"Zika virus is a flavivirus transmitted primarily by Aedes aegypti and Aedes albopictus mosquitoes, and infection can be asymptomatic or result in an acute febrile illness with rash (1). Zika virus infection during pregnancy is a cause of microcephaly and other severe birth defects (2). Infection has also been associated with Guillain-Barré syndrome (GBS) (3) and severe thrombocytopenia (4,5). In December 2015, the Puerto Rico Department of Health (PRDH) reported the first locally acquired case of Zika virus infection. This report provides an update to the epidemiology of and public health response to ongoing Zika virus transmission in Puerto Rico (6,7). A confirmed case of Zika virus infection is defined as a positive result for Zika virus testing by reverse transcription–polymerase chain reaction (RT-PCR) for Zika virus in a blood or urine specimen. A presumptive case is defined as a positive result by Zika virus immunoglobulin M (IgM) enzyme-linked immunosorbent assay (MAC-ELISA)* and a negative result by dengue virus IgM ELISA, or a positive test result by Zika IgM MAC-ELISA in a pregnant woman. An unspecified flavivirus case is defined as positive or equivocal results for both Zika and dengue virus by IgM ELISA. During November 1, 2015–July 7, 2016, a total of 23,487 persons were evaluated by PRDH and CDC Dengue Branch for Zika virus infection, including asymptomatic pregnant women and persons with signs or symptoms consistent with Zika virus disease or suspected GBS; 5,582 (24%) confirmed and presumptive Zika virus cases were identified. Persons with Zika virus infection were residents of 77 (99%) of Puerto Rico’s 78 municipalities. During 2016, the percentage of positive Zika virus infection cases among symptomatic males and nonpregnant females who were tested increased from 14% in February to 64% in June. Among 9,343 pregnant women tested, 672 had confirmed or presumptive Zika virus infection, including 441 (66%) symptomatic women and 231 (34%) asymptomatic women. One patient died after developing severe thrombocytopenia (4). Evidence of Zika virus infection or recent unspecified flavivirus infection was detected in 21 patients with confirmed GBS. The widespread outbreak and accelerating increase in the number of cases in Puerto Rico warrants intensified vector control and personal protective behaviors to prevent new infections, particularly among pregnant women."

The 1999–2013 United States Cancer Statistics (USCS): Incidence and Mortality Web-based Report includes the official federal statistics on cancer incidence from registries that have high-quality data, and cancer mortality statistics. It is produced by the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI). This report shows that in 2013, 1,536,119 Americans received a new diagnosis of invasive cancer, and 584,872 Americans died of this disease (these counts do not include in situ cancers or the more than 1 million cases of basal and squamous cell skin cancers diagnosed each year).

This year’s report features information on invasive cancer cases diagnosed during 2013, the most recent year of incidence data available, among residents of 49 states, six metropolitan areas, and the District of Columbia—geographic areas in which about 99% of the U.S. population resides. Incidence data are from CDC’s National Program of Cancer Registries (NPCR) and NCI’s Surveillance, Epidemiology, and End Results (SEER) Program. Data from population-based central cancer registries in these states and metropolitan areas meet the criteria for inclusion in this report.

The report also provides cancer mortality data collected and processed by CDC’s National Center for Health Statistics. Mortality statistics, based on records of deaths that occurred during 2013, are available for all 50 states and the District of Columbia.

The report also includes incidence rates and counts for Puerto Rico for 2009 through 2013 by sex and age, as well brain tumor and childhood cancer data.

USCS data are presented in the following applications—

• United States Cancer Statistics (USCS)
• Interactive Cancer Atlas (InCA)
• State Cancer Facts

As part of the response to the Zika outbreak, CDC, in collaboration with state, local, tribal, and territorial health departments, established a pregnancy registry for comprehensive monitoring of pregnancy and infant outcomes following possible Zika virus infection. The registry is an active surveillance system of pregnant women with laboratory evidence of possible Zika virus infection in the 50 US states and DC, and in the US territories. On May 20, 2016, CDC released detailed information about the registry and will initiate weekly reporting of the number of pregnant women followed in the registry.