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Ensamblamos una serie de casos sospechosos de síndrome congénito por Zika en un hospital de maternidad en Tuxtla Gutiérrez, Chiapas, México, para evaluar por qué no fueron notificados y explorar la hipótesis de enfermedad por Zika incrementada por anticuerpos anti-dengue. En un total de 13 casos sospechosos revisamos registros clínicos e imágenes, entrevistas que revelaron que solamente uno de los 12 fue confirmado por laboratorio, porque en los demás no se recolectaron especímenes adecuados de los neonatos como lo requería la definición de caos. Encontramos 1) microcefalia, 2) hipoplasia y adelgazamiento de las estructuras cerebrales, 3) malformaciones múltiples, 4) calcificaciones o quistes, 5) meningocele/encefalocele, y 6) hidrocefalia en 100%, 76.9%, 38.5%, 38.5%, 30.8%, y 23.1%, en ese orden. Los casos se aglutinaron geográficamente y 77% ocurrieron entre Mayo del 2016 y Marzo del 2017, y recordaban que o un profesional de la salud les dijo que tuvieron fiebre por Zika. Utilizando como grupo de referencia a mujeres que tuvieron recién nacidos normales en el mismo hospital, y una prueba de neutralización por reducción de placa al 80% para los virus dengue 1 y 2, encontramos un incremento de casi 4 veces en el riesgo de síndrome congénito por Zika para aquellos con altos niveles de anticuerpos anti-dengue 1 compardo con anticuerpos al dengue 2 (cociente de suertes = 3.6; intervalo de confianza del 95%: 0.7, 20.5), alcanzando solamente una significancia estadística limítrofe. La definición de caso del síndrome congénito por Zika durante la pandemia probablemente necesitaba ser más simple para ganar sensibilidad.
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