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COCA Email Updates: June 6 - June 20

This information is for historic and reference purposes only.  Content has not been updated since the last reviewed date at the bottom of this page.

If you have any questions on these or other clinical issues, please write to us at coca@cdc.gov

Sign up for Email Updates and Reminders

Available for download: June 20, 2016, COCA Email Update


COCA News and Announcements

Upcoming COCA Calls:
NEW: CDC Guideline for Prescribing Opioids for Chronic Pain
Date: Wednesday, June 22, 2016
Time: 2:00 – 3:00 pm (Eastern Time)
Dial in Number: 800-857-0686 (U.S. Callers); 1-312-470-0194 (International Callers)
Passcode: 3377346
Webinar: https://www.mymeetings.com/nc/join.php?i=PW8523104&p=3377346&t=c
The amount of opioids prescribed in the U.S. quadrupled from 1999-2014. Unfortunately, opioid-related overdose deaths have increased in parallel with prescribing increases, and the amount of pain that patients report remains unchanged. The CDC Guideline for Prescribing Opioids for Chronic Pain provides recommendations for safer and more effective prescribing of opioids for chronic pain in patients 18 and older in outpatient settings outside of active cancer treatment, palliative care, and end-of-life care. During this COCA Call, clinicians will hear an overview of the CDC recommendations and learn when and how opioids should be initiated for chronic pain, how to assess risk and address harms of opioid use, and when and how opioids should be discontinued. This is the first call in a series of 4.

NEW: Identification and Care of Patients with Hantavirus Disease
Date: Thursday, June 30, 2016
Time: 2:00 – 3:00 pm (Eastern Time)
Dial in Number:800-779-5346 (U.S. Callers); 517-308-9340 (International Callers)
Passcode: 2718213
Webinar: https://www.mymeetings.com/nc/join.php?i=PW8830943&p=2718213&t=c
Hantavirus infection in the United States can cause severe and life-threatening illness, requiring rapid assessment, presumptive diagnosis, and high-level supportive care of respiratory and cardiac functions. Hantavirus infection causes a cardiopulmonary syndrome, which includes rapid accumulation of pulmonary edema following a flu-like prodrome. Approximately 37% of cases end in death. Although hantavirus disease is rare, clinicians should be aware of the risk factors, clinical picture, and essential care elements. During this COCA call, clinicians will learn about the epidemiology, diagnosis, and clinical care of patients with hantavirus disease in the United States.

Recent COCA Calls:
Little Bite, Big Disease: Recognizing and Managing Tickborne Illnesses
Date: Tuesday, May 24, 2016

During this COCA Call, clinicians learned about the treatment, management, and prevention of tickborne diseases in the U.S., with an emphasis on Lyme disease, Rocky Mountain spotted fever and newly emerging tickborne diseases.

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: CDC Begins Reporting Pregnancy and Birth Outcomes of Women Affected by Zika Virus During Pregnancy
CDC began reporting poor outcomes of pregnancies with laboratory evidence of possible Zika virus infection. CDC will report two types of outcomes:
– Live-born infants with birth defects
– Pregnancy losses with birth defects

NEW: MMWR: Screening of Blood Donations for Zika Virus
Zika virus screening of locally collected blood donations was implemented on April 3, 2016, using a newly developed, FDA-authorized nucleic acid test. A total of 68 (0.5%) presumptive viremic donors in Puerto Rico were identified from 12,777 donations tested during April 3–June 11, 2016

Fact Sheets and Posters 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 

MMWR: Patterns in Zika Virus Testing and Infection, by Report of Symptoms and Pregnancy Status — United States, January 3–March 5, 2016
A low proportion of persons who had testing for Zika virus in the United States had confirmed Zika virus infection. Approximately 99% of asymptomatic pregnant women who were tested had no laboratory evidence of Zika virus infection.

Tools for Health-Care Providers
View printable and easy to use CDC fact sheets, guidance documents, and testing algorithms for Zika virus infection.

Clinical Consultation Service for Health-Care Providers Caring for Pregnant Women with Possible Zika Virus Infection. 
CDC maintains a 24/7 consultation service for health-care 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 ZikaPregnancy@cdc.gov or call 770-488-7100.

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]).

Questions and Answers For Health-Care Providers Caring for Pregnant Women and Women of Reproductive Age with Possible Zika Virus Exposure

Clinicians Caring for Infants and Children

Congenital Microcephaly Case Definitions

Questions and Answers For Health-Care Providers Caring for Infants and Children with Possible Zika Virus Infection

Interim Guidelines for Health-Care Providers Caring for Infants and Children with Possible Zika Virus Infection — United States, February 2016
CDC has updated its interim guidelines for U.S. health-care 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, 2016
The following recommendations apply to men who have traveled to or reside in areas with active Zika virus transmission and their female or male sex partners. These recommendations replace the previously issued recommendations and are updated to include time intervals after travel to areas with active Zika virus transmission or after Zika virus infection for taking precautions to reduce the risk for sexual transmission.

Zika and Sexual Transmission

Zika Travel Information

Technical Statement on the Role of Disinsection in the Context of Zika Outbreaks, 2016
CDC does not recommend routine use of insecticides (disinsection) inside commercial passenger airplanes to prevent the spread of Zika virus.

MMWR: Ongoing Zika Virus Transmission — Puerto Rico, November 1, 2015–April 14, 2016
During November 1, 2015–April 14, 2016, a total of 6,157 specimens from suspected Zika virus–infected patients from Puerto Rico were evaluated and 683 (11%) had laboratory evidence of current or recent Zika virus infection.

CDC Issues Advice for Travel to the 2016 Summer Olympic Games

Zika Travel Notices

Clinical Evaluation and Testing

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

Diagnostic Testing
Contact your state or local health department to facilitate testing.

Collection and Submission of Body Fluids for Zika Virus Testing

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: 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.

ZAP Summit Follow-up Teleconferences

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.

Top 10 Zika Response Planning Tips: Brief Information for State, Tribal, Local, and Territorial Health Officials

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: 24

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

Hurricane Readiness – (CDC)

CDC Feature: Prepare for Spring 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.

June 20, 2016 / Vol. 65/Nos. 23 Download .pdf document of this issue

Infectious, Vector-Borne, and Zoonotic Diseases

new: Discovery of First MCR-1 Gene in E. coli Bacteria Found in a Human in United States – (CDC)
E. coli bacteria carrying the mrc-1 gene was found in a urine sample from a Pennsylvania woman with no recent travel outside of the U.S. The mcr-1 gene makes bacteria resistant to the antibiotic colistin, which is used as a last-resort drug to treat patients with multi-drug-resistant infections, including carbapenem-resistant Enterobacteriaceae (CRE).  The mcr-1 gene exists on a plasmid, a small piece of DNA that is capable of moving from one bacterium to another, spreading antibiotic resistance among bacterial species.  The CDC and federal partners have been hunting for this gene in the U.S. ever since its emergence in China in 2015.

Seasonal Influenza

Information for Health Professionals  – (CDC)

Weekly Flu View – May 21 (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)

Travel Safety

NEW: Medical Tourism
Receiving medical care abroad can be risky. Learn about the risks and how to minimize them.

Current Travel Warnings – May 31 (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: Loperamide (Imodium): Drug Safety Communication – Serious Heart Problems With High Doses From Abuse and Misuse– (FDA)
Majority of reported problems occurred in individuals intentionally misusing and abusing high doses of loperamide in attempts to self-treat opioid withdrawal symptoms or to achieve a feeling of euphoria.

NEW: Step 2 60 Gold by The Body Shot Bar: Recall – Undeclared Drug Ingredients– (FDA)
Sibutramine is known to substantially increase blood pressure and/or pulse rate in some patients and may present a significant risk for patients with a history of coronary artery disease, congestive heart failure, arrhythmias or stroke.

NEW: Canagliflozin (Invokana, Invokamet) and Dapagliflozin (Farxiga, Xigduo XR): Drug Safety Communication – Strengthened Kidney Warnings – (FDA)
Revised warnings in the drug labels to include information about acute kidney injury and added recommendations to minimize this risk.

UPDATED: Zecuity (sumatriptan) Migraine Patch: Drug Safety Communication – FDA Evaluating Risk of Burns and Scars– (FDA)
Health care professionals should discontinue prescribing Zecuity, and patients should stop using any remaining patches and contact their prescribers for an alternative migraine medicine.

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.

FoodSafety.gov Reports FDA and USDA Food Recalls, Alerts, Reporting & Resources – (HHS/USDA/FDA/CDC/NIH)

Foodsafety.gov 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.

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