Zika virus infection during pregnancy is a cause of microcephaly and other severe fetal brain defects; however, the full spectrum of infant outcomes is not yet known. CDC has updated its interim guidance for U.S. healthcare providers caring for infants born to mothers with possible Zika virus infection during pregnancy. During this COCA Call, clinicians will learn 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.

Sometimes, emergencies don’t wait for you to be ready. In 2015, the country of Georgia invited CDC to conduct a training on the principles of Crisis and Emergency Risk Communication (CERC). But before we could get there, the capital city of Tblisi was struck by a major flood. The flash flood and ensuing mudslide killed 20 people and covered much of the city in water and mud. There were news reports about the massive damage, human casualties, and even escaped zoo animals. Ready or not, responders had to jump in and communicate clearly about the emergency.

The Florida Department of Health (FL DOH) has identified an area with local mosquito-borne Zika virus transmission (active Zika virus transmission) in Miami (http://www.cdc.gov/zika/intheus/florida-update.html). Based on the earliest time of symptom onset and a maximal two-week incubation period for Zika virus, this guidance applies to women of reproductive age and their partners who live in or traveled to this area after June 15, 2016. This is an ongoing investigation, and CDC is rapidly learning more about the extent of active Zika virus transmission in the area identified by the FL DOH. With the recommendations below, CDC is applying existing guidance to the occurrence of Zika virus transmission in this area of Florida. As more information becomes available, we will update these recommendations.

The Florida Department of Health (FL DOH) has identified an area with local mosquito-borne Zika virus transmission (active Zika virus transmission) in Miami (http://www.cdc.gov/zika/intheus/florida-update.html). Based on the earliest time of symptom onset and a maximal two-week incubation period for Zika virus, this guidance applies to women of reproductive age and their partners who live in or traveled to this area after June 15, 2016. This is an ongoing investigation, and CDC is rapidly learning more about the extent of active Zika virus transmission in the area identified by the FL DOH. With the recommendations below, CDC is applying existing guidance to the occurrence of Zika virus transmission in this area of Florida. As more information becomes available, we will update these recommendations.

Countries need to be prepared to handle emergencies. Having the right laws in place is an important part of the preparation. When laws are not clearly defined, responders can have a hard time figuring out what to do during a public health emergency and who has the authority to take action. When a deadly disease outbreak hits, this can have devastating consequences.

School is out, and summer is a time for hanging out with family and friends, taking vacations and going away to camp. It is also the season for disasters like tornadoes (http://emergency.cdc.gov/disasters/tornadoes/index.asp), hurricanes (http://emergency.cdc.gov/disasters/hurricanes/index.asp) and wildfires (http://emergency.cdc.gov/disasters/wildfires/index.asp). Include your children in planning and preparing for emergencies to help keep them safe.

Antibiotic-resistant gonorrhea is a public health issue. CDC estimates there are more than 800,000 new gonorrhea infections each year. Left untreated, it can cause pelvic inflammatory disease in women, which can lead to serious reproductive complications including tubal infertility, ectopic pregnancy, and chronic pelvic pain. Prevention relies largely on prompt detection and effective antimicrobial treatment; however, treatment has been compromised by the evolution of antibiotic resistance to the antibiotics used to treat gonorrhea.

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.

Between 1999-2014, nonopioid treatments for chronic pain were used less frequently while the amount of opioids prescribed in the United States quadrupled. Unfortunately, long-term opioid use for chronic pain is associated with serious risks, including abuse, dependence, and overdose. In addition, there is insufficient evidence to determine whether pain relief, function, or quality of life improves with long-term opioid therapy. The CDC Guideline for Prescribing Opioids for Chronic Pain provides recommendations for safer and more effective prescribing of opioids for chronic pain in patients 18 years of age and older in outpatient settings outside of active cancer treatment, palliative care, and end-of-life care. During this COCA Call, a case study will be used to illustrate how clinicians can identify appropriate treatment strategies for chronic

At first glance, this photo taken on a set of concrete steps in Washington, D.C., may look like an ordinary group shot—but it took an extraordinary series of events to make it happen.

Bioterrorism is not a new threat. One of the earliest recorded uses of biological weapons dates back to the 6th century B.C., when Persian armies poisoned wells with a fungus (http://www.selectagents.gov/history.html). Modern threats, however, are more complex and could cause widespread devastation. The anthrax attacks of 2001 focused our nation on making sure especially dangerous pathogens and poisons (which we call select agents and toxins) are being handled safely and are protected at all times.

This week is Mosquito Control Awareness Week! Now that it’s mosquito season, it is the perfect time to look in and around your home for ways to control mosquitoes that can carry viruses like Zika and West Nile. There are many options when it comes to mosquito control for your home. No single activity will effectively control mosquitoes, so you should combine both indoor and outdoor mosquito control activities to keep in and around your home free of mosquitoes.

Ever wondered what’s causing the water in your favorite lake to turn red? Or were the family photos from your river rafting trip spoiled by brown water in the background? You may be looking at an algal bloom. Summer is upon us and warm weather is the perfect environment for these algal blooms, which can cause a range of problems, from simply being an eyesore to becoming a harmful algal bloom (HAB) that can make people and animals sick or damage local environments.

Testing for Zika virus infection using real-time reverse-transcription polymerase chain reaction (rRT-PCR) molecular assays is now commercially available. When requesting Zika rRT-PCR testing from a commercial laboratory, providers should be aware that commercial laboratories performing rRT-PCR currently do not also offer Zika IgM enzyme-linked immunosorbent assay (ELISA) or confirmatory serologic testing (plaque reduction neutralization test, or PRNT). Therefore, if possible, providers should store a serum aliquot for subsequent Zika IgM ELISA testing if the rRT-PCR assay is negative. Otherwise, collection of an additional serum sample may be necessary.

Testing for Zika virus infection using real-time reverse-transcription polymerase chain reaction (rRT-PCR) molecular assays is now commercially available. When requesting Zika rRT-PCR testing from a commercial laboratory, providers should be aware that commercial laboratories performing rRT-PCR currently do not also offer Zika IgM enzyme-linked immunosorbent assay (ELISA) or confirmatory serologic testing (plaque reduction neutralization test, or PRNT). Therefore, if possible, providers should store a serum aliquot for subsequent Zika IgM ELISA testing if the rRT-PCR assay is negative. Otherwise, collection of an additional serum sample may be necessary.

Determining serotype for Haemophilus influenzae (Hi) and serogroup for Neisseria meningitidis (Nm) is crucial for identifying potential outbreaks and determining appropriate public health responses. Several new commercial multiplex polymerase chain reaction (PCR) assays capable of simultaneously testing a single specimen for an array of pathogens that cause blood infections, meningitis, or encephalitis are available. These assays can rapidly identify Hi and Nm species, but most do not determine serotype or serogroup. Laboratories should continue to perform culture and use validated, specific real-time PCR assays capable of detecting and differentiating all six serotypes (a-f) of Hi and six serogroups (A, B, C, W, X, and Y) of Nm; otherwise, additional steps need to be taken including performing a reflex culture or at a minimum retaining a clinical sample for further testing.

Determining serotype for Haemophilus influenzae (Hi) and serogroup for Neisseria meningitidis (Nm) is crucial for identifying potential outbreaks and determining appropriate public health responses. Several new commercial multiplex polymerase chain reaction (PCR) assays capable of simultaneously testing a single specimen for an array of pathogens that cause blood infections, meningitis, or encephalitis are available. These assays can rapidly identify Hi and Nm species, but most do not determine serotype or serogroup. Laboratories should continue to perform culture and use validated, specific real-time PCR assays capable of detecting and differentiating all six serotypes (a-f) of Hi and six serogroups (A, B, C, W, X, and Y) of Nm; otherwise, additional steps need to be taken including performing a reflex culture or at a minimum retaining a clinical sample for further testing.

The Centers for Disease Control and Prevention (CDC) is collaborating in a coordinated public health response to the Department of Defense (DoD) announcement on May 26 of the first mcr-1 gene found in bacteria from a human in the United States. Escherichia coli (E. coli) bacteria carrying the mcr-1 gene were found in a urine sample from a person in Pennsylvania with no recent travel outside of the United States who presented to a clinic with a urinary tract infection. The mcr-1 gene makes bacteria resistant to the antibiotic colistin, which is used as a last-resort drug to treat patients with infections caused by multidrug-resistant bacteria, including carbapenem-resistant Enterobacteriaceae (CRE). The mcr-1 gene exists on a plasmid, a small piece of DNA that is capable of moving from one bacterium to another, potentially spreading antibiotic resistance to other bacterial species. CDC is issuing this HAN notice as a reminder to U.S. healthcare facilities about recommendations to prevent antibiotic resistant infections and alert them to additional recommendations for detecting and reporting bacteria with the mcr-1 gene.

The Centers for Disease Control and Prevention (CDC) is collaborating in a coordinated public health response to the Department of Defense (DoD) announcement on May 26 of the first mcr-1 gene found in bacteria from a human in the United States. Escherichia coli (E. coli) bacteria carrying the mcr-1 gene were found in a urine sample from a person in Pennsylvania with no recent travel outside of the United States who presented to a clinic with a urinary tract infection. The mcr-1 gene makes bacteria resistant to the antibiotic colistin, which is used as a last-resort drug to treat patients with infections caused by multidrug-resistant bacteria, including carbapenem-resistant Enterobacteriaceae (CRE). The mcr-1 gene exists on a plasmid, a small piece of DNA that is capable of moving from one bacterium to another, potentially spreading antibiotic resistance to other bacterial species. CDC is issuing this HAN notice as a reminder to U.S. healthcare facilities about recommendations to prevent antibiotic resistant infections and alert them to additional recommendations for detecting and reporting bacteria with the mcr-1 gene.

The amount of opioids prescribed in the U.S. quadrupled from 1999-2014. Unfortunately, opioid-related overdose deaths have increased in parallel with prescribing increases, and the amount of pain that patients report remains unchanged. The CDC Guideline for Prescribing Opioids for Chronic Pain provides recommendations for safer and more effective prescribing of opioids for chronic pain in patients 18 and older in outpatient settings outside of active cancer treatment, palliative care, and end-of-life care. During this COCA Call, clinicians will hear an overview of the CDC recommendations and learn when and how opioids should be initiated for chronic pain, how to assess risk and address harms of opioid use, and when and how opioids should be discontinued.