Reuters

CDC

What is the current situation?

In December 2015, a locally transmitted case of Zika virus infection was detected in Puerto Rico. This is the first case of Zika virus in Puerto Rico. Local transmission means that mosquitoes in Puerto Rico have been infected with Zika virus, spreading it to humans.

CDC recommends that travelers to affected areas in South America, Central America, the Caribbean, or Mexico protect themselves from mosquito bites(http://wwwnc.cdc.gov/travel/page/avoid-bug-bites). Zika outbreaks have been identified recently in several countries in Central and South America. The outbreak began in Brazil in May. Recently, the Ministry of Health in Brazil has raised concerns about a possible association between the Zika virus outbreak and increased numbers of babies born with birth defects. For this reason, pregnant women should take extra precautions to avoid mosquito bites.

What can travelers do to prevent Zika virus infection?

There is no vaccine or medicine to prevent Zika virus infection. Travelers can protect themselves by preventing mosquito bites.

Prevent mosquito bites:

• Cover exposed skin by wearing long-sleeved shirts and long pants.
• Use an insect repellent approved by the Environmental Protection Agency as directed.
• Higher percentages of active ingredients provide longer protection. Use products with the following active ingredients:
  • DEET (Products containing DEET include Off!, Cutter, Sawyer, and Ultrathon.)
  • Picaridin (Also known as KBR 3023, Bayrepel, and icaridin. Products containing picaridin include Cutter Advanced, Skin So Soft Bug Guard Plus, and Autan [outside the United States].)
  • Oil of lemon eucalyptus (OLE) or PMD (Products containing OLE include Repel.)
  • IR3535 (Products containing IR3535 include Skin So Soft Bug Guard Plus Expedition and SkinSmart.)
• Always follow product directions and reapply as directed:

• If you are also using sunscreen, apply sunscreen first, let it dry, then apply insect repellent.
• Follow package directions when applying repellent on children. Avoid applying repellent to their hands, eyes, or mouth.
• Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). You can buy pre-treated clothing and gear or treat them yourself.
  • Clothing treated with permethrin remains protective after multiple washings. See the product information to find out how long the protection will last.
  • If treating items yourself, follow the product instructions carefully.
  • Do not use permethrin directly on skin.
• Stay and sleep in screened-in or air-conditioned rooms.
• Use a bed net if the area where you are sleeping is exposed to the outdoors.

If you feel sick and think you may have Zika virus infection:

• Talk to your doctor or nurse if you develop a fever with a rash, joint pain, or red eyes.
  • Tell them about your travel.
  • For more information about medical care abroad, see Getting Health Care Abroad(/travel/page/getting-health-care-abroad)(http://wwwnc.cdc.gov/travel/page/getting-health-care-abroad) and a list of International Joint Commission-accredited facilities.
• Get lots of rest and drink plenty of liquids.
• Avoid spreading the disease by preventing additional mosquito bites.

Traveler Information

• Avoid Bug Bites(/travel/page/avoid-bug-bites)(http://wwwnc.cdc.gov/travel/page/avoid-bug-bites)-information for travelers
• Insect Repellent Use and Safety
• CDC Zika website
• Zika virus:  What you need to know
• Mosquito bite prevention for travelers

Clinician Information

• Zika Virus Outside Africa (EID article)
• Protection against Mosquitoes, Ticks, & Other Insects & Arthropods(/travel/yellowbook/2016/the-pre-travel-consultation/protection-against-mosquitoes-ticks-other-arthropods)(http://wwwnc.cdc.gov/travel/yellowbook/2016/the-pre-travel-consultation/protection-against-mosquitoes-ticks-other-arthropods)
• Zika: Information for Health Care Providers

CNN

CDC

Malik A, El Masry KM, Ravi M, Sayed F. Middle East respiratory syndrome coronavirus during pregnancy, Abu Dhabi, United Arab Emirates, 2013. Emerg Infect Dis. 2016 Mar [date cited]. http://dx.doi.org/10.3201/eid2203.151049

“…..On November 19, 2013, a 32-year-old woman residing in Abu-Dhabi, United Arab Emirates, sought medical care for fever and back pain of 4 days’ duration. The woman, a school teacher from Jordan, was 32 weeks pregnant; she reported 3 earlier pregnancies (2 live births) and no concurrent conditions. Emergency department (ED) and obstetric physicians suspected urinary tract infection. The patient declined admission but returned to the ED on November 22 with worsening fever, cough, and shortness of breath. She denied recent travel, sick contacts, or animal exposure within the previous 2 weeks. Lung examination results were within normal limits; the patient had no signs of active labor or fetal distress. Chest computed tomography scan revealed bilateral consolidation; pulmonary embolus was not seen.

The patient was admitted to the medical unit with suspected community-acquired pneumonia. Ceftriaxone and azithromycin were initiated. Her condition deteriorated, and on November 23, she was transferred to the intensive care unit (ICU) because of respiratory failure and hypotension. On November 24, acute respiratory distress syndrome developed, requiring respiratory and hemodynamic support. Empiric oseltamivir and vancomycin were added to the treatment regimen. Later that day, the baby was delivered by caesarean section because the patient was persistently hypoxemic while on maximal ventilator support. Transient improvement in oxygenation was noted after the delivery. The newborn, who was noted to be healthy and had Apgar scores of 6 and 8 at 1 and 5 minutes, respectively, had no contact with the mother after birth.

Nasopharyngeal aspirate samples were tested for influenza A(H1N1)pdm09 virus and MERS-CoV by real-time reverse transcription PCR (2), and multiple other laboratory and culture tests were conducted (Table(http://wwwnc.cdc.gov/eid/article/22/3/15-1049-t1)). Most yielded negative results, but on November 25, the regional laboratory reported the MERS-CoV real-time reverse transcription PCR results were positive. Laboratory testing was done by qualitative assay, using the 2012 novel human CoV (human coronavirus–Erasmus Medical Center). The assay, performed according to a previously described method (3), contains reagents and enzyme for specific amplification of the region upstream of the envelope gene in the CoV genome.

On November 26, oral ribavirin (400 mg and 600 mg morning and evening, respectively) and subcutaneous peginterferon-α (180 µg 1×/wk) were initiated. On November 27, ribavirin was increased to 1,200 mg every 8 hours, and meropenem was begun. Septic shock developed in the patient, requiring maximal vasopressors and ventilator support. Despite intensive support, the patient’s condition continued to deteriorate; she died on December 2. Cultures of blood, tracheal aspirate, and urine obtained on the day of death showed no growth; a chest radiograph revealed improvement in pulmonary edema and consolidation.

Union-Tribune

**  “….First found in California in 2013, Aedes Aegypti and Aedes Albopictus have roughly tripled in number around the state during the past several seasons. They’re now found in 82 cities, including Escondido, Los Angeles, Fresno and parts of the Bay Area. At the beginning of this year, the count was 28 cities….”

**  “…So far, California has seen no locally acquired cases of disease spread by these mosquitoes, which include dengue fever, yellow fever and Chikungunya……”

 NY Times

NASA:  2103 snows.

USA Today

**  “….Officials said the number of people injured was 53% lower than the previous year, because of rain and a government campaign to warn people of the dangers of firecrackers….”

CNN

**  “….German media reported Friday morning that Munich police said an unspecified Islamic extremist group is suspected to be behind the plans, which were to attack multiple targets in Munich….”