ZIKA CASES (1/15 -9/7/16) USA- 2,964 total Travel associated 2,920 Locally acquired mosquito borne cases 43 Lab acquired 1 Sexually transmitted 24 US TERRITORIES-15,869 (most locally acquired-not travel mainly PR, USVI & Samoa) NYS 734 (NYC 553)

Incubation period 3-14 days 80% asymptomatic Incubation period 3-14 days Viremia: after symptom onset-days to 1 wk (some cases longer) Zika RNA+ in semen 6 mo after Can be negative in blood but + in placenta & semen (very limited data)- Main s & s-rash, fever, conjunctivitis, H/A, aches Whole blood appears to have longer periods of detectable viremia than compared to serum. Zika RNA has been detected in whole blood as late as 58 days after symptom onset. Zika virus infection in pregnancy is a cause of microcephaly & other fetal brain abnormalities. Miscarriage, stillbirth, hearing deficits, are what has been seen so far but the full clinical effects of Zika in pregnancy is not known yet. Zika has been assoc with an increased incidence of GB syndrome (38 cases connected to Zika in US & US territories-most in PR)

FDA guidance on tissue (3/2016) FDA identifies zika as a transfusion-transmitted infection-(8/26/16 guidance) In a 2013 outbreak 2.8% samples from asymptomatic blood donors + zika RNA In 2016 1% of blood donors in PR +zika Probable transfusion transmission in Brazil Tissue Guidance recommends no deceased donation from people with a dx of zika in the past 6 mo-no recommendations on people who have travelled to zika area or had sex FDA- no living donation from a person with it or at risk (travel, sex with someone infected) for 6 mo Initial blood guidance focused on screening for history of travel & self deferral of donation. Now recommend testing of all donations. PR & FL required to test immediately. NY is listed as one of 11 states that should do so within 4 wks of guidance (8-26-16)

ZIKA RISKS TO RECIPIENT Flavivirus-same type of arbovirus as WNV Antigenic cross talk with Dengue & WNV Proliferates in immune system cells WNV donor transmission-NYC 2005 GB connection to Zika Organ Trx pts: neuroinvasive disease 40X pop WNV; Zika 100X 38 GB cases have been found to test positive for zika. (not sure which tests-PCR, serology, urine )

DTAC GUIDANCE Focus on recent travel hx Signs & Symptoms (Rash, fever, H/A, conjunctivitis) in donor Living donors-defer donation, if possible https://optn.transplant.hrsa.gov/news/guidance-on-zika-virus/ Diagnostic and donor screening is limited/under development There are diagnostic tests-molecular (RNA-PCR) & serological tests & urine. But all limited commercially. This is changing daily, especially with the FDA blood screening recommendations. No FDA licensed donor screening tests are available-but an investigational IND has been developed and testing under IND implemented in PR, & FL. 2 new IND applications (investigational new drug application under and emergency use authorization (EUA) have been submitted recently to include organ donor testing. AOPO and AATB are keeping on top of this & working with the FDA & CDC & HRSA. DTAC has their meeting in October

RESOURCES NYSDOH Zika Info Line 888-364-4723 (M-F0 9AM-5PM) Webinar for transplant professionals hosted by the NYSDOH-NYS Transplant Council September 22 12 noon Hear from NYS public health experts & DTAC

OTHER RESOURCES NYSDOH – http://www.health.ny.gov/diseases/zika_virus/ CDC Zika page http://www.cdc.gov/zika/ FDA Zika http://www.fda.gov/EmergencyPreparedness/Counterterrorism/MedicalCountermeasures/MCMIssues/ucm485199.htm

ZIKA WEBINAR INFO Host: NYSDOH and the NYS Transplant Council Date/time: Thursday, September 22nd 2016, 12 - 1 p.m. EST Speakers: Kirsten St. George, MAppSc, PhD, Chief Viral Diseases, Wadsworth Center, NYSDOH; Lewis Teperman MD, FACS, Vice Chair of Surgery and Director of Transplant, Northwell Heath and Marian Michaels, MD, MPH, Professor of Pediatrics and Surgery, University of Pittsburgh School of Medicine, Disease Transmission Advisory Committee (DTAC) Vice Chair, United Network for Organ Sharing (UNOS) Click here to register: https://meetny.webex.com/meetny/onstage/g.php?MTID=e580da9c168d10edd8994b963a60f4e4b  

NYSDOH CONTACTS Nancey Agard RN, MS nancey.agard@health.ny.gov Lisa McMurdo RN, MPH lisa.mcmurdo@health.ny.gov 518-402-1003

NYS HEALTH COMMERCE A health professional can request an HCS account http://www.health.ny.gov/prevention/immunization/information_system/providers/hpn_account_instructions.htm