Nicholas J Arisco, Pablo S Fontoura, Cassio Peterka, Marcia C Castro
{"title":"Mobility hinders malaria elimination goals in the Brazilian Amazon.","authors":"Nicholas J Arisco, Pablo S Fontoura, Cassio Peterka, Marcia C Castro","doi":"10.1371/journal.pcbi.1014843","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Human mobility across the Brazilian Amazon-shaped by frontier development, land-use change, mining activity, and climatic shocks-remains a major barrier to malaria elimination. Brazil aims to eliminate Plasmodium falciparum (Pf) by 2030 and Plasmodium vivax (Pv) by 2035, yet malaria incidence has plateaued since 2020. We quantify parasite-specific mobility and assess how importations drive malaria reintroduction and reestablishment in areas approaching elimination.</p><p><strong>Methods: </strong>We analyzed 5,521,411 de-identified malaria cases from Sivep-Malaria (2003-2023) across 808 municipalities in the nine-state Brazilian Amazon. We (i) used multivariable monthly sequence analysis to classify \"Municipal Malaria Importation Trajectories\" (MMITs) using local/imported composition, incidence per 1,000, and source/sink network typologies; (ii) characterized mobility networks by parasite species and locality type (rural, urban, settlement, indigenous, mining); and (iii) developed a parasite-specific rule-based classification procedure to identify reintroduction, and defined reestablishment as sustained local transmission.</p><p><strong>Results: </strong>Sequence analysis produced five MMIT clusters, spanning municipalities nearing elimination to areas with sustained high local transmission and distinct profiles of declining transmission with intense vs. moderate importation. Overall, 959,281 cases (17.38%) were imported. Cases were predominantly Pv (81.68%), with Pf comprising 17.15%; Pf was more common among imported than locally acquired infections. Mobility patterns shifted after mid-2020: by 2023, > 50% of exported cases originated in mining localities despite ~0.2% land coverage, with Pf importation increasingly concentrated in municipalities overlapping the Yanomami Indigenous Land. From 2006-2023, we identified 63 Pf and 221 Pv reintroduced locally acquired cases following ≥3 years of zero local transmission, leading to reestablishment in 6 and 23 municipalities, respectively, and generating 864 subsequent Pf and 6,524 subsequent Pv cases. Post-reintroduction transmission persisted for long periods (mean 762 days for Pf; 815 days for Pv).</p><p><strong>Conclusion: </strong>Malaria elimination in Brazil is increasingly hindered by parasite-specific mobility, especially linked to mining-indigenous confluences, and by repeated reintroduction in receptive municipalities nearing elimination (notably along the arc of deforestation). Mobility-informed surveillance and targeted reactive strategies are essential to achieve and sustain Brazil's malaria elimination goals.</p>","PeriodicalId":20241,"journal":{"name":"PLoS Computational Biology","volume":"22 10","pages":"e1014843"},"PeriodicalIF":3.6000,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641346/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"PLoS Computational Biology","FirstCategoryId":"99","ListUrlMain":"https://doi.org/10.1371/journal.pcbi.1014843","RegionNum":2,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/10/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"BIOCHEMICAL RESEARCH METHODS","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Human mobility across the Brazilian Amazon-shaped by frontier development, land-use change, mining activity, and climatic shocks-remains a major barrier to malaria elimination. Brazil aims to eliminate Plasmodium falciparum (Pf) by 2030 and Plasmodium vivax (Pv) by 2035, yet malaria incidence has plateaued since 2020. We quantify parasite-specific mobility and assess how importations drive malaria reintroduction and reestablishment in areas approaching elimination.
Methods: We analyzed 5,521,411 de-identified malaria cases from Sivep-Malaria (2003-2023) across 808 municipalities in the nine-state Brazilian Amazon. We (i) used multivariable monthly sequence analysis to classify "Municipal Malaria Importation Trajectories" (MMITs) using local/imported composition, incidence per 1,000, and source/sink network typologies; (ii) characterized mobility networks by parasite species and locality type (rural, urban, settlement, indigenous, mining); and (iii) developed a parasite-specific rule-based classification procedure to identify reintroduction, and defined reestablishment as sustained local transmission.
Results: Sequence analysis produced five MMIT clusters, spanning municipalities nearing elimination to areas with sustained high local transmission and distinct profiles of declining transmission with intense vs. moderate importation. Overall, 959,281 cases (17.38%) were imported. Cases were predominantly Pv (81.68%), with Pf comprising 17.15%; Pf was more common among imported than locally acquired infections. Mobility patterns shifted after mid-2020: by 2023, > 50% of exported cases originated in mining localities despite ~0.2% land coverage, with Pf importation increasingly concentrated in municipalities overlapping the Yanomami Indigenous Land. From 2006-2023, we identified 63 Pf and 221 Pv reintroduced locally acquired cases following ≥3 years of zero local transmission, leading to reestablishment in 6 and 23 municipalities, respectively, and generating 864 subsequent Pf and 6,524 subsequent Pv cases. Post-reintroduction transmission persisted for long periods (mean 762 days for Pf; 815 days for Pv).
Conclusion: Malaria elimination in Brazil is increasingly hindered by parasite-specific mobility, especially linked to mining-indigenous confluences, and by repeated reintroduction in receptive municipalities nearing elimination (notably along the arc of deforestation). Mobility-informed surveillance and targeted reactive strategies are essential to achieve and sustain Brazil's malaria elimination goals.
期刊介绍：
PLOS Computational Biology features works of exceptional significance that further our understanding of living systems at all scales—from molecules and cells, to patient populations and ecosystems—through the application of computational methods. Readers include life and computational scientists, who can take the important findings presented here to the next level of discovery.
Research articles must be declared as belonging to a relevant section. More information about the sections can be found in the submission guidelines.
Research articles should model aspects of biological systems, demonstrate both methodological and scientific novelty, and provide profound new biological insights.
Generally, reliability and significance of biological discovery through computation should be validated and enriched by experimental studies. Inclusion of experimental validation is not required for publication, but should be referenced where possible. Inclusion of experimental validation of a modest biological discovery through computation does not render a manuscript suitable for PLOS Computational Biology.
Research articles specifically designated as Methods papers should describe outstanding methods of exceptional importance that have been shown, or have the promise to provide new biological insights. The method must already be widely adopted, or have the promise of wide adoption by a broad community of users. Enhancements to existing published methods will only be considered if those enhancements bring exceptional new capabilities.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
