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Possible cases of microcephaly related Zika in TolimaThursday, April 21, 2016 - 10:35Photo supplied Journal EXTRA La Dorada.Sandra Liliana Torres, Secretary of Health of Tolima.Three cases of microcephaly in the department of Tolima are being investigated by health authorities in order to confirm whether they are connected with Zika fever. Until the closing of this edition, the Ministry of Health had not provided an official report. The report During the meeting forward on the premises of the Ministry of Health of Tolima, the epidemiological situation was reported throughout the department. Data until 16 April, the number of confirmed cases of people infected with the virus Zika amounts to four thousand 757; There are also two deaths being studied, 585 cases in pregnant women and three suspected cases of microcephaly related disease.The latter figure lit the alarms. "In 100 days we have it committed substantial resources in the order of a thousand 170 million pesos to make and implement activities in hyperendemic and endemic municipalities, 40 thousand benefited fumigation and promotion and prevention throughout the apartment housing," he said the Secretary. He also said that "the Ministry is the only entity authorized in the country to the official report, it has so far confirmed cases of microcephaly in Cundinamarca and Norte de Santander." Strategies On the subject of strategic plans for promotion and prevention, the Secretariat highlighted the strengths in the implementation of programs such as "Wanted" and "The task is Zika" to empower the community to protective habits. Finally, Sandra Torres said that "the community has to be clear that the epidemic began to decline, however, in this rainy season is very important to implement to the letter the protection measures, especially washing and brushing pools, where the transmitter mosquito females lay their eggs. " http://ladorada.extra.com.co/noticias/local/posibles-casos-de-microcefalia-relacionados-con-el-zika-en-e-202509

E, 3 CASES OF MICROCEPHALY ARE REPORTED AS A RESULT OF THE ZIKA VIRUS IN THE DEPARTMENT OF TOLIMAImage taken from internet To date, 3 cases of microcephaly are reported as a result of the Zika virus in the department of Tolimaon: April 18, 2016In: TolimaNo CommentsSandra Torres, Secretary of Health of Tolima, gave balance of the actions taken by the government to address the Zika, stating that as part of the shares have fumigated near 23000 homes in different municipalities of the department. Likewise, the official said that to date are reported 3 possible cases of microcephaly, two in Ibague and one in the municipality of Melgar.

Sandra Torres, Secretary of Health of Tolima, gave balance of the actions taken by the government to address the Zika, stating that as part of the shares have fumigated near 23000 homes in different municipalities of the department. Likewise, the official said that to date are reported 3 possible cases of microcephaly, two in Ibague and one in the municipality of Melgar. http://ondasdeibague.com/a-la-fecha-se-reportan-3-casos-de-microcefalia-a-raiz-del-virus-del-zika-en-el-departamento-del-tolima/

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Houston-area woman first expectant mother here testing positive for Zika virusBy Markian Hawryluk April 21, 2016 0 A pregnant Fort Bend County woman who traveled from El Salvador earlier this year has tested positive for the Zika virus, Legacy Community Health announced. It is believed to be the first confirmed case of the virus in an expectant mother in the Houston area. It's not clear whether she contracted the virus from a mosquito bite in El Salvador or through sexual contact with a male partner, Legacy officials said Thursday. The woman's case came to light when she sought medical care at a Legacy health clinic in Fort Bend County. "We are closely monitoring the patient through her pregnancy and hope for the best for mom and baby," Dr. Natalie Vanek, a Legacy infectious disease specialist, said in a statement. The clinic is echoing messages from public health authorities urging pregnant women to avoid travel to Central or South American countries where the mosquito-borne virus is circulating. This pregnant patient is the third case of Zika in Fort Bend County. There have been 12 confirmed cases in Houston and Harris County and at least 31 statewide. 'Focused on prevention' Public health officials stressed that the latest case changes nothing about the risk to Houston residents. "We are focused on prevention, not panic," Vanek said. Harris County public health officials are asking residents to get rid of standing water around their homes that can provide breeding sites for mosquitoes, particularly after the heavy rains and flooding this week. The Centers for Disease Control and Prevention confirmed last week a Zika infection can cause microcephaly, a birth defect in which babies are born with underdeveloped brains and heads. On Thursday, the agency released new data on the testing of people suspected of having a Zika infection. From Jan. 3 to March 5, 4,534 people in the U.S. were tested, including 3,335 pregnant women. About a third of those tested reported at least one Zika symptom, and nearly 12 percent of individuals with symptoms tested positive. Of the 2,425 asymptomatic pregnant women, only seven tested positive. Not 'if' but 'when' So far, 358 individuals have been diagnosed with Zika in the United States, including 31 pregnant women. Seven of the cases were sexually transmitted, while the remainder were all infected outside the country. Zika also can be passed on through sexual contact, and the CDC has recommended that men refrain from unprotected sex for at least eight weeks after traveling to an affected region or six months after developing symptoms. There is no evidence now that women can transmit the virus to their sexual partners. Health officials are urging those infected with the virus to wear mosquito repellent and take other precautions to avoid being bitten to keep the virus from infecting the local mosquito population. While experts expect some outbreaks of Zika in the U.S. in the coming months, so far, there have been no confirmed cases of someone infected with Zika through a mosquito bite within the country. "Our planning isn't if, it's when," Dr. John Hellerstadt, commissioner of the Texas Department of State Health Services said at a Zika Virus Summit in Dallas on Wednesday. "We know the devastating effect for women of childbearing age, and that risk will only increase." http://www.houstonchronicle.com/news/houston-texas/houston/article/Houston-area-woman-first-expectant-mother-here-7294840.php

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10 PM EDT Tonight Dr. Henry L. Niman, PhDZika Panic Begins

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DELUCA: State confirms Niagara Zika caseMichele DeLuca Commentary 14 hrs ago Michele DeLuca 0A new friend of mine may be the first person to test positive for the Zika virus in Niagara County. The good news is that she’s the only case confirmed here. Better news is that she didn’t get infected here. But the concerning news is the length of time it took for her to get proof she had the virus, given that in February the Zika virus was declared a “world health emergency,” by the World Health Agency. My friend is Shoshanna Cogan of Lewiston. She’s a leadership facilitator and trainer who travels the world giving seminars. More than three months ago she was doing some volunteer work on a Caribbean island and spending a few weeks in a Spanish immersion program. Her husband, Shannon Hodges, a professor at Niagara University, had visited her there for a few days of vacation and the two got a chance to enjoy each other’s company in the sunshine. Shannon recalls getting a few mosquito bites on the island, but Shoshanna didn’t see a mosquito the whole time she was there. When Shannon got home a few weeks before his wife, he was very sick. He had a rash, fever, movement was painful and he was exhausted. Shoshanna, still on the island, was feeling the same symptoms but also had a case of conjuntivitis, or pink eye. She recognized the symptoms and suspected Zika immediately. She convinced Shannon to go to the doctor, but the resulting blood test ordered for him, did not check for the virus. As soon as Shoshanna arrived back at her Lewiston home, she began her attempts to be tested for the virus. Her efforts included many hours on the phone as she waded through a maze of health care personnel who were confused about how to help her or didn’t know what to do next. Finally, after several weeks and two blood tests, her suspicions were confirmed. She had Zika. She sent me copies of the test results more than a week ago. Long story short, on Wednesday, after many requests to the state health department which oversees such things — requests that included the facts of Shoshanna’s positive tests — I was finally able to get official confirmation from the state that there was a case of Zika reported in Niagara County. The state Health Department spokesperson is still working to confirm for me where the positive result came from. I’m going to presume that it came from Shoshanna. Although Shoshanna and Shannon no longer have symptoms, and as such are not contagious, there are now 73 confirmed cases of Zika in New York state, almost half of which come from areas just outside New York City. According to recent Associated Press reports, there are 672 confirmed cases in U.S. territories such as Puerto Rico and the United States, including 64 pregnant women. It’s estimated that 40 million people will travel between the U.S. and countries with Zika outbreaks. A month ago Gov. Andrew Cuomo announced a plan to combat the virus in the state. Early in April, President Barack Obama announced that $589 million left over from a largely successful fight against Ebola will now go to combating the growing threat of Zika in the U.S. Zika, discovered in 1947 in Uganda, has recently started to spread through the globe due to movement of the mosquito which transmits the disease and the humans which can act as carriers while the virus is active. The disease can be transmitted during the infectious stage through sexual activity or if a mosquito bites someone who is infected and then bites another person. The scariest thing about the virus is that it can cause serious birth defects in the developing brain of a fetus, if its mother gets infected while pregnant. So pregnant women are being advised not to travel to countries where the virus is rampant, such as Brazil, the current epicenter of the virus. It is suggested they use copious amounts of mosquito repellant with DEET. There is also research that links the virus to Guillain Barre syndrome in those infected with the virus. Clearly, there is reason to be careful. Moving forward, I hope health and government officials are more expedient about sharing information. But as a leadership expert, trainer and coach, Shoshanna is choosing to stay positive about her experience. Her lessons, she wrote recently, and are to stay focused on what she can control and influence, such as enjoying life and doing all she can to stay healthy mentally, physically and spiritually. “At any given moment, we can consider our range of options and make the best choices we can,” she said. “Everyone loses in the shame-and-blame game.” Contact Michele DeLuca at 282-2311, ext. 2263 or email her [email protected]. What is the Zika virus? Zika virus disease is a disease spread primarily through the bite of an infected Aedes species mosquito. The most common symptoms of Zika are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting for several days to a week after being bitten by an infected mosquito. People rarely die of Zika. For this reason, many people might not realize they have been infected. Once a person has been infected, he or she is likely to be protected from future infections. The disease, which can be transferred through body fluids, can be spread from a pregnant woman to her fetus and has been linked to a serious birth defect of the brain called microcephaly in babies of mothers who had Zika virus while pregnant. Zika virus was first discovered in 1947 and is named after the Zika forest in Uganda. In 1952, the first human cases of Zika were detected and since then, outbreaks of Zika have been reported in tropical Africa, Southeast Asia, and the Pacific Islands. Because the symptoms of Zika are similar to those of many other diseases, many cases may not have been recognized. In May 2015, the Pan American Health Organization issued an alert regarding the first confirmed Zika virus infection in Brazil and on Feb 1, 2016, the World Health Organization declared Zika virus a public health emergency of international concern. — Center for Disease Control

My friend is Shoshanna Cogan of Lewiston. She’s a leadership facilitator and trainer who travels the world giving seminars. More than three months ago she was doing some volunteer work on a Caribbean island and spending a few weeks in a Spanish immersion program. Her husband, Shannon Hodges, a professor at Niagara University, had visited her there for a few days of vacation and the two got a chance to enjoy each other’s company in the sunshine. Shannon recalls getting a few mosquito bites on the island, but Shoshanna didn’t see a mosquito the whole time she was there. When Shannon got home a few weeks before his wife, he was very sick. He had a rash, fever, movement was painful and he was exhausted. Shoshanna, still on the island, was feeling the same symptoms but also had a case of conjuntivitis, or pink eye. She recognized the symptoms and suspected Zika immediately. She convinced Shannon to go to the doctor, but the resulting blood test ordered for him, did not check for the virus. As soon as Shoshanna arrived back at her Lewiston home, she began her attempts to be tested for the virus. Her efforts included many hours on the phone as she waded through a maze of health care personnel who were confused about how to help her or didn’t know what to do next. Finally, after several weeks and two blood tests, her suspicions were confirmed. She had Zika. She sent me copies of the test results more than a week ago. Long story short, on Wednesday, after many requests to the state health department which oversees such things — requests that included the facts of Shoshanna’s positive tests — I was finally able to get official confirmation from the state that there was a case of Zika reported in Niagara County. The state Health Department spokesperson is still working to confirm for me where the positive result came from. I’m going to presume that it came from Shoshanna. http://www.niagara-gazette.com/opinion/columns/deluca-state-confirms-niagara-zika-case/article_16450193-4332-54a0-9ba1-bc3c5545536f.html

Apr. 21, 2016 Department of Health Daily Zika UpdateNo New Cases TodayContact:Communications [email protected](850) 245-4111 Tallahassee, Fla. — In an effort to keep Florida residents and visitors safe and aware about the status of the Zika virus, the Florida Department of Health will issue a Zika virus update each week day at 2 p.m. Updates will include a CDC-confirmed Zika case count by county and information to better keep Floridians prepared. There are no new cases today. Of the cases confirmed in Florida, three cases are still exhibiting symptoms. According to the CDC, symptoms associated with the Zika virus last between seven to 10 days. Based on CDC guidance, several pregnant women who have traveled to countries with local-transmission of Zika have received antibody testing, and of those, five have tested positive for the Zika virus. The CDC recommends that a pregnant woman with a history of Zika virus and her provider should consider additional ultrasounds. It is recommended that women who are pregnant or thinking of becoming pregnant postpone travel to Zika affected areas. County Number of Cases (all travel related) Alachua 4 Brevard 2 Broward 13 Clay 1 Collier 1 Hillsborough 3 Lee 4 Miami-Dade 39 Orange 5 Osceola 4 Palm Beach 4 Polk 3 Santa Rosa 1 Seminole 1 St. Johns 1 Cases involving pregnant women* 5 Total 91 *Counties of pregnant women will not be shared. On Feb. 12, Governor Scott directed the State Surgeon General to activate a Zika Virus Information Hotline for current Florida residents and visitors, as well as anyone planning on traveling to Florida in the near future. The hotline, managed by the Department of Health, has assisted 1,488 callers since it launched. The number for the Zika Virus Information Hotline is 1-855-622-6735. All cases are travel-associated. There have been no locally-acquired cases of Zika in Florida. For more information on the Zika virus, click here. The department urges Floridians to drain standing water weekly, no matter how seemingly small. A couple drops of water in a bottle cap can be a breeding location for mosquitoes. Residents and visitors also need to use repellents when enjoying the Florida outdoors. More Information on DOH action on Zika: On Feb. 3, Governor Scott directed the State Surgeon General to issue a Declaration of Public Health Emergency for the counties of residents with travel-associated cases of Zika.There have been 15 counties included in the declaration– Alachua, Brevard, Broward, Clay, Collier, Hillsborough, Lee, Miami-Dade, Orange, Osceola, Palm Beach, Polk, Santa Rosa, Seminole and St. Johns – and will be updated as needed. DOH encourages Florida residents and visitors to protect themselves from all mosquito-borne illnesses by draining standing water; covering their skin with repellent and clothing; and covering windows with screens.DOH has a robust mosquito-borne illness surveillance system and is working with the CDC, the Florida Department of Agriculture and Consumer Services and local county mosquito control boards to ensure that the proper precautions are being taken to protect Florida residents and visitors.On April 6, Governor Rick Scott and Interim State Surgeon General Dr. Celeste Philip hosted a conference call with Florida Mosquito Control Districts to discuss ongoing preparations to fight the possible spread of the Zika virus in Florida. There were 74 attendees on the call.Florida currently has the capacity to test 6,646 people for active Zika virus and 1,466 for Zika antibodies.Federal Guidance on Zika: According to the CDC, Zika illness is generally mild with a rash, fever and joint pain. CDC researchers have concluded that Zika virus is a cause of microcephaly and other birth defects.The FDA released guidance regarding donor screening, deferral and product management to reduce the risk of transfusion-transmission of Zika virus. Additional information is available on the FDA website here.The CDC has put out guidance related to the sexual transmission of the Zika virus. This includes the CDC recommendation that if you have traveled to a country with local transmission of Zika you should abstain from unprotected sex.For more information on Zika virus, click here. About the Florida Department of Health The department works to protect, promote and improve the health of all people in Florida through integrated state, county and community efforts. Follow us on Twitter at @HealthyFla and on Facebook. For more information about the Florida Department of Health please visit www.FloridaHealth.gov. http://www.floridahealth.gov/newsroom/2016/04/042116-zika-update.html

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Thursday, April 14, 2016Five cases of Zika confirmed in WV, so farby Lydia Nuzum, Staff WriterAP file photoAedes aegypti mosquitoes sit in a petri dish at the Fiocruz institute in Recife, Pernambuco state, Brazil, on Jan. 27. The mosquito, which could be found in West Virginia, is a vector for the proliferation of the Zika virus currently spreading throughout Latin America. Four more cases of Zika virus, the mosquito-borne illness responsible for major birth defects in hundreds of South American babies, have been confirmed in West Virginians who have traveled outside the country, according to state health officials. The Department of Health and Human Resources said there have been five total cases in the state. The first, a Clay County man who traveled to Haiti for a church mission trip, was confirmed in early March. The other four cases are among others who traveled to Haiti for the same mission trip, although the DHHR did not release their home counties. Since late January, the DHHR has sent 24 samples for testing to the federal Centers for Disease Control and Prevention. It has received the results for the five positive tests, as well as 13 negative tests, and is awaiting the results of six more tests, according to Dr. Rahul Gupta, commissioner of the West Virginia Bureau for Public Health. In March, Gupta told reporters that eight of the 11 tests pending at the CDC at the time were samples from pregnant women; all of those test results have since been received and no pregnant women were among the five diagnosed with Zika, Gupta said. Of the six samples still pending, one is for a pregnant woman, Gupta said. “Four out of five who contract Zika will be asymptomatic,” he said. “That fifth person will usually have mild symptoms, like fever, rash, body aches, conjunctivitis. Pregnant women are where we have the most concern; those are the ones we need to test, if there’s a travel history.” The virus in pregnant women has been linked to microcephaly, a neurodevelopmental disorder that occurs during fetal development and causes abnormally small heads and impaired brain development in affected children. Because of this, the CDC has warned pregnant women and those who might become pregnant to avoid traveling to areas where the virus is active. Because many Zika cases are asymptomatic, the state recommends that pregnant women who have traveled to countries where the virus is endemic be tested, even if they have not become ill. There have been no confirmed cases of Zika transmitted by mosquitoes inside the United States, but Gupta said he anticipates that the country eventually will have to deal with cases transmitted by native mosquitoes. Two types of Aedes mosquitoes carry the virus — one, Aedes albopictus, is common in West Virginia, and the CDC has declared that the other, Aedes aegypti, could be found in the state. While aegypti is less common, albopictus is a concern for public health officials because of its hardiness — its eggs can survive for a short time without water, and Gupta said the state is developing a Zika action plan that includes greater vector control and surveillance. “The emphasis here is about travel, at this point, but going into the summer, it will be about mosquito control,” Gupta said. “There are certainly other parts of the nation that are a lot more at risk. However, we do have the albopictus mosquito, and even though it is less effective at carrying the virus, it still can.” Zika also can be transmitted sexually — seven cases of the virus transmitted through intercourse have been reported in the United States, so far, according to the CDC. Gupta said those who have traveled to Zika-endemic countries should be tested for the virus and practice safe sex, to avoid transmitting the disease to a partner. For more information, or to report a suspected case of Zika, visit www.dide.wv.gov or call 304-558-5358, Ext. 1. Reach Lydia Nuzum at [email protected], 304-348-5189 or follow @lydianuzum on Twitter. - See more at: http://www.wvgazettemail.com/news/20160414/five-cases-of-zika-confirmed-in-wv-so-far#sthash.J2Ds2MC9.dpuf

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Maryland Confirmed Zika Virus Infections (As of April 20, 2016) Travel-AssociatedLocally Acquired Vector-BorneTotal909 http://phpa.dhmh.maryland.gov/Pages/Zika.aspx

Maryland Confirmed Zika Virus Infections (As of April 20, 2016) Travel-AssociatedLocally Acquired Vector-BorneTotal909

RTSENTERTAINMENTNATIONWORLDBUSINESSOPINIONLIFESTYLETRAVELMaria Silva Flor, 20, holds her 2-month-old baby, Maria Alves, who was born with microcephaly. LIVING WITH ZIKAOn the frontline of Brazil’s war with Zika, a mother’s first question: ‘How big is the head?’By ALEXANDRA ZAVIS | Photos by KATIE FALKENBERG CAMPINA GRANDE, BRAZIL | APRIL 21, 2016 I t’s 7:30 a.m. and the hallway outside the neurosurgeon’s office at the Pedro I Municipal Hospital is filling with mothers and their babies. The women arrive with questions: Will their children ever learn to walk? Will they ever speak? The doctor, Alba Batista, wishes she had answers. She used to see two, maybe three cases of microcephaly a year. But since December, more than 40 newborns with the condition — an abnormally small skull, often with an underdeveloped brain — have shown up at Pedro I. Thousands of other cases have been reported across Brazil since the fall, a surge that researchers link to the Zika virus. ADVERTISEMENTBatista wraps a tape measure around the head of a crying baby boy as seven medical students gather around. She shines a light into each of his eyes and tickles his stomach with a brush to watch his reaction. Holding a brain scan up to the light, she points out telltale lesions and calcium deposits. The baby’s brain is damaged, but the doctor has seen worse. “There’s a possibility that he will develop better,” she tells his mother. “Are we sure? No.” Tears well up in the mother’s eyes. So many babies. So much bad news to deliver. Asked what the future is for these children, Batista turns to wipe away her own tears. Who knows? “Only God,” she says. “Here, we are humans.” Top: Dr. Alba Batista, a neurosurgeon at Pedro I Municipal Hospital, reviews CT scans of a microcephaly patient with medical students. Bottom: Francinelma Santos holds son Jhin Pirlo as she waits with physiotherapist Jeime Leal. View more photos Desperate for good newsPedro I is the oldest hospital in Campina Grande, a city of 400,000 where everybody seems to be talking about the strange epidemic of babies with small heads. A national crisisBrazil has confirmed 1,168 cases of microcephaly and other malformations potentially caused by the Zika virus. Cases as of April 16 by state Bahia 219 cases Pernambuco 333 cases Paraiba 109 cases Maranhao 90 cases Ceara 81 cases Federal District 4 cases Brasilia 1-5 6-10 11-50 51-100 101-200 201+ 0 Source: Brazilian Health Ministry P. Krishnakumar / @latimesgraphics The patients come from across Paraiba, one of nine states in the vast northeastern part of Brazil that accounts for the majority of microcephaly cases. Local health clinics offer routine checkups, but seeing a specialist can mean traveling 200 miles each way to Pedro I. A squat, two-story structure with a whitewashed facade, the hospital now houses one of the country’s first microcephaly centers. It occupies three small rooms along a narrow hallway. Purple pompoms decorate the doors, breaking the monotony of the gray tile floors and scuffed walls. The center has assembled a team of experts to care for the babies and organizes support groups for the mothers. But doctors here worry that many families seem to be in denial, clinging to the idea that microcephaly is simply a matter of head size. At this stage, the babies can do most of the things as others the same age. But the condition can be accompanied by vision, hearing, learning and motor problems that require lifelong care. What doctors suspect from looking at brain scans — but nobody knows for sure — is that the damage caused by the Zika virus is often worse than from other causes of microcephaly, including genetic disorders and drug or alcohol use during pregnancy. Plans are in the works for a new wing to accommodate more therapy rooms and equipment the children will need as they grow older. Resources are tight, though. The outbreak of Zika, a mosquito-borne virus that did not begin to spread widely in the Americas until last spring, could not have happened at a worse time, in the midst of Brazil’s worst recession in 80 years and a political crisis in which the president could be impeached. In Rio de Janeiro, hospitals and clinics temporarily cut back their services because salaries went unpaid and gloves, medicines and other basic supplies ran out. Pedro I has avoided the worst of those problems. The hospital is more than a treatment center. It has become a refuge for families, a place where parents can find comfort and camaraderie amid all the uncertainty. Samuel Amorim Santiago, 2 months, who was born with microcephaly, undergoes neurological testing. View more photos More questions than answersIn Room 114, the hospital’s only physiotherapist, Jeime Leal, hoists 4-month-old Gilberto onto a bright yellow exercise ball. The baby throws back his head and wails. “Oh Gilberto, how handsome you are!” Leal says in a soothing voice, as she rocks the ball from side to side. “You don’t need to be like this. I’m just helping you.” The hope is that early stimulation and exercises will improve his development. But Gilberto’s weak neck makes it difficult for him to hold a seated position on the moving ball. His mother, Josemary Gomes, hates to watch him cry and slips out of the room. Watch The sessions are conducted on a lime-green mat that takes up most of the cramped space that doubles as Leal’s office. Two rag dolls sit on the windowsill, and cardboard flowers and hearts decorate the walls. Gilberto won’t let up. His mother had to wake him up at 3:45 a.m. to catch a free municipal van to Pedro I. Gomes, who is raising four boys on her own, can’t afford the bus fare. She used to make a living as a cook and cleaner. “My only work now is taking care of Gilberto,” she says. They spend the rest of the morning waiting. The van that will take them home doesn’t leave until all the passengers are finished with their appointments. In the six years that Leal worked at a pediatrician’s office, she never had a microcephaly case. When she started at Pedro I in December, there were seven cases at the hospital. She now sees twice that number in a single day. Leal set up a group on the WhatsApp chat service so the mothers can ask questions and share experiences. When she gets home that night, her phone lights up with messages. Kalissandra de Olivera watches her son Nicolas receive physiotherapy. View more photos “We’ve become a family here”In the hallway outside Room 114, mothers share coffee, cake and news about their babies. When one young couple cannot console their distraught daughter, a more experienced mother takes the child and paces the hallway until she stops crying. “I do the same thing with my daughter,” says Celeneide de Sales Silva as she returns the infant to her parents. Her daughter, 3-month-old Yane, is the only child with microcephaly in their small town of Soledade. “People come up to me and want to look at the size of her head,” she says. “They are surprised because they think her head is not that small. They say babies with microcephaly are ugly babies.” It’s different at Pedro I, she says: “We’ve become a family here.” Mothers socialize while they wait for their babies' physiotherapy appointments. View more photos Waiting and worryingIn the waiting room for the hospital’s only CT scanner, sweat beads down Sidnayde dos Santos’ forehead as she sits with her 19-year-old daughter and 3-month-old grandson. There is no air conditioning, and the temperature soars as the afternoon drags on. A movie dubbed into Portuguese plays on a small television, but none of the half-dozen or so patients is watching. The family has been waiting two hours when a staff member comes in and makes an announcement: The scanner is broken. A technician has been summoned to fix it. Dos Santos groans. “This is Brazil,” she explains. It takes an hour and a half to repair the machine. Finally, Amanda dos Santos and her son, Emanuel, enter the scan room. “He doesn’t look like a baby with microcephaly,” a woman waiting with her teenage son tells Dos Santos. “Does he cry a lot?” she wants to know. Not at all when he was born, replies Dos Santos, who delivered her grandson at home and doesn’t think there is anything seriously wrong with him. “I had to slap him,” she says. Another woman suggests that she advise her daughter not to have more children. Dos Santos ignores the comment. Each day at home she and her daughter put Emanuel through the exercises the therapist showed them. They say they can already see improvements. When her daughter emerges from the CT room, Dos Santos wraps Emanuel in a white eyelet blanket and kisses his forehead. “See how strong he is,” she says. Amanda dos Santos, 19, comforts her 3-month-old, Emanuel, before a brain scan. View more photos How big is the head?Room 117 is where pregnant women come to learn the results of their ultrasound tests. Once, most just wanted to know: Is it a boy or a girl? These days, the first question they ask is: How big is the head? Alcione Calixo fiddles with her wedding band while a nurse roots through a tall file cabinet for an answer. When she was 19 weeks pregnant, she broke out in a fever and rash. “I panicked,” she recalls. “I thought right away it was Zika.” Calixo knew what such a diagnosis could mean for her unborn child. She works as a nurse technician at the city’s maternity hospital, and has seen microcephaly cases. But by the time she located a facility that could test for Zika, it was too late. The virus is detectable in a patient’s blood for only about a week after the onset of symptoms. “I cried a lot,” she says. “I am still afraid there might be a problem.” She has tried to protect herself against mosquitoes. “I am always in jeans and closed shoes,” Calixo tells the nurse, but then looks down at her red sundress and sandals and exposed skin. “Today it was so hot.” Finally the nurse, Clarissa Gonzaga, locates Calixo’s file and smiles. “Everything is normal,” she says. “What about the size of his head?” Calixo presses. “It’s normal,” the nurse assures her, but cautions that some cases of microcephaly don’t show up on scans. Her baby, a boy she has named Igor, is due next month. Top: Claudenice Batista, who is eight months pregnant, waits to get the results of an ultrasound showing whether her unborn child has microcephaly. Bottom: Kalissandra de Olivera sleeps next to her son in a hallway as they wait for a van to take them to a meeting for mothers whose babies have microcephaly. View more photos This story was reported with a grant from the United Nations Foundation. Contact the reporter and photographer. Produced by Lily Mihalik. http://static.latimes.com/zika-hospital/

Zika Virus – April 21, 2016. Texas has had 31 confirmed cases of Zika virus disease. Of those, 30 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. Case counts by county: Bexar – 3Dallas – 6Denton – 1Fort Bend – 2Grayson – 1Harris – 12Tarrant – 3Travis – 2Wise – 1

On 30 March, Colombia reported 50 live births with microcephaly between 4 January 2016 and 20 March 2016. So far, seven of the investigated cases presented Zika virus positive results by real-time PCR (Table 2). http://apps.who.int/iris/bitstream/10665/205505/1/zikasitrep_21Apr2016_eng.pdf?ua=1

Microcephaly and other fetal malformations potentially associated with Zika virus infection or suggestive of congenital infection have been reported in six countries (Brazil, Cabo Verde, Colombia, French Polynesia, Martinique and Panama). Two cases, each linked to a stay in Brazil, were detected in Slovenia and the United States of America. A further case, linked to a brief stay in Mexico, Guatemala and Belize, was detected in a pregnant woman in the United States of America. http://www.who.int/emergencies/zika-virus/situation-report/21-april-2016/en/

Microcephaly and other fetal malformations potentially associated with Zika virus infection or suggestive of congenital infection have been reported in six countries (Brazil, Cabo Verde, Colombia, French Polynesia, Martinique and Panama). Two cases, each linked to a stay in Brazil, were detected in Slovenia and the United States of America. A further case, linked to a brief stay in Mexico, Guatemala and Belize, was detected in a pregnant woman in the United States of America. http://www.who.int/emergencies/zika-virus/situation-report/21-april-2016/en/

Microcephaly and other fetal malformations potentially associated with Zika virus infection or suggestive of congenital infection have been reported in six countries (Brazil, Cabo Verde, Colombia, French Polynesia, Martinique and Panama). Two cases, each linked to a stay in Brazil, were detected in Slovenia and the United States of America. A further case, linked to a brief stay in Mexico, Guatemala and Belize, was detected in a pregnant woman in the United States of America. http://www.who.int/emergencies/zika-virus/situation-report/21-april-2016/en/

Microcephaly and other fetal malformations potentially associated with Zika virus infection or suggestive of congenital infection have been reported in six countries (Brazil, Cabo Verde, Colombia, French Polynesia, Martinique and Panama). Two cases, each linked to a stay in Brazil, were detected in Slovenia and the United States of America. A further case, linked to a brief stay in Mexico, Guatemala and Belize, was detected in a pregnant woman in the United States of America. http://www.who.int/emergencies/zika-virus/situation-report/21-april-2016/en/