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COCA Email Updates: August 1 – August 15

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Available for download: August 15, 2016, COCA Email Update

COCA News and Announcements

Upcoming COCA Calls:
NEW: Dosing and Titrating Opioids
Date: Wednesday, August 17, 2016
Time: 2:00 - 3:00 pm (Eastern Time)
Participate by Phone:

  • U.S. Callers: 800-779-0686
  • International Callers: 312-470-0194
Passcode: 3377346
Evidence indicates that the risk for opioid-use disorder and overdose increases as dosage increases. CDC Guideline for Prescribing Opioids for Chronic Pain provides recommendations about the types of opioid formulations at initiation, starting dosages, morphine milligram equivalent dosage calculation methods, dose titrating considerations, and tapering methods. During this COCA Call, clinicians will learn about the association between opioid dosage and opioid therapy benefits and harms. In addition, presenters will use a case study of a patient with severe back pain on oxycodone to guide clinicians through safe opioid prescribing practices.

Recent COCA Calls:
Updated Interim Zika Clinical Guidance for Pregnant Women and Data on Contraceptive Use to Decrease Zika-affected Pregnancies
Date: Tuesday, August 9, 2016
During this COCA Call, clinicians learned about the updated CDC interim guidance for caring for pregnant women with possible Zika virus exposure, and strategies for increasing access to contraceptive methods and services to minimize the number of pregnancies affected by Zika.

Assessing Benefits and Harms of Opioid Therapy for Chronic Pain
Date: Wednesday, August 3, 2016
During this COCA Call, presenters explored a case study on how recommendations from the CDC Guideline for Prescribing Opioids for Chronic Pain were used to ascertain the associated benefits and risks when a patient with fibromyalgia was prescribed oxycodone following a motor vehicle crash.

Archived COCA Conference Calls

Free continuing education credits (CME, CNE, ACPE, CEU, CECH, and AAVSB/RACE) are available for most calls. More information about free CE.

CDC Emergency Response

2016 Zika Virus

NEW: Interim CDC Zika Response Plan
The purpose of this document is to describe the CDC response plan for locally acquired cases of Zika virus infection in the continental United States and Hawaii.

Updated: Key Messages—Zika Virus
A collection of the most up-to-date and cleared information on the ongoing Zika virus outbreak.

Updated: Zika Virus Information for Healthcare Providers
CDC's Zika webpage for healthcare provider resources.

Zika Virus: Information for Clinicians Slide Set

Print Resources in Different Languages
CDC fact sheets and posters for distribution to patients are available in languages, including Spanish, Arabic, Tagalog, Vietnamese, Mandarin, Creole, and Korean. These resources cover a variety of topics, including travel information, insect repellent, sexual transmission, and mosquito control.

Clinicians Caring for Pregnant Women and Women of Reproductive Age 

NEW: Contraceptive Use Among Nonpregnant and Postpartum Women at Risk for Unintended Pregnancy, and Female High School Students, in the Context of Zika Preparedness — United States, 2011–2013 and 2015, August 2016
State and local strategies are needed to increase access to contraceptive methods and related services, reduce the risk for unintended pregnancy, and minimize the number of pregnancies affected by Zika infection.

MMWR Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure — United States, July 2016
To increase the proportion of pregnant women with Zika virus infection who receive a definitive diagnosis, CDC recommends expanding real-time reverse transcription–polymerase chain reaction (rRT-PCR) testing.

U.S. Zika Pregnancy Registry and Tribal Healthcare Providers: How to Contribute

Clinical Consultation Service for Healthcare Providers Caring for Pregnant Women with Possible Zika Virus Infection
CDC maintains a 24/7 consultation service for healthcare providers caring for pregnant women with possible Zika virus infection. This consultation service is NOT for patients or the general public. To contact the service, email or call 770-488-7100.

Outcomes of Pregnancies with Laboratory Evidence of Possible Zika Virus Infection in the United States
CDC will report two types of outcomes:

  • - Live-born infants with birth defects
  • - Pregnancy losses with birth defects

Doctor’s Visit Checklist: For Pregnant Women Who Traveled to an Area with Zika

Doctor’s Visit Checklist: For Pregnant Women Living in an Area with Zika

MMWR: Interim Guidance for Health-Care Providers Caring for Women of Reproductive Age with Possible Zika Virus Exposure — United States, 2016
CDC has updated its interim guidance for U.S. health-care providers caring for women of reproductive age with possible Zika virus exposure to include recommendations for counseling women and men with possible Zika virus exposure who are interested in conceiving. The updated guidelines also include recommendations for Zika virus testing and guidance for women residing along the US-Mexico Border.

MMWR: Preventing Transmission of Zika Virus in Labor and Delivery Settings Through Implementation of Standard Precautions — United States, 2016
CDC recommends Standard Precautions in all health-care settings to protect both health-care personnel and patients from infection with Zika virus as well as from blood-borne pathogens (e.g., human immunodeficiency virus [HIV] and hepatitis C virus [HCV]).

Clinical Guidance for Healthcare Providers Caring for Pregnant Women

Clinical Guidance for Healthcare Providers Caring for Women of Reproductive Age

Clinicians Caring for Infants and Children

Clinical Guidance for Healthcare Providers Caring for Infants & Children

Congenital Microcephaly Case Definitions

MMWR: Interim Guidelines for Healthcare Providers Caring for Infants and Children with Possible Zika Virus Infection — United States, February 2016
CDC has updated its interim guidelines for U.S. healthcare providers caring for infants born to mothers who traveled to or resided in areas with Zika virus transmission during pregnancy and expanded guidelines to include infants and children with possible acute Zika virus disease.

Sexual Transmission

MMWR: Interim Guidance for Prevention of Sexual Transmission of Zika Virus — United States, July 2016
CDC is expanding its existing recommendations to cover all pregnant couples, which includes pregnant women with female sex partners. This guidance also describes what other couples (those who are not pregnant or planning to become pregnant) can do to reduce the risk for Zika virus transmission.

Zika and Sexual Transmission

Zika Travel Information

CDC Issues Travel Guidance Related to Miami Neighborhood with Active Zika Spread Transmission
CDC and Florida are issuing travel, testing and other recommendations for people who frequently traveled to or lived in a 1-square mile area of Miami with active Zika transmission on or after June 15, 2016.

Country Classification Technical Guidance
To protect travelers from Zika, scientists and travel experts at CDC are monitoring the status of Zika in countries around the world and making appropriate travel recommendations. These recommendations are based on a number of factors, including the historical or current presence of Zika in the country. Based on this assessment, areas with Zika are classified as epidemic or endemic.

CDC Issues Advice for Travel to the 2016 Summer Olympic Games

Zika Travel Notices

Clinical Evaluation and Testing

Zika Virus Resources for Laboratories

Testing for Zika Virus
Contact your state or local health department to facilitate testing.

Official CDC Health Alert Network (HAN) Health Update - CDC Recommendations for Subsequent Zika IgM Antibody Testing
Testing for Zika virus infection using real-time reverse-transcription polymerase chain reaction (rRT-PCR) molecular assays is now commercially available. CDC provides further recommendations for actions to take when requesting Zika rRT-PCR testing from a commercial laboratory.

MMWR: Interim Guidance for Interpretation of Zika Virus Antibody Test Results
If serologic testing indicates recent flavivirus infection that could be caused by either Zika or dengue virus, patients should be clinically managed for both infections because they might have been infected with either virus. Patients with clinically suspected dengue should receive appropriate management to reduce the risk for hemorrhagic medical complications.

Official CDC Health Alert Network (HAN) Update - Diagnostic Testing of Urine Specimens for Suspected Zika Virus Infection

MMWR: Interim Guidance for Zika Virus Testing of Urine - United States, 2016

CDC and OSHA Issue Interim Guidance for Protecting Workers from Occupational Exposure to Zika Virus
CDC and the Occupational Safety and Health Administration (OSHA) issued new guidance and information for protecting workers from occupational exposure to Zika virus.

Biosafety Guidance for Transportation of Specimens and for Work with Zika Virus in the Laboratory

Clinical Evaluation & Disease
Zika virus is transmitted to humans primarily through the bite of an infected Aedes species mosquito. The most common symptoms of Zika virus disease are fever, rash, joint pain, and conjunctivitis. Most people infected with Zika virus are asymptomatic. Characteristic clinical findings are acute onset of fever with maculopapular rash, arthralgia, or conjunctivitis. Other commonly reported symptoms include myalgia and headache.

State, Local, Tribal and Territorial Health Department Resources

NEW: Zika Community Action Response Toolkit (Z-CART)
The Z-CART outlines an approach to risk communication and community engagement planning and is intended as a template for state, local, and tribal agencies to adapt to their needs and to use for reviewing plans for communicating about Zika during the event of a locally transmitted Zika virus.

CDC Emergency Vector Control Request Form

CDC Draft Interim Zika Response Plan
The purpose of this document is to describe the CDC response plan for the first locally acquired cases of Zika virus infection in the continental United States and Hawaii.

US Zika Pregnancy Registry
CDC has established the US Zika Pregnancy Registry to learn more about pregnant women in the United States with confirmed Zika virus infection and their infants and is collaborating with state, tribal, local, and territorial health departments to collect information about pregnancy and infant outcomes following Zika virus infection during pregnancy.

Zika Active Pregnancy Surveillance System (ZAPSS)/Sistema de Vigilancia Activa de Zika en Embarazos (SVAZE)
The Puerto Rico Department of Health and Centers for Disease Control and Prevention have developed a surveillance system called Zika Active Pregnancy Surveillance System (ZAPSS)/Sistema de Vigilancia Activa de Zika en Embarazos (SVAZE). The surveillance system will be used to evaluate the association between Zika virus infection during pregnancy and adverse outcomes during pregnancy, birth, and early childhood up to 3 years old.

Pregnant women with any laboratory evidence of possible Zika virus infection in the United States and territories, 2016
These data reflect pregnant women in the US Zika Pregnancy Registry and the Zika Active Pregnancy Surveillance System in Puerto Rico.

Zika Crisis and Emergency Risk Communication Discussions
To address the communication concerns and needs of state, local, and territorial health communicators, as well as partner organizations, CDC is hosting a series of Crisis and Emergency Risk Communication (CERC) teleconferences related to Zika issues. These teleconferences will be held on a weekly basis beginning Tuesday, May 17, from 1-2 pm (Eastern Time). Each week, a new topic will be presented on a different aspect of CERC.

Zika Virus Microsite
CDC has developed an easily embeddable collection of Zika virus information for partner and stakeholder websites. This collection, called a microsite, can supplement partner web sites with CDC’s up-to-date, evidence-based content. . The content is automatically updated when CDC’s website is updated.

CDC News and Announcements

CDC Science Clips: Volume 8, Issue: 32

Each week select science clips are shared with the public health community to enhance awareness of emerging scientific knowledge. The focus is applied public health research and prevention science that has the capacity to improve health now.

Public Health Preparedness

Emergency Preparedness and Response - (CDC)

Find preparedness resources for all hazards.

Emergency Preparedness and Response Training Resources for Clinicians – (CDC)

Find online and in-person training resources.

Natural Disasters and Severe Weather

CDC Feature: Keep Your Cool in Hot Weather – (CDC)

Food and Water Needs: Preparing for a Disaster or Emergency – (CDC)

Health and Safety Concerns for All Disasters – (CDC)

Morbidity and Mortality Weekly Report (MMWR)

The MMWR series is CDC’s primary vehicle for scientific publication of timely, reliable, authoritative, accurate, objective, and useful public health information and recommendations. To subscribe electronically, go to. Electronically Subscribe.

August 12, 2016 / Vol. 65/Nos. 31 Download .pdf document of this issue

Infectious, Vector-Borne, and Zoonotic Diseases

Seasonal Influenza

A Toolkit for Long-Term Care Employers
Within this comprehensive toolkit are a number of resources intended to help long-term care facility, agency, or corporation owners and administrators provide access to influenza vaccination for their workforce and to help any employer of workers in long-term care understand the importance of influenza vaccination for their employees.

Information for Health Professionals– (CDC)

Weekly Flu View – August 6 (CDC)

Flu View is a weekly influenza surveillance report prepared by CDC Influenza Division. All data are preliminary and may change as CDC receives more reports.

Planning and Preparedness: Health Professionals and Seasonal Flu  – (HHS)
Healthcare providers play an important role during flu season. The following guidance and information will assist healthcare providers and service organizations to plan and respond to seasonal flu.

Travel Safety

Current Travel Warnings - July 27 (US Department of State)
The U.S. Department of State issues Travel Warnings when long-term, protracted conditions make a country dangerous or unstable. Travel Warnings recommend that Americans avoid or carefully consider the risk of travel to that country. The State Department also issues Travel Warnings when the U.S. Government's ability to assist American citizens is constrained due to the closure of an embassy or consulate, or because of a drawdown of State Department staff.

Food, Drug and Device Safety

NEW: Multistate Outbreak of Burkholderia cepacia Infections– (CDC)
FDA released an updated statement including a voluntary recall of all of liquid products manufactured by PharmaTech and distributed by: Rugby, Major, Bayshore, Metron, Centurion, and Virtus. In addition to the above recall of all liquid products manufactured by PharmaTech, both FDA and CDC continue to recommend that clinicians and patients not use any brand of liquid docusate sodium product as a stool softener or for any other medical purpose.

MedWatch: The FDA Safety Information and Adverse Event Reporting Program – (FDA)

MedWatch is your Food and Drug Administration (FDA) gateway for clinically important safety information and reporting serious problems with human medical products. Reports of FDA and USDA Food Recalls, Alerts, Reporting, and Resources – (HHS/USDA/FDA/CDC/NIH) lists notices of recalls and alerts from both FDA and USDA. Visitors to the site can report a problem or make inquiries.

The CDC and HHS logos are the exclusive property of the Department of Health and Human Services and may not be used for any purpose without prior express written permission. Use of trade names and commercial sources is for identification only and does not imply endorsement by the US Department of Health and Human Services.

Links to non-Federal organizations are provided solely as a service to our users. Links do not constitute an endorsement of any organization by CDC or the Federal Government, and none should be inferred. The CDC is not responsible for the content of the individual organizations.