December 19, 2016
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This issue contains guidance documents relevant to current public health events and information from December 5–December 19.
The next COCA Update is scheduled for January 2.
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COCA News and Announcements
Recent COCA Calls
Gearing up for the Travel Season: How Clinicians Can Ensure Their Patients are Packed with Knowledge on Zika Prevention
Date: Thursday, December 8, 2016
During this COCA Call, clinicians learned about current CDC travel recommendations, how to determine which patients should be tested for Zika after traveling to an area with Zika, and the recommendations for patients before and after travel to help them protect themselves and others from Zika.
Effectively Communicating with Patients about Opioid Therapy
Date: Tuesday, December 13, 2016
During this COCA Call, clinicians learned how to apply principles of motivational interviewing and a six-step process that is patient-centered and supports clinical judgment when conflict arises. Presenters reviewed two case studies in which they applied communication strategies, and provided examples of patient-provider dialogue.
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) is available for most calls. For more information about free CE, visit emergency.cdc.gov/coca/continuingeducation.asp.
CDC Emergency Response - 2016 Zika Virus
NEW: Emerging Infectious Diseases—Zika Virus RNA Replication and Persistence in Brain and Placental Tissue
A new study by CDC is the first to show Zika virus RNA replicating in brain tissues of infants with microcephaly who later died and in placentas of women who suffered pregnancy losses after Zika infection during pregnancy. CDC scientists found Zika virus RNA persisted in fetal brains and in placentas for more than seven months after the pregnant women contracted Zika. The researchers also found evidence of the virus replicating in an infant with microcephaly who died two months after birth. The RNA levels were about 1,000 times higher in the infants’ brains than in the women’s placentas.
NEW: Birth Defects Among Fetuses and Infants of US Women With Evidence of Possible Zika Virus Infection During Pregnancy
Based on preliminary data from the U.S. Zika Pregnancy Registry, among 442 completed pregnancies, 6% resulted in a fetus or infant with evidence of a Zika virus–related birth defect, primarily microcephaly with brain abnormalities, whereas among women with possible Zika virus infection during the first trimester, 11% had a fetus or infant with a birth defect.
Zika Virus Information for Healthcare Providers
CDC's Zika webpage for healthcare provider resources.
UPDATED: Key Messages—Zika Virus
A collection of the most up-to-date, cleared information on the ongoing Zika virus outbreak.
Print Resources in Different Languages
CDC fact sheets and posters for distribution to patients are available in Spanish, Arabic, Tagalog, Vietnamese, Mandarin, Creole, Korean, and other languages. 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
Pregnancy and Zika Testing Clinical Algorithm
The interactive clinical algorithm allows healthcare providers to receive recommendations tailored to their pregnant patients with possible Zika exposure. Healthcare providers can answer questions about pregnant patients and, based on the responses, receive information regarding the type of testing indicated as well as clinical management recommendations. It can be used on computers and mobile devices/tablets.
U.S. Zika Pregnancy Registry
CDC and state, tribal, local, and territorial health departments request that healthcare providers, especially obstetric and pediatric healthcare providers, participate in the U.S. Zika Pregnancy Registry.
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
NEW: MMWR: Preliminary Report of Microcephaly Potentially Associated with Zika Virus Infection During Pregnancy—Colombia, January–November 2016
This report provides preliminary national birth defects surveillance data on congenital microcephaly following a large outbreak of Zika virus infection in Colombia. Microcephaly prevalence increased more than fourfold overall in 2016 compared to 2015, with a ninefold increase in July 2016 (the peak month) compared to July 2015. The temporal association between Zika virus infections and microcephaly, with the peak of reported microcephaly occurring approximately 24 weeks after the peak of the Zika outbreak, provides evidence that the greatest risk period is likely during the first trimester of pregnancy and early in the second trimester of pregnancy.
Measuring Infant Head Circumference: An Instructional Video for Healthcare Providers in English and Spanish
CDC is working to ensure that infants with microcephaly and other brain abnormalities receive the services they need. Accurately identifying infants with microcephaly is crucial. The goal of this instructional video is to provide clinicians with the tools needed to accurately measure infant head circumference and length.
In English: https://www.youtube.com/watch?v=HWV1JdAhsSo
En Español: https://www.youtube.com/watch?v=tPBxXkIIjt0
Clinical Guidance for Healthcare Providers Caring for Infants & Children
Zika and Sexual Transmission
NEW: Advice For People Living In or Traveling to Brownsville, Texas
On December 14, 2016, CDC issued guidance related to Zika for people living in or traveling to Brownsville, Cameron County, TX and has designated Brownsville as a Zika cautionary area (yellow area).. On November 28, the Texas Department of State Health Services reported the state’s first case of local mosquito-borne Zika virus infection in Brownsville. Additional cases of mosquito-borne Zika have been identified in the area, suggesting that there is a risk of continued spread of Zika virus in Brownsville.
Zika Travel Information
Advice for People Living in or Traveling to South Florida
On December 9, 2016, CDC removed the red area designation for the remaining 1.5-square-mile area of South Miami Beach after three mosquito incubation periods (45 days) passed without any new locally transmitted cases of Zika. Guidance for yellow areas now applies to the South Miami Beach area and all of Miami-Dade County.
Clinical Evaluation and Testing
Guidance for U.S. Laboratories Testing for Zika Virus Infection
The guidance was updated to be inclusive of the currently available Emergency Use Authorization (EUA) assays; it takes into account the recent updates to the CDC Trioplex Real-time RT-PCR Assay EUA, which includes the addition of whole blood as an acceptable specimen type. The updated guidance also specifies that plaque reduction neutralization testing (PRNT) confirmation is currently not routinely recommended in Puerto Rico, where dengue is endemic.
Clinical Evaluation & Disease
Testing for Zika
State, Local, Tribal, and Territorial Health Department Resources
CDC Zika Interim 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.
State, Local, Tribal, and Territorial Health Department Resources
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 News and Announcements
NEW: CDC in 2016: Keeping America Safe From Health Threats New And Old
The health threats of 2016 came in all sizes, ranging from drug-resistant superbugs to Zika-carrying mosquitoes to a powerful hurricane. In a digital press kit released December 14, CDC highlighted key agency activities during 2016 and previews what could come in 2017. In its 70th year, CDC continues to protect the health of all Americans, whether threats came from infectious or chronic diseases, environmental dangers, occupational hazards, or injuries.
NEW: CDC Winnable Battles: Letter From Director
CDC Science Clips: Volume 8, Issue: 50
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
Winter 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: Seasonal Influenza
NEW: Flu Vaccine Coverage Remains Low This Year – (CDC)
As of early November, only about 2 out of 5 people in the United States reported having gotten this season’s flu vaccine, yet flu vaccine offered substantial benefit last season by preventing an estimated 5 million flu illnesses and 71,000 flu hospitalizations. CDC is releasing this information during the 11th National Influenza Vaccination Week (NIVW), an event to encourage ongoing flu vaccination into the holidays and beyond.
2015–2016 Flu Season – (CDC)
Influenza Vaccination Information for Health Care Workers – (CDC)
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 – December 3 (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.
Current Travel Warnings – December 13 (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 www.cdc.gov/mmwr/mmwrsubscribe.html
December 16, 2016 / Vol. 65 / No. 49 Download .pdf document of this issue
- Resurgence of Progressive Massive Fibrosis in Coal Miners — Eastern Kentucky, 2016
- Assessing Change in Avian Influenza A(H7N9) Virus Infections During the Fourth Epidemic — China, September 2015–August 2016
- Leading Causes of Cancer Mortality — Caribbean Region, 2003–2013
- Monitoring of Persons with Risk for Exposure to Ebola Virus — United States, November 3, 2014–December 27, 2015
- Use of a 2-Dose Schedule for Human Papillomavirus Vaccination — Updated Recommendations of the Advisory Committee on Immunization Practices
Food, Drug, and Device Safety
NEW: Convenience Kits containing Multi-Med Single Lumen Catheters by Centurion: Class I Recall—Excess Material May Split or Separate
The catheters have a potential for excess material to remain at the tip of the catheter from the manufacturing process. If this occurs, the excess material may separate from the catheter during use and could enter the patient’s bloodstream. This can result in serious adverse health consequences such as the development of blood clots, embolism of the excess material to vital organs, or death.
Pharmacists on the Front Lines of Opioid Overdose Prevention
Pharmacists and prescribers share a common goal of ensuring safe and effective treatment for patients. CDC released a new brochure developed specifically for pharmacists that outlines the pharmacist’s role in curbing the opioid epidemic and offers tips on how to engage with patients. The brochure is part of a suite of CDC-published user-friendly resources for patients and providers, related to the CDC Guideline for Prescribing Opioids for Chronic Pain.
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.
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.