COCA News and Announcements - September 12, 2016

September 12, 2016

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This issue contains guidance documents relevant to current public health events and information from August 29 - September 12.

The next COCA Update is scheduled for September 26.

For questions about these or other clinical issues, please write to us at

Additional Resources
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COCA Home Page

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.

Archived COCA conference calls are available at
Free continuing education (CME, CNE, ACPE, CEU, CECH, and AAVSB/RACE) is available for most calls. For more information about free CE, visit

CDC Emergency Response - 2016 Zika Virus

Key Zika Considerations for Healthcare Settings 

NEW: Puerto Rico: Guillain-Barré Passive Surveillance System

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

UPDATED: Zika Training for Healthcare Providers
View recorded webinars and on-demand trainings.

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 revised guidance recommending universal testing of donated whole blood and blood components for Zika virus in the U.S. and its territories.

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

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 

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

Consultation Service for Healthcare Providers Caring for Pregnant Women with Possible Zika Virus Infection
CDC maintains a 24/7 consultation service for health officials and healthcare providers caring for pregnant women.  To contact the service, call 770-488-7100 or email

Outcomes of Pregnancies with Laboratory Evidence of Possible Zika Virus Infection in the United States, 2016
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, March 2016
CDC recommends Standard Precautions in all healthcare settings to protect both healthcare 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

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

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

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

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

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.

Clinical Evaluation and Testing

When to Test for Zika Virus

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

Collection and Submission of Fetal Tissues for Zika Virus Testing PDF

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, June 2016
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 HAN Health Update—Diagnostic Testing of Urine Specimens for Suspected Zika Virus Infection, May 2016

MMWR: Interim Guidance for Zika Virus Testing of Urine — United States, May 2016

Clinical Evaluation & Disease
Zika virus is transmitted to humans primarily through the bite of an infected Aedes species mosquito. 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: Areas of Active Transmission for the Purpose of Blood and Tissue Safety Intervention

Interim CDC Zika Response Plan
The purpose of this document is to describe the CDC response plan for 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  

U.S. Zika Pregnancy Registry
CDC has established the U.S. 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
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 (CERC) Discussions
To address the communication concerns and needs of state, local, and territorial health communicators, as well as partner organizations, CDC hosted a series of Crisis and Emergency Risk Communication (CERC) teleconferences related to Zika issues. All teleconferences have been archived on CDC's website.

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 for Health Professionals – (CDC)
Find preparedness resources for health professionals at

Emergency Preparedness and Response Training Resources for Clinicians – (CDC)
Find online and in-person training resources at

Natural Disasters and Severe Weather

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)

Infectious, Vector-Borne, and Zoonotic Diseases

NEW: Investigation of Escherichia coli Harboring the mcr-1 Resistance Gene — Connecticut, 2016
In this investigation of potentially travel-associated mcr-1 acquisition, no transmission beyond the index patient or persistent environmental contamination were identified, and the patient was transiently colonized. At this time, CDC recommends that Enterobacteriaceae isolates with a colistin or polymyxin B MIC ≥4 μg/ml be tested for the presence of mcr-1; testing is available through CDC. Prompt reporting of mcr-1–carrying isolates to public health officials allows for a rapid response to identify transmission and limit further spread. 

NEW: Investigation of First Identified mcr-1 Gene in an Isolate from a U.S. Patient — Pennsylvania, 2016
In May 2016, mcr-1-positive Escherichia coli was first isolated from a specimen from a U.S. patient when a Pennsylvania woman was evaluated for a urinary tract infection. The urine culture and subsequent testing identified the gene in an extended-spectrum beta-lactamase (ESBL)-producing E. coli with reduced susceptibility to colistin.

Seasonal Influenza

Information for Health Professionals – (CDC)
The pages listed offer public health and health care professionals key information about vaccination, infection control, prevention, treatment, and diagnosis of seasonal influenza

Weekly U.S. Influenza Surveillance Report: Flu View – August 27 (CDC)
Flu View is a weekly influenza surveillance report prepared by CDC’s 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 31 (U.S. 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.

Morbidity and Mortality Weekly Report (MMWR)


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

September 8, 2016 / Vol. 65 / No. 35  Download .pdf document of this issue 

Food, Drug, and Device Safety

NEW: Ovarian Cancer Screening Tests: Safety Communication - FDA Recommends Against Use – (FDA)
Using unproven ovarian cancer screening tests may be harmful for women with increased risk for developing ovarian cancer.

NEW: Opioid Pain or Cough Medicines Combined With Benzodiazepines: Drug Safety Communication - FDA Requiring Boxed Warning About Serious Risks and Death – (FDA)
Combined use of opioid medicines with benzodiazepines or other drugs that depress the central nervous system has resulted in serious side effects, including slowed or difficult breathing and deaths.

MedWatch: The FDA Safety Information and Adverse Event Reporting Program – (FDA)
MedWatch is your 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 the U.S. Department of Agriculture. Visitors to the site can report a problem or make inquiries.

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