COCA News and Announcements

This issue contains guidance documents relevant to current public health events and information from July 18 - August 1.

The next COCA Update is scheduled for August 15.

For questions about these or other clinical issues, please write to us at coca@cdc.gov.

COCA News and Announcements

Upcoming COCA Call

Assessing Benefits and Harms of Opioid Therapy for Chronic Pain
Date: Wednesday, August 3, 2016
Time: 2:00 - 3:00 pm (Eastern Time)
Dial in: 800-779-0686 (U.S. Callers); 312-470-0194  (International Callers)
Passcode: 3377346
Webinar: https://www.mymeetings.com/nc/join.php?i=PW8523117&p=3377346&t=c
Although evidence supports short-term effectiveness of opioids to treat pain, there is insufficient data that long-term use of opioids effectively treats chronic pain. In fact, long-term use of opioids in high doses can contribute to opioid-use disorder and overdose. Therefore, long-term opioid therapy should only be used when the benefits outweigh the risks. During this COCA Call, presenters will explore a case study on how recommendations from the CDC Guideline for Prescribing Opioids for Chronic Pain were used to ascertain the associated benefits and risks when a patient with fibromyalgia was prescribed oxycodone following a motor vehicle crash.
https://emergency.cdc.gov/coca/calls/2016/callinfo_080316.asp

NEW: Updated Interim Zika Clinical Guidance for Pregnant Women and Data on Contraceptive Use to Decrease Zika-affected Pregnancies
Date: Tuesday, August 9, 2016
Time: 2:00 - 3:00 pm (Eastern Time)
Dial in: 888-942-9686 (U.S. Callers); 517-308-9076 (International Callers)
Passcode: 4687942
Webinarhttps://www.mymeetings.com/nc/join.php?i=PW9512922&p=4687942&t=c
CDC’s top priority for the Zika response is to protect pregnant women and their fetuses from the adverse effects of Zika virus infection during pregnancy. As a result, CDC continues to evaluate all available evidence and update recommendations as new information becomes available. CDC has updated its interim guidance for U.S. healthcare providers caring for pregnant women with possible Zika virus exposure on Tuesday, July 26 based on emerging evidence about laboratory testing for the diagnosis of Zika. 

On August 2, 2016, CDC published contraceptive use data for states where mosquito-borne transmission of Zika is possible. A primary strategy to reduce Zika-related pregnancy complications is to prevent pregnancy among women who want to delay or avoid pregnancy. During this COCA Call, clinicians will learn about the updated CDC interim guidance for caring for pregnant women with possible Zika virus exposure, and strategies for increasing access to contraceptive methods and services to minimize the number of pregnancies affected by Zika.
https://emergency.cdc.gov/coca/calls/2016/callinfo_080916.asp

Recent COCA Calls

CDC Recommendations for Nonopioid Treatments in the Management of Chronic Pain
Date: Wednesday, July 27, 2016
During this COCA Call, a case study was used to illustrate how clinicians can identify appropriate treatment strategies for chronic pain. In addition, clinicians learned about the effectiveness and risks of nonpharmacologic and nonopioid pharmacologic treatments for chronic pain.
http://emergency.cdc.gov/coca/calls/2016/callinfo_072716.asp

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

CDC Emergency Response

2016 Zika Virus

NEW: Key Messages—Zika Virus
A collection of the most up-to-date and cleared information on the ongoing Zika virus outbreak.
http://www.cdc.gov/zika/pdfs/zika-key-messages.pdf

UPDATED: Zika Virus Information for Healthcare Providers
CDC's Zika webpage for healthcare provider resources.
http://www.cdc.gov/zika/hc-providers/index.html

Zika Virus: Information for Clinicians Slide Set
http://www.cdc.gov/zika/pdfs/clinicianppt.pdf

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. 
http://www.cdc.gov/zika/fs-posters/index.html

Clinicians Caring for Pregnant Women and Women of Reproductive Age

NEW: 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.
http://www.cdc.gov/mmwr/volumes/65/wr/mm6529e1.htm?s_cid=mm6529e1_w

U.S. Zika Pregnancy Registry and Tribal Healthcare Providers: How to Contribute
http://www.cdc.gov/zika/pdfs/zika_pregnancyregistry_tribal.pdf

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 ZIKAMCH@cdc.gov.

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
http://www.cdc.gov/zika/geo/pregnancy-outcomes.html

Doctor’s Visit Checklist: For Pregnant Women Who Traveled to an Area with Zika
http://www.cdc.gov/zika/pdfs/docvisit-checklist-travelpreg.pdf

Doctor’s Visit Checklist: For Pregnant Women Living in an Area with Zika
http://www.cdc.gov/zika/pdfs/zika-clinicvisit-checklist.pdf

MMWR: Interim Guidance for Healthcare Providers Caring for Women of Reproductive Age with Possible Zika Virus Exposure — United States, April 2016
CDC has updated its interim guidance for U.S. healthcare providers caring for women of reproductive age with possible Zika virus exposure  to include recommendations for counseling women and men with possible Zika virus exposure who are interested in conceiving. The updated guidelines also include recommendations for Zika virus testing and guidance for women residing along the U.S.-Mexico Border.
http://www.cdc.gov/mmwr/volumes/65/wr/mm6512e2er.htm?s_cid=mm6512e2er_w

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]).
http://www.cdc.gov/mmwr/volumes/65/wr/mm6511e3.htm?s_cid=mm6511e3_w

Clinical Guidance for Healthcare Providers Caring for Pregnant Women
http://www.cdc.gov/zika/hc-providers/pregnant-woman.html

Clinical Guidance for Healthcare Providers Caring for Women of Reproductive Age
http://www.cdc.gov/zika/hc-providers/women-reproductive-age.html

Clinicians Caring for Infants and Children

Clinical Guidance for Healthcare Providers Caring for Infants & Children
http://www.cdc.gov/zika/hc-providers/infants-children.html 

Congenital Microcephaly Case Definitions
http://www.cdc.gov/zika/public-health-partners/microcephaly-case-definitions.html
 
MMWR: Interim Guidelines for Healthcare Providers Caring for Infants and Children with Possible Zika Virus Infection — United States, February 2016
CDC has updated its interim guidelines for U.S. healthcare providers caring for infants born to mothers who traveled to or resided in areas with Zika virus transmission during pregnancy and expanded guidelines to include infants and children with possible acute Zika virus disease.
http://www.cdc.gov/mmwr/volumes/65/wr/mm6507e1.htm

Sexual Transmission

NEW: 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.
http://www.cdc.gov/mmwr/volumes/65/wr/mm6529e2.htm?s_cid=mm6529e2_w

Zika and Sexual Transmission
http://www.cdc.gov/zika/transmission/sexual-transmission.html

Travel Information

NEW: MMWR: Ongoing Zika Virus Transmission — Puerto Rico, November 1, 2015–July 7, 2016
The Zika virus outbreak in Puerto Rico continues to expand in geographic extent and number of infected persons. Residents of and travelers to Puerto Rico should continue to employ mosquito bite avoidance behaviors, take precautions to reduce the risk for sexual transmission, and seek medical care for any acute illness with rash or fever.
http://www.cdc.gov/mmwr/volumes/65/wr/mm6530e1.htm?s_cid=mm6530e1_e

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.
http://www.cdc.gov/zika/geo/country-classification.html

CDC Issues Advice for Travel to the 2016 Summer Olympic Games
http://wwwnc.cdc.gov/travel/notices/alert/2016-summer-olympics-rio

Clincial Evaluation and Testing

Zika Virus Resources for Laboratories
http://www.cdc.gov/zika/laboratories/index.html

Testing for Zika Virus
Contact your state or local health department to facilitate testing.
http://www.cdc.gov/zika/hc-providers/testing-for-zikavirus.html

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.
http://emergency.cdc.gov/han/han00392.asp

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.
http://www.cdc.gov/mmwr/volumes/65/wr/mm6521e1.htm?s_cid=mm6521e1_e

Official CDC HAN Health Update—Diagnostic Testing of Urine Specimens for Suspected Zika Virus Infection, May 2016
https://emergency.cdc.gov/han/han00389.asp

MMWR: Interim Guidance for Zika Virus Testing of Urine — United States, May 2016
http://www.cdc.gov/mmwr/volumes/65/wr/mm6518e1.htm?s_cid=mm6518e1_w

CDC and OSHA Issue Interim Guidance for Protecting Workers from Occupational Exposure to Zika Virus, April 2016
CDC and the Occupational Safety and Health Administration (OSHA) issued guidance and information for protecting workers from occupational exposure to Zika virus.
http://www.cdc.gov/niosh/topics/outdoor/mosquito-borne/pdfs/osha-niosh_fs-3855_zika_virus_04-2016.pdf#page=1

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.
http://www.cdc.gov/zika/hc-providers/clinicalevaluation.html

State, Local, Tribal, and Territorial Health Department Resources

CDC Emergency Vector Control Request Form
http://www.cdc.gov/zika/public-health-partners/zika-vector-control-arf-2yearcontract.xlsx  

CDC Draft Interim 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.
http://www.cdc.gov/zika/pdfs/zika-draft-interim-conus-plan.pdf  

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.  
http://www.cdc.gov/zika/hc-providers/registry.html

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. 
http://www.cdc.gov/zika/public-health-partners/zapss.html

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.
http://www.cdc.gov/zika/geo/pregwomen-uscases.html 

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 is hosting a series of Crisis and Emergency Risk Communication (CERC) teleconferences related to Zika issues. These teleconferences will be held on a weekly basis on Tuesdays from 1-2 pm (Eastern Time). Each week, a new topic will be presented on a different aspect of CERC.
https://emergency.cdc.gov/cerc/zika-teleconferences.asp

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.
https://tools.cdc.gov/medialibrary/index.aspx#/microsite/id/234558

CDC News and Announcements 

CDC Science Clips: Volume 8, Issue: 30
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.
www.cdc.gov/library/sciclips/issues/

Public Health Preparedness

Emergency Preparedness and Response for Health Professionals – (CDC)
Find preparedness resources for health professionals at
http://emergency.cdc.gov/health-professionals.asp

Emergency Preparedness and Response Training Resources for Clinicians – (CDC)
Find online and in-person training resources at
emergency.cdc.gov/coca/trainingresources.asp

Natural Disasters and Severe Weather

NEW: CDC Feature: Keep Your Cool in Hot Weather – (CDC)
http://www.cdc.gov/features/extremeheat/index.html

Food and Water Needs: Preparing for a Disaster or Emergency – (CDC)
emergency.cdc.gov/disasters/foodwater/prepare.asp 

Health and Safety Concerns for All Disasters – (CDC)
emergency.cdc.gov/disasters/alldisasters.asp

Infectious, Vector-Borne, and Zoonotic Diseases

Seasonal Influenza

Information for Health Professionals – (CDC)
http://www.cdc.gov/flu/professionals/index.htm

Weekly U.S. Influenza Surveillance Report: Flu View – June 16 (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.
http://www.cdc.gov/flu/weekly/

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.
www.flu.gov/planning-preparedness/hospital/index.html

Travel Safety

Current Travel Warnings – July 27 (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.
travel.state.gov/content/passports/english/alertswarnings.html

Morbidity and Mortality Weekly Report (MMWR)

MMWR publications are prepared by CDC. To electronically subscribe, go to www.cdc.gov/mmwr/mmwrsubscribe.html

July 29, 2016 / Vol. 65 / No. 29  Download .pdf document of this issue 

Food, Drug, and Device Safety

NEW: Angiodynamics Soft Vu Omni Flush Angiographic Catheter by Stryker Sustainability Solutions (formerly Ascent Healthcare Solutions): Class I Recall - Tip Separation
Stryker Sustainability Solutions (formerly Ascent Healthcare Solutions) is recalling Angiodynamics Soft Vu Omni Flush Angiographic Catheters due to reports of separation of the tip of the catheter from the main body. Tip separation leads to loss of device function, possible surgical intervention to retrieve a separated segment, or other complications such as blocking blood flow to bodily organs.
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm512644.htm

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. 
http://www.fda.gov/Safety/MedWatch/default.htm

FoodSafety.gov: Reports of FDA and USDA Food Recalls, Alerts, Reporting, and Resources – (HHS/USDA/FDA/CDC/NIH)
Foodsafety.gov 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.
www.foodsafety.gov/recalls/recent/index.html

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