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Zika
Topic Collection
September 12, 2025

Topic Collection: Zika

Healthcare providers and emergency medical professionals need to be able to recognize and treat diseases caused by novel pathogens. Zika virus can be more difficult than many other diseases to recognize and, though it has less implications for emergency care, it can result in severe health consequences.

This Topic Collection contains resources that can help our audience: learn more about managing patients at risk of or infected by Zika virus disease (particularly pregnant women who contract the virus during pregnancy); understand related infection control principles; and develop plans based on research and existing materials. Note: Jurisdictional Zika plans generally reflect a focus on vector control and risk communication without significant information about clinical information or coordination with the healthcare system. Where these issues are mentioned they are mentioned in passing.

For more information, we encourage you to access our factsheet, Zika: Resources at Your Fingertips. Information on Zika is constantly evolving. If you are a clinician treating a patient, please check the Centers for Disease Control and Prevention (CDC) Zika site for the most current information and clinical guidance.

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

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Must Reads

ASPR TRACIE. (2022). Zika: Resources at Your Fingertips. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This document provides Zika virus disease resources and an overview of public health and healthcare system considerations and implications that are applicable to professionals in those systems, emergency management stakeholders, and other audiences. Appendix A contains resources from the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) and relevant contact links. Appendix B includes citations with annotations for additional relevant resources and Zika Guidance.
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Center for Infectious Disease Research and Policy. (2016). Zika Resource Page.
This webpage offers a compilation of resources on Zika virus disease including governmental publications, academic publications, research pieces, and popular media mentions. The compilation is updated regularly.
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Centers for Disease Control and Prevention. (2016). Zika Virus.
This website provides the Centers for Disease Control and Prevention resources related to Zika Virus disease including outbreak status, current clinical recommendations, and prevention and mitigation information.
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Rasmussen, S., Jamieson, D., Honein, M., and Petersen, L. (2016). Zika Virus and Birth Defects - Reviewing the Evidence for Causality. The New England Journal of Medicine. 374:1981-1987.
The authors evaluated available data to determine causality of Zika infection and birth defects, most notably microcephaly. This evidence included Zika virus infection during specific times in pregnancy, a specific rare phenotype involving microcephaly, and data that support biologic plausibility. The researchers concluded that the evidence supports a causal relationship between Zika virus infection and birth defects.
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World Health Organization. (2016). Zika: Strategic Response Plan (Revised for July 2016-December 2017).
This World Health Organization (WHO) plan provides the basis for coordination and collaboration among WHO and its partners to ensure international preparedness and response capacities are supported to the fullest extent possible. The plan focuses on preventing and managing medical complications caused by Zika virus infection (with a focus on pregnant women, their partners, and their households) and integrated mosquito management, sexual and reproductive health counselling, and related health education and care.
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Clinical Management – General

Madad, S., Masci, J., Cagliuso, N., and Allen, M. (2016). Preparedness for Zika Virus Disease — New York City, 2016. Morbidity and Mortality Weekly. 65(7):182-187.
The authors share how NYC Health + Hospitals built upon a framework that was established in 2014 to screen patients for possible exposure to Ebola virus disease to create and implement a Zika Preparedness and Response Action Plan. The plan--which can be replicated by other healthcare systems-- includes universal travel screening, signage depicting areas with active Zika virus transmission, evaluation for possible Zika virus exposure, diagnostic testing and linking of infected patients to appropriate specialists, and education on Zika virus disease and preventive measures.
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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2016). Guillain-Barré Syndrome and Other Neurological Deficits Planning Resource.
This planning resource can enhance healthcare coalition and healthcare system preparedness and response to a domestic Zika virus disease outbreak, as it highlights some of the anticipated hospital resource needs essential to caring for Guillain-Barré syndrome and other neurological deficits.
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Clinical Management –Infants and Children

* Adebanjo, T., Godfred-Cato, S., Viens, L., et al. (2017). Update: Interim Guidance for the Diagnosis, Evaluation, and Management of Infants with Possible Congenital Zika Virus Infection — United States, October 2017. Morbidity and Mortality Weekly. 66(41): 1089-1099.
This document summarizes interim guidelines for U.S. healthcare providers caring for infants with possible congenital Zika virus infection.
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* Centers for Disease Control and Prevention. (2016). Congenital Zika Syndrome and Other Birth Defects. U.S. Department of Health and Human Services.
The Centers for Disease Control and Prevention share information and definitions for definite and possible congenital microcephaly related to Zika on this webpage.
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Centers for Disease Control and Prevention. (2016). Microcephaly.
This webpage includes a definition and links to information on microcephaly. It also includes a link to the page "Zika Virus and Pregnancy."
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* MotherToBaby. (2024). Zika.
This website provides background on Zika during pregnancy, including tips for prevention, fact sheets on Zika, related blogs, and external resources from the Centers for Disease Control and Prevention.
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Mulkey, S., Arroyave-Wessel, M., Peyton, C., et al. (2020). Neurodevelopmental Abnormalities in Children with In Utero Zika Virus Exposure Without Congenital Zika Syndrome. JAMA Pediatrics. 174(3): 269-276.
The authors of this cohort study investigate infants exposed to Zika virus (ZIKV) in utero with no clinical sign of Congenital Zika Syndrome (CZS). A longitudinal study of infant neurodevelopment includes infants born to women who met the Centers for Disease Control and Prevention criteria for probable Zika virus infection and laboratory confirmed tests during their pregnancies. The focus is to evaluate the early neurodevelopmental outcomes of infants with normocephaly who were exposed to the virus and had normal neuroimaging findings at birth and whether they are at risk as they age for neurodevelopmental delays.
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Muniz, L., Maciel, R., Ramos, D., et al. (2022). Audiological Follow-Up of Children with Congenital Zika Syndrome. Heliyon. 8:e08720.
The authors of this prospective observational study describe the frequency of hearing loss in children with congenital Zika syndrome (CZS). They hypothesized CZS may contribute to functional disabilities due to continued viral activity in neural tissue following birth. The study showed that sensorineural hearing loss is a clinical feature of CZS and present at birth with no delayed onset or progressive decline in hearing.
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Paixao, E., Cardim, L., Costa, M., et al. (2022). Mortality from Congenital Zika Syndrome - Nationwide Cohort Study in Brazil. The New England Journal of Medicine. 386: 757-767.
The authors describe results from a retrospective population-based cohort study of live births in Brazil between January 1, 2015 and December 31, 2018. They found an overall mortality rate 11 times higher in children with congenital Zika syndrome compared to those without. They also found that the increased mortality risk for children with congenital Zika syndrome persisted throughout the first three years of life.
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Ticona, J., Nery, N., Doss-Gollin, S., et al. (2021). Heterogeneous Development of Children with Congenital Zika Syndrome-Associated Microcephaly. PLoS One. 16(9):e0256444.
The authors of this study followed 42 children, 2 years of age and older with Congenital Zika Syndrome (CZS) related to microcephaly. A correlation was observed between heterogenous neurodevelopment and neurological capabilities which indicate cognitive and motor development outcomes to children exposed to Zika virus in utero. The children experienced major neurodevelopmental delays to include spasticity.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2016). Supporting Children with Special Healthcare Needs Planning Resource.
This matrix highlights some of the existing federal and national services and programs for supporting children with special healthcare needs in the context of Zika. It includes guidance and links to helpful resources.
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World Health Organization. (2016). Psychosocial Support for Pregnant Women and for Families with Microcephaly and other Neurological Complications in the Context of Zika Virus: Interim Guidance for Healthcare Providers.
This resource provides a framework for healthcare providers to work with other sectors, such as social work and education to provide a comprehensive support network for pregnant women and their families following a diagnosis of congenital Zika infection.
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World Health Organization. (2016). Screening, Assessment, and Management of Neonates and Infants with Complications Associated with Zika Virus Exposure in Utero.
This guidance is designed to support the development of national and local clinical protocols and policies to address infants and children’s medical, developmental, and social needs following Zika virus exposure in utero.
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Clinical Management – Maternal/Fetal

* Adebanjo, T., Godfred-Cato, S., Viens, L., et al. (2017). Update: Interim Guidance for the Diagnosis, Evaluation, and Management of Infants with Possible Congenital Zika Virus Infection — United States, October 2017. Morbidity and Mortality Weekly. 66(41): 1089-1099.
This document summarizes interim guidelines for U.S. healthcare providers caring for infants with possible congenital Zika virus infection.
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Brasil, P., Pereira, J., Gabaglia, C., et al. (2016). Zika Virus Infection in Pregnant Women in Rio de Janeiro - Preliminary Report. The New England Journal of Medicine.
Researchers in Rio de Janeiro enrolled 88 pregnant women in a prospective study, where they were tested for Zika virus and then followed throughout their pregnancies. Seventy-two of the 88 women enrolled tested positive for Zika virus infection. The authors concluded that “despite mild clinical symptoms, Zika virus infection during pregnancy appears to be associated with grave outcomes, including fetal death, placental insufficiency, fetal growth restriction, and CNS injury.”
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* Centers for Disease Control and Prevention. (2016). Congenital Zika Syndrome and Other Birth Defects. U.S. Department of Health and Human Services.
The Centers for Disease Control and Prevention share information and definitions for definite and possible congenital microcephaly related to Zika on this webpage.
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* Centers for Disease Control and Prevention. (2016). Preventing Mosquito Bites.
This webpage includes information on insect repellent, including safety, and application.
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Centers for Disease Control and Prevention. (2016). Zika Symptoms and Complications. U.S. Department of Health and Human Services.
This webpage includes information on the symptoms of Zika, how it is diagnosed, and how it is treated.
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Costello, A., Dua, T., Duran, P., et al. (2016). Defining the Syndrome Associated with Congenital Zika Virus Infection. Bulletin of the World Health Organization.
The authors provide an overview of the congenital abnormalities associated with Zika.
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* MotherToBaby. (2024). Zika.
This website provides background on Zika during pregnancy, including tips for prevention, fact sheets on Zika, related blogs, and external resources from the Centers for Disease Control and Prevention.
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Oduyebo, T., Polen, K., Walke, H., et al. (2017). Update: Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure – United States (Including U.S. Territories), July 2017. Morbidity and Mortality Weekly Report. 66(29): 781-793.
The authors list guidelines healthcare providers can use to evaluate pregnant women with possible Zika virus exposure.
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Rasmussen, S., Jamieson, D., Honein, M., and Petersen, L. (2016). Zika Virus and Birth Defects - Reviewing the Evidence for Causality. The New England Journal of Medicine. 374:1981-1987.
The authors evaluated available data to determine causality of Zika infection and birth defects, most notably microcephaly. This evidence included Zika virus infection during specific times in pregnancy, a specific rare phenotype involving microcephaly, and data that support biologic plausibility. The researchers concluded that the evidence supports a causal relationship between Zika virus infection and birth defects.
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Tepper, N., Goldberg, H., Vargas Bernal, M., et al. (2016). Estimating Contraceptive Needs and Increasing Access to Contraception in Response to the Zika Virus Disease Outbreak Puerto Rico, 2016. Morbidity and Mortality Weekly. 65(12):311-314.
The authors explain how increased access to contraception could reduce the rates of unintended pregnancy and fewer adverse Zika-related pregnancy and birth outcomes.
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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2016). Maternal-Fetal Health Planning Resource.
This matrix illustrates some of the anticipated hospital and healthcare system resources needs essential to caring for high-risk pregnancies and children born with microcephaly or other birth defects that may be associated with Zika virus infection.
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Clinical Management - Testing

Centers for Disease Control and Prevention. (2016). Collecting and Submitting Body Fluid Specimens for Zika Virus Testing. U.S. Department of Health and Human Services.
The Centers for Disease Control and Prevention provide guidelines for collecting, testing, and shipping spinal fluid, urine, and other body fluids for Zika virus. Guidelines for reporting results are also included.
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Centers for Disease Control and Prevention. (2019). Clinical Testing and Diagnosis for Zika Virus Disease. U.S. Department of Health and Human Services.
The Centers for Disease Control and Prevention share information and related links on Zika diagnostic testing. Instructions for specimen collection and submission are also included.
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Rabe, I., Staples, E., Villanueva, J., et al. (2016). Interim Guidance for Interpretation of Zika Virus Antibody Test Results. Morbidity and Mortality Weekly Report. 65(21).
The authors provide guidelines for interpreting Zika virus antibody test results and managing patients with suspected Zika or Dengue virus infection.
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Sharp, T., Fischer, M., Munoz-Jordan, J., et al. (2019). Dengue and Zika Virus Diagnostic Testing for Patients with a Clinically Compatible Illness and Risk for Infection with Both Viruses. Morbidity and Mortality Weekly Report. 68(1): 1-10.
The authors summarize current guidance on dengue and Zika virus diagnostic testing.
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Education and Training

Centers for Disease Control and Prevention. (2019). Zika Virus. U.S. Department of Health and Human Services.
The Centers for Disease Control and Prevention provides links to select training resources on the Zika virus and related topics for health professionals.
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Ethical Considerations

Nuffield Council on Bioethics. (2016). Zika: Ethical Considerations.
This document highlights Zika-specific ethical considerations related to public health ethics, research in developing countries, solidarity, the sharing of biological and health data, and the regulation of emerging biotechnologies.
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The Network for Public Health Law. (2017). Primer: Emergency Legal Preparedness Concerning Zika Virus.
This primer, presented in a PowerPoint format, outlines public health concerns from Zika Virus disease and discusses potential legal issues in the U.S. and abroad.
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* U.S. Food and Drug Administration. (2016). Zika Virus. U.S. Department of Health and Human Services.
This page, provided by the U.S. Food and Drug Administration, includes links to Zika-specific information in English, Spanish, and Portuguese. Links to resources on emergency use authorization (which allows the use of certain medical products for emergencies based on scientific data); information regarding the blood supply; and information on the safety and use of insect repellants are also provided.
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Occupational Safety

National Institute for Occupational Safety and Health. (2024). Mosquito-Borne Diseases in Workers. Centers for Disease Control and Prevention.
The information on this webpage is geared towards employers and workers, and includes tips for preventing mosquito-borne diseases such as Zika and West Nile.
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Plans, Tools, and Templates

Department of Public Health and Wellness, Office of Emergency and Public Health Planning. (2016). Louisville (KY) Zika Response Plan.
This plan highlights actions that will be taken in the event of locally-acquired/transmitted by the bite of a local vector cases of Zika virus disease in Kentucky, and morespecifically, within the Louisville Metro jurisdiction.
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Texas Department of State Health Services. (2016). Regional Response Teams: Zika Response.
This document highlights the roles and responsibilities of Zika response teams in Texas. It can serve as a model for other states and jurisdictions.
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Texas Department of State Health Services. (2019). Zika Virus Annex.
Developed by and for the State of Texas, this Zika preparedness and response plan can be used by others charged with creating related guidance.
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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2016). Guillain-Barré Syndrome and Other Neurological Deficits Planning Resource.
This planning resource can enhance healthcare coalition and healthcare system preparedness and response to a domestic Zika virus disease outbreak, as it highlights some of the anticipated hospital resource needs essential to caring for Guillain-Barré syndrome and other neurological deficits.
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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2016). Maternal-Fetal Health Planning Resource.
This matrix illustrates some of the anticipated hospital and healthcare system resources needs essential to caring for high-risk pregnancies and children born with microcephaly or other birth defects that may be associated with Zika virus infection.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2016). Zika Virus Planning Considerations for Healthcare Facilities and Coalitions.
This document highlights some of the anticipated hospital and healthcare system planning issues essential to caring for suspect Zika cases, complicated Zika cases, pregnancies associated with Zika virus infection, and children born to Zika-infected mothers who have birth defects that may be associated with Zika virus infection.
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World Health Organization. (2016). Zika: Strategic Response Plan (Revised for July 2016-December 2017).
This World Health Organization (WHO) plan provides the basis for coordination and collaboration among WHO and its partners to ensure international preparedness and response capacities are supported to the fullest extent possible. The plan focuses on preventing and managing medical complications caused by Zika virus infection (with a focus on pregnant women, their partners, and their households) and integrated mosquito management, sexual and reproductive health counselling, and related health education and care.
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Prevention and Vector Control

Centers for Disease Control and Prevention. (2016). Preventing Mosquito Bites.
The Centers for Disease Control and Prevention share information on mosquito bite protection, focusing on Zika, dengue, chikungunya, and how to prevent bites when traveling.
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* Centers for Disease Control and Prevention. (2016). Preventing Mosquito Bites.
This webpage includes information on insect repellent, including safety, and application.
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Centers for Disease Control and Prevention. (2024). Mosquito Control Resources. U.S. Department of Health and Human Services.
This webpage includes guidance and best practices, an identification key, surveillance software, and links to publications and other resources related to mosquito control.
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Texas Department of State Health Services. (2016). Zika Prevention.
These 15- and 30- second videos were developed by and for the State of Texas. Available on YouTube, in English and Spanish, these videos encourage residents to visit www.texaszika.org to learn more about preventing Zika.
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Reproductive Health (Prevention/Transmission)

Centers for Disease Control and Prevention. (2016). Sexual Transmission of Zika Virus.
Resources on this page are focused primarily on the sexual transmission of Zika, including knows and unknowns. Links to resources in English and Spanish are also provided.
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Centers for Disease Control and Prevention. (2016). Sexual Transmission of Zika Virus.
The Centers for Disease Control and Prevention shares updated interim guidance for those with possible Zika virus exposure who are planning to conceive and interim guidance to prevent transmission of Zika virus through sexual contact.
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Centers for Medicare & Medicaid Services. (2016). Re: Medicaid Family Planning Services and Supplies. U.S. Department of Health and Human Services.
This letter was sent from the Centers for Medicare and Medicaid Services to all State Health Officials (SHOs) to clarify previous guidance on the delivery of family planning services and supplies to all Medicaid beneficiaries.
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Mansuy, J.M., Dutertre, M., Mengell, C., et al. (2016). Zika Virus: High Infectious Viral Load in Semen, a New Sexually Transmitted Pathogen? The Lancet Infectious Diseases. 16(4): 405.
The authors tested a Zika patients' semen two weeks after system onset and found viral load was nearly 100,000 times that of his blood or urine. The authors discuss implications regarding sexual transmission.
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Polen, K., Gilboa, S., Hills, S., et al. (2018). Update: Interim Guidance for Preconception Counseling and Prevention of Sexual Transmission of Zika Virus for Men with Possible Zika Virus Exposure – United States, August 2018. Morbidity and Mortality Weekly Report. 67(31): 868-871.
The recommendations in this guidance document apply to men who have traveled to or reside in areas with active Zika virus transmission and their female or male sex partners.
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U.S. Department of Health and Human Services, Office of Population Affairs. (2018). Providing Family Planning Care for Non-Pregnant Women and Men of Reproductive Age in the Context of Zika.
This toolkit was developed to help providers of family planning services share information with non-pregnant clients about the risk of Zika infection.
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World Health Organization. (2020). WHO Guidelines for the Prevention of Sexual Transmission of Zika Virus.
The World Health Organization explains updated guidance regarding prevention of sexual transmission of the Zika virus.
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Research

Bhatnagar, J., Rabeneck, D., Martines, R., et al. (2016). Zika Virus RNA Replication and Persistence in Brain and Placental Tissue. Emerging Infectious Diseases. 23(3).
This study examined placental tissues from 44 women and brain tissues from 8 deceased infants who had microcephaly. All samples were from patients suspected to be infected with Zika, and testing detected Zika virus in all infant tissues and nearly three-quarters of the placental tissues of women with adverse pregnancy or birth outcomes. Zika virus RNA was found in placentas and fetal brains more than seven months after pregnant women contracted Zika. Additionally, Zika RNA levels were 1,000 times higher in the brain than the placenta tissues.
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Bingham, A., Cone, M., Mock, V., et al. (2016). Comparison of Test Results for Zika Virus RNA in Urine, Serum, and Saliva Specimens from Persons with Travel-Associated Zika Virus Disease - Florida, 2016. Morbidity and Mortality Weekly Report. 65(18).
The Florida Department of Health Bureau of Public Health Laboratories conducted testing on samples from 913 persons who met the state criteria for testing. Test results for urine and serum samples showed that approximately twice as many urine specimens tested positive for Zika virus than serum specimens, suggesting that urine might be a more useful specimen for identifying acute Zika virus infection.
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Risk Communications

Texas Department of State Health Services. (2016). Zika Communications Toolkit.
This Zika toolkit includes posters, push cards, and fact sheets--specific to Texas and available in English and Spanish--that can be tailored to other states and jurisdictions.
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Zika Overview Resources

ASPR TRACIE. (2022). Zika: Resources at Your Fingertips. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This document provides Zika virus disease resources and an overview of public health and healthcare system considerations and implications that are applicable to professionals in those systems, emergency management stakeholders, and other audiences. Appendix A contains resources from the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) and relevant contact links. Appendix B includes citations with annotations for additional relevant resources and Zika Guidance.
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Center for Infectious Disease Research and Policy. (2016). Zika Resource Page.
This webpage offers a compilation of resources on Zika virus disease including governmental publications, academic publications, research pieces, and popular media mentions. The compilation is updated regularly.
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Centers for Disease Control and Prevention. (2016). Zika Virus.
This website provides the Centers for Disease Control and Prevention resources related to Zika Virus disease including outbreak status, current clinical recommendations, and prevention and mitigation information.
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Pan American Health Organization. (2016). Zika Virus Infection.
This website provides an outline of the disease and its progression specifically in the Americas. It provides information for the general public and health professionals on disease spread, identification, treatment and prevention.
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* U.S. Food and Drug Administration. (2016). Zika Virus. U.S. Department of Health and Human Services.
This page, provided by the U.S. Food and Drug Administration, includes links to Zika-specific information in English, Spanish, and Portuguese. Links to resources on emergency use authorization (which allows the use of certain medical products for emergencies based on scientific data); information regarding the blood supply; and information on the safety and use of insect repellants are also provided.
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World Health Organization. (2016). Zika Virus and Complications: Questions and Answers.
This webpage provides responses to commonly asked questions about Zika virus and mosquito protection and surveillance, sexual transmission, travel, neurological syndromes, pregnancy, and government response.
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World Health Organization. (2016). Zika Virus Disease.
This World Health Organization website provides an outline of Zika and an overview of its progression around the world. Links to Situation Reports and information on signs and symptoms, transmission, diagnosis, treatment, and prevention are included on the page.
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Agencies and Organizations

Center for Infectious Disease Research and Policy. Zika Resource Page.
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Centers for Disease Control and Prevention. Zika Virus.
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Pan American Health Organization. Zika Virus Infection.
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U.S. Food and Drug Administration. Zika Virus Response Updates from FDA.
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World Health Organization. Zika Virus Disease.
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This Topic Collection contains all of the resources found in the ASPR TRACIE document Zika: Resources at Your Fingertips. That document was updated regularly and reviewed by the following subject matter experts, listed in alphabetical order (an asterisk indicates the expert also reviewed this Topic Collection): Marion Danis,* MD, Department of Bioethics, National Institutes of Health; Dan Hanfling, MD, Contributing Scholar, UPMC Center for Health Security, Member, InterAgency Board, Health and Medical Responder Safety, Attending Physician, BestPractices, Inc. (a division of EmCare), Clinical Professor of Emergency Medicine, George Washington University, and Strategic Advisor, U.S. Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response (HHS/ASPR), Hospital Preparedness Program; John Hick,* MD, HHS ASPR and Hennepin County Medical Center; Alicia Livinski, Biomedical Librarian, HHS National Institutes of Health; Gavin Macgregor-Skinner, BVSc, MSc, MPH, MRCVS, Global Projects Manager, Elizabeth R. Griffin Foundation, Director of Global Response, BIDMC/HHI Fellowship in Disaster Medicine, Harvard Medical School Teaching Hospital, Assistant Professor, and Penn State College of Medicine; Anthony Macintyre, MD, The George Washington University Department of Emergency Medicine; Nancy Petit, MD, Head, Division of Obstetrics, Trinity Health, SFDE; Mary Russell,* EdD, MSN, Emergency Services, Boca Raton Regional Hospital; Meghan Treber,* MS, Principal, Public Health Preparedness Practice, ICF International, ICF ASPR TRACIE Project Director; and Ty J. Vannieuwenhoven,* DVM, MPH, MSS, DACVPM, Chief Veterinary Officer, National Disaster Medical System (NDMS), HHS ASPR.

Additional review conducted by Mili Patel, JD, MPH, Public Health Analyst, HHS ASPR, Division for At-Risk Individuals, Behavioral Health & Community Resilience.
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