Transcript for CDC Telebriefing: Zika Virus Update - 5-20-2016
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Press Briefing Transcript
Friday, May 20, 2016, 10:00 AM EDT
Please Note:This transcript is not edited and may contain errors.
OPERATOR: welcome and thank you for standing by. During the question and answer session, please press star 1 on your touchtone phone. Also, today is being recorded. I’d like to turn the conference over to Ms. Kathy Harben.
KATHY HARBEN: thank you all for joining us this morning for this update on Zika virus, specifically the MMWR article announcing the change in how CDC reports the number of pregnant women affected by Zika virus. Today Dr. Denise Jamieson, a clinical OBGYN with CDC division of reproductive health and co-lead of the pregnancy task force will provide opening remarks. Also joining us is Dr. Margaret Honein. She is chief of CDC’s birth defects branch, National Center for Birth Defects and Developmental Disabilities. And co-lead of the pregnancy and birth defects task force. Dr. Jamieson will now give opening remarks.
DR. DENISE JAMIESON: Good morning. As of today, national reporting of the number of U.S. pregnant women affected by Zika virus will change. Previously CDC reported the number of pregnant women with Zika virus which included only pregnant women with symptoms or pregnancy complications consistent with Zika. CDC will now report pregnancy data from two enhanced surveillance systems (The U.S. Zika Pregnancy Registry and the Puerto Rico Active surveillance system. Both of these systems include pregnant women with any laboratory evidence of possible Zika virus infection with or without symptoms. The new reporting systems are the topic of a MMWR, which has just been released. And we also be shortly updating the pregnancy numbers on the CDC’s website. I’ll now turn it over to Dr. Margaret Honein for additional comments.
DR. MARGARET HONEIN: thank you for joining us. Today I’ll provide further information on how we are reporting on the number of pregnant women affected by Zika virus. Before today, CDC’s ArboNET used an interim case definition established by the state and territorial epidemiologist to report the number of those are Zika disease. We’ve learned a lot in the past four months and now we know of reports of asymptomatic Zika infections linked to microcephaly brain defects and miscarriage. Recent published studies indicate that there are babies with microcephaly that have test results suggesting Zika infection but whose mothers did not recall having any symptoms of Zika. Therefore, starting today, CDC will begin reporting the number of pregnant women with any laboratory evidence of possible Zika virus infection with or without symptoms from the U.S. Zika pregnancy registry and the Puerto Rico Zika active pregnancy Zika surveillance system. This reporting is in line with our recommendations with ongoing pregnancies at risk for poor outcomes associated with Zika based on our current understanding with the risk of Zika infection during pregnancy. Research to further determine the link between Zika infection symptoms and birth outcomes is still underway. As of last Thursday, May 12th, the two Zika virus infection surveillance systems are monitoring 157 pregnant women in the U.S. states and 122 pregnant women in the U.S. territories with laboratory evidence of possible Zika virus infection. That is a total of 279 pregnant women in the U.S. states and territories. These updated numbers reflect all pregnant women in the United States, including U.S. territories, with any laboratory evidence of Zika virus infection regardless of whether they had symptoms. This includes pregnant women in whom Zika virus particles have been detected and women whose tests indicate an immune reaction to a recent virus that is likely to be Zika.
There are a couple of important reasons for this change. First, reporting numbers from the U.S. Zika pregnancy registry and the Puerto Rico active surveillance system will provide a more complete picture of the effects of Zika on pregnant women in the U.S. states and territories. Second, since Zika virus outbreak began, experts have found that interpretation of laboratory testing for Zika virus infection can be difficult. The surveillance systems include pregnant women with any laboratory evidence of Zika virus infection. This includes pregnant women who are likely to have Zika but whose laboratory testing results suggest they might have been infected with another virus such as dengue. Because of the potential risk of Zika virus infection during pregnancy, CDC’s top priority for the Zika response will continue to be protecting pregnant women and their fetuses. Understanding the range of health effects linked with Zika infection during pregnancy, as well as how many and which pregnancies may be at risk of poor outcomes is essential for guiding our public health response to Zika. Reporting the total number of pregnant women with any laboratory evidence of possible Zika virus infection from the U.S. Zika pregnancy registry and the Puerto Rico active surveillance system will provide a more comprehensive picture of the effects of Zika in the U.S. States and territories. This comprehensive information will assist healthcare providers as they counsel pregnant women affected by Zika. It is also essential for planning at the federal, state and local levels for the clinical public health and services needed to support pregnant women and families affected by Zika. Our goal is to track all Zika affected pregnancies through the U.S. Zika Pregnancy Registry and the Puerto Rico Zika Active Pregnancy Surveillance System. To get the complete picture we need participation by all jurisdictions. All jurisdictions are encouraged to participate because it will allow us to gather as much data as possible as quickly as possible to arm pregnant women, healthcare providers and public health authorities with needed information. It is important to note that these new numbers are not comparable to CDC’s previous reports of pregnant women who have Zika virus. These updated numbers reflect a broader range of pregnant women. The new numbers will affect the number of pregnant women with any laboratory evidence of possible Zika virus infection as of 12 noon each Thursday the week before. The numbers will be reported weekly on the CDC website, but will reflect the total count as of one week prior to allow time for verification of numbers.
KATHY HARBEN: Thank you, Dr. Honein. Ashley we’re now ready to open up the line for questions.
OPERATOR: We will now begin the question and answer session. If you would like to ask a question, please press star 1. Please unmute your phone and state your name clearly when prompted. To withdraw your request press star 2. One moment please for your first question. Again, if you’d like to ask a question, please press star 1. Our first question comes from Mike Stobbe with the Associated Press.
MIKE STOBBE: Hi. Thank you for taking my call. I have a couple of questions. First to Dr. Honein’s last comment about they’re not directly comparable. Can you give us an idea now that we have this new definition and this new number what the pace of new diagnosis has been? Have we seen under this new definition — have we been seeing a steady trickle or have we seen a bunch of new ones in recent weeks? What’s been the pace only under this new definition, what’s been the pace of new cases? And then I wanted to ask — it was back in January that i think Oliver row mellow had the study that showed asymptomatic women had given birth to children with abnormalities. Why now in May the change if that’s been reported for several months? And then the last question, do you know of any cases — I’m sorry. That’s it. Those two.
Margaret Honein Okay. So this is Margaret Honein. You can see in the figure from the MMWR which hopefully you’ve all received by now that we’ve been monitoring pregnant women with both symptomatic and asymptomatic infections since February when we started the registry. This is not a change in who we’re monitoring. We have always been monitoring this broad definition of pregnant women with any laboratory evidence of Zika virus infection. The change is that we’re now publicly reporting the number so that we’ve giving a more transparent picture of all the monitoring that we’re doing. This is a whiter net than the arbonet definition but this is consistent with the definitions established with the U.S. Zika registry and the Zika Active Pregnancy Registry in Puerto Rico from the beginning. I think the why now question is in an attempt to be transparent about the monitoring and the full count of pregnant women that we think are at risk of adverse outcomes. We’ve learned a lot in the past four months about the risk of adverse out comes. And with the growing evidence, both some publications about asymptomatic pregnant women having a variety of adverse outcomes and other accumulating data, we felt it was important to publicly share the numbers that we have been monitoring since February.
MIKE STOBBE was there some turning point event? Why in May and not like last month?
DR. MARGARET HONEIN: We’ve been working closely with the state, local and territorial health departments to get case reports from as many jurisdictions as possible to verify those numbers with them. we were hoping to transition to this a couple of weeks ago but it’s taken time to work with all the different jurisdictions and make sure that we have accurate numbers of what’s being monitoring in all of those locations. We’re also continuing to monitor every publication on this disease and we’re gathering more information and learning more every single day. We know a lot more about this and what the potential risk is using this broader case definition than we did a few months ago.
OPERATOR: Your next question comes from Betsy McKay with the wall street journal.
BETSY MCKAY: I wondered if you could tell us how many of these 279 pregnant women have had pregnancy complications of any kind, you know, birth defects, miscarriages, whatever. I think Dr. Honein said that, you know, information on those birth outcomes would be coming later. But is there anything you can tell us now? Because this is a dramatic increase in numbers. You know, readers and viewers are going to want to know what this means. You know, the last thing we know is that there are about seven cases in the U.S. of these complications. So is it only seven? Is it more than seven? Is it half of these cases? Anything you could tell us would be really helpful. The second question is, the report says that some of the pregnant women were infected through sexual transmission rather than through mosquito bites in travel. How many of those women were affected by sexual transmission? Thanks.
DR. MARGARET HONEIN: thank you for your question. I’ll address the first one. The majority of the pregnancies being monitored by these two Zika virus surveillance systems are still ongoing. At this time there’s relatively few adverse birth out comes and we’re not reporting on specific outcomes out of concern of protecting the privacy of the affected families. Among those pregnancies with lab evidence of Zika virus infection that are being monitored by these two surveillance systems, CDC is aware of less than a dozen adverse out comes. The adverse outcomes include miscarriages and birth defects.
While we’re not reporting the specific information about the cases at this time, we are working closely with our partners at state, local and territorial health departments to obtain full information on those adverse outcomes. Also, since most of the pregnancies we’re monitoring are ongoing, it’s not possible to use this information to estimate the risk of adverse outcomes. To appropriate estimate the risk we would need to consider the number of adverse outcomes out of the total number of completed pregnancies. The Zika Pregnancy Surveillance Systems will eventually be able to provide the information that’s needed to estimate risk and to provide the critical answers to the questions you’re asking, but we’re not at that stage yet. And to your second question, we’re also not reporting the numbers out of the registry that are by sexual transmission versus mosquito born transmission at this point in time.
OPERATOR: Your next question comes from Elizabeth Cohen with CNN. Your line is open.
ELIZABETH COHEN: Hi, thanks very much for having this press conference. I would second that the question about wanting to know more about outcomes. I think that in the past CDC has done that in different situations without violating privacy. It’s unclear why we can’t do that now. But having given the answer that you’re given, I was wondering can you be more specific when you say most are still ongoing. Also do you know if in which registry there were any asymptomatic women who gave birth to or had miscarriages or had a Zika related outcome? And if so, how many?
DR. MARGARET HONEIN: So I don’t have information on linking symptoms of lack of symptoms to the adverse outcomes we’re aware of yet. And we really have not complete information at this point of time on the adverse outcomes. So I think it would be premature for us to be sharing that until we’d gathered more comprehensive information. We do know of at least four published reports that have had various levels of information about asymptomatic mothers having babies with adverse outcomes such as microcephaly, miscarriages and other outcomes. So some of this is based on what we’re reading in the literature, more than what we’re seeing in the pregnancy registries.
ELIZABETH COHEN: When you say four reports, were those four individual women or reports of many women with several — four individual women or four reports about women?
DR. MARGARET HONEIN: I think of the four published reports, one is an individual case and the others are larger case series.
OPERATOR: your next question comes from Maggie Fox with NBC News.
MAGGIE FOX: First of all, I missed what you said CDC was aware of how many adverse outcomes, please? I just missed the number. Second, does this suggest that more women who are pregnant and suspect they might have had Zika should be getting tested? And is there capacity for this testing especially given that state and local health departments are being cut back and there’s still not funding out there? Thanks.
DR. MARGARET HONEIN: So we have CDC recommendations for testing of both symptomatic pregnant women and also guidance to offer testing to asymptomatic pregnant women who have traveled to or reside in areas of Zika virus transmission. That recommendation is to offer testing once at the initiation of prenatal care and once during the second trimester. We’re committed to making sure that this is available. It’s critical for pregnant women who have information on whether or not they have likely been infected with Zika virus infection. So we have dramatically increased the state capacity for helping with this testing. CDC is working hard on this testing.
DR. DENISE JAMIESON: And the decision about whether jurisdiction should institute testing is based on the decision of local authorities, based on the local transmission rates as well as the laboratory capacity.
OPERATOR: your next question comes from Eben Brown with Fox News.
EBEN BROWN: A couple questions. the number 279, does this include women who are currently pregnant or women who both are currently pregnant and also who were pregnant but have since either given birth or have miscarried or for some reason no longer pregnant? I’m not clear on that. And then I’ve got a follow-up.
DR. MARGARET HONEIN: The number 279 includes all of the pregnant women, those that are still pregnant as well as those who are no longer pregnant but were pregnant at the time of their Zika virus infection. The majority of these are ongoing pregnancies.
EBEN BROWN: okay. Are the women who are no longer pregnant still being monitored for anything follow up-wise or are they added into your tally but no longer being monitored?
DR. MARGARET HONEIN: So in some cases we’re continuing to gather complete information about their pregnancies and adverse outcome but we’re not doing ongoing monitoring of the woman herself after the end of her pregnancy.
EBEN BROWN: Okay. Why not institute this time of tallying and record keeping from the very beginning? I know that there was a change and i understand the reasoning for the change. But why was this not done from the very beginning of especially CDC really taking a big interest in this?
DR. MARGARET HONEIN: We did begin these pregnancy registries early on in the response. However, we have gathered new information and its being published every day new information. We’re learning more every day. We’re working very hard to better understand this virus. And the accumulating evidence about the potential for adverse outcomes in a much broader group than we originally thought might be the case really motivated us to push forward and report on the pregnancy information. The pregnancy registry information – the broader definition. So while we’ve been gathering this, as the data accumulated about the risk of asymptomatic infections, it seemed more and more important to be very transparent and share the full number of pregnant women with adverse outcomes associated with Zika.
KATHY HARBEN: next question, please.
OPERATOR: Your next question comes from Dan Childs with ABC News. Your line is open.
DAN CHILDS: Thank you so much for taking my call. The question that I had is given that four in five people infected with Zika show no symptoms how confident are we that we’re catching all cases of pregnant women. Is this system going to be ready to catch all or even most of these cases?
DR. MARGARET HONEIN: The system is ready to monitor these cases but it’s very important that healthcare providers be aware of our guidelines and our offering testing to asymptomatic pregnant women who either have traveled to an area with ongoing Zika virus transmission or reside in an area with ongoing Zika transmission. We are taking efforts to communicate with professional groups and seek their assistance in making sure healthcare providers are aware of our recommendations and are communicating this information to their patients.
DAN CHILDS: I just had one follow up question. Will CDC be monitoring and reporting microcephaly cases and other cases of birth defects in the future and if so is there a projected date for that?
DR. MARGARET HONEIN: We don’t have a projected date at this point, but we do anticipate at some point coming out with outcomes to accompany this registry information. We are monitoring all the outcomes, want to verify the outcomes and eventually will plan to report that.
OPERATOR: your next question comes from Donald McNeil from the “New York Times.”
DONALD MCNEIL: Hi, can you explain why you’re not giving the number of cases that are sexually transmitted? I mean, this is a serious issue. We already know that a lot of women don’t take it seriously. It’s hard to convince pregnant women to use condoms when they’re already pregnant. It’s hard to convince their partners. It seems this information would be pretty useful in convincing people that it’s a serious threat.
DR. MARGARET HONEIN: I think we know of a relatively small number of cases in pregnant women that are definitively resulted from sexual transmission. But in so many cases where someone has traveled to an area of ongoing Zika virus transmission via mosquitos we can’t definitively separate the method of transmission for those women. I think those public health messages are critically important for all women and not just based on the numbers where we know because a woman didn’t travel that the only risk factor would have been sexual transmission. So I think it is critically important to get that message out that we know sexual transmission can occur, that there is CDC guidance about preventing transmission to women who are pregnant or women who are thinking about becoming pregnant and their partners.
OPERATOR: Your next question comes from Brady Dennis with “Washington Post.” Your line is open.
BRADY DENNIS: Thanks for having the call. I had one thing to clarify earlier when we started talking about the numbers. I couldn’t tell if it was Dr. Honein or Dr. Jamieson who said there have been about a dozen or so adverse outcomes among these women. Am I understanding that correctly? And who was that saying that?
DR. MARGARET HONEIN: This is Dr. Honein. CDC is aware of less than a dozen adverse outcomes at this time but we don’t have full information on all of the outcomes.
BRADY DENNIS: Mainly because they’re ongoing?
John Cohen Mainly because they are ongoing pregnancies, correct.
BRADY DENNIS: Okay.
OPERATOR: Your next question comes from Kevin Finnegan with CBS News. Your line is open.
KEVIN FINNEGAN: Good morning. I just want to talk about how you’re casting a very broad net. I’m just wondering is there any danger of over estimation because of dengue cross reaction.
DR. DENISE JAMIESON: This is Denise Jamieson. Given what we now know as we said we think it’s important to cast a wide net and to include both asymptomatic and symptomatic pregnant women. The biggest change in the numbers is due to including these asymptomatic with Zika virus infection. And we do exclude any women with evidence of other viral infections such as dengue. Since laboratory testing and in particular with sear logic testing has its limitations there may be a few women included who do not have Zika virus infections. But since tested women either travel to or reside in areas with large ongoing outbreaks of Zika virus we are confident that most of these pregnant women reporting do have Zika virus infections.
KATHY HARBEN: Next question, please.
OPERATOR: Your next question comes from Elizabeth St. Phillip with CTV national news. Your line is open. Elizabeth, your line is open. We’ll go to the next question. Your next question comes from John Cohen with science magazine.
JOHN COHEN: I wanted to clarify one thing and ask another question. In your press release from MMWR, it reads as though you were only reporting case definitions in general, not specifically for pregnant women who had symptoms. And the W.H.O. case definitions are people who test positive on laboratory tests that doesn’t have that symptom requirement. Which leads to the more complicated question of why have that symptom requirement in the first place when W.H.O. and P.A.O have a simple lab test. And then I have a follow-up question.
DR. MARGARET HONEIN: The council of state and territorial epidemiologist has an interim question. That is an interim case definition and that is still being worked on by that group. And there will not be a final case definition until June. So CDC is working closely with the counsel of state and territorial epidemiologists and there is a lot of discussion about these issues. So I think that there are many revisions and clarifications being made to those. What we have right now is to work within the existing case definition with arbonet reporting, a broader definition for the pregnancy registries.
JOHN COHEN: given that 80 percent of the people have no symptoms, are estimated to have no symptoms and the W.H.O and P.A.O are using a different system, isn’t that confusing?
DR. MARGARET HONEIN: We know that there are a lot of asymptomatic infections with Zika virus. we don’t know the exact percentage but we know there are a lot of asymptomatic infections and for that reason we have carefully monitored with the pregnancy surveillance systems both symptomatic Zika virus disease and asymptomatic Zika virus infections. So we agree with you it’s very important to monitor both.
OPERATOR: Your next question comes from Elizabeth Cohen with CNN. Your line is open.
ELIZABETH COHEN: Thank you. I wanted to ask a little bit more about the increase. So it makes sense that there have been more pregnant women with Zika over time since the outbreak began in the United States. But it also makes sense of course that it’s grown with the reporting because of the reporting. So these new higher numbers could be a reflection of both of those changes, the natural increase of the number of pregnant women with Zika in the U.S. but also because of the changing reporting. Would it be incorrect to attribute to both of those thing?
DR. DENISE JAMIESON: It’s not because we’re counting them differently. We’ve been monitoring both systems since early on in the outbreak. What’s different now is that we’re reporting them in a different way. As the numbers of pregnant women have increased, we felt it was more and more important to make sure that the pregnant women who we were monitoring that we were also transparent about reporting those numbers. I think it’s a combination of both, both increasing numbers of pregnant women with increase in Zika virus infection as well as a very recent change in the way we’re reporting out the numbers on a weekly basis.
ELIZABETH COHEN: okay. Thank you for clarifying. I had a follow-up question about sexual transmission. When a woman travels to a Zika area or lived there, there’s really no way of knowing whether it was from sexual transmission or from a mosquito bite. But there have been at least nine women, if I’m remembering that number right, who contracted Zika without ever leaving the continental U.S. but their male partners has been travelers. First of all, has that number nine increased since you reported it? And second have any of those women become pregnant?
DR. DENISE JAMIESON: Sorry what was the last part of your question?
ELIZABETH COHEN: Has that nine number, if I’m remembering it correctly — you reported it a while back. As that nine number increased and have any of those women become pregnant — any of those Zika positive women become pregnant? I’m talking people who were in the U.S. and never traveled, contracted it sexually.
DR. MARGARET HONEIN: I’m not aware of any — I don’t think we have that information. So the recommendation would be after travel to an area with ongoing Zika virus infection, if there’s no symptoms we would recommend both men and women wait eight weeks to conceive because of the possibility of asymptomatic infection. But I’m not aware of case reports at this time that would fall into the category of being conceived during that time post travel. Is that what you’re asking?
OPERATOR: Your next question comes from Joe Neel with national public radio.
JOE NEEL: I’d like to know what Elizabeth — if you could open Elizabeth’s line again, I’d like to hear the end of that. But my question until we can do that is I’d like to put this in some type of context. What is the baseline rate of microcephaly in the U.S.?
DR. MARGARET HONEIN: In the United States microcephaly affected about six per 10,000 infants.
JOE NEEL: And do you have any idea, any estimate when you might be able to put a number on the risk that Zika poses for microcephaly in U.S. women?
DR. MARGARET HONEIN: We’re learning more every day but we don’t have enough data to estimate that at this time. There are two published reports that can inform that question, though. One in French Polynesia where they had eight cases of microcephaly. There was a paper published that estimated first trimester infection might relate to about a 1 percent risk. And second there was a paper published based on data from Rio de Janeiro in Brazil looking at ultrasound screenings. So not definitive pregnancy out comes but from ongoing pregnancies for the most part that estimated about a 30 percent risk of adverse outcomes. But we need much more data to provide more precise and better estimates of the risk.
JOE NEEL: Thank you.
OPERATOR: Your next question comes from Gregory Korte from USA Today.
GREGORY KORTE: I’m still trying to get a sense of – with these new numbers reflect as i gather both the change in methodology and an increase in the number of cases. what would the number be today under the old methodology just to kind of maybe help us suss out how much of this is methodological and is there any reason to believe since you’re monitoring pregnant women more carefully, is that the best way to get the overall sort of Zika trajectory in the United States?
DR. MARGARET HONEIN: So the last week of reporting with the arbonet numbers was last week. And in the U.S. states there were 47 cases of Zika virus disease and in the territories there were 65 cases. So 47 in arbonet compared to 157 in the U.S. states with the pregnancy registers and 65 in arbonet compared to 122 in the U.S. territories. And I’m sorry could you repeat the second part of your question?
GREGORY KORTE: Is looking at these numbers the best way to get a sense of the overall trajectory of the Zika spread in the United States given that you’re monitoring pregnant women most closely here?
DR. MARGARET HONEIN: Yes. I think this gives a good indication of the prevalence of Zika virus infection because pregnant women are being prioritized for referral to testing. So we recommend testing of both symptomatic pregnant women and asymptomatic pregnant women during initiation of prenatal care and during the second trimester. If you look at the figures in the MMWR, you can see what appears to be following the CDC recommendations more testing of asymptomatic pregnant women and identifying those infections that are occurring without symptoms.
OPERATOR: Your next question comes from Katie Leslie from Dallas Morning News. Your line is open.
KATIE LESLIE: Hi. Thanks for having this press conference today. I had a general question about transmission. I understand that no one has yet contracted Zika from a mosquito. But for those who have from traveling abroad or sexually, how long are they considered contagious? I’ve seen warnings to take steps to prevent the spread in the first week of infection. But how confident are you that that window of infection, either sexually or that a mosquito would bite that person is just one week and what should be done to prevent the spread to I guess mosquitos at this point?
DR. DENISE JAMIESON: This is Denise Jamieson. We are recommending that people take precautions upon returning from travel and use insect repellant and avoid mosquito bites for three weeks following their return from an area with ongoing Zika virus transmission.
KATIE LESLIE: I cover Texas. I think they’ve had 35 cases. People who have that now, are they being quarantined? I mean, what happens to those who do have it and they’re back in the states? They don’t leave their homes?
DR. DENISE JAMIESON: Yes. People who have Zika virus infection currently in the United States, we recommend that they avoid further mosquito bites and use insect repellants for three weeks following return from travel. And for those with documented Zika virus infection, we recommend similarly that they take precautions and avoid mosquito bites for several weeks after the onset of symptoms.
KATHY HARBEN: at this point we do want to check and see if Elizabeth Cohen, if your question was answered.
OPERATOR: Elizabeth Cohen, your line is open.
ELIZABETH COHEN: Thank you for coming back to me. I appreciate that. So if the set of women who we know in the continental United States caught Zika sexually and we know this because they didn’t travel to a Zika endemic area but their male partners had Zika so we know they caught it sexually. Amongst these women, did any of them get pregnant while Zika positive, any of them in this 297 number.
DR. MARGARET HONEIN: The number is 279 pregnant women who were monitored.
ELIZABETH COHEN: Sorry.
DR. MARGARET HONEIN: Just to be clear. I don’t know the answer to that.
OPERATOR: Your next question comes from Megan Rosen with science news. Your line is open.
MEGAN ROSEN: Hi, just a follow-up question about the 279 women. Can you tell us how many of these women are in the first, second or third trimester, how many of them have given birth and whether or not these births were live births or miscarriages.
DR. MARGARET HONEIN: No, we don’t have those details to report at this time.
MEGAN ROSEN: Okay. Thank you.
KATHY HARBEN: We have time for one more question.
OPERATOR: As a reminder if you’d like to ask a question, please press star 1.
KATHY HARBEN: Hearing no questions, thank you, Dr. Honein and Dr. Jamieson for joining us today. Thank you also to the reporters who have been with us. If you have follow-up questions you can cause the press office at 404-639-2286. We will post a transcript of this telebriefing on the CDC newsroom website. Thank you for joining us. This concludes our call.