RECIFE, Brazil Angela Rocha, a pediatrician in northeastern Brazil, measures the head of a child born with microcephaly, a tragic neurological complication linked to Zika, the mosquito-borne virus sparking a health scare across the Americas.
Outside the room, seven mothers cradling infants with abnormally small heads line up for hours for tests. More than 1,000 cases of microcephaly have been reported in just a few months in Pernambuco state, the epicenter of the Zika outbreak.
"We were taken by surprise," says Rocha, a veteran infectious disease specialist at the Oswaldo Cruz University in the state capital of Recife, where doctors are struggling to care for 300 babies born with the condition.
Surprise is an understatement.
For a country that for years has battled the Aedes aegypti mosquito - responsible for previous epidemics of dengue, yellow fever and other tropical diseases - the outbreak of Zika has caught the government, public health administrators and doctors entirely off guard.
A tropical climate, dense cities, poor sanitation and slipshod construction provided ideal conditions for mosquito breeding grounds and the spread of the Zika virus in Brazil's northeast, across the country and to more than 20 others throughout the Americas.
"We just didn't have the conditions or resources necessary to stop the mosquito or the virus," says Maria da Gloria Teixeira, an epidemiologist in the neighbouring state of Bahia and a director of the Brazilian Association of Collective Health, a grouping of public health professionals.
Amid warnings from governments and multilateral health agencies, pregnant women in Brazil and beyond are now seeking to avoid exposure to the mosquito, at least until contagion is contained or scientists develop a vaccine, which could still take years.
Brazilian health officials this week said they plan to reach an agreement with the U.S. National Institutes of Health to work on a vaccine. Some Latin American countries have advised women to delay getting pregnant.
Although a cause has not been proven, microcephaly has been clinically linked by scientists to mothers believed to have been infected with Zika while expecting.
Pernambuco has more than one-third of the 3,700 cases of microcephaly reported in Brazil since September, and its hospitals have been overwhelmed.
Health officials say the number of newly reported cases is falling in the state even as it rises in other areas.
But the crisis will demand special care for hundreds of deformed or neurologically damaged children for years to come, a new burden on already deficient hospitals in a public health system suffering from budget cuts because of government shortfalls and an economic recession.
Every day, about five new cases arrive at the Recife hospital, compared to 18 at the peak of the crisis in late November, says Rocha.
She and her colleagues are hoping the decline means the worst is over, but they cannot be sure because so little is known about the virus and its complications.
There is no cure at present for Zika, which usually appears as a mild fever with temporary body aches. These symptoms can be easily mistaken for a mild case of dengue, a fever that infected 1.6 million Brazilians last year and killed more than 800.
To step up its fight against the mosquito, Brazil has deployed thousands of municipal, state and federal workers, including soldiers, to scour cities for mosquito breeding grounds, fumigate and educate residents on the dangers of still and stagnant water, where the female insects lay their eggs.
On Feb. 13, the government will deploy 220,000 troops in a one-day mobilization to hand out leaflets and help identify potential trouble spots.
In Recife, Brazil's seventh largest city, officials are digging in for a long struggle.
"We are just getting a glimpse of the dimension of a problem likely to remain with us for years to come," said Recife's health secretary, Jailson Correia.
In November, Recife asked Brazil's federal government for 29 million reais ($7.18 million) in funding to deal with the crisis, and so far has received only 1.3 million reais.
Rocha said the emotional and economic cost of the avalanche of handicapped children is incalculable.
The babies, many of whom will eventually suffer convulsions, need brain stimulus therapy promptly to improve their chances of survival. As many as 12 babies have recently died in the state because of the condition.
Other complications are appearing among some, including impaired vision and hearing, and badly deformed limbs.
Some cannot swallow and the most critical ones have serious breathing problems, said Vanessa Van der Linden, one of only five child neurologists in the state.
Van der Linden was the first doctor to notice the alarming rise in microcephaly cases last September, alerting public health authorities. The defects surged in November, when three babies were born with microcephaly on the same night at the dilapidated Barão de Lucena children's hospital where she works.
"There was panic," Van der Linden said.
Things have calmed some.
Only 29 new cases of microcephaly were reported last week in all of Pernambuco, compared to a peak of 196 in late November. After selling out of insect repellent during the two most critical months, the product is once more on drug store shelves.
For many, of course, the improvements come too late.
Gleyse Kelly da Silva, a 27-year-old toll booth worker, recalls having a rash, a light fever and a back ache for three days last April.
Her daughter, Maria Giovanna, was born in October with microcephaly. Silva still hopes Maria Giovanna will learn to speak but she is frustrated with the public health system, which has yet to provide any therapy.
"The quicker therapy starts, the better for my child," she said. "They should bring more doctors here, because there are so many babies. Their mothers can't get appointments."
(Editing by Paulo Prada and Kieran Murray)
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