Mexico to give papers to children, pregnant women in migrant caravan

MEXICO CITY (Reuters) – Mexico said on Thursday it would give humanitarian visas to children and pregnant women in a migrant caravan moving north from southern Mexico, adopting a softer approach to the task of containing migrant flows than at times taken recently.

Lasting a year, the visas grant migrants access to public services like healthcare, as well as the ability to work.

Thousands of migrants from Central America and the Caribbean last weekend began traveling slowly from the southern border in a bid to reach the United States or Mexico City.

According to a Reuters witness, the majority of the latest caravan members are families with young children.

A major caravan moving through Mexico last month met with often heavy-handed resistance from Mexican authorities, sparking complaints about their tactics and even condemnation from President Andres Manuel Lopez Obrador.

As recently as Saturday, some 400 law enforcement officers in anti-riot gear tried to block the caravan’s path at a highway checkpoint in the city of Tapachula near the Guatemalan border.

One family, including small children, was knocked to the ground in the struggle.

Still, a Mexican official told Reuters authorities did not want to become embroiled in violent confrontations due to the number of children and pregnant women in the caravan.

The latest caravan comes amid record numbers of apprehensions by U.S. Customs and Border Protection and growing criticism of U.S. President Joe Biden from Republicans, who say he has not done enough to curb illegal immigration.

(Reporting by Jake Kincaid; Editing by Dave Graham and Marguerita Choy)

Breakthrough infections can lead to long COVID; genes may explain critical illness in young, healthy adults

By Nancy Lapid

(Reuters) – The following is a summary of some recent studies on COVID-19. They include research that warrants further study to corroborate the findings and that have yet to be certified by peer review.

Breakthrough infections can lead to long COVID

The persistent syndrome of COVID-19 after-effects known as long COVID can develop after “breakthrough” infections in vaccinated people, a new study shows. Researchers at Oxford University in the UK reviewed data on nearly 20,000 U.S. COVID-19 patients, half of whom had been vaccinated. Compared to unvaccinated patients, people who were fully vaccinated – and in particular those under age 60 – did have lower risks for death and serious complications such as lung failure, need for mechanical ventilation, ICU admission, life-threatening blood clots, seizures, and psychosis. “On the other hand,” the research team reported on medRxiv on Thursday ahead of peer review, “previous vaccination does not appear to protect against several previously documented outcomes of COVID-19 such as long COVID features, arrhythmia, joint pain, Type 2 diabetes, liver disease, sleep disorders, and mood and anxiety disorders.” The absence of protection from long COVID “is concerning given the high incidence and burden” of these lasting problems, they added.

Genes may explain critical COVID-19 in young, healthy adults

A gene that helps the coronavirus reproduce itself might contribute to life-threatening COVID-19 in young, otherwise healthy people, new findings suggest. French researchers studied 72 hospitalized COVID-19 patients under age 50, including 47 who were critically ill and 25 with non-critical illness, plus 22 healthy volunteers. None of the patients had any of the chronic conditions known to increase the risk for poor outcomes, such as heart disease or diabetes. Genetic analysis identified five genes that were significantly “upregulated,” or more active, in the patients with critical illness, of which the most frequent was a gene called ADAM9. As reported on Thursday in Science Translational Medicine, the researchers saw the same genetic pattern in a separate group of 154 COVID-19 patients, including 81 who were critically ill. Later, in lab experiments using human lung cells infected with the coronavirus, they found that blocking the activity of the ADAM9 gene made it harder for the virus to make copies of itself. More research is needed, they say, to confirm their findings and to determine whether it would be worthwhile to develop treatments to block ADAM9.

Pregnant women get sub-par benefit from first vaccine dose

Women who get the first dose of an mRNA COVID-19 vaccine while pregnant or breastfeeding need the second dose to bring their protective benefit up to normal, according to a new study. Researchers compared immune responses to the mRNA vaccines from Moderna Inc or Pfizer Inc and partner BioNTech SE in 84 pregnant women, 31 breastfeeding women, and 16 similarly-aged nonpregnant, non-lactating women. After the first shot, everyone developed antibodies against the coronavirus. But antibody levels were lower in women who were pregnant or breastfeeding. Other features of the immune response also lagged in the pregnant and lactating women after the first dose but “caught up” to normal after the second shot. In a report published on Thursday in Science Translational Medicine, the researchers explained that in order for a mother’s body to nurture the fetus, “substantial immunological changes occur throughout pregnancy.” The new findings suggest that pregnancy alters the immune system’s response to the vaccine. Given that pregnant women are highly vulnerable to complications from COVID-19, “there is a critical need” for them to get the second dose on schedule, the researchers said.

Coronavirus found to infect fat cells

Obesity is a known risk factor for more severe COVID-19. One likely reason may be that the virus can infect fat cells, researchers have discovered. In lab experiments and in autopsies of patients who died of COVID-19, they found the virus infects two types of cells found in fat tissue: mature fat cells, called adipocytes, and immune cells called macrophages. “Infection of fat cells led to a marked inflammatory response, consistent with the type of immune response that is seen in severe cases of COVID-19,” said Dr. Catherine Blish of Stanford University School of Medicine, whose team reported the findings on bioRxiv on Wednesday ahead of peer review. “These data suggest that infection of fat tissue and its associated inflammatory response may be one of the reasons why obese individuals do so poorly when infected with SARS-CoV-2,” she said.

(Reporting by Nancy Lapid; Editing by Bill Berkrot)

More risks to pregnant women, their newborns from COVID-19 than known before – study

(Reuters) – Pregnant women infected with COVID-19 and their newborn children face higher risks of complications than was previously known, a study by British scientists showed on Friday.

An infection of the new coronavirus in such newborns is associated with a three-fold risk of severe medical complications, according to a study conducted by scientists at the University of Oxford.

While pregnant women are at higher risk of complications such as premature birth, high blood pressure with organ failure risk, need for intensive care and possible death.

“Women with COVID-19 during pregnancy were over 50% more likely to experience pregnancy complications compared to pregnant women unaffected by COVID-19,” said Aris Papageorghiou, co-lead of the trial and a professor of fetal medicine at Oxford University.

The study was conducted in more than 2,100 pregnant women across 18 countries, where each woman affected by COVID-19 was compared to two non-infected women giving birth at the same time in the same hospital.

Findings from the study, published in the medical journal JAMA Pediatrics, also showed a delivery by caesarean section may be associated with an increased risk of virus infection in newborns.

However, breastfeeding does not seem to heighten risks of babies contracting COVID-19 from their mothers, scientists said.

(Reporting by Pushkala Aripaka in Bengaluru; Editing by Shinjini Ganguli)

T cell shortage linked to severe COVID-19 in elderly; antiseptic spray may limit virus spread

By Nancy Lapid

(Reuters) – The following is a roundup of some of the latest scientific studies on the novel coronavirus and efforts to find treatments and vaccines for COVID-19, the illness caused by the virus.

Shortage of ‘naive’ T cells raises COVID-19 risk in elderly

A lower supply of a certain type of immune cell in older people that is critical to fighting foreign invaders may help explain their vulnerability to severe COVID-19, scientists say. When germs enter the body, the initial “innate” immune response generates inflammation not specifically targeted at the bacteria or virus.

Within days, the more precise “adaptive” immune response starts generating antibodies against the invader along with T cells that either assist in antibody production or seek out and attack infected cells.

In a small study published on Wednesday in Cell, COVID-19 patients with milder disease had better adaptive immune responses, and in particular, stronger T-cell responses to the coronavirus.

People over age 65 were much more likely to have poor T cell responses, and a poorly coordinated immune response in general, coauthor Shane Crotty of the La Jolla Institute for Immunology said in a news release.

As we age, our supply of “naive” T cells shrinks, he explained. Put another way, we have fewer “inexperienced” T cells available to be activated to respond to a new invader. “Ageing and scarcity of naive T cells may be linked risk factors for failure to generate a coordinated adaptive immune response, resulting in increased susceptibility to severe COVID-19,” the researchers said.

Antiseptic nasal spray may help limit coronavirus spread

An antiseptic nasal spray containing povidone-iodine may help curb transmission of the new coronavirus, preliminary research suggests.

In test tube experiments, a team of ear, nose and throat doctors found that a povidone-iodine nasal spray inactivated the virus in as little as 15 seconds. The nasal spray they tested is typically used to disinfect the inside of the nose before surgery. Formulations designed for use on skin are not safe in the nose, the researchers note.

They reported on Thursday in JAMA Otolaryngology – Head and Neck Surgery that they now have their patients use the spray before intranasal procedures, to reduce the risk of virus transmission through the air via droplets and aerosol spread.

They also suggest instructing patients to perform nasal decontamination before coming to appointments, to “further decrease intranasal viral load and … prevent spread in waiting areas and other common areas.” They caution, however, that routine use of povidone-iodine would not be safe for some people, including pregnant women and patients with thyroid conditions. Larger clinical trials have not yet proved that viral transmission is curbed by intranasal povidone-iodine solutions, but “these studies are already underway,” the researchers said.

Not all COVID-19 antibody tests are equal

Some COVID-19 antibody tests are much more reliable than others. But even with the best ones, reliability varies among patient subgroups, a new study suggests. Some tests look for IgM or IgA antibodies, the first antibodies produced by the immune system in response to an invader, which do not remain long in the body.

Other tests – the most common kind – look for IgG antibodies, which generally develop within seven to 10 days after symptoms begin and remain in the blood for some time after the patient recovers.

In a study posted on medRxiv on Wednesday in advance of peer review, researchers analyzed data from 11,809 individuals whose COVID-19 had been diagnosed with highly rated tests to see how well the various antibody assays would “recall” that the patient had been infected.

The most commonly used assays, which look for IgG, had a 91.2% recall rate. But the IgA and IgM assays had estimated recall rates of 20.6% and 27.3%, respectively, coauthor Natalie Sheils of UnitedHealth Group told Reuters. “Recall varies significantly across sub-populations and according to timing of the tests, with performance becoming relatively stable after day 14,” she said. “The tests performed better for men versus women, for non-whites versus whites and for individuals above age 45.” More research is needed to understand why these variations occur, Sheils added.

(Reporting by Nancy Lapid; Editing by Bill Berkrot)

‘Fear of the unknown’: U.S. pregnant women worried by lack of virus research

By Gabriella Borter

(Reuters) – After the first two cases of the novel coronavirus in the state of Georgia were confirmed this week, Leigh Creel, who is 20 weeks pregnant and lives outside Atlanta, made a nervous phone call to her doctor to ask about the risk to her and her fetus.

The response she got was not comforting. Health experts do not know if pregnant women are more susceptible to the virus or if contracting it will increase the likelihood of adverse pregnancy outcomes, such as pre-term labor or transmission of the virus in utero.

They are racing to learn more about the sometimes fatal respiratory disease that has rapidly spread worldwide from China, including how it might uniquely affect pregnant women.

For expectant mothers, the mystery surrounding the virus is worrying.

“It’s concerning to me when I feel like I know as much as the healthcare professionals,” said Creel, who works in sales and lives with her husband and toddler.

The U.S. death toll from COVID-19 now stands at 14, most of them in Washington state, where 12 people have died in a cluster of at least 50 infections in the Seattle area. More than 3,400 people have died worldwide.

Public health officials in Washington’s Seattle and King Counties have advised that people at “higher risk of severe illness,” including pregnant women, should avoid physical contact and going out in public.

Dr. Laura Sienas, an obstetrician-gynecologist at the University of Washington Medical Center, said most of her pregnant patients have asked what they can do to protect themselves.

Sienas said her hospital has stopped short of urging pregnant women to quarantine themselves, contrary to local public health official guidelines.

Instead, she has emphasized diligent hygiene and avoiding close contact with others, the same guidance the U.S. Centers for Disease Control has offered on its website.

To that end, Sienas has tried to arrange check-ups via telephone, aiming to limit the number of in-person visits pregnant patients make to the hospital.

“There’s definitely that fear of the unknown, and pregnancy is a time when there are a lot of things that you don’t know and can’t control,” Sienas told Reuters. “Trying to give people small steps that they are able to control, like handwashing, has been a bit reassuring to patients.”


Scientists have not yet developed a vaccine against the virus, and research on its transmission and effects on pregnant women has been limited.

A narrow study of nine coronavirus-positive pregnant women in the Wuhan region of China, all in their third trimester, found no evidence that COVID-19 was transferred in utero. The women showed symptoms similar to non-pregnant adult patients.

The World Health Organization published an analysis of 147 pregnant women (64 of whom were confirmed to have COVID-19, 82 who were suspected and 1 who was asymptomatic) and found that 8% had a severe condition and 1% were critically ill.

“There’s some suggestion from other coronaviruses such as SARS that pregnant women may have a more severe disease, but we really don’t know,” said Dr. Denise Jamieson, chief of gynecology and obstetrics at Emory Healthcare in Atlanta and a former epidemic intelligence officer at the CDC.

Normal immunologic and physiologic changes in pregnant women might make them more susceptible to viral infections, including COVID-19, according to the CDC.

“There doesn’t seem to be any great answers out there for anyone, so your mind can really run wild with the possibilities,” said Rachel Storniolo, 36, who lives in Philadelphia and is due to give birth in May.

The study of the Chinese women, published in the scientific magazine The Lancet, found no traces of the virus in breast milk. Still, Jamieson said she would warn coronavirus-positive mothers that they risk transmitting the virus to their infants through respiratory droplets if they choose to breastfeed.

“If a woman has confirmed coronavirus, the safest thing in terms of ensuring that the infant does not get infected from the mother is to separate the mom and baby,” she said, adding that separation might be necessary for several days until the mother is asymptomatic.

Officials have not reported any cases of pregnant women with coronavirus in the United States, and they believe pregnant women – and the rest of the general public – who live outside the outbreak areas are at low risk.

But some women, like Brandi Cornelius, 36, of Portland, Oregon, who is 23 weeks pregnant, are not taking any chances.

“I went to the bank and I used hand sanitizer three times while I was there,” she said. “It helps my body to go to prenatal yoga, for example, but do I want to be in a room full of people?”

(Reporting by Gabriella Borter in New York; Editing by Frank McGurty and Dan Grebler)

More hospital closings in rural America add risk for pregnant women

Dr. Nicole Arthur (R), visits Tariyana Wiggins, a high school teacher, shortly after the birth of Troy O’Brien Williams in the hospital room at the North Baldwin Infirmary, a 70-bed hospital in rural Bay Minette, Alabama, U.S. on June 22, 2017. REUTERS/Jilian Mincer

By Jilian Mincer

Bay Minette, Alabama (Reuters) – Dr. Nicole Arthur, a family practice physician, was trained to avoid Cesarean deliveries in child-birth, unless medically necessary, because surgery increases risks and recovery time.

But she has adjusted her approach since arriving last year at the 70-bed North Baldwin Infirmary in rural, southern Alabama.

Low patient admissions and high costs mean the hospital does not have doctors on site around-the-clock to administer anesthesia in the case of an unexpected emergency Cesarean.

As a result, Dr. Arthur performs the surgery if there are any signs of complication, rather than waiting and running the risk that comes with the 20 to 30 minutes it takes for an anesthesiologist to arrive in the middle of the night.

“It’s better for me to do a C-section when I suspect that something may happen,” she said of her new strategy. “Getting the baby out healthy and happy outweighs some of the risk.”

Physicians in rural communities across America are facing the same tough choices as Dr. Arthur. Hospitals are scaling back services, shutting their maternity wards or closing altogether, according to data from hospitals, state health departments, the federal government and rural health organizations.

Nationally, 119 rural hospitals that have shut since 2005, with 80 of those closures having occurred since 2010, according to the most recent data from the North Carolina Rural Health Research Program.

To save on insurance and staffing costs, maternity departments are often among the first to get shuttered inside financially stressed rural hospitals, according medical professionals and healthcare experts.

“It’s been a slow and steady decline,” said Michael Topchik, the National Leader for the Chartis Center for Rural Health, about maternity ward closings. “It’s very expensive care to offer, especially when it’s lower volume.”

More than 200 maternity wards closed between 2004 and 2014 because of higher costs, fewer births and staffing shortages, leaving 54 percent of rural counties across the United States without hospital-based obstetrics, data from the University of Minnesota’s Rural Health Research Center show.

The trend has escalated recently even though the national healthcare law, known as Obamacare, was designed in part to help rural hospitals thrive. But unpaid patient debt has risen among rural hospitals by 50 percent since the Affordable Care Act was passed, according to the National Rural Health Association, especially in states that decided not to expand Medicaid – the state and federal insurance program for the poor.

The outlook for these hospitals was not poised to improve had Congress approved legislation to replace Obamacare. Senate Republicans’ proposed cuts to Medicaid would have pushed about 150 more rural hospitals into the red, according to the Chartis Center for Rural Health, mainly in states that voted Republican in the last election.

But late on Monday, Senate Majority Leader Mitch McConnell said the Republican effort to repeal and immediately replace Obamacare will not be successful, after two of McConnell’s Senate conservatives announced that they would not support the bill.


The consequences go beyond politics.

When local doctors and midwives leave town, rural women lose access to essential services. Many skip or delay prenatal care that could prevent complications, premature birth or even death. The U.S. infant mortality rate is among the highest in developing countries at 5.8 deaths per 1,000 births.

Pregnant woman in rural areas are more likely to have their deliveries induced or by Cesarean section that, while potentially life-saving, are more expensive and risky than a normal vaginal birth, according to patients, medical professionals and researchers.

Almost a year after her second son’s birth, Courtney Cross is still repaying money she borrowed because of the smaller paychecks and larger gas bills she had from driving 60 minutes each way to a specialist in Mobile, Alabama.

“There were some days I had to reschedule because of the money factor,” said Cross, a medical technician and mother of two, who some months made the trip multiple times. “I had to make money.”

Cross is not alone. The most common reasons for the hospital closures are people and money. More and more people are moving to urban areas in pursuit of work and a better paycheck. And in most states, lower revenue from insurance and U.S. government payments are pushing these hospitals into financial stress, particularly in states that did not build out their Medicaid programs as Obamacare allowed.

“The majority of births in rural America are paid for by Medicaid, and Medicaid is not the most generous payer,” said Diane Calmus, government affairs and policy manager for the National Rural Health Association. “For most hospitals it is a money losing proposition.”

This is the main reason why Connie Trujillo shuttered her midwife practice this spring in Las Vegas, New Mexico. The local hospital had closed its maternity ward, and the closest hospital to deliver babies was at least 60 miles away. She sees more elective inductions because the patients live far away and can’t afford to go back and forth.

“Some of them just don’t have the resources,” she said. A year after shuttering, the hospital is trying to hire additional staff to reopen the ward.


The number of induced U.S. deliveries nationally has doubled since 1990 to about 23.3 percent, but rates are significantly higher in rural areas, where it is routinely offered to women traveling long distances, especially if the weather is bad.

Induced labor and surgery come at a high cost. Commercial insurance and Medicaid paid about 50 percent more for Cesarean than vaginal births, according to a 2013 Truven Health Analytics report. The report said Medicaid payments for maternal and newborn care for a vaginal birth was $9,131 versus $13,590 for a C-section.

In largely rural West Virginia – where the Summersville Regional Medical Center became the latest hospital to stop delivering newborns earlier this year – elected inductions for first time mothers rose to 28.7 percent in 2015 from 24.1 percent in 2011, according to data provided to Reuters by the West Virginia Perinatal Partnership, a statewide effort to improve care.

“Inductions allow the physicians to manage their case loads and timing of deliveries,” said Amy Tolliver, director of the Perinatal Partnership. “We know that inductions are happening in small hospitals that have difficulty with staffing.”

To address staffing issues at Dr Arthur’s hospital in Alabama, the facility paid temporary doctors for a year to keep the department open when one of its two maternity doctors stopped doing deliveries.

“It’s important to have access (to obstetrics),” said hospital president Benjamin Hansert, who also organized a group of doctors from Mobile about 40 minutes away to cover some of the shifts so that staff doctors would not always be on call. “Where the mother goes for care, the rest of the family will follow.”

For the full graphic on hospital closures, click

(Editing by Caroline Humer and Edward Tobin)

Zika virus findings show hearing loss to some babies

An Aedes aegypti mosquito is seen inside a test tube as part of a research on preventing the spread of the Zika virus and other mosquito-borne diseases at a control and prevention center in Guadalupe,

CHICAGO (Reuters) – A study in Brazil of 70 babies whose mothers had confirmed Zika infections found that nearly 6 percent had hearing loss, adding a new complication to the list of ills the virus can cause when women are infected during pregnancy.

The Brazilian study, published on Tuesday in the U.S. Centers for Disease Control and Prevention’s weekly report on death and disease, confirmed less rigorous reports of deafness among infants born to mothers with Zika infections.

The finding is part of an effort to fully characterize the harm caused by the Zika virus during pregnancy. The virus is best known for causing the severe birth defect microcephaly, characterized by undersized heads and underdeveloped brains. But other studies have shown that Zika can cause other brain abnormalities, vision problems and joint deformities.

In the latest study, a team led by Dr. Marli Tenório and Dr. Ernesto Marques of the Oswaldo Cruz Foundation in Pernambuco, Brazil, examined records from 70 infants with microcephaly whose mothers had laboratory-confirmed Zika infections during pregnancy.

They found that nearly 6 percent had hearing loss without any other plausible cause.

Several other viral infections during pregnancy can cause hearing loss, including rubella and cytomegalovirus, or CMV, infections. The current study adds Zika infection to that list.

Scientists say Zika should now be considered a risk factor for hearing loss, and children who were exposed during pregnancy but have normal hearing at birth should be screened regularly for delayed or progressive hearing loss.

The connection between Zika and microcephaly first came to light last fall in Brazil, which has since confirmed more than 1,800 cases of microcephaly.

(Reporting by Julie Steenhuysen; Editing by Jonathan Oatis)

Pregnant in Miami: Zika’s arrival adds new anxieties

Visitors walk through the Wynwood arts district of Miami

By Letitia Stein and Jilian Mincer

TAMPA, Fla./NEW YORK (Reuters) – Since Florida officials declared that the Zika virus is circulating in the state, Miami-area resident Karla Maguire has avoided taking her toddler son to a playground where mosquitoes may be biting. She walks her dogs less frequently and vigilantly applies bug repellent when she must go outside.

An obstetrician and gynecologist who is herself pregnant, Maguire has become scrupulous about following the advice that she gives patients to protect against Zika, which can cause a rare but devastating birth defect. Maguire works near the city’s Wynwood neighborhood identified on Friday as the first site of local Zika transmission in the continental United States.

“It is frustrating to spend a lot of time avoiding mosquitoes,” said Maguire, a physician at the University of Miami Miller School of Medicine, noting the discomfort of wearing long sleeves during Florida’s steamy summer. “You just end up being inside a lot.”

Physicians in Miami and beyond have seen this week a spike in concerned calls from pregnant women, particularly after health officials advised them not to travel to Wynwood and said any expecting mothers who had done so since mid-June should be tested for Zika.

On Wednesday, Florida said it would provide Zika testing to pregnant women at county health departments at no cost, and make available additional lab services to handle “the expected increase in tests being administered.”

The warnings raised anxiety in a city already on high alert for Zika’s arrival from Latin America, where it has spread quickly since first being detected in Brazil last year. The threat to newborns aside, Zika is otherwise considered a mild illness, and up to 80 percent of people infected have no symptoms.

All summer, Florida health officials have issued daily notices tallying the rise in cases acquired through travel to countries where Zika is widespread and advised the public to protect against mosquito bites. Along with 15 local cases, Florida is monitoring 391 picked up through travel abroad, which include 55 cases involving pregnant women.

One baby born in the state to a woman infected in Haiti has been diagnosed with the birth defect microcephaly, a condition defined by small head size that can lead to developmental problems.


Health officials expect that southern U.S. states vulnerable to mosquito-borne disease will see smaller, localized Zika outbreaks, given widespread use of window screens and air conditioning, compared with Latin American countries.

In Miami’s trendy Wynwood district, known as a place to hop between art galleries and tour outdoor murals, some doctors fear that a counterculture ethos may diminish the impact of medical recommendations to combat Zika.

Batsheva Stern, who is 28 weeks pregnant, sees no reason to avoid the district, where her husband, Zak, owns a popular bakery.

“I’m not so nervous,” said Stern, 27, recounting the advice of her midwife: “Don’t freak out, nothing is happening.”

But Dr. Elizabeth Etkin-Kramer, a gynecologist in private practice nearby, worries about birth defects resulting from unplanned pregnancies in some of her Wynwood-area patients who eschew birth control pills, noting the community is also skeptical of vaccines and antibiotics.

On Tuesday, she met with a patient who is 18 weeks pregnant and working near the affected area. The patient questioned her recommendation to be tested for Zika infection.

“Her feeling is, if something is going on, there is nothing you can do about it, short of termination,” said Etkin-Kramer, an officer in the Florida district of the American Congress of Obstetricians and Gynecologists. “I think it would be important to know, and if God forbid she is positive, then we can look closely by ultrasound and get a lot more information.”

Beatriz Mendes Pereira Lopes, 26, an attorney who is five months pregnant, has moved twice trying to avoid Zika. She went to Miami in April, as the hot months in her home of Brazil spurred mosquito breeding.

Last month, she returned to Brazil, now in its cooler winter, anticipating its mosquitoes would be in hibernation. Now that Zika has begun circulating in Miami, she concedes that her future options may be limited until a vaccine is developed.

“It’s impossible to get rid of all the world’s mosquitoes,” she said via email.

(Reporting by Letitia Stein in Tampa, Fla. and Jilian Mincer in New York; Additional reporting by Zachary Fagenson in Miami; Editing by Michele Gershberg and Bernard Orr)