Two of the cases announced today involve healthcare workers, both of them foreign women, ages 55 and 57. The MOH said their infections represent secondary healthcare-related exposure.

The other three patients had household contact exposure to the virus. They are a 31-year-old foreign woman, a 20-year-old Saudi woman, and a 58-year-old Saudi man.

CDC

Pregnant Women with Any Laboratory Evidence of Possible Zika Virus Infection

What these updated numbers show

• These updated numbers reflect counts of pregnant women in the United States with any laboratory evidence of possible Zika virus infection, with or without symptoms. Pregnant women with laboratory evidence include those in whom viral particles have been detected and those with evidence of an immune reaction to a recent virus that is likely to be Zika.
• This information will help healthcare providers as they counsel pregnant women affected by Zika and is essential for planning at the federal, state, and local levels for clinical, public health, and other services needed to support pregnant women and families affected by Zika.

What these new numbers do not show

• These new numbers are not comparable to the previous reports. These updated numbers reflect a different, broader population of pregnant women.
• These updated numbers are not real time estimates. They will reflect the number of pregnant women reported with any laboratory evidence of possible Zika virus infection as of 12 noon every Thursday the week prior; numbers will be delayed one week.

Where do these numbers come from?

These data reflect pregnant women in the US Zika Pregnancy Registry and the Zika Active Pregnancy Surveillance System in Puerto Rico. CDC, in collaboration with state, local, tribal and territorial health departments, established these registries for comprehensive monitoring of pregnancy and infant outcomes following Zika virus infection.

The data collected through these registries will be used to update recommendations for clinical care, to plan for services and support for pregnant women and families affected by Zika virus, and to improve prevention of Zika virus infection during pregnancy.

What are the outcomes for these pregnancies?

Visit CDC’s webpage for updated counts of poor pregnancy outcomes related to Zika. Most of the pregnancies monitored by these systems are ongoing. CDC will not report outcomes until pregnancies are complete.

CDC

Outcomes of Pregnancies with Laboratory Evidence of Possible Zika Virus Infection in the United States, 2016

Stop The Bleeding Coalition

Stop the Bleeding Coalition Partners

1.  Sauaia, A; Moore, FA Moore EE, et al (1995). “Epidemiology of trauma deaths”. Journal of Trauma 38: 185–193.
   
2. Jump up^ Carey, ME (1996). “Analysis of wounds incurred by U.S. Army Seventh Corps personnel treated to Corps hospitals during Operation Desert Storm”. Journal of Trauma: 165–169.
   
3.  http://usatoday30.usatoday.com/news/nation/ems-day2-cover.htm
4. http://leb.fbi.gov/2014/january/active-shooter-events-from-2000-to-2012
5. http://www.globalresearch.ca/mass-shootings-in-america-a-historical-review/5355990
6. http://www.cnn.com/2013/09/16/us/20-deadliest-mass-shootings-in-u-s-history-fast-facts/

NY Public Library

WHO

Yellow fever – Angola

On 21 January 2016, the Ministry of Health of Angola notified WHO of an outbreak of yellow fever (YF). The first case (with onset date of 5 December 2015) was identified in Viana municipality, Luanda province.

As of 10 June, 3,137 suspected cases, including 345 deaths, had been reported from all the 18 provinces of Angola. A total of 847 cases had been laboratory-confirmed. The confirmed cases are from 78 districts of 16 provinces. Local transmission has been documented in 31 districts of 12 provinces (Benguela, Cuango Cubango, Cuanza Norte, Cuanza Sul, Cunene, Huambo, Huila, Luanda, Lunda Norte, Malanje, Uige, and Zaire).

Luanda and Huambo remain the most affected provinces with 1,778 cases (489 confirmed) and 508 cases (126 confirmed), respectively. The other most affected provinces are Benguela (291 suspected cases), Huila (135 suspected cases), Cuanza Sul (99 suspected cases) and Uige (54 suspected cases). The majority of the cases are aged 15 to 24 years.

Efforts to strengthen surveillance are ongoing, and the number of cases in the country is slowly decreasing, though new clusters of cases are being reported in new districts. The epidemiological trend and pattern show that YF virus circulation continues to extend to other provinces and the risk for exportation to other countries with close linkages to Angola still exists.

The epidemiological situation in Lunda Norte is of particular concern. This province shares borders with the Democratic Republic of the Congo (DRC) and regularly experiences a high flow of people and goods in and out of DRC. To date, three laboratory confirmed cases, imported from Lunda Norte, have been reported by DRC.

Public health response

The national task force is leading the response to the outbreak, under the National Director of Public Health (NDPH). WHO set up an Incident Management System (IMS) to coordinate international partners’ support to the NDPH. The IMS integrates and coordinates the work of several organizations, including the Institut Pasteur of Dakar, UNICEF, Centers for Disease Control and Prevention, Medicos del Mundo and Médecins Sans Frontières.

The IMS partner response to the outbreak is articulated around five pillars:

• strengthening surveillance, with a focus on case investigations and laboratory confirmation
• vaccination,
• vector control,
• case management, and
• social mobilization.

As of June 10, almost half of the country had been vaccinated (10,641,209 people) and the country had received 11,635,800 vaccines. Mass vaccination campaigns have taken place in all the districts of Luanda, seven districts of Benguela, five districts of Cuanza Sul, five districts of Huambo, three districts of Huila, and two of Uige. Vaccination is ongoing in two districts of Lunda Norte and one in Zaire, all of which border DRC. Additional mass vaccination campaigns are being planned in these and other provinces, including Cuando Cubango, Cunene and Namibe. Reactive vaccination has taken place in Cafunfu town (Lunda Norte) and the city of Lubango (Huila), among others. Plans are under way to complete vaccination in areas with low vaccination coverage (so called ‘mop up’ campaigns) in Luanda and Benguela.

WHO and partners are providing technical and financial support to the response. The current challenges include the need to strengthen the response to the outbreak at the provincial level and address border health issues.

WHO risk assessment

The evolution of the epidemiological situation in Angola is concerning and needs to be closely monitored. Based on experiences from previous similar events, it is expected that additional cases will be reported. The reports of YF imported cases in China, DRC, and Kenya demonstrate the threat that this outbreak constitutes to the entire world. Viraemic patients travelling to areas where competent vectors and susceptible human populations are present pose a risk for the establishment of local cycles of transmission. There is an urgent need to continue strengthening the quality of the response in Angola and to enhance preparedness in neighbouring countries and in countries that have diaspora communities in Angola. WHO continues to monitor the epidemiological situation and conduct risk assessments based on the latest available information.

WHO advice

Yellow fever can easily be prevented through immunization provided that vaccination is administered at least 10 days before travel. WHO, therefore, urges Members States especially those where the establishment of a local cycle of transmission is possible (i.e. where the competent vector is present) to strengthen the control of immunisation status of travellers to all potentially endemic areas.

In the context of an ongoing YF outbreak in Angola, special attention should also be placed on travellers returning from Angola and other potentially endemic areas. If there are medical grounds for not getting vaccinated, this must be certified by the appropriate authorities.

WHO does not recommend any restriction of travel and trade to Angola based on the current information available.

CDC

The 57-page plan:  http://files.ctctcdn.com/6f0559fe101/01ee9685-9672-4d5c-88e5-0873b30c950f.pdf

CDC will support and help states with key tasks at different stages of the outbreak

Phase level 0 —signifying preparedness activity for when the vector is present or possible in the state—to level 4, when widespread local Zika infections are occurring is several jurisdictions within a state.  Most states are currently in phase 0 or 1, meaning Aedes mosquitoes are biting and travel-related or sexually transmitted cases have occurred.

Phase 2 would be a single locally acquired case or a case cluster in a single household.

Phase 3 consists of widespread local transmission contained to a 1-mile area

Phase 4 is widespread transmission in multiple locations.

WHO

WHO statement on the third meeting of the International Health Regulations (2005) (IHR(2005)) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations

The third meeting of the Emergency Committee (EC) convened by the Director-General under the International Health Regulations (2005) (IHR 2005) regarding microcephaly, other neurological disorders and Zika virus was held by teleconference on 14 June 2016, from 13:00 to 17:15 Central European Time. In addition to providing views to the Director-General on whether the event continued to constitute a Public Health Emergency of International Concern (PHEIC), the Committee was asked to consider the potential risks of Zika transmission for mass gatherings, including the Olympic and Paralympic Games scheduled for August and September 2016, respectively, in Rio de Janeiro, Brazil.

The Committee was briefed on the implementation of the Temporary Recommendations issued by the Director-General on 8 March 2016 and updated on the epidemiology and association of Zika virus infection, microcephaly and Guillain-Barré Syndrome (GBS) since that time. The following States Parties provided information on microcephaly, GBS and other neurological disorders occurring in the presence of Zika virus transmission: Brazil, Cabo Verde, Colombia, France, and the United States of America. Advisors to the Committee provided further information on the potential risks of Zika virus transmission associated with mass gatherings and the upcoming Olympic and Paralympic Games, and the Committee thoroughly reviewed the range of public perspectives, opinions and concerns that have recently been aired on this subject.

The Committee concurred with the international scientific consensus, reached since the Committee last met, that Zika virus is a cause of microcephaly and GBS, and, consequently, that Zika virus infection and its associated congenital and other neurological disorders is a Public Health Emergency of International Concern (PHEIC). The Committee restated the advice it provided to the Director-General in its 2^nd meeting in the areas of public health research on microcephaly, other neurological disorders and Zika virus, surveillance, vector control, risk communications, clinical care, travel measures, and research and product development.

The Committee noted that mass gatherings, such as the Olympic and Paralympic Games, can bring together substantial numbers of susceptible individuals, and can pose a risk to the individuals themselves, can result in the amplification of transmission and can, potentially, contribute to the international spread of a communicable disease depending on its epidemiology, the risk factors present and the mitigation strategies that are in place. In the context of Zika virus, the Committee noted that the individual risks in areas of transmission are the same whether or not a mass gathering is conducted, and can be minimized by good public health measures. The Committee reaffirmed and updated its advice to the Director-General on the prevention of infection in international travellers as follows:

• Pregnant women should be advised not to travel to areas of ongoing Zika virus outbreaks; pregnant women whose sexual partners live in or travel to areas with Zika virus outbreaks should ensure safe sexual practices or abstain from sex for the duration of their pregnancy,

• Travellers to areas with Zika virus outbreaks should be provided with up to date advice on potential risks and appropriate measures to reduce the possibility of exposure through mosquito bites and sexual transmission and, upon return, should take appropriate measures, including practicing safer sex, to reduce the risk of onward transmission,

• The World Health Organization should regularly update its guidance on travel with evolving information on the nature and duration of risks associated with Zika virus infection.

Based on the existing evidence from the current Zika virus outbreak, it is known that this virus can spread internationally and establish new transmission chains in areas where the vector is present. Focusing on the potential risks associated with the Olympic and Paralympic Games, the Committee reviewed information provided by Brazil and Advisors specializing in arboviruses, the international spread of infectious diseases, travel medicine, mass gatherings and bioethics. The Committee concluded that there is a very low risk of further international spread of Zika virus as a result of the Olympic and Paralympic Games as Brazil will be hosting the Games during the Brazilian winter when the intensity of autochthonous transmission of arboviruses, such as dengue and Zika viruses, will be minimal and is intensifying vector-control measures in and around the venues for the Games which should further reduce the risk of transmission.

The Committee reaffirmed its previous advice that there should be no general restrictions on travel and trade with countries, areas and/or territories with Zika virus transmission, including the cities in Brazil that will be hosting the Olympic and Paralympic Games. The Committee provided additional advice to the Director-General on mass gatherings and the Olympic and Paralympic Games as follows:

• Countries, communities and organizations that are convening mass gatherings in areas affected by Zika virus outbreaks should undertake a risk assessment prior to the event and increase measures to reduce the risk of exposure to Zika virus,
• Brazil should continue its work to intensify vector control measures in and around the cities and venues hosting Olympic and Paralympic Games events, make the nature and impact of those measures publicly available, enhance surveillance for Zika virus circulation and the mosquito vector in the cities hosting the events and publish that information in a timely manner, and ensure the availability of sufficient insect repellent and condoms for athletes and visitors,
• Countries with travellers to and from the Olympic and Paralympic Games should ensure that those travellers are fully informed on the risks of Zika virus infection, the personal protective measures that should be taken to reduce those risks, and the action that they should take if they suspect they have been infected. Countries should also establish protocols for managing returning travellers with Zika virus infection based on WHO guidance,
• Countries should act in accordance with guidance from the World Health Organization on mass gatherings in the context of Zika virus outbreaks, which will be updated as further information becomes available on the risks associated with Zika virus infection and factors affecting national and international spread.

Based on this advice the Director-General declared the continuation of the Public Health Emergency of International Concern (PHEIC). The Director-General reissued the Temporary Recommendations from the 2^nd meeting of the Committee, endorsed the additional advice from the Committee’s 3^rd meeting, and issued them as Temporary Recommendations under the IHR (2005). The Director-General thanked the Committee Members and Advisors for their advice.

Reuters

“…..Of the roughly 206,200 people who arrived in Europe by sea this year to June 4, one in three was a child….”

UNICEF’s seven point plan for refugee and migrant children
1. Children must be protected against trafficking  and exploitation.
2. Under no circumstances should children be locked up just because they are refugees or migrants.
3. Children must not be sent back to their home countries if they face harm or death.
4. Children must be given access to services such as health and education.
5. Unaccompanied or separated children must be kept safe. Family reunification is often the best way to  do this.
6. The best interests of the child should be a primary consideration in any decision concerning that child.
7. Safe and sustainable legal global pathways for migration must be established.