Transcript for CDC Telebriefing: Updates on CDC recommendations related to Zika virus

OPERATOR: Welcome, and thank you for standing by.  All participants will be able to listen only until the question and answer portion of today’s conference.  Today’s conference is being recorded.  If you have any objections, please disconnect at this time.  i would now like to turn the conference over to Mrs. Kathy Harben.

KATHY HARBEN: Thank you, Julie.  And thank you all for joining us for these updates on CDC recommendations related to Zika virus.  With us today to provide an overview of the updates is Dr.  Denise Jamieson.  She’s a clinical OBGYN with CDC’s division of reproductive health.  For the question and answer period, we also have Dr. Sonja Rasmussen and that’s r-a-s-m-u-s-s-e-n.  She’s a clinical geneticist and director of the Division of Public Health Information and Dissemination and editor and chief of CDC’s Morbidity and Mortality Weekly Report, that’s the MMWR.  We also have Dr. Alexandra Oster.  She’s a medical epidemiologist in the division of HIV/AIDS Prevention at CDC.  And we also have today with us Dr. Catherine Spong, and she is acting director of NIH’s National Institute of Child Health and Human Development.  Now, I’d like to turn the call over to Dr. Jamieson.

DR. DENISE JAMIESON: Good afternoon.  CDC continues to learn more about Zika literally every day, and as we learn more, we’re eager to share that information with you.  Today, we’re here to talk about three articles published in the MMWR with new recommendations and information to prevent Zika virus transmission and its health effects.  First, updated interim guidance for healthcare professionals for counseling patients about pregnancy planning and the timing of pregnancy after possible exposure to the Zika virus.  Second, updated interim guidance for preventing sexual transmission with information about how long men and women should consider using condoms or not having sex. And third, considerations and challenges, based on Puerto Rico’s experience, for reducing unintended pregnancy in areas of Zika transmission. Before we go into the new guidance, I first wanted briefly to update you on the latest numbers reported to CDC and the latest numbers in Puerto Rico, the U.S. territory that, to date, has been most affected by the virus.
As of today, we know of 273 Zika virus cases from 35 states and the District of Columbia that has diseases such as Zika.  These have been reported to CDC through the arbonet which is the U.S. surveillance system for arboviral diseases.  All are travel-related or sexually transmitted cases.  In addition, there have been 261 cases reported from Puerto Rico, 14 cases from American Samoa, and 11 cases from the U.S.  Virgin Islands.  Of these, 99 percent are presumed to be locally transmitted by mosquitos within the territories.  Puerto Rico is by far the most affected area.  I’ll now turn to the update on the updated guidance related to pregnancy planning. Today, we have issued updated guidance for health professionals who counsel patients about pregnancy planning and the timing of pregnancy after possible exposure to the Zika virus.

Mounting evidence supports a link between Zika and Microcephaly, a birth defect that is a sign of incomplete brain development and possibly other problems such as miscarriage. The rate of these complications is not known yet, but we’re studying this. We know there’s a risk, but it’s important to remember that even in places with active Zika transmission women are delivering apparently healthy infants.  Our goal here is to ensure that doctors and other health care professionals have clear guidance to inform discussions with their patients about possible exposure to Zika virus, pregnancy planning, and timing of pregnancy.  The updated CDC recommendations are these.

First, for women and men who have been diagnosed with Zika virus or who have symptoms of Zika, including fever, rash, joint pain, or red eyes after possible exposure to Zika Virus, CDC recommends health care providers advise that women wait at least eight weeks after their symptoms first appear before trying to get pregnant.  Men wait six months after their symptoms first appear to have unprotected sex.  In making these recommendations, we consider the longest known risk period for these categories.  We then allowed for three times the known period of time that the virus persisted.

For men and women without symptoms of Zika virus, but who had possible exposure to Zika from recent travel or sexual contact, CDC recommends that health care providers advise their patients to wait at least eight weeks after their possible exposure before trying to get pregnant in order to minimize risks.  For men and women without symptoms of Zika virus who live in an area with active Zika transmission, CDC recommends health care providers talk with their patients about their pregnancy plans during a Zika virus outbreak, the potential risks of Zika, and how they can prevent Zika virus infection.  These are very complex, deeply personal decisions, and we are communicating the potential risks of pregnancy for people who have had Zika and for those who live in areas with active transmission.  We are encouraging health care providers to have conversations with couples about pregnancy planning and their individual circumstances and to discuss strategies to prevent unintended pregnancies. Men and women who reside in areas with active Zika virus transmission who are considering pregnancy need clear guidance to help them inform the deeply personal and very complex decision about timing of pregnancy.  Conversations about health risks of pregnancy can be very difficult, but are important to have.  Health care providers should discuss the risks of Zika, emphasize ways to prevent Zika Virus infection, and provide information about safe and effective contraceptive methods. As part of their pregnancy planning and counseling with their healthcare providers, some women and their partners residing in areas with active Zika virus transmission might decide to delay pregnancy.

Next, I’d like to discuss the updated interim guidance for preventing sexual transmission of Zika.  The recommendations for men who live in or traveled to an area with active Zika virus transmission who have a pregnant partner remain the same.  CDC recommends that a man with a pregnant partner should use condoms every time they have sex or do not have sex throughout the duration of the pregnancy. To be effective, condoms must be used correctly from the start to the finish every time during sex; this includes vaginal, anal, or oral sex.  The updated guidance includes new time frames for men and their non-pregnant sex partners based on the couple’s situation, including whether the man lives in or has traveled to an area with active Zika virus transmission and whether he has symptoms of possible Zika infection.  The guidance are based on available information about how long the virus remains in the semen and based on whether or not men have symptoms of infection.  Couples should consider condoms or not having sex for at least six months after the symptoms begin.  This includes men who live in and men who traveled to areas with Zika. Couples with men who travelled to areas with Zika but who did not develop symptoms of Zika should consider using condoms or not having sex for at least eight weeks after their return in order to minimize risk. Couples with men who live in an area of Zika but have not developed symptoms should consider using condoms or not having sex while there is active Zika Transmission in the area.  Couples who do not want to get pregnant should use the most effective contraceptive method that they can use correctly and consistently.  Couples who are trying to get pregnant should consult with their health care provider.

Finally, I’d like to briefly talk about what we have learned, based on Puerto Rico’s experience, about the importance of increasing access to contraception in areas of active Zika transmission.  Because of the potential of Zika Virus’ to affect pregnant women and their fetuses, strategies to prevent unintended pregnancies are a critical part of current efforts to prevent Zika-related health effects. Based on Puerto Rico’s experience, the CDC has identified considerations and challenges in reducing unintended pregnancies in areas with active Zika transmission.  Approximately 2/3 of pregnancies in Puerto Rico are unintended, indicating a potential unmet need for access to birth control.  In this report, researchers estimated about 138,000 women in Puerto Rico may be at risk for unintended pregnancy and are not using one of the most effective or moderately effective forms of birth control. In areas with active Zika transmission Women and their partners who do not want to get pregnant now should be advised about the range of effective birth control methods and counseled that correct and consistent use of these methods is important if they do not want to become pregnant.

We’ll take questions in just a minute, but I’d first like to share information from the Department Of Health And Human Services about their efforts to ensure access to contraception during this outbreak.  The Department Of Health And Human Services is working to leverage existing programs that currently provide resources for or access to contraception in Puerto Rico, including programs administered by the Health Resources and Services Administration, Office of Population Affairs within the Office of the Assistant Secretary for Health, and the Centers for Medicare and Medicaid Services.  HHS is also coordinating with federal, local, and private partners to identify additional resources to support increased access to the most effective forms of contraception.  HRSA has 20 health centers grantees that operate 84 centers in Puerto Rico which serve over 330,000 people, including nearly 80,000 women ages 15 to 45.  HHS is exploring expansion of services at these centers which currently include prenatal care and other volunteer family-planning services. OPA is working to provide additional funds for contraceptive services as well as facilitate the training of providers in long-acting reversible contraceptive methods. OPA supports two Title X grantees that operate 15 clinics in Puerto Rico which serve over 19,000 people. Family-planning services are a mandatory benefit under Medicaid for men and women and are exempt from cost sharing requirements.  CMS is working to provide additional guidance to states and territories on how their Medicaid program can support the Zika response, including coverage for contraception.  We’ll now take questions.

OPERATOR: thank you.  If you would like to ask a question, please press star 1, and you’ll be prompted to record your first and last name.  To withdraw your question, press star 2.  One moment, please.

OPERATOR:  One moment while we gather questions.  First question comes from Helen Branswell with “STAT News.” Your line is open.

HELEN BRANSWELL Thanks very much for taking my question.  I have a couple, if i could, please.  You said women and their partners who live in areas where Zika is spreading locally and their partners may decide to delay pregnancy.  Has CDC explored the opportunity — not the opportunity, but option of recommending flat out that women in areas where Zika is spreading should not — should try not to get pregnant?

DR. DENISE JAMIESON:  I think decisions regarding when and how to have children are personal and complex.  Even in the best of circumstances, having a baby is still a risky undertaking.  Unfortunately, Zika adds one more potential risk. So I think our obligation is to provide the best available evidence about what those risks are and what we don’t know and know about those risks so women and their partners can make informed decisions.

HELEN BRANSWELL another question, if i could.  In the interim guidance of the prevention of sexual transmission of Zika virus in the United States, in the beginning of it you say for men who have traveled or resided in areas of active Zika transmission and their female or male sexual partners.  Although most of the guidance appears to be about preventing transmission to women who might become pregnant, why you have included — you raise there the issue of men who have sex with men.  why?

DR. ALEXANDRA OSTER:   We know Zika is of particular concern in pregnancy because of the adverse fetal outcomes, but we know some couples who will be concerned about sexual transmission of Zika through sexual routes and that they’ll want to know how they can potentially act to prevent transmission. Zika virus has been detected in semen when it is no longer detectable in blood, so our guidelines address sexual contact that involves semen, which includes vaginal intercourse, anal intercourse, and oral mouth-to-penis sex or fellatio.

KATHY HARBEN: I just want to clarify that was Dr. Alexandra Oster who was speaking.

KATHY HARBEN:  Next question, please.

OPERATOR: Our next question is from Mike Stobbe with the “Associated Press.”  Your line is open.

MIKE STOBBE: Thank you for taking my call.  I had two quick clarifying questions and one additional question.  Doctor, did you say the current case count in Puerto Rico is 261?  I thought it was 317.  Also, among the six sexually transmitted cases that have been described, is one of them the Dallas case, the one that the Dallas health department drew attention to?  The last question is regarding the Puerto Rican report.  It describes what proportion of women of childbearing age are not using effective birth control.  Do you know for the continental United States what the same proportion is?

DR. JENNIFER MCQUISTON: this is Dr. Jennifer McQuiston.  I’ve not been previously introduced.  I’m going to answer your first question about numbers.  We are revising the numbers posted on our website today based on communications with Puerto Rico, so the numbers reported on this call today are correct.

DR. ALEXANDRA OSTER: And this is Dr. Oster. To answer your question about the six confirmed cases involving sexual transmission that are currently reported on the CDC website that does include the case that was reported by Dallas.

DR. DENISE JAMIESON: And this is Dr. Jamieson.  I apologize.  I still don’t know the answer to the question of in the United States what proportion of women are at risk for unintended pregnancy.

MIKE STOBBE:  Thank you. Dr. McQuiston So the number is 261 then in Puerto Rico right now?

DR. JENNIFER MCQUISTON:  Yes.  There are 258 cases that are thought to be locally transmitted by mosquitos and the other two are travel-related.  Our website will soon reflect those updates.

OPERATOR: Our next question comes from Sabrina Tavernise “The New York Times.”  Your line is open.

SABRINA TAVERNISE: Thanks for taking my question.  I may have missed this, but of the recommendations of eight weeks for women and six months for men in preventing sexual transmission guidelines thing, is that different from before?  Is it new that you’re giving any type of time limit?

DR. DENISE JAMIESON:  This is Dr. Jamieson.  Yes, those are new recommendations. Previously, we were really focused on protecting pregnant women, and our recommendations were around women who are already pregnant.  What’s new in these updated guidance is we’re now concerned about the time — the periconceptional period, the period around the time when the woman conceives, so these are new guidelines.

SABRINA TAVERNISE:  got it.  There were no guidelines about peri — before conception before at all, right?

DR. DENISE JAMIESON:  that’s correct.  So these are new.  Before it was just women who were currently pregnant.

SABRINA TAVERNISE: Got it, got it.

DR. DENISE JAMIESON: Next question, please.

OPERATOR: Our next question comes from Lena Sun with “The Washington Post.”  Your line is open.

LENA SUN: Hi, thank you very much.  i just wanted to clarify something on the numbers.  The Puerto Rico health department, i believe, is off for the rest of the week because of — well, at least until Monday because of the holiday.  And so the 261.  Of those 261 cases, do you know how many include pregnant women?  Their previous case count said it was 24, but that was based on a lower number.  And i have another question.

DR. JENNIFER MCQUISTON:  Yes, I’m sorry.  i don’t have the updated pregnancy numbers at this time.

LENA SUN:  okay.  And my other question is more general.  Could you maybe pull back or explain for the average reader how solid is the science on which folks are basing these recommendations?  I took a quick look at the MMWRs, and there’s an explanation about how long it’s in the semen and adding extra time on that, but how solid do you think the science is?  And if it’s not, then is this your best attempt to give some guidance to women because we really don’t have anything out there?

DR. DENISE JAMIESON: I think you’re exactly right.  Unfortunately, there’s still a lot we don’t know, and there’s still a lot we need to know.  these recommendations are exactly as you say, our best attempt to try and provide reasonable time frames based on what we know about how long the virus persists in blood and how long the virus persists in semen. But we are not — these recommendations will continue to change and evolve as we learn more, but we are — this is our best attempt at this time knowing what we know.

KATHY HARBEN:  next question, please.

OPERATOR:  our next question is from Robert King the “Washington Examiner.”  Your line is open.

ROBERT KING Hi, thank you for taking my question. Can you go through again the recommendations that were updated? I know the recommendations on having sex for six months are new, but can you please again tell me what did you update and why did you try and do that, i guess?

DR. DENISE JAMIESON:  So previously, our recommendations were based on protecting women who are already pregnant.  as we look at other viral diseases, such as rubella, and as we learn more about Zika in pregnancy and we learn more supporting a link between Zika and poor pregnancy outcome, we become more concerned about the peri-conceptional period, the period of time around when conception occurs.  And so these recommendations are new in that we’re recommending that for people who either have Zika disease or who travel to an area with active Zika transmission, we’re now recommending that they wait a period of time before attempting to get pregnant.

DR. DENISE JAMIESON Next question.

ROBERT KING: So there’s no change to the prior recommendations that you put out for anything?  I know that you have the new recommendations, but you didn’t do any other updates to any other prior recommendations?

DR. DENISE JAMIESON: So these replace the recommendations that we previously issued.

ROBERT KING: Okay.  Thank you.

OPERATOR: Our next question comes from Heather Tesoriero “CBS evening news.”  Your line is open.

HEATHER TESORIERO: Hi, thank you.  Thank you for taking my question.  I’m just wondering — and I’m sorry if someone has addressed this previously on the call, but most of us in the media have been characterizing an association or a link between Zika and pregnancy and fetal abnormalities, the microcephaly. I’m just wondering if we are at a point now –  Is the agency willing or able to say that it is a causal relationship?

DR. DENISE JAMIESON:  I think we’re learning more every day, and I think the evidence of a link between Zika and a spectrum of birth outcomes is becoming stronger and stronger.  At this point, we’re not using causal language, but the evidence is mounting.

HEATHER TESORIERO:  Okay, thank you.

KATHY HARBEN: Next question, please.

OPERATOR: Our next question comes from Joette Giovinco with WVTV.  Your line is open.

JOETTE GIOVINCO: Thank you so much for taking my question.  I was reading the MMWR and the unintended pregnancy rate in Puerto Rico was higher.  65 percent, I believe, compared to the U.S.  and I was just wondering how much of that do you think really relates back to the access to effective contraception, the cost, various other things, versus maybe cultural issues that may be going on there in Puerto Rico?

DR. DENISE JAMIESON: It seems there are considerable barriers to accessing the most effective method of contraception.  For example, long-acting reversible methods are not readily available in Puerto Rico.  From our health care provider colleagues in Puerto Rico, there is a desire to provide a more broad range of contraceptive options for women in Puerto Rico.  The CDC has contraceptive guidance that recommends that all methods of contraception, including long-acting reversible methods, be offered to women who desire to prevent unintended pregnancy, and long-acting reversible methods should be an important component of that.

JOETTE GIOVINCO: So will those be provided then at no cost for those individuals?

DR. DENISE JAMIESON: We’re exploring and developing a plan in order to make those methods more available in Puerto Rico along with our Puerto Rican Department of Health colleagues and OBGYN leadership in Puerto Rico.

JOETTE GIOVINCO: Okay.  Thank you.  Thank you very much.

KATHY HARBEN: Thank you.  We have time for two more questions.

OPERATOR: Okay.

OPERATOR: We have one more question. We have Michael Crupain with the “Dr. Oz” show.  Your line is open.

MICHAEL CRUPAIN: Thank you.  I was wondering if you could help clarify how you chose these time periods a little more.  I understand most people who get Zika don’t have clinical symptoms, so why is there such a big difference in the time frame?  I guess people who are traveling to the area could still have an infection and not know.

DR. DENISE JAMIESON: So the big difference in the time frame is for men who have Zika and men who are asymptomatic.  That’s based on the persistence of the virus in the semen.  Semen has been PCR positive for up to two months after infection, so that’s why that is a longer time period than the eight weeks.  But I think you bring up a good point and that is, as I said earlier, there’s a lot we still need to know to make better evidence-based recommendations.  We’re using what we know about the persistence of virus in the blood and the semen, but again we would like to know more and we would like to have recommendations that are based on more evidence.

KATHY HARBEN: Thank you. Dr. Jamieson will now have a few closing remarks.

DR. DENISE JAMIESON:  In closing, I’d like to say that CDC’s commitment to protecting Americans from health risks is absolute.  It’s why we are here.  It’s what makes the thousands of doctors, lab experts, disease control experts, and other scientists come to work in the morning every day.  In Atlanta, throughout the U.S., including Puerto Rico and other affected U.S. territories, more than 600 CDC staff are working around the clock to continue to learn more and to do more to protect people.  As always, as we learn more, we will share it so Americans can decide how best to protect their own health.  Thank you very much.

KATHY HARBEN:  thank you, everyone.  This concludes our telebriefing.  A transcript of this call will be posted to the CDC newsroom as soon as possible.  If you need additional information or have other questions, you can call the CDC press office at 404-639-3286 or e-mail media@CDC.gov.  Thank you.

OPERATOR:  thank you for your participation.  You may disconnect at this time.

###
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES