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COCA Email Updates: August 15 – August 29

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Available for download: August 29, 2016, COCA Email Update

COCA News and Announcements

Recent COCA Calls:

Zika Update: Clinical Laboratory Testing and Care of Infants with Congenital Zika Virus Infection
Date:Tuesday, August 23, 2016
During this COCA Call, clinicians learned about these updated interim clinical guidelines, which include evaluation and management recommendations. This information can help pediatric healthcare providers better understand the appropriate tests and clinical approaches for evaluating and managing infants, born to mothers in the United States and its territories, with laboratory evidence of Zika virus infection.

Dosing and Titrating Opioids
Date:Wednesday, August 17, 2016
During this COCA Call, clinicians learned about the association between opioid dosage and opioid therapy benefits and harms. In addition, presenters used a case study of a patient with severe back pain on oxycodone to guide clinicians through safe opioid prescribing practices.

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: Key Zika Considerations for Healthcare Settings

NEW: FDA Advises Testing for Zika Virus in All Donated Blood and Blood Components in the U.S. - (FDA)
The U.S. Food and Drug Administration issued a revised guidance recommending universal testing of donated whole blood and blood components for Zika virus in the U.S. and its territories.

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

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: Official CDC Health Alert Network (HAN) Health Advisory—CDC Expands Guidance for Travel and Testing of Pregnant Women, Women of Reproductive Age, and Their Partners for Zika Virus Infection Related to Mosquito-borne Zika Virus Transmission in Miami-Dade, Florida, August 2016

NEW: Zika Virus Testing for Any Pregnant Woman Not Living in an Area With Zika

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: 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

NEW: Resources and Guidance for Healthcare Providers Caring for Infants Affected by Zika Virus

NEW: MMWR: Interim Guidance for the Evaluation and Management of Infants with Possible Congenital Zika Virus Infection — United States, August 2016

NEW: Webcast Recordings: Clinical Evaluation & Management of Infants with Congenital Zika Infection
During this meeting, pediatric health specialists, non-governmental partners, and federal officials gathered at CDC to discuss clinical evaluation and management of infants with congenital Zika virus infection in the United States.

Congenital Microcephaly Case Definitions

Sexual Transmission

NEW: MMWR: Likely Sexual Transmission of Zika Virus from a Man with No Symptoms of Infection — Maryland, 2016
Based on the report’s findings, it might be appropriate to consider persons who have condomless sex with partners returning from areas with ongoing Zika virus transmission as exposed to Zika virus, regardless of whether the returning traveler reports symptoms of Zika virus infection.

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

Travel Information

UPDATED: Advice for People Living in or Traveling to South Florida
The Florida Department of Health has identified two areas of Miami-Dade County where Zika is being spread by mosquitoes. In addition to the previously identified area in the Wynwood neighborhood, there is now mosquito-borne spread of Zika virus in a section of Miami Beach.

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 Travel Notice for the 2016 Summer Olympic Games

Zika Travel Notices

Clinical Evaluation and Testing

NEW: When to Test for Zika Virus PDF

NEW: Collection and Submission of Specimiens for Zika Virus Testing at Time of Birth

NEW: Collection and Submission of Fetal Tissues for Zika Virus Testing PDF

NEW: MMWR: Guillain-Barré Syndrome During Ongoing Zika Virus Transmission — Puerto Rico, January 1–July 31, 2016
Countries affected by Zika virus have reported increased cases of Guillain-Barré syndrome (GBS), an uncommon autoimmune disorder. In February 2016, the Puerto Rico Department of Health implemented the GBS Passive Surveillance System. Fifty-six suspected GBS cases with onset of neurologic signs were identified during January 1–July 31, 2016.

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, June 2016
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, May 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.

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

Interim CDC 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.

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

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: 34

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 26, 2016 / Vol. 65/Nos. 33 Download .pdf document of this issue

Infectious, Vector-Borne, and Zoonotic Diseases

Seasonal Influenza

Information for Health Professionals– (CDC)

Weekly Flu View – August 20 (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 - August 23 (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: Official CDC Health Alert Network (HAN) Health Update—Influx of Fentanyl-laced Counterfeit Pills and Toxic Fentanyl-related Compounds Further Increases Risk of Fentanyl-related Overdose and Fatalities– (CDC)
The purpose of this HAN update is to alert public health departments, health care professionals, first responders, and medical examiners and coroners to new developments that have placed more people at risk for fentanyl-involved overdoses from IMF and may increase the risk of non-fatal and fatal overdose.

UPDATED: 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.

NEW: Oxacillin for Injection, USP, 10g by Sagent: Recall - Iron Oxide Particulate Matter - (FDA)
If metal particulate in an injectable product is administered to a patient, it may result in local swelling, irritation of blood vessels or tissue, or blockage of blood vessels. Blockage of blood vessels can lead to serious events, which may be life-threatening, such as stroke, heart attack, respiratory failure, kidney failure, or liver failure.

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.