There are now 16 counties where , commonly known as the yellow fever mosquito, has been detected, according to the state Department of Public Health. Five of those counties have also detected Aedes albopictus, the Asian tiger mosquito.

These mosquitoes, distinguished from other species because they primarily sip human blood during the day instead of at night, can spread the Zika virus, which infected more than 1 million people during that began in 2015 in Brazil. The virus also can spread during sex.

babies were born with in Brazil during the epidemic. Microcephaly is a condition in which a baby’s head is much smaller than expected, and can occur because the baby’s brain has not developed properly.

In California, these invasive mosquitoes were detected in 2011 in Los Angeles County, and since have spread northward into the Central Valley.

Although the invasive mosquitoes now inhabit a large swath of the state, authorities have recorded no cases of “” of the dangerous viruses, which means there’s no evidence these Aedes mosquitoes in California are carriers. The California residents who have fallen ill with the dangerous viruses became infected during international travel to areas where the viruses are endemic.

But the potential for in-state transmission remains.

“We do have people in California traveling abroad and bringing back those viruses every year, and now that the mosquito is spreading across the state, the risk has increased, but it’s still very low,” said Jeremy Wittie, president of the Mosquito and Vector Control Association of California.

The number of reported travel-associated cases of Zika has dropped from 509 in 2015 and 2016 combined to 25 so far this year, according to the California Department of Public Health.

Public health officials work with people who were infected overseas to minimize the risk that they will spread the virus in the state.

While state and local vector control agencies keep a close eye on these species of Aedes mosquitoes, their biggest concerns are still West Nile virus and St. Louis encephalitis, which are spread by different species of mosquitoes, more common in California. This year, there have been 89 human cases of West Nile virus reported in 15 counties, including two deaths, .

Vector control officials also stress the need for public awareness about how Californians can protect themselves and prevent mosquitoes from proliferating. “It’s simple for people to make a few changes to their lifestyle that would limit the spread of these mosquitoes,” Wittie said.

Wittie recommends people check their properties weekly and drain any standing water to limit the places where mosquitoes can reproduce.

Though these mosquitoes can travel only short distances on their own, they can be transported via international and local trade, or even in a car. They thrive in urban and residential areas, unlike other species, because their eggs can survive in dry conditions for months and require just a tiny amount of standing water to hatch.

“These mosquitoes are adept at living in tight spaces with humans,” Wittie said.

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In 2005, she was an infectious-disease doctor at the nearly 3,000-bed Charity Hospital in New Orleans, one of a small number of physicians left managing patients and performing triage in the wake of Hurricane Katrina. She spent weeks and months dealing with the aftermath, before moving to Texas, where she heads the University of Texas-San Antonio’s Center for Medical Humanities and Ethics, part of its Health Science Center.

As Houston begins assessing Harvey’s impact, she’s “constantly comparing and contrasting,” she said. After all, Berggren remembers the power outages and the lack of clean drinking water. She knows firsthand the trauma suffered by the medical personnel trying to keep people healthy under devastating circumstances.

“I remember what it was like to be standing on the balcony of the ninth floor of Charity Hospital looking out over the floodwaters,” Berggren reflected.

But Berggren has also seen improvements. Harvey is the first major storm since the federal government revised emergency preparedness standards for hospitals, to Katrina and 2012’s Superstorm Sandy. Now, health care providers that receive Medicare or Medicaid dollars disaster preparedness plans for at-risk patients and mechanisms to maintain basic power.

Berggren shared her distinctive perspective last week, drawing on her knowledge of Texas, her memories from New Orleans and knowledge as one of the country’s leading bioethicists. The following transcript has been edited for length and clarity.

Q: What kind of burden does a storm like this one place on local hospitals, and on the health care system?

The first responders are always the people there locally. They’re being affected by the disaster at the same time as the population is. You have sort of a dual role.

Where I saw this burden take its biggest toll was two or three days into the post-Katrina storm, at Charity. The people who had the hardest time were the folks who didn’t know the safety or whereabouts of or well-being of their loved ones.

All the health care providers in Ben Taub now, and other hospitals caring for patients that had to be left behind — this is a very stressful and difficult time.

Q: Does that affect what kind of care they give, while seeing potentially increased need?

You have to start working with much more limited resources. There’s going to be limitations in communications. We’ve already heard about looming limitations for food. Water has been OK, power has been OK — so those are two factors that weigh heavily in Houston’s favor. After Katrina, we lost power. We really didn’t have the ability to use our water supply. It was, in that respect at least, more dire.

However, as the days go by, the rains continue, the flooding continues — supplies are going to run out. There are going to be a lot of logistical hurdles.

Q: Hurricane Katrina shone a spotlight on some of these challenges that can arise at a hospital navigating a natural disaster — are there lessons you think people learned that we’re maybe seeing applied here in Harvey?

It does look like they were far better prepared, with regard to having protection for their power supply and for water in these hospitals.

You can never really be fully prepared. What I recall before Katrina is there was kind of a set of misplaced priorities. We had to all undergo about four hours of training about sexual harassment in the workplace because Tulane was worried about that that year in particular — and had had exactly zero hurricane preparedness. We didn’t even know what Code Gray was.

I think that whole region along the Gulf Coast is much more attuned to the fact that we have to prioritize educating health professionals about disaster preparedness. I see better preparedness in the medical community and I like to think that’s part of the Hurricane Katrina legacy.

Q: What challenges should we expect in the storm’s wake?

There are always going to be vulnerable people, disenfranchised groups of people. If they’re not gotten out and they become further deprived of food and shelter and having their basic needs met, you’re going to see, unfortunately, I fear, the potential for violence. We had the experience at Charity Hospital of getting shot at by snipers, and we never knew who they were. We assumed they were disenfranchised people who had become desperate and been deprived of food or perhaps medication.

It’s going to be very hard to get regular services back up and running. I would say mental health is going to be a big problem. We saw a number of suicides in New Orleans after Katrina. People have a bit of a sense of despair when they become aware of the scope and scale of the disaster.

Post-Katrina it took many, many, many months to see the mental health counselors and psychiatrists return. I would hope that in the intermediate-range and long-range planning for disaster recovery that mental health is given a really high priority.

Next, I would worry about some infectious-disease issues. There’s a lot that’s been written about Houston’s risk for a Zika outbreak. Of course, the way you combat Zika is you get rid of standing water — and what does Houston have right now?

Q: Lots of standing water?

Lots of standing water! They have had a superb proactive public health response up until now. I only hope the state continues to support that.

We have a lot of people living with chronic illness in general. When it’s tuberculosis, when it’s HIV, those people need their medications on a regular schedule, without interruption.

There were a lot of logistical hurdles in New Orleans, post-Katrina, in keeping patients on their full HIV regimens and full tuberculosis regimens. My patients with AIDS and tuberculosis, who were evacuated without their medications — it took a long time before they could get to a place where they really felt they could confidently tell their health care providers what their needs were.

I had AIDS patients contacting me and saying, “Is it OK if I take my pills every other day to make them last longer?” And that’s exactly what you don’t want to do.

Q: With people saying recovery will take months and even years — what sort of long-term impact might we see on the health system in Houston, and on local public needs?

Physical infrastructure will take time to repair, but you can still provide funding to help people access care.

One vulnerable group that I would like to highlight is pregnant women. Between 2010 and 2014 we saw a 79 percent increase in maternal death [in Texas].

Houston doesn’t have to have all the floodwater evacuated and the buildings pristine to provide health care to vulnerable people.

Q: Having moved from Louisiana to Texas, what is it like for you watching another hurricane play out in your new home?

I’m comparing and contrasting constantly. I’m always checking the news. I’m checking in with my resident who’s assigned at Ben Taub. I’m seeing things that are being done a lot better and I’m seeing things that I wish could be done differently. …

Disasters bring out the best and the worst in people. We always want to look to criticize and identify the mistakes, but these are also opportunities to see how good we really can be.

The capacity of our people to take care of one another and to rise to the occasion and to go beyond themselves is just so inspiring.

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Andrea Pardo, de 33 años, de Issaquah, Washington, fue examinada para el virus en octubre, después de quedar embarazada mientras vivía en México. Los resultados estuvieron listos en diciembre, pero Pardo no fue notificada hasta abril, cuando ya tenía 37 semanas de embarazo, justo antes de dar a luz a su hija Noemí.

Hasta ahora, la beba luce sana. Pero no comunicarle en tiempo y forma, atraso que adjudican a un error en la clínica de la Universidad de Washington, donde Pardo recibe atención, la privó de la oportunidad de tomar una decisión informada sobre su embarazo, dijo.

“Nada habría cambiado para mí”, dijo. “Pero si lo hubiera descubierto alrededor de las 20 semanas, supongo que podría haber tomado algunas decisiones”.

El doctor Timothy Dellit, experto en enfermedades infecciosas de UW Medicine, dijo a Kaiser Health News que llamó a Pardo para explicarle el error.

“Me disculpé porque no se le entregaron los resultados en diciembre”, dijo. “Fue una manera desafortunada de manejar esas pruebas”.

El incidente se suma a las preguntas sobre el seguimiento cuidadoso de las pruebas de zika, y las consecuencias potenciales de los resultados a destiempo ​​o inexactos, incluso cuando las recomendaciones sobre la vigilancia se han ampliado.

Luego que comenzara el brote de zika a principios de 2015 en Brasil, se han venido reportando ensayos defectuosos o pruebas retrasadas ​​en los Estados Unidos, dijeron funcionarios de salud.

En febrero, cerca de realizadas a mujeres embarazadas en el laboratorio de salud pública de Washington, DC, tuvieron que repetirse después del descubrir que los técnicos no habían seguido un paso necesario, lo que generó que todos los resultados fueran negativos. Más tarde, una mujer embarazada resultó positiva para el virus, y otras 25 mujeres embarazadas tuvieron resultados no concluyentes, dijo LaShon Beamon, portavoz del Departamento de Ciencias Forenses del distrito.

A pesar de que “no es la norma”, dijo la doctora Kelly Wroblewski, directora de enfermedades infecciosas de la Asociación de Laboratorios de Salud Pública, la experta ha oído hablar de varios casos recientes de pacientes que no recibieron los resultados de la prueba apenas estuvieron listos.

“Los informes no están llegando a los médicos correctos”, dijo. “Dónde y cómo está ocurriendo, no lo sé”.

Funcionarios de salud, en los Estados Unidos y fuera del país, han llevado a cabo cientos de miles de pruebas a medida que el zika se ha ido expandiendo. Solo los Centros para el Control y Prevención de Enfermedades (CDC) han enviado 400.000 pruebas en Estados Unidos y sus territorios, y más de 700.000 a todo el mundo, dijo el portavoz Tom Skinner.

En mayo, funcionarios de los CDC para la prueba del zika para incluir no sólo a mujeres embarazadas que podrían haber estado expuestas al virus, sino también para mujeres con factores de riesgo que están pensando en quedar embarazadas.

El virus del zika, que puede transmitirse de una mujer embarazada a su feto, puede causar defectos de nacimiento potencialmente graves, incluyendo microcefalia, caracterizada por una cabeza mucho más pequeña que el promedio, problemas de visión y audición y retrasos en el desarrollo. Después de noticias de que el virus se estaba propagando en Latinoamérica, las , hallaron los investigadores.

Pardo dijo que probablemente no habría terminado su embarazo, aunque hubiera sabido antes que estaba infectada con el zika, pero habría querido tener información precisa.

Dellit dijo que el personal de la clínica sabía que Pardo había estado expuesta al virus y que la habían cuidado de manera adecuada. Agregó que los funcionarios han renovado los protocolos de prueba, verificando los resultados de los laboratorios externos y comunicándoselos a los pacientes, agregó.

Pardo viajó a Las Guacamayas, México, el pasado mes de junio para estar con su esposo, Héctor Pardo, de 28 años. Originalmente, el hombre llegó a los Estados Unidos sin papeles cuando era adolescente, y tuvo que irse del país mientras se resolvía su situación migratoria. Regresó al estado de Washington en diciembre y ahora trabaja para una compañía de muebles.

Andrea Pardo está con licencia por maternidad de su trabajo como consejera académica en el departamento de microbiología de la Universidad de Washington. La pareja también tiene una hija de 3 años.

Andrea quedó embarazada en agosto pasado. Al mismo tiempo, desarrolló lo que creía que era una erupción por el calor y otros síntomas de la enfermedad, pero un médico minimizó cualquier riesgo de infección por zika, contó.

Se trata de un virus sigiloso; 4 de cada 5 personas nunca saben que están infectadas, mientras que otras pueden mostrar síntomas leves, como fiebre, erupción cutánea, dolor en las articulaciones y músculos, y ojos rojos. Sin embargo, los efectos en fetos pueden ser devastadores, dicen los expertos.

Un análisis de sangre en México dio negativo para zika. Pardo regresó a los Estados Unidos cuando tenía 16 semanas de embarazo, y resultó positiva para el dengue, que, como el zika, es un flavivirus. Debido a que los dos virus pueden reaccionar de forma cruzada en las pruebas, los médicos no pudieron saber con certeza si también tenía una infección por zika.

Las muestras de Pardo fueron enviadas para pruebas adicionales, las cuales fueron procesadas rápidamente por el departamento de salud del estado y por un laboratorio aprobado por los CDC en Minnesota. Pero no le enviaron los resultados a Pardo.

La mujer se enteró de los resultados sólo cuando recibió una carta a finales de abril de científicos de la Universidad de Washington que estaban reclutando pacientes con zika para un ensayo clínico. Le dijeron que había dado positivo para zika.

“Pensé que era negativa”, dijo. “Estaba muy molesta. ¿Cómo se atrevieron a darme un diagnóstico que no era cierto?”

Pardo presionó a su médico para que le diera respuestas, y fue entonces cuando supo que habría estado infectada.

Llevó a su beba al Hospital de Niños de Seattle, donde expertos examinaron a Noemí para ver si presentaba microcefalia.

La doctora Hannah Tully, neuróloga pediátrica, confirmó que la beba parece sana, sin signos de una infección por zika.

Pero Pardo dijo que no podía dejar de pensar su prueba positiva. Ella está preocupada por la posibilidad de que su hija pudiera desarrollar problemas, una de las muchas incógnitas del azote del Zika.

“Fue impactante sólo porque no sabía cómo abogar por mi bebé”, dijo. “Afortunadamente, ella se está desarrollando normalmente, pero incluso sin microcefalia, los médicos realmente no saben”.

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Andrea Pardo, 33, of Issaquah, Wash., was tested for the virus in October, after becoming pregnant while living in Mexico. The results were ready by December, but Pardo wasn’t notified until April — 37 weeks into her pregnancy, just before she delivered her daughter, Noemi.

So far, the baby appears healthy. But the delay, blamed on a mistake at the University of Washington clinic where Pardo received care, deprived her of the chance to make an informed choice about her pregnancy, she said.

“Nothing would have changed for me,” she said. “But if I had found out around 20 weeks, I guess I could have made some decisions there.”

Dr. Timothy Dellit, a UW Medicine infectious-disease expert, told Kaiser Health News he called Pardo to explain the error.

“I apologized for the fact that test results were not given to her back in December,” he said. “It was just an unfortunate way those tests were handled.”

Although it’s “not the norm,” said Dr. Kelly Wroblewski, director of infectious diseases for the Association of Public Health Laboratories, she has heard of several recent instances of patients not receiving Zika test results promptly.

“The reports aren’t getting to the right clinicians,” she said. “Where and how that breakdown is happening, I can’t say from where I sit.”

Health officials in the U.S. and beyond have conducted hundreds of thousands of tests as Zika spreads. The CDC alone has sent out 400,000 tests in U.S. states and territories and more than 700,000 worldwide, spokesman Tom Skinner said.

In May, officials with the Centers for Disease Control and Prevention to include not only pregnant women who might have been exposed to the virus but women with risk factors who are thinking of becoming pregnant.

The Zika virus, which can be passed from a pregnant woman to her fetus, can cause potentially severe birth defects, including microcephaly, characterized by a small head, vision and hearing problems and developmental delays. After news that the virus was spreading in Latin America, , researchers found.

Pardo said she probably wouldn’t have terminated her pregnancy had she known earlier that she was infected with Zika — but she would have wanted accurate information.

Dellit said clinic staff knew that Pardo had been exposed to Zika and cared for her appropriately. Officials have revamped the test protocols, double-checking that results from outside labs make it into medical files and are communicated to patients, he added.

Pardo traveled to Las Guacamayas, Mexico, last June to be with her husband, Hector Pardo, 28. He originally came to the U.S. as a teenager without documentation and had to leave the country while his immigration status was resolved. He returned to Washington state in December and now works for a furniture company.

Andrea Pardo is on maternity leave from her job as an academic counselor in the University of Washington’s microbiology department. The couple also have a 3-year-old daughter.

Andrea became pregnant last August. At the same time, she developed what she thought was a heat rash and other symptoms of illness, but a doctor there downplayed any risk of Zika infection, she said.

It’s a stealthy virus; 4 out of 5 people never know they’re infected, while others might show mild symptoms, such as fever, rash, joint pain, muscle aches and red eyes. The effects in unborn fetuses, however, can be devastating, experts say.

A blood test in Mexico was negative for Zika. Pardo returned to the U.S., when she was 16 weeks pregnant, and tested positive for dengue, which, like Zika, is a flavivirus. Because the two viruses can cross-react in tests, doctors couldn’t tell for sure whether she had a Zika infection, too.

Pardo’s samples were sent for additional tests, which were processed promptly by the state health department and by a CDC-approved laboratory in Minnesota. But the results weren’t sent to Pardo.

She learned of the results only when she received a letter in late April from UW scientists recruiting patients with Zika for a research trial. It said she had tested positive for Zika.

“I thought I was negative,” she said. “I was really upset about it. How dare they give me a diagnosis that wasn’t true?”

Pardo pressed her doctor for answers — and learned then she was presumed infected.

She took her baby to Seattle Children’s Hospital, where Noemi was seen by experts in microcephaly.

Dr. Hannah Tully, a pediatric neurologist, confirmed that the baby appears healthy, with no sign of a Zika infection.

But Pardo said she’s haunted by the positive results of her test. She worries her daughter could still develop problems — one of the many unknowns of the Zika scourge.

“It was shocking just because I didn’t know how to advocate for my baby,” she said. “Thankfully, she was developing normally, but even without microcephaly, they don’t really know.”

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Había estado aterrada por las fotos que veía por internet, bebés en Brasil y en Puerto Rico cuyos cráneos se veían deformes, devastados por el virus del zika que se diseminaba por Latinoamérica.

Días antes, los doctores en los Estados Unidos le habían dicho a Ríos, una mamá primeriza de 20 años, que estaba infectada con el zika, y que era muy probable que hubiera contraído el virus por la picadura de un mosquito cuando visitó a sus padres en Colima, México, el verano pasado.

Ríos quiso desesperadamente que estuvieran equivocados.

“Vi que los bebés tenían cabezas chatas”, recordó. “Y que tenían problemas para comer, ver, hablar, caminar. Que tenían convulsiones. Solo pude exclamar: ‘O, Dios mío’”.

Pero cuando nació Aryanna Guadalupe Sánchez-Ríos —con 5 libras y 10 onzas, y una capa de pelo negro y lacio— fue claro que los miedos de Ríos se habían vuelto realidad. La cabeza de la beba era mucho más pequeña de lo normal —27 cm en vez de los 35 cm normales— una condición conocida como microcefalia. Un ultrasonido anterior había mostrado extensos depósitos de calcio en el cerebro, más señales del daño del zika, dijeron los médicos.

Así y todo, Ríos se negó a perder las esperanzas. Para ella, la cabeza de Aryanna “no era realmente chata”, solo pequeña, contó. Pruebas de la vista mostraron cicatrices en el centro de las retinas, una posible señal de pérdida de la vista causada por el virus. Pero Ríos está segura de que los ojos grandes y pardos de su beba ya rastrean la luz y el movimiento.

“Yo solo quiero que ella esté bien”, dijo.

A pesar de las alertas de los doctores y los datos médicos, la joven mamá se mantiene optimista, sosteniéndose en su profunda fe católica para construir una vida con su hija. Hasta el 23 de mayo, Aryanna era una de los nacidos en los estados de Estados Unidos y en Washington, DC, con defectos de nacimiento relacionados con el zika.

Otros ocho abortos espontáneos se han atribuido a esta infección, según los Centros para el Control y Prevención de Enfermedades (CDC), que mantiene actualizaciones periódicas.

Aryanna, quien nació a finales de enero, y los otros bebés, son el centro de los esfuerzos de oficiales de los Estados Unidos para monitorear los efectos de largo plazo de la devastadora epidemia, a medida que comienza una nueva temporada para el peligroso mosquito.

“Muchas personas piden milagros”, dijo Ríos, quien colocó un brazalete de cuentas con un amuleto de la Virgen María en la muñeca izquierda de su hija. “Siento como si tuviera que indagar profundo en su corazón”.

Hasta ahora, Ríos está entre las cerca de en los estados y el Distrito de Columbia con evidencia de laboratorio de posibles infecciones por zika, según los CDC. Unas 1,600 han completado sus embarazos.

De aquéllas con infecciones de zika confirmadas, han tenido bebés con daño cerebral u otros defectos graves, reveló un análisis reciente de los CDC.

A Ríos le hicieron dos veces la prueba para el zika y le dijeron que no estaba infectada. Pero pocos días antes que naciera Aryanna, el tercer test dio positivo.

“Un doctor me dijo, ‘usted tiene zika, por eso su beba tiene microcefalia’”, recordó. “Podría haber sido más amable”.

Después de nacer, Aryanna también dio positivo para el virus.

La noticia fue devastadora para Ríos, una ciudadana estadounidense que había estado viviendo con su esposo y sus padres en Colima, una ciudad de más de 700,000 habitantes en la costa mexicana del Pacífico. Ríos regresó a los Estados Unidos el otoño pasado, para estar con familiares en Lacey, 90 minutos al sur de Seattle.

“Dije, ‘¿cómo puede ser posible?’ No tenía ningún síntoma”, contó Ríos.

Ella supo después que 4 de cada 5 personas infectadas con el virus del zika no presentan síntomas de la enfermedad.

Incluso ahora, le cuesta creer que algo está mal. Cuando Aryanna se despierta de una siesta, somnolienta y cálida, Ríos la envuelve en una manta rosa y la acuna en el sofá.

“¡Hola, Stinky! ¡Hola, linda bebita!”, bromea, besando la regordeta mejilla de Aryanna. “La veo como a un bebé normal”.

Ríos y Aryanna están registradas en el , un banco de datos en el cual los departamentos de salud locales y estatales están haciendo seguimiento de mujeres y bebés con evidencias de infección en laboratorio.

Aún en Washington, un estado de bajo riesgo en el que los mosquitos Aedes aegypti y Aedes albopictus que trasmiten el zika no se han encontrado, se han identificado a 18 mujeres embarazadas con pruebas de laboratorio con evidencia del virus desde el año pasado, dijo Hanna Oltean, epidemióloga que registra los casos de Washington. Aunque el zika puede trasmitirse también a través del sexo, todos parecen haber sido adquiridos durante viajes al exterior.

De las mujeres residentes locales, tres dieron a luz bebés con microcefalia, incluyendo a Ríos.

“Ha habido una curva de aprendizaje definitiva en salud pública”, dijo Oltean. “Esta es la primera enfermedad transmitida por mosquitos con estas características”.

La doctora Hannah Tully, pediatra especialista en neurología en el Seattle Children’s Hospital, examinó a Aryanna a las cinco semanas de nacida, y de nuevo este mes. Experta en microcefalia, Tully ha visto a muchos niños con el desorden, pero el zika es diferente, dijo. El daño parece ser mayor que el que se ve típicamente en la microcefalia causada por otras condiciones, incluyendo infecciones y parto prematuro.

“El zika dispara esta catástrofe de inflamación y muerte celular”, explicó Tully.

Ahora, los científicos saben que el zika, alguna vez un oscuro virus, apunta y ataca a las células madres neurales en el cerebro del feto en desarrollo. Los bebés que nacen con el a menudo tienen microcefalia grave, disminución del tejido cerebral y daño ocular, movimientos articulares limitados y tono muscular rígido. Investigaciones recientes sugieren que también podrían sufrir problemas auditivos y trastornos convulsivos, como epilepsia.

“Es de crítica importancia que estos bebés sean evaluados temprano”, dijo la doctora Margaret Honeim, jefa del área de defectos de nacimiento de los CDC. “Todavía no sabemos el rango completo de problemas que podrían tener”.

Es una pregunta crucial, agregó Honeim. Cada semana, se suman 30 a 40 nuevos casos en el registro de embarazos.

Los costos completos no están claros. En septiembre, el Congreso asignó cerca de a agencias federales para la crisis del zika. Los CDC ya han gastado alrededor de $300 millones en fondos redirigidos y han designado alrededor de $394 millones más, según la vocera de una agencia.

El presupuesto de la Casa Blanca lanzado en mayo propone establecer para responder a brotes emergentes como el zika. Pero también recortaría $1.3 mil millones de los CDC y $838 millones del Instituto Nacional de Alergias y Enfermedades Infecciosas, en donde los científicos están trabajando en una vacuna para prevenir la infección por zika.

Y ninguno de esos fondos cubre lo que puede costar criar niños como Aryanna.

Un de investigadores de la Yale University y la Johns Hopkins Bloomberg School of Public Health calcula los gastos médicos, y otros costos, para un niño afectado por el zika en $4.1 millones a lo largo de la vida. Estimados previos de los CDC fueron más altos: .

El solo pensarlo asusta a Ríos, quien comparte un modesto apartamento de dos habitaciones con su hermana y su cuñado. La condición de Aryanna implica que Ríos no puede volver a su trabajo como recepcionista en una firma de empaques, por lo que depende de la familia para la renta, comida, pañales, ropa y transporte.

Esa asistencia también es precaria. La hermana de Ríos, Jessica, de 21 años, la ha llevado en auto a las citas médicas en Seattle. Pero en mayo su auto se rompió, forzando a María a usar el transporte público.

Ríos recibe fórmula del programa (WIC), y la atención médica de Aryanna la cubre el Medicaid, el programa estatal y federal para personas pobres y discapacitadas. Ríos aplicó para beneficios por discapacidad del Social Security, pero el proceso es largo y la asistencia no llega.

“¿De dónde voy a sacar $4 millones?, se preguntó.

Ríos nació en Auburn, Washington, y vivió allí hasta los 15 años, cuando se mudó con sus padres a México, para cuidar a su abuela enferma. Volvió a los Estados Unidos a los 18 para terminar la secundaria. Fue entonces cuando conoció a su esposo, Julio Sánchez, de 26, quien estaba trabajando como jardinero con una visa temporal.

Se enamoraron y se casaron en septiembre de 2015. Se mudaron a Colima tres meses después, en diciembre, luego que su visa expirara, y justo después que se reportaran los tres primeros casos de zika en México.

Ríos descubrió que estaba embarazada en abril de 2016, primero los doctores pensaron que tenía un quiste en un ovario. Una súbita hemorragia hizo que Ríos tuviera que pasar los cinco meses siguientes del embarazo en cama, y durante ese tiempo estuvo preocupada más por un aborto espontáneo que por un virus trasmitido por un mosquito.

Incluso cuando a los seis meses de embarazo un ultrasonido mostró que el desarrollo de la cabeza del bebé tenía un atraso de dos semanas, los médicos no se preocuparon.

“Dijeron, ‘no se preocupe’”, recordó Ríos. “En Colima, no vi a nadie alarmado por el zika”.

En febrero, oficiales de salud en México reportaron que ahora Colima es uno de los cuatro estados en el país con la incidencia más alta de infecciones por zika, con de mujeres embarazadas, de 2015 hasta el 2 de marzo de este año.

Ríos quería dar a luz en los Estados Unidos para asegurarse de que su hija fuera ciudadana y recibiera el cuidado adecuado, aunque significara dejar a su marido. Ella le envía mensajes de texto constantemente, y fotos de Aryanna con un traje de flores o un pijama de Minnie Mouse.

“Sólo espero que tenga algún tipo de permiso para estar en los Estados Unidos”, dijo Ríos. Pero, con un nuevo presidente en la Casa Blanca que se opone a la inmigración, agregó, duda de que eso suceda pronto.

Su esposo se reunió con Aryanna en abril, cuando Ríos viajó con la beba a Colima.

“Ni siquiera sabía lo que era el zika”, recordó.

Los padres de Ríos, ambos de 40 años, no pudieron ocultar su preocupación por su hija y su primer nieto.

La familia fue directamente desde el aeropuerto con la beba a una iglesia en Talpa de Allende, donde el padre de Ríos caminó de rodillas desde la entrada hasta el altar, un gesto de fe para mantener a Aryanna a salvo del daño.

“Mi mamá sólo me dice, ‘todo va a estar bien'”, contó Ríos.

A veces, Ríos no está tan segura. Sus días giran alrededor de Aryanna, quien recibe visitas semanales de una enfermera y un fisioterapeuta, y tiene citas médicas programadas con seis meses de anticipación.

Un viernes reciente, la beba soportó una ronda de nueve horas de pruebas médicas, incluyendo exámenes neurológicos y de la vista, y una resonancia magnética. Aryanna fue paciente mientras un técnico medía su cabeza, de 33.2 centímetros. A los 3 meses, todavía era más chica que la típica cabeza de un recién nacido que mide 35 centímetros.

Pero la niña gritó enojada cuando la doctora Michelle Trager Cabrera, oftalmóloga pediátrica, le puso una luz brillante enfrente y miró profundamente sus ojos oscuros.

“Hay una posibilidad de que su visión pueda estar muy deteriorada”, concluyó Cabrera, quien vio cicatrices en las retinas del bebé.

“¿Sólo quiero saber si ella podría usar anteojos?”, preguntó Ríos.

“Este es un problema relativamente nuevo que no entendemos bien”, dijo Cabrera, agregando con suavidad: “No creo que los anteojos vayan a ayudar”.

Esa noticia preocupó a Ríos. También los resultados de la resonancia magnética, que confirmaron que Aryanna tenía daño cerebral por los efectos del zika, contó.

En el hospital, Ríos le pidió a su hermana que cuidara a la beba por un minuto. Salió, se sentó, puso la cabeza entre sus manos y empezó a llorar.

“Trato de ser fuerte por ella”, dijo Ríos, entre sollozos. “Estoy realmente asustada. Es difícil”.

Lo peor del zika, agregó, es que nadie, ni siquiera los doctores, pueden decir lo que sigue.

“Todavía tengo esperanza”, dijo. “Estoy intentando todo para que mi niña esté bien”.

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LACEY, Wash. — When her daughter was born at Providence St. Peter Hospital in January, the first thing Maria Rios checked was the baby’s head.

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born in U.S. states and Washington, D.C., with Zika-related birth defects.

Another eight pregnancy losses have been attributed to Zika infections, according to the Centers for Disease Control and Prevention, which updates counts regularly.

Aryanna, who was born in late January, and the other infants are now at the center of efforts by U.S. officials to monitor the lasting effects of the devastating outbreak, even as another dangerous mosquito season begins.

“A lot of people ask for miracles,” said Rios, who keeps a beaded bracelet with an amulet of the Blessed Virgin Mary on her daughter’s left wrist. “I feel like you have to ask deep from your heart.”

To date, Rios is among nearly in U.S. states and the District of Columbia with laboratory evidence of possible Zika virus infections, according to the CDC. Nearly 1,600 have completed their pregnancies.

Of those with confirmed Zika infections, 1 in 10 women in at least 44 states have had a baby with brain damage or other serious defects,

Rios was tested twice for Zika and told that she was free of infection. But days before Aryanna was born, a third test came back positive.

“A doctor told me, ‘You have Zika. That’s why your baby has microcephaly,’” Rios recalled. “She could have said it a little bit nicer.”

After birth, Aryanna tested positive for the virus, too.

The news was devastating for Rios, a U.S. citizen who had been living with her husband and her parents in Colima, a city of more than 700,000 on the Pacific coast of Mexico. She had returned to the U.S. last fall to stay with family in Lacey, 90 minutes south of Seattle.

“I said, ‘How could that be possible?’ I didn’t have any symptoms,” said Rios.

She found out only later that 4 of every 5 people infected with the Zika virus show no signs of the disease.

Even now, she finds it hard to believe that anything’s wrong. When Aryanna wakes from a nap, sleepy and warm, Rios swaddles her in a pink polka-dotted blanket and cradles her on the couch.

“Hi, Stinky! Hi, pretty girl!” she croons, kissing Aryanna’s chubby cheek. “I look at her like a normal baby.”

Rios and Aryanna are enrolled in the , where state and local health departments are tracking women and infants with laboratory evidence of infection.

Even in Washington, a low-risk state where the Aedes aegypti and Aedes albopictus mosquitoes that spread Zika aren’t found, 18 pregnant women have been identified with lab evidence of the virus since last year, said Hanna Oltean, an epidemiologist tracking Washington’s cases. All appear to have acquired the virus through travel, though Zika can be transmitted through sex as well.

Of those local women, three have delivered babies with microcephaly, including Rios.

“There’s been a definite learning curve in public health,” Oltean said. “This is the first mosquito-borne disease that has been anything like this.”

Dr. Hannah Tully, a pediatric neurologist at Seattle Children’s Hospital, examined Aryanna five weeks after birth and again this month. An expert in microcephaly, Tully has seen many children with the disorder, but Zika is different, she said. The damage appears to be greater than that typically found when microcephaly is caused by other conditions, including infections and premature birth.

“Zika triggers this catastrophe of inflammation and cell death,” Tully said.

Scientists now know that Zika, a once-obscure virus, targets and attacks neural stem cells in the developing fetal brain. Babies born with often have severe microcephaly, diminished brain tissue and eye damage, as well as restricted joint movement and rigid muscle tone. Recent research suggests they also might suffer hearing problems and seizure disorders, such as epilepsy.

“It’s critically important that these babies be evaluated early,” said Dr. Margaret Honein, chief of the CDC’s birth defects branch. “We don’t yet know the full range of health problems these babies might have.”

It’s a crucial question, Honein added. Every week, another 30 to 40 cases are added to the pregnancy registry.

The full costs aren’t clear, either. In September, Congress allocated about to federal agencies for the Zika crisis. CDC has already spent about $300 million in redirected funds and has designated about $394 million more, according to an agency spokeswoman.

The White House budget released in May proposes to pay for responses to emerging outbreaks like Zika. But it also would cut $1.3 billion from the CDC and $838 million from the National Institute of Allergy and Infectious Diseases, where scientists are working on a vaccine to prevent Zika infection.

And none of that funding covers what it may take to raise children like Aryanna.

led by researchers at Yale University and the Johns Hopkins Bloomberg School of Public Health pegs the medical and other expenses for a Zika-affected child at $4.1 million over a lifetime. Previous CDC estimates have been as high as

The thought scares Rios, who shares a modest, two-bedroom apartment with her sister and brother-in-law. Aryanna’s condition means Rios can’t return to her former job as a receptionist for a packaging firm, so she relies on family for rent, food, diapers, clothes and transportation.

That assistance is precarious, too. Rios’ sister, Jessica Rios, 21, has been providing rides to medical appointments in Seattle. But her car broke down in May, forcing Maria Rios to scramble for last-minute transportation.

Rios gets formula from the federal , WIC, and Aryanna’s medical care is covered by Medicaid, the state and federal program for poor and disabled people. Rios has applied for Social Security disability benefits, but the process is long and the assistance hasn’t come through.

“Where would I get $4 million?’” she said.

Rios was born in Auburn, Wash., and raised there until age 15, when she moved with her parents to Mexico to help take care of her ailing grandmother. She returned at 18 to finish high school. That’s when she met her husband, Julio Sanchez, 26, who was working in the U.S. as a landscaper on a temporary visa.

The pair dated, fell in love and married in September 2015. They moved to Colima three months later, in December, after his visa expired, just after the first three cases of Zika infection were reported in Mexico.

Rios discovered she was pregnant in April 2016; doctors initially thought she had a cyst on an ovary. Sudden bleeding put Rios on bed rest for five months, and she spent that time worried more about miscarriage than any mosquito-borne virus.

Even when an ultrasound at six months showed that the baby’s head lagged in development by two weeks, doctors weren’t concerned.

“They said, ‘Oh, don’t worry,’” Rios recalled. “In Colima, I didn’t see anybody alarmed about Zika.”

In February, Mexican health officials reported that Colima is now one of four states in the country with the highest incidence of Zika infections, with from 2015 through March 2.

Rios wanted to give birth in the U.S. to ensure that her daughter would be a citizen and to receive proper care, even though it meant leaving her husband behind. She texts him constantly, sending photos of Aryanna in a flower-print onesie and Minnie Mouse pajamas.

“I just hope he gets some sort of permission to be in the U.S.,” Rios said. But, with a new president opposed to immigration in the White House, she said, she doubts that will happen soon.

Her husband met Aryanna in April, when Rios traveled with the baby back to Colima.

“He didn’t even know what Zika was,” Rios recalled. “I said, ‘Look it up.’”

Rios’ parents, both in their early 40s, couldn’t hide their concern for their daughter and their first grandchild.

The family drove straight from the airport with the baby to a church in Talpa de Allende, where Rios’ father walked on his knees from the back to the altar, a gesture of faith aimed at keeping Aryanna safe from harm.

“My mom just keeps telling me, ‘Everything’s going to be fine,’” Rios said.

Sometimes, Rios is not so sure. Her days revolve around Aryanna, who receives weekly visits from a public health nurse and a physical therapist and has doctors’ appointments lined up six months in advance.

The baby endured a nine-hour round of medical tests on a recent Friday, including neurological and eye exams and an MRI. Aryanna was patient while a technician measured her head – 33.2 centimeters. At 3 months, it was still smaller than a typical newborn measurement of 35 centimeters.

But the child screamed in outrage as Dr. Michelle Trager Cabrera, a pediatric ophthalmologist, shined a bright light and peered deeply into her dark eyes.

“There’s a chance her vision could be quite impaired,” concluded Cabrera, who saw scarring on the baby’s retinas.

“I just want to know if she could wear glasses?” Rios asked.

“This is a relatively new problem that we don’t understand well,” Cabrera said, adding gently: “I don’t think glasses are going to help.”

That news worried Rios. So did the results of the MRI, which confirmed Aryanna had brain damage from the effects of the Zika infection, Rios said.

At the hospital, Rios asked her sister to watch the baby for a minute and stepped outdoors into a hospital atrium. She sat down at a table, placed her head in her hands and started to cry.

“I try to be strong for her,” Rios said, between sobs. “I’m really scared. It’s hard.”

The worst thing about Zika, she said, is that no one, not even the doctors, can tell her what’s next.

“I still have my hope,” she said. “I’m trying everything for my girl to be OK.”

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How great of a threat? That’s where it gets tricky.

No locally acquired cases of the virus have been reported in the United States this year. But as public health agencies gear up for mosquito season, uncertainty remains around what resources states may need and whether they will receive adequate federal support. In addition, researchers still have questions about how the virus works and its long-term effects. These forces could complicate efforts to track outbreaks and provide accurate information about prevention and disease management.

“We still have much to learn. And much remains to be done,” Lyle Petersen, director of the Centers for Disease Control and Prevention’s Division of Vector-Borne Diseases, said last week at a House Energy and Commerce hearing.

Last year,  with the disease — most contracted the virus while traveling in South and Central America. Sixty-four babies in the U.S. have been affected since the government began reporting outcomes last June. In rare cases, people who had not traveled abroad contracted Zika through a local mosquito or through sexual contact. Puerto Rico, a U.S. territory, had cases in 2016.

Again this year, determining if areas are experiencing active Zika transmission will require active surveillance and testing — both of mosquitoes and of people potentially exposed. Most people who contract the virus don’t show visible symptoms.

Implementing that testing is challenging, experts said.

“Should you begin universal screenings in communities that are at risk?” asked Jeff Engel, executive director of the Council of State and Territorial Epidemiologists, which represents the specialists working in public health departments. “That is a tough resource question and probably is not feasible.”

Last year, Congress appropriated $1.1 billion toward fighting Zika. That among research, overseas response and state public health efforts. , the CDC warned state officials those federal dollars were running out. They to last through the end of this fiscal year, in September.

Meanwhile, the White House budget released Tuesday proposes establishing an emergency fund to finance responses to outbreaks like Zika. But it also calls for a $1.3 billion cut to the CDC and slashes $838 million from the National Institute of Allergy and Infectious Diseases, the agency behind vaccine development. So far, there has been little talk from Congress of approving extra funding.

“Funding from Congress has been critical for our response to Zika. However, additional support will be needed,” said Rick Bright, director of the federal Biomedical Advanced Research and Development Authority, a subsidiary of the U.S. Department of Health and Human Services, at the hearing.

Some advocates also warn at HHS could limit the agency’s capacity to support a Zika response.

“Obviously we live in tough times when it comes to budget constraints,” said Tom Skinner, a CDC spokesman. “And we have to find creative ways to do the best we can with what we’re given.”

If those constraints thwart surveillance efforts this year, experts warned, it will make it harder to know precisely when Zika hits. That blind spot puts women of childbearing age — for whom the virus’ consequences are most dramatic — at greater risk. Reports highlight microcephaly as a significant consequence, but a burgeoning field of research suggests its impact on children may be broader, and may manifest years after a child is born.

“Without active surveillance — I’m worried we missed [many cases of] Zika last year and we’ll miss Zika this year,” said Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, in Houston. “If you’re a woman of reproductive age, living on the Gulf Coast of the United States, or Arizona or Southern California, and you’re pregnant or might be pregnant — you don’t really know if Zika’s in your area or not.”

Texas, which experienced six cases of local Zika transmission last year, has identified counties it deems most vulnerable. All pregnant women in those areas are advised to get Zika screenings as part of their routine prenatal care. The state works with the CDC to monitor how many pregnant women test positive and intends to monitor babies born to mothers who experienced infection.

But long-term follow-up will probably require more funding, noted Chris Van Deusen, a spokesman for Texas’ Department of State Health Services. And leveraging prenatal care to push Zika testing has its own shortcomings. Many women most at risk are low-income, Van Deusen noted, and therefore less likely to interact with the health care system, or get prenatal care. Those people won’t be tested or accounted for in the state’s Zika tracking efforts.

That, Hotez said, compromises authorities’ ability to discover Zika when it hits and then get the word out. “The only way we identify Zika outbreaks like [last year’s] in South Florida is through serendipity,” he said.

Testing is another concern. Current tests are unreliable in identifying Zika among patients previously infected with related viruses, such as dengue.

Limited resources could also strain the states’ ability to process tests efficiently. Last year, the volume of patient samples sent for Zika testing overwhelmed laboratories in some affected areas, noted Kelly Wroblewski, director of infectious disease at the Association of Public Health Laboratories.

The surge translated to delays in determining if women had Zika. That could continue this year, since universal testing in affected areas is a burden that many of these labs don’t have the resources to meet.

If the virus spreads, Wroblewski said, “we may find a capacity gap.”

Many states also lack the infrastructure to adequately address an outbreak. Surveillance of mosquito-borne diseases is virtually nonexistent in many states, from the Council of State and Territorial Epidemiologists. Mosquito surveillance among states dropped from 96 percent in 2004 to 80 percent in 2012. In many areas, mosquito eradication has shrunk along with dwindling public health budgets.

“We need better mosquito control methods, we need better surveillance,” Petersen said at last week’s hearing. “We need to develop more of a nationally standard approach to vector control and laboratory testing. … This will require a sustained effort to rebuild infrastructure.”

The scarcity of resources is compounded by scientists’ limited knowledge of the virus.

Experts are “discovering new things every day,” particularly regarding how the virus plays out after birth, Engel said. Beyond an obvious condition like microcephaly — which results in an abnormally small head and brain impairment — it’s tough to say just how consequential the disease can be. Preliminary work suggests children without microcephaly whose mothers carried the virus may have developmental issues later in life. But the extent of those issues — and the odds they do in fact manifest — is unclear. And limited knowledge about how Zika interacts with similar viruses means available tests aren’t always accurate.

“Unfortunately, it’s the problem with these rapidly emerging diseases; you can’t get the research up quickly enough to get the best answers,” said Scott Weaver, director of the Institute for Human Infections and Immunity at the University of Texas Medical Branch in Galveston.

Because Zika’s long-term consequences remain murky, states are trying to keep tabs on children whose mothers tested positive. Beyond Texas, Louisiana is also tracking children for at least three years after birth, even if they don’t show obvious symptoms. But that assumes a surveillance system is robust enough to track all mothers who carried the virus. It also assumes sufficient resources to keep monitoring children. Those, experts said, are hardly guaranteed. And they still might not be enough.

“It’s going to take a generation of pediatric neurologists to study and sort this out,” Hotez said. “This is just the beginning.”

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The Centers for Disease Control and Prevention told state health officials in a meeting last month that Zika funding is running out and that additional support should not be expected, according to a . An agency spokeswoman declined to confirm the report, saying in an email that the CDC did not yet have a budget for the next fiscal year and could not speculate on how funding for Zika might be affected.

Last year, Congress provided to the CDC for Zika response and preparedness that was mostly passed on to local and state public health departments.

In California, the federal money helped to expand mosquito surveillance, tracking of birth defects related to Zika and programs to educate residents about the disease, among other efforts. The money has been distributed to states through different grants for different purposes. Between fiscal years 2016 and 2017, for example, the state of California received for the surveillance of Zika-related birth defects. Los Angeles County received another  also to be used for the tracking of birth defects.

California Healthline requested comment from the state’s department of public health, but the agency did not provide information in time for publication.

Compared to other states, the Zika risk in California tends to be low. A federal published last year showed that the West’s drier climate keeps in check the population of Aedes aegypti mosquitoes known to transmit the virus. Southern states are more humid and at higher risk.

As of April 21, 534 Zika virus infections have been reported in California since October 2015, according to state data. All of the infections were related to travel. Five babies have been born in California with Zika-related birth defects, state data also show.

According to the CDC, 58 babies in the U.S. were born with birth defects related to Zika as of April 11. Those defects include microcephaly, a condition in which a baby’s head and brain are smaller than normal, causing developmental delays and other problems.

The potential end of federal funds may affect states’ ability to track Zika-related birth defects, said Cindy Pellegrini, the senior vice president of public policy and government affairs at the March of Dimes.

Before Zika emerged, microcephaly was so rare that most states did not track it. If states can no longer afford to do so, it will be difficult for health officials to know for certain which cases of birth defects were triggered by Zika, Pellegrini said.

The CDC and the March of Dimes recently launched , a website in which the public can search for providers who are qualified and willing to treat women and children with Zika. The site currently covers only 10 states, including California.

Mosquitoes that can transmit Zika to people have been detected in in California: Fresno, Madera, Riverside, San Mateo, Tulare, Kern, Los Angeles, Orange, San Bernardino, Imperial and San Diego.

San Diego County, which has reported 87 infections contracted abroad, last month born with Zika-related microcephaly. San Diego County health officials said they are aware that Zika funding from the CDC was a one-time investment and used their share of funds to purchase lab equipment and hire temporary staff.

Since 2015, when the first case of Zika was confirmed in Brazil, the state of California established guidelines to handle the growing caseload of infections. Some of these include consulting with doctors on testing and interpreting results, educating the public on the risks of sexual transmission of Zika and monitoring pregnant women with suspected infections.

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La velocidad y los efectos debilitantes del en el Hemisferio Occidental generaron una carrera para desarrollar una vacuna. Poco más de un año después de que se declarara a esta pandemia como una emergencia sanitaria mundial, un grupo de voluntarios están siendo sometidos a pruebas preliminares.

Pero los investigadores dicen que la incertidumbre sobre si la epidemia de zika continuará afecta su capacidad de terminar las pruebas. Necesitan áreas con un brote viral activo para realizar ensayos en humanos a gran escala y asegurarse de que la vacuna realmente proteja contra la enfermedad.

“Por un lado, usted no quiere ver brotes de infección”, dijo el doctor Anthony Fauci, director del Instituto Nacional de Alergia y Enfermedades Infecciosas (NIAID). “Pero, por otro lado, [sin ellos] puede que tenga que esperar mucho tiempo para asegurarse de que la vacuna funciona”.

Todas las vacunas que se están probando ahora están en la etapa de ensayos clínicos de fase I, lo que significa que se están realizando pruebas de seguridad en un número pequeño de personas. Según publicado el martes 21 de febrero en la revista Immunity, las vacunas representan una variedad de técnicas científicas para frustrar a la enfermedad, que van desde la inactivación del virus hasta la manipulación de su ADN.

El NIAID anunció el martes que está lanzando otro ensayo de fase I para una vacuna hecha en base a proteínas encontradas en la saliva del mosquito. Esta vacuna busca desencadenar una respuesta del sistema inmune humano a la saliva del mosquito y cualquier virus que se encuentre en la saliva. Si tiene éxito, el producto podría proteger a las personas contra un espectro de enfermedades transmitidas por mosquitos, incluyendo el zika.

El coronel Nelson Michael, director del U.S. Military HIV Research Program de los Estados Unidos en el Walter Reed Army Institute of Research y coautor del artículo, dijo que espera informes preliminares en abril sobre la seguridad de algunas de las vacunas que comenzaron a investigarse primero. A partir de ahora, dijo, es imposible adivinar qué vacuna demostrará ser más efectiva a la hora de generar inmunidad.

“A veces es difícil predecir qué caballo ganará la carrera”, dijo Michael.

El zika, que a por picaduras de mosquitos o contacto sexual, a menudo infecta sin presentar síntomas. En algunos casos, causa algunos similares a los de la gripe, como fiebre, dolores musculares y dolor en las articulaciones en adultos y, en raras ocasiones, síndrome de Guillain-Barré, que puede provocar parálisis temporal. Pero el virus es más notorio por causar que algunos niños, cuyas madres estuvieron expuestas al zika, nazcan con microcefalia: un defecto de nacimiento por el cual la cabeza del bebé es más pequeña que el tamaño promedio, que genera graves retrasos en el desarrollo.

El virus atrajo la atención internacional tras la aparición de cientos de casos de bebés con microcefalia en Brasil. Rápidamente atravesó Sudamérica y el Caribe antes de detenerse en la costa sur de los Estados Unidos.

La Organización Mundial de la Salud una “emergencia de salud pública de interés internacional” el 1 de febrero de 2016, y luego el 18 de noviembre.

Las vacunas que cumplen con el estándar de seguridad en ensayos clínicos de fase I se someten a rondas posteriores de pruebas para medir la efectividad. Para conocer la eficacia, los investigadores confían en el estándar de oro de administrar la vacuna a un gran número de personas en riesgo para ver si el medicamento es efectivo. Sin embargo, la llegada del zika al Hemisferio Occidental es reciente, lo que significa que los investigadores no saben si el virus se convertirá en una amenaza constante, o si se trató solo de una única explosión.

La incertidumbre plantea varias implicaciones para acelerar el desarrollo de una vacuna. Una pausa en el brote podría causar retrasos significativos en las pruebas, lo que también retrasaría la aparición de un producto disponible comercialmente, explicó Fauci.

Mientras que los investigadores pueden utilizar métodos alternativos para medir la eficacia sin pruebas a gran escala, una disminución en la circulación del virus podría retrasar el proceso por años, porque las pruebas de la vacuna no serían eficaces.

“Si no tenemos muchas infecciones esta temporada en Sudamérica y Puerto Rico, puede tomar años para asegurarnos que la vacuna funcione”, dijo.

Fauci espera lanzar en marzo la próxima ronda de pruebas en humanos para una vacuna de ADN desarrollada por el NIAID.

Michael también se preocupa de que la disminución en el número de casos podría llevar al sector privado a retirar los fondos para el desarrollo de la vacuna. Se necesitan millones de dólares para desarrollar una droga o una vacuna, y las compañías farmacéuticas desempeñan un papel crítico en el desarrollo y la fabricación de estos productos, dijo. Pero esas empresas tienen muchos intereses competitivos, agregó, y si es difícil probar una vacuna este año, los esfuerzos de prevención del zika, tanto públicos como privados, pueden derivarse a otras áreas.

“Este es un problema constante, en dónde se ponen sus recursos”, dijo.

Hasta ahora, las señales sugieren que el clima de nuevo podría ser propicio para el zika este año. Las temperaturas, más cálidas que las habituales, están afectando a áreas en todo el Hemisferio Occidental, informó , incluyendo focos de brotes en Brasil. Las temperaturas más altas aumentan la voracidad del principal transmisor del virus del zika, el mosquito Aedes aegypti.

En los Estados Unidos, las áreas con poblaciones de Aedes aegypti están monitoreando de cerca el número de mosquitos. El año pasado, Texas y Florida lidiaron con casos locales de infección por zika (no trasmitidos por viajeros).

En Texas, funcionarios de salud pública han monitoreado las poblaciones de mosquitos durante todo el invierno para rastrear su número y la presencia del virus. Chris Van Deusen, portavoz del Departamento Estatal de Servicios de Salud de Texas, ha visto un número menos de Aedes aegypti y ningún caso de Zika.

Van Deusen dijo que el estado también está monitoreando el brote en México, ya que el tráfico pesado a través de la frontera aumenta la posibilidad de transmisión. Los funcionarios también esperan otro brote de casos de transmisión local, indicó.

“Hay tantos factores a tomar en cuenta, que es realmente imposible hacer una predicción sólida”, dijo.

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The speed and debilitating effects of Zika outbreak in the Western Hemisphere prompted a sprint to develop a vaccine. Just a little more than a year after the pandemic was declared a global health emergency, a handful of candidates are undergoing preliminary testing in humans.

But researchers say the uncertainty over whether the Zika epidemic will continue affects their ability to finish testing. They need locations with an active viral outbreak to conduct large-scale human trials and make sure the vaccine actually protects against disease.

The NIAID announced Tuesday it is launching yet another Phase I trial for a vaccine made out of proteins found in mosquito saliva. The product is intended to trigger a human immune system response to the mosquito’s saliva and any viruses mixed with it. If successful, the product could protect humans against a spectrum of mosquito-transmitted diseases, including Zika.

Col. Nelson Michael, director of the U.S. Military HIV Research Program at the Walter Reed Army Institute of Research and co-author of the paper, said he expects preliminary reports on the safety of some of the older vaccines in April. As of now, he said, it is impossible to guess which vaccine will prove most effective in providing immunity.

“Sometimes it’s difficult to predict which horse will win the race,” Michael said.

Zika ― which is or sexual contact, often infects people without showing symptoms. In some cases, it causes flu-like symptoms, such as fever, muscle aches and joint pain in adults ― and, in rare cases, Guillain-Barré syndrome, which can cause temporary paralysis. But it is most notorious for causing some children to be born with microcephaly ― a birth defect in which a child’s head is smaller than the average size ― if their mothers were exposed to Zika.

The virus garnered international attention after hundreds of cases of disabled babies surfaced in Brazil. It quickly swept through South America and the Caribbean before stopping on the southern coast of the U.S.

The World Health Organization a “public health emergency of international concern” on Feb. 1, 2016, then .

Vaccines that meet the safety standard in Phase I clinical trials undergo subsequent rounds of testing to gauge effectiveness. To measure this, researchers rely on the gold standard of administering the vaccine to large number of people at risk to see if the medicine is effective. However, Zika’s recent arrival to the Western Hemisphere means researchers don’t know whether the virus will become a perennial threat, or a one-time explosion.

The uncertainty poses several implications for the surge in Zika vaccine development. A lull in the outbreak could cause significant delays in testing, pushing back the timetable for a commercially available product, Fauci said.

While researchers can use alternative methods to measure efficacy without large-scale testing, a decline in the circulation of the Zika virus could set progress back by years because the vaccine testing would be ineffective.

“If we don’t get a lot of infections this season in South America and Puerto Rico, it may take years to make sure the vaccine works,” he said.

Fauci expects to launch the next round of human trials for a DNA vaccine developed by the NIAID next month.

Michael also worries that a lag in the number of Zika cases could lead the private sector to pull funds from vaccine development. It takes millions of dollars to develop a drug or vaccine, and pharmaceutical companies play a critical role in making and manufacturing them, he said. But those companies have many competing interests, he noted, and if it is hard to test a vaccine this year, the public and private Zika prevention efforts may turn their attention elsewhere.

“This is a constant issue where you put your resources,” he said.

So far, signs suggest that the climate could be ripe for Zika again this year. Warmer-than-usual temperatures are affecting areas across the Western Hemisphere, CBS reported, including hotbeds of the Zika outbreaks in Brazil. The higher temperatures increase the voracity of Zika’s main transmitter, the Aedes aegypti mosquito.

In the United States, areas with populations of the Aedes aegypti are closely monitoring their numbers. Last year, Texas and Florida dealt with locally acquired cases of Zika infection.

In Texas, public health officials have monitored mosquito populations throughout the winter to track their numbers and any presence of the virus. Despite unseasonably warm weather, said Chris Van Deusen, spokesman for the Texas Department of State Health Services, they have seen lower numbers of the Aedes aegypti and no cases of Zika.

Van Deusen said the state is also monitoring the outbreak in Mexico, since heavy traffic across the border increases the possibility of transmission. Officials are expecting another outbreak of locally transmitted cases of disease, Van Deusen said.

“There’s so many factors that go into it, it’s really impossible to make an ironclad prediction,” he said.

This article was updated to add information about the vaccine testing process.

ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).