Please note: An erratum has been published for this issue. To view the erratum, please click here.

Morbidity and Mortality Weekly Report

Initial Public Health Response and Interim Clinical Guidance for

the 2019 Novel Coronavirus Outbreak — United States,
December 31, 2019–February 4, 2020
Anita Patel, PharmD1; Daniel B. Jernigan, MD1; 2019-nCoV CDC Response Team

On February 5, 2020, this report was posted as an MMWR cases in the United States. Although these measures might not
Early Release on the MMWR website (https://www.cdc.gov/mmwr). prevent the eventual establishment of ongoing, widespread
On December 31, 2019, Chinese health officials reported transmission of the virus in the United States, they are being
a cluster of cases of acute respiratory illness in persons associ- implemented to 1) slow the spread of illness; 2) provide time
ated with the Hunan seafood and animal market in the city of to better prepare health care systems and the general public
Wuhan, Hubei Province, in central China. On January 7, 2020, to be ready if widespread transmission with substantial asso-
Chinese health officials confirmed that a novel coronavirus ciated illness occurs; and 3) better characterize 2019-nCoV
(2019-nCoV) was associated with this initial cluster (1). As of infection to guide public health recommendations and the
February 4, 2020, a total of 20,471 confirmed cases, including development of medical countermeasures including diagnos-
2,788 (13.6%) with severe illness,* and 425 deaths (2.1%) had tics, therapeutics, and vaccines. Public health authorities are
been reported by the National Health Commission of China monitoring the situation closely. As more is learned about this
(2). Cases have also been reported in 26 locations outside of novel virus and this outbreak, CDC will rapidly incorporate
mainland China, including documentation of some person- new knowledge into guidance for action by CDC and state
to-person transmission and one death (2). As of February 4, and local health departments.
11 cases had been reported in the United States. On January Some coronaviruses, such as Middle East Respiratory
30, the World Health Organization (WHO) Director-General Syndrome (MERS) and Severe Acute Respiratory Syndrome
declared that the 2019-nCoV outbreak constitutes a Public (SARS), are the result of human-animal interactions.
Health Emergency of International Concern.† On January 31, Preliminary investigation of 2019-nCoV also suggests a zoo-
the U.S. Department of Health and Human Services (HHS) notic origin (6), but the exact origin has not yet been deter-
Secretary declared a U.S. public health emergency to respond mined. Person-to-person spread is evident (7); however, how
to 2019-nCoV.§ Also on January 31, the president of the easily the virus is transmitted between persons is currently
United States signed a “Proclamation on Suspension of Entry unclear. 2019-nCoV is similar to coronaviruses that cause
as Immigrants and Nonimmigrants of Persons who Pose a Risk MERS and SARS, which are transmitted mainly by respira-
of Transmitting 2019 Novel Coronavirus,” which limits entry tory droplets. Signs and symptoms of patients with confirmed
into the United States of persons who traveled to mainland 2019-nCoV infection include fever, cough, and shortness of
China to U.S. citizens and lawful permanent residents and breath (8). Based on the incubation period of illness from
their families (3). CDC, multiple other federal agencies, state MERS and SARS coronaviruses, CDC believes that symptoms
and local health departments, and other partners are imple- of 2019-nCoV infection occur within 2 to 14 days following
menting aggressive measures to slow transmission of 2019- infection. Preliminary information suggests that older adults
nCoV in the United States (4,5). These measures require the and persons with underlying health conditions or compro-
identification of cases and their contacts in the United States mised immune systems might be at higher risk for severe ill-
and the appropriate assessment and care of travelers arriving ness from this virus (9); however, many characteristics of this
from mainland China to the United States. These measures are novel coronavirus and how it might affect individual persons
being implemented in anticipation of additional 2019-nCoV and potentially vulnerable population subgroups, such as the
elderly or those with chronic health conditions, remain unclear.
* Includes any of the following: dyspnea, respiratory rate >30 breaths per minute,
hypoxemia, or chest x-ray with multilobar infiltrates or >50% progression of
pulmonary infiltration within 24–48 hours per WHO. https://www.who.int/docs/
Epidemiology of First U.S. Cases
default-source/coronaviruse/situation-reports/20200123-sitrep-3-2019-ncov.pdf. On January 21, 2020, the first person in the United
† https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-
States with diagnosed 2019-nCoV infection was reported.
meeting-of-the-international-health-regulations-(2005)-emergency-committee-
regarding-the-outbreak-of-novel-coronavirus-(2019-ncov). As of February 4, a total of 293 persons from 36 states, the
§ https://www.phe.gov/emergency/news/healthactions/phe/Pages/2019-nCoV.aspx. District of Columbia, and the U.S. Virgin Islands were under
investigation based on current patient under investigation

140 MMWR / February 7, 2020 / Vol. 69 / No. 5 US Department of Health and Human Services/Centers for Disease Control and Prevention
 Morbidity and Mortality Weekly Report

(PUI) definitions,¶ and also included those being evaluated

Summary
because they are close contacts. Of these PUIs, 11 patients
What is already known about this topic?
have confirmed 2019-nCoV infection using a real-time
reverse transcription–polymerase chain reaction (RT-PCR) In December 2019, an outbreak of acute respiratory illness
caused by a novel coronavirus (2019-nCoV) was detected in
assay developed by CDC. These 11 cases were diagnosed in mainland China. Cases have been reported in 26 additional
the following states: Arizona (one), California (six), Illinois locations, including the United States.
(two), Massachusetts (one), and Washington (one) (Table). What is added by this report?
Nine cases were in travelers from Wuhan. Eight of these nine
Nine of the first 11 U.S. 2019-nCoV patients were exposed in
cases were identified as a result of patients seeking clinical care Wuhan, China. CDC expects more U.S. cases.
for symptoms and clinicians connecting with the appropriate
What are the implications for public health practice?
public health systems. Two cases (one each in California and
CDC, multiple other federal agencies, state and local health
Illinois) occurred in close contacts of two confirmed cases and departments, and other partners are implementing aggressive
were diagnosed as part of routine monitoring of case contacts. measures to substantially slow U.S. transmission of 2019-nCoV,
All patients are being monitored closely for progressing illness. including identification of U.S. cases and contacts and managing
No deaths have been reported in the United States. travelers arriving from mainland China to the United States. Interim
guidance is available at https://www.cdc.gov/coronavirus/index.
html and will be updated as more information becomes available.
Public Health Response
CDC established a 2019-nCoV Incident Management
Structure on January 7, 2020. On January 21, CDC activated U.S. quarantine stations, located at 18 major U.S. ports
its Emergency Operations Center to optimize coordination for of entry, are part of a comprehensive regulatory system
domestic and international 2019-nCoV response efforts. To authorized under section 361 of the Public Health Service
date, CDC has deployed teams to the U.S. jurisdictions with Act (42 U.S. Code Section 264), that limits the introduction
cases to assist with epidemiologic investigation and to work of infectious diseases into the United States to prevent their
closely with state and local partners to identify and monitor spread. On January 17, consistent with existing communicable
close contacts and better understand the spectrum of illness, disease response protocols, CDC Quarantine staff members
transmission, and virulence associated with this novel virus. instituted enhanced entry screening of travelers on direct and
Information learned from these investigations will help inform connecting flights from Wuhan, China, arriving at three major
response actions. CDC has closely monitored the global U.S. airports: Los Angeles (LAX), New York City (JFK), and
impact of this virus with staff members positioned in CDC San Francisco (SFO),†† which then expanded to include travel-
offices around the world, including mainland China, and in ers arriving in Atlanta (ATL) and Chicago (ORD). These five
coordination with other countries and WHO. This coordina- airports together receive approximately 85% of all air travelers
tion has included deploying CDC staff members to work with from Wuhan, China, to the United States. U.S. Customs and
WHO and providing active support to CDC offices in affected Border Protection officers identified travelers arriving from
countries. In addition, CDC in response to the escalating risks Wuhan and referred them to CDC for health screening.§§ Any
of travel from China has issued a series of Travelers’ Health traveler from Wuhan with signs or symptoms of illness (e.g.,
Notices for both Wuhan and the rest of China regarding the fever, cough, or difficulty breathing) received a more compre-
2019-nCoV outbreak. On January 27, CDC issued a Level 3 hensive public health assessment performed by CDC public
travel notice for travelers to avoid all nonessential travel to health and medical officers.¶¶ All travelers from Wuhan were
mainland China.** also provided CDC’s Travel Health Alert Notice (T-HAN)***
¶ Criteria to guide evaluation and testing of patients under investigation for
2019-nCoV include 1) fever or signs or symptoms of lower respiratory tract †† https://www.cdc.gov/media/releases/2020/p0117-coronavirus-screening.html.
illness (e.g., cough or shortness of breath) in any person, including a health care §§ CDC’s initial health screening includes a measurement of each traveler’s
worker, who has had close contact with a patient with laboratory-confirmed temperature with a handheld noncontact thermometer, observation of these
2019-nCoV infection within 14 days of symptom onset; 2) fever and signs or travelers for visible signs of respiratory illness (e.g., cough or difficulty
symptoms of lower respiratory tract illness (e.g., cough or shortness of breath) breathing), and review of symptoms through a self-administered questionnaire.
in any person with a history of travel from Hubei Province, China, within ¶¶ The more comprehensive public health assessment determines, based on the
14 days of symptom onset; or 3) fever and signs or symptoms of lower respiratory traveler’s illness and exposure, whether the traveler should be taken to a
tract illness (e.g., cough or shortness of breath) requiring hospitalization in any hospital for further medical evaluation and care, which might include testing
person with a history of travel from mainland China within 14 days of symptom for 2019-nCoV.
onset. More information is available at https://emergency.cdc.gov/han/ *** https://www.cdc.gov/coronavirus/2019-ncov/travelers/communication-
han00427.asp and https://emergency.cdc.gov/han/han00426.asp. resources.html.
** https://wwwnc.cdc.gov/travel/notices/warning/novel-coronavirus-china.

US Department of Health and Human Services/Centers for Disease Control and Prevention MMWR / February 7, 2020 / Vol. 69 / No. 5 141
 Please note: An erratum has been published for this issue. To view the erratum, please click here.

Morbidity and Mortality Weekly Report

TABLE. Characteristics of initial 2019 novel coronavirus cases (N = 11) — United States, January 21–February 4, 2020
Date
laboratory confirmation
Case State Approximate age (yrs) Sex Place of exposure announced
1 Washington 30s M Wuhan 1/21/2020
2 Illinois 60s F Wuhan 1/24/2020
3 Arizona 20s M Wuhan 1/26/2020
4 California 30s M Wuhan 1/27/2020
5 California 50s M Wuhan 1/27/2020
6 Illinois 60s M Household Illinois 1/30/2020
7 California 40s M Wuhan 1/31/2020
8 Massachusetts 20s M Wuhan 2/01/2020
9 California 50s F Wuhan 2/02/2020
10 California 50s M Wuhan 2/02/2020
11 California 50s F Household California 2/02/2020
Abbreviations: F = female; M = male.

that advised them to monitor their health for 14 days and of the test at any CDC-qualified lab across the country. CDC is
described recommended actions to take if relevant symptoms working closely with FDA and public health partners, includ-
develop. As of February 1, 2020, a total of 3,099 persons on ing the American Public Health Laboratories, to rapidly share
437 flights were screened; five symptomatic travelers were these tests domestically and internationally through CDC’s
referred by CDC to local health care providers for further International Reagent Resource (https://www.internationalre-
medical evaluation, and one of these persons tested positive agentresource.org/). In addition, CDC uploaded the genome
for 2019-nCoV. of the virus from the first reported cases in the United States to
On January 24, 2020, travel bans began to be instituted GenBank, the National Institutes of Health genetic sequence
by the Chinese government, resulting in restricted travel in database of publicly available DNA sequences (https://www.
and out of Hubei Province, including the city of Wuhan, ncbi.nlm.nih.gov/genbank/). CDC also is growing the virus
and fewer travelers undergoing entry screening in the in cell culture, which is necessary for further studies, including
United States. In response to the escalating risks associated for additional genetic characterization. Once isolated, the virus
with travel from mainland China, on January 31, 2020, the will be made available through BEI Resources (https://www.
Presidential Proclamation further refined the border health beiresources.org/) to assist research efforts.
strategy to temporarily suspend entry, undergo additional
screening, or possible quarantine for individuals that have Clinical and Infection Control Guidance
visited China (excluding Hong Kong, Macau, and Taiwan) Additional information about 2019-nCoV is needed to bet-
in the past 14 days. These enhanced entry screening efforts ter understand transmission, disease severity, and risk to the
are taking place at 11 airports at which all air travelers from general population. Although CDC and partners are actively
China are being directed. learning about 2019-nCoV, initial CDC guidance is based
on guidance for management and prevention of respiratory
Laboratory and Diagnostic Support illnesses including influenza, MERS, and SARS. No vaccine
Chinese health officials posted the full 2019-nCoV genome or specific treatment for 2019-nCoV infection is currently
sequence on January 10, 2020, to inform the development available. At present, medical care for patients with 2019-nCoV
of specific diagnostic tests for this emergent coronavirus is supportive.
(1). Within a week, CDC developed a Clinical Laboratory On January 31, CDC published its third Health Advisory
Improvement Amendments–approved real-time RT-PCR test with interim guidance for clinicians and public health prac-
that can diagnose 2019-nCoV respiratory samples from clini- titioners.††† In addition, CDC issued a Clinical Action
cal specimens. On January 24, CDC publicly posted the assay Alert through its Clinician Outreach and Communication
protocol for this test (https://www.cdc.gov/coronavirus/2019- Activity network on January 31.§§§ Interim guidance for
nCoV/lab/index.html). On January 4, 2020, the Food and health care professionals is available at https://www.cdc.
Drug Administration issued an Emergency Use Authorization gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html.
to enable emergency use of CDC’s 2019-nCoV Real-Time
RT-PCR Diagnostic Panel. To date, this test has been limited ††† https://emergency.cdc.gov/han/han00427.asp.
to use at CDC laboratories. This authorization allows the use §§§ https://emergency.cdc.gov/coca/calls/2020/callinfo_013120.asp.

142 MMWR / February 7, 2020 / Vol. 69 / No. 5 US Department of Health and Human Services/Centers for Disease Control and Prevention
 Morbidity and Mortality Weekly Report

Health care providers should identify patients who might may be collected and stored. Specimens should be collected
have been exposed and who have signs or symptoms related as soon as possible once a PUI is identified regardless of time
to 2019-nCoV infection, isolate these patients, and inform since symptom onset.
public health departments. This includes obtaining a detailed For persons who might have 2019-nCoV infection and their
travel history for patients being evaluated with fever and close contacts, information and guidance on how to reduce
lower respiratory tract illness. Criteria to guide evaluation the risk for transmitting and acquiring infection is available
and testing of PUIs for 2019-nCoV include 1) fever or signs at https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-
or symptoms of lower respiratory tract illness (e.g., cough prevent-spread.html. Close contacts should immediately
or shortness of breath) in any person, including health care call their health care providers if they develop symptoms. In
workers, who has had close contact¶¶¶ with a patient with addition, CDC is working closely with state and local health
laboratory-confirmed 2019-nCoV infection within 14 days partners to develop and disseminate information to the pub-
of symptom onset; 2) fever and signs or symptoms of lower lic on general prevention of respiratory illness, including the
respiratory tract illness (e.g., cough or shortness of breath) 2019-nCoV. This includes everyday preventive actions such as
in any person with a history of travel from Hubei Province, washing your hands, covering your cough, and staying home
China, within 14 days of symptom onset; or 3) fever and signs when you are ill. Additional information and resources for this
or symptoms of lower respiratory tract illness (e.g., cough or outbreak are available on the CDC website (https://www.cdc.
shortness of breath) requiring hospitalization in any person gov/coronavirus/2019-ncov/index.html).
with a history of travel from mainland China within 14 days
Discussion
of symptom onset. Additional nonhospitalized PUIs may be
tested based on consultation with state and local public health The 2019-nCoV has impacted multiple countries, caused
officials. Clinicians should evaluate PUIs for other possible severe illness, and sustained person-to-person transmission
causes of illness (e.g., influenza and respiratory syncytial virus) making it a concerning and serious public health threat.
as clinically indicated. It is unclear how this virus will impact the U.S. over time.
CDC currently recommends a cautious approach to the For the general population, who are unlikely to be exposed
examination of PUIs. These patients should be asked to wear to this virus at the current time, the immediate health risk
a surgical mask as soon as they are identified, and directed to from 2019-nCoV is considered low. CDC, multiple other
a separate area, if possible, separated by at least 6 ft (2 m) from federal agencies, state and local health departments, and other
other persons. Patients should be evaluated in a private room partners are implementing aggressive measures to slow U.S.
with the door closed, ideally an airborne infection isolation transmission of 2019-nCoV (4,5). These measures require the
room, if available. Health care personnel entering the room identification of cases and contacts in the United States and the
should use standard precautions, contact precautions, airborne effective management of the estimated 14,000 travelers arriv-
precautions, and eye protection (e.g., goggles or a face shield). ing from mainland China to the United States each day (3).
Clinicians should immediately notify the health care facility’s These measures are being implemented based on the assump-
infection control personnel and local health department. The tion that there will be more U.S. 2019-nCoV cases occurring
health department will determine whether the patient needs to with potential chains of transmission, with the understanding
be considered a PUI for 2019-nCoV and be tested for infection. that these measures might not prevent the eventual establish-
If directed by the health department, to increase the likeli- ment of ongoing, widespread transmission of the virus in the
hood of detecting 2019-nCoV infection, CDC recommends United States.
collecting and testing both upper and lower respiratory tract It is important for public health agencies, health care pro-
specimens.**** Additional specimen types (e.g., stool or urine) viders, and the public to be aware of this new 2019-nCoV so
that coordinated, timely, and effective actions can help prevent
¶¶¶ Close contact is defined as 1) being within approximately 6 ft (2 m) of a
additional cases or poor health outcomes. The critical role that
2019-nCoV patient for a prolonged period while not wearing recommended the U.S. health care system plays in halting or significantly
personal protective equipment (PPE) (e.g., gowns, gloves, National Institute slowing U.S. transmission of 2019-nCoV is already evident:
for Occupational Safety and Health–certified disposable N95 respirator, and
eye protection); close contact can occur while caring for, living with, visiting, eight of the first 11 U.S. cases were detected by clinicians col-
or sharing a health care waiting area or room with a 2019-nCoV patient; or laborating with public health to test persons at risk. The early
2) having direct contact with infectious secretions of a 2019-nCoV patient recognition of cases in the United States reduces transmis-
(e.g., being coughed on) while not wearing recommended PPE.
**** https://www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical- sion risk and increases understanding of the virus, including
specimens.html. its transmission and severity, to inform national and global
response actions.

US Department of Health and Human Services/Centers for Disease Control and Prevention MMWR / February 7, 2020 / Vol. 69 / No. 5 143
 Please note: An erratum has been published for this issue. To view the erratum, please click here.

Morbidity and Mortality Weekly Report

2019-nCoV symptoms are similar to those of influenza National Center for Immunization and Respiratory Diseases, CDC;
(e.g., fever, cough, or sore throat), and the outbreak is occur- Jennifer Buigut, National Center for Emerging and Zoonotic
ring during a time of year when respiratory illnesses from Infectious Diseases, CDC; Stephen Burke, National Center for
influenza, respiratory syncytial virus, and other respiratory Immunization and Respiratory Diseases, CDC; Rachel Burke,
viruses are highly prevalent. To prevent influenza, all persons National Center for Immunization and Respiratory Diseases, CDC;
Erin Burns, National Center for Immunization and Respiratory
aged ≥6 months should receive an annual influenza vaccine,
Diseases, CDC; Jay Butler, Office of the Deputy Director of
and vaccination is still available and effective in helping to Infectious Disease, CDC; Russell Cantrell, Center for State, Tribal,
prevent influenza (10). Reducing the number of persons in Local and Territorial Support, CDC; Cristina Cardemil, National
the United States with seasonal influenza will reduce possible Center for Immunization and Respiratory Diseases, CDC; Jordan
confusion with 2019-nCoV infection and possible additional Cates, National Center for Immunization and Respiratory Diseases,
risk to patients with seasonal influenza. Public health authori- CDC; Marty Cetron, National Center for Emerging and Zoonotic
ties are monitoring the situation closely. As more is learned Infectious Diseases, CDC; Kevin Chatham-Stephens, National
about this novel virus and this outbreak, CDC will rapidly Center on Birth Defects and Developmental Disabilities, CDC;
incorporate new knowledge into guidance for action. Kevin Chatham-Stevens, National Center on Birth Defects and
Developmental Disabilities, CDC; Nora Chea, National Center for
Acknowledgments Emerging and Zoonotic Infectious Diseases, CDC; Bryan
Arizona Department of Health Services; Maricopa County Christensen, National Center for Emerging and Zoonotic Infectious
Department of Public Health; California Department of Public Diseases, CDC; Victoria Chu, National Center for Immunization
Health; Los Angeles County Department of Public Health; Orange and Respiratory Diseases, CDC; Kevin Clarke, Center for Global
County Health Department; San Benito County Public Health Health, CDC; Angela Cleveland, National Center for Immunization
Services Department; Santa Clara County Public Health Department; and Respiratory Diseases, CDC; Nicole Cohen, National Center for
Illinois Department of Public Health; Chicago Department of Public Emerging and Zoonotic Infectious Diseases, CDC; Max Cohen,
Health; Cook County Department of Public Health; DuPage County Center for State, Tribal, Local and Territorial Support, CDC; Amanda
Health Department; Massachusetts Department of Public Health; Cohn, National Center for Immunization and Respiratory Diseases,
Washington State Department of Health; Snohomish Health District. CDC; Jennifer Collins, National Center for Emerging and Zoonotic
Infectious Diseases, CDC; Erin Conners, National Center for
2019-nCoV CDC Response Team Emerging and Zoonotic Infectious Diseases, CDC; Aaron Curns,
Fatuma Abdirizak, National Center for Immunization and National Center for Immunization and Respiratory Diseases, CDC;
Respiratory Diseases, CDC; Glen Abedi, National Center for Rebecca Dahl, National Center for Immunization and Respiratory
Immunization and Respiratory Diseases, CDC; Sharad Aggarwal, Diseases, CDC; Walter Daley, Center for Preparedness and Response,
National Center for Immunization and Respiratory Diseases, CDC; CDC; Vishal Dasari, Center for State, Tribal, Local and Territorial
Denise Albina, National Center for Emerging and Zoonotic Support, CDC; Elizabeth Davlantes, Center for State, Tribal, Local
Infectious Diseases, CDC; Elizabeth Allen, National Center for and Territorial Support, CDC; Patrick Dawson, National Center for
Emerging and Zoonotic Infectious Diseases, CDC; Lauren Andersen, Emerging and Zoonotic Infectious Diseases, CDC; Lisa Delaney,
National Center for Emerging and Zoonotic Infectious Diseases, National Institute for Occupational Safety and Health, CDC;
CDC; Jade Anderson, Center for Preparedness and Response, CDC; Matthew Donahue, Center for State, Tribal, Local and Territorial
Megan Anderson, Center for Preparedness and Response, CDC; Tara Support, CDC; Chad Dowell, National Institute for Occupational
Anderson, Center for State, Tribal, Local and Territorial Support, Safety and Health, CDC; Jonathan Dyal, National Center for
CDC; Kayla Anderson, National Center on Birth Defects and Immunization and Respiratory Diseases, CDC; William Edens,
Developmental Disabilities, CDC; Ana Cecilia Bardossy, National National Center for Immunization and Respiratory Diseases, CDC;
Center for Emerging and Zoonotic Infectious Diseases, CDC; Rachel Eidex, National Center for Emerging and Zoonotic Infectious
Vaughn Barry, National Center for Injury Prevention and Control, Diseases, CDC; Lauren Epstein, National Center for Emerging and
CDC; Karlyn Beer, National Center for Emerging and Zoonotic Zoonotic Infectious Diseases, CDC; Mary Evans, National Center
Infectious Diseases, CDC; Michael Bell, National Center for for Injury Prevention and Control, CDC; Ryan Fagan, National
Emerging and Zoonotic Infectious Diseases, CDC; Sherri Berger, Center for Emerging and Zoonotic Infectious Diseases, CDC; Kevin
Office of the Director, CDC; Joseph Bertulfo, Office of the Director, Farris, National Center for Immunization and Respiratory Diseases,
CDC; Holly Biggs, National Center for Immunization and CDC; Leora Feldstein, National Center for Immunization and
Respiratory Diseases, CDC; Jennifer Bornemann, Office of the Respiratory Diseases, CDC; LeAnne Fox, National Center for
Director, CDC; Josh Bornstein, Office of the Director, CDC; Willie Immunization and Respiratory Diseases, CDC; Mark Frank, Center
Bower, National Center for Emerging and Zoonotic Infectious for Preparedness and Response, CDC; Brandi Freeman, National
Diseases, CDC; Joseph Bresee, National Center for Immunization Center for Immunization and Respiratory Diseases, CDC; Alicia
and Respiratory Diseases, CDC; Clive Brown, National Center for Fry, National Center for Immunization and Respiratory Diseases,
Emerging and Zoonotic Infectious Diseases, CDC; Alicia Budd, CDC; James Fuller, Center for Global Health, CDC; Romeo Galang,

144 MMWR / February 7, 2020 / Vol. 69 / No. 5 US Department of Health and Human Services/Centers for Disease Control and Prevention
 Morbidity and Mortality Weekly Report

National Center for Chronic Disease Prevention and Promotion, Diseases, CDC; Brian Manns, National Center for Immunization
CDC; Sue Gerber, National Center for Immunization and and Respiratory Diseases, CDC; Nina Marano, National Center for
Respiratory Diseases, CDC; Runa Gokhale, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Mariel Marlow,
Emerging and Zoonotic Infectious Diseases, CDC; Sue Goldstein, National Center for Immunization and Respiratory Diseases, CDC;
National Center for Immunization and Respiratory Diseases, CDC; Barbara Marston, Center for Global Health, CDC; Nancy McClung,
Sue Gorman, Center for Preparedness and Response, CDC; William National Center for Immunization and Respiratory Diseases, CDC;
Gregg, National Center for Immunization and Respiratory Diseases, Liz McClure, Center for Global Health, CDC; Emily McDonald,
CDC; William Greim, National Center for Emerging and Zoonotic National Center for Emerging and Zoonotic Infectious Diseases,
Infectious Diseases, CDC; Steven Grube, Office of the Director, CDC; Oliva McGovern, National Center for Immunization and
CDC; Aron Hall, National Center for Immunization and Respiratory Respiratory Diseases, CDC; Nancy Messonnier, National Center for
Diseases, CDC; Amber Haynes, National Center for Immunization Immunization and Respiratory Diseases, CDC; Claire Midgley,
and Respiratory Diseases, CDC; Sherrasa Hill, National Center for National Center for Immunization and Respiratory Diseases, CDC;
Immunization and Respiratory Diseases, CDC; Jennifer Hornsby- Danielle Moulia, National Center for Immunization and Respiratory
Myers, National Institute for Occupational Safety and Health, CDC; Diseases, CDC; Janna Murray, National Center for Immunization
Jennifer Hunter, National Center for Emerging and Zoonotic and Respiratory Diseases, CDC; Kate Noelte, Center for Preparedness
Infectious Diseases, CDC; Christopher Ionta, National Center for and Response, CDC; Michelle Noonan-Smith, Office of the Director,
Immunization and Respiratory Diseases, CDC; Cheryl Isenhour, CDC; Kristen Nordlund, National Center for Immunization and
National Center for Immunization and Respiratory Diseases, CDC; Respiratory Diseases, CDC; Emily Norton, National Institute for
Max Jacobs, Center for State, Tribal, Local and Territorial Support, Occupational Safety and Health, CDC; Sara Oliver, National Center
CDC; Kara Jacobs Slifka, National Center for Emerging and for Immunization and Respiratory Diseases, CDC; Mark Pallansch,
Zoonotic Infectious Diseases, CDC; Daniel Jernigan, National National Center for Immunization and Respiratory Diseases, CDC;
Center for Immunization and Respiratory Diseases, CDC; Michael Umesh Parashar, National Center for Immunization and Respiratory
Jhung, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Anita Patel, National Center for Immunization and
Diseases, CDC; Jamie Jones-Wormley, Center for Preparedness and Respiratory Diseases, CDC; Manisha Patel, National Center for
Response, CDC; Anita Kambhampati, National Center for Immunization and Respiratory Diseases, CDC; Kristen Pettrone,
Immunization and Respiratory Diseases, CDC; Shifaq Kamili, National Center for Health Statistics, CDC; Taran Pierce, National
National Center for Immunization and Respiratory Diseases, CDC; Center for Emerging and Zoonotic Infectious Diseases, CDC; Harald
Pamela Kennedy, National Center for Immunization and Respiratory Pietz, Center for Preparedness and Response, CDC; Satish Pillai,
Diseases, CDC; Charlotte Kent, Center for Surveillance, National Center for Emerging and Zoonotic Infectious Diseases,
Epidemiology and Laboratory Services, CDC; Marie Killerby, CDC; Lewis Radonovich, National Institute for Occupational Safety
National Center for Immunization and Respiratory Diseases, CDC; and Health, CDC; Sarah Reagan-Steiner, National Center for
Lindsay Kim, National Center for Immunization and Respiratory Emerging and Zoonotic Infectious Diseases, CDC; Amy Reel,
Diseases, CDC; Hannah Kirking, National Center for Immunization National Center for Immunization and Respiratory Diseases, CDC;
and Respiratory Diseases, CDC; Lisa Koonin, National Center for Heather Reese, National Center for Immunization and Respiratory
Immunization and Respiratory Diseases, CDC; Ram Koppaka, Diseases, CDC; Brian Rha, National Center for Immunization and
National Center for Immunization and Respiratory Diseases, CDC; Respiratory Diseases, CDC; Philip Ricks, Center for Global Health,
Christine Kosmos, Center for Preparedness and Response, CDC; CDC; Melissa Rolfes, National Center for Immunization and
David Kuhar, National Center for Emerging and Zoonotic Infectious Respiratory Diseases, CDC; Shahrokh Roohi, National Center for
Diseases, CDC; Wendi Kuhnert-Tallman, Deputy Director for Emerging and Zoonotic Infectious Diseases, CDC; Lauren Roper,
Infectious Diseases, CDC; Stephanie Kujawski, National Center for National Center for Immunization and Respiratory Diseases, CDC;
Immunization and Respiratory Diseases, CDC; Archana Kumar, Lisa Rotz, National Center for Emerging and Zoonotic Infectious
National Center for Immunization and Respiratory Diseases, CDC; Diseases, CDC; Janell Routh, National Center for Immunization
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conflicts of interest. No potential conflicts of interest were disclosed.

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