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COCA Email Updates: February 27 - March 13

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Available for download: March 13, 2017, COCA Email Update

COCA News and Announcements

Recent COCA Calls:

2016–2017 Influenza Season Activity and Recommendations for Clinicians
Date: Thursday, February 16, 2017
During this COCA Call, clinicians learned about 2016 –2017 influenza activity to date, and heard an overview of CDC’s recommendations for healthcare providers including influenza vaccination and the use of antiviral medications for the treatment of influenza.

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

General Resources

NEW: MMWR: Baseline Prevalence of Birth Defects Associated with Congenital Zika Virus Infection—Massachusetts, North Carolina, and Atlanta, Georgia, 2013–2014
CDC used data from population-based birth defects surveillance programs to assess the prevalence of birth defects during 2013–2014 that met the surveillance case definition for birth defects potentially related to Zika virus infection, before introduction of Zika virus into the United States. After introduction of Zika virus, the proportion of infants and fetuses with birth defects born to mothers with laboratory evidence of possible Zika infection reported by the US Zika Pregnancy Registry during January 15–September 22, 2016, was approximately 20 times higher than the prevalence of potentially Zika-related birth defects among pregnancies during the pre-Zika years.

NEW: EID Journal Article: Estimated Incubation Period for Zika Virus Disease
New data reported by the Centers for Disease Control and Prevention (CDC) suggest that the incubation period for Zika virus—or the time between infection and showing symptoms—is estimated at 3-14 days. Until this point, the incubation period has not been well-defined and was previously established based on incubation period of similar arboviral diseases. CDC used data from 197 US travelers to areas with Zika, were likely infected by mosquito bite and who had signs and symptoms of Zika following their visits to estimate the incubation period.

NEW: EID Journal Article: Use of Blood Donor Screening Data to Estimate Zika Virus Incidence, Puerto Rico, April–August 2016
CDC evaluated blood donation screening data collected by two of Puerto Rico’s largest blood centers and estimates 469,321 people in Puerto Rico, approximately 12.9% of the population, were infected with Zika from April-August 2016. Results from blood donation screening during outbreaks can add to what is known about Zika through routine clinical and surveillance data and improve targeting of public health prevention and response efforts.

Zika Virus Information for Healthcare Providers

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

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

Pregnancy and Zika Testing
The interactive clinical algorithm allows healthcare providers to receive recommendations tailored to their pregnant patients with possible Zika exposure. Healthcare providers can answer questions about pregnant patients and, based on the responses, receive information regarding the type of testing indicated as well as clinical management recommendations. It can be used on computers and mobile devices/tablets.

U.S. Zika Pregnancy Registry
CDC and state, tribal, local, and territorial health departments request that healthcare providers, especially obstetric and pediatric healthcare providers, participate in the US Zika Pregnancy Registry.

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

Sexual Transmission

Zika and Sexual Transmission

Travel Information

Advice For People Living In or Traveling to Brownsville, Texas
On December 14, 2016, CDC issued guidance related to Zika for people living in or traveling to Brownsville, Cameron County, TX and has designated Brownsville as a Zika cautionary area (yellow area).. On November 28, the Texas Department of State Health Services reported the state’s first case of local mosquito-borne Zika virus infection in Brownsville. Additional cases of mosquito-borne Zika have been identified in the area, suggesting that there is a risk of continued spread of Zika virus in Brownsville.

Zika Travel Information

Advice for People Living in or Traveling to South Florida
On December 9, 2016, CDC removed the red area designation for the remaining 1.5-square-mile area of South Miami Beach after three mosquito incubation periods (45 days) passed without any new locally transmitted cases of Zika. Guidance for yellow areas now applies to the South Miami Beach area and all of Miami-Dade County.

Clinical Evaluation and Testing

Guidance for U.S. Laboratories Testing for Zika Virus Infection 
The guidance was updated to be inclusive of the currently available Emergency Use Authorization (EUA) assays; it takes into account the recent updates to the CDC Trioplex Real-time RT-PCR Assay EUA, which includes the addition of whole blood as an acceptable specimen type. The updated guidance also specifies that plaque reduction neutralization testing (PRNT) confirmation is currently not routinely recommended in Puerto Rico, where dengue is endemic.

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.

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

State, Local, Tribal and Territorial Health Department Resources

CDC U.S. Zika Pregnancy Registry Healthcare Provider Toolkit for Health Departments
This toolkit is a suite of tools and resources to help health departments educate and inform healthcare providers to identify, counsel, report, and follow infants born to pregnant women with laboratory evidence of Zika virus infection. We invite you to use this toolkit to raise awareness about the U.S. Zika Pregnancy Registry and improve reporting and completeness of data collected.
For Obstetricians:
For Pediatricians:

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 News and Announcements

CDC Science Clips: Volume 9, Issue: 9

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

Winter 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)

MMWR publications are prepared by CDC. To electronically subscribe, go to

March 10, 2017 / Vol. 66 / No. 9 Download .pdf document of this issue

Infectious, Vector-Borne, and Zoonotic Diseases

Seasonal Influenza

Weekly Flu View - March 4 – (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.

Information for Health Professionals– (CDC)

2016–2017 Flu Season - (CDC)

Travel Safety

Current Travel Warnings - February 22 (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 Listeriosis Linked to Soft Raw Milk Cheese Made by Vulto Creamery
CDC is collaborating with public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) to investigate a multistate outbreak of Listeria monocytogenes infections (listeriosis). Six people infected with the outbreak strain ofListeria have been reported from four states since September 1, 2016. A list of states and the number of cases in each can be found on the Case Count Map page. Whole genome sequencing performed on clinical isolates from all six ill people shows that the isolates are closely related genetically. This close genetic relationship provides additional evidence that people in this outbreak became ill from a common source.

NEW: Multistate Outbreak of Shiga toxin-producing Escherichia coli O157:H7 Infections Linked to I.M. Healthy Brand SoyNut Butter
CDC is collaborating with public health and regulatory officials in several states and the U.S. Food and Drug Administration (FDA) to investigate a multistate outbreak of Shiga toxin-producing Escherichia coli O157:H7 (STEC O157:H7) infections. Epidemiologic evidence available at this time indicates that I.M. Healthy brand SoyNut Butter is a likely source of this outbreak. Sixteen people infected with the outbreak strain of STEC O157:H7 have been reported from nine states. A list of the states and the number of cases in each can be found on the Case Count Map page.SoyNut Butter is a nut-free substitute for peanut butter.

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.