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The global population at risk from mosquito-borne diseases—including dengue, yellow fever, chikungunya and Zika—is expanding in concert with changes in the distribution of two key vectors: Aedes aegypti and Aedes albopictus. The distribution of these species is largely driven by both human movement and the presence of suitable climate. Using statistical mapping techniques, we show that human movement patterns explain the spread of both species in Europe and the United States following their introduction. We find that the spread of Ae. aegypti is characterized by long distance importations, while Ae. albopictus has expanded more along the fringes of its distribution. We describe these processes and predict the future distributions of both species in response to accelerating urbanization, connectivity and climate change. Global surveillance and control efforts that aim to mitigate the spread of chikungunya, dengue, yellow fever and Zika viruses must consider the so far unabated spread of these mosquitos. Our maps and predictions offer an opportunity to strategically target surveillance and control programmes and thereby augment efforts to reduce arbovirus burden in human populations globally., 0, SCOPUS: ar.j, SCOPUS: er.j, info:eu-repo/semantics/published

Summary Background Effective Aedes aegypti control is limited, in part, by the difficulty in achieving sufficient intervention coverage. To maximise the effect of vector control, areas with persistently high numbers of Aedes-borne disease cases could be identified and prioritised for preventive interventions. We aimed to identify persistent Aedes-borne disease hotspots in cities across southern Mexico. Methods In this spatial analysis, geocoded cases of dengue, chikungunya, and Zika from nine endemic Mexican cities were aggregated at the census-tract level. We included cities that were located in southern Mexico (the arbovirus endemic region of Mexico), with a high burden of dengue cases (ie, more than 5000 cases reported during a 10-year period), and listed as high priority for the Mexican dengue control and prevention programme. The Getis-Ord Gi*(d) statistic was applied to yearly slices of the dataset to identify spatial hotspots of each disease in each city. We used Kendall's W coefficient to quantify the agreement in the distribution of each virus. Findings 128 507 dengue, 4752 chikungunya and 25 755 Zika clinical cases were reported between Jan 1, 2008, and Dec 31, 2016. All cities showed evidence of transmission heterogeneity, with a mean of 17·6% (SD 4·7) of their total area identified as persistent disease hotspots. Hotspots accounted for 25·6% (SD 9·7; range 12·8–43·0) of the population and 32·1% (10·5; 19·6–50·5) of all Aedes-borne disease cases reported. We found an overlap between hotspots of 61·7% for dengue and Zika and 53·3% for dengue and chikungunya. Dengue hotspots in 2008–16 were significantly associated with dengue hotspots detected during 2017–20 in five of the nine cities. Heads of vector control confirmed hotspot areas as problem zones for arbovirus transmission. Interpretation This study provides evidence of the overlap of Aedes-borne diseases within geographical hotspots and a methodological framework for the stratification of arbovirus transmission risk within urban areas, which can guide the implementation of surveillance and vector control. Funding USAID, the US Centers for Disease Control and Prevention, the Canadian Institutes of Health Research, International Development Research Centre, Fondo Mixto CONACyT (Mexico)-Gobierno del Estado de Yucatan, and the US National Institutes of Health. Translation For the Spanish translation of the abstract see Supplementary Materials section.

Background: The clinical manifestations of microcephaly/congenital Zika syndrome (microcephaly/CZS) have harmful consequences on the child&rsquo, s health, increasing vulnerability to childhood morbidity and mortality. This study analyzes the case fatality rate and child&ndash, maternal characteristics of cases and deaths related to microcephaly/CZS in Brazil, 2015&ndash, 2017. Methods: Population-based study developed by linkage of three information systems. We estimate frequencies of cases, deaths, case fatality rate related to microcephaly/CZS according to child and maternal characteristics and causes of death. Multivariate logistic regression models were applied. Results: The microcephaly/CZS case fatality rate was 10% (95% CI 9.2&ndash, 10.7). Death related to microcephaly/CZS was associated to moderate (OR = 2.15, 95% CI 1.63&ndash, 2.83), and very low birth weight (OR = 3.77, 95% CI 2.20&ndash, 6.46), late preterm births (OR = 1.65, 95% CI 1.21&ndash, 2.23), Apgar &lt, 7 at 1st (OR = 5.98, 95% CI 4.46&ndash, 8.02) and 5th minutes (OR = 4.13, 95% CI 2.78&ndash, 6.13), among others. Conclusions: A high microcephaly/CZS case fatality rate and important factors associated with deaths related to this syndrome were observed. These results can alert health teams to these problems and increase awareness about the factors that may be associated with worse outcomes.

The coronavirus disease of 2019 (COVID-19) pandemic challenges public health systems around the world. Tropical countries will face complex epidemiological scenarios involving the simultaneous transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with viruses transmitted by Aedes aegypti. The occurrence of arboviral diseases with COVID-19 in the Latin America and the Caribbean (LAC) region presents challenges and opportunities for strengthening health services, surveillance and control programs. Financing of training, equipment and reconversion of hospital spaces will have a negative effect on already the limited resource directed to the health sector. The strengthening of the diagnostic infrastructure reappears as an opportunity for the national reference laboratories. Sharing of epidemiological information for the modeling of epidemiological scenarios allows collaboration between health, academic and scientific institutions. The fear of contagion by COVID-19 is constraining people with arboviral diseases to search for care which can lead to an increase in serious cases and could disrupt the operation of vector-control programs due to the reluctance of residents to open their doors to health personnel. Promoting intense community participation along with the incorporation of long lasting innovations in vector control offers new opportunities for control. The COVID-19 pandemic offers challenges and opportunities that must provoke positive behavioral changes and encourage more permanent self-care actions.

Since the 1980s, dengue incidence has increased 30-fold. However, in 2017, there was a noticeable reduction in reported dengue incidence cases within the Americas, including severe and fatal cases. Understanding the mechanism underlying dengue's incidence and decline in the Americas is vital for public health planning. We aimed to provide plausible explanations for the decline in 2017.An expert panel of representatives from scientific and academic institutions, Ministry of Health officials from Latin America and PAHO/WHO staff met in October 2017 to propose hypotheses. The meeting employed six moderated plenary discussions in which participants reviewed epidemiological evidence, suggested explanatory hypotheses, offered their expert opinions on each and developed a consensus.The expert group established that in 2017, there was a generalised decreased incidence, severity and number of deaths due to dengue in the Americas, accompanied by a reduction in reported cases of both Zika and chikungunya virus infections, with no change in distribution among age groups affected. This decline was determined to be unlikely due to changes in epidemiological surveillance systems, as similar designs of surveillance systems exist across the region. Although sudden surveillance disruption is possible at a country or regional level, it is unlikely to occur in all countries simultaneously. Retrospective modelling with epidemiological, immunological and entomological information is needed. Host or immunological factors may have influenced the decline in dengue cases at the population level through immunity; however, herd protection requires additional evidence. Uncertainty remains regarding the effect on the outcome of sequential infections of different dengue virus (DENV) types and Zika virus (ZIKV), and vice versa. Future studies were recommended that examine the epidemiological effect of prior DENV infection on Zika incidence and severity, the epidemiological effect of prior Zika virus infection on dengue incidence and severity, immune correlates based on new-generation ELISA assays, and impact of prior DENV/other arbovirus infection on ZIKV immune response in relation to number of infections and the duration of antibodies in relation to interval of protection. Follow-up studies should also investigate whether increased vector control intensification activities contributed to the decline in transmission of one or more of these arboviruses. Additionally, proposed studies should focus on the potential role of vector competence when simultaneously exposed to various arboviruses, and on entomological surveillance and its impact on circulating vector species, with a goal of applying specific measures that mitigate seasonal occurrence or outbreaks.Multifactorial events may have accounted for the decline in dengue seen in 2017. Differing elements might explain the reduction in dengue including elements of immunity, increased vector control, and even vector and\or viruses changes or adaptations. Most of the results of this expert consensus group meeting are hypothetical and based on limited evidence. Further studies are needed.Depuis les années 1980, l'incidence de la dengue a été multipliée par 30. Cependant, en 2017, il y a eu une réduction notable du nombre de cas d'incidence de dengue rapportés dans les Amériques. Nous voulions fournir des explications plausibles à la baisse en 2017. MÉTHODES: Un groupe d'experts constitué de représentants d'institutions scientifiques et académiques, d'officiels des Ministères de la Santé d'Amérique Latine et de membres du personnel de l’OPS/OMS s'est réuni en octobre 2017 pour proposer et évaluer des hypothèses. RÉSULTATS: En 2017, il y a eu une baisse généralisée de l'incidence, de la sévérité et du nombre de décès dus à la dengue dans les Amériques, accompagnée d'une réduction des cas rapportés d'infections par le virus Zika et par le virus du chikungunya, sans modification dans la répartition entre les groupes d’âge affectés. Il a été déterminé que ce déclin était peu probablement dû aux changements dans les systèmes de surveillance épidémiologique, étant donné que des systèmes de surveillance similaires existaient dans toute la région. Bien que des perturbations soudaines dans la surveillance soient possibles au niveau national ou régional, il est peu probable que cela se produise simultanément dans tous les pays. Une modélisation rétrospective avec des informations épidémiologiques, immunologiques et entomologiques est nécessaire. Des facteurs liés à l'hôte ou immunologiques peuvent avoir influencé le déclin des cas de dengue au niveau de la population par le biais de l'immunité; cependant, l’évidence d'une protection conférée par l'effet du troupeau nécessite des données supplémentaires. Une incertitude subsiste quant à l'effet sur le résultat des infections séquentielles de différents types du virus de la dengue (DENV) et du virus Zika (ZIKV), et vice-versa. Les études à venir devraient examiner (1) l'effet épidémiologique d'une infection antérieure par le DENV sur l'incidence et la sévérité du virus Zika, (2) l'effet épidémiologique d'une infection antérieure par le virus Zika sur l'incidence et la sévérité de la dengue, (3) les corrélats immunitaires basés sur des tests ELISA de nouvelle génération, (4) l’ impact d'une infection antérieure à DENV/autres arbovirus sur la réponse immunitaire au ZIKV en fonction du nombre d'infections et de la durée des anticorps en fonction de l'intervalle de protection, (5) si des activités d'intensification de la lutte antivectorielle ont contribué à la diminution de la transmission d'un ou plusieurs de ces arbovirus, (6) le rôle potentiel de la compétence vectorielle lorsqu'ils sont exposés simultanément à différents arbovirus, (7) la surveillance entomologique et son impact sur la circulation d'espèces de vecteurs, dans le but d'appliquer des mesures spécifiques qui réduisent l'occurrence saisonnière d’épidémies.Des événements multifactoriels pourraient expliquer le déclin observé de la dengue en 2017. La plupart des résultats de cette réunion du groupe de consensus d'experts sont hypothétiques, reposent sur des données limitées et requièrent des investigations supplémentaires.

Dengue is a major public health challenge in Brazil. We assessed the relationship between symptomatic dengue infection during pregnancy and adverse birth outcomes in the country between 2007 and 2013.We did a retrospective observational cohort study using information reported in the Brazilian national reportable disease information system (SINAN) and the livebirth information system (SINASC) databases. We probabilistically linked confirmed dengue-positive and dengue-negative pregnancies with live childbirths using Fine-Grained Record Integration and Linkage (FRIL) software. We also included an external reference population of randomly selected newborn babies. Pregnancy was adopted as the unit of analysis. We assessed the relationship between symptomatic dengue infection during pregnancy and adverse birth outcomes, using multivariable logistic regression adjusted for relevant covariates.3898 dengue-positive pregnant women, 3165 dengue-negative women, and 3898 newborn babies from the reference population were included in the analysis. Preterm birth occurred in 322 (8·4%) of 3821 cases in the dengue-positive group versus 324 (10·4%) of 3101 in the dengue-negative group (unadjusted analysis: relative risk [RR] 0·81, 95% CI 0·70-0·93; adjusted analysis: odds ratio [OR] 1·26, 95% CI 1·06-1·49, p=0·006) and 349 (9·1%) of 3818 in the reference population (RR 0·92, 0·80-1·07; OR 0·98, 0·83-1·16, p=0·84). The prevalence of low birthweight (2500 g) was similar for dengue-positive women and dengue-negative women (8·3% [322 of 3897] vs 9·8% [310 of 3163]; OR 1·17, 95% CI 0·99-1·39, p=0·07), and in the reference population (8·3% vs 9·0% [350 of 3895]; OR 1·00, 0·85-1·17, p=0·97). The prevalence of malformations did not differ significantly for the dengue-positive group (27 [0·7%] of 3789) versus the dengue-negative group (27 [0·9%] of 3059, p=0·51) or versus the reference population (32 [0·9%] of 3738, p=0·56).In the adjusted analysis, the risk of preterm birth seems to be increased in women with symptomatic dengue infection during pregnancy. However, symptomatic dengue infection during pregnancy does not appear to be associated with congenital malformations or low birthweight.Sanofi Pasteur.

Background The re-emergence of worldwide concern with arthropod-borne viruses (arboviruses) draws increasing attention to their mosquito vectors, particularly Aedes aegypti, whose control heavily rely on insecticide use. As a consequence, insecticide resistance is frequent, but the general patterns of occurrence, cross-resistance and prevailing mechanisms remain unrecognized in some areas such as the Neotropical region. Thus, we sought here to recognize the general trends and patterns of insecticide resistance in Latin America and the Caribbean. A systematic literature review (2008-2018) aimed the data-gathering for the region and meta-analyses to address the stated knowledge gap. Results A high incidence of insecticide resistance prevails in the mosquito populations of the region. Dichlorodiphenyltrichloroethane (DDT), temephos and deltamethrin were the main insecticides evaluated and the meta-analyses indicate a high frequency of DDT-resistant populations (86.7 ± 0.1%), followed by temephos (75.7 ± 0.1%) and deltamethrin (33.0 ± 0.1%). No evidence of cross-resistance was detected among these three insecticides, and the V1016I knockdown (KDR) site mutation does not explain the patterns of deltamethrin resistance in the region. Conclusion Resistance to DDT, temephos and deltamethrin is serious and widespread, and there is no cross-resistance among them. Altered target site sensitivity is not the main pyrethroid resistance mechanism, which is likely due to a mix of mechanisms. Therefore, the replacement of deltamethrin and particularly temephos in the region by alternative insecticides is an important resistance management recommendation, but should be done with compounds out of the cross-resistance spectrum for these populations and insecticides. Nonetheless, the non-recognition of the prevalent resistance mechanisms in the region makes this suggestion more difficult to apply and invites more broad-scale studies of resistance mechanisms to fill this knowledge gap and improve the resistance management recommendations. © 2020 Society of Chemical Industry.

During the past year and a half, Zika virus has been spreading rapidly throughout Latin America. In this letter, evidence for the Guillain–Barre syndrome being temporally associated with Zika virus transmission is presented.

Widespread transmission of Zika virus by Aedes mosquitoes has been recognized in Brazil since late 2014, and in October 2015, an increase in the number of reported cases of microcephaly was reported to the Brazil Ministry of Health.* By January 2016, a total of 3,530 suspected microcephaly cases had been reported, many of which occurred in infants born to women who lived in or had visited areas where Zika virus transmission was occurring. Microcephaly surveillance was enhanced in late 2015 by implementing a more sensitive case definition. Based on the peak number of reported cases of microcephaly, and assuming an average estimated pregnancy duration of 38 weeks in Brazil (1), the first trimester of pregnancy coincided with reports of cases of febrile rash illness compatible with Zika virus disease in pregnant women in Bahia, Paraíba, and Pernambuco states, supporting an association between Zika virus infection during early pregnancy and the occurrence of microcephaly. Pregnant women in areas where Zika virus transmission is occurring should take steps to avoid mosquito bites. Additional studies are needed to further elucidate the relationship between Zika virus infection in pregnancy and microcephaly.

Resumo Objetivo: descrever os desafios da implantação do sistema de vigilância e prevenção de chikungunya no Brasil. Métodos: estudo descritivo dos casos suspeitos da doença notificados no Sistema de Informação de Agravos de Notificação (Sinan) entre 2014 e 2016. Resultados: no período estudado, foram notificados mais de 100 mil casos prováveis de chikungunya no país, com maior concentração nos estados do Nordeste (83,3% entre 2014 e 2015; 91,0% em 2016); o Sinan apresentou excelente oportunidade de encerramento dos casos entre 2014 e 2015 (85%) e alta completitude das variáveis obrigatórias. Conclusão: com a introdução de chikungunya no Brasil em 2014, houve um preparo prévio em termos de Saúde Pública para minimizar seus efeitos na sociedade; a implantação do sistema de vigilância ampliou a coleta de informações da doença, embora muitos desafios mostrem-se evidentes na prática, haja vista a incidência crescente de casos, demandando maior capacidade operante desse setor.

OBJETIVO: estimar os custos do Programa Municipal de Controle da Dengue de Goiânia-GO, Brasil. MÉTODOS: estudo de custo de programa considerando períodos epidêmico (outubro/2009-abril/2010) e endêmico (maio-setembro/2010) de transmissão da doença, na perspectiva do Sistema Único de Saúde (SUS); os componentes de custo analisados foram recursos humanos, capacitação, infraestrutura, equipamentos de escritório, transporte, equipamentos de proteção individual, material de campo, material laboratorial, inseticidas e mobilização social; custos de capital (investimento) e recorrentes foram considerados. RESULTADOS: a média mensal de custos recorrentes foi de R$1.355.760 (US$814,075) e R$981.100 (US$589,108) nos períodos epidêmico e endêmico respectivamente; o custo de capital anual foi estimado em R$683.315 (US$410,301); cerca de 82%, 15% e 3% do custo total referem-se, respectivamente, às fontes de recurso municipal, federal e estadual. CONCLUSÃO: o custo adicional resultante das epidemias de dengue fornece subsídios para um melhor planejamento das atividades de prevenção e controle da infecção. OBJECTIVE: to estimate the cost of the Municipal Program for Dengue Control in Goiânia, GO, Brazil. METHODS: Costs of program considering epidemic (October/2009-April/2010) and endemic (May-September/2010) periods of dengue transmission, from the perspective of the National Unified Health System (SUS); cost components considered were human resources, training, infrastructure, office equipment, transportation, personal protective equipment, field equipment, laboratory equipment, insecticides and social mobilization; capital (investment) and recurring costs were considered. RESULTS: average monthly recurring costs were R$1,355,760 (US$814,075) and R$981,100 (US$589,108), for the epidemic and endemic periods, respectively; annual capital cost was R$683,315 (US$410,301); approximately 82%, 15% and 3% of the total cost were from municipal, federal and state level funding sources, respectively. CONCLUSION: estimated incremental costs resulting from dengue epidemics provide information to support planning of dengue prevention and control activities. OBJETIVO: estimar los costos del Programa Municipal de Control de Dengue en el municipio de Goiânia-GO, Brasil. MÉTODOS: estudio de costos del programa teniendo en cuenta períodos epidémicos (octubre/2009-abril/2010) y endémicos (mayo-septiembre/2010) de la transmisión de dengue; dentro de la perspectiva del Sistema Único de Salud (SUS); los componentes de los costos analizados fueron recursos humanos, capacitación, infraestructura, equipo de oficina, transporte, equipo de protección personal, equipo de campo, materiales de laboratorio, insecticidas y movilización social, teniendo en cuenta los costos de capital (inversión) y recurrentes. RESULTADOS: el valor mensual de costos recurrentes fue R$1.355.760 (US$814,075) y R$981.100 (US$589,108), en los períodos epidémicos y endémicos, respectivamente; los costos de capital durante el periodo de estudio fueron R$683,315 (US$410,301); alrededor de 82%, 15% y 3% de los costos totales fueron de fuente municipal, federal y estatal, respectivamente. CONCLUSIÓN: el conocimiento de los costos adicionales resultantes de las epidemias de dengue puede apoyar a una mejor planificación de las actividades de prevención y control del dengue.

Aedes aegypti, historically known as yellow fever (YF) mosquito, transmits a great number of other viruses such as Dengue, West Nile, Chikungunya, Zika, Mayaro and perhaps Oropouche, among others. Well established in Africa and Asia, Aedes mosquitoes are now increasingly invading large parts of the American continent, and hence the risk of urban YF resurgence in the American cities should because of great concern to public health authorities. Although no new urban cycle of YF was reported in the Americas since the end of an Aedes eradication programme in the late 1950s, the high number of non-vaccinated individuals that visit endemic areas, that is, South American jungles where the sylvatic cycle of YF is transmitted by canopy mosquitoes, and return to Aedes-infested urban areas, increases the risk of resurgence of the urban cycle of YF. We present a method to estimate the risk of urban YF resurgence in dengue-endemic cities. This method consists in (1) to estimate the number of Aedes mosquitoes that explains a given dengue outbreak in a given region; (2) calculate the force of infection caused by the introduction of one infective individual per unit area in the endemic area under study; (3) using the above estimates, calculate the probability of at least one autochthonous YF case per unit area produced by one single viraemic traveller per unit area arriving from a YF endemic or epidemic sylvatic region at the city studied. We demonstrate that, provided the relative vector competence, here defined as the capacity to being infected and disseminate the virus, of Ae. aegypti is greater than 0.7 (with respect to dengue), one infected traveller can introduce urban YF in a dengue endemic area.

Prior to the current public health emergency following the emergence of chikungunya and Zika Virus Disease in the Americas during 2014 and 2015, multi-country research investigated between 2011 and 2013 the efficacy of novel Aedes aegypti intervention packages through cluster randomised controlled trials in four Latin-American cities: Fortaleza (Brazil); Girardot (Colombia), Acapulco (Mexico) and Salto (Uruguay). Results from the trials led to a scaling up effort of the interventions at city levels. Scaling up refers to deliberate efforts to increase the impact of successfully tested health interventions to benefit more people and foster policy and program development in a sustainable way. The different scenarios represent examples for a ‘vertical approach’ and a ‘horizontal approach’. This paper presents the analysis of a preliminary process evaluation of the scaling up efforts in the mentioned cites, with a focus on challenges and enabling factors encountered by the research teams, analysing the main social, political, administrative, financial and acceptance factors.

Background Infectious diseases are a leading threat to public health. Accurate and timely monitoring of disease risk and progress can reduce their impact. Mentioning a disease in social networks is correlated with physician visits by patients, and can be used to estimate disease activity. Dengue is the fastest growing mosquito-borne viral disease, with an estimated annual incidence of 390 million infections, of which 96 million manifest clinically. Dengue burden is likely to increase in the future owing to trends toward increased urbanization, scarce water supplies and, possibly, environmental change. The epidemiological dynamic of Dengue is complex and difficult to predict, partly due to costly and slow surveillance systems. Methodology / Principal findings In this study, we aimed to quantitatively assess the usefulness of data acquired by Twitter for the early detection and monitoring of Dengue epidemics, both at country and city level at a weekly basis. Here, we evaluated and demonstrated the potential of tweets modeling for Dengue estimation and forecast, in comparison with other available web-based data, Google Trends and Wikipedia access logs. Also, we studied the factors that might influence the goodness-of-fit of the model. We built a simple model based on tweets that was able to ‘nowcast’, i.e. estimate disease numbers in the same week, but also ‘forecast’ disease in future weeks. At the country level, tweets are strongly associated with Dengue cases, and can estimate present and future Dengue cases until 8 weeks in advance. At city level, tweets are also useful for estimating Dengue activity. Our model can be applied successfully to small and less developed cities, suggesting a robust construction, even though it may be influenced by the incidence of the disease, the activity of Twitter locally, and social factors, including human development index and internet access. Conclusions Tweets association with Dengue cases is valuable to assist traditional Dengue surveillance at real-time and low-cost. Tweets are able to successfully nowcast, i.e. estimate Dengue in the present week, but also forecast, i.e. predict Dengue at until 8 weeks in the future, both at country and city level with high estimation capacity., Author summary Dengue is a fast-growing mosquito-borne viral disease, with an estimated annual incidence of 390 million infections, of which 96 million manifest clinically. Dengue burden is likely to increase in the future. Mentioning a disease in social networks is correlated with physician visits by patients, and can be used to estimate disease activity. Traditional, biologically-focused monitoring techniques, based on laboratory diagnostics, are accurate but costly and slow. Alternative approaches for surveillance aim to capture health-seeking behavior at earlier stages of disease progression, specially capturing the asymptomatic and mild clinic manifestation population who do not seek medical care formally. Twitter data have potential application for Dengue surveillance, improving the estimation and prediction of the disease, in space and time, being a valuable and low-cost addition to assist traditional surveillance. We show that tweets are strongly associated with Dengue cases. Tweets are a useful tool for estimating and forecasting Dengue cases until 8 weeks in the future, both at country and city level, even in less developed areas.

Summary Background A Zika virus epidemic emerged in northeast Brazil in 2015 and was followed by a striking increase in congenital microcephaly cases, triggering a declaration of an international public health emergency. This is the final report of the first case-control study evaluating the potential causes of microcephaly: congenital Zika virus infection, vaccines, and larvicides. The published preliminary report suggested a strong association between microcephaly and congenital Zika virus infection. Methods We did a case-control study in eight public maternity hospitals in Recife, Brazil. Cases were neonates born with microcephaly, defined as a head circumference of 2 SD below the mean. Two controls without microcephaly were matched to each case by expected date of delivery and area of residence. We tested the serum of cases and controls and the CSF of cases for detection of Zika virus genomes with quantitative RT-PCR and for detection of IgM antibodies with capture-IgM ELISA. We also tested maternal serum with plaque reduction neutralisation assays for Zika and dengue viruses. We estimated matched crude and adjusted odds ratios with exact conditional logistic regression to determine the association between microcephaly and Zika virus infection. Findings We screened neonates born between Jan 15 and Nov 30, 2016, and prospectively recruited 91 cases and 173 controls. In 32 (35%) cases, congenital Zika virus infection was confirmed by laboratory tests and no controls had confirmed Zika virus infections. 69 (83%) of 83 cases with known birthweight were small for gestational age, compared with eight (5%) of 173 controls. The overall matched odds ratio was 73·1 (95% CI 13·0–∞) for microcephaly and Zika virus infection after adjustments. Neither vaccination during pregnancy or use of the larvicide pyriproxyfen was associated with microcephaly. Results of laboratory tests for Zika virus and brain imaging results were available for 79 (87%) cases; within these cases, ten were positive for Zika virus and had cerebral abnormalities, 13 were positive for Zika infection but had no cerebral abnormalities, and 11 were negative for Zika virus but had cerebral abnormalities. Interpretation The association between microcephaly and congenital Zika virus infection was confirmed. We provide evidence of the absence of an effect of other potential factors, such as exposure to pyriproxyfen or vaccines (tetanus, diphtheria, and acellular pertussis, measles and rubella, or measles, mumps, and rubella) during pregnancy, confirming the findings of an ecological study of pyriproxyfen in Pernambuco and previous studies on the safety of Tdap vaccine administration during pregnancy. Funding Brazilian Ministry of Health, Pan American Health Organization, and Enhancing Research Activity in Epidemic Situations.

Zika virus has spread rapidly throughout the Americas and has been associated with fetal abnormalities and a variety of neurologic disorders. This report updates the epidemiologic findings over the past 2 years.

In mid-2015, Salvador, Brazil, reported an outbreak of Guillain-Barré syndrome (GBS), coinciding with the introduction and spread of Zika virus (ZIKV). We found that GBS incidence during April–July 2015 among those ≥12 years of age was 5.6 cases/100,000 population/year and increased markedly with increasing age to 14.7 among those ≥60 years of age. We conducted interviews with 41 case-patients and 85 neighborhood controls and found no differences in demographics or exposures prior to GBS-symptom onset. A higher proportion of case-patients (83%) compared to controls (21%) reported an antecedent illness (OR 18.1, CI 6.9–47.5), most commonly characterized by rash, headache, fever, and myalgias, within a median of 8 days prior to GBS onset. Our investigation confirmed an outbreak of GBS, particularly in older adults, that was strongly associated with Zika-like illness and geo-temporally associated with ZIKV transmission, suggesting that ZIKV may result in severe neurologic complications., Author summary Shortly following the introduction of Zika virus (ZIKV), a type of flavivirus transmitted by mosquitoes, into Brazil in early 2015, the Brazil Ministry of Health began receiving increased reports of a paralyzing condition known as Guillain-Barré syndrome (GBS). The areas with the greatest number of GBS cases appeared to correlate geographically and temporally with the areas reporting the highest rate of ZIKV infections. This association had been previously observed during a ZIKV outbreak in French Polynesia, however, this had not been systematically examined in a case-control investigation for the ZIKV outbreak in South America. In this investigation, the authors found that the occurrence of GBS in the affected population was nearly four times higher than would be expected, and the risk for GBS was particularly elevated among older adults. GBS was associated with ZIKV-like symptoms and with a combination of ZIKV-like symptoms plus laboratory evidence of a recent flavivirus infection. Taken together, these findings provide strong support for and greater understanding of the link between ZIKV and GBS.

Currently, sticky traps are regularly employed to assist in the surveillance of Aedes aegypti infestation. We tested two alternative procedures for specimen identification performed by local health agents: directly in the field, as recommended by certain manufacturers, or after transportation to the laboratory. A total of 384 sticky traps (MosquiTRAP) were monitored monthly during one year in four geographically representative Brazilian municipalities. When the same samples were inspected in the field and in the laboratory, large differences were noted in the total number of mosquitoes recorded and in the number of specimens identified as Ae. aegypti by both procedures. Although field identification has the potential to speed vector surveillance, these results point to uncertainties in the evaluated protocol.

Summary Background With more than a million spectators expected to travel among 12 different cities in Brazil during the football World Cup, June 12–July 13, 2014, the risk of the mosquito-transmitted disease dengue fever is a concern. We addressed the potential for a dengue epidemic during the tournament, using a probabilistic forecast of dengue risk for the 553 microregions of Brazil, with risk level warnings for the 12 cities where matches will be played. Methods We obtained real-time seasonal climate forecasts from several international sources (European Centre for Medium-Range Weather Forecasts [ECMWF], Met Office, Meteo-France and Centro de Previsao de Tempo e Estudos Climaticos [CPTEC]) and the observed dengue epidemiological situation in Brazil at the forecast issue date as provided by the Ministry of Health. Using this information we devised a spatiotemporal hierarchical Bayesian modelling framework that enabled dengue warnings to be made 3 months ahead. By assessing the past performance of the forecasting system using observed dengue incidence rates for June, 2000–2013, we identified optimum trigger alert thresholds for scenarios of medium-risk and high-risk of dengue. Findings Our forecasts for June, 2014, showed that dengue risk was likely to be low in the host cities Brasilia, Cuiaba, Curitiba, Porto Alegre, and Sao Paulo. The risk was medium in Rio de Janeiro, Belo Horizonte, Salvador, and Manaus. High-risk alerts were triggered for the northeastern cities of Recife (p high =19%), Fortaleza (p high =46%), and Natal (p high =48%). For these high-risk areas, particularly Natal, the forecasting system did well for previous years (in June, 2000–13). Interpretation This timely dengue early warning permits the Ministry of Health and local authorities to implement appropriate, city-specific mitigation and control actions ahead of the World Cup. Funding European Commission's Seventh Framework Research Programme projects DENFREE, EUPORIAS, and SPECS; Conselho Nacional de Desenvolvimento Cientifico e Tecnologico and Fundacao de Amparo a Pesquisa do Estado do Rio de Janeiro.

Brazil will host the FIFA World Cup™, the biggest single-event competition in the world, from June 12-July 13 2014 in 12 cities. This event will draw an estimated 600,000 international visitors. Brazil is endemic for dengue. Hence, attendees of the 2014 event are theoretically at risk for dengue. We calculated the risk of dengue acquisition to non-immune international travellers to Brazil, depending on the football match schedules, considering locations and dates of such matches for June and July 2014. We estimated the average per-capita risk and expected number of dengue cases for each host-city and each game schedule chosen based on reported dengue cases to the Brazilian Ministry of Health for the period between 2010-2013. On the average, the expected number of cases among the 600,000 foreigner tourists during the World Cup is 33, varying from 3-59. Such risk estimates will not only benefit individual travellers for adequate pre-travel preparations, but also provide valuable information for public health professionals and policy makers worldwide. Furthermore, estimates of dengue cases in international travellers during the World Cup can help to anticipate the theoretical risk for exportation of dengue into currently non-infected areas. Published version

The global population at risk from mosquito-borne diseases-including dengue, yellow fever, chikungunya and Zika-is expanding in concert with changes in the distribution of two key vectors: Aedes aegypti and Aedes albopictus. The distribution of these species is largely driven by both human movement and the presence of suitable climate. Using statistical mapping techniques, we show that human movement patterns explain the spread of both species in Europe and the United States following their introduction. We find that the spread of Ae. aegypti is characterized by long distance importations, while Ae. albopictus has expanded more along the fringes of its distribution. We describe these processes and predict the future distributions of both species in response to accelerating urbanization, connectivity and climate change. Global surveillance and control efforts that aim to mitigate the spread of chikungunya, dengue, yellow fever and Zika viruses must consider the so far unabated spread of these mosquitos. Our maps and predictions offer an opportunity to strategically target surveillance and control programmes and thereby augment efforts to reduce arbovirus burden in human populations globally.

University of Oxford. Department of Zoology, Oxford, UK / Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. University of Birmingham. Institute of Microbiology and Infection. Birmingham, UK. University of Oxford. Department of Zoology. Oxford UK. University of Oxford. Department of Zoology. Oxford, UK / Harvard Medical School. Boston, MA, USA / Boston Children's Hospital. Boston, MA, USA. University of Oxford. Department of Zoology. Oxford, UK. Fred Hutchinson Cancer Research Center. Vaccine and Infectious Disease Division. Seattle, WA, USA / University of Washington. Department of Epidemiology. Seattle, WA, USA. University of S?o Paulo. School of Medicine &Institute of Tropical Medicine. Department of Infectious Disease. S?o Paulo, SP, Brazil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. University of Oxford. Department of Statistics. Oxford, UK. University of Oxford. Department of Zoology. Oxford, UK. Institut Pasteur. Biostatistics and Integrative Biology. Mathematical Modelling of Infectious Diseases and Center of Bioinformatics. Paris, FR / Centre National de la Recherche Scientifique. Paris, FR. University of Oxford. Department of Zoology. Oxford, UK. Ministry of Health. Coordena??o dos Laborat?rios de Sa?de. Bras?lia, DF, Brazil. Ministry of Health. Coordena??o Geral de Vigil?ncia e Resposta ?s Emerg?ncias em Sa?de P?blica. Bras?lia, DF, Brazil / Funda??o Oswaldo Cruz. Center of Data and Knowledge Integration for Health. Salvador, BA, Brazil. Ministry of Health. Departamento de Vigil?ncia das Doen?as Transmiss?veis. Brasilia, DF, Brazil. Ministry of Health. Coordena??o Geral dos Programas de Controle e Preven??o da Mal?ria e das Doen?as Transmitidas pelo Aedes. Bras?lia, DF, Brazil / Pan American Health Organization (PAHO). Buenos Aires, AR. Ministry of Health. Coordena??o Geral dos Programas de Controle e Preven??o da Mal?ria e das Doen?as Transmitidas pelo Aedes. Bras?lia, DF, Brazil / Funda??o Oswaldo Cruz. Rio de Janeiro, RJ, Brazil. Ministry of Health. Coordena??o Geral dos Programas de Controle e Preven??o da Mal?ria e das Doen?as Transmitidas pelo Aedes. Bras?lia, DF, Brazil Ministry of Health. Departamento de Vigil?ncia das Doen?as Transmiss?veis. Brasilia, DF, Brazil. Ontario Institute for Cancer Research. Toronto, ON, Canada. University of Nottingham. Nottingham, UK The Scripps Research Institute. Department of Immunology and Microbial Science. La Jolla, CA, USA. The Scripps Research Institute. Department of Immunology and Microbial Science. La Jolla, CA, USA. University of California. Departments of Laboratory Medicine and Medicine & Infectious Diseases. San Francisco, CA, USA. University of California. Departments of Laboratory Medicine and Medicine & Infectious Diseases. San Francisco, CA, USA. Instituto Mexicano del Seguro Social. Divisi?n de Laboratorios de Vigilancia e Investigaci?n Epidemiol?gica. Ciudad de M?xico, MC. Instituto Mexicano del Seguro Social. Divisi?n de Laboratorios de Vigilancia e Investigaci?n Epidemiol?gica. Ciudad de M?xico, MC. Universidad Nacional Aut?noma de M?xico. Instituto de Biotecnolog?a. Cuernavaca, MC. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brazil. Paul-Ehrlich-Institut. Langen, Germany. Laborat?rio Central de Sa?de P?blica Noel Nutels. Rio de Janeiro, RJ, Brazil. Laborat?rio Central de Sa?de P?blica Noel Nutels. Rio de Janeiro, RJ, Brazil. Laborat?rio Central de Sa?de P?blica Noel Nutels. Rio de Janeiro, RJ, Brazil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Funda??o Oswaldo Cruz. Salvador, BA, Brazil. Laborat?rio Central de Sa?de P?blica. Natal, RN, Brazil. Laborat?rio Central de Sa?de P?blica. Natal, RN, Brazil / Universidade Potiguar. Natal, RN, Brazil. Laborat?rio Central de Sa?de P?blica. Natal, RN, Brazil / Faculdade Natalense de Ensino e Cultura. Natal, RN, Brazil. Laborat?rio Central de Sa?de P?blica. Jo?o Pessoa, PB, Brazil. Laborat?rio Central de Sa?de P?blica. Jo?o Pessoa, PB, Brazil. Laborat?rio Central de Sa?de P?blica. Jo?o Pessoa, PB, Brazil. Laborat?rio Central de Sa?de P?blica. Jo?o Pessoa, PB, Brazil. Funda??o Oswaldo Cruz. Recife, PE, Brazil. Funda??o Oswaldo Cruz. Recife, PE, Brazil. Funda??o Oswaldo Cruz. Recife, PE, Brazil / Colorado State University. Department of Microbiology, Immunology &Pathology. Fort Collins, CO, USA. Funda??o Oswaldo Cruz. Recife, PE, Brazil. Heidelberg University Hospital. Department for Infectious Diseases. Section Clinical Tropical Medicine. Heidelberg, Germany. Funda??o Oswaldo Cruz. Recife, PE, Brazil. Laborat?rio Central de Sa?de P?blica. Macei?, AL, Brazil. Laborat?rio Central de Sa?de P?blica. Macei?, AL, Brazil. Laborat?rio Central de Sa?de P?blica. Macei?, AL, Brazil. Universidade Estadual de Feira de Santana. Feira de Santana, BA, Brazil. Secretaria de Sa?de de Feira de Santana. Feira de Santana, BA, Brazil. Universidade Federal do Amazonas. Manaus, AM, Brazil. University of S?o Paulo. School of Medicine &Institute of Tropical Medicine. Department of Infectious Disease. S?o Paulo, SP, Brazil. University of S?o Paulo. School of Medicine &Institute of Tropical Medicine. Department of Infectious Disease. S?o Paulo, SP, Brazil. Hospital S?o Francisco. Ribeir?o Preto, SP, Brazil. University of S?o Paulo. School of Medicine &Institute of Tropical Medicine. Department of Infectious Disease. S?o Paulo, SP, Brazil. Universidade Federal do Tocantins. Palmas, TO, Brazil. University of S?o Paulo. School of Medicine &Institute of Tropical Medicine. Department of Infectious Disease. S?o Paulo, SP, Brazil. University of Sydney. Sydney, Australia. University of Edinburgh. Institute of Evolutionary Biology. Edinburgh, UK / National Institutes of Health. Fogarty International Center. Bethesda, MD, USA. Fred Hutchinson Cancer Research Center. Vaccine and Infectious Disease Division. Seattle, WA, USA. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil / University of Texas Medical Branch. Department of Pathology. Galveston, TX, USA. University of S?o Paulo. School of Medicine &Institute of Tropical Medicine. Department of Infectious Disease. S?o Paulo, SP, Brazil. Funda??o Oswaldo Cruz. Salvador, BA, Brazil. University of Birmingham. Institute of Microbiology and Infection. Birmingham, UK. University of Oxford. Department of Zoology, Oxford, UK / Metabiota. San Francisco, CA, USA. University of S?o Paulo. School of Medicine &Institute of Tropical Medicine. Department of Infectious Disease. S?o Paulo, SP, Brazil. Funda??o Oswaldo Cruz. Salvador, BA, Brazil. Funda??o Oswaldo Cruz. Salvador, BA, Brazil / University of Rome Tor Vergata. Rome, Italy. Transmission of Zika virus (ZIKV) in the Americas was first confirmed in May 2015 in northeast Brazil. Brazil has had the highest number of reported ZIKV cases worldwide (more than 200,000 by 24 December 2016) and the most cases associated with microcephaly and other birth defects (2,366 confirmed by 31 December 2016). Since the initial detection of ZIKV in Brazil, more than 45 countries in the Americas have reported local ZIKV transmission, with 24 of these reporting severe ZIKV-associated disease. However, the origin and epidemic history of ZIKV in Brazil and the Americas remain poorly understood, despite the value of this information for interpreting observed trends in reported microcephaly. Here we address this issue by generating 54 complete or partial ZIKV genomes, mostly from Brazil, and reporting data generated by a mobile genomics laboratory that travelled across northeast Brazil in 2016. One sequence represents the earliest confirmed ZIKV infection in Brazil. Analyses of viral genomes with ecological and epidemiological data yield an estimate that ZIKV was present in northeast Brazil by February 2014 and is likely to have disseminated from there, nationally and internationally, before the first detection of ZIKV in the Americas. Estimated dates for the international spread of ZIKV from Brazil indicate the duration of pre-detection cryptic transmission in recipient regions. The role of northeast Brazil in the establishment of ZIKV in the Americas is further supported by geographic analysis of ZIKV transmission potential and by estimates of the basic reproduction number of the virus.

Background Dengue is an increasingly incident disease across many parts of the world. In response, an evidence-based handbook to translate research into policy and practice was developed. This handbook facilitates contingency planning as well as the development and use of early warning and response systems for dengue fever epidemics, by identifying decision-making processes that contribute to the success or failure of dengue surveillance, as well as triggers that initiate effective responses to incipient outbreaks. Methodology/Principal findings Available evidence was evaluated using a step-wise process that included systematic literature reviews, policymaker and stakeholder interviews, a study to assess dengue contingency planning and outbreak management in 10 countries, and a retrospective logistic regression analysis to identify alarm signals for an outbreak warning system using datasets from five dengue endemic countries. Best practices for managing a dengue outbreak are provided for key elements of a dengue contingency plan including timely contingency planning, the importance of a detailed, context-specific dengue contingency plan that clearly distinguishes between routine and outbreak interventions, surveillance systems for outbreak preparedness, outbreak definitions, alert algorithms, managerial capacity, vector control capacity, and clinical management of large caseloads. Additionally, a computer-assisted early warning system, which enables countries to identify and respond to context-specific variables that predict forthcoming dengue outbreaks, has been developed. Conclusions/Significance Most countries do not have comprehensive, detailed contingency plans for dengue outbreaks. Countries tend to rely on intensified vector control as their outbreak response, with minimal focus on integrated management of clinical care, epidemiological, laboratory and vector surveillance, and risk communication. The Technical Handbook for Surveillance, Dengue Outbreak Prediction/ Detection and Outbreak Response seeks to provide countries with evidence-based best practices to justify the declaration of an outbreak and the mobilization of the resources required to implement an effective dengue contingency plan., Author Summary An evidence-based handbook was generated to facilitate deployment of dengue surveillance and response systems for timely and effective management of outbreaks, and to identify the factors required for success. Evidence was evaluated using literature reviews, policymaker and stakeholder interviews, assessment of dengue contingency planning and outbreak management in ten endemic countries, and a statistical analysis to identify outbreak early warning signs in five countries. Best practices for managing dengue outbreaks included timely and context-specific dengue contingency plans that distinguished between routine practices and outbreak interventions, surveillance systems, outbreak definitions, alert algorithms, and managerial, clinical and vector control capacity. A computer-assisted early warning system was developed to enable each locality to develop its own context-specific scheme. Today, most countries do not have comprehensive, detailed contingency plans for dengue outbreaks, responding simply by intensifying vector control, with minimal focus on integrated management of clinical care, epidemiological, laboratory and vector surveillance, and risk communication. To rectify this, our handbook provides countries with evidence-based best practices to justify the declaration of an outbreak and for the mobilization and management of appropriate resources required to implement a dengue contingency plan.

Resumo OBJETIVO: descrever as principais estratégias de controle do Aedes aegypti, com ênfase nas inovações tecnológicas promissoras para utilização no Brasil. MÉTODOS: trata-se de estudo de revisão não sistemática da literatura. RESULTADOS: diversas tecnologias têm sido desenvolvidas como alternativas no controle do Ae. aegypti, utilizando-se diferentes mecanismos de ação - como monitoramento seletivo da infestação, medidas sociais, dispersão de inseticidas, novos agentes de controle biológico e técnicas moleculares para controle populacional dos mosquitos -, considerando-se também a combinação entre elas. As tecnologias em desenvolvimento demandam avaliação da eficácia, viabilidade e custos para implementação como estratégias complementares às ações já preconizadas pelo Programa Nacional de Controle da Dengue. CONCLUSÃO: a integração de diferentes estratégias de controle vetorial compatíveis e eficazes, considerando as tecnologias disponíveis e as características regionais, parece ser um método viável para tentar reduzir a infestação dos mosquitos e a incidência das arboviroses transmitidas por eles. Abstract OBJECTIVE: to describe the main strategies to control Aedes aegypti, with emphasis on promising technological innovations for use in Brazil. METHODS: this study is a non-systematic review of the literature. Results: several technologies have been developed as alternatives in the control of Ae. aegypti, using different mechanisms of action, such as selective monitoring of the infestation, social interventions, dispersing insecticides, new biological control agents and molecular techniques for population control of mosquitoes, also considering the combination between them. Evolving technologies require evaluation of the effectiveness, feasibility and costs of implementation strategies as complementary to the actions already recommended by the National Program for Dengue Control. CONCLUSION: the integration of different compatible and effective vector control strategies, considering the available technologies and regional characteristics, appears to be a viable method to try to reduce the infestation of mosquitoes and the incidence of arbovirus transmitted by them.

Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Centro de Inova??es Tecnol?gicas. Ananindeua, PA, Brazil / University of Oxford. Department of Zoology. Oxford, UK. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. University of Oxford. Department of Zoology. Oxford, UK. Universidade de S?o Paulo. Instituto Adolfo Lutz. S?o Paulo, SP, Brasil. Universidade de S?o Paulo. Instituto Adolfo Lutz. S?o Paulo, SP, Brasil. University of Oxford. Department of Zoology. Oxford, UK. University of Oxford. Department of Zoology. Oxford, UK. University of Oxford. Wellcome Trust Centre for Human Genetics. Oxford, UK. University of Oxford. Wellcome Trust Centre for Human Genetics. Oxford, UK. Universidade de S?o Paulo. Instituto Adolfo Lutz. S?o Paulo, SP, Brasil. Universidade de S?o Paulo. Instituto Adolfo Lutz. S?o Paulo, SP, Brasil. Universidade de S?o Paulo. Instituto Adolfo Lutz. S?o Paulo, SP, Brasil. Universidade de S?o Paulo. Instituto Adolfo Lutz. S?o Paulo, SP, Brasil. Universidade de S?o Paulo. Instituto Adolfo Lutz. S?o Paulo, SP, Brasil. Universidade de S?o Paulo. Instituto Adolfo Lutz. S?o Paulo, SP, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. University of Oxford. Department of Zoology. Oxford, UK / Metabiota. San Francisco, CA 94104, USA. University of Oxford. Department of Zoology. Oxford, UK. University of Oxford. Department of Zoology. Oxford, UK. Funda??o Oswaldo Cruz. Salvador, BA, Brasil. Universidade Estadual de Feira de Santana, Feira de Santana. Departamento de Sa?de. Centro de P?s-Gradua??o em Sa?de Coletiva. Feira de Santana, BA, Brasil. Funda??o Oswaldo Cruz. Salvador, BA, Brasil. University of Washington. Institute for Health Metrics and Evaluation,. Seattle, WA, USA / University of Oxford. Wellcome Trust Centre for Human Genetics. Oxford, UK. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Centro de Inova??es Tecnol?gicas. Ananindeua, PA, Brasil Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Centro de Inova??es Tecnol?gicas. Ananindeua, PA, Brasil Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Centro de Inova??es Tecnol?gicas. Ananindeua, PA, Brasil Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Centro de Inova??es Tecnol?gicas. Ananindeua, PA, Brasil Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Centro de Inova??es Tecnol?gicas. Ananindeua, PA, Brasil Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Centro de Inova??es Tecnol?gicas. Ananindeua, PA, Brasil Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Centro de Inova??es Tecnol?gicas. Ananindeua, PA, Brasil Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Centro de Inova??es Tecnol?gicas. Ananindeua, PA, Brasil Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Centro de Inova??es Tecnol?gicas. Ananindeua, PA, Brasil Funda??o Oswaldo Cruz. Instituto Oswaldo Cruz. Laborat?rio de AIDS e Imunologia Molecular. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto Oswaldo Cruz. Laborat?rio de AIDS e Imunologia Molecular. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto Oswaldo Cruz. Laborat?rio de AIDS e Imunologia Molecular. Rio de Janeiro, RJ, Brasil. Li Ka Shing Knowledge Institute. St. Michael?s Hospital. Toronto, Canada / University of Toronto. Department of Medicine. Division of Infectious Diseases. Toronto, Canada. University of Toronto.Dalla Lana School of Public Health. Toronto, Canada; Brasil. Minist?rio da Sa?de. Bras?lia, DF, Brasil. Brasil. Minist?rio da Sa?de. Bras?lia, DF, Brasil. University of Texas Medical Branch. Department of Pathology. Galveston, TX, USA. University of Oxford. Department of Zoology. Oxford, UK / Metabiota. San Francisco, CA 94104, USA. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas, Centro de Inova??o tecnol?gica. Ananindeua, PA, Brasil / University of Texas Medical Branch. Department of Pathology. Galveston, TX, USA. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil Brazil has experienced an unprecedented epidemic of Zika virus (ZIKV), with ~30,000 cases reported to date. ZIKV was first detected in Brazil in May 2015 and cases of microcephaly potentially associated with ZIKV infection were identified in November 2015. Using next generation sequencing we generated seven Brazilian ZIKV genomes, sampled from four self-limited cases, one blood donor, one fatal adult case, and one newborn with microcephaly and congenital malformations. Phylogenetic and molecular clock analyses show a single introduction of ZIKV into the Americas, estimated to have occurred between May-Dec 2013, more than 12 months prior to the detection of ZIKV in Brazil. The estimated date of origin coincides with an increase in air passengers to Brazil from ZIKV endemic areas, and with reported outbreaks in Pacific Islands. ZIKV genomes from Brazil are phylogenetically interspersed with those from other South American and Caribbean countries. Mapping mutations onto existing structural models revealed the context of viral amino acid changes present in the outbreak lineage; however no shared amino acid changes were found among the three currently available virus genomes from microcephaly cases. Municipality-level incidence data indicate that reports of suspected microcephaly in Brazil best correlate with ZIKV incidence around week 17 of pregnancy, although this does not demonstrate causation. Our genetic description and analysis of ZIKV isolates in Brazil provide a baseline for future studies of the evolution and molecular epidemiology in the Americas of this emerging virus.

SUMMARYThe classical Ross–Macdonald model is often utilized to model vector-borne infections; however, this model fails on several fronts. First, using measured (or estimated) parameters, which values are accepted from the literature, the model predicts a much greater number of cases than what is usually observed. Second, the model predicts a single large outbreak that is followed by decades of much smaller outbreaks, which is not consistent with what is observed. Usually towns or cities report a number of recurrences for many years, even when environmental changes cannot explain the disappearance of the infection between the peaks. In this paper, we continue to examine the pitfalls in modelling this class of infections, and explain that, if properly used, the Ross–Macdonald model works and can be used to understand the patterns of epidemics and even, to some extent, be used to make predictions. We model several outbreaks of dengue fever and show that the variable pattern of yearly recurrence (or its absence) can be understood and explained by a simple Ross–Macdonald model modified to take into account human movement across a range of neighbourhoods within a city. In addition, we analyse the effect of seasonal variations in the parameters that determine the number, longevity and biting behaviour of mosquitoes. Based on the size of the first outbreak, we show that it is possible to estimate the proportion of the remaining susceptible individuals and to predict the likelihood and magnitude of the eventual subsequent outbreaks. This approach is described based on actual dengue outbreaks with different recurrence patterns from some Brazilian regions.

Recently, a prototype dengue early warning system was developed to produce probabilistic forecasts of dengue risk three months ahead of the 2014 World Cup in Brazil. Here, we evaluate the categorical dengue forecasts across all microregions in Brazil, using dengue cases reported in June 2014 to validate the model. We also compare the forecast model framework to a null model, based on seasonal averages of previously observed dengue incidence. When considering the ability of the two models to predict high dengue risk across Brazil, the forecast model produced more hits and fewer missed events than the null model, with a hit rate of 57% for the forecast model compared to 33% for the null model. This early warning model framework may be useful to public health services, not only ahead of mass gatherings, but also before the peak dengue season each year, to control potentially explosive dengue epidemics. DOI: http://dx.doi.org/10.7554/eLife.11285.001, eLife digest Dengue is a viral infection spread by mosquitoes and is widespread in tropical and sub-tropical regions. Dengue epidemics in Brazil often occur without warning, and can overwhelm the public health services. Forecasts of seasonal climates combined with early data from a dengue surveillance system could help public health services anticipate dengue outbreaks several months in advance. However, this information has not been previously exploited to predict dengue epidemics in a practical real-life framework. Recently, a group of researchers developed a prototype of a dengue early warning system based on 13 years worth of data, and used it to predict the risk of dengue three months ahead of the 2014 FIFA World Cup in Brazil. Now Lowe et al. – including most of the researchers involved in the earlier work – have evaluated the prototype against the actual reported cases of dengue during the event. Brazil is divided into over 550 'microregions', and the forecasts correctly predicted high risk of dengue for 57% of the microregions reporting high levels of dengue during the games. Forecasts based on seasonal dengue averages would have only detected high risk in 33% of these microregions. The forecasts also correctly predicted the dengue risk level in seven out of the twelve cities where the World Cup games were hosted. However, the prototype failed to predict the high risk in both São Paulo and Brasília. Lowe et al. speculate that this may have been due to changes in how water was stored in these cities (standing water is a breeding site for mosquitoes) and the circulation of a new strain of the dengue virus. The implementation of seasonal climate forecasts and early reports of dengue cases into an early warning system is now a priority for public health authorities. This action is likely to help them to prepare for and minimize epidemics of dengue and other diseases that are spread by mosquitoes, such as chikungunya and Zika virus. DOI: http://dx.doi.org/10.7554/eLife.11285.002

We analyzed dengue incidence in the period between October 2006-July 2007 of 146 cities around the country were Larval Index Rapid Assay (LIRA) surveillance was carried out in October 2006. Of these, we chosen 61 cities that had 500 or more cases reported during this period. We calculated the incidence coefficient, the force of infection (lambda) and the basic reproduction number (R0) of dengue in those 61 cities and correlated those variables with the LIRA. We concluded that lambda and R0 are more associated with the number of cases than LIRA. In addition, the average R0 for the 2006/2007 dengue season was almost as high as that calculated for the 2001/2002 season, the worst in Brazilian history.

BACKGROUND\ud Worldwide, dengue is an unrelenting economic and health burden. Dengue outbreaks have become increasingly common, which place great strain on health infrastructure and services. Early warning models could allow health systems and vector control programmes to respond more cost-effectively and efficiently.\ud \ud METHODOLOGY/PRINCIPAL FINDINGS\ud The Shewhart method and Endemic Channel were used to identify alarm variables that may predict dengue outbreaks. Five country datasets were compiled by epidemiological week over the years 2007-2013. These data were split between the years 2007-2011 (historic period) and 2012-2013 (evaluation period). Associations between alarm/ outbreak variables were analysed using logistic regression during the historic period while alarm and outbreak signals were captured during the evaluation period. These signals were combined to form alarm/ outbreak periods, where 2 signals were equal to 1 period. Alarm periods were quantified and used to predict subsequent outbreak periods. Across Mexico and Dominican Republic, an increase in probable cases predicted outbreaks of hospitalised cases with sensitivities and positive predictive values (PPV) of 93%/ 83% and 97%/ 86% respectively, at a lag of 1-12 weeks. An increase in mean temperature ably predicted outbreaks of hospitalised cases in Mexico and Brazil, with sensitivities and PPVs of 79%/ 73% and 81%/ 46% respectively, also at a lag of 1-12 weeks. Mean age was predictive of hospitalised cases at sensitivities and PPVs of 72%/ 74% and 96%/ 45% in Mexico and Malaysia respectively, at a lag of 4-16 weeks.\ud \ud CONCLUSIONS/SIGNIFICANCE\ud An increase in probable cases was predictive of outbreaks, while meteorological variables, particularly mean temperature, demonstrated predictive potential in some countries, but not all. While it is difficult to define uniform variables applicable in every country context, the use of probable cases and meteorological variables in tailored early warning systems could be used to highlight the occurrence of dengue outbreaks or indicate increased risk of dengue transmission.

Dengue and chikungunya are increasing global public health concerns due to their rapid geographical spread and increasing disease burden. Knowledge of the contemporary distribution of their shared vectors, Aedes aegypti and Aedes albopictus remains incomplete and is complicated by an ongoing range expansion fuelled by increased global trade and travel. Mapping the global distribution of these vectors and the geographical determinants of their ranges is essential for public health planning. Here we compile the largest contemporary database for both species and pair it with relevant environmental variables predicting their global distribution. We show Aedes distributions to be the widest ever recorded; now extensive in all continents, including North America and Europe. These maps will help define the spatial limits of current autochthonous transmission of dengue and chikungunya viruses. It is only with this kind of rigorous entomological baseline that we can hope to project future health impacts of these viruses. DOI: http://dx.doi.org/10.7554/eLife.08347.001, eLife digest Mosquitoes spread many disease-causing viruses and parasites between people and other animals, including viral infections such as dengue and chikungunya. Both infections cause high fevers often accompanied with excruciating joint pain or other flu-like symptoms. Dengue and chikungunya have become growing public health problems over the last fifty years. Today about half of the world's population is at risk of dengue infection, while chikungunya outbreaks, which were previously limited to Africa and Asia, have recently been reported in the Caribbean, South America and Europe. The dengue and chikungunya viruses are transmitted between people by two species of mosquitoes called Aedes aegypti and Ae. albopictus. Therefore it is important to work out where these mosquito species are found around the globe to identify the areas at risk. It is also important to predict where these species could become established if they were introduced, in order to identify areas that could become at risk in the future. Kraemer et al. now provide updated predictions about the distribution of these two mosquito species around the globe. These predictions are based upon the most up-to-date data on the known locations of the species combined with information on environmental conditions across the globe. The updated maps show that these Aedes mosquitoes are now found across all continents, including North America and Europe. Aedes albopictus mosquitoes in particular are rapidly expanding their territory around the globe. Kraemer et al. used their new maps to show that, unlike in the United States, many of the areas in Europe and China that could support this mosquito species do not yet appear to have been colonized. These findings provide a map of the distribution of both species as it stands at the moment. Further work is now needed to better understand which factors are contributing to the rapid expansion of these mosquitoes' range and what might be done to control this spread. DOI: http://dx.doi.org/10.7554/eLife.08347.002

Background In December 2013, an outbreak of Chikungunya virus (CHIKV) caused by the Asian genotype was notified in the Caribbean. The outbreak has since spread to 38 regions in the Americas. By September 2014, the first autochthonous CHIKV infections were confirmed in Oiapoque, North Brazil, and in Feira de Santana, Northeast Brazil. Methods We compiled epidemiological and clinical data on suspected CHIKV cases in Brazil and polymerase-chain-reaction-based diagnostic was conducted on 68 serum samples from patients with symptom onset between April and September 2014. Two imported and four autochthonous cases were selected for virus propagation, RNA isolation, full-length genome sequencing, and phylogenetic analysis. We then followed CDC/PAHO guidelines to estimate the risk of establishment of CHIKV in Brazilian municipalities. Results We detected 41 CHIKV importations and 27 autochthonous cases in Brazil. Epidemiological and phylogenetic analyses indicated local transmission of the Asian CHIKV genotype in Oiapoque. Unexpectedly, we also discovered that the ECSA genotype is circulating in Feira de Santana. The presumed index case of the ECSA genotype was an individual who had recently returned from Angola and developed symptoms in Feira de Santana. We estimate that, if CHIKV becomes established in Brazil, transmission could occur in 94% of municipalities in the country and provide maps of the risk of importation of each strain of CHIKV in Brazil. Conclusions The etiological strains associated with the early-phase CHIKV outbreaks in Brazil belong to the Asian and ECSA genotypes. Continued surveillance and vector mitigation strategies are needed to reduce the future public health impact of CHIKV in the Americas. Electronic supplementary material The online version of this article (doi:10.1186/s12916-015-0348-x) contains supplementary material, which is available to authorized users.

Aedes aegypti and Ae. albopictus are the main vectors transmitting dengue and chikungunya viruses. Despite being pathogens of global public health importance, knowledge of their vectors’ global distribution remains patchy and sparse. A global geographic database of known occurrences of Ae. aegypti and Ae. albopictus between 1960 and 2014 was compiled. Herein we present the database, which comprises occurrence data linked to point or polygon locations, derived from peer-reviewed literature and unpublished studies including national entomological surveys and expert networks. We describe all data collection processes, as well as geo-positioning methods, database management and quality-control procedures. This is the first comprehensive global database of Ae. aegypti and Ae. albopictus occurrence, consisting of 19,930 and 22,137 geo-positioned occurrence records respectively. Both datasets can be used for a variety of mapping and spatial analyses of the vectors and, by inference, the diseases they transmit.

Brazil has experienced an increase in dengue disease severity in the past 5 years., In the last 5 years, Brazil has accounted for ≈70% of reported dengue fever cases in the Americas. We analyzed trends of dengue and dengue hemorrhagic fever (DHF) from the early 1980s to 2002 by using surveillance data from the Brazilian Ministry of Health. Two distinct epidemiologic patterns for dengue were observed: localized epidemics (1986–1993), and endemic and epidemic virus circulation countrywide (1994–2002). Currently, serotypes 1, 2, and 3 cocirculate in 22 of 27 states. Dengue and DHF affected mainly adults; however, an increase in occurrence of DHF among children has been recently detected in northern Brazil, which suggests a shift in the occurrence of severe disease to younger age groups. In 2002, hospitalizations increased, which points out the change in disease severity compared to that seen in the 1990s. We describe the epidemiology of dengue in Brazil, characterizing the changing patterns of it and DHF during the last 20 years.

Patients with dengue fever and comorbidities seem to be at higher risk of developing complications and/or severe dengue compared to healthier individuals. This study systematically reviews the evidence related to comorbidities and dengue. A systematic literature review was performed in five databases (EMBASE, PUBMED, Global Health, SciELO, Cochrane) and grey literature for full-text articles since its inceptions until October 10, 2015. A total of 230 articles were retrieved. Sixteen studies were analysed after applying all inclusion and exclusion criteria. Seven case control studies and nine retrospective cohort studies showed that comorbidities may contribute to severe dengue, especially 1) cardiovascular disease, 2) stroke, 3) diabetes, 4) respiratory disease and 5) renal disease, as well as old age. However, due to heterogeneity in studies, the real estimate effect of comorbidities as modifiers of dengue severity could not be established. Further research in regions with high prevalence of dengue infection would contribute to a better understanding of the relevance of comorbidities in severe dengue, especially with a standardised protocol, for outcomes, specific comorbidities, study design—best using prospective designs—and sample sizes., Author Summary Dengue fever is a viral disease, transmitted by Aedes mosquitoes. Although for most cases of dengue fever the illness is self-limiting or asymptomatic, severe dengue can occur. Severe dengue is now classified by 1) plasma leakage, and/or 2) severe haemorrhage and/or 3) organ failure. Complications and deaths occur in this group of cases with severe dengue. Patients with dengue fever and comorbidities seem to be at higher risk of developing complications and/or severe dengue compared to healthier individuals. This study systematically reviews the evidence related to comorbidities and the severe forms of dengue fever. Sixteen studies were analysed after applying all inclusion and exclusion criteria. Seven case control studies and nine retrospective cohort studies assessed comorbidities and development of severe forms of dengue. The results showed that comorbidities are relevant to severe dengue, especially 1) cardiovascular disease, 2) stroke, 3) diabetes, 4) respiratory disease and 5) renal disease, as well as old age. The study of comorbidities in dengue fever is fundamental for improved patient outcome by differential case management of patients, reducing the burden of the disease. Further research in regions with high prevalence of dengue infection would contribute to a better understanding of the relevance of comorbidities with severe forms of dengue fever. An agreed protocol for such studies is urgently needed.

Objetivo. Determinar as prevalências estaduais e nacional do bócio endêmico relacionado com a deficiência de iodo em escolares de 6 a 14 anos, com base em dados obtidos no inquérito nacional realizado de 1994 a 1996 no Brasil. Materiais. Em 428 municípios de todos os estados brasileiros, o exame de inspeção-palpação foi utilizado para coletar dados de 178 774 escolares de 6 a 14 anos. Uma sub-amostra foi selecionada para determinação do conteúdo de iodo na urina e sal culinário residencial. Resultados. Em comparação com dados de 1975, último inquérito antes deste aqui relatado, constatou-se queda de 86% na prevalência mediana de bócio graus I e II (de 12 para 1%). Em 21% dos municípios, a prevalência observada foi zero. Das 16 803 amostras urinárias para dosagem de iodo foi possível recuperar 7 702 e associá-las às respectivas fichas clínicas individuais (perda de 54%). A mediana de iodo urinário foi de 14,0 mig/dL e não se verificou correlação significativa com os dados clínicos de bócio. Os estados do Acre, Amapá e Tocantins tiveram mediana populacional de excreção urinária de iodo igual ou abaixo de 9,0 mig/dL. Em três municípios a dosagem urinária de iodo foi gravemente baixa (< 2,5 mig/dL) em todas as amostras: Paranã (Tocantins); Conceição (Paraíba); e Nova Roma (Goiás). O sal consumido nas residências (458 amostras coletadas) apresentou sub-dosagem de iodo suplementar, com 50% abaixo de 20 mg/kg ou 20 ppm. Em 7% das amostras, a dosagens de iodo foi menor do que 10 mg/kg de sal, inclusive em estados produtores de sal, como o Rio Grande do Norte. Conclusões. Há evidências de expansão da área endêmica de bócio para as regiões de abertura de fronteira agrícola, com exposição de crianças a dieta doméstica carente de iodo veiculado pelo sal. Esta carência associou-se com o aumento de risco para bócio (OR = 1,85; 1,68 < OR < 2,03; IC 95% Cornfield) nas áreas onde a iodação do sal consumido foi deficiente (< 10 mg/kg).

Background This year, Brazil will host about 600,000 foreign visitors during the 2014 FIFA World Cup. The concern of possible dengue transmission during this event has been raised given the high transmission rates reported in the past by this country. Methodology/Principal Findings We used dengue incidence rates reported by each host city during previous years (2001–2013) to estimate the risk of dengue during the World Cup for tourists and teams. Two statistical models were used: a percentile rank (PR) and an Empirical Bayes (EB) model. Expected IR's during the games were generally low (, Author Summary This year the 2014 FIFA World Cup will be hosted by Brazil, a country that has reported a higher number of dengue cases annually than any other country worldwide over the last decade. About 600,000 foreign tourists are expected and may be at risk for this disease. Games will be played in 12 different cities across the country and teams will stay in 27 different basecamp locations. We used weekly dengue surveillance data from previous years (2001–2013) and the first 19 weeks in 2014 to estimate the risk of dengue during the World Cup in each location and found that the expected incidence rates were relatively low. We also found interesting differences across estimation methods. Based on current ticket allocations, we expect that between 26 and 59 dengue cases will occur among tourists and none among teams. Quantitative risk estimates based on historical data should be made routinely for mass gathering events.

Após caracterização clínico-epidemiológica da oncocercose na região Yanomâmi, RR, Brasil, iniciada em 1993, a Fundação Nacional de Saúde (FNS) implementou um projeto piloto de controle e tratamento nos pólos de base de Tootobi e Balawaú. Nestes, foram estudadas biópsias de pele de 426 pessoas. Nos nódulos de 86,7% de pacientes, foi encontrada Onchocerca volvulus. A prevalência global encontrada na população examinada foi 66,2%. O tratamento, com ivermectina, teve uma cobertura de 80,1% da população total. Reações adversas ao medicamento foram relatadas em 12,3% dos pacientes, sendo consideradas como leves e moderadas. Estes resultados são concordantes com os descritos na literatura médica e sugerem a factibilidade da ampliação do referido Programa para toda a área Yanomâmi, numa próxima fase.After to characterize the clinic and epidemiological picture of the onchocerciasis in Yanomâmi region, RR, Brazil, begun in 1993, the National Health Foundation (FNS) implemented a Control and Treatment Pilot Project in Tootobi and Balawaú. Here, it was studied skin biopsies from 426 inhabitants. In the nodules of 86.7% from patients was encountered Onchocerca volvulus. The over-all prevalence in the examined population was 66.2%. The treatment with ivermectin covered 80.1% of total population. Adverse reactions, light and moderate, of the medicament were reported in 12.3% of the patients. These results agreeing with the medical literature and suggesting the viability of to increase of the programme for all Yanomâmi area in the next phase.

Introduction The mosquito Aedes aegypti, vector of dengue, chikungunya and yellow fever viruses, is an important target of vector control programs in tropical countries. Most mosquito surveillance programs are still based on the traditional household larval surveys, despite the availability of new trapping devices. We report the results of a multicentric entomological survey using four types of traps, besides the larval survey, to compare the entomological indices generated by these different surveillance tools in terms of their sensitivity to detect mosquito density variation. Methods The study was conducted in five mid-sized cities, representing variations of tropical climate regimens. Surveillance schemes using traps for adults (BG-Sentinel, Adultrap and MosquiTRAP) or eggs (ovitraps) were applied monthly to three 1 km2 areas per city. Simultaneously, larval surveys were performed. Trap positivity and density indices in each area were calculated and regressed against meteorological variables to characterize the seasonal pattern of mosquito infestation in all cities, as measured by each of the four traps. Results The House Index was consistently low in most cities, with median always 0. Traps rarely produced null indices, pointing to their greater sensitivity in detecting the presence of Ae. aegypti in comparison to the larval survey. Trap positivity indices tend to plateau at high mosquito densities. Despite this, both indices, positivity and density, agreed on the seasonality of mosquito abundance in all cities. Mosquito seasonality associated preferentially with temperature than with precipitation even in areas where temperature variation is small. Conclusions All investigated traps performed better than the House Index in measuring the seasonal variation in mosquito abundance and should be considered as complements or alternatives to larval surveys. Choice between traps should further consider differences of cost and ease-of-use., Author Summary Dengue vector surveillance programs regularly use household surveys for searching breeding sites that are positive for Ae. aegypti larvae. Infestation indices are calculated as the percentage of positive houses, or percentage of positive containers, and are used to guide control actions and to issue alerts. However, these indices are costly and prone to error due to variation in searching effort and the sometimes cryptic nature of the mosquito egg laying behavior. In the recent years, many devices for trapping mosquitoes were developed. One problem when deciding which trap to choose for surveillance is the lack of a gold standard to compare trap-based indices with. In this scenario, choice relies on the behavior of the trap indices, that is, how well they inform about mosquito population growth, decline, or spread. Our study compared infestation indices produced by four different trap schemes as well the immature survey. We observed that any trap is more sensitive in detecting the mosquito presence than the immature survey, and they are better in capturing the temporal variation in mosquito abundance as well. However, traps are very different in terms of cost, ease-of-use and sensitivity and trap choice should further consider these factors.

To the Editor: Brazil is responsible for >60% of reported cases of dengue fever (DF) in the American region (a designation of the Pan American Health Organization, which includes all of North, Central and South America) (1). The epidemiologic characteristics of dengue diseases in Brazil differ from those described in Southeast Asia. In Brazil, the incidence of DF and dengue hemorrhagic fever (DHF) is highest in adults. By contrast, in Southeast Asia, DHF cases predominate and occur more often in children than in adults (2,3).