niman

Map Update https://www.google.com/maps/d/edit?hl=en&hl=en&authuser=0&authuser=0&mid=1FlIB7hHnVgGD9TlbSx5HwAj-PEQ

Latest Facts and Advisories as of 6/15/2016 [Español (PDF)]Reported cases of Zika in New York City: 15119 of the 151 cases were pregnant at the time of diagnosis;All cases contracted Zika while visiting other countries; andAll patients have recovered.

TABLE I. Provisional cases of selected* infrequently reported notifiable diseases (<1,000 cases reported during the preceding year), United States, week ending June 11, 2016 (WEEK 23)† Disease Total cases reported for previous years Current weekCum 20165-year weekly average§20152014201320122011States reporting cases during current week (No.23) Anthrax-------1 Arboviral diseases ¶,**: Chikungunya virus ††-423897NNNNNNNN Eastern equine encephalitis virus--0688154 Jamestown Canyon virus §§--011112223 La Crosse virus §§--155808578130 Powassan virus-117812716 St. Louis encephalitis virus--02310136 Western equine encephalitis virus-------- Botulism, total1583195161152168153 foodborne150371542724OK (1 ) infant-47213812713612397 other(wound & unspecified)-602019121832 Brucellosis2462127929911479NY (1 ), OH (1 ) Chancroid-7011--158 Cholera--025141740 Cyclosporiasis **-1914645388784123151 Diphtheria----1-1- Haemophilus influenzae, invasive disease (age <5 yrs) ¶¶: serotype b1802940313014NY (1 ) nontypeable serotype-76315012814111593 other serotype-531128266233263230 unknown serotype195419939343748VA (1 ) Hansen's disease **-1918888818282 Hantavirus Infections **: Hantavirus infection (non-HPS) ††-2-1NNNNNNNN Hantavirus pulmonary syndrome (HPS)-411732213023 Hemolytic uremic syndrome, post-diarrheal **3675273250329274290NY (1 ), OK (2 ) Hepatitis B, virus infection perinatal-13139474840NP Influenza-associated pediatric mortality **, ***171113014116052118CA (1 ) Leptospirosis **-1503838NNNNNN Listeriosis218313767769735727870VA (1 ), FL (1 ) Measles †††-311618866718755220 Meningococcal disease, invasive §§§: serogroup ACWY-483105123142161257 serogroup B-3221048999110159 other serogroup1702025172020OK (1 ) unknown serogroup3844143196298260323NY (1 ), NYC (1 ), CO (1 ) Novel influenza A virus infections ¶¶¶-20632131314 Plague--01310443 Poliomyelitis, paralytic-----1-- Polio virus infection, nonparalytic **-------- Psittacosis **13048622MI (1 ) Q fever total **:1394158168170135134 acute1333123132137113110TN (1 ) chronic-603536332224 Rabies, human--011216 SARS CoV-------- Smallpox-------- Streptococcal toxic shock syndrome **11274335259224194168MT (1 ) Syphilis, congenital ****-1267489458348322360 Toxic shock syndrome (staphylococcal) **-1316659716578 Trichinellosis **-501114221815 Tularemia3348314180203149166MO (1 ), TN (1 ), TX (1 ) Typhoid fever21197367349338354390NYC (1 ), AZ (1 ) Vancomycin-intermediate Staphylococcus aureus **347318421224813482OH (1 ), MO (1 ), LA (1 ) Vancomycin-resistant Staphylococcus aureus **--01--2- Viral hemorrhagic Fevers ††††: Crimean-Congo hemorrhagic fever----NPNPNPNP Ebola hemorrhagic fever----4NPNPNP Guanarito hemorrhagic fever----NPNPNPNP Junin hemorrhagic fever----NPNPNPNP Lassa fever----1NPNPNP Lujo virus----NPNPNPNP Machupo hemorrhagic fever----NPNPNPNP Marburg fever----NPNPNPNP Sabia-associated hemorrhagic fever----NPNPNPNP Yellow fever-------- Zika ††,§§§§ Zika virus congenital infectionNANANANNNNNNNNNN Zika virus disease, non-congenital infection66970NNNNNNNNNNMA (1 ), MD (3 ), OK (1 ), TX (1 )[ Export This Table ] [ Next Part ] [ NNDSS Interactive Tables ] [ Mortality Interactive Tables ] -: No reported cases N: Not reportable. NA: Not Available NN: Not Nationally Notifiable. NP: Nationally notifiable but not published. Cum: Cumulative year-to-date counts. * Case counts for reporting years 2015 and 2016 are provisional and subject to change. Data for years 2011 through 2014 are finalized. For further information on interpretation of these data, see http://wwwn.cdc.gov/nndss/document/ProvisionalNationaNotifiableDiseasesSurveillanceData20100927.pdf. † This table does not include cases from the U.S. territories. Three low incidence conditions, rubella, rubella congenital, and tetanus, are in Table II to facilitate case count verification with reporting jurisdictions. § Calculated by summing the incidence counts for the current week, the 2 weeks preceding the current week, and the 2 weeks following the current week, for a total of 5 preceding years. Additional information is available at http://wwwn.cdc.gov/nndss/document/5yearweeklyaverage.pdf. ¶ Includes both neuroinvasive and nonneuroinvasive. Updated weekly reports from the Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (ArboNET Surveillance). Data for West Nile virus are available in Table II. ** Not reportable in all reporting jurisdictions. Data from states where the condition is not reportable are excluded from this table, except for the arboviral diseases and influenza-associated pediatric mortality. Reporting exceptions are available at http://wwwn.cdc.gov/nndss/downloads.html. †† Office of Management and Budget approval of the NNDSS Revision #0920-0728 on January 21, 2016, authorized CDC to receive data for these conditions. CDC is in the process of soliciting data for these conditions (except Zika virus, congenital infection). CDC and the U.S. states are still modifying the technical infrastructure needed to collect and transmit data for Zika virus congenital infections. §§ Jamestown Canyon virus and Lacrosse virus have replaced California serogroup diseases. ¶¶ Data for Haemophilus influenzae (all ages, all serotypes) are available in Table II. *** Please refer to the MMWR publication for weekly updates to the footnote for this condition. ††† Please refer to the MMWR publication for weekly updates to the footnote for this condition. §§§ Data for meningococcal disease (all serogroups) are available in Table II. ¶¶¶ Please refer to the MMWR publication for weekly updates to the footnote for this condition. **** Updated weekly from reports to the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. †††† Please refer to the MMWR publication for weekly updates to the footnote for this condition. §§§§ All cases reported have occurred in travelers returning from affected areas, with their sexual contacts, or infants infected in utero.National Notifiable Diseases Surveillance System (NNDSS) MMWR web application provided by CDC WONDER, http://wonder.cdc.gov

2015 total from prior week is 59 2016 total below Zika ††,§§§§ Zika virus congenital infectionNANANANNNNNNNNNN Zika virus disease, non-congenital infection66970NNNNNNNNNNMA (1 ), MD (3 ), OK (1 ), TX (1 ) http://wonder.cdc.gov/mmwr/mmwr_2016.asp?mmwr_year=2016&mmwr_week=23&mmwr_table=1&request=Submit&mmwr_location=

Ministry of Health confirmed 30 new cases of microcephalyBy Kerolyn Araújo - June 15, 2016Share on Facebook Tweet to Twitter Last week, the Ministry of Health confirmed the diagnosis of microcephaly and other changes in the nervous system in 30 babies, all suggestive of having been caused by congenital infection. In all, 1,581 cases are now recorded in October last year until June 11. Other3,047 babies with suspected defects had not yet completed the tests for accurate diagnosis. Of the total confirmed, 226 were laboratory tests proving that were caused by Zika virus.However, for the Ministry of Health this number does not reflect reality. For the binder, most confirmed were caused by viruses Zika , but difficulties of diagnosing the disease, the situation has not been proven in the laboratory. The new report recorded 3,308 cases discarded because of normal subjects, because they have microcephaly, defects confirmed because no infectious or do not meet the case definition. The 1,581 confirmed cases in Brazil occurred in 562 municipalities located in 25 Brazilian states and the Federal District. Most of the records (1,394) was recorded in the Northeast. http://www.oestadoce.com.br/editorias/viver/ministerio-da-saude-confirma-30-novos-casos-de-microcefalia

Zika: The Epidemic at America's DoorZika may have already infected 80,000 Americans, just in Puerto Rico, and Congress has refused to act — what if Miami or New York is next? BY JANET REITMAN June 15, 2016 Share Tweet Share Comment Email "There's a surprise a day with the virus," says the CDC's Zika expert. "That's the untold story — there's a lot we just don't know." Puerto Rico's Martin Peña canal is a winding, heavily polluted waterway that snakes 3.7 miles through the center of San Juan. Eight small, deeply impoverished communities, all lacking an efficient sewage system, surround the channel, and have for generations dumped untreated waste directly into the mud-colored water. One Friday in late April, it rained torrentially all night, turning the narrow streets into waist-high, foul-smelling rivers, washing away furniture, appliances, clothing and cars. Some degree of flooding happens about 20 times a year, and signs are posted along the canal advising, in Spanish, that "contact with the water may cause illness." In the past, the health risks have included gastrointestinal ailments, as well as mosquito-borne viruses, like dengue fever. This spring, another mosquito-related illness, the Zika virus, was added to the list. SIDEBARAbortion Rights at Risk: The GOP's War on Women Rages On »On the Sunday after this deluge, I visit the tiny community of Buena Vista Hato Rey, which is drying out after a day of 90-degree heat. Navigating around gigantic mud puddles, I find my way to the small, one-story home of Dolores Perez, who is standing in her courtyard surrounded by her soggy possessions: rugs, jeans, sweatshirts, a hair dryer. She's lived in the house for 43 years, she tells me, and had lain awake all of Friday night waiting for the flood, which she and her family eventually managed to push back with brooms, mops and dustpans. This time, they'd been able to save their furniture, she said; in the future, who could tell? The Perez family, thanks to their damaged pipes, hadn't had running water in about a year. "We called the water company 11 times – finally they tell us, 'Get a plumber,'" Perez's brother says, wryly. Yet there is plenty of standing water – in the streets, the gutters, the abandoned houses and empty lots – none of which the city of San Juan is able to do much about. If the water isn't removed, it is a near certainty that swarms of mosquitoes will be born in those pools, and at least some of them will carry Zika, which could, if public-health estimates are right, infect up to 875,000 of the island's 3.5 million people by the end of the year. The specter of this plague, whose true impact may take months to emerge, looms over Puerto Rico, the largely impoverished island territory, roughly the size of Connecticut, that has become the Zika epicenter for the United States. Of the 1,301 mosquito-borne cases recorded in the U.S., 97 percent of them are in Puerto Rico, neither a state nor a sovereign nation, but whose people are, nonetheless, U.S. citizens. As of early June, the start of Puerto Rico's long, hot and rainy summer, there are 1,259 recorded cases on the island, though some health officials believe the true number may be more than 80,000. In February, the Obama administration requested $1.9 billion in emergency aid to combat Zika, but Congress has yet to approve any funds. In May, the Senate put forth a bill to provide $1.1 billion, but House Republicans rejected the measure, instead proposing the government provide $622 million, most of which would be redirected from money set aside to fight Ebola and other infectious diseases. A week later, Congress broke for a 10-day recess without coming to a decision. Dr. Tom Frieden, head of the Centers for Disease Control and Prevention, told the National Press Club that he was shocked by the delay: "We have a narrow window of opportunity to scale up effective Zika-prevention measures, and that window of opportunity is closing." Panicking that his state could soon face "disaster" as mosquito season approached, Florida Gov. Rick Scott, a Republican, wrote a letter to President Obama, beseeching him to make federal funds available. "Congress has failed to act, and now they are on vacation," he said. In 2014, Congress agreed to spend $5.4 billion on the Ebola epidemic, and Frieden, who notes the CDC is still trying to stamp out Ebola in West Africa, said he "hopes that Congress will do the right thing with Zika." But unlike Ebola, which causes gruesome symptoms often followed by death, Zika is somewhat of a stealth virus. Most people infected will have no symptoms. Some may come down with conjunctivitis or break out in a skin rash, or experience muscle or joint pain or run a fever. Within a week or so, all of the symptoms, if they even emerged, are gone. In a certain number of cases, however, this may only be the beginning. Women who are infected with Zika during pregnancy run the risk of passing the virus to the fetus, which may then develop birth defects, the worst being microcephaly, a condition that causes babies to be born with undersize brains and heads. Depending on the severity, children with microcephaly may be stillborn or die shortly after birth, and those who live longer may require extensive, and expensive, medical care – the CDC estimates that it could cost $10 million to care for one microcephalic child. Zika, which seems to be particularly drawn to neurological tissue, may also cause swelling of the brain or spinal cord in adults, and has been linked to Guillain-Barré syndrome, an autoimmune neurological condition that can cause severe, if usually temporary, paralysis. But the scariest aspect of Zika is how little that scientists actually know about it. "There's a surprise a day with this virus," says Dr. Lyle Petersen, director of the CDC's division of vector-borne diseases, which are illnesses spread by arthropods like mosquitoes and ticks. Zika is spread by the Aëdes aegypti, the same mosquito that carries dengue, yellow fever and chikungunya. But Zika, notes Petersen, is the first virus since the rubella outbreak of the 1960s to cause major birth defects. Microcephaly may be just one of many complications. Researchers are also preparing for the possibility that Zika will cause a host of developmental problems that are, so far, unknown, and may take months or years to emerge. "That's really the untold story of this: We don't know the whole spectrum," says Petersen. "Are children that are born that look 'normal' really normal? That's going to take time, and some very sophisticated testing, to figure out." Epidemiologists were surprised that a virus spread by mosquito could cause birth defects (rubella, they note, was spread by humans). Even more of a shock was that Zika could be sexually transmitted through semen. This is uncommon in vector-borne diseases, and it's a concern, says Petersen, because while mosquitoes are still the primary method of transmission, Zika lives in the blood for no more than a week or so. But the virus appears to linger much longer in other bodily fluids. "Does it mean that somebody can transmit [Zika] sexually four months after they've been infected? We don't really know that," he says. "And that's the problem. There is a lot we just don't know." Frequent floods around Puerto Rico's Martin Peña Canal create dangerous breeding grounds for Zika. EPAZika was first discovered in 1947 in the Zika Forest of Uganda, where researchers were studying the impact of mosquito-borne viruses on rhesus monkeys. Over the next 60 years, there were only 14 documented cases of Zika in humans, mainly in Africa and parts of southern Asia. Then, in 2007, a Zika outbreak began on the tiny South Pacific island of Yap, where some 900 people were infected, though most had few or no symptoms. The next Zika outbreak occurred six years later, in 2013, when 31,000 people sought treatment for the virus in French Polynesia and its nearby islands. By 2014, Zika had spread to Brazil, where maternity wards in the summer of 2015 began to notice a strange new phenomenon: at first one or two, and then dozens of babies, born with small, almost pointed heads. Although Brazil remains the hardest-hit, with perhaps 1.5 million Brazilians infected and more than 1,500 babies born with Zika-related microcephaly, Zika has since circled the globe, spreading across Latin America and the Caribbean, where there is active transmission of the virus in 41 countries and territories. Writing in the New England Journal of Medicine last winter, Dr. Anthony Fauci, director of the National Institute for Allergies and Infectious Disease at the National Institutes of Health, noted that Zika was just the latest mosquito-borne virus to reach the Western Hemisphere in the past 20 years, following the path of dengue fever, West Nile virus and chikungunya. This, he suggested, "forces us to confront a potential new disease-emergence phenomenon: pandemic expansion of multiple, heretofore relatively unimportant [mosquito-borne viruses] previously restricted to remote ecologic niches." Three central factors contribute to the spread of these diseases, the first being climate change. Mosquitoes thrive in warm weather, and as temperatures rise, notes Petersen, "mosquitoes become more infectious, and they become more infectious faster." Outbreaks of West Nile virus, for instance, have happened during heat waves. Increased urbanization is also a major contributor, as is the recent explosion of global travel. Diseases like Zika "hitchhike in the blood," says the CDC's Frieden. "This is the new normal. We are a globalized and urbanized world, and diseases are just a plane ride away." There are currently 618 confirmed cases of Zika in the continental U.S., among them 195 pregnant women, one of whom recently gave birth to a baby with microcephaly in New Jersey. She, like all of the people diagnosed with Zika, contracted the illness while traveling or living outside of the 50 states. There have also been some reports of sexual transmission in the U.S. and in Europe, including one case in France where Zika appears to have been transferred through oral sex. Though alarming, every case of sexual transmission has, so far, come from contact with people who were infected with the virus by a mosquito, says Petersen, who doesn't expect this to change. Zika might live in other bodily fluids longer than in blood, "but it's not six months," he says. "This is not going to be something like syphilis or gonorrhea." Right now, scientists predict that while there may be an uptick in "imported" cases of Zika, the chances of a major Zika outbreak happening in the continental U.S. are fairly low – though Aëdes aegypti and its cousin Aëdes albopictus, which can also carry Zika, are endemic along the coasts and in the Southern U.S., leaving cities like Houston and Miami, and the Florida Keys, more vulnerable. Over the past decade, there have been small outbreaks of dengue and chikungunya in pockets of the U.S., including most recently a dengue outbreak in Hawaii, but these have been limited in scope, suggesting that Zika will likely follow the same pattern. That said, notes Petersen, "Obviously, this virus is not dengue or chikungunya, so I think we have to be prepared for transmission to occur in any place where the vector is present. Who knows what will happen?" Even in the worst-case scenario, Petersen says, if the virus were to infect an entire city or region, there could be aerial spraying of mosquito-killing insecticide and warnings to pregnant women that they should avoid these infested areas. And given the prevalence of a host of factors, ranging from effective sanitation to the ubiquity of window screens and air conditioning, this kind of outbreak anywhere in the continental U.S., and much of Europe, for that matter, is unlikely. "I can't imagine a scenario where [Zika would be so widespread that] we'd say, 'Don't go to Florida,'" says Petersen. "I can see saying 'Don't go to Puerto Rico or parts of Miami.' But if what is happening in Puerto Rico was happening in Florida, it would be a national catastrophe." Of the $1.9 billion the White House has requested for Zika, $828 million would go to the CDC to fund expanded mosquito-control programs, surveillance and public-education campaigns, both in the U.S. and internationally. Another $200 million would help fund the National Institutes of Health, the Food and Drug Administration and the Department of Health and Human Services to accelerate and possibly expand diagnostic testing and speed the creation of a vaccine, which scientists say won't be ready before 2018. The government has nixed any idea of performing mandatory, or even voluntary, testing on people returning from Zika-infested regions. "There are about 40 million travelers each year between the U.S. and areas with active Zika outbreaks," says Frieden. "You can't test everyone." Instead, the CDC's main priority is protecting pregnant women, the population most at risk. "That includes having them avoid travel to areas where Zika is spreading, and for travelers to use repellent upon return to prevent Zika from entering the U.S. mosquito population," he says. President Obama speaks to the media about the Zika virus, accompanied by Vice President Joe Biden, on May 20th. Mark Wilson/GettyAbout $750 million of the money Obama has requested for Zika would go to Puerto Rico, which in addition to undergoing a public-health disaster is also facing a $70 billion debt crisis. This has thrown the island's health care industry, the spending for which accounts for 20 percent of its gross domestic product, into particular crisis. Over the past year, Puerto Rico has been forced to cut back on a variety of health-related services, shuttering hospital wards, or even entire facilities, and delaying payments to the major insurers. The Puerto Rico Healthcare Crisis Coalition, a newly formed advocacy group, estimates that 3,000 doctors have left Puerto Rico since 2010, a steady brain drain that amounted last year to a loss of roughly one doctor per day. According to Dr. Victor Ramos, the head of Puerto Rico's College of Physicians and Surgeons, without immediate relief, the country's heath care system could collapse entirely by late summer. Mosquito-borne illnesses, though not exclusively diseases of poverty, have a disproportionate impact on the poor, but urbanization, one of the key factors in the spread of all infectious disease, means that rich and poor invariably collide. One irony of San Juan is that some of its poorest and most trash-ridden neighborhoods are located just blocks from its financial center, known as the Golden Mile – indeed, the San Juan headquarters of the Swiss banking giant UBS, a major player in Puerto Rico's current debt crisis, looms over the slums, with which it shares the same sewer system. This potent reminder of Puerto Rico's class divisions – not to mention the essential interconnectedness of those on both sides of this divide – is also a larger metaphor for the island's quasi-colonial relationship with the United States, which not only controls Puerto Rico's economic development, but also determines what it will be given by the federal government to address its most pressing local issues, including public health. Even after 1952, when Puerto Rico received its own constitution, its chief governing authority was still Congress, which has subjected the former colony to an inequitable system by which Puerto Ricans, who do not have a vote in Congress and cannot vote in federal elections, don't pay federal income tax, but do pay the same Medicare and Social Security taxes as those on the mainland – and receive roughly half of the entitlements as the states. Almost 50 percent of Puerto Rico's population lives below the poverty line, and close to 70 percent relies on some form of government-funded health care. The federal government covers $1.2 billion of the island's $2.5 billion in Medicaid costs, though that number will drop to less than $400 million once a temporary fund established by the Affordable Care Act in 2011 runs dry, which officials say could happen as soon as September 2017. In contrast, Mississippi, the poorest U.S. state – though not as poor as Puerto Rico – received $3.6 billion in 2014, more than 70 percent of its total bill. What this has meant, explains Dr. Johnny Rullán, an epidemiologist who is also the island's former secretary of health, is that the federal government has given Puerto Ricans a choice: either ignore their poor or dig into their own pockets to provide them with health care. "Since we care about our poor people," says Rullán, "we chose [the latter], which puts us 1 to 2 billion dollars in debt a year," leaving the island no money for public health. This inconvenient truth is just one of many intractable problems plaguing Puerto Rico, some of which pertain to the island's tangled finances, others to its messy relationship with Washington. But either way, Zika could easily push Puerto Rico over the edge. "They are completely, 100 percent overwhelmed, and they are facing a real health emergency," says Nicholas Prouty, a San Juan-based real estate investor and Democratic fundraiser who, since the Zika crisis began, has lobbied the White House to provide relief to Puerto Rico and other affected regions using the Stafford Disaster Relief and Emergency Assistance Act, which would allow the president to circumvent Congress. "If we continue on the same path, the consequences of Zika for Puerto Rico will be devastating," Prouty says. He conjures a grim scenario of swarms of newly hatched mosquitoes, having incubated in the summer heat, emerging during a heavy rain from the countless discarded tires that currently litter the island. "This is when the situation metastasizes and reaches the tipping point," he says. "Add to it reduced garbage collection due to government austerity, and you got yourself the recipe for heartbreak" – babies born with deformities, and a massive infusion of public money needed to support them, for life. Zika has caused at least 1,500 Brazilian babies to be born with microcephaly. Mario Tama/GettyConsider the short but pointed life of Aëdes aegypti, sometimes called the "cockroach mosquito." It is a carrier, or vector, of a host of diseases, from yellow fever to dengue to Zika, all of which have direct impact on humans. That is because, unlike some other mosquitoes – and there are 3,500 different species of mosquito, divided into 41 genus types – aegypti are human-centric. "These are mosquitoes that have quite literally co-evolved side by side with humans," says Dr. Tyler Sharp, the CDC's chief epidemiologist in Puerto Rico. "Most everybody on the island, myself included, have these mosquitoes in their homes, and that is because we are their main food source, and we provide them with their main habitat for reproduction, which is usually discarded trash." Aegypti lay their eggs on anything that can accumulate water – old tires being a favorite, as well as Styrofoam containers, birdbaths, dog bowls, gutters and bottle caps. Once deposited, the eggs, which look like black smudges, can live up to a year. But once submerged in water, as during a heavy rain, they hatch, at which point they move quickly from larvae to pupae to, within about a week, full-grown mosquitoes, whose first objective, as Sharp puts it, is to find a "blood meal." Uniquely, while most mosquitoes live outdoors, aegypti prefer to live as close to us as possible: They can find homes under the bed, at the back of a closet, in the garage. Only female aegypti carry Zika, which they acquire by biting a person with an active Zika infection. After that, the virus incubates inside the mosquito for about a week until it is ready to be transmitted to the next person she bites, who will then transmit the virus to the next mosquito. As aegypti rarely fly beyond a few hundred feet of where they were hatched (unlike other mosquitoes, which can travel miles), the entire human-to-mosquito-to-human transmission process happens in very limited space. "The more people there are, the more garbage there is, the more mosquitoes there are," says Sharp. "And the more mosquitoes there are, the greater the frequency of transmission of the pathogens." The sheer destructiveness of aegypti has prompted scientists in both the public and private sectors to try to devise new ways to trap and kill mosquitoes, though there's still the question of how to reduce the risk of infection, period. "We're asking that question now," says Sharp, who works out of the CDC's Dengue Branch, which is located in a secure and secluded compound in eastern San Juan. Long before anyone heard of Zika, there was dengue, which has been endemic to Puerto Rico since the 1960s. A new trap has been shown to reduce the risk of human infection by 50 percent, but it is costly. Is there actually an affordable intervention that works in terms of reducing human risk of infection? "Um, not yet," Sharp admits. In other words, right now, the mosquitoes are winning. Early this past April, Claudia Moreno, a 27-year-old web producer, woke up one morning with what felt like a nasty hangover. She was exhausted and her head pounded. By afternoon, she'd also developed a fever and chills. Over the next few days, more symptoms emerged: severe joint and muscle pain at first, then an itchy and painful case of conjunctivitis, and most disturbingly, a bright reddish-orange rash that started on her face and spread over her entire body. "That's when I started to worry," she tells me when we meet in San Juan a few weeks later. Claudia, who asked me to not use her real name, lives in a small and tidy apartment in Santurce, a gentrifying area sometimes called the "Brooklyn of San Juan." She is part of a younger generation who left Puerto Rico for college or grad school – in Claudia's case, a master's degree in Europe – but then returned to the island, where mosquitoes are simply a part of everyday life. In Claudia's apartment, which lacks both air conditioning and window screens, mosquitoes live in her bedroom closet, and they breed, she assumes, in bits of standing water in her potted herbs and hanging plants. During the first few days of her illness, Claudia assumed she had dengue fever. But when her boyfriend told her that he too was sick, she began to think it might be something else. After reading about Zika on the CDC's website, Claudia concluded that they probably had the virus, though whether through sex or mosquito, she wasn't sure. But either way, she didn't do much about it. "I guess I could have gone to the doctor," she tells me as we sit drinking coffee on her terrace. But she didn't want to. Seeing a doctor on the island can take up an entire day. As many Puerto Ricans tell me, the wait to be seen can be so long at hospitals and local clinics, as well as in the offices of many private physicians, that people arrive as early as six in the morning to get their name on a list. "Then you have a four-hour period of people waiting [until] the doctor comes to the office, around 11:00," says Claudia. "Then he starts seeing patients at around 1:00. And so, if you don't get bored or if you don't, like, die, he's going to see you, at 6:00." She smiles. "If I'm not coughing blood, I'm not going to the doctor." The Atlanta airport warns of the threat of Zika. Mike Stewart/APThis, if indeed she had Zika (Claudia notes that since she was never diagnosed, she can't be certain), would make Claudia part of what health officials suspect is a hidden majority of Puerto Ricans who have had, or will get, the virus but will never receive a conclusive diagnosis, either because going to a doctor seemed like too much of a hassle, or they had no symptoms. Or even if they did, "some people don't want to know," says Dr. Brenda Rivera, chief epidemiologist for the Puerto Rico Department of Health. A veterinarian by training, Rivera is managing a crisis-response team of local health workers, combined with specialists from CDC headquarters in Atlanta, all of whom work out of Puerto Rico's emergency-operations center, a large, sealed room where a gigantic screen projects an image of the Aëdes aegypti, with its signature white-striped legs, over a map of the island, shaded to reflect where Zika infections have been found. A huge digital clock above the map notes, on the day I visit, that it is the 21st minute of the third hour of the 76th day of the "Level 1" emergency response, the highest level assigned by the CDC. Trying to get a handle on what the response consists of, though, is difficult, since right now the "crisis" is less a visceral, visible reality than it is a ticking time bomb. Of those individuals who do get their blood tested for Zika, it can take a month to get the results, which is true on the mainland as well. This, combined with the sheer ubiquity of mosquitoes, has led some people to shrug off testing. Aëdes aegypti are nervous creatures, "easily disturbed," as scientists put it, and go from one person to the next, biting perhaps four or five people in a single blood meal. It takes only one person with Zika to infect the mosquito, which, during its next meal, might infect a neighbor who is pregnant or wanting to be pregnant, or whose partner is pregnant. Each year, there are 30,000 babies born in Puerto Rico. If health officials' calculus is correct, about a quarter of them will be born to mothers who were at one point infected with Zika. How many will have microcephaly is still unknown. CDC researchers have postulated it could be anywhere from one percent to as high as 13 percent. I never knew about microcephaly until now," says Dr. Carmen Zorilla, an obstetrician specializing in high-risk pregnancies at the University of Puerto Rico's medical center in San Juan, known as Centro Medico. In her office off the hospital's pediatrics unit, Zorilla, an elegant woman in her early sixties, is struggling to explain the strange and disturbing course of this most extreme of Zika's manifestations – which is not, she notes, the same as anencephaly, which is when a fetus simply doesn't have a brain. "These are fetuses that do have brains, but [they're] really small," she says. "You can see this on ultrasounds: The fetus has this normal-size head, and it has a scalp. And then all of a sudden the brain [looks like it] shrinks..." To illustrate, Zorilla cups one manicured hand over the other and then slowly slides it forward, as if pressing down on a ball, while searching for the appropriate English word for what happens next. "The brain looks like a prune," she says finally. Even as scientists continue to learn more about Zika's impact on fetal development, what is currently known is that many women who get infected during their first trimester will have perfectly normal pregnancies, or at least what seems to be normal. And then each subsequent month presents new and more terrifying possibilities. "The problem is, even if the fetus is affected, you might not have ultrasound evidence of neurological damage until much later," says Zorilla. "If at all." Adding to the unease is the international news coverage of Zika, much of it citing alarming proclamations from health officials – "Zika virus: 'Scarier than initially thought,'" CNN announced in April. Almost everyone I meet in San Juan brings up the immense publicity Zika has received in Puerto Rico, much of it by the mainland press, which has hurt tourism, the island's one genuinely thriving industry. The day I met Rivera, in fact, she was in the midst of trying to convince officials from Major League Baseball that, provided they use strong mosquito repellent, it was perfectly safe for the Miami Marlins and the Pittsburgh Pirates to come to San Juan to play a two-game series over Memorial Day weekend. But the league, citing some players' concerns over "contracting and potentially transmitting the Zika virus to their partners," canceled the games, moving the series to... Miami, where there are currently 50 Zika cases. Miami-Dade County, in fact, has been under an official state of emergency over Zika since February. "The same chances you have to get Zika in Puerto Rico, you will have in Miami," Puerto Rico's governor, Alejandro Garcia Padilla, noted on C-SPAN. "It's offensive. It's just ignorant." Mosquito inspectors are closely monitoring Zika's spread in Florida Mark Elias/Bloomberg/GettyShortly after leaving San Juan, I visit Lyle Petersen, who is heading up the CDC's Zika response from its main campus in Atlanta. A lanky Californian in his mid-fifties, Petersen was sent to Atlanta from the division of vector-borne diseases headquarters in Fort Collins, Colorado. There, and in Atlanta, he says, scientists are focusing on Zika, as well as yellow fever, which recently killed several hundred people in Angola. "And Lyme disease is totally out of control," he says. Petersen's main specialty, however, is West Nile, a virus that was unknown in the Western Hemisphere until 1999, and then spread rapidly across the U.S. About 10 years ago, Petersen himself came down with West Nile virus after getting bitten by a mosquito somewhere between his front door and his mailbox. He spent most of the next few months in bed. "West Nile is in every state and causes thousands of people to die or become brain-damaged or paralyzed every year," he says. "And those aren't the tropical Aëdes mosquitoes – those are Culex mosquitoes, the type you find flying around everywhere." Petersen speaks of West Nile to illustrate both the vast array of insect-borne viruses now lurking in our modern world and their tremendous cost. Months of political wrangling between Democrats and Republicans over Zika funds have focused on the details of Obama's $1.9 billion proposal, an open-ended plan that some GOP lawmakers have described as a "slush fund." Both the CDC's Frieden and Fauci from the NIH insist this is not just a blank check, but money necessary to combat Zika without "robbing Peter to pay Paul," as Frieden says. Fauci adds, "We asked for $1.9 billion because we need $1.9 billion." Petersen, though, acknowledges that years of budget cuts at both the NIH and CDC have severely impacted the agencies' emergency preparedness. "Certainly we need money immediately to deal with this – it's a massive response," he says, as we sit in a glass-enclosed conference room overlooking the CDC's emergency-operations center, which seems to be empty. "There are hundreds of people working on Zika," he assures me. "But part of the problem is we haven't been able to build capacity over the past 15 years." America's public-health infrastructure tends to deal reactively with crises – hundreds of millions of dollars, for example, were spent to combat West Nile in the early 2000s. But once the initial crisis passed, says Petersen, "the whole system for monitoring and dealing with these diseases eroded. So now we have another crisis, and there is a critical lack of staffing to deal with these specific types of diseases." And yet, ironically, he says, the rate of vector-borne diseases is only going up. This is due to social and environmental factors as well as lack of political will. Well before the West Nile virus gained a foothold in the Northeast, New York City had drastically cut back on its mosquito-control program. When the virus arrived, in 1999, the city was stuck with a skeleton crew. "When there is an absence of disease, politicians start to ask, 'Why are we funding these preventive public-health measures,'" says Dr. Laura Kahn, a research scholar with Princeton's Science and Global Security program. Kahn is a leader in the "one health" movement, an emerging public-health specialty linking human, animal and environmental health. "It's easy in the urban environment to feel separate from the natural world, but we are a part of the natural world, and it's not that diseases go away, it's that we've got them under control," she says. "As soon as we cut back on prevention, they start roaring back. But they can all be prevented," she adds, "if we had political leaders who made sure their people all had good sanitation, clean water and adequate sewage systems, to prevent mosquitoes from being able to proliferate." Right now, there is no money. So far in 2016, Zika has cost the Puerto Rican economy more than $30 million in lost tourist revenue from canceled hotel reservations – a disaster for the island, now possibly weeks away from defaulting on an $800 million debt payment. During the time I spend on the island, in April, the Sunday edition of El Nuevo Dia, the island's main newspaper, reports that Puerto Rico's health care crisis has gotten so bad, one of the five managed-care companies contracted to provide low-income health care threatened to pull out of the program unless it was paid its share of the $21 million the government owed its health providers. Similar ultimatums have come from private companies providing services ranging from food for prisons to, most recently, used-tire collection, a vital measure in reducing mosquito breeding grounds. The CDC's Lyle Petersen and the Pasteur Institute's Amadou Sall discuss Zika research at the Pan American Health Organization on March 2nd. Saul Leob/GettySome government officials I speak with assure me that these issues have been quickly resolved – and indeed, both the managed-care companies and the sanitation contractors received payment for their services not long after going public. Nonetheless, these issues speak to a larger structural dysfunction that predates Zika or even Puerto Rico's mounting debt. For 64 years, Puerto Rico built its economy by offering itself as a tax haven for U.S. companies. While exploiting various tax incentives helped develop the island's physical and societal infrastructure, it was never meant to provide lasting economic stability. To the contrary, "We have multimillion-dollar companies whose money doesn't stay one day in Puerto Rico," says San Juan Mayor Carmen Yulin Cruz, who notes that more than $34 billion is taken out of Puerto Rico every year by U.S. corporations and sent to banks offshore. This has made Puerto Rico only more dependent on the U.S., preventing it from creating the sort of self-sustaining economic model that states on the mainland enjoy. And this, in turn, just further cripples its ability to deal with Zika. While it waits for Congress to approve emergency-response funds, which could take months, given the summer recess, Puerto Rico has had to turn to private donations for things like condoms and insect repellent for its "Zika prevention kits." The New York Times recently reported that the CDC Foundation, a private charity that supports the work of the CDC, has raised only $1.7 million to stem the Zika epidemic worldwide, as opposed to the $55 million it raised for Ebola. Just the new mosquito traps, says Rullán, the island's former secretary of health, would cost Puerto Ricans $20 apiece. Each home needs three. "That's $60 million. Then you have to decide if you're going to treat septic tanks or water meters. And if you're going to use aerial larvicide, which requires helicopters – that costs billions." A courtly, white-haired physician who was called out of retirement to advise Puerto Rico's governor on Zika, Rullán is frustrated, and with good reason. "Puerto Rico has the best chance of all to prove we can eliminate this disease, because we have the CDC right here, but you have to start now with a strategy that can be monitored until we get the job done." At an international conference of experts in vector control, which took place in late May in San Juan, Rullán had a talk with the director of the Florida Keys Mosquito-Control District, which has 71 full-time and 39 part-time employees, and receives county funds. The Keys are home to more than 40 species of mosquito, including Aëdes aegypti. Recently, after one person came down with dengue, local officials deployed their entire mosquito-control infrastructure to contain the spread of the disease. Now, Rullán says, the Keys are similarly geared up for Zika, even though they have yet to have a confirmed case. "They had five cases of dengue four years ago, and because of that, they have done aerial spraying and larvicide, they've done all the traps, they've done all these PSAs on how to do source reduction, and they've started to work on a six-month plan to reduce mosquitoes," he says. "We don't have any mosquito-control agency, but what we do have is about 30,000 cases of dengue a year, probably 85,000 cases of Zika, 139 pregnant women with Zika in their blood. And yet there's no vector-control plan, no public-service announcements and no funding, unless it starts appearing from wherever it appears. So how do you think I feel when I talk to the guy from Key West? It gets to a point where you go, 'Does Puerto Rico matter?'" In talking to public-health officials like Frieden or Fauci, they are very careful to include Puerto Rico as part of the United States, though as Fauci tells me, "in terms of Zika, Puerto Rico is more like Brazil than it is the continental U.S." He is referring to the scale of the outbreak, but there is still something unspoken that makes it difficult to see Puerto Rico as just as "American" as Florida. "The entire way the U.S. has dealt with Zika in Puerto Rico says a lot about how the U.S. still views Puerto Rico," says Mayor Yulin, who is one of a number of Puerto Ricans who see the hidden hand of colonialism even in the government's refusal to help stop an epidemic. "They don't see it, so it's not there," says Rullán. "But it is there. There is a huge ice mass just below the surface." He wonders when anyone will care. "You just need a few babies born with microcephaly here in the continental U.S. for people to say, 'Why didn't you do anything?'" says Fauci. The current funding proposals in the House wouldn't give Puerto Rico nearly enough. "And that's a problem," he says. From The Archives Issue 1264: July 1, 2016 Read more: http://www.rollingstone.com/culture/features/zika-the-epidemic-at-americas-door-20160615#ixzz4BfVwCGDy Follow us: @rollingstone on Twitter | RollingStone on Facebook

Map Update https://www.google.com/maps/d/edit?hl=en&hl=en&authuser=0&authuser=0&mid=1FlIB7hHnVgGD9TlbSx5HwAj-PEQ

Total below does not include most of cases in Pregnant Registry StatesCDCStatesStatesStatesStatesStatesCDCStatesStatesStatesStates 1-Jun2-Jun2-Jun3-Jun6-Jun7-Jun8-Jun9-Jun9-Jun10-Jun13-Jun14-JunAL525555525566AR545555555555AZ434444424444CA504450535353534853575757CO222222244444CT1911919191920120202023DE333333344455DC566666666666FL162128165165166171172132172175176183GA171717171717181718192021HI98999991010101010IL181618181818181618181818IN677777777777IA666777777777KS222222222222KY656666666666LA444444444444MD171919191919192121212121MA161717171717172020202020ME555555566666MI466666677777MN171717171717171717171717MO444444446666MS333333333333MT111111111111NC121212121212121112121212ND101111101111NE222222222222NH444444444444NJ161419201616211721282828NM112333333333NV666666666666NY183130184186189191204164208211221229OH121212131414141414141414OK444444455555OR1061010101012612121212PA191919192323232324242424RI444444444444SC111111111111TN344444444444TX543654545454544054555757UT222222222222VA181820202020202025252525VT111111111111WA74888894991010WI222222222222WV666666666666 758618777786791798822691846865882901

Zika Virus – June 15, 2016. Texas has had 42 reported cases of Zika virus disease. Of those, 41 were in travelers who were infected abroad and diagnosed after they returned home; one of those travelers was a pregnant woman. One case involved a Dallas County resident who had sexual contact with someone who acquired the Zika infection while traveling abroad. Texas Zika Cases by County: CountyCasesBexar6Collin2Dallas6Denton2Ellis1Fort Bend2Grayson1Harris13Tarrant4Travis2Val Verde1Williamson1Wise1Total42

Confirmed Zika Cases in Oregon, 2016As of 6/14/2016 Travel-associated cases: 7 Oregon mosquito-acquired cases: 0 Total: 7

Map Update https://www.google.com/maps/d/edit?hl=en&hl=en&authuser=0&authuser=0&mid=1FlIB7hHnVgGD9TlbSx5HwAj-PEQ

As of June 14, 201621 confirmed travel-related Zika cases in Georgiahttp://dph.georgia.gov/

As of June 14, 201621 confirmed travel-related Zika cases in Georgia

Map Update https://www.google.com/maps/d/edit?hl=en&hl=en&authuser=0&authuser=0&mid=1FlIB7hHnVgGD9TlbSx5HwAj-PEQ

Surveillance for Zika virus has been ongoing in Connecticut since February 15, 2016. No locally acquired cases have been reported. The following annual statistics are preliminary and are current as of the date shown. http://www.ct.gov/dph/cwp/view.asp?a=3136&pm=1&Q=580282 Zika Virus Testing, Cumulative Results Current as of June 14, 2016 Table: Travel History of Patients with Positive Test Results byZika Affected Country or Territory Visited - Connecticut, February 15 - June 14, 2016 Countries/Territories VisitedZika Positive Flavivirus Positive* Total Aruba 11 Brazil 11 Colombia112 Dominican Republic11 11 El Salvador 11 Guatemala 11 Haiti123 Honduras2 2 Mexico 11 Puerto Rico 3 3Total 18 826 *Test results unable to distinguish between Zika virus, a single-stranded RNA virus in the genusFlavivirus, and others that are closely related including dengue, West Nile, Japanese encephalitis, and yellow fever viruses1. A positive test may mean infection with any of these viruses. Figure: Number of Patients with Positive Zika Virus Test Result by Test Type and Month of Specimen Collection - Connecticut, February 15 - June 14, 2016 Tests Performed for Diagnosis of Zika Virus Infection

Surveillance for Zika virus has been ongoing in Connecticut since February 15, 2016. No locally acquired cases have been reported. The following annual statistics are preliminary and are current as of the date shown. Zika Virus Testing, Cumulative Results Current as of June 14, 2016 Table: Travel History of Patients with Positive Test Results byZika Affected Country or Territory Visited - Connecticut, February 15 - June 14, 2016 Countries/Territories VisitedZika Positive Flavivirus Positive* Total Aruba 11 Brazil 11 Colombia112 Dominican Republic11 11 El Salvador 11 Guatemala 11 Haiti123 Honduras2 2 Mexico 11 Puerto Rico 3 3Total 18 826 *Test results unable to distinguish between Zika virus, a single-stranded RNA virus in the genusFlavivirus, and others that are closely related including dengue, West Nile, Japanese encephalitis, and yellow fever viruses1. A positive test may mean infection with any of these viruses. Figure: Number of Patients with Positive Zika Virus Test Result by Test Type and Month of Specimen Collection - Connecticut, February 15 - June 14, 2016 Tests Performed for Diagnosis of Zika Virus Infection

El Salvador confirms Zika-linked microcephaly caseBy ASSOCIATED PRESS PUBLISHED: 18:10 EST, 14 June 2016 | UPDATED: 18:10 EST, 14 June 2016 SAN SALVADOR, El Salvador (AP) — Health officials in El Salvador have confirmed the first case of a severe birth defect associated with the Zika virus. Public Health Minister Violeta Menjivar said Tuesday that the baby boy with microcephaly was born recently to a 20-year-old mother. El Salvador confirmed the presence of the Zika virus in December 2015. The government had identified 278 pregnant women suspected of having the virus. Of those, 118 have already given birth to babies without microcephaly. Babies with microcephaly have abnormally small heads and underdeveloped brains. http://www.dailymail.co.uk/wires/ap/article-3641929/El-Salvador-confirms-Zika-linked-microcephaly-case.html

El Salvador confirms first Zika-linked birth defectJune 15, 2016El Salvador on Tuesday confirmed its first case of microcephaly in a baby that was linked to a Zika infection in the mother. Microcephaly is a birth defect that causes an abnormally small head and deformed brain. Health Minister Violeta Menjivar said the infant was born in April to a family living in the country's central La Paz province, and the Zika connection was proved "a short while ago." Zika, a virus typically carried by mosquitos, was first detected in the Central American country in November and 10,476 cases of infection have been recorded. Among them, the health ministry counted 274 pregnant women suspected to have been infected with Zika. Of those, 118 gave birth to babies without microcephaly. Menjivar noted that cases of babies with microcephaly believed caused by Zika have also occurred in countries including Brazil, Colombia, Martinique, Panama, Puerto Rico and the United States. Abortion is illegal in El Salvador, a predominantly Christian country. http://medicalxpress.com/news/2016-06-el-salvador-zika-linked-birth-defect.html

El Salvador confirms first Zika-linked birth defectJune 15, 2016El Salvador on Tuesday confirmed its first case of microcephaly in a baby that was linked to a Zika infection in the mother. Microcephaly is a birth defect that causes an abnormally small head and deformed brain. Health Minister Violeta Menjivar said the infant was born in April to a family living in the country's central La Paz province, and the Zika connection was proved "a short while ago." Zika, a virus typically carried by mosquitos, was first detected in the Central American country in November and 10,476 cases of infection have been recorded. Among them, the health ministry counted 274 pregnant women suspected to have been infected with Zika. Of those, 118 gave birth to babies without microcephaly. Menjivar noted that cases of babies with microcephaly believed caused by Zika have also occurred in countries including Brazil, Colombia, Martinique, Panama, Puerto Rico and the United States. Abortion is illegal in El Salvador, a predominantly Christian country. http://medicalxpress.com/news/2016-06-el-salvador-zika-linked-birth-defect.html

http://www.elespanol.com/mundo/20160615/132816723_8.html El Salvador confirmed the first case of microcephaly linked to ZikaThe Central American country is the seventh in which this occurs Minister of Health of El Salvador, Violeta Menjivar, confirmed Tuesday the first case of microcephaly in a baby, born last April, linked to the Zika virus, which El Salvador becomes the seventh country to register this types of cases. "We have confirmed the first case of association Zika and microcephaly (a newborn) , " he revealed the head of the Ministry of Health (MINSAL) at a press conference in which he did not specify the exact date or place of birth " to preserve the anonymity of the family. " Menjivar said that in El Salvador" microcephaly has always been "and that so far this year totaling 48 cases of infants with this disease, which killed three and only 'one we I could confirm that it has to do with the virus. "

El Salvador confirms its first case of birth defect due to ZikaZika infections in pregnant women can cause microcephaly which is a birth defect marked by small head size and can lead to severe developmental problems in babies. By: Agencies | El Salvador | Updated: June 15, 2016 9:33 amThe connection between Zika and microcephaly was first found in Brazil which has reported 1400 such cases so far. (Source: Reuters file photo)Health officials in El Salvador have confirmed the first case of a severe birth defect associated with the Zika virus. Public Health Minister Violeta Menjivar said on Tuesday that the baby boy with microcephaly was born recently to a 20-year-old mother. “Year-to-date 48 cases of microcephaly have been reported, of which one has been determined to be due to Zika,” he told reporters. El Salvador confirmed the presence of the Zika virus in December 2015. The government had identified 278 pregnant women suspected of having the virus. Of those, 118 have already given birth to babies without microcephaly. http://indianexpress.com/article/lifestyle/health/el-salvador-confirms-first-case-of-microcephaly-linked-to-zika-2853765/

Tue Jun 14, 2016 4:51pm EDTRelated: HEALTHEl Salvador says confirms first case of microcephaly linked to Zika El Salvador confirmed on Tuesday its first case of microcephaly in a baby linked to the Zika virus, the health ministry said. "Year-to-date 48 cases of microcephaly have been reported, of which one has been determined to be due to Zika," Health Minister Violeta Menjivar told reporters. U.S. health officials have concluded that Zika infections in pregnant women can cause microcephaly, a birth defect marked by small head size that can lead to severe developmental problems in babies. The World Health Organization has said there is strong scientific consensus that Zika can also cause Guillain-Barre, a rare neurological syndrome that causes temporary paralysis in adults. The connection between Zika and microcephaly first came to light last fall in Brazil, which has now confirmed more than 1,400 cases of microcephaly that it considers to be related to Zika infections in the mothers. (Reporting by Mexico City Newsroom) http://www.reuters.com/article/us-health-zika-elsalvador-idUSKCN0Z02M0

Tue Jun 14, 2016 4:51pm EDTRelated: HEALTHEl Salvador says confirms first case of microcephaly linked to Zika El Salvador confirmed on Tuesday its first case of microcephaly in a baby linked to the Zika virus, the health ministry said. "Year-to-date 48 cases of microcephaly have been reported, of which one has been determined to be due to Zika," Health Minister Violeta Menjivar told reporters. U.S. health officials have concluded that Zika infections in pregnant women can cause microcephaly, a birth defect marked by small head size that can lead to severe developmental problems in babies. The World Health Organization has said there is strong scientific consensus that Zika can also cause Guillain-Barre, a rare neurological syndrome that causes temporary paralysis in adults. The connection between Zika and microcephaly first came to light last fall in Brazil, which has now confirmed more than 1,400 cases of microcephaly that it considers to be related to Zika infections in the mothers. (Reporting by Mexico City Newsroom) http://www.reuters.com/article/us-health-zika-elsalvador-idUSKCN0Z02M0

Sequence Map Update https://www.google.com/maps/d/u/0/edit?hl=en&mid=1XSxKe6FIecV8f33cQwyc7uylxeU

Sequences producing significant alignments:Select:AllNone Selected:0 AlignmentsDownloadGenBankGraphicsDistance tree of resultsShow/hide columns of the table presenting sequences producing significant alignmentsSequences producing significant alignments:Select for downloading or viewing reportsDescriptionMax scoreTotal scoreQuery coverE valueIdentAccessionSelect seq gb|KU866423.2|Zika virus isolate Zika virus/SZ01/2016/China polyprotein gene, complete cds345345100%2e-91100%KU866423.2Select seq gb|KX358623.1|Zika virus isolate AF01 nonstructural protein 5 gene, partial cds345345100%2e-91100%KX358623.1Select seq gb|KX280026.1|Zika virus isolate Paraiba_01, complete genome345345100%2e-91100%KX280026.1Select seq gb|KX253996.1|Zika virus isolate ZKC2/2016, complete genome345345100%2e-91100%KX253996.1Select seq gb|KX197192.1|Zika virus isolate ZIKV/H.sapiens/Brazil/PE243/2015, complete genome345345100%2e-91100%KX197192.1Select seq gb|KX185891.1|Zika virus isolate Zika virus/CN/SZ02/2016 polyprotein gene, complete cds345345100%2e-91100%KX185891.1Select seq gb|KX101067.1|Zika virus isolate Bahia12, partial genome345345100%2e-91100%KX101067.1Select seq gb|KX101064.1|Zika virus isolate Bahia11, partial genome345345100%2e-91100%KX101064.1Select seq gb|KX101060.1|Zika virus isolate Bahia02, partial genome345345100%2e-91100%KX101060.1Select seq gb|KX117076.1|Zika virus isolate Zhejiang04, complete genome345345100%2e-91100%KX117076.1Select seq gb|KX059014.1|Zika virus isolate Haiti/1230/2014 NS5 gene, partial cds345345100%2e-91100%KX059014.1Select seq gb|KX059013.1|Zika virus isolate Haiti/1227/2014 NS5 gene, partial cds345345100%2e-91100%KX059013.1Select seq gb|KX051563.1|Zika virus isolate Haiti/1/2016, complete genome345345100%2e-91100%KX051563.1Select seq gb|KU509998.3|Zika virus strain Haiti/1225/2014, complete genome345345100%2e-91100%KU509998.3Select seq gb|KU963796.1|Zika virus isolate SZ-WIV01 polyprotein gene, complete cds345345100%2e-91100%KU963796.1Select seq gb|KU940228.1|Zika virus isolate Bahia07, partial genome345345100%2e-91100%KU940228.1Select seq gb|KU940224.1|Zika virus isolate Bahia09, partial genome345345100%2e-91100%KU940224.1Select seq gb|KU955589.1|Zika virus isolate Z16006 polyprotein gene, complete cds345345100%2e-91100%KU955589.1Select seq gb|KU926310.1|Zika virus isolate Rio-S1, complete genome345345100%2e-91100%KU926310.1Select seq gb|KU926309.1|Zika virus isolate Rio-U1, complete genome345345100%2e-91100%KU926309.1Select seq gb|KU820899.2|Zika virus isolate ZJ03, complete genome345345100%2e-91100%KU820899.2Select seq gb|KU729217.2|Zika virus isolate BeH823339 polyprotein gene, complete cds345345100%2e-91100%KU729217.2Select seq gb|KU729218.1|Zika virus isolate BeH828305 polyprotein gene, complete cds345345100%2e-91100%KU729218.1Select seq gb|KU744693.1|Zika virus isolate VE_Ganxian, complete genome345345100%2e-91100%KU744693.1Select seq gb|KU497555.1|Zika virus isolate Brazil-ZKV2015, complete genome345345100%2e-91100%KU497555.1Select seq gb|KU232300.1|Zika virus isolate 067ZV_PEBR15 NS5 protein gene, partial cds345345100%2e-91100%KU232300.1Select seq gb|KU232298.1|Zika virus isolate 050ZV_PEBR15 NS5 protein gene, partial cds345345100%2e-91100%KU232298.1Select seq gb|KU232297.1|Zika virus isolate 049ZV_PEBR15 NS5 protein gene, partial cds345345100%2e-91100%KU232297.1Select seq gb|KU232294.1|Zika virus isolate 061ZV_PEBR15 NS5 protein gene, partial cds345345100%2e-91100%KU232294.1Select seq gb|KU232292.1|Zika virus isolate 054ZV_PEBR15 NS5 protein gene, partial cds345345100%2e-91100%KU232292.1Select seq gb|KU232290.1|Zika virus isolate 036ZV_PEBR15 NS5 protein gene, partial cds345345100%2e-91100%KU232290.1Select seq gb|KU556802.1|Zika virus isolate MEX/InDRE/14/2015 NS5 protein gene, partial cds345345100%2e-91100%KU556802.1Select seq gb|KU647676.1|Zika virus strain MRS_OPY_Martinique_PaRi_2015 polyprotein gene, complete cds345345100%2e-91100%KU647676.1Select seq gb|KU321639.1|Zika virus strain ZikaSPH2015, complete genome345345100%2e-91100%KU321639.1Select seq gb|KM078970.1|Zika virus strain CHI2490414 NS5 protein gene, partial cds345345100%2e-91100%KM078970.1Select seq gb|KM078961.1|Zika virus strain CHI2612114 NS5 protein gene, partial cds345345100%2e-91100%KM078961.1Select seq gb|KM078936.1|Zika virus strain CHI1410214 NS5 protein gene, partial cds345345100%2e-91100%KM078936.1Select seq gb|KM078933.1|Zika virus strain CHI1058514 NS5 protein gene, partial cds345345100%2e-91100%KM078933.1Select seq gb|KM078930.1|Zika virus strain CHI2283714 NS5 protein gene, partial cds345345100%2e-91100%KM078930.1Select seq gb|KM078929.1|Zika virus strain CHI1805214 NS5 protein gene, partial cds345345100%2e-91100%KM078929.1Select seq gb|KF993678.1|Zika virus strain PLCal_ZV from Canada polyprotein gene, partial cds345345100%2e-91100%KF993678.1Select seq gb|KJ776791.1|Zika virus strain H/PF/2013 polyprotein gene, complete cds345345100%2e-91100%KJ776791.1Select seq gb|KU232296.1|Zika virus isolate 045ZV_PEBR15 NS5 protein gene, partial cds34234298%2e-90100%KU232296.1Select seq gb|KU232293.1|Zika virus isolate 057ZV_PEBR15 NS5 protein gene, partial cds34234298%2e-90100%KU232293.1Select seq gb|KM078971.1|Zika virus strain CHI2613014 NS5 protein gene, partial cds342342100%2e-9099%KM078971.1Select seq gb|KU820897.3|Zika virus isolate FLR polyprotein gene, complete cds340340100%7e-9099%KU820897.3Select seq gb|KX262887.1|Zika virus isolate 103451, complete genome340340100%7e-9099%KX262887.1Select seq gb|KX247646.1|Zika virus isolate Zika virus/Homo sapiens/COL/UF-1/2016, complete genome340340100%7e-9099%KX247646.1Select seq gb|KX198135.1|Zika virus strain ZIKV/Homo sapiens/PAN/BEI-259634_V4/2016, complete genome340340100%7e-9099%KX198135.1Select seq gb|KX156776.1|Zika virus strain ZIKV/Homo sapiens/PAN/CDC-259364_V1-V2/2015, complete genome340340100%7e-9099%KX156776.1Select seq gb|KX156775.1|Zika virus strain ZIKV/Homo sapiens/PAN/CDC-259249_V1-V3/2015, complete genome340340100%7e-9099%KX156775.1Select seq gb|KX156774.1|Zika virus strain ZIKV/Homo sapiens/PAN/CDC-259359_V1-V3/2015, complete genome340340100%7e-9099%KX156774.1Select seq gb|KX087102.1|Zika virus strain ZIKV/Homo sapiens/COL/FLR/2015, complete genome340340100%7e-9099%KX087102.1Select seq gb|KU991811.1|Zika virus isolate Brazil/2016/INMI1 polyprotein gene, complete cds340340100%7e-9099%KU991811.1Select seq gb|KU985087.1|Zika virus isolate MEX/InDRE/Zika-2/2015 nonstructural protein 5 gene, partial cds340340100%7e-9099%KU985087.1Select seq gb|KU870645.1|Zika virus isolate FB-GWUH-2016, complete genome340340100%7e-9099%KU870645.1Select seq gb|KU179098.1|Zika virus isolate JMB-185 nonstructural protein 5 gene, partial cds340340100%7e-9099%KU179098.1Select seq gb|KU707826.1|Zika virus isolate SSABR1, complete genome340340100%7e-9099%KU707826.1Select seq gb|KU527068.1|Zika virus strain Natal RGN, complete genome340340100%7e-9099%KU527068.1Select seq gb|KU501217.1|Zika virus strain 8375 polyprotein gene, complete cds340340100%7e-9099%KU501217.1Select seq gb|KU501216.1|Zika virus strain 103344 polyprotein gene, complete cds340340100%7e-9099%KU501216.1Select seq gb|KU365780.1|Zika virus strain BeH815744 polyprotein gene, complete cds340340100%7e-9099%KU365780.1Select seq gb|KU365779.1|Zika virus strain BeH819966 polyprotein gene, complete cds340340100%7e-9099%KU365779.1Select seq gb|KU365777.1|Zika virus strain BeH818995 polyprotein gene, complete cds340340100%7e-9099%KU365777.1Select seq gb|KU232295.1|Zika virus isolate 068ZV_PEBR15 NS5 protein gene, partial cds33833897%2e-89100%KU232295.1Select seq gb|KU758877.1|Zika virus isolate 17271 polyprotein gene, complete cds336336100%8e-8999%KU758877.1Select seq gb|KX247632.1|Zika virus isolate MEX_I_7 polyprotein gene, complete cds336336100%8e-8999%KX247632.1Select seq gb|KX087101.2|Zika virus strain ZIKV/Homo sapiens/PRI/PRVABC59/2015, complete genome336336100%8e-8999%KX087101.2Select seq gb|KX056898.1|Zika virus isolate Zika virus/GZ02/2016 polyprotein gene, complete cds336336100%8e-8999%KX056898.1Select seq gb|KU955590.1|Zika virus isolate Z16019 polyprotein gene, complete cds336336100%8e-8999%KU955590.1Select seq gb|KU922960.1|Zika virus isolate MEX/InDRE/Sm/2016, complete genome336336100%8e-8999%KU922960.1Select seq gb|KU922923.1|Zika virus isolate MEX/InDRE/Lm/2016, complete genome336336100%8e-8999%KU922923.1Select seq gb|KU820898.1|Zika virus isolate GZ01 polyprotein gene, complete cds336336100%8e-8999%KU820898.1Select seq gb|KU740184.2|Zika virus isolate GD01 polyprotein gene, complete cds336336100%8e-8999%KU740184.2Select seq gb|KU853013.1|Zika virus isolate Dominican Republic/2016/PD2, complete genome336336100%8e-8999%KU853013.1Select seq gb|KU853012.1|Zika virus isolate Dominican Republic/2016/PD1, complete genome336336100%8e-8999%KU853012.1Select seq gb|KU761564.1|Zika virus isolate GDZ16001 polyprotein gene, complete cds336336100%8e-8999%KU761564.1Select seq gb|KU501215.1|Zika virus strain PRVABC59, complete genome336336100%8e-8999%KU501215.1Select seq gb|KU365778.1|Zika virus strain BeH819015 polyprotein gene, complete cds336336100%8e-8999%KU365778.1Select seq gb|KU312312.1|Zika virus isolate Z1106033 polyprotein gene, complete cds336336100%8e-8999%KU312312.1Select seq gb|KU681081.3|Zika virus isolate Zika virus/H.sapiens-tc/THA/2014/SV0127- 14, complete genome33433499%3e-8899%KU681081.3Select seq gb|KU232289.1|Zika virus isolate 020ZV_PEBR15 NS5 protein gene, partial cds33133195%3e-87100%KU232289.1Select seq gb|KU232288.1|Zika virus isolate 001ZV_PEBR15 NS5 protein gene, partial cds33133195%3e-87100%KU232288.1Select seq gb|EU545988.1|Zika virus polyprotein gene, complete cds331331100%3e-8798%EU545988.1Select seq gb|KU232299.1|Zika virus isolate 015ZV_PEBR15 NS5 protein gene, partial cds32932995%1e-86100%KU232299.1Select seq gb|KJ873160.1|Zika virus isolate NC14-03042014-3481 nonstructural protein 5 gene, partial cds32932995%1e-86100%KJ873160.1Select seq gb|KU937936.1|Zika virus isolate ZIKVNL00013 polyprotein gene, complete cds327327100%4e-8698%KU937936.1Select seq gb|KU940227.1|Zika virus isolate Bahia08, partial genome32732794%4e-86100%KU940227.1Select seq gb|KU955593.1|Zika virus isolate Zika virus/H.sapiens-tc/KHM/2010/FSS13025, complete genome327327100%4e-8698%KU955593.1Select seq gb|JN860885.1|Zika virus isolate FSS13025 polyprotein gene, partial cds327327100%4e-8698%JN860885.1Select seq gb|KU232291.1|Zika virus isolate 051ZV_PEBR15 NS5 protein gene, partial cds32432496%5e-8599%KU232291.1Select seq gb|KU681082.3|Zika virus isolate Zika virus/H.sapiens-tc/PHL/2012/CPC-0740, complete genome322322100%2e-8497%KU681082.3Select seq gb|KU752544.1|Zika virus isolate PoHuZV469196 nonstructural protein 5 gene, partial cds31331390%9e-82100%KU752544.1Select seq gb|KU752545.1|Zika virus isolate PoHuZV472846 nonstructural protein 5 gene, partial cds30730790%4e-8099%KU752545.1Select seq gb|HQ234499.1|Zika virus isolate P6-740 polyprotein gene, partial cds300300100%6e-7895%HQ234499.1Select seq gb|KF258813.1|Zika virus isolate Java non-structural protein 5 mRNA, partial cds29129188%3e-7598%KF258813.1Select seq gb|KX198134.1|Zika virus strain ZIKV/Aedes africanus/SEN/DAK-AR-41524_A1C1-V2/1984, complete genome25025098%9e-6389%KX198134.1Select seq gb|KU955595.1|Zika virus isolate Zika virus/A.taylori-tc/SEN/1984/41671-DAK, complete genome25025098%9e-6389%KU955595.1Select seq gb|KU955592.1|Zika virus isolate Zika virus/A.taylori-tc/SEN/1984/41662-DAK, complete genome25025098%9e-6389%KU955592.1Select seq gb|KU955591.1|Zika virus isolate Zika virus/A.africanus-tc/SEN/1984/41525-DAK, complete genome25025098%9e-6389%KU955591.1Select seq gb|KJ873161.1|Zika virus isolate NC14-02042014-3220 nonstructural protein 5 gene, partial cds25025072%9e-63100%KJ873161.1Select seq gb|KF383107.1|Zika virus strain ArA27407 nonstructural protein 5 gene, partial cds25025098%9e-6389%KF383107.1Select seq gb|KF383106.1|Zika virus strain ArA27443 nonstructural protein 5 gene, partial cds25025098%9e-6389%KF383106.1Select seq gb|HQ234501.1|Zika virus isolate ArD_41519 polyprotein gene, partial cds25025098%9e-6389%HQ234501.1Select seq gb|DQ859059.1|Zika virus strain MR 766 polyprotein gene, complete cds24624698%1e-6189%DQ859059.1Select seq gb|KF383117.1|Zika virus strain ArD128000 polyprotein gene, complete cds24424498%4e-6189%KF383117.1Select seq gb|KF383116.1|Zika virus strain ArD7117 polyprotein gene, complete cds24424498%4e-6189%KF383116.1Select seq gb|KF383114.1|Zika virus strain AnD30332 nonstructural protein 5 gene, partial cds24424498%4e-6189%KF383114.1Select seq gb|KF383101.1|Zika virus strain ArD127710 nonstructural protein 5 gene, partial cds24424498%4e-6189%KF383101.1Select seq gb|KF383099.1|Zika virus strain ArD127987 nonstructural protein 5 gene, partial cds24424498%4e-6189%KF383099.1Select seq gb|KF383098.1|Zika virus strain ArD127988 nonstructural protein 5 gene, partial cds24424498%4e-6189%KF383098.1Select seq gb|KF383097.1|Zika virus strain ArD127994 nonstructural protein 5 gene, partial cds24424498%4e-6189%KF383097.1Select seq gb|KF383089.1|Zika virus strain ArD165531 nonstructural protein 5 gene, partial cds24424498%4e-6189%KF383089.1Select seq gb|KF383085.1|Zika virus strain ArD9957 nonstructural protein 5 gene, partial cds24424498%4e-6189%KF383085.1Select seq gb|KU963573.1|Zika virus isolate ZIKV/Macaca mulatta/UGA/MR-766_SM150-V8/1947 polyprotein (GP1) gene, complete cds241241100%5e-6088%KU963573.1Select seq gb|KU955594.1|Zika virus isolate Zika virus/M.mulatta-tc/UGA/1947/MR-766, complete genome241241100%5e-6088%KU955594.1Select seq gb|KU720415.1|Zika virus strain MR 766 polyprotein gene, complete cds241241100%5e-6088%KU720415.1Select seq dbj|LC002520.1|Zika virus genomic RNA, complete genome, strain: MR766-NIID241241100%5e-6088%LC002520.1Select seq gb|KF383088.1|Zika virus strain ArD30101 nonstructural protein 5 gene, partial cds24124198%5e-6088%KF383088.1Select seq gb|KF383087.1|Zika virus strain ArD30156 nonstructural protein 5 gene, partial cds24124198%5e-6088%KF383087.1Select seq gb|HQ234498.1|Zika virus isolate MR_766 polyprotein gene, partial cds241241100%5e-6088%HQ234498.1Select seq gb|AY632535.2|Zika virus strain MR 766, complete genome241241100%5e-6088%AY632535.2Select seq gb|AF013415.1|Zika virus strain MR-766 NS5 protein (NS5) gene, partial cds241241100%5e-6088%AF013415.1Select seq gb|KF383104.1|Zika virus strain ArA982 nonstructural protein 5 gene, partial cds23923999%2e-5988%KF383104.1Select seq gb|KF383103.1|Zika virus strain ArA986 nonstructural protein 5 gene, partial cds23923999%2e-5988%KF383103.1Select seq gb|KF383086.1|Zika virus strain ArA975 nonstructural protein 5 gene, partial cds23923999%2e-5988%KF383086.1Select seq gb|KF268950.1|Zika virus isolate ARB7701 polyprotein gene, complete cds23723798%6e-5988%KF268950.1Select seq gb|KF268948.1|Zika virus isolate ARB13565 polyprotein gene, complete cds23723798%6e-5988%KF268948.1Select seq gb|KF383121.1|Zika virus strain ArD158095 polyprotein gene, partial cds23023099%9e-5787%KF383121.1Select seq gb|KF383119.1|Zika virus strain ArD158084 polyprotein gene, complete cds23023099%9e-5787%KF383119.1Select seq gb|KF268949.1|Zika virus isolate ARB15076 polyprotein gene, complete cds22822898%3e-5687%KF268949.1Select seq gb|KU963574.1|Zika virus isolate ZIKV/Homo sapiens/NGA/IbH-30656_SM21V1-V3/1968 polyprotein (GP1) gene, complete cds22322398%1e-5486%KU963574.1Select seq gb|KF383115.1|Zika virus strain ArB1362 polyprotein gene, complete cds22322393%1e-5488%KF383115.1Select seq gb|KF383084.1|Zika virus strain HD78788 nonstructural protein 5 gene, partial cds22322393%1e-5488%KF383084.1Select seq gb|HQ234500.1|Zika virus isolate IbH_30656 polyprotein gene, partial cds22322398%1e-5486%HQ234500.1Select seq gb|KF383118.1|Zika virus strain ArD157995 polyprotein gene, complete cds21021093%8e-5186%KF383118.1Select seq gb|KX101065.1|Zika virus isolate Bahia15, partial genome20320358%1e-48100%KX101065.1Select seq gb|KF383113.1|Zika virus strain ArA1465 nonstructural protein 5 gene, partial cds19919993%1e-4785%KF383113.1Select seq gb|KF383120.1|Zika virus strain ArD142623 nonfunctional polyprotein gene, partial sequence18718793%9e-4483%KF383120.1Select seq gb|KF383095.1|Zika virus strain ArD132915 nonstructural protein 5 gene, partial cds17817893%5e-4182%KF383095.1Select seq gb|KF383093.1|Zika virus strain ArD149810 nonstructural protein 5 gene, partial cds17817893%5e-4182%KF383093.1Select seq gb|KF383092.1|Zika virus strain ArD147917 nonstructural protein 5 gene, partial cds17817893%5e-4182%KF383092.1Select seq gb|KF383091.1|Zika virus strain ArD149938 nonstructural protein 5 gene, partial cds17817893%5e-4182%KF383091.1Select seq gb|EU074027.1|Zika virus strain MR 766 NS5 gene, partial cds16816871%2e-3888%EU074027.1Select seq gb|HM147822.1|West Nile virus from South Africa, complete genome14014098%1e-2977%HM147822.1Select seq gb|KX101061.1|Zika virus isolate Bahia03, partial genome13821561%4e-29100%KX101061.1