Press Room

State and Territorial Health Officials Respond to New CDC Report That Finds Zika Infection During Any Trimester Can Lead to Severe Birth Defects

ARLINGTON, VA (June 9, 2017)—In response to a new CDC report on the impact the Zika virus may have on pregnancy outcomes, the Association of State and Territorial Health Officials (ASTHO) calls on public health leaders nationwide to remain vigilant and focused on preventing the risk of Zika infection in the continental United States and the U.S. territories.

The report includes data from pregnancy registries in the U.S. territories and Pacific freely associated states, including American Samoa, Puerto Rico, the Federated States of Micronesia, the Republic of Marshall Islands, and the U.S. Virgin Islands, and is the largest study of its kind to look at completed pregnancies with laboratory confirmation of Zika virus infection. Five percent of women in the U.S. territories who had a confirmed Zika virus infection during their pregnancy had a baby or fetus with Zika-related birth defects, consistent with the findings of a similar CDC study on Zika-related birth outcomes in the continental United States.

“Our territorial health officials have unique public health needs and budgetary challenges that make addressing major public health threats different in many ways from those of the fifty states, even though we see similar rates of Zika-related birth defects,” says Michael Fraser, ASTHO’s executive director. “The new CDC study shows how Zika virus infection in the territories remains a concern and we must support our territorial health officials to sustain their responses to this public health threat.”

Health officials say robust reporting, monitoring, and birth defects surveillance systems are key to understanding the magnitude of the risk of Zika infection during each trimester. The effects of Zika during pregnancy are not always recognizable at birth, and these systems provide important data to help identify and facilitate access to clinical care and support services for infants and their families.

With this latest study, states and territories now have sufficient data to begin to develop preliminary estimates of risk for each trimester. Among the women with confirmed Zika infection during the first trimester, nearly 1 in 12 (8%) had a baby or fetus with Zika virus-associated birth defects. About five percent of women infected during their second trimester and four percent infected in their third trimester had babies with Zika-related birth defects. Zika poses a serious threat to pregnant women and their babies, regardless of when the infection occurs.

Currently, CDC’s National Center on Birth Defects and Developmental Disabilities is operating the U.S. Zika pregnancy registry using FY17 emergency funds allocated for Zika response. States and territories report data from their registries to the CDC, which aggregates and publishes data for the nation. The Center’s emergency funding to states and territories for birth defects surveillance—a separate funding stream from pregnancy surveillance—expires July 31, 2017.

Pregnancy surveillance funding, as well as emergency funding for additional epidemiology, laboratory services, and mosquito control, expires July 31, 2018, although states may expend those dollars sooner based on what occurs during this summer’s potential outbreak. Ensuring robust surveillance capacity is essential for local, state, territorial, and federal public health officials and healthcare providers to direct efforts to monitor and provide care for infants affected by Zika virus and their families.

“It is too early to say that the threat of a major Zika virus infection outbreak this summer has passed,” Fraser adds. “Even though Zika cases have been on the decline, the conditions for increased local transmission this summer are good—and that should concern us all. A mild winter in many states and an active mosquito season early this year means we must be very, very vigilant in our surveillance and prevention efforts. We have models of mosquito-borne virus infection and models of sexually-transmitted virus infection. Zika involves both, which makes modeling very difficult. State and territorial health departments rely heavily on data to deploy coordinated public health responses to Zika virus, but the current funding landscape potentially jeopardizes these efforts, especially in the territories that have different needs, unique geographies, and a very different interface with CMS through their jurisdictions’ Medicaid programs.”

ASTHO commends Congress for providing supplemental funding for FY17 to ensure rapid response capabilities to address the Zika crisis and health officials are concerned by the President’s FY18 proposed budget cuts to the CDC and other federal agencies that support public health efforts, including Zika response. ASTHO urges Congress to provide adequate funding in the FY18 appropriations bills to address this ongoing public health threat in our states and territories.


ASTHO is the national nonprofit organization representing the public health agencies of the United States, the U.S. territories, and the District of Columbia, as well as the more than 100,000 public health professionals these agencies employ. ASTHO members, the chief health officials of these jurisdictions, are dedicated to formulating and influencing sound public health policy and to ensuring excellence in state-based public health practice.