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Advances in diagnostic techniques coupled with ongoing environmental changes have resulted in intensified surveillance and monitoring of arbovirus circulation in the Amazon. This increased effort has resulted in increased detection of insect-specific viruses among hematophagous arthropods collected in the field. This study aimed to document the first isolation of Agua Salud alphavirus in mosquitoes collected within the Brazilian Amazon. Arthropods belonging to the family Culicidae were collected within a forest fragment located in the Environmental Protection Area of the metropolitan region of Belem. Subsequently, these specimens were meticulously identified to the species level. Afterward, the collected batches were macerated, and the resulting supernatant was then inoculated into C6/36 and Vero cell cultures to facilitate viral isolation. The presence of arboviruses within the inoculated cell cultures was determined through indirect immunofluorescence analysis. Furthermore, positive supernatant samples underwent nucleotide sequencing to precisely identify the viral strains present. Notably, a batch containing Culex (Melanoconion) mosquitoes was identified to be positive for the genus Alphavirus via indirect immunofluorescence. This study is the first report on insect-specific alphavirus isolation in Brazil and the first-ever description of Agua Salud alphavirus isolation within Amazon Forest remnants.

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In this study, we provide a genomic description of the first isolation of the Umattila virus (UMAV) in Brazil. The virus was obtained from the blood of a bird (Turdus fumigatus) and isolated in a C6/36 cell culture. The viral genome contains ten segments, and its organization is characteristic of viruses of the genus Orbivirus (family Sedoreoviridae). The coding region of each segment was sequenced, demonstrating the nucleotide identity with UMAV. The phylogenetic inference results were in line with these findings and demonstrated the formation of two distinct monophyletic clades containing strains isolated around the world, where our isolate, belonging to the same clade as the prototype strain, was allocated to a different subclade, highlighting the genetic divergence between them. This work reports the first isolation of UMAV in Brazil, and due to the scarcity of information on this viral agent in the scientific literature, it is essential to carry out further studies to better understand its epidemiology, dispersion, and, in particular, its interactions with vertebrate hosts, vectors, and the environment.

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Dengue virus serotype 2 (DENV-2) is responsible for dengue epidemics on a global scale and is associated with severe cases of the disease. This study conducted a phylogenetic investigation of DENV-2 isolates from 2017 to 2021 originating from the northern states of Brazil. A total of 32 samples from DENV-2 isolates were analyzed, including 12 from Acre, 19 from Roraima, and one from Tocantins. Only one lineage of the Asian-American genotype and one lineage of the cosmopolitan genotype were observed: Lineage 1, Asian-American genotype (connection to Puerto Rico); Lineage 5, cosmopolitan genotype (connection to Peru). Our results provide important data regarding the study of DENV genotypes and lineage distribution and open up possibilities for probable introduction and dissemination routes.

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The present study was designed as an exploratory investigation to characterize the overall profile of chemokines, growth factors, and pro-inflammatory/regulatory cytokines during acute DENV infection according to DENV-1, DENV-2, DENV-4 serotypes and age: children: <1-10-year-old (yo); adolescents:11-20 yo; adults 21-40 yo; and older adults: 41-75 yo. The levels of soluble immunemediators were measured in serum by high-throughput microbeads array in 636 subjects including 317 DENV-infected and 319 age-matching non-infected control (NI). Overall, most soluble mediators were increased in DENV-infected patients as compared to NI group regardless of age and DENV serotype, with high magnitude order of increase for CCL2, CXCL10, IL-1ß, IFN-γ, IL1-Ra (fold change >3x), except PDGF in which no fold change was observed. Moreover, despite the age ranges, DENV-1 and DENV-4 presented increased levels of VEGF, IL-6, and TNF-α in serum but decreased levels of PDGF, while DENV-2 exhibited increased levels of CXCL8, CCL4, and IL-12. Noteworthy was that DENV-2 showed increased levels of IL-12, IL-15, IL-17, IL-4, IL-9, and IL-13, and maintained an unaltered levels of PDGF at younger ages (<1-10 yo and 11-20 yo), whereas in older ages (21-40 yo and 41-75 yo), the results showed increased levels of CCL2, IL-6, and TNF-α, but lower levels of PDGF. In general, DENV infection at younger age groups exhibited more complex network immunoclusters as compared to older age groups. Multivariate analysis revealed a clustering of DENV cases according to age for a set of soluble mediators especially in subjects infected with DENV-2 serotype. Altogether, our findings demonstrate that the profile of circulating soluble mediators differs substantially in acute DENV according to age and DENV serotypes suggesting the participation of serotype-associated immune response, which may represent a potential target for development of therapeutics and could be used to assist medical directive for precise clinical management of severe cases.

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BACKGROUND: Pit viper snakebites are challenging as they often cause tissue injury and secondary bacterial infection that may impair full recovery of the affected limb. We describe the evolution of a snakebite injury with secondary infection and the use of specialized dressings to achieve tissue repair and complete closure of the wound. CASE: Ms E., a 45-year-old woman, was bitten by a pit viper that began as a small lesion and progressed to necrosis, cellulitis, edema, and hyperemia of the perilesional skin, local inflammation, and infection. We implemented a combination of topical hydrogel therapy with calcium alginate and hydrofiber with 1.2% silver to promote autolytic debridement, combat local infection, and provide a moist wound environment. The wound required daily local treatment for 2 months due to extensive tissue damage, combined with the proteolytic action of the bothropic venom. CONCLUSION: The care of wounds caused by snakebites is a challenge for the health care team due to tissue loss resulting from the action of the venom and secondary bacterial infection. Close follow-up with the use of systemic antibiotics and topical therapies proved effective in minimizing tissue loss in this case.

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Viruses with encephalitogenic potential can cause neurological conditions of clinical and epidemiological importance, such as Saint Louis encephalitis virus, Venezuelan equine encephalitis virus, Eastern equine encephalitis virus, Western equine encephalitis virus, Dengue virus, Zika virus, Chikungunya virus, Mayaro virus and West Nile virus. The objective of the present study was to determine the number of arboviruses with neuroinvasive potential isolated in Brazil that corresponds to the collection of viral samples belonging to the Department of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute (SAARB/IEC) of the Laboratory Network of National Reference for Arbovirus Diagnosis from 1954 to 2022. In the analyzed period, a total of 1,347 arbovirus samples with encephalitogenic potential were isolated from mice; 5,065 human samples were isolated exclusively by cell culture; and 676 viruses were isolated from mosquitoes. The emergence of new arboviruses may be responsible for diseases still unknown to humans, making the Amazon region a hotspot for infectious diseases due to its fauna and flora species characteristics. The detection of circulating arboviruses with the potential to cause neuroinvasive diseases is constant, which justifies the continuation of active epidemiological surveillance work that offers adequate support to the public health system regarding the virological diagnosis of circulating arboviruses in Brazil.

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BACKGROUND/AIM: This study aimed to evaluate the toxicities and response rate of a modified TPF (docetaxel, cisplatin, and 5-fluorouracil) protocol in patients with locally advanced head and neck cancer (ECOG performance status ≤1). PATIENTS AND METHODS: Induction treatment consisted of cisplatin 25 mg/m2/day as a 90 min infusion for three consecutive days, leucovorin 20 mg/m2/day as a bolus for four consecutive days, 5-fluorouracil (5-FU) 370 mg/m2/day as a bolus for four consecutive days, and paclitaxel 60 mg/m2 as a 1-h infusion on Days 1, 8, and 15, repeated every 3-4 weeks (twelve cycles to 6 patients). RESULTS: The main toxicities were grade 1 neuropathy, mucositis, and fatigue. There were four episodes of severe toxicities (grade ≥3). There was one early death, and 2 patients were discontinued due to hematological toxicity. Other side effects included neutropenia, nausea, diarrhea, and vomiting. CONCLUSION: Induction therapy with cisplatin, 5-fluorouracil, leucovorin, and paclitaxel in head and neck cancer is not feasible because of severe toxicity.

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West Nile virus is a flavivirus transmitted by mosquitoes, mainly of the genus Culex. In Brazil, serological studies have already indicated the circulation of the virus since 2003, with the first human case detected in 2014. The objective of the present paper is to report the first isolation of WNV in a Culex (Melanoconion) mosquito. Arthropods were collected by protected human attraction and CDC light bait, and taxonomically identified and analyzed by viral isolation, complement fixation and genomic sequencing tests. WNV was isolated from samples of Culex (Melanoconion) mosquitoes, and the sequencing analysis demonstrated that the isolated strain belonged to lineage 1a. The finding of the present study presents the first evidence of the isolation and genome sequencing of WNV in arthropods in Brazil.

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Non-human primates contribute to the spread of yellow fever virus (YFV) and the establishment of transmission cycles in endemic areas, such as Brazil. This study aims to investigate virological, histopathological and immunohistochemical findings in livers of squirrel monkeys (Saimiri spp.) infected with the YFV. Viremia occurred 1-30 days post infection (dpi) and the virus showed a predilection for the middle zone (Z2). The livers were jaundiced with subcapsular and hemorrhagic multifocal petechiae. Apoptosis, lytic and coagulative necrosis, steatosis and cellular edema were also observed. The immune response was characterized by the expression of S100, CD11b, CD57, CD4 and CD20; endothelial markers; stress and cell death; pro and anti-inflammatory cytokines, as well as Treg (IL-35) and IL-17 throughout the experimental period. Lesions during the severe phase of the disease were associated with excessive production of apoptotic pro-inflammatory cytokines, such as IFN-γ and TNF-α, released by inflammatory response cells (CD4+ and CD8+ T lymphocytes) and associated with high expression of molecules of adhesion in the inflammatory foci observed in Z2. Immunostaining of the local endothelium in vascular cells and the bile duct was intense, suggesting a fundamental role in liver damage and in the pathogenesis of the disease.

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In 2018, during the surveillance for West Nile virus (WNV) in horses with neurological clinical signs in the state of Espírito Santo (Brazil), 19 animals were investigated, and 52 biological samples were collected for WNV diagnostic. One brain sample was positive for WNV by RT-qPCR and the virus was isolated in C6/36 cell culture and sequenced. We obtained a nearly complete genome of WNV co-infected with Peruvian horse sickness virus (PHSV) in the cell culture. After confirmation of PHSV by next-generation sequencing, a new PHSV RT-qPCR protocol was developed, which was used to detect another horse positive only for PHSV. This assay provides a simple and direct method for easy identification of PHSV from biological samples from horses and may become a useful tool in the epidemiological surveillance of this virus. It is the first case of PHSV in Brazil, and only the third country overall to report, 23 years after the first confirmed notification in Peru. Moreover, it is the first reported co-infection of PHSV and WNV in a horse with neurological signs, confirmed by RT-qPCR.

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The rapid and disorderly urbanization in the Amazon has resulted in the insertion of forest fragments into cities, causing the circulation of arboviruses, which can involve hematophagous arthropods and free-ranging birds in the transmission cycles in urban environments. This study aimed to evaluate the circulation of arboviruses in free-ranging birds and hematophagous arthropods captured in an Environmental Protection Area in the Belem metropolitan area, Brazil. Birds were captured using mist nets, and hematophagous arthropods were collected using a human protected attraction technique and light traps. The birds' sera were subjected to a hemagglutination inhibition test to detect antibodies against 29 arbovirus antigens. Arthropod macerates were inoculated into C6/36 and VERO cell cultures to attempt viral isolation and were tested using indirect immunofluorescence, subsequent genetic sequencing and submitted for phylogenetic analysis. Four bird sera were positive for arbovirus, and one batch of Psorophora ferox was positive for Flavivirus on viral isolation and indirect immunofluorescence. In addition, the Ilheus virus was detected in the sequencing and phylogenetic analysis. The presence of antibodies in sera from free-ranging birds and the isolation of Ilheus virus in Psorophora ferox indicate the circulation of arboviruses in forest remnants in the urban center of Belem.

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A panoramic analysis of chemokines, pro-inflammatory/regulatory cytokines, and growth factors was performed in serum samples from patients with acute DENV infection (n=317) by a high-throughput microbeads array. Most soluble mediators analyzed were increased in DENV patients regardless of the DENV serotype. The substantial increase (≥10-fold) of CXCL10, IL-6, and IFN-γ, and decreased levels of PDGF (<0.4-fold) was universally identified in all DENV serotypes. Of note, increased levels of CXCL8, CCL4, and IL-12 (≥3-9-fold) were selectively observed in DENV2 as compared to DENV1 and DENV4. Heatmap and biomarker signatures further illustrated the massive release of soluble mediators observed in DENV patients, confirming the marked increase of several soluble mediators in DENV2. Integrative correlation matrices and networks showed that DENV infection exhibited higher connectivity among soluble mediators. Of note, DENV2 displayed a more complex network, with higher connectivity involving a higher number of soluble mediators. The timeline kinetics (Day 0-1, D2, D3, D4-6) analysis additionally demonstrated differences among DENV serotypes. While DENV1 triggers a progressive increase of soluble mediators towards D3 and with a decline at D4-6, DENV2 and DENV4 develop with a progressive increase towards D4-6 with an early plateau observed in DENV4. Overall, our results provided a comprehensive overview of the immune response elicited by DENV infection, revealing that infection with distinct DENV serotypes causes distinct profiles, rhythms, and dynamic network connectivity of soluble mediators. Altogether, these findings may provide novel insights to understand the pathogenesis of acute infection with distinct DENV serotypes.

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Chikungunya virus (CHIKV) was first reported in Brazil in 2014 and, after it spread countrywide, an outbreak of febrile illness with reports of arthralgia happened in the municipality of Xinguara, Pará, Brazil in 2017, indicating the virus' circulation. Here, we aimed to investigate CHIKV in mosquito vectors collected during an active surveillance of virus isolation in cell culture by using molecular detection and viral genome sequencing. A total of 492 Aedes, Culex and Mansonia mosquitoes were collected and separated in 36 pools according to the species and sex, and 22.2% (8/36) were positive. CHIKV was indentified in pools of Ae. aegypti females (n = 5), an Ae. aegypti male (n = 1) and in Culex quinquefasciatus females (n = 2). However, as the mosquitoes' whole bodies were macerated and used for detection, one cannot suggest the role of the latter in the viral transmission. Despite this, vector competence studies must be carried out in the different species to investigate long-term adaptations. Viral genome sequencing has characterized the East-Central-South-African (ECSA) genotype in all positive pools analyzed, corroborating previous reports for the Amazon region.

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Abstract Objectives To investigate the 5-year prevalence of patients admitted to public inpatient care units due to a mental disorder, stratifying them by age group and diagnosis, and to assess trends of admissions over this time period in Porto Alegre. Methods All admissions to the public mental health care system regulated by the city-owned electronic system Administração Geral dos Hospitais (AGHOS) were included in the analysis. The total population size was obtained by estimations of Fundação de Economia e Estatística (FEE). General information about 5-year prevalence of inpatient admissions, time-series trends e prevalence by age groups and diagnosis were presented. Results There were 32,608 admissions over the 5-year period analyzed. The overall prevalence of patients was 1.62% among the total population, 0.01% among children, 1.12% among adolescents, 2.28% among adults and 0.93% among the elderly. The most common diagnosis was drug-related, followed by mood, alcohol-related and psychotic disorders. There was a linear trend showing an increase in the number of admissions from 2013 to the midst of 2014, which dropped in 2015. Conclusions Admissions due to mental disorders are relatively common, mainly among adults and related to drug use and mood disorders. Time trends varied slightly over the 5 years. Prevalence rates in real-world settings might be useful for policymakers interested in planning the public mental health system in large Brazilian cities.

Resumo Objetivos Investigar a prevalência de 5 anos de pacientes internados no sistema público de saúde por motivo de saúde mental, estratificando-os por grupo etário e diagnóstico, e avaliar tendências temporais nas admissões nesse período em Porto Alegre. Métodos Todas as admissões no sistema público de saúde mental reguladas pelo sistema eletrônico da cidade, denominado Administração Geral dos Hospitais (AGHOS), foram incluídos na análise. A população total foi obtida a partir de estimativas da Fundação de Economia e Estatística (FEE). Informações gerais sobre a prevalência de 5 anos de admissões, tendências das séries temporais e prevalência por grupo etário e por diagnóstico foram apresentadas. Resultados Ocorreram 32.608 admissões no período de 5 anos analisado. A prevalência global de pacientes foi de 1,62% na população total, 0,01% em crianças, 1,12% em adolescentes, 2,28% em adultos e 0,93% em idosos. Os diagnósticos mais comuns foram relacionados ao uso de drogas, seguidos de transtornos de humor, relacionados ao álcool e transtornos psicóticos. Houve uma tendência linear mostrando um aumento no número de admissões de 2013 a meados de 2014, que caíram em 2015. Conclusões Admissões por transtornos mentais são relativamente comuns, principalmente entre adultos e relacionados ao uso de drogas e transtornos de humor. Tendências lineares variaram levemente nos últimos 5 anos. Estimativas de prevalência no mundo real podem ser úteis para formuladores de políticas interessados em planejar o sistema público de saúde mental em grandes cidades brasileiras.

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OBJECTIVES: To investigate the 5-year prevalence of patients admitted to public inpatient care units due to a mental disorder, stratifying them by age group and diagnosis, and to assess trends of admissions over this time period in Porto Alegre. METHODS: All admissions to the public mental health care system regulated by the city-owned electronic system Administração Geral dos Hospitais (AGHOS) were included in the analysis. The total population size was obtained by estimations of Fundação de Economia e Estatística (FEE). General information about 5-year prevalence of inpatient admissions, time-series trends e prevalence by age groups and diagnosis were presented. RESULTS: There were 32,608 admissions over the 5-year period analyzed. The overall prevalence of patients was 1.62% among the total population, 0.01% among children, 1.12% among adolescents, 2.28% among adults and 0.93% among the elderly. The most common diagnosis was drug-related, followed by mood, alcohol-related and psychotic disorders. There was a linear trend showing an increase in the number of admissions from 2013 to the midst of 2014, which dropped in 2015. CONCLUSIONS: Admissions due to mental disorders are relatively common, mainly among adults and related to drug use and mood disorders. Time trends varied slightly over the 5 years. Prevalence rates in real-world settings might be useful for policymakers interested in planning the public mental health system in large Brazilian cities.

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Biodigested coffee processing wastewater (CPW) presents a high organic load and does not meet the limits imposed by legislation (namely in Brazil) for discharge into water bodies. Anaerobic digestion generally cannot provide a satisfactory organic matter reduction in CPW as a significant fraction of recalcitrant compounds still persists in the treated effluent. So, this study aims to find alternative ways to remove refractory organic compounds from this wastewater in order to improve the biodegradability and reduce the toxicity, which will allow its recirculation back into the anaerobic digester. Three treatment approaches (Fenton's oxidation - Approach 1, Coagulation/flocculation (C/F) - Approach 2, and the combination of C/F with Fenton's process - Approach 3) were selected to be applied to the biodigested CPW in order to achieve that objective. The application of the Fenton process under the optimal operating conditions (initial pH = 5.0; T = 55 °C, [Fe3+] = 1.8 g L-1 and [H2O2] = 9.0 g L-1) increased the biodegradability (the BOD5:COD ratio raised from 0.34 ± 0.02 in biodigested CPW to 0.44 ± 0.01 after treatment) and eliminated the toxicity (0.0% of Vibrio fischeri inhibition) along with moderate removals of organic matter (51.3%, 55.7% and 39.7% for total organic carbon - TOC, chemical oxygen demand - COD and biochemical oxygen demand - BOD5, respectively). The implementation of a coagulation/flocculation process upstream from Fenton's oxidation, under the best operating conditions (pH 10-11 and [Fe3+] = 250 mg L-1), also allowed to slightly increase the biodegradability (from 0.34 to 0.47) and reduce the toxicity, whereas providing a higher removal of organic matter (TOC = 76.2%, COD = 76.5 and BOD5 = 66.3% for both processes together). Approach 1 and Approach 3 showed to be the best ones, implying similar operating costs (∼74 R$ m-3/∼17 € m-3) and constitute an attractive option for managing biodigested CPW.

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The simultaneous circulation of Dengue virus (DENV), Chikungunya virus (CHIKV) and Zika virus (ZIKV) arboviruses have placed Brazil among the main worldwide endemic areas. Brazilian Northeast region concentrates the highest incidence of infections caused by CHIKV and ZIKV. In Maranhão, the second biggest northeastern state, there are cases of human infections caused by these three arboviruses and presence of Aedes aegypti and Aedes albopictus vectors. In this context, this study aimed to investigate the circulation of CHIKV, DENV and ZIKV in Ae. aegypti and Ae. albopictus mosquitoes collected in urban areas of Barra do Corda, Caxias, Codó, São Luís and São Mateus do Maranhão municipalities in the state of Maranhão through Quantitative Reverse Transcription Polymerase Chain Reaction (RT-qPCR) technique. 428 Ae. aegypti and 1 Ae. albopictus were collected, which formed 44 pools. Three of these showed positive results for CHIKV: AR832767 (five Ae. aegypti female collected in Caxias), AR832784 and AR832785 (both composed of 20 Ae. aegypti female collected in São Mateus do Maranhão). This study consolidates information about CHIKV circulation in state of Maranhão, as well as the role of Ae. aegypti in the transmission of CHIKV in urban area.

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Zika virus (ZIKV) has recently caused a pandemic disease, and many cases of ZIKV infection in pregnant women resulted in abortion, stillbirth, deaths and congenital defects including microcephaly, which now has been proposed as ZIKV congenital syndrome. This study aimed to investigate the in situ immune response profile and mechanisms of neuronal cell damage in fatal Zika microcephaly cases. Brain tissue samples were collected from 15 cases, including 10 microcephalic ZIKV-positive neonates with fatal outcome and five neonatal control flavivirus-negative neonates that died due to other causes, but with preserved central nervous system (CNS) architecture. In microcephaly cases, the histopathological features of the tissue samples were characterized in three CNS areas (meninges, perivascular space, and parenchyma). The changes found were mainly calcification, necrosis, neuronophagy, gliosis, microglial nodules, and inflammatory infiltration of mononuclear cells. The in situ immune response against ZIKV in the CNS of newborns is complex. Despite the predominant expression of Th2 cytokines, other cytokines such as Th1, Th17, Treg, Th9, and Th22 are involved to a lesser extent, but are still likely to participate in the immunopathogenic mechanisms of neural disease in fatal cases of microcephaly caused by ZIKV.

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Objetivo: Traçar o perfil transfusional da primeira centena de pacientes submetidos a transplante hepático em um hospital escola, em Fortaleza, Ceará. Método: Trata-se de um estudo observacional, analítico e retrospectivo. Resultados: Dentre os cem pacientes inicialmente incluídos no estudo, houve dez retransplantes. Um paciente foi excluído do estudo por impossibilidade de acesso ao prontuário. Por esses motivos, 89 prontuários foram analisados. Conclusão: Os pacientes, em sua maioria, eram adultos com idade média de 47 anos, do gênero masculino e com grande prevalência de cirurgias abdominais prévias. O grupo sanguíneo mais prevalente foi o grupo A, e a principal causa do transplante, a cirrose por álcool. Em média, os pacientes receberam seis unidades de hemocomponentes, sendo o concentrado de hemácias o mais frequentemente transfundido.

Objective: To identify the profile of the first hundred transfusion patients undergoing liver transplantation at a university hospital in Fortaleza, Ceará. Method: An observational, analytical, and retrospective study was performed. Results: There were 10 retransplantations among the 100 patients initially enrolled in the study. One patient was excluded from the study owing to the inability to access the medical records. For this reason, 89 medical records were analyzed. Conclusion: Most patients were male adults with an average age of 47 years, and a high prevalence of previous abdominal surgeries were observed among them. The most common blood group was group A, and the leading cause of transplantation was cirrhosis induced by alcohol. On average, patients received 6 units of blood components, and the most frequently transfused were packed red blood cells.

Objetivo: Trazar el perfil de transfusión de los cien primeros pacientes sometidos a trasplante de hígado en un hospital universitario en Fortaleza, Ceará, Brasil. Método: Se realizó un estudio de observación, analítico y retrospectivo. Resultados: Entre los 100 pacientes incluidos inicialmente en el estudio, hubo 10 re-trasplantes. Se excluyó un paciente del estudio porque no había acceso a sus registros médicos. Por estas razones, se analizaron 89 registros médicos. Conclusión: La mayoría de los pacientes eran adultos con una edad promedio de 47 años, sexo masculino y con un alto predominio de cirugías abdominales previas. El grupo sanguíneo más frecuente fue el grupo A y la principal causa del trasplante fue la cirrosis inducida por alcohol. En promedio, los pacientes recibieron seis unidades de componentes sanguíneos, siendo el concentrado de glóbulos rojos el más frecuentemente transfundido.

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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. We performed next-generation sequencing to generate 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. Results of phylogenetic and molecular clock analyses show a single introduction of ZIKV into the Americas, which we estimated to have occurred between May and December 2013, more than 12 months before the detection of ZIKV in Brazil. The estimated date of origin coincides with an increase in air passengers to Brazil from ZIKV-endemic areas, as well as with reported outbreaks in the 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 correlation 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 of this emerging virus in the Americas.

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