activities that, from the start of a mosquito season, might help bring population numbers down and then hopefully reduce the likelihood of transmission in the future.

For pregnant women, this is a good time to plan how you might enhance surveillance for Zika in this very vulnerable population. It’s also a good time to identify resources that pregnant women might need in the event of local transmission.

And at CDC, working with many of our partners, we have been distributing something called Zika prevention kits in Puerto Rico and some of the other territories that gives pregnant women tools they can use to protect themselves, such as repellents, larvacides that they can use around the homes, condoms to prevent sexual transmission.

So these are the sorts of things that identifying resources in advance and planning for their distribution could be very helpful. We do know that blood safety is a concern with Zika and in Puerto Rico, local blood collections have stopped and they are outsourcing blood according to FDA recommendations.

So within the mainland United States, it’s important to think that if local Zika virus transmission is happening, there were also be blood safety issues to think about.

So consulting with your local blood collection centers now on their blood safety plans is important so that everyone understands what that response pattern will look like.

Once mosquito season starts, and here in Georgia, I think we’re almost there - it’s about 80 degrees here today - it’s important for the partners that are going to be working on the Zika response to begin organizing regular meetings and providing updates.

In addition to this, giving everybody information that can be helpful for - to guide their efforts, this is also a great chance to connect with CDC and other partners and find out what they’re doing.

From a communications perspective, you don’t need to wait for a Zika outbreak to have a communications campaign preparing people, and so messaging for awareness, how they can protect themselves against mosquitoes and really getting people engaged and thinking about how they can reduce residential sources of water they could contribute to Aedes breeding sites is important.

From the surveillance perspective, it’s important during mosquito season to rapidly follow up on suspected cases through laboratory testing and to encourage healthcare providers to immediately report those results.

While this needs to be happening even during pre-mosquito season and during mosquito season, it’s especially critical because those people need to be contacted and counseled about what they should be doing to protect themselves against mosquito bites.

During this time, as well, vector control mainly focuses on reducing residential sources of water where the mosquitoes can breed and organizing community interventions to disrupt those breeding grounds, so community cleanups, removal of any discarded tires. These are all things that are great to do during mosquito season.

In the event of the first confirmed local transmission case, that would activate the state incident management structure and would result in a connection to CDC and partners to see if additional resources might be needed.

If a state wanted to call an Epi- Aid), this is the time that would happen. Surveillance would include intensifying the - looking for human cases around this first confirmed case.

Ideally you’re finding human cases very, very quickly before they become widespread within a county. The only way to know that is to really be intensifying surveillance around that first case.

Vector controls, and a situation like this, if you really only have a localized case were a few cases in a household, vector control might include conducting intensified larval and adult mosquito control it that house or building and in a protective radius around it.

And that would include both residential habitat reduction, reducing water sources. It would include both larvacide and (adulticide) mosquito chemicals, outdoor space spraying.

There are a lot of things that can be done in an intensive way around a case patient’s home. In addition, a county may consider additional interventions, whether they wanted to do more widespread spraying through truck-mounted sprayers or even aerial sprays.

The decision about when to move to more widespread spraying is a very local decision and it depends on a lot of factors. But thinking about them in advance and building them into a plan is a great idea.

The first confirmed case of local transmission, it is very likely that pregnant women in that county are going to be very worried. So communicating clearly and early, specifically targeting your messages to pregnant women about what they can do to protect themselves, about where they should go for help is important.

Letting your local blood collection agencies know that you’ve had a single confirmed case is important and that way they’re ready and prepared in the event that transmission becomes more widespread.

Widespread local transmission is the fourth risk category and this is really when you have multiple cases in a county and multiple different areas that don’t seem to be all linked in time and space.

States and jurisdictions should really know in advance how they might respond, what their geographic counties might be for aggressive response efforts.

It’s envisioned it could be at the county level, it might be at the ZIP Code level. It might be at a level that’s contained within the health department’s access area, however states decide to do it.

It just needs to be communicated so that the response efforts are understood and that the blood safety centers know or blood collection centers know. This is the time you’re going to intensify your communication and outreach to the citizens, letting them know what they need to know to the communication plans you developed in the preparation phase.

And intensifying surveillance for human cases beyond those first cases, really working with your hospitals and clinics. In this phase, vector control needs to become intense and it needs to be expanded to include much wider areas.

And this is where your truck-mounted spraying or your aerial spraying might need to be implemented, depending on your state and county decisions and needs.

Once you have widespread local transmission and you’re doing much more urgent sector control, it also becomes very important to monitor the effectiveness of your control efforts, and so mosquito trapping surveillance is one way to do this.

I’ve gone through - oh, wait, we have a little bit more. Widespread local transmission - pregnant women outreach. We talked about this a little bit. Again, this isn’t necessarily guidance that every state or local jurisdiction would follow, but in the event that there’s widespread local transmission at a county or jurisdiction level, messaging about whether pregnant women might want to consider changing travel plans could be considered.

Again, that is a very local (need) and decision. Implementing your intervention plans is important. Pregnant women might need special intervention plans.

If they live in homes without air-conditioning or screening, they might need help actually mosquito proofing their homes so that they have a safe environment for the duration of their pregnancy.

You might also consider looking retrospectively for pregnant women who may have had Zika virus to see if any cases were missed so that they can be followed appropriately.

At the point of widespread local transmission, blood safety centers must begin following FDA guidance, and this means that local collection of blood will stop and that they will either need to outsource blood or they could to local collections if and when blood tests become available. Those are still in the research phase and they are not widely available at this time.

And with that, I’m going to turn it over to Christine Kosmos, who heads our state coordination task force. Stop review.

Christine Kosmos: CDC has been activated for a Zika response. We’ve been working very closely with our state and local partners to assist you with your planning and readiness for Zika.

Now at this point, I want to take a little break and do a quick poll to get a snapshot of where state and locals are in their planning process. This will help us finalize our reparations for the Zika action planning summit here at CDC on April 1st.

So (Demetrius), can we go to the poll? So hopefully you can see this on your screen and it asks you to just describe your jurisdiction’s Zika planning efforts to date.

So the responses are , hasn’t started yet, you’ve met but you don’t have - or you haven’t met but you have plans to do so, your jurisdiction has been meeting and developing your response plan, your jurisdiction already has a draft Zika plan or you’re not sure what your jurisdiction’s activity has been so far.

So we’ll give you a couple of seconds to answer that. Okay, just a couple more seconds. All right, I think we’ll close the poll. So essentially what this shows is that states and locals are already meeting and many of you already have a draft action plan in the works which is excellent news.

And since the EOC has been activated here at CDC, we provided a lot of technical assistance to our state and local partners. Specifically, we’ve had a lot of outreach to state and local lab directors, epidemiologists, NCH directors, preparedness directors, professional partner organizations, just to name a few.

In addition to that, CDC has provided a lot of guidance through MMWRs. We’ve published eleven MMWRs related to Zika. We’ve issued eight travel advisories. We’ve issued more than 20 plans for state and local use.

Some of them for state and planning. Some of them are lab related guidance. Many of them are for clinicians and healthcare providers. You have a lot of communication and risk communication tools on our Web site.

We have Zika posters and fact sheets. And we’ve also convened more than 40 calls including two national calls into call specifically for clinicians to provide state and locals with the technical assistance that you need.

So in the next few minutes, I want to bring all of this together because we’ve been dealing with a lot of areas subject matter experts, but this is really our opportunity to pull it all together and provide states and tribes and locals with a coordinated, one-stop shop approach to Zika planning and preparedness and provide your planning teams with CDC’s best available advice on how to approach Zika preparedness within state, local and tribal regions.

So in the next few minutes, I’m going to familiarize you with a few of the CDC resources that can really assist you with your planning. So first am going to walk you through the actual Zika action planning template that Jenny just walked through, just to familiarize you with it and show you how it works, so can you click on the link, (Kate) and the planning template form?

So on your screen, you’ll see the actual planning template that Jenny walked through. So it’s by phase, so you’ll see there are the specific actions that Jenny talked about broken out into the preparedness with all the specific guidance documents.

Then it goes into mosquito season, confirm local transmission, widespread local transmission, et cetera. And you’ll see in the left column, that’s the CDC advice and recommendation and it gives you, on the left - or the right-hand side, opportunity to write some of your jurisdictional action steps.

Now we’re hoping that you use this planning template and other resources that we’re providing today to really drill down into your specific plans and bring those particular gaps or areas that you want further assistance to the summit on April 1st.

Now, (Kate), can we go to the Zika Web site? So in addition to that, and sort of continuing in the vein of the one-stop shop, I want to just walk through the CDC Zika Web site which is a lot of information specifically for Zika.

It includes the latest guidance documents, MMWRs. You’ll see the MMWRs on the right-hand side, also the tools and the templates and the resources for state and local, as well as some public facing documents.

There’re Zika FAQs, scientific publications. And please consider this to be one of the best sources of information to assist in your planning and response. And then finally, just - I want to mention that the last thing that we’re offering to you or the last thing in this seminar, that we’re offering to you, is that our CDC entomologists are finalizing a vector control and surveillance strategy for the US.

We’re going to be sending it out to you very soon to assist in your planning, so more to come on that. So to summarize, we are asking you today, and this is kind of your checklist, to assign a lead Zika preparedness coordinator in your team, for those of you that have not yet started, to assess your jurisdictional risk, and there’s information included in the planning template that assists you in determining your jurisdictional risk.

Review the existing CDC guidance and resources that we have here and that I just walked through today, including the (ZAP) planning template which we just walked through, as a way to document some of your activities as well is to document some of the areas where you might need some additional technical assistance.

And want to have that draft plan, where you identify some of the gaps in preparedness and response, we’re going to ask you to bring that back to the summit on April 1st.

And speaking of the summit, I’m going to turn it back over to Sara Zigler who is going to give you some information about the summit.

Sara Zigler: Thank you, Chris. I’m excited to be able to share information with you all about the Zika Action Plan Summit that will take place on April 1st at CDC. I’m going to provide you a brief overview of the summit and how we think you might be able to best make the summit work for you and your jurisdiction.

The summit will include three tracks - a Zika science plenary, leadership planning for state and local government leaders and readiness action planning for state and local scientific and technical staff.

The first two parts will be streamed via live Webcast and archived on the (ZAP) Web site, which is www.CDC.gov/zap. The science plenary will include who is at risk, how to identify and diagnose cases and preventing and responding to mosquito-borne illnesses.

The leadership planning track will include information on crisis and emergency risk communication and the Zika response and how to manage policy to increase public understanding of Zika.

In addition, in the readiness action planning track, state and local scientific and technical participants will have an opportunity for action planning which will include specialized technical assistance.

So how might you engage in the summit? There are two ways for our state and local partners to engage in the summit - in person, as part of a jurisdiction team or virtually, through the live Webcast of the summit on April 1st.

The live Webcast will be archived for viewing after the summit as well. Please go to our will Web site, www.CDC.gov/zap, to find out more information. CDC encourages participation in person from states and jurisdictions that are most likely to have Aedes aegypti mosquitoes circulating and/or high regional travel volume with returning travelers from countries with local Zika transmission.

There is a listing of those state jurisdictions on the Web site. CDC will be providing financial support for state and local participants that attend the summit. I just want to clarify - CDC will be providing financial support for state and local participants that attend the Zika Action Plan Summit.

Everyone must register for the meeting so that we can make the necessary arrangements. Registration for this summit closes on Tuesday, March 15th. For those of you are contemplating in-person participation, we recommend that you consider a team composition that includes individuals from a variety of disciplines that contribute to your jurisdiction’s planning for Zika virus response.

You may consider state and local leaders such as governors, public information officers, a mayor, county commissioners or some scientific and technical staff such as your state health officer, your state epidemiologist, state veterinarian or vector control lead, your state preparedness director, a maternal and child health director, local health and environmental health officials.

We strongly urge state jurisdictions to include local health representation in their team composition. We’re planning for a Zika Action Plan Summit that is focused on providing content that will meet the needs of our state, local and tribal partners.

We would appreciate some of your feedback now through two quick rapid polls. We have two questions for you about what might be your priorities for receiving technical assistance from CDC and the other US government partners that will be involved in the summit.

Please select the best option from the two lists that you’ll see in this poll. We’ll do poll number one and leave this open for a few seconds I let everyone respond. And then we will go to a second question with different options for you to select from.

Please identify your jurisdiction’s priority technical assistance (TA) need from this first list. We appreciate that all of you are giving us your feedback so we can consider that as we make the final planning arrangements for the Zika Action Plan Summit.

Thank you all very much. We’re going to begin closing out this poll. And now for the second question - please identify your jurisdiction’s priority technical assistance needs from this list.

Again, we appreciate this feedback as we will consider it as we make final arrangements for the Zika Action Plan Summit’s curriculum. We’ll give it just a couple more seconds and then we’ll begin to close out this poll.

Thank you all very much for giving us your feedback. We have concluded the presentation section of this Webinar. We’re now going to wor- go to questions and answers.

While the operator is opening up the line to receive questions from the phone, we did receive one question in written form that we well answer. The question was too how to define widespread transmission for the purposes of blood safety. I’m going to turn this answer over to Jenny McQuiston.

Jennifer McQuiston: Hi, thanks for this question. So we - CDC, in concert with our state health officials who we consulted on the development of these guidelines, we kind of played with the idea of whether a certain number would be something that we would want to put out there as the designation for widespread transmission. And we talked about five or more cases possibly meeting that definition. But we decided not to actually put it in the guidance because in some cases...

Coordinator: To ask a question on the phone, please press Star 1 and record your name when prompted. Again, to ask a question on the phones, please press Star 1 now.

Jennifer McQuiston: That your county might be having a widespread transmission concern. So this is really something that we’re hoping that states and local jurisdictions think about and know what they’re trigger point is for widespread transmission. And I think that five or more cases would certainly qualify.

Woman: And operator, we’ll go to the phone if there are any questions.

Coordinator: Yes, and again, as a reminder, to ask a question my phone, please press Star 1 and record your name when prompted. One moment, please, for the first question. The first question comes from (Phil Wong). Your line is open.

(Phil Wong): Yes, hi. This is (Phil Wong). I’m with the City of Austin Health and Human Services Department and (this) follows up on the first written question, I think. And you talked about widespread transmission definitions for blood transmission concerns.

Also, I mean, in terms of how the geographic, what, area, you’re talk- going to be talking about, and I actually missed the end of the question with some of the question’s query procedures that - you know, our blood bank - I just got off the phone with our blood bank and they are very concerned regarding, you know, if our city gets designated or county gets designated as having the widespread transmission, what the implications would be for collecting blood.

Woman: Thanks for that question. We know that these are questions and issues that states and local jurisdictions are definitely going to be thinking about and making decisions about.

And we wanted to roll out the idea of a phased in jurisdictional response because every county and jurisdiction might have a different comfort level and what they feel they want to define as their geographic boundaries for that response.

Some counties may want to do it within the boundaries of their county lines. Some may want to combine counties if they feel like there’s a risk for transmission on a border, for example.

Some counties may be very large and feel like they can contain this jurisdiction only within a ZIP Code designation, so it really is left up to the state and local health departments, the boundaries that they want to set for what an active response would be, what your area of active transmission would be defined as, and correspondingly then, what your area of blood safety concerns would be contained within.

(Phil Wong): Okay, thank you.

Coordinator: The next question comes from (Tom Daly). Your line is open.

(Tom Daly): Hi. I was just looking for some clarification on the financial support that you mentioned it to the affected states. Is that - with that the 100% of the travel costs or a certain share?

Woman: It is CDC’s intention to support the travel expenses for the state and local representatives with consideration for space capacity that we have within our facilities and other factors.

We have a lot of interest for the Zika Action Plan Summit and so when you contact us through the Web site, you will receive a call back and we will communicate with you and find out more about your interest in attending the summit and work with you to identify the number of people that can be supported from CDC.

(Tom Daly): Okay, great. Thank you.

Coordinator: The next question comes from (Scott Lindquist). Your line is open.

(Scott Lindquist): Hi, this is (Scott Lindquist) calling from Washington state. I guess we’re looking for some advice on what our priority is in the state that we clearly do not have this mosquito. Our biggest issues have been around travelers.

So in our action plan, which we’ve drafted, we do have mosquito control districts. We do have (radication) plans, but quite frankly, it’s very unusual for us to see this mosquito at all and probably is not going to be seen in Washington. Any advice for us?

Dr. Anne Schuchat: Yes, hi. This is Anne Schuchat. Thanks for that question. You know, I think the first thing to stress is that this is - this virus is new to the Americas and the mosquito vector, Aedes aegypti, if not, you know, we’re not thinking it’s going to be a problem in Washington state.

So, you know, the prediction is that you’re going to have to deal with transmission from - they you’re going to have a lot of travelers and that you may have sexual transmission and that you’re going to have communication, laboratory, healthcare of affected babies and communication kinds of concerns and likely, not mosquito types of concerns.

But because this is a new condition, we think it’s important to think about things and not wait until you have a problem or wait until we see mosquitoes everywhere.

Certainly we are most concerned about the southern states where we know the vector is common and we also know that the Aedes albopictus can be a vector for this virus and the geographic that might be broader.

I think that the idea that 40 million people travel to Zika affected areas each year and beyond pregnancy, we now have sexual transmission to think about. We feel like every state is going to have some people with Zika infections that are complex and will need to be able to message and manage those.

But I think this - the whole focus on the summit and the planning is to know who the right counterparts are into think ahead to be ready for what’s likely and then to have at least thought about what’s unlikely.

Jennifer McQuiston: And this is Jennifer McQuiston. I will just add that if you visit the Web site and look at the phased risk-based plan, it outlines some state risk assessments that can be helpful for states in determining what level of plan you want to create and what you want to focus on.

And so the first risk assessment is that all states will likely need to provide public information, particularly to pregnant women because even if you’re in a state without Aedes aegypti, you’re pregnant women are going to be concerned and want messaging.

And then to assess returning travelers who may have contracted Zika virus infection and manage any risk for sexual transmission. The second state risk assessment would be for states with Aedes albapictus mosquitoes and those dates should presume that transmission as possible and be ready to prevent, detect and respond to cases of Zika.

And then the third state risk assessment would be states with known Aedes aegypti mosquitoes, and those states we think need to develop plans that more intensively monitor for cases, both in returning travelers and also possible local transmission, and then to prepare and respond vigorously to stop clusters of Zika before they become widespread.

So those are the sort of three risk-based assessments that we’ve put out there. I have an additional question that’s command - how will guidance change regarding travel when local transmission is occurring in a locality within the continental United States? I don’t think that the risk - the phased risk-based plan necessarily gets into the details of whether travel restrictions would be required or recommended.

I do think that pregnant women should now when there is a local area of transmission where active transmission is happening so that they can make their own decisions about travel. And so I think a lot of that is going to depend on messaging properly so that people are informed and can make their own decisions.

Woman: Maybe I could just supplement that a little bit. I think that we have - you know, you all in the state and local health departments know how many possible scenarios there are, you know, in terms of a back - a home or a block that has the mosquitoes in cases versus large numbers of infected mosquitoes with the virus and then possibly some human cases that have been detected.

You know, we also know that the way people live and travel in the community in the continental US is quite different than in Puerto Rico or much of South America in terms of screens and air-conditioning and, you know, air-conditioned malls and air-conditioned doctor’s offices and so forth.

So I think the issue of exactly what might be local - even widespread transmission in the continental US might not look the same as in Puerto Rico or Brazil.

And so the local and state planning really needs to customize (for) what we might see. Obviously, there are some neighborhoods that might be at great risk in the continental US and I think that’s the type of scenario that we should be thinking of.

One of the factors that we want people to plan on is mosquito (unintelligible) and that can help you understand hotspots and where we’ll need to be making sure we have control.

Woman: This is a great time to add that during the summit, on April 1st, there is actually going to be a track where we’re inviting states and localities to share their personal experiences in managing vector-borne outbreaks associated with Aedes aegypti. So we will hopefully have state and local representatives they can talk about what they’ve done in similar situations that can help inform the local decision.

Woman: Operator, we’ll go back for a couple more phone questions.

Coordinator: Thank you. The next question comes from Zach Thompson. Your line is open.

Zach Thompson: Zach Thompson, director of Dallas County Health and Human Services. I’m joined here with our health authority, Dr. Christopher Perkins. I want to commend you for the summit call today and I participated on a similar call earlier this week on Tuesday, March 8th.

I guess my question I want to reiterate how important it is and how critical local health departments will be to participate in person at the summit. We’re on the front lines.

As you know, Dallas County had the second sexually-transmitted case of Zika. Also, we’ve been involved in day-to-day planning, so I’m hoping that you could pass on to Dr. Frieden, the importance of local health departments being a part of the state team since we’re actually on the front line, have to deal with the municipalities, have to deal with the elected officials. And so any summit that does not include local health departments will definitely have a big gap. So thanks a lot.

Woman: Thanks very much for that comment and I just want to reassure you that we are addressing local health department engagement in the summit in two ways. First, by encouraging our state jurisdictions to include (local) representation, and also, by working proactively with the states from the local health departments that we have heard from to ensure that the representa- composition of any team is reflective of the needs of that jurisdiction. We understand your concerns and we’re trying to be very responsive to that.

Coordinator: The next question comes from (Laquanda Nesbitt). Your line is open.

(Laquanda Nesbitt): Hi. My question has been asked and answered. Thank you.

Coordinator: And so the next question is from (Mary McIntyre). Your line is open.

(Mary McIntyre): Yes, this is Mary McIntyre, Alabama Department of Public Health. I have several people here in the room with me. But we wanted to know is, we’re focusing on the composition of the team and what you’re looking at as far as the maximum number of people that would be allowed to come from any state. If we are trying to actually address state, local and partners in this effort, what is the number that we should be aiming for?

Woman: Thanks so much for the question. What we would, one, want to remind you, that for any team members that are not able to travel in person to CDC, that we will have live Webcasts of the large majority of the summit.

In addition to that, when you contact us through the Web site, you will get a call back from a member of our ZAP registration planning team who will work with you to identify the number of individuals we can support on the team.

Because of the large interest for this meeting, it is not a one-size-fits-all answer for this situation for the ZAP planning Summit and so we’ll work with you individually to address that question and we encourage you to contact us as soon as possible so we can get those plans underway.

(Mary McIntyre): Thank you. We have. We’ve contacted you.

Woman: So we had one additional question that came in on email and we’re going to ask Dr. Matt Kuehnert who works with lead safety here at CDC to answer it.

Dr. Matt Kuehnert: The question was, is there specific guidance on planning for blood supply interruption in the case of widespread local transmission? And we would - that’s a great question.

We would encourage state and local health departments to reach out to blood centers that locally collect in their area. We’ve already heard from Texas that blood centers are reaching out to you.

And we can certainly help in that regard and discuss that in the summit. What I will say now is that there is a plan to have blood donor screening tests available in April and by FDA guidance, the - what blood centers have to follow is that if there isn’t a screening test available, then in an area of local transmission, they essentially need to outsource until the screening test is available.

In addition, but centers may not, depending on the situation, choose to screen and want to outsource. So it’s going to be a blood center by blood center decision. Not all blood centers are the American Red Cross. There’re smaller blood centers as many of you know.

So I think it’s important to reach out to them and speak to them about what their plans are to best understand what their scenarios are and what can be done to assist them.

Woman: Operator, we have time for one more question before will complete the meeting.

Coordinator: Very good, and the next question comes from (Kim Stein). Your line is open.

(Kim Stein): Hi. I’m calling from the Michigan Department of Health and my question has to do with human case surveillance. We’re curious to know if - or if and when some of the Southern tier states, where, you know, (HSI) is, you know, present, when the states may begin screening people want travelers for Zika virus in order to detect local transmission. The current guidelines don’t permit us (screening) the people have not traveled out of the United States yet.

Jennifer McQuiston: I’m sorry, this is Jennifer. I think we’re trying to understand the question. The call came through and it broke up a little bit for us. Is the question when states and the southern part of the United States will begin to test symptomatic people who have not traveled?

(Kim Stein): Yes. I mean, you mentioned in Georgia, for instance, you know, mosquito season is upon you. So in other words, how will we know when that virus has reached the continental United States?

Marc Fisher: This is Marc Fisher with the epidemiology team here and that’s a very good question. It’s very difficult to identify the, you know, first local transmission in a given area. So right now, as you mentioned, the testing recommendations are for symptomatic persons who have a specific exposure that is through travel or a sexual contact of somebody who has traveled. And the only testing for asymptomatic people would be for pregnant women who have travelled.

The identification of the first local transmission in an area is really going to come from a combination of information that’s going to come from recognition of an unusual cluster of illness, of people with fever and rash or from mosquito surveillance or issues regarding possibly blood transmission. There’s not going to be a way to, during mosquito season, to test every person who has a symptomatic illness and has not traveled to identify the first case.

(Kim Stein): To know if there’s any test available for mosquitoes at this time for Zika.

Woman: So there are tests that can be applied to testing mosquito pools but at this time we’re not recommending it necessarily as a strategy for all states. But these are great questions that I think we can begin to talk about at the summit and be able to make sure that we’ve got technical expertise available for states that would wish to test mosquito pools that they have the guidance that they need.

Woman: We are reaching the end of our Webinar time. We would appreciate, for those of you that have participated in the Webinar, to give us some feedback. We have two more questions that are coming up they were welcome to answer for us, and on those questions, as you give us your feedback, we also have an email address where you’re welcome to send any comments or questions to us about any of the contents that we covered today.

It will help inform our preparations for the Zika Action Plan Summit in the coming weeks. We’re looking forward to you all participating with us in that summit virtually or in person depending on what’s most appropriate for your jurisdiction.

Woman: So the first question is that you understand the purpose of the Zika Action Plan Summit and then we have one more question after that. You can provide feedback to us at [email protected].

Again, that email address is [email protected]. For additional information about registering for the Zika Action Plan Summit, please go to our Web site, www.CDC.gov/zap.

There’s a link there where you can click on it to submit a registration request to us and then we will get in touch with you to have a conversation at a designated time to find out more information about your jurisdiction’s interest and then be able to follow up with you to make arrangements for you to engage either virtually or in person at the Zika Action Plan Summit.

Next question, close out the poll. This last question is, how valuable was this Webinar to you? Thank you all very much for participating in this Webinar and we look forward to continuing to work with you in the coming weeks as we prepare for our Zika action plans.

Coordinator: And that does conclude today’s conference. Thank you for your participation. You may disconnect at this time.

http://www.cdc.gov/zap/pre-summit-webinar.html

niman · April 1, 2016

White House convenes summit on Zika virus

Liz Szabo, USA TODAY10:39 a.m. EDT April 1, 2016

The White House convened a summit Friday about how to fight the Zika virus, urging state, local and national officials to act now to prevent and control the disease.

"If we wait until we see widespread transmission in the United States, if we wait until the public is panicking because they're seeing babies born with birth defects, we will have waited too late," said Amy Pope, the White House deputy homeland security adviser and deputy assistant to President Barack Obama.

USA TODAY

Zika Virus: Full coverage

The nation's highest priority should be to protect pregnant women and their fetuses, said Thomas Frieden, director of the Centers for Disease Control and Prevention in Atlanta, which hosted the summit. The Zika virus is now strongly linked to "catastrophic" birth defects, including microcephaly, in which babies are born with abnormally small heads, Frieden said.

"We need urgent action from all of us to minimize the risk to pregnant women," said Denise Jamieson, medical officer in the CDC's division of reproductive health.

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

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Zika virus: Heartbreaking images of birth defects

The mosquitoes that spread Zika virus live across much of the USA and are especially common in Florida, Texas and Hawaii, which have had outbreaks of related mosquito-borne viruses. The mosquitoes have dramatically expanded their range in recent year and now live even in dry areas, such as Los Angeles.

More than 300 U.S. travelers have been infected with the virus after returning from Zika-affected areas and another 349 have been diagnosed in Puerto Rico, where the disease is spreading among local mosquitoes.

The White House has asked Congress for $1.9 billion to fight the Zika virus at home and abroad. Congressional Republicans have resisted providing that funding, arguing that the USA should use unspent Ebola money instead.

USA TODAY

Zika Q&A: Growing evidence links virus to major birth defects

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ZIKA VIRUS IN THE NEWSAP: Insecticide Shipments Stopped As Zika Spread | 02:38

An Associated Press investigation has found that Brazil's fight against Zika was hampered last fall because the Health Ministry ran out of larvicide. Shipments across the country were suspended between August and October. (March 18) AP

http://www.usatoday.com/story/news/2016/04/01/white-house-convenes-summit-zika-virus/82507082/

niman · April 1, 2016

ZIKA VIRUS - SPECIAL EDITION
April 1, 2016

Zika virus (Zika) outbreaks are occurring in many countries and territories. Please share the following information with those who may find it useful.
Table of Contents
Announcements
CDC's Role in the Zika Response
CDC's Estimated Range of Ae. Aegypti and Ae. Albopictus in the US
NY Times Article: "CDC Offers Guidelines for Delaying Pregnancy After Zika Exposure"
Communication Tips
Online Resources
Stay Connected
Social Media Partner Resources
Contact Us
Types of Transmission

Zika virus is spread to people primarily through the bite of an infected Aedes species mosquito (Ae. aegypti and Ae. albopictus). To date, Zika has not been spread by mosquitoes in the continental United States. However, lab tests have confirmed Zika virus in travelers returning to the United States from areas with Zika. These travelers have gotten the virus from mosquito bites. Zika virus can also be spread during sex by a man infected with Zika to his partners. Some non-travelers in the United States have become infected with Zika through sex with a traveler.
With the recent outbreaks in the Americas, the number of Zika cases among travelers visiting or returning to the United States will likely increase. CDC is not able to predict how much Zika virus would spread in the continental United States. Many areas in the United States have the type of mosquitoes that can become infected with and spread Zika virus. However, recent outbreaks in the continental United States of chikungunya and dengue, which are spread by the same type of mosquito, have been relatively small and limited to a small area.

Not having sex is the best way to prevent sexual transmission of Zika. Couples with men who live in or travel to areas with Zika can prevent the spread of Zika by not having sex or using condoms (warning: this link contains sexually graphic images) from start to finish, every time they have vaginal, anal, or oral (mouth-to-penis) sex.
Birth Defects

Zika virus can be passed from a pregnant woman to her fetus. Zika infection during pregnancy is linked to microcephaly, a severe birth defect that is a sign of incomplete brain development. CDC is investigating the link between Zika and microcephaly.

In addition to microcephaly, other problems have been detected among fetuses and infants infected with Zika virus before birth, such as absent or poorly developed brain structures, defects of the eye, hearing deficits, and impaired growth. Although Zika virus has been linked with these other problems in infants, there is more to learn. Researchers are collecting data to better understand the extent of Zika virus’ impact on pregnant women and their birth outcomes.
Guillain-Barré Syndrome

Guillain-Barré syndrome (GBS) is an uncommon sickness of the nervous system in which a person’s own immune system damages the nerve cells, causing muscle weakness, and sometimes, paralysis.
The Brazil Ministry of Health has reported an increased number of people who have been infected with Zika virus who also have GBS.
GBS is very likely triggered by Zika in a small proportion of infections, much as it is after a variety of other infections.
CDC is working with Brazil to study the possibility of a link between Zika and GBS.
Symptoms

The most common symptoms of Zika virus disease are

Fever
Rash
Joint pain
Conjunctivitis (red eyes)
Most people infected with Zika virus won’t even know they have the disease because they won’t have symptoms. The sickness is usually mild with symptoms lasting for several days to a week. People usually don’t get sick enough to go to the hospital, and they very rarely die of Zika.
Treatment

There is no vaccine to prevent or medicine to treat Zika virus disease.
The following steps can reduce the symptoms of Zika:
Get plenty of rest.
Drink fluids to prevent dehydration.
Take medicine, such as acetaminophen, to reduce fever and pain.
Do not take aspirin or other non-steroidal anti-inflammatory drugs (NSAIDS) untildengue can be ruled out to reduce the risk of bleeding.
If you are taking medicine for another medical condition, talk to your healthcare provider before taking additional medication.
To prevent others from getting sick, strictly follow steps to prevent mosquito bites during the first week of illness. See your doctor or healthcare provider if you develop symptoms.
Prevention

The best way to prevent diseases spread by mosquitoes is to protect yourself and your family from mosquito bites.
Wear long-sleeved shirts and long pants.
Stay in places with air conditioning and window and door screens to keep mosquitoes outside.
Treat your clothing and gear with permethrin or buy pre-treated items.
Use Environmental Protection Agency (EPA)-registered insect repellents. Always follow the product label instructions.
Sleep under a mosquito bed net if air conditioned or screened rooms are not available or if sleeping outdoors.

To learn more, please visit CDC's Zika virus page.
Announcements
New Link: Preconception Counseling Guide for Men and Women Living in Areas with Zika
New Link: Women and Their Partners who are Thinking About Pregnancy
Updated Link: Zika and Pregnancy
Updated MMWR: Interim Guidance for Prevention of Sexual Transmission of Zika Virus – United States, 2016
Updated MMWR:Estimating Contraceptive Needs and Increasing Access to Contraception in Response to the Zika Virus Disease Outbreak – Puerto Rico, 2016
Updated MMWR:Interim Guidance for Health Care Providers Caring for Women of Reproductive Age with Possible Zika Virus Exposure – United States, 2016
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CDC's Role in the Zika Response
Click this link and the image above to learn more about CDC's role in the Zika response.
return to top
CDC's Estimated Range of Ae. Aegypti and Ae. Albopictus in the US
Click above to enlarge the PDF.
NY Times Article: "CDC Offers Guidelines for Delaying Pregnancy After Zika Exposure"
Click the photo to read the article, and visit CDC's "Women and their partners who are thinking about pregnancy" page to learn more about the suggested timeframes for pregnancy after possible exposure to Zika.
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Communication Tips

Reaching At-Risk Populations

To reach varied populations, communicators must consider culture, primary languages, and trusted sources of information among their audiences. For example, Latino and Spanish-speaking populations in the US may have loved ones in areas where Zika virus disease (Zika) is currently spreading. When CDC provides Zika communication materials that are effective for and meaningful to Latino and Spanish-speaking audiences, they help these audiences become better equipped to avoid Zika and to share Zika prevention information with their loved ones.
Currently, CDC is translating key messages, informational materials, and CDC’s Zika website into Spanish. CDC is also adapting the materials to make it easier for those most at risk to identify with the messages and images. Messages and images targeted to these audiences let them know that the information is meant for them and that they can make a difference in their health and the health of their loved ones. CDC and its partners are also working with Latino and Spanish-speaking organizations and audiences in areas with ongoing Zika transmission to ensure that the information provided is the information they need, and that it is presented in a way that recognizes and respects their ways of life. With audience feedback and a better understanding of their specific interests, messages can become even more meaningful and actionable.

Understanding the cultural background, community history, location, and values of your audiences is an important factor in effective communication. Understanding allows you to better address your audiences’ public health concerns and to provide them with understandable, actionable steps they can take to protect themselves and their families.

For more information, please visit our CERC website and refer to Crisis and Emergency Risk Communication, 2014 Edition.

Have you used CERC in your work? To share your CERC stories, e-mail[email protected]. Your stories may appear in future CERC Corners.

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Online Resources
Zika Key Messages: Detailed information on transmission, symptoms, travel, etc.(Mensajes Clave Sobre La Enfermedad Por El Virus Del Zika)
Zika Posters and Fact Sheets: Visual resources on Zika
Zika and Pregnancy: Information for pregnant women about Zika
Zika Travel Notices: Travel notices for areas where Zika is spreading
Zika Virus Digital Press Kit: Includes Zika facts, images, infographics, and more
Zika Virus Microsite: Offers an easy way to share information and stay up to date with developments in the current Zika virus outbreak, including prevention, symptoms, treatment, and information for pregnant women and travelers
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Stay Connected
These social media messages are available so that you can share on your organization's social media accounts.

CDC has updated its interim guidelines for U.S. healthcare providers caring for women of reproductive age during the Zika virus outbreak. Per the updated guidelines, women with a diagnosis of Zika virus disease should wait at least 8 weeks after symptom onset to attempt conception. Men with a diagnosis of Zika virus disease should wait at least 6 months after symptom onset to attempt conception. Women and men with possible exposure to Zika virus, but without clinical illness, should wait at least 8 weeks after exposure to attempt conception. Read more at MMWR.1.usa.gov/22L3kyh

CDC has updated guidelines for the prevention of sexual transmission of Zika virus. According to the new guidelines, men who have traveled to or reside in an area with ongoing Zika virus transmission and their pregnant sex partners should consistently and correctly use condoms during all forms of sex or abstain from sex for the duration of the pregnancy. Men and their non-pregnant sex partners who want to reduce the risk of sexual transmission of Zika virus should use condoms consistently and correctly during sex or abstain from sex. 1.usa.gov/1PvuT5o

Learn about how removing standing water can help prevent the spread of #Zika.http://1.usa.gov/1VAO9FU  .

The best way to prevent#Zika is to prevent mosquito bites.http://1.usa.gov/1QbHwpF

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Social Media Partner Resources

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@CDCEmergency
@CDCTravel
@CDC_NCEZID
@CDC_eHealth
@CDCGlobal
@cdcespanol (en español)

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CDC Travelers’ Health
CDC Global
CDC Clinician Outreach and Communication Activity

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niman · April 1, 2016

SCIENTIFIC METHOD / SCIENCE & EXPLORATION

CDC braces for Zika’s US invasion as scientists watch virus melt fetal brain

Experts prepare for pockets of transmission on US mainland as mosquito season begins.

by Beth Mole - Apr 1, 2016 4:28pm EDT

1

A female Aedes aegypti mosquito takes flight after a blood meal.
CDC

The Centers for Disease Control and Prevention gathered more than 300 local, state, and federal authorities and experts at its Atlanta headquarters Friday to prepare for clusters of mosquito-transmitted Zika infections on the US mainland.

“The mosquitoes that carry Zika virus are already active in US territories, hundreds of travelers with Zika have already returned to the continental US, and we could well see clusters of Zika virus in the continental US in the coming months,” CDC Director Tom Frieden said in a statement prior to today’s meeting. “Urgent action is needed, especially to minimize the risk of exposure during pregnancy.”

Zika, a virus that has been tearing across Central and South America since last year, is mostly transmitted by mosquito, but it can also be spread through sexual contact. Generally the virus only causes mild illness, with symptoms including fever, rash, pink eye, and aches. But in the recent outbreaks, Zika has been linked to rare cases of paralyzing auto-immune disease, called Guillain-Barré syndrome. Of most concern, it's also linked to devastating birth defects, including microcephaly, in which babies are born with small, malformed heads and brains.

While researchers are still studying the link between Zika and microcephaly, health experts fear that microcephaly is just one of the potential problems for the unborn. “Perhaps one of the most important unknowns is what is the range of fetal abnormalities in addition to microcephaly,” Frieden said in a press conference during the summit. Microcephaly may just be the extreme, he and others noted. Babies exposed to the virus in utero may also suffer from less obvious developmental and cognitive problems, he speculated.

The fear is bolstered by recent data that has only strengthened the tie between the virus and the birth defect, with some studies finding the virus killing off developing brain cells. In a study released this week in the New England Journal of Medicine, researchers report tracking the development of a fetus whose mother was infected with the virus during a trip to Central America while she was three months pregnant.

With blood tests and magnetic resonance images (MRI), researchers watched as the baby’s brain essentially turned to liquid in the course of nine weeks. The woman aborted the fetus at week 21.

Friday’s one-day summit covered such breaking scientific data on the virus and provided training to authorities on how to prevent, treat, and talk with the public (particularly pregnant women) about Zika and its health effects. Experts also focused on coordinating efforts to stamp down mosquito populations.

Enlarge / Estimated range of Aedes aegypti and Aedes albopictus in the United States, 2016.
CDC

There’s a hodge-podge of practices in various communities for tackling mosquito control, and many of them are very effective, according to Amy Pope, a White House deputy homeland security advisor and deputy assistant to the president who spoke at the press conference. “The goal of today’s summit is to bring all of those practices together in one place, give folks sort of the menu of options, so that they can develop a comprehensive plan well in advance of when we see mosquitoes biting around the continental United States,” she said.

Though health experts don’t foresee extensive mosquito-borne outbreaks of Zika in the US, there’s reason to expect small clusters of transmission. Zika is transmitted by Aedes mosquitoes, particularlyAedes aegypti and to a lesser extent Aedes albopictus. These mosquitoes, which are present in some areas of the US, can also transmit yellow fever, dengue, and chikungunya viruses. Small outbreaks of chikungunya and dengue pop up in certain areas each year, particularly in Texas and Florida. Health experts suspect that Zika may behave similarly.

Enlarge / A representation of the surface of the Zika virus with protruding envelope glycoproteins (red) shown.
Courtesy of Kuhn and Rossmann research groups, Purdue University.

Frieden stressed the difficulty of knocking backAedes populations, which are day-biters that can breed in very small amounts of standing water. Coordinated, sustained, and well-funded efforts are needed to control these populations, he said.

So far, there is no vaccine or specific treatment for Zika. However, in another scientific report in the journal Science this week, researchers report getting the first detailed, 3D image of the virus using cryo-electron microscopy. While the viral close-up looks unsurprisingly similar to that of dengue—a related virus—there are minor differences. Those findings could provide clues to how researchers might defeat the virus with a vaccine.

New England Journal of Medicine, 2015. DOI:10.1056/NEJMoa1601824 (About DOIs).

Science, 2015. DOI: 10.1126/science.aaf5316

http://arstechnica.com/science/2016/04/cdc-braces-for-zikas-us-invasion-as-scientists-watch-virus-melt-fetal-brain/

niman · April 1, 2016

State Health Officials Urged to Get Ready Now for Zika in US

By MIKE STOBBE, AP MEDICAL WRITER

ATLANTA — Apr 1, 2016, 6:09 PM ET

The government urged health officials around the country Friday to get ready now in case there are outbreaks of the mosquito-borne Zika virus in the U.S. this summer.

A Zika epidemic has been sweeping through Latin America and the Caribbean, and officials think it's likely some small clusters of Zika will occur in the U.S. when mosquito numbers boom.

At a "Zika Summit" on Friday, experts prodded some 300 state and local officials gathered at the Centers for Disease Control and Prevention headquarters to make Zika response plans now.

When West Nile virus — transmitted by a different mosquito — moved through the U.S. about 15 years ago, health officials were caught flat-footed, noted Dr. Georges Benjamin, executive director of the American Public Health Association.

"This is an opportunity to get ahead of the curve," he told the summit's attendees.

The Zika virus causes only a mild and brief illness, at worst, in most people. But in the last year, infections in pregnant women have been strongly linked to fetal deaths and to potentially devastating birth defects, mostly in Brazil.

The virus is spread mainly by Aedes aegypti mosquitoes, which also live in parts of the U.S. It was thought to be mainly in the South but the CDC revised its map this week, showing the mosquito has been found in parts of the Midwest and Northeast.

Officials don't expect Zika to be a big problem, though, in the U.S. for a number of reasons, including the widespread use of air conditioning and screens. The Zika mosquito likes to bite indoors. They think the clusters may be small and surface only in a few states — most likely Florida and Texas. But they don't know for sure.

So far, there have been no Zika infections in the U.S. caught from mosquitoes. More than 300 illnesses have been reported, all linked to travel to Zika outbreak regions.

About 350 additional cases have been reported in U.S. territories, most of them in Puerto Rico, where mosquitoes are already spreading the virus. Together, dozens or even hundreds of births in the 50 states and territories could be affected in devastating ways by Zika, said Dr. Edward McCabe of the March of Dimes, who spoke at the summit.

"We have a few short weeks to stop the Zika virus from gaining a foothold," McCabe said.

During the summit, state and local officials were encouraged to map where the Zika mosquito lives and breeds in the state and which insecticides would work best in their area.

The Zika response will likely mean workers will go door to door, sometimes asking to go on properties and even spray. That's different from the truck- and aerial-spraying seen in conventional mosquito eradication efforts.

It will be a kind of campaign not seen in this country since efforts to wipe out yellow fever in the 1950s and 1960s, and it will take different kinds of equipment, approaches and more staff, CDC officials said.

Local health officials at the summit said the work ahead is daunting, especially since it's not clear where they're going to get the money. And health departments are already struggling financially, said Dr. Jeff Duchin, a Seattle-based county public health official who was at the meeting representing the Infectious Diseases Society of America.

"Our priority is to make sure we have enough resources to meet the threat," Duchin said.

Paul Ettestad, New Mexico's public health veterinarian, said some of the state's counties only have a handful of people doing mosquito control work — the same people who also handle snow removal in the winter

"They don't have much," Ettestad said

The Obama administration in February requested nearly $2 billion in emergency funding for Zika response work. Congressional leaders have not formally voted on the request.

One of the things money is needed for, officials said, is better and faster blood tests for Zika. Now, it takes between a few days to a week to get results.

If Zika starts spreading in the U.S, women of childbearing age are going to be "intensely concerned," predicted Dr. Bill Foege, a former CDC director and expert on global health. "They're going to want to know if they are infected and they're not going to want to wait a week."

http://abcnews.go.com/Health/wireStory/state-health-officials-urged-ready-now-zika-us-38092149

niman · April 1, 2016

Stop Zika before it gains foothold in U.S., say health officials

By Rosalind Bentley - The Atlanta Journal-Constitution

0

Posted: 5:40 p.m. Friday, April 1, 2016

Highlights

CDC wants Congress to approve $1.9 billion in spending for Zika

There are no national protocols to combat the mosquitoes that carry the Zika virus

Georgia is adding nine state workers to monitor mosquito populations for the virus

Realizing the fight against the devastating Zika virus will hinge on effective mosquito control, federal, state and municipal health officials met at the Centers for Disease Control and Prevention Friday to share strategies and plead for federal dollars to stop the spread of the disease.

About 180 health department commissioners, doctors, environmental protection officers and other health care workers met to get ahead of a virus that threatens to hit the continental United States as mosquito season starts. While there was unanimity among conferees that stopping the virus hinges on mosquito control, there is no uniform national plan to contain the virus if and when it arrives on the mainland. For that to happen, CDC Director Dr. Tom Frieden urged Congress to approve a $1.9 billion request from the White House, $828 million of which would go to the CDC’s Zika effort. The federal dollars would fund things like the development of vaccines, research, and awareness campaigns.

“Without additional resources we won’t be able to get the resources we need to get to the state and local levels to provide Americans with the protection they deserve,” Frieden said.

Congress has said the CDC should use any remaining Ebola funds to fight Zika, but Frieden and others said that would not be sufficient.

“Shifting money from crisis to crisis will have us chasing our tails,” said Dr. Ed McCabe, medical director of the March of Dimes. “We have a few short months to stop Zika from gaining a foot hold in the U.S. If we don’t the consequences will be dire.”

The virus is already spreading across the U.S. territory of Puerto Rico with 325 cases of the virus recorded so far, including 40 pregnant women, according to the CDC. So far there have been 312-travel related cases of Zika in the U.S. including at least 21 pregnant women.

Pregnant women are the target of the CDC’s response to the virus because of Zika’s links to a range of debilitating birth defects, including microcephaly. Microcephaly causes babies to be born with undersized heads, underdeveloped brains and a host of physical and cognitive problems. Zika has also been linked to miscarriages and other dire health problems in babies. The virus is spread through two types of mosquitoes found in Georgia, the aedes aegypti and aedes albopictus. It is also sexually transmitted.

Georgia has had 11 travel-related cases of Zika so far. None have involved pregnant women. But State Public Health Commissioner Dr. Brenda Fitzgerald said Friday she is worried that a travel-related case would lead to eventual cases of mosquito-borne transmission in the state. While the state does not have a consistent mosquito control program, Fitzgerald, who is coordinating the state’s Zika response, said her department is filling nine new positions specifically for state-wide mosquito surveillance to help identify and clean up potential mosquito breeding grounds.

“This response is going to require overlapping efforts,” Fitzgerald said.

But those measures must begin immediately and they must be nationwide, experts said.

“If we wait until the public is panicking, until we see babies being born with birth defects, we have waited too long,” said Amy Pope, White House Deputy Homeland Security Advisor said.

http://www.myajc.com/news/news/stop-zika-before-it-gains-foothold-in-us-say-healt/nqxgr/

niman · April 5, 2016

Transcript for CDC Telebriefing: Zika Summit Press Conference

Press Briefing Transcript

Friday, April 1, 2016 at 12:30 pm E.T.

Audio recording[MP3, 9.83 MB]

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

MICHELLE BONDS: Good afternoon. Thank you for joining us today at the press conference at the Zika Action Summit, I am Michelle Bonds, the Director of Public Affairs at CDC. Today, you will hear from five speakers and then we will take questions. When we take questions from the room and from the phone, please state your name and affiliation before asking a question. Our first speaker is the Director of CDC, Dr. Frieden...Dr. Frieden.

TOM FRIEDEN: Good afternoon, everybody, thanks very much for being here. We’ve had a terrific response to the Zika Action Plan Summit. We had more than 300 people from all around the country here. We have over 2,000 people participating by web and we have heard from the manufacturers of Deet that there is a lot of concern about Zika … the increase in the purchase of mosquito repellant. The bottom line here is that we are all working here to protect pregnant woman. The key here is to reduce the risk to pregnant women. It has been to the day ten weeks since we first issued a travel advisory about Zika. and in that ten weeks, we have learned an enormous amount, we’ve done an enormous amount, but there is much more to learn …… Some of what we learned is the risk associated with Guillain-Barre and a range of adverse pregnancy outcomes. We’ve also learned that sexual transmission is much more likely than we anticipated and we learned from focus groups with pregnant women in Puerto Rico and elsewhere, that there is a great desire on the part of women to do whatever they can to protect themselves.

That itself is the bottom line. The risk of pregnant woman and the developing fetus and all of our activities need to be focused on mitigating that risk. In the past ten weeks, we’ve issued series of guidance and advice, on travel, on clinical care, testing on sexual transmission prevention and we’ve been able to scale up laboratory testing to provide Zika test kits to states around the U.S. and to countries around the world. We are working intensively if Puerto Rico to protect pregnant woman to the greatest extent possible, to reduce mosquito populations and to increase access to effective voluntary contraception for women who choose to delay pregnancy. Nothing about Zika is going to be easy or quick; the control of this particular mosquito is hard, and although we’re learning a lot quickly, there is still a lot we don't know. There is an urgent need to both learn more and do more and all of us have a role to play. In the federal government, there has been a terrific across federal government collaboration involving not just us at the CDC but many other parts of HHS in which you’ll hear about in a minute -- as well as HUD, EPA, and many other parts of the government working together robustly and rapidly as possible. In addition, we've had some generous submissions from private foundations to the CDC Foundation and that’s allowed us to move quicker and do things we would have not been able to do otherwise. We appreciate that tremendously. We are all in this together. There is something for everyone. Whether it's at the federal level, state, private, local and territorial levels, public sector, private sector, with commissions, patients, reducing the risk of pregnant women is crucial to protect future generations. The enthusiasm that we see for this response indicates the urgency with which Zika is appropriately seen. Many things at this summit both decidedly determined to move forward if terms of the localities and states doing more, but at the end, it's really important we have the resources we need to respond effectively. Because many things do cost money and without additional resources we will not be able to get the resources to the state and local entities that they need for our robust response. We won't be able to do the innovations we need to get ahead of not just this mosquito-borne threat but other mosquito-borne threats as well and we need the resources in order to provide Americans with the protections that they deserve. Thank you.

MICHELLE BONDS: our next speaker is at the White House Deputy Homeland Security Adviser.

AMY POPE: Good afternoon, everyone. It’s been a real pleasure to be here today at the Zika Action Plan Summit. It’s really a critical opportunity to bring together key players of state, local, private sector and fawn government organizations as well as our federal subject matter experts to refine our risk-based Zika Action Plan for states. On behalf of the white house, we are thrilled to be partnering with the National Governor's Association on combatting Zika in the homeland. Since late last year, we at the white house have been very concerned about Zika and its possible association with birth defects such as microcephaly and this rare neurological disorder called Guillanne-Barre syndrome. At the president’s direction, we have been working very aggressively to combat this virus – taking measures to ensure we are all prepared. We take this threat very seriously. While it’s a very different disease, and will require a different response, than Ebola, for example. We learned many valuable lessons from Ebola. Number one is the value of preparedness. As the white house Ebola response coordinator, i know from first-hand experience, that we cannot wait until we see wide-spread transmission in the United States before taking steps to prepare – it’s just too late at that point. That’s why on February 22nd, the white house sent an emergency supplemental request to congress for $1.9 billion -- to support our preparedness and response activities. Our quest includes money for fortifying our domestic public health system, to prevent, detect and respond to the Zika Virus. To accelerate our vaccine research and development to provide a long-term strategy to limit Zika. To expand our diagnostic testing capabilities. To educate health care providers, pregnant women and their partners. To improve our epidemiology, to expand our laboratory capacity. To improve health services and support for low-income pregnant women and to enhance the capability of Zika impacted countries around the world, to better combat mosquitos, control transmission and support the affected population. We’ve asked congress to act swiftly on our proposal to Zika in the homeland. Now, I know, that some in congress have suggested that we just use the money we have to fight Ebola to fight Zika. We said we're going to look at all of our resources, including some of our Ebola funding. When we're bringing the money to this fight but we cannot undermine our fight against Ebola or all the other health epidemics that exist to take the fight to Zika. But let me be clear, even if we make these hard choices, the money we have now is not enough. Congress needs to act and do it now. We need to ensure our state, local, tribal and territorial partners are better prepared to protect the people in their cities and towns. Now at the end of this summit, we expect the state and local summit participants to go back home with action plans in hand. We are working to provide resources to these states to help implement these plans. But we simply can't do it all without congress. But in the meantime, we're not going to wait. We’ve leaned forward in our response, especially in the U.S. Territories. Puerto Rico, as you know, is experiencing an outbreak of Zika now. CDC is leading the federal response there and working closely with the Puerto Rico department of health and with federal partners to protect pregnant women from Zika infection. But acting now in the absence of the necessary funding is forcing us to make difficult choices about the programs that protect to the health and safety of all Americans. We cannot erode the gains we made in our fight to Ebola. Afight is not yet over. As we are seeing today in Liberia and New Guinea. We will continue to support efforts to mitigate new infections through the developments of vaccines and drugs and stand ready to rapidly respond to new cases. We also continue to shore up our responsibilities for emergency detection of diseases whewn they’re introduced here. At this summit, the reason we are here today, because it represents a critical opportunity for states that may be affected by Zika in the coming months. And this is not something we can do alone. We’ve come here together today and we must work together going forward to stop outbreaks of Zika and to protect those most at risk of Zika infection.

MICHELLE BONDS: thank you. Our next speaker is Dr. Nicole Lowry, Assistant Secretary for Preparedness Health and Response with the Department of Health and Human Services.

NICOLE LOWRY: thank you, hi, everybody, thank you for being here. As you know, today's advance is an important part of our work to be sure the state the communities across the country are prepared, in other words, that they have the plan, systems in place to prevent detect and respond to the Zika Virus. Since the early reports of the potential link between the Zika Virus and epidemiological orders, the department of human services have taken a proactive and increasingly targeted at protecting their people long before the first cases of related Zika in the United States. We pulled together all the people to be sure we were ready and well-coordinated. Although, our understanding of Zika and its risks are focused of protecting those most at risk as you heard from Dr. Frieden. Especially pregnant women and their developing fetuses and women who may become pregnant. 96 to working with state and federal colleagues with Zika, which is what part of today's event is about. We’ve activated our countermeasure enterprise. We did the again well before Zika really came on most of the radar screen. And we did this actually for Ebola well in advance of the Ebola epidemic. We found when we put the pedal to the metal, we can all come together and get our diagnostic tests and vaccines developed quickly. Our expectation is that the same will be true for Zika. CDC, NIH, the FDA, the biomedical advance research and development authority, the department of defense, EPA are all working together toward this goal. Right now we are in dialogue with a great group of developers of diagnostic testing vaccines. We are really encouraged by their interest and tear progress. In the meantime the CDC has already developed tests to diagnose the Zika Virus and Zika Virus protection. But we need to expand that capability and in the long run, we are going to need better and faster tests. We’ve also worked to ensure a safe blood supply in Puerto Rico, collaborating the industry, to develop and deploy a screening test for investigational use approved yesterday by the FDA. As we are seeing if Puerto Rico, responding to Zika will require a collaboration across government and based on strong data. it requires the combination to prevent and reduce transmission, protect pregnant women, who are at highest risk, ensure women of child-bearing age who don't want to get pregnant have access to effective contraception and response to the excuse and long-term health of those who develop complications that may be Zika related. Today’s summit is an important step to ensure that those communities across the United States are prepared. If you heard, we are expecting people to return home, with action plans, to be able to lean forward so that we can all do the best job we can do protect the American people..

MICHELLE BONDS: Our next speaker is Edward Ehlinger, MD, Commissioner of Health for Minnesota and President of ASTHO

EDWARD EHLINGER Good afternoon. I’m here at the summit as the commissioner of health in Minnesota along with a team i brought with me i am here also as the President of the Association of state and territorial health officials, which represents 59 states, territories and the district of Columbia. Thanks to dr. tom Frieden and the CDC for pulling us together. This is a national problem. What we are hearing is demonstrating the need for a strong public health enterprise. We need a strong public health presence at the federal, state and local level. Because it affects everybody. Even the states like Minnesota, where we don't have the Aedes Egypti mosquito, we are dealing with Zika on a daily basis. A whole variety of ways. We all know at the state and local level, we need a lot of knowledge, a lot of capacity and under surveillance and monitoring at the local level for assessment and diagnosis of individuals and the community. We need epidemiology, clinical, lab approaches to go forward. We need to find out treatments that are necessary for them as we move, particularly with pregnant women. We need to prevent the transmission and to protect pregnant women. We need follow-up. We need a lot of education and guidance for public health and for medical care as we move forward. So we have to do this all the while we continue to address the other threats that are common to us every single day that really impacts our health and security. so all of this that we have to do at the state and local level and the federal level requires research and it's a lot of education and training like we are doing today and it also requires the resources. The majority, most people don't know the majority of public health services that are provided in the state are federally funded. When you look at infectious disease and emergency response, the proportion of federal funding is immense. We need that federal support and because we are already at a deficit in many of our funding sources leading to inefficient responses to needs and demand, like in my state, Ebola, Lyme disease, west Nile virus, plus the floods and the tornadoes and the lead testing in water and Zika added to the pressures in our jurisdictions. So this highlights the need for as we’ve mentioned earlier, needed resources. We need resources to deal with Zika Specifically, but we also need resources to maintain the base level of preparedness that goes on all the time in our states and we need to have some funding to allow us to respond to the next infectious disease that we have coming and we know it’s coming. We’ve had so many kind of threats in the last five-to-ten years, we know more are coming. So we need that kind of resources. We need to work collectively. We need strong public health enterprise at all levels, certainly those of us in state, local jurisdiction, are pleased to be able to work with our federal partners and strengthen that federal public health enterprise. Thank you.

MICHELLE BONDS: Dr. Ed McCabe The medical director of the march of dimes is our last speaker.

ED MCCABE: thank you very much for letting us participate in the Summit. The March of Dimes is very concerned we have a narrow window of opportunity and it will close rapidly. We have the opportunities to slow the spread of Zika into the United States over the next few months. If we're successful, we could save dozens or even hundreds of infants from being born with devastating birth defects. We must act now. For over 75 years, the march of dimes has worked tirelessly to prevent birth defects and infant mortality. For this emergency, the foundation has built a rapid response group with members of the CDC and trusted sources and to update constantly the material on the web and social media in English and in Spanish. Today we face the virus that appears to be linked to devastating defects, miscarriages and complications of pregnancy. For most birth defects, prevention is impossible. Because we don't know what the causes are. This is not the case with this virus. We know exactly how to prevent the birth defect. We must protect pregnant women from being bitten by mosquitos that carry the virus. The real challenge then is whether our nation will do what is needed to help pregnant women stay healthy. Today, representatives of states and local governments are gathering to prepare Zika plans and learn from each other. They are already committed to doing everything they can, but they cannot do it alone. Congress must also do its part. The march of dimes and our partners are calling on emergency spending legislation to give CDC, other federal agencies and states the resources they need to combat Zika Virus. We are grateful for their commitment, extraordinary work of staff and scientists here at CDC and other agencies and in the states. But they should not have to fight Zika by raiding funds from other important agencies – shifting money from crisis to crisis will have us chasing our tail instead of organizing a holistic comprehensive response to these public health challenge. We don't have the time that it took to learn about west nile virus. we have a short time in next few months to stop the Zika Virus from gaining a foothold. congress must act immediately for us to provide the resources. our families depend on it. thank you.

MICHELLE BONDS: We will now take questions from people on the phone. In the room, please wait for a microphone. Then state your name and affiliation.

BETSY MCKAY: I’m Betsy McKay from the "Wall Street Journal." Dr. Frieden, I’d want to ask if you are at the point of saying that Zika is the cause of fetal abnormalities and Guillanne-Barre syndrome and if not what remains to be learned before you can do that.

TOM FRIEDEN: One at a time, first in terms of the Guillain-barre syndrome, this would not be particularly surprising a wide range of bacteria viruses, and other challenges with our systems and trigger Guillain-barre syndrome, evidence is certainly highly suggestive. We have now seen one study that does show an association in what was retrospective. I anticipate that that causal connection will be confirmed in the near future; we ourselves, in collaboration with the Brazilian Authorities, have completed a case study of the guillian-barre syndrome in Brazil. We anticipate that will be confirmed, if you look at the formal proof, they are probably not quite there yet in terms of Guillain-Barre. I think all of us look at it and anticipate that it will be confirmed. With microcephaly the challenges are different. It is unprecedented. It has been more than 50 years since there has been a viral cause of a severe birth defect identified. So we've never identified a mosquito-borne cause of birth defect. So we want to be extremely careful. What is clear is that the spectrum of risk to pregnancy is beyond microcephaly. The spectrum includes miscarriage and appears to be present in all trimesters of the pregnancy. Although, we would anticipate it would peak in the first or second trimester. In terms of the formal criteria for causality, that is something we are looking at closely. We will have more information about it in the coming days.

ANDREW JOSEPH: I am Andrew Joseph with STAT News. I am wondering. Have there been any documented cases yet of sexual transmission from an asymptomatic man? Also, are there any discussions ongoing about broadening your condom recommendations? Because I believe Public Health England has a broader recommendation than the CDC right now.

TOM FRIEDEN: So, in terms of the first question, all of the sexual transmissions that we have documented have been from symptomatic males, when they are symptomatic or during the symptomatic period. However, if you are trying to use that to say that asymptomatic people don't spread it, you can't really say that. Because if you had an illness which is relatively non-specific, you might not if the individual had a secondary case, tie it back to Zika. If that index case was asymptomatic, in terms of recommendations for reducing sexual transmissions, we recently updated our recommendations, we have detailed guidelines and the reasoning for those guidelines on the web. There are individual or groups; this is what we think balances most protection and the best interpretation of current and available data. Next question.

ERICA EDWARDS: Hi, I’m Erica Edwards NBC News. There was a report out this morning that cases of Zika are declining in some part of Latin America like Colombia, wondering if that’s what you are seeing. Also, could that mean the virus is burning out as more and more people are becoming infected and becoming immune.

TOM FRIEDEN: If Zika behaves as Chikungunya and Dengue behaves, and that's a big if. We don't know if it will. We may see explosive spread in one area followed by a long period of lower level transmission. However, one area might be one part of the country, one city, one part of the city. So it's very difficult to predict what the pattern will be. What is certain is that the better we track, the better we understand the trend and prevent and respond to the greatest extent possible, but we also, remember, that even if you have widespread transmission in a city, it might only affect 25-30 percent of the individuals. If we take Puerto Rico as a model, with Chikungunya in Puerto Rico, it was introduced or first identified on May 5th of 2014. Within eight weeks, it was all over the island and in eight months, 25 percent of the adults were infected. But it continues to spread in Puerto Rico two years later. If we take Dengue in Puerto Rico for example, it spread there and now 90 percent of adults have anti-bodies to Dengue. They have been infected with at least one of the Dengue types. The virus unfortunately doesn't burn out. It may spread with greater intensity or less intensity.

MIKE STOBBE: Hi, Mike Stobbe from the Associated Press Dr. Lurie talked about tests and the need for better and faster tests could you say again, how long does the PCR test take to bring back results, how long does the antibody test? Could you say some people said if we do see local transmission in the fall, there will be a great concern and a great demand to have test results immediately? Is it likely that we will have a test in place then that would give concerned women a test result that day or within a day?

TOM FRIEDEN: Well, I’ll start and Dr. Lurie will continue. First off, let me go to what types of tests we have out there. There is the PCR or polymerase Chain Reaction and CDC has just gotten approved through the Emergency Use Authorization Program of FDA a trio-plex PCR that we developed in our laboratories that tests, at one go, Dengue, Chikungunya and Zika. That test actually has to incubate overnight, so it takes a day or two to come back with results. That’s what the science maximally allows. And we can produce hundreds of thousands of those tests and have those available. But that only identifies virus when it is present. When the RNA is present, which is roughly a week, in the blood maybe a little bit longer in urine, that’s something that needs to be studied. The more challenging is to see if a prior test, a prior infection has been present.

For that, we use an antibody test or IGM MAC ELISA that’s also a CDC-developed test which the FDA has issued emergency use authorization for and we're rolling out the laboratory response network to states all over the U.S. so they can offer testing to take some time for them to validate the test and begin offering it. An increasing number are doing that in the coming weeks. If the MAC ELISA is positive, the confirmatory testing needs to be done by a neutralization assay that is done only at the CDC laboratory and that takes about a week to occur. Because you actually have to grow the virus and the virus doesn't grow that well and quickly for that to be able to be done. So the testing is much more available than it was and that is due to literally around-the-clock work of a superb team of laboratory specialists at CDC. But it's not as available as we wished it were. I’ll speak in a moment about some of the innovations our labs are doing. But we really do need the commercial sector and private sector and others to come forward and do more. Roche Diagnostics came up with a test for the blood supply the FDA approved yesterday. Which is terrific; it means that in Puerto Rico, they can soon go back to collecting blood, screening it for Zika and using it. That is a very important development. There is work being done on the point-of-care tests and Dr. Lurie may speak more about that. What we're doing at this point is optimizing both MAC-ELISA tests so that we can produce it more rapidly, using virus-like particles and cutting edge technique to be able to produce large numbers in shorter periods of time. The lab works around the clock and will, I think, be able to increase production capacity. For that neutralization aspect that requires the virus to grow, as soon as it happened, the team had a great idea, which was to create a viral chimera. Create a new virus to be used in the lab, using a faster growing virus but with the Zika proteins embedded into the virus genome so they would produce the Zika antigen, which we then tested. So if that's the case, that works, we will cut that one-week confirmation down to a three- or four-day confirmation with a faster growing chimeric virus. So there are some innovations we are working on. But the bottom line is, without significantly increased resources, it's going to be very difficult, to do the kind of innovations that provides rapid testing and rapid control.

NICOLE LURIE: Thanks for the question. Our focus has been primarily on developing diagnostic tests that will be able to tell a pregnant woman whether she has been exposed or contracted the Zika Virus. We are also interested in improving the diagnostic test capacity for people who want to know am i infected now? I think you understand now the difference between those two kinds of tests. We are working very aggressively with a full course of diagnostic tests developers to do that. As dr. Frieden says, it takes money. We’re in a little game of cat and mouse here, because some of the developers are a little reluctant to put a lot of skin in the game, until they know that there will be money to support those efforts. Nonetheless, we are leaning forward as quickly as we possibly can to do that. one of the lessons that we learned from Ebola was in order to get to the commercially-developed tests the manufacturer is going to need to validate their tests against a whole bunch of Zika-positive samples and they're going to need to be able to demonstrate on a lot of samples that they can differentiate Zika from Dengue or Chikungunya and you’ve heard about that cross reactivity. One of the things we are in the process of doing now is trying to compile and curate a full series of diagnostic validation panels so that the developers actually have the material to move forward with to develop their tests. it typically hasn't been anybody's real responsibility across government. We all got together and recognized that as a government responsibility and we are actively working on that now. But that requires finding 50 or so people to confirm the Zika Virus, going to where they are, having them be willing to donate blood for that. We are in the process of doing that. Our goal is to meet the developer with those diagnostic panels when they are ready with their tests.

MARY BOYLE: Thank you. Hi, Mary Boyle with NHK Japan Broadcasting. With regards to the efforts of the hard-hit areas which is Brazil and Colombia, what do you think is the conflict between the guidelines issued by the CDC and those countries’ legal and cultural issues with contraception?

TOM FRIEDEN: Our goal in terms of contraception is that any woman who chooses to delay pregnancy has ready access to the most effective forms of contraception. we have good experience in this country expanding access to long acting reversible contraception. Wwe know that long acting reversible contraceptives are much more likely to succeed. And so certainly for any part of the U.S., we encourage local health care providers and jurisdictions to make effective contraception possible and readily available not just possible in theory. We’re encouraged by some of the comments from various religious leaders understanding in such an unusual time there are important resources that women can avail themselves of. In addition, we think it's very important to continue to focus on reducing the risk to pregnant women. This is the essential, the most targeted group at risk of the Zika Virus and target of our response in terms of maximizing that protection. I want to reiterate that here in the U.S., including Puerto Rico, we do not have a recommendation not to become pregnant. We do have a different recommendation that if a woman and her partner choose not to become pregnant, that there be ready access to effective contraception.

MARY BOYLE: And I have one follow up question. Do you feel the CDC is being too cautious with its guidelines?

TOM FRIEDEN: Is your question about anything in particular?

MARY BOYLE: infected men are advised to wait six months?

TOM FRIEDEN: We are being maximally protective. The key here is to protect pregnant women. it may well be that the viral persistence in semen is only a few weeks. But we have no idea if that's the case and, therefore, we say, if a man has been in a Zika area, and his sexual partner is pregnant, he should wear a condom every time he has sex. Any other question?

MEGHAN PACKER: Meghan Packer, CBS 46 --What are some of the most important steps to be taken right now in the U.S. at the local and community level?

TOM FRIEDEN: First off, women who are pregnant should not travel to areas where Zika is spreading. Men who have been in areas where it is spreading and have a sexual partner who is pregnant, use a condom. In areas of the U.S. where Zika is spreading such as Puerto Rico, pregnant women should use mosquito repellent, long sleeves, screens on their windows and doors and take steps to reduce mosquito populations. This summit is working through action plans for every jurisdiction that is affected. That means making sure that they're prepared to monitor and respond effectively as possible and maybe that will say more about what jurisdictions are doing.

EDWARD EHLINGER: Certainly, throughout the country, we have states and jurisdictions that are here to really learn what is specific to their area. What is happening in Houston, where they have the Aedes Egyptii Mosquito, they're doing a whole lot of different things in terms of mosquito spraying and with the mosquito control district the education and the social media that they are doing to educate folks about decreasing the risk for exposure to mosquitos. Certainly in Minnesota where we don't have the Aedes mosquito, we’re really educating our providers, the general information about travel and people coming back from travel. Also, we are trying to describe to our OBGYNs and the physicians in our clinics how to talk to folks about travel and how to do a travel history when they come back. So it really varies from point to point across the country depending on the risks that are there. A lot of the things are being implemented in localities throughout the country at the local level and at the state level.

TOM FRIEDEN: Okay.

MARYN MCKENNA: Maryn McKenna National Geographic. Dr. Frieden, Dr. McCabe made reference to dozens, possibly hundreds of infants who might be affected by birth defects. At CDC, have you been able to come up with any possible numbers for the potential public health impact of Zika on the mainland U.S.?

TOM FRIEDEN: We don't want to speculate on what may happen, we want to maximize our preparedness of what we can prevent from happening.

The front line of the battle against Zika in the U.S. is Puerto Rico. We are very concerned that Puerto Rico could have hundreds of thousands of Zika infections and potentially thousands of pregnant women infected within the continental U.S. It depends very much on several things, how many women travel. We’ve already had dozens of pregnant women who’ve traveled to become infected. If fewer pregnant women travel to Zika-affected areas, fewer Zika-infected pregnancies we are going to have. We have two pregnant women, six sexually transmitted total in the U.S. And in terms of local transmissions within the U.S., we have seen with Dengue and Chikungunya that there can be clusters in local areas. We’ve seen that in Florida, we’ve seen it in Texas, and we’ve seen transmission of Dengue in Hawaii. So in those areas, we need a maximum protective response to track mosquitos, control mosquitoes and reduce risk to pregnant women. But we don't have specific projections of what might happen. We are looking at what might happen globally but there are just too many unknowns. Perhaps one of the most important unknowns is what is the range of fetal abnormalities in addition to microcephaly? Microcephaly is not a diagnosis, it's a description. It’s a description of a devastating fetal malformation that's occurred and has interrupted normal brain development. It’s highly likely that infants who are not affected by microcephaly but do have Zika trans-placental infection, will have some other effects. Whether it affects our parents in the short term or long term, it will be very hard to say.

ED MCCABE: I agree, when you see the syndrome, which is what we are seeing here, we see the extremes of the syndromes. As Dr. Frieden has said, we don't know the impact the infection may have on the baby the baby’s whole life. And to the point about projection, we just don't want to see that experiment happen in the U.S. There is no reason why we should come back two years from now and say we were right or wrong about our projections. Let’s stop this. We know what we need to do to stop it. Let’s put the resources out there to stop it and not play another numbers game two years from now.

JONATHAN TERRY: Jonathan Terry with Fox News-- This morning, we saw a map showing a rather disjointed patchwork of mosquito control districts. What is your best advice to local governments on how they can sort of unify or coordinate that patchwork?

TOM FRIEDEN: This is one of the real challenges, really, if there is one bottom line i have for today's summit, we need sustainable mosquito control capacity throughout the country and whether it's Zika or West Nile or Dengue or the next vector-borne threat, it's so important that we have the resources there and we will do whatever we can at the federal government, the state, local government, also need to do more mosquito abatement. In the morning session, we heard that some of the mosquito districts are very powerful and are very effective. Others are basically the guy who shovels the snow in the winter and the fog in the summer. So they're quite variable in their capacities. That’s one of the reasons we need money from congress but in addition to state and local governments also need to invest in mosquito control in the long term. Amy Pope?

AMY POPE: The issue you raise is exactly why we’re having this summit today. What we realize is that there was no set of best practices for people who wanted to control this vector out there. What we do know is there are very good instances of communities that have been able to better manage the vector. we know from our experiences, for example, there have been very good practices that are in place and so if the goal of today’s summit is to bring all of those practices together in one place, give folks sort of the menu of options so that they can develop a comprehensive plan well in advance of when we see mosquitoes biting around the continental United States.

(UNKNOWN: CONSUMER REPORTS): Can you talk a bit about resistance and if resistance testing is being done extensively and how it’s informing guidelines with respect to insecticides and bug spray.

TOM FRIEDEN: Thank you. In terms of resistance, most of our work has been in Puerto Rico, which is most heavily affected. We set up the laboratory for resistance in Puerto Rico, I’ve visited and I’ve seen the resistance testing they are doing, it's quite impressive. It’s not easy, you have to go out and collect the eggs of the Aedes Egypti Mosquito; then you have to grow them and wait until they hatch into larvae. When they're adults you have to put them into a bottle. It’s very simple. You basically take a glass bottle and you roll insecticide around until it covers all parts of it. You put 25 mosquitos in there. Which is harder than you might think or easier than you might think. You measure, every 15 minutes, what proportion of the mosquitos are knocked down. And I was able to see the test during this visit. Unfortunately in Puerto Rico, many of the pyrethroid insecticides have a high degree of resistance. So I saw very effective insecticides with mosquitos flying happily around an hour later, it doesn't affect it whatsoever. And then with at least one of the insecticides, mosquitoes were knocked down within 15 minutes. What we found in Puerto Rico, and what we're finding in Mexico and elsewhere and in our international work is that insecticide resistance can be quite focal. Remember from Dr. Petersen, that these mosquitos don’t fly that far. So you might find as we found in Puerto Rico that there was no one pyrethroid that worked on that whole entire Island.

That makes mosquito control even more complicated. Even more technically challenging, because you then have to match the insecticide used to the resistance of population. It’s another area in the U.S. where we need much better data and much better testing. It is in some ways similar to antibiotic resistance where you want to know the resistance pattern before you use antibiotics and sometimes using the location and the combination to prevent the further development of resistance. Other questions?

REPORTER: Talk about each state should have a plan. How many states have plans and how many states say they have the staff and money to implement the plans right now?

TOM FRIEDEN: I think it's safe to say no state would say they have enough money and staff to respond effectively today. Because this is a big challenge. There is a shortage of entomologists out there. There is a shortage of dollars to do the expensive things needed. I think most or the great majorities of states have done a lot to prepare. But this summit is to accelerate that action.

EDWARD P. EHLINGERTHIS: This is a rapidly changing environment. So what ASTHO (Association of State and Territorial Health Officials) is doing, we are surveying all of our members, to see what they are doing, what resources they are putting into it. Also asking them what things are they not doing in response to changing those priorities. So we’ll be getting that information. We know everybody is paying attention. We’ve had multiple calls of all the state officials throughout the country. We’ve had several calls so everybody is working on it, they’re doing different things. As I mentioned earlier, the needs are a little bit different in Hawaii and Texas and Florida than they are in Vermont and Washington or North Dakota. But everybody is working on it in some way, shape or form. We are trying to collect all that, so that we can feed that back to CDC. What are the needs? How do they vary? What kind of resources are needed? Where do we need to focus our attention? We will be getting that i am hoping in the next few weeks as we survey our colleagues.

UNKNOWN: Does anybody have a completed plan or are you saying everyone is drawing them up right now?

TOM FRIEDEN: right now, there is no complete, there is no definition of a complete plan. We are learning every single day about new things. We are learning what issues are out there. We are learning how the virus is moving, how we're going to be responding, getting new information. So people, some people have really robust plans from mosquito control to testing to education, to social media, but is that a complete plan? We don't know yet, because we don't know all of the things that we don't know.

AMY POPE I’d only add this is not the first time that we’re starting this conversation. Back in February when all of the governors were in Washington to meet with the president we came together and realized that we very much needed this kind of planning because – someone noted the patchwork of mosquito control efforts around the country-- and since that time, CDC and our other federal partners have been working with states to develop their plan so that people coming into this already have something in hand and then the goal, today they walk out and they import the expertise and the knowledge that they’ve gained from their colleges. But as we pointed out, we are learning every single day. I would challenge anybody who says they have their complete plan in place. We believe at this point you need to be adjusted to learn more.

TOM FRIEDEN: We’ll take a question from the phone.

OPERATOR: Thank you. Our first question from the phone is Dennis Thompson with Health Day. Your line is opened.

DENNIS THOMSON: My question has been answered. Thank you. Sorry about that.

DONALD McNEIL/NYT: If this was World War II and you went to congress asking for money to fight the Japanese, and their response was, well, take it from the money we already gave you to fight the Germans. You would find that an almost absurd response. I can't. You can explain it that way. I can't think of the time congress has looked at a new epidemic and said, ah, forget it. Go take the money from one of the old ones. We’ve had a series of epidemics in this country. Could anybody Dr. Frieden or from the White House comment on why you’re running into this kind of resistance on this one disease?

AMY POPE: Well what I think Congress is doing is asking the American people to choose which disease they want the most protection from and that just doesn’t make a lot of sense. When we worked with congress to get the money for Ebola, we believe they actually showed quite a bit of foresight in saying we’re not going to fight this epidemic by epidemic. We’re going to make an investment in our global health security and we, with the money, the investment that they made, have been working with countries around the world to put together a plan to prevent and respond to vector borne diseases. We think this will ultimately make America safer because we will see things like Zika coming, we will see things like Lassa fever, or Ebola as these outbreaks happen. Frankly, we don’t think funding epidemic by epidemic makes a lot of good policy sense. We don’t think it’s fair to ask Americans to choose. We’re hoping congress will do the right thing and act.

TOM FRIEDEN: I would also comment that Ebola is not over. In fact just this morning a new case of Ebola was confirmed in Liberia. Sadly a women who died from Ebola was confirmed after going through the diagnostic test and that investigation is underway. We also have a cluster in Guinea that we’re following up on. With the global health security dollars that Congress invested, we’re confronting a very large outbreak of Yellow Fever in Angola. We’re dealing with Lassa fever in Nigeria, so it’s a dangerous world out there and the more we can stop diseases from spreading overseas, the safer we can be here at home. Another question from the phone for anything that hasn’t been answered.

DONNA YOUNG (Scripps News): Thank you so much for taking my question. This is for anybody, Dr. Frieden or Dr. Lurie. Talking again about the projections, have you actually provided any sort of cost estimate to Congress, not specifically looking at this disease, but the cost estimate of birth defects in general and maybe compare that to the cost of developing a vaccine and treatment to prevent this from infecting pregnant women? Has there been any kind of economic analysis presented to them as an argument as to why they need to provide this funding to develop the vaccine? Thank you.

TOM FRIEDEN: I will make a brief comment then pass to Dr. McCabe who can say more. The request to congress is $1.9 billion dollars of which $828 million is for CDC. That part of the CDC request covers both our continental US, Puerto Rico and territories, and our international activities. Our birth defects specialists tell us a single child with birth defects can usually cost $10 million dollars to care for or more.

ED MCCABE: I don’t think we can take all of birth defects and talk about these babies. First of all we only know the severe microcephaly that these babies are experiencing. This is devastating. I was chair of pediatrics at UCLA for 16 years. The paper in the New England Journal a couple weeks ago out of Brazil was from the team there. They were telling me that the future of these babies is going to be very, very difficult. We really need to stop that, so that we don’t we don’t see that occurring in the US to the degree we’ve seen it in other countries. The costs are going to be terribly high through the life of that child and unfortunately some of these children aren’t living very long. I think it’s difficult, we don’t have the experience yet to know what the life is going to be and again back to those babies that we see in the pictures from Brazil with severe Microcephaly, we can see them, we know how devastated their brains are. What about the baby who was born and had placenta insufficiency, also in the same New England Journal paper? All of the organs were small because the placenta could not provide the nutrition required for that baby to grow normally. We don’t know what the future of that baby is going to be. Then for the babies who may not even show growth problems, but may yet have unknown problems with their brain development with learning and school. We just really don’t know what it’s going to be like, but it’s very concerning, what we’re seeing so far.

TOM FRIEDEN: Thank you. We will take another question from the phone.

EBEN BROWN (Fox News): Thank you. My question has already been answered, so I appreciate your time.

TOM FRIEDEN: Thank you. Do we have any more questions in the room? One more here.

11 ALIVE NEWS: I’m going to go off topic from Zika for just a moment, only because we don’t see you face to face very often. I’m here in Atlanta with 11 alive news. Just yesterday we heard that there was a CDC worker who got infected with Salmonella, so I just wanted to have you tell us how that happened and is anything being changed, just from your perspective.

TOM FRIEDEN: The investigation is underway, but we’ve committed to doing and what we’ve done here is be completely transparent with anything that occurs in our laboratories. One individual worker, a trainee, who had been fully trained in safety does appear, not confirmed, appears to have been infected with salmonella in the laboratory. They are well. They are recovered. They are back at work.
No one else was affected. Nothing was released and we created as a result of the recent incidents a laboratory leadership service. This is a set of laboratory detectives analogous to our epidemic intelligence service. They are investigating. They have identified what they think is the probable cause and we’ve already issued to the entire agency measures that would prevent this from happening again. I think we have one last question here.

MIKE STOBBE/AP: I just want to clarify numbers. First of all did you say 2 of the 6 sexual transmissions were pregnant women? And also, when you were presenting earlier I wasn’t clear on how many Dengue and Chikungunya have been reported in Texas and Florida before. I think you said two dozen, but then there was a further discussion and I didn’t catch the final count list.

TOM FRIEDEN: We can get back to you with the exact numbers in both cases. Last question.

UNKNOWN: Dr. Frieden, of the cases in the United States, I know CDC has reported some of the outcomes earlier in your paper, do you have any more updates to give us because I think WHO reported in their latest report that there was a woman from Cape Verde who gave birth to a full term baby, with microcephaly here in the United states. Can you give us the broader context, the numbers of Microcephaly cases?

TOM FRIEDEN: We are now monitoring in the continental US, about 3 dozen women who have been infected with Zika at some point. We’ve seen many. It’s in the 20’s and 30’s in Puerto Rico. In the territories it’s in the mid 30’s. 21 in the continental US. We’ve already seen several miscarriages among those women. We’ve reported earlier outcomes. The case you mentioned, although delivered in the US, was reported elsewhere because of the way the disease reporting is done. It was the earlier case in Hawaii and we’ll continue to provide those outcomes as the pregnancies progress. We’ve seen all stages of pregnancy and some for which the stages are still being determined. We have seen some women particularly in Puerto Rico who appear to have not had symptoms, so that obviously makes it difficult or impossible to know what stage of pregnancy they might have been infected in. We would be happy to get you information afterwards. I want to thank everyone for being here. There is an enormous amount of work being done across all levels of government. Across the US government, you have White House here, HHS, across state and local governments, you have state health departments represented here. Private sector, we have March of Dimes here. This really is all in response to reduce the risks to pregnant women. All of us have a role to play and we need to do that and we are doing that. With a great sense of urgency and commitment. Thank you all very much.

MICHELLE BONDS: This concludes our press conference. Media who have follow-up questions can call 404-639-3286 or e-mail us at [email protected]. thank you.

http://www.cdc.gov/media/releases/2016/t0404-zika-summit.html

CDC Action Plan Zika Summit

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Friday, April 1, 2016 | 7:00 AM – 5:00 PM

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Opening Science Plenary

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Readiness Action Planning Track

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Zika Action Plan Pre Summit Webinar

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White House convenes summit on Zika virus

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ZIKA VIRUS - SPECIAL EDITION

April 1, 2016

Zika virus (Zika) outbreaks are occurring in many countries and territories. Please share the following information with those who may find it useful.

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Transcript for CDC Telebriefing: Zika Summit Press Conference

Press Briefing Transcript

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