#Development, #environmental #degradation, and #disease spread in the #Brazilian #Amazon (PLOS Biol., abstract)

[Source: PLOS Biology, full page: (LINK). Abstract, edited.]


Development, environmental degradation, and disease spread in the Brazilian Amazon

Marcia C. Castro , Andres Baeza, Cláudia Torres Codeço, Zulma M. Cucunubá, Ana Paula Dal’Asta, Giulio A. De Leo, Andrew P. Dobson, Gabriel Carrasco-Escobar, Raquel Martins Lana, Rachel Lowe, Antonio Miguel Vieira Monteiro, Mercedes Pascual, Mauricio Santos-Vega


Published: November 15, 2019 / DOI: https://doi.org/10.1371/journal.pbio.3000526 / This is an uncorrected proof.



The Amazon is Brazil’s greatest natural resource and invaluable to the rest of the world as a buffer against climate change. The recent election of Brazil’s president brought disputes over development plans for the region back into the spotlight. Historically, the development model for the Amazon has focused on exploitation of natural resources, resulting in environmental degradation, particularly deforestation. Although considerable attention has focused on the long-term global cost of “losing the Amazon,” too little attention has focused on the emergence and reemergence of vector-borne diseases that directly impact the local population, with spillover effects to other neighboring areas. We discuss the impact of Amazon development models on human health, with a focus on vector-borne disease risk. We outline policy actions that could mitigate these negative impacts while creating opportunities for environmentally sensitive economic activities.


Citation: Castro MC, Baeza A, Codeço CT, Cucunubá ZM, Dal’Asta AP, De Leo GA, et al. (2019) Development, environmental degradation, and disease spread in the Brazilian Amazon. PLoS Biol 17(11): e3000526. https://doi.org/10.1371/journal.pbio.3000526

Published: November 15, 2019

Copyright: © 2019 Castro et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: The National Socio-Environmental Synthesis Center (SESYNC) under funding from the National Science Foundation (DBI-1639145) supported this work. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Abbreviations: DETER, Detection of Deforestation in Real Time; EIA, environmental impact assessment; EMBRAPA, Brazilian Agricultural Research Corporation; INPE, Instituto Nacional de Pesquisas Espaciais; NMCP, National Malaria Control Program; OTCA, Organización del Tratado de Cooperación Amazónica; PAHO, Pan American Health Organization

Provenance: Not commissioned; externally peer reviewed.

Keywords: Public Health; Environmental disasters; Emerging Diseases; Infectious Diseases; Brazil; Amazon.


#Clinical #findings in #congenital #infection by #Zika virus: a retrospective study in a reference hospital in Central-West #Brazil (BMC Pediatr., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

BMC Pediatr. 2019 Oct 29;19(1):389. doi: 10.1186/s12887-019-1762-6.

Clinical findings in congenital infection by Zika virus: a retrospective study in a reference hospital in Central-West Brazil.

de Paula Guimarães C1, Macedo MS2, Barbosa MA3, Marques SM4, Costa PS4, de Oliveira ÊC4.

Author information: 1 Hospital das Clínicas da UFG/EBSERH, Goiânia, GO, Brazil. enfguimaraes@yahoo.com.br. 2 Secretaria Municipal de Saúde, Goiânia, GO, Brazil. 3 Faculdade de Enfermagem da UFG, Goiânia, GO, Brazil. 4 Faculdade de Medicina da UFG, Goiânia, GO, Brazil.




An increased number of congenital Zika virus infections with neurological and musculoskeletal malformations have been diagnosed worldwide, however, there are still several gaps in the knowledge about this infection, its associated mechanism, timing of transmission, and description of throughout findings of signs and symptoms, which is described in this paper. The purpose of this study is to describe aspects of congenital Zika syndrome (CZS) beyond the central nervous system comprising detailed delineation of all the other clinical findings.


A retrospective research developed using electronic medical records. We analyzed the files of 69 children with an initial diagnosis of microcephaly by Zika vírus who were born in 2015, 2016 and 2017, treated during the period from 2016 to 2017.


The newborns presented several neurological and musculoskeletal malformations, eye damage, hearing impairment and other malformations.


The present study has significant impact for health care teams following lactents with Congenital Zika Syndrome.

KEYWORDS: Malformations; Microcephaly; Zika virus

PMID: 31660908 DOI: 10.1186/s12887-019-1762-6

Keywords: Zika Virus; Zika Congenital Syndrome; Pediatrics; Brazil.


Long-term #survival and cause-specific #mortality of #patients newly diagnosed with #tuberculosis in São Paulo state, #Brazil, 2010–15: a population-based, longitudinal study (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Long-term survival and cause-specific mortality of patients newly diagnosed with tuberculosis in São Paulo state, Brazil, 2010–15: a population-based, longitudinal study

Otavio T Ranzani, PhD, Prof Laura C Rodrigues, PhD, Sidney Bombarda, PhD, Cátia M Minto, MSc, Prof Eliseu A Waldman, PhD, Prof Carlos R R Carvalho, PhD

Open Access / Published: October 29, 2019 / DOI: https://doi.org/10.1016/S1473-3099(19)30518-3




Long-term survival and cause-specific mortality of patients who start tuberculosis treatment is rarely described. We aimed to assess the long-term survival of these patients and evaluate the association between vulnerable conditions (social, health behaviours, and comorbidities) and cause-specific mortality in a country with a high burden of tuberculosis.


In this population-based, longitudinal study in São Paulo state, Brazil, we described the 5-year survival of patients who were newly diagnosed with tuberculosis in 2010. We included patients with newly-diagnosed tuberculosis, aged 15 years or older, and notified to the São Paulo State Tuberculosis Program in 2010. We excluded patients whose diagnosis had changed during follow-up (ie, they did not have tuberculosis) and patients who had multidrug-resistant (MDR) tuberculosis. We selected our population with tuberculosis from the dedicated electronic system TBweb. Our primary objective was to estimate the excess mortality over 5 years and within the group who survived the first year, compared with the general São Paulo state population. We also estimated the association between social vulnerability (imprisonment and homelessness), health behaviours (alcohol and drug use), and comorbidities (diabetes and mental disorders) with all-cause and cause-specific mortality. We used the competing risk analysis framework, estimating cause-specific hazard ratios (HRs) adjusted for potential confounding factors.


In 2010, there were 19 252 notifications of tuberculosis cases. We excluded 550 cases as patients were younger than 15 years, 556 cases that were not tuberculosis, 2597 retreatments, and 48 cases of MDR tuberculosis, resulting in a final cohort of 15 501 patients with tuberculosis. Over a period of 5 years from tuberculosis diagnosis, 2660 (17%) of 15 501 patients died. Compared with the source population, matched by age, sex, and calendar year, the standardised mortality ratio was 6·47 (95% CI 6·22–6·73) over 5 years and 3·93 (3·71–4·17) among those who survived the first year. 1197 (45%) of 2660 deaths were due to infection. Homelessness and alcohol and drug use were associated with death from infection (adjusted cause-specific HR 1·60, 95% CI 1·39–1·85), cardiovascular (1·43, 1·06–1·95), and external or ill-defined causes of death (1·80, 1·37–2·36). Diabetes was associated with deaths from cardiovascular causes (1·70, 1·23–2·35).


Patients newly diagnosed with tuberculosis were at a higher risk of death than were the source population, even after tuberculosis treatment. Post-tuberculosis sequelae and vulnerability are associated with excess mortality and must be addressed to mitigate the tuberculosis burden worldwide.


Wellcome Trust.

Keywords: Tuberculosis; Antibiotics; Drugs Resistance; Society; Poverty; Brazil.


#Surge of #respiratory #illnesses in #children due to #fires in #Brazil’s #Amazon region (Lancet Resp Med., summary)

[Source: The Lancet Respiratory Medicine, full page: (LINK). Summary, edited.]

Surge of respiratory illnesses in children due to fires in Brazil’s Amazon region

Lise Alves

Published: October 29, 2019 / DOI: https://doi.org/10.1016/S2213-2600(19)30410-2


As thousands of kilometres of forest burned in the Amazon during the months of June through August, the world cried out for the preservation of the largest rainforest in the world. Environmentalists denounced the widespread deforestation of the area, with fires being set in protected areas and even very near indigenous reserves.


This article is available free of charge.

Copyright © 2019 Elsevier Ltd. All rights reserved.

Keywords: Environmental disasters; Environmental pollution; Brazil.


#Amazon #deforestation drives #malaria #transmission, and malaria burden reduces #forest clearing (Proc Natl Acad Sci USA, abstract)

[Source: Proceedings of the National Academy of Sciences of the United States of America, full page: (LINK). Abstract, edited.]

Amazon deforestation drives malaria transmission, and malaria burden reduces forest clearing

Andrew J. MacDonald and Erin A. Mordecai

PNAS first published October 14, 2019 / DOI: https://doi.org/10.1073/pnas.1905315116

Edited by Burton H. Singer, University of Florida, Gainesville, FL, and approved September 17, 2019 (received for review March 27, 2019)



Widespread human impacts on the environment are expected to harm human health, which may in turn alter our interactions with the environment. However, evidence for impacts of environmental changes on health, and for feedbacks between environmental change and health, remains locally specific and context dependent. Using a large, geospatial dataset encompassing the Brazilian Amazon rainforest across 13 y, we identify strong evidence for a feedback between deforestation and malaria: Deforestation significantly increases malaria transmission, while high malaria burden simultaneously reduces forest clearing. Our results put into broader context the contradictory effects of deforestation on malaria found in earlier studies and provide evidence useful to land use policy and public health interventions that provide win–win solutions for conservation and health.



Deforestation and land use change are among the most pressing anthropogenic environmental impacts. In Brazil, a resurgence of malaria in recent decades paralleled rapid deforestation and settlement in the Amazon basin, yet evidence of a deforestation-driven increase in malaria remains equivocal. We hypothesize an underlying cause of this ambiguity is that deforestation and malaria influence each other in bidirectional causal relationships—deforestation increases malaria through ecological mechanisms and malaria reduces deforestation through socioeconomic mechanisms—and that the strength of these relationships depends on the stage of land use transformation. We test these hypotheses with a large geospatial dataset encompassing 795 municipalities across 13 y (2003 to 2015) and show deforestation has a strong positive effect on malaria incidence. Our results suggest a 10% increase in deforestation leads to a 3.3% increase in malaria incidence (∼9,980 additional cases associated with 1,567 additional km2 lost in 2008, the study midpoint, Amazon-wide). The effect is larger in the interior and absent in outer Amazonian states where little forest remains. However, this strong effect is only detectable after controlling for a feedback of malaria burden on forest loss, whereby increased malaria burden significantly reduces forest clearing, possibly mediated by human behavior or economic development. We estimate a 1% increase in malaria incidence results in a 1.4% decrease in forest area cleared (∼219 fewer km2 cleared associated with 3,024 additional cases in 2008). This bidirectional socioecological feedback between deforestation and malaria, which attenuates as land use intensifies, illustrates the intimate ties between environmental change and human health.

Brazil – Plasmodium falciparum – Plasmodium vivax – instrumental variables – environmental change



1 To whom correspondence may be addressed. Email: andy.j.macdon@gmail.com.

Author contributions: A.J.M. designed research; A.J.M. performed research; A.J.M. analyzed data; A.J.M. and E.A.M. wrote the paper; and E.A.M. helped in the development of the project.

The authors declare no competing interest.

This article is a PNAS Direct Submission.

This article contains supporting information online at www.pnas.org/lookup/suppl/doi:10.1073/pnas.1905315116/-/DCSupplemental.

Published under the PNAS license.

Keywords: Malaria; Environmental disasters; Brazil.


#Yellowfever virus re-emergence and spread in Southeast #Brazil, 2016-2019 (J Virol., abstract)

[Source: Journal of Virology, full page: (LINK). Abstract, edited.]

Yellow fever virus re-emergence and spread in Southeast Brazil, 2016-2019

Marta Giovanetti, Marcos Cesar Lima de Mendonça, Vagner Fonseca, Maria Angélica Mares-Guia, Allison Fabri, Joilson Xavier, Jaqueline Goes de Jesus, Tiago Gräf, Cintia Damasceno dos Santos Rodrigues, Carolina Cardoso dos Santos, Simone Alves Sampaio, Flavia Lowen Levy Chalhoub, Fernanda de Bruycker Nogueira, Julien Theze, Alessandro Pecego Martins Romano, Daniel Garkauskas Ramos, Andre Luiz de Abreu, Wanderson Kleber Oliveira, Rodrigo Fabiano do Carmo Said, Carlos F. Campelo de Alburque, Tulio de Oliveira, Carlos Augusto Fernandes, Shirlei Ferreira Aguiar, Alexandre Chieppe, Patrícia Carvalho Sequeira, Nuno Rodrigues Faria, Rivaldo Venâncio Cunha, Luiz Carlos Junior Alcantara, Ana Maria Bispo de Filippis

DOI: 10.1128/JVI.01623-19



The recent re-emergence of yellow fever virus (YFV) in Brazil has raised serious concerns due to the virus’ rapid dissemination in the southeastern region. To better understand YFV genetic diversity and dynamics during the recent outbreak in southeastern Brazil we generated 18 complete and near-complete genomes from the peak of the epidemic curve from non-human primates (NHPs) and human infected cases across Espírito Santo and Rio de Janeiro states. Genomic sequencing of 18 YFV genomes revealed the estimated timing, source and likely routes of yellow fever virus transmission and dispersion during one of the largest outbreaks ever registered in Brazil. We showed that during the recent epidemic YFV was re-introduced from Minas Gerais to Espírito Santo and Rio de Janeiro states multiple times between 2016 to 2019. The analysis of data from portable sequencing could identify the corridor of spread of YFV. These findings reinforce that continued genomic surveillance strategies can provide information on virus genetic diversity and transmission dynamics that might assist in the understanding arbovirus epidemics.



Arbovirus infections in Brazil including yellow fever, dengue, zika and chikungunya result in considerable morbidity and mortality and are pressing public health concerns. However, our understanding of these outbreaks is hampered by limited availability genomic data. In this study, we investigated the genetic diversity and spatial distribution of YFV during the current outbreak by analyzing genomic data from areas in southeastern Brazil not covered by other previous studies. To gain insights into the routes of YFV introduction and dispersion, we tracked the virus by sequencing YFV genomes sampled from non-human primates and infected patients from the southeastern region. Our study provides an understanding of how YFV initiates transmission in new Brazilian regions and illustrates that genomics in field can augment traditional approaches to infectious disease surveillance and control.

Copyright © 2019 American Society for Microbiology. All Rights Reserved.

Keywords: Arbovirus; Yellow fever; Brazil.


Space–time #dynamics of a triple #epidemic: #dengue, #chikungunya and #Zika #clusters in the city of #Rio de Janeiro (Proc Roy Soc B., abstract)

[Source: Proceedings of the Royal Society, Biological Sciences, full page: (LINK). Abstract, edited.]

Space–time dynamics of a triple epidemic: dengue, chikungunya and Zika clusters in the city of Rio de Janeiro

Laís Picinini Freitas, Oswaldo Gonçalves Cruz, Rachel Lowe and Marilia Sá Carvalho

Published: 09 October 2019 / DOI: https://doi.org/10.1098/rspb.2019.1867



Dengue, an arboviral disease transmitted by Aedes mosquitoes, has been endemic in Brazil for decades. However, vector-control strategies have not led to a significant reduction in the disease burden and have not been sufficient to prevent chikungunya and Zika entry and establishment in the country. In Rio de Janeiro city, the first Zika and chikungunya epidemics were detected between 2015 and 2016, coinciding with a dengue epidemic. Understanding the behaviour of these diseases in a triple epidemic scenario is a necessary step for devising better interventions for prevention and outbreak response. We applied scan statistics analysis to detect spatio-temporal clustering for each disease separately and for all three simultaneously. In general, clusters were not detected in the same locations and time periods, possibly owing to competition between viruses for host resources, depletion of susceptible population, different introduction times and change in behaviour of the human population (e.g. intensified vector-control activities in response to increasing cases of a particular arbovirus). Simultaneous clusters of the three diseases usually included neighbourhoods with high population density and low socioeconomic status, particularly in the North region of the city. The use of space–time cluster detection can guide intensive interventions to high-risk locations in a timely manner, to improve clinical diagnosis and management, and pinpoint vector-control measures.

Keywords: Zika Virus; Dengue Fever; Chikungunya fever; Brazil.