%PDF-1.3 1 0 obj << /Type /Catalog /Outlines 2 0 R /Pages 3 0 R >> endobj 2 0 obj << /Type /Outlines /Count 0 >> endobj 3 0 obj << /Type /Pages /Kids [6 0 R 177 0 R 222 0 R 356 0 R 358 0 R ] /Count 5 /Resources << /ProcSet 4 0 R /Font << /F1 8 0 R /F2 9 0 R /F3 10 0 R /F4 11 0 R /F5 12 0 R >> /XObject << /I1 13 0 R /I2 14 0 R /I3 193 0 R >> >> /MediaBox [0.000 0.000 612.000 792.000] >> endobj 4 0 obj [/PDF /Text /ImageC ] endobj 5 0 obj << /Creator (DOMPDF) /CreationDate (D:20180723051901+00'00') /ModDate (D:20180723051901+00'00') /Title (Epidemiology of Chikungunya Virus in Bahia, Brazil, 2014-2015 PLOS Currents Outbreaks) >> endobj 6 0 obj << /Type /Page /Parent 3 0 R /Annots [ 15 0 R 17 0 R 19 0 R 21 0 R 23 0 R 25 0 R 27 0 R 29 0 R 31 0 R 33 0 R 35 0 R 37 0 R 39 0 R 41 0 R 43 0 R 45 0 R 47 0 R 49 0 R 51 0 R 53 0 R 55 0 R 57 0 R 59 0 R 61 0 R 63 0 R 65 0 R 67 0 R 69 0 R 71 0 R 73 0 R 75 0 R 77 0 R 79 0 R 81 0 R 83 0 R 85 0 R 87 0 R 89 0 R 91 0 R 93 0 R 95 0 R 97 0 R 99 0 R 101 0 R 103 0 R 105 0 R 107 0 R 109 0 R 111 0 R 113 0 R 115 0 R 117 0 R 119 0 R 121 0 R 123 0 R 125 0 R 127 0 R 129 0 R 131 0 R 133 0 R 135 0 R 137 0 R 139 0 R 141 0 R 143 0 R 145 0 R 147 0 R 149 0 R 151 0 R 153 0 R 155 0 R 157 0 R 159 0 R 161 0 R 163 0 R 165 0 R 167 0 R 169 0 R 171 0 R 173 0 R 175 0 R ] /Contents 7 0 R >> endobj 7 0 obj << /Length 34406 >> stream q 375.000 0 0 39.000 222.000 738.000 cm /I2 Do Q q 15.000 709.302 577.500 28.698 re W n 0.267 0.267 0.267 rg BT 15.000 718.042 Td /F2 21.0 Tf [(Epidemiology of Chikungunya Virus in Bahia, Brazil, 2014-2015)] TJ ET Q 0.271 0.267 0.267 rg BT 15.000 700.036 Td /F3 9.8 Tf [(February 1, 2016)] TJ ET BT 88.388 700.036 Td /F3 9.8 Tf [()] TJ ET 0.267 0.267 0.267 rg BT 93.263 700.036 Td /F3 9.8 Tf [(Discussion)] TJ ET BT 26.250 688.195 Td /F1 9.8 Tf [(Nuno Rodrigues Faria)] TJ ET 0.271 0.267 0.267 rg BT 121.615 688.195 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 127.036 688.195 Td /F1 9.8 Tf [(Jos Loureno)] TJ ET 0.271 0.267 0.267 rg BT 190.986 688.195 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 196.407 688.195 Td /F1 9.8 Tf [(Erenilde Marques de Cerqueira)] TJ ET 0.271 0.267 0.267 rg BT 331.873 688.195 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 337.294 688.195 Td /F1 9.8 Tf [(Mariclia Maia de Lima)] TJ ET 0.271 0.267 0.267 rg BT 437.524 688.195 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 442.945 688.195 Td /F1 9.8 Tf [(Oliver Pybus)] TJ ET 0.271 0.267 0.267 rg BT 498.208 688.195 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 503.629 688.195 Td /F1 9.8 Tf [(Luiz Carlos )] TJ ET BT 26.250 676.290 Td /F1 9.8 Tf [(Junior Alcantara)] TJ ET 0.271 0.267 0.267 rg BT 26.250 664.386 Td /F1 9.8 Tf [(Rodrigues Faria N, Loureno J, Marques de Cerqueira E, Maia de Lima M, Pybus O, Carlos Junior Alcantara L. Epidemiology )] TJ ET BT 569.744 664.386 Td /F1 9.8 Tf [(of )] TJ ET BT 26.250 652.481 Td /F1 9.8 Tf [(Chikungunya Virus in Bahia, Brazil, 2014-2015. PLOS Currents Outbreaks. 2016 Feb 1 . Edition 1. doi: )] TJ ET BT 26.250 640.576 Td /F1 9.8 Tf [(10.1371/currents.outbreaks.c97507e3e48efb946401755d468c28b2.)] TJ ET q 15.000 23.644 577.500 614.551 re W n 0.271 0.267 0.267 rg BT 26.250 611.474 Td /F4 12.0 Tf [(Abstract)] TJ ET BT 26.250 591.519 Td /F1 9.8 Tf [(Chikungunya is an emerging arbovirus that is characterized into four lineages. One of these, the Asian genotype, has spread )] TJ ET BT 26.250 579.615 Td /F1 9.8 Tf [(rapidly in the Americas after its introduction in the Saint Martin island in October 2013. Unexpectedly, a new lineage, the East-)] TJ ET BT 26.250 567.710 Td /F1 9.8 Tf [(Central-South African genotype, was introduced from Angola in the end of May 2014 in Feira de Santana \(FSA\), the second )] TJ ET BT 26.250 555.805 Td /F1 9.8 Tf [(largest city in Bahia state, Brazil, where over 5,500 cases have now been reported. Number weekly cases of clinically confirmed )] TJ ET BT 26.250 543.900 Td /F1 9.8 Tf [(CHIKV in FSA were analysed alongside with urban district of residence of CHIKV cases reported between June 2014 and )] TJ ET BT 26.250 531.996 Td /F1 9.8 Tf [(October collected from the municipalitys surveillance network. The number of cases per week from June 2014 until September )] TJ ET BT 26.250 520.091 Td /F1 9.8 Tf [(2015 reveals two distinct transmission waves. The first wave ignited in June and transmission ceased by December 2014. )] TJ ET BT 26.250 508.186 Td /F1 9.8 Tf [(However, a second transmission wave started in January and peaked in May 2015, 8 months after the first wave peak, and this )] TJ ET BT 26.250 496.281 Td /F1 9.8 Tf [(time in phase with Dengue virus and Zika virus transmission, which ceased when minimum temperature dropped to )] TJ ET BT 26.250 484.377 Td /F1 9.8 Tf [(approximately 15C. We find that shorter travelling times from the district where the outbreak first emerged to other urban )] TJ ET BT 26.250 472.472 Td /F1 9.8 Tf [(districts of FSA were strongly associated with incidence in each district in 2014 \(R)] TJ ET BT 378.459 476.360 Td /F1 8.7 Tf [(2)] TJ ET BT 383.278 472.472 Td /F1 9.8 Tf [(\).)] TJ ET BT 26.250 435.869 Td /F4 12.0 Tf [(Funding Statement)] TJ ET BT 26.250 415.915 Td /F1 9.8 Tf [(This work was funded by the Universal/CNPq grant. \(457480/2014-9\) and the European Research Council under the European )] TJ ET BT 26.250 404.010 Td /F1 9.8 Tf [(Unions Seventh Framework Programme \(FP7/2007-2013\)/ERC grant agreement no. 614725-PATHPHYLODYN.)] TJ ET BT 26.250 374.908 Td /F4 12.0 Tf [(Article)] TJ ET BT 26.250 354.954 Td /F1 9.8 Tf [(The Chikungunya virus \(CHIKV\) is an alphavirus that belongs to the Semliki Forest Virus antigenic complex)] TJ ET 0.267 0.267 0.267 rg BT 488.459 356.461 Td /F4 8.7 Tf [(1)] TJ ET 0.271 0.267 0.267 rg BT 493.277 354.954 Td /F1 9.8 Tf [(. Local outbreaks of )] TJ ET BT 26.250 343.049 Td /F1 9.8 Tf [(CHIKV-like disease have been documented since the eighteenth century)] TJ ET 0.267 0.267 0.267 rg BT 339.488 344.556 Td /F4 8.7 Tf [(2)] TJ ET 0.271 0.267 0.267 rg BT 344.307 343.049 Td /F1 9.8 Tf [( and the virus was discovered in 1952 in Tanzania)] TJ ET 0.267 0.267 0.267 rg BT 560.533 344.556 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 565.351 343.049 Td /F1 9.8 Tf [( . )] TJ ET BT 26.250 331.144 Td /F1 9.8 Tf [(Over the last 50 years, CHIKV has spread beyond its African heartlands and caused explosive outbreaks comprising millions of )] TJ ET BT 26.250 319.239 Td /F1 9.8 Tf [(cases in Indian Ocean islands and Asia.)] TJ ET 0.267 0.267 0.267 rg BT 199.127 320.747 Td /F4 8.7 Tf [(4)] TJ ET 0.271 0.267 0.267 rg BT 203.946 319.239 Td /F1 9.8 Tf [(The virus is mosquito-borne and transmission is associated with the vector species )] TJ ET BT 26.250 307.335 Td /F5 9.8 Tf [(Aedes albopictus)] TJ ET BT 100.496 307.335 Td /F1 9.8 Tf [( and )] TJ ET BT 122.180 307.335 Td /F5 9.8 Tf [(Ae. aegypti)] TJ ET BT 170.959 307.335 Td /F1 9.8 Tf [(, which are responsible for transmission cycles in urban and peri-urban environments)] TJ ET 0.267 0.267 0.267 rg BT 537.257 308.842 Td /F4 8.7 Tf [(5)] TJ ET 0.271 0.267 0.267 rg BT 542.076 307.335 Td /F1 9.8 Tf [(. )] TJ ET BT 26.250 295.430 Td /F1 9.8 Tf [(Clinical symptoms include polyarthralgia, rash, high fever and severe headaches)] TJ ET 0.267 0.267 0.267 rg BT 373.594 296.937 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 378.412 295.430 Td /F1 9.8 Tf [( and outbreaks are often characterized by a )] TJ ET BT 26.250 283.525 Td /F1 9.8 Tf [(rapid spread and high morbidity, resulting in losses in productivity)] TJ ET 0.267 0.267 0.267 rg BT 308.025 285.032 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 312.844 283.525 Td /F1 9.8 Tf [(. To date, four distinct CHIKV genotypes have been )] TJ ET BT 26.250 271.620 Td /F1 9.8 Tf [(identified. Two genotypes the East-Central-South African \(ECSA\) and the West African genotypes occupy a basal position )] TJ ET BT 26.250 259.716 Td /F1 9.8 Tf [(in the phylogeny of CHIKV)] TJ ET 0.267 0.267 0.267 rg BT 140.598 261.223 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 145.417 259.716 Td /F1 9.8 Tf [( and are mostly enzootic in Africa. Of the remaining two genotypes, the Asian genotype is )] TJ ET BT 26.250 247.811 Td /F1 9.8 Tf [(predominant in Southeast Asia, whilst the more recent Indian Ocean lineage spread from the Comoros islands in 2004 and )] TJ ET BT 26.250 235.906 Td /F1 9.8 Tf [(caused a large outbreak in India and Southeast Asia in 2005-2008.)] TJ ET BT 26.250 216.501 Td /F1 9.8 Tf [(In October 2013, the Asian genotype was first reported in the Americas, in the island of Saint Martin in the Caribbean)] TJ ET 0.267 0.267 0.267 rg BT 529.701 218.009 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 534.520 216.501 Td /F1 9.8 Tf [(. By the )] TJ ET BT 26.250 204.597 Td /F1 9.8 Tf [(end of December 2015, nearly 1 million cases had been notified in the Americas, resulting in 71 deaths, and autochthonous )] TJ ET BT 26.250 192.692 Td /F1 9.8 Tf [(transmission has been reported in more than 50 territories)] TJ ET 0.267 0.267 0.267 rg BT 276.601 194.199 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 286.238 192.692 Td /F1 9.8 Tf [(. In September 2014 the Brazilian Ministry of Health confirmed )] TJ ET BT 26.250 180.787 Td /F1 9.8 Tf [(autochthonous transmission of CHIKV in the Amap federal state, which borders French Guiana in northern Brazil, and in Feira )] TJ ET BT 26.250 168.882 Td /F1 9.8 Tf [(de Santana \(FSA\), a well-connected municipality and the second largest city \(617,528 inhabitants in 2015, www.ibge.gov.br\) of )] TJ ET BT 26.250 156.978 Td /F1 9.8 Tf [(Bahia federal state \(BA, northeast of Brazil, where both )] TJ ET BT 266.870 156.978 Td /F5 9.8 Tf [(Aedes)] TJ ET BT 294.512 156.978 Td /F1 9.8 Tf [( vectors circulate)] TJ ET 0.267 0.267 0.267 rg BT 367.656 158.485 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 377.293 156.978 Td /F1 9.8 Tf [(. Genome sequencing revealed that the Asian )] TJ ET BT 26.250 145.073 Td /F1 9.8 Tf [(genotype was circulating in the north of the country. However, 3 genomes sampled from FSA revealed that a distinct lineage, )] TJ ET BT 26.250 133.168 Td /F1 9.8 Tf [(the ECSA genotype, had entered the Americas for the first time)] TJ ET 0.267 0.267 0.267 rg BT 298.841 134.675 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 308.478 133.168 Td /F1 9.8 Tf [(. The ECSA genotype in FSA is closely related to CHIKV )] TJ ET BT 26.250 121.263 Td /F1 9.8 Tf [(strains circulating in Angola. Despite sparse data on CHIKV in Angola, there are recent reports of CHIKV cases exported from )] TJ ET BT 26.250 109.359 Td /F1 9.8 Tf [(Angola to other locations)] TJ ET 0.267 0.267 0.267 rg BT 133.558 110.866 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 143.196 109.359 Td /F1 9.8 Tf [(. Angola is climatically suitable for )] TJ ET BT 291.659 109.359 Td /F5 9.8 Tf [(Aedes)] TJ ET BT 319.300 109.359 Td /F1 9.8 Tf [( spp. mosquitoes)] TJ ET 0.267 0.267 0.267 rg BT 393.001 110.866 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 402.638 113.247 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 405.047 110.866 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 414.685 109.359 Td /F1 9.8 Tf [( and CHIKV was previously isolated )] TJ ET BT 26.250 97.454 Td /F1 9.8 Tf [(from )] TJ ET BT 48.460 97.454 Td /F5 9.8 Tf [(Aedes aegypti)] TJ ET BT 110.246 97.454 Td /F1 9.8 Tf [( in Luanda)] TJ ET 0.267 0.267 0.267 rg BT 155.779 98.961 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 165.416 97.454 Td /F1 9.8 Tf [(. As a result of the two independent introductions of distinct CHIKV genotypes into Brazil, )] TJ ET BT 26.250 85.549 Td /F1 9.8 Tf [(epidemiological analysis suggests that ~94% of the Brazilian population is at risk of CHIKV infection)] TJ ET 0.267 0.267 0.267 rg BT 455.708 87.056 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 465.346 85.549 Td /F1 9.8 Tf [(. In 2015, the Brazilian )] TJ ET BT 26.250 73.644 Td /F1 9.8 Tf [(Ministry of Health has notified a total of 20,661 CHIKV suspected cases 7,823 \(38%\) of these have been confirmed with )] TJ ET BT 26.250 61.740 Td /F1 9.8 Tf [(clinical \(35%\) and laboratory \(3%\) confirmation)] TJ ET 0.267 0.267 0.267 rg BT 228.348 63.247 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 237.985 61.740 Td /F1 9.8 Tf [( across 84 cities in Brazil of which Feira de Santana has notified by far the )] TJ ET BT 26.250 49.835 Td /F1 9.8 Tf [(greatest number of cases \(4,088 only in 2015\). It is likely that these numbers represent only a fraction of the individuals infected )] TJ ET BT 26.250 37.930 Td /F1 9.8 Tf [(because CHIKV cases based on clinical diagnosis may be mistaken for dengue virus \(DENV\) or Zika virus \(ZIKV\) infection. )] TJ ET Q q 15.000 709.302 577.500 28.698 re W n 0.267 0.267 0.267 rg BT 15.000 718.042 Td /F2 21.0 Tf [(Epidemiology of Chikungunya Virus in Bahia, Brazil, 2014-2015)] TJ ET Q 0.271 0.267 0.267 rg BT 15.000 700.036 Td /F3 9.8 Tf [(February 1, 2016)] TJ ET BT 88.388 700.036 Td /F3 9.8 Tf [()] TJ ET 0.267 0.267 0.267 rg BT 93.263 700.036 Td /F3 9.8 Tf [(Discussion)] TJ ET BT 26.250 688.195 Td /F1 9.8 Tf [(Nuno Rodrigues Faria)] TJ ET 0.271 0.267 0.267 rg BT 121.615 688.195 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 127.036 688.195 Td /F1 9.8 Tf [(Jos Loureno)] TJ ET 0.271 0.267 0.267 rg BT 190.986 688.195 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 196.407 688.195 Td /F1 9.8 Tf [(Erenilde Marques de Cerqueira)] TJ ET 0.271 0.267 0.267 rg BT 331.873 688.195 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 337.294 688.195 Td /F1 9.8 Tf [(Mariclia Maia de Lima)] TJ ET 0.271 0.267 0.267 rg BT 437.524 688.195 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 442.945 688.195 Td /F1 9.8 Tf [(Oliver Pybus)] TJ ET 0.271 0.267 0.267 rg BT 498.208 688.195 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 503.629 688.195 Td /F1 9.8 Tf [(Luiz Carlos )] TJ ET BT 26.250 676.290 Td /F1 9.8 Tf [(Junior Alcantara)] TJ ET 0.271 0.267 0.267 rg BT 26.250 664.386 Td /F1 9.8 Tf [(Rodrigues Faria N, Loureno J, Marques de Cerqueira E, Maia de Lima M, Pybus O, Carlos Junior Alcantara L. Epidemiology )] TJ ET BT 569.744 664.386 Td /F1 9.8 Tf [(of )] TJ ET BT 26.250 652.481 Td /F1 9.8 Tf [(Chikungunya Virus in Bahia, Brazil, 2014-2015. PLOS Currents Outbreaks. 2016 Feb 1 . Edition 1. doi: )] TJ ET BT 26.250 640.576 Td /F1 9.8 Tf [(10.1371/currents.outbreaks.c97507e3e48efb946401755d468c28b2.)] TJ ET q 15.000 23.644 577.500 614.551 re W n 0.271 0.267 0.267 rg BT 26.250 611.474 Td /F4 12.0 Tf [(Abstract)] TJ ET BT 26.250 591.519 Td /F1 9.8 Tf [(Chikungunya is an emerging arbovirus that is characterized into four lineages. One of these, the Asian genotype, has spread )] TJ ET BT 26.250 579.615 Td /F1 9.8 Tf [(rapidly in the Americas after its introduction in the Saint Martin island in October 2013. Unexpectedly, a new lineage, the East-)] TJ ET BT 26.250 567.710 Td /F1 9.8 Tf [(Central-South African genotype, was introduced from Angola in the end of May 2014 in Feira de Santana \(FSA\), the second )] TJ ET BT 26.250 555.805 Td /F1 9.8 Tf [(largest city in Bahia state, Brazil, where over 5,500 cases have now been reported. Number weekly cases of clinically confirmed )] TJ ET BT 26.250 543.900 Td /F1 9.8 Tf [(CHIKV in FSA were analysed alongside with urban district of residence of CHIKV cases reported between June 2014 and )] TJ ET BT 26.250 531.996 Td /F1 9.8 Tf [(October collected from the municipalitys surveillance network. The number of cases per week from June 2014 until September )] TJ ET BT 26.250 520.091 Td /F1 9.8 Tf [(2015 reveals two distinct transmission waves. The first wave ignited in June and transmission ceased by December 2014. )] TJ ET BT 26.250 508.186 Td /F1 9.8 Tf [(However, a second transmission wave started in January and peaked in May 2015, 8 months after the first wave peak, and this )] TJ ET BT 26.250 496.281 Td /F1 9.8 Tf [(time in phase with Dengue virus and Zika virus transmission, which ceased when minimum temperature dropped to )] TJ ET BT 26.250 484.377 Td /F1 9.8 Tf [(approximately 15C. We find that shorter travelling times from the district where the outbreak first emerged to other urban )] TJ ET BT 26.250 472.472 Td /F1 9.8 Tf [(districts of FSA were strongly associated with incidence in each district in 2014 \(R)] TJ ET BT 378.459 476.360 Td /F1 8.7 Tf [(2)] TJ ET BT 383.278 472.472 Td /F1 9.8 Tf [(\).)] TJ ET BT 26.250 435.869 Td /F4 12.0 Tf [(Funding Statement)] TJ ET BT 26.250 415.915 Td /F1 9.8 Tf [(This work was funded by the Universal/CNPq grant. \(457480/2014-9\) and the European Research Council under the European )] TJ ET BT 26.250 404.010 Td /F1 9.8 Tf [(Unions Seventh Framework Programme \(FP7/2007-2013\)/ERC grant agreement no. 614725-PATHPHYLODYN.)] TJ ET BT 26.250 374.908 Td /F4 12.0 Tf [(Article)] TJ ET BT 26.250 354.954 Td /F1 9.8 Tf [(The Chikungunya virus \(CHIKV\) is an alphavirus that belongs to the Semliki Forest Virus antigenic complex)] TJ ET 0.267 0.267 0.267 rg BT 488.459 356.461 Td /F4 8.7 Tf [(1)] TJ ET 0.271 0.267 0.267 rg BT 493.277 354.954 Td /F1 9.8 Tf [(. Local outbreaks of )] TJ ET BT 26.250 343.049 Td /F1 9.8 Tf [(CHIKV-like disease have been documented since the eighteenth century)] TJ ET 0.267 0.267 0.267 rg BT 339.488 344.556 Td /F4 8.7 Tf [(2)] TJ ET 0.271 0.267 0.267 rg BT 344.307 343.049 Td /F1 9.8 Tf [( and the virus was discovered in 1952 in Tanzania)] TJ ET 0.267 0.267 0.267 rg BT 560.533 344.556 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 565.351 343.049 Td /F1 9.8 Tf [( . )] TJ ET BT 26.250 331.144 Td /F1 9.8 Tf [(Over the last 50 years, CHIKV has spread beyond its African heartlands and caused explosive outbreaks comprising millions of )] TJ ET BT 26.250 319.239 Td /F1 9.8 Tf [(cases in Indian Ocean islands and Asia.)] TJ ET 0.267 0.267 0.267 rg BT 199.127 320.747 Td /F4 8.7 Tf [(4)] TJ ET 0.271 0.267 0.267 rg BT 203.946 319.239 Td /F1 9.8 Tf [(The virus is mosquito-borne and transmission is associated with the vector species )] TJ ET BT 26.250 307.335 Td /F5 9.8 Tf [(Aedes albopictus)] TJ ET BT 100.496 307.335 Td /F1 9.8 Tf [( and )] TJ ET BT 122.180 307.335 Td /F5 9.8 Tf [(Ae. aegypti)] TJ ET BT 170.959 307.335 Td /F1 9.8 Tf [(, which are responsible for transmission cycles in urban and peri-urban environments)] TJ ET 0.267 0.267 0.267 rg BT 537.257 308.842 Td /F4 8.7 Tf [(5)] TJ ET 0.271 0.267 0.267 rg BT 542.076 307.335 Td /F1 9.8 Tf [(. )] TJ ET BT 26.250 295.430 Td /F1 9.8 Tf [(Clinical symptoms include polyarthralgia, rash, high fever and severe headaches)] TJ ET 0.267 0.267 0.267 rg BT 373.594 296.937 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 378.412 295.430 Td /F1 9.8 Tf [( and outbreaks are often characterized by a )] TJ ET BT 26.250 283.525 Td /F1 9.8 Tf [(rapid spread and high morbidity, resulting in losses in productivity)] TJ ET 0.267 0.267 0.267 rg BT 308.025 285.032 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 312.844 283.525 Td /F1 9.8 Tf [(. To date, four distinct CHIKV genotypes have been )] TJ ET BT 26.250 271.620 Td /F1 9.8 Tf [(identified. Two genotypes the East-Central-South African \(ECSA\) and the West African genotypes occupy a basal position )] TJ ET BT 26.250 259.716 Td /F1 9.8 Tf [(in the phylogeny of CHIKV)] TJ ET 0.267 0.267 0.267 rg BT 140.598 261.223 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 145.417 259.716 Td /F1 9.8 Tf [( and are mostly enzootic in Africa. Of the remaining two genotypes, the Asian genotype is )] TJ ET BT 26.250 247.811 Td /F1 9.8 Tf [(predominant in Southeast Asia, whilst the more recent Indian Ocean lineage spread from the Comoros islands in 2004 and )] TJ ET BT 26.250 235.906 Td /F1 9.8 Tf [(caused a large outbreak in India and Southeast Asia in 2005-2008.)] TJ ET BT 26.250 216.501 Td /F1 9.8 Tf [(In October 2013, the Asian genotype was first reported in the Americas, in the island of Saint Martin in the Caribbean)] TJ ET 0.267 0.267 0.267 rg BT 529.701 218.009 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 534.520 216.501 Td /F1 9.8 Tf [(. By the )] TJ ET BT 26.250 204.597 Td /F1 9.8 Tf [(end of December 2015, nearly 1 million cases had been notified in the Americas, resulting in 71 deaths, and autochthonous )] TJ ET BT 26.250 192.692 Td /F1 9.8 Tf [(transmission has been reported in more than 50 territories)] TJ ET 0.267 0.267 0.267 rg BT 276.601 194.199 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 286.238 192.692 Td /F1 9.8 Tf [(. In September 2014 the Brazilian Ministry of Health confirmed )] TJ ET BT 26.250 180.787 Td /F1 9.8 Tf [(autochthonous transmission of CHIKV in the Amap federal state, which borders French Guiana in northern Brazil, and in Feira )] TJ ET BT 26.250 168.882 Td /F1 9.8 Tf [(de Santana \(FSA\), a well-connected municipality and the second largest city \(617,528 inhabitants in 2015, www.ibge.gov.br\) of )] TJ ET BT 26.250 156.978 Td /F1 9.8 Tf [(Bahia federal state \(BA, northeast of Brazil, where both )] TJ ET BT 266.870 156.978 Td /F5 9.8 Tf [(Aedes)] TJ ET BT 294.512 156.978 Td /F1 9.8 Tf [( vectors circulate)] TJ ET 0.267 0.267 0.267 rg BT 367.656 158.485 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 377.293 156.978 Td /F1 9.8 Tf [(. Genome sequencing revealed that the Asian )] TJ ET BT 26.250 145.073 Td /F1 9.8 Tf [(genotype was circulating in the north of the country. However, 3 genomes sampled from FSA revealed that a distinct lineage, )] TJ ET BT 26.250 133.168 Td /F1 9.8 Tf [(the ECSA genotype, had entered the Americas for the first time)] TJ ET 0.267 0.267 0.267 rg BT 298.841 134.675 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 308.478 133.168 Td /F1 9.8 Tf [(. The ECSA genotype in FSA is closely related to CHIKV )] TJ ET BT 26.250 121.263 Td /F1 9.8 Tf [(strains circulating in Angola. Despite sparse data on CHIKV in Angola, there are recent reports of CHIKV cases exported from )] TJ ET BT 26.250 109.359 Td /F1 9.8 Tf [(Angola to other locations)] TJ ET 0.267 0.267 0.267 rg BT 133.558 110.866 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 143.196 109.359 Td /F1 9.8 Tf [(. Angola is climatically suitable for )] TJ ET BT 291.659 109.359 Td /F5 9.8 Tf [(Aedes)] TJ ET BT 319.300 109.359 Td /F1 9.8 Tf [( spp. mosquitoes)] TJ ET 0.267 0.267 0.267 rg BT 393.001 110.866 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 402.638 113.247 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 405.047 110.866 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 414.685 109.359 Td /F1 9.8 Tf [( and CHIKV was previously isolated )] TJ ET BT 26.250 97.454 Td /F1 9.8 Tf [(from )] TJ ET BT 48.460 97.454 Td /F5 9.8 Tf [(Aedes aegypti)] TJ ET BT 110.246 97.454 Td /F1 9.8 Tf [( in Luanda)] TJ ET 0.267 0.267 0.267 rg BT 155.779 98.961 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 165.416 97.454 Td /F1 9.8 Tf [(. As a result of the two independent introductions of distinct CHIKV genotypes into Brazil, )] TJ ET BT 26.250 85.549 Td /F1 9.8 Tf [(epidemiological analysis suggests that ~94% of the Brazilian population is at risk of CHIKV infection)] TJ ET 0.267 0.267 0.267 rg BT 455.708 87.056 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 465.346 85.549 Td /F1 9.8 Tf [(. In 2015, the Brazilian )] TJ ET BT 26.250 73.644 Td /F1 9.8 Tf [(Ministry of Health has notified a total of 20,661 CHIKV suspected cases 7,823 \(38%\) of these have been confirmed with )] TJ ET BT 26.250 61.740 Td /F1 9.8 Tf [(clinical \(35%\) and laboratory \(3%\) confirmation)] TJ ET 0.267 0.267 0.267 rg BT 228.348 63.247 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 237.985 61.740 Td /F1 9.8 Tf [( across 84 cities in Brazil of which Feira de Santana has notified by far the )] TJ ET BT 26.250 49.835 Td /F1 9.8 Tf [(greatest number of cases \(4,088 only in 2015\). It is likely that these numbers represent only a fraction of the individuals infected )] TJ ET BT 26.250 37.930 Td /F1 9.8 Tf [(because CHIKV cases based on clinical diagnosis may be mistaken for dengue virus \(DENV\) or Zika virus \(ZIKV\) infection. )] TJ ET Q q 15.000 709.302 577.500 28.698 re W n 0.267 0.267 0.267 rg BT 15.000 718.042 Td /F2 21.0 Tf [(Epidemiology of Chikungunya Virus in Bahia, Brazil, 2014-2015)] TJ ET Q 0.271 0.267 0.267 rg BT 15.000 700.036 Td /F3 9.8 Tf [(February 1, 2016)] TJ ET BT 88.388 700.036 Td /F3 9.8 Tf [()] TJ ET 0.267 0.267 0.267 rg BT 93.263 700.036 Td /F3 9.8 Tf [(Discussion)] TJ ET BT 26.250 688.195 Td /F1 9.8 Tf [(Nuno Rodrigues Faria)] TJ ET 0.271 0.267 0.267 rg BT 121.615 688.195 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 127.036 688.195 Td /F1 9.8 Tf [(Jos Loureno)] TJ ET 0.271 0.267 0.267 rg BT 190.986 688.195 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 196.407 688.195 Td /F1 9.8 Tf [(Erenilde Marques de Cerqueira)] TJ ET 0.271 0.267 0.267 rg BT 331.873 688.195 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 337.294 688.195 Td /F1 9.8 Tf [(Mariclia Maia de Lima)] TJ ET 0.271 0.267 0.267 rg BT 437.524 688.195 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 442.945 688.195 Td /F1 9.8 Tf [(Oliver Pybus)] TJ ET 0.271 0.267 0.267 rg BT 498.208 688.195 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 503.629 688.195 Td /F1 9.8 Tf [(Luiz Carlos )] TJ ET BT 26.250 676.290 Td /F1 9.8 Tf [(Junior Alcantara)] TJ ET 0.271 0.267 0.267 rg BT 26.250 664.386 Td /F1 9.8 Tf [(Rodrigues Faria N, Loureno J, Marques de Cerqueira E, Maia de Lima M, Pybus O, Carlos Junior Alcantara L. Epidemiology )] TJ ET BT 569.744 664.386 Td /F1 9.8 Tf [(of )] TJ ET BT 26.250 652.481 Td /F1 9.8 Tf [(Chikungunya Virus in Bahia, Brazil, 2014-2015. PLOS Currents Outbreaks. 2016 Feb 1 . Edition 1. doi: )] TJ ET BT 26.250 640.576 Td /F1 9.8 Tf [(10.1371/currents.outbreaks.c97507e3e48efb946401755d468c28b2.)] TJ ET q 15.000 23.644 577.500 614.551 re W n 0.271 0.267 0.267 rg BT 26.250 611.474 Td /F4 12.0 Tf [(Abstract)] TJ ET BT 26.250 591.519 Td /F1 9.8 Tf [(Chikungunya is an emerging arbovirus that is characterized into four lineages. One of these, the Asian genotype, has spread )] TJ ET BT 26.250 579.615 Td /F1 9.8 Tf [(rapidly in the Americas after its introduction in the Saint Martin island in October 2013. Unexpectedly, a new lineage, the East-)] TJ ET BT 26.250 567.710 Td /F1 9.8 Tf [(Central-South African genotype, was introduced from Angola in the end of May 2014 in Feira de Santana \(FSA\), the second )] TJ ET BT 26.250 555.805 Td /F1 9.8 Tf [(largest city in Bahia state, Brazil, where over 5,500 cases have now been reported. Number weekly cases of clinically confirmed )] TJ ET BT 26.250 543.900 Td /F1 9.8 Tf [(CHIKV in FSA were analysed alongside with urban district of residence of CHIKV cases reported between June 2014 and )] TJ ET BT 26.250 531.996 Td /F1 9.8 Tf [(October collected from the municipalitys surveillance network. The number of cases per week from June 2014 until September )] TJ ET BT 26.250 520.091 Td /F1 9.8 Tf [(2015 reveals two distinct transmission waves. The first wave ignited in June and transmission ceased by December 2014. )] TJ ET BT 26.250 508.186 Td /F1 9.8 Tf [(However, a second transmission wave started in January and peaked in May 2015, 8 months after the first wave peak, and this )] TJ ET BT 26.250 496.281 Td /F1 9.8 Tf [(time in phase with Dengue virus and Zika virus transmission, which ceased when minimum temperature dropped to )] TJ ET BT 26.250 484.377 Td /F1 9.8 Tf [(approximately 15C. We find that shorter travelling times from the district where the outbreak first emerged to other urban )] TJ ET BT 26.250 472.472 Td /F1 9.8 Tf [(districts of FSA were strongly associated with incidence in each district in 2014 \(R)] TJ ET BT 378.459 476.360 Td /F1 8.7 Tf [(2)] TJ ET BT 383.278 472.472 Td /F1 9.8 Tf [(\).)] TJ ET BT 26.250 435.869 Td /F4 12.0 Tf [(Funding Statement)] TJ ET BT 26.250 415.915 Td /F1 9.8 Tf [(This work was funded by the Universal/CNPq grant. \(457480/2014-9\) and the European Research Council under the European )] TJ ET BT 26.250 404.010 Td /F1 9.8 Tf [(Unions Seventh Framework Programme \(FP7/2007-2013\)/ERC grant agreement no. 614725-PATHPHYLODYN.)] TJ ET BT 26.250 374.908 Td /F4 12.0 Tf [(Article)] TJ ET BT 26.250 354.954 Td /F1 9.8 Tf [(The Chikungunya virus \(CHIKV\) is an alphavirus that belongs to the Semliki Forest Virus antigenic complex)] TJ ET 0.267 0.267 0.267 rg BT 488.459 356.461 Td /F4 8.7 Tf [(1)] TJ ET 0.271 0.267 0.267 rg BT 493.277 354.954 Td /F1 9.8 Tf [(. Local outbreaks of )] TJ ET BT 26.250 343.049 Td /F1 9.8 Tf [(CHIKV-like disease have been documented since the eighteenth century)] TJ ET 0.267 0.267 0.267 rg BT 339.488 344.556 Td /F4 8.7 Tf [(2)] TJ ET 0.271 0.267 0.267 rg BT 344.307 343.049 Td /F1 9.8 Tf [( and the virus was discovered in 1952 in Tanzania)] TJ ET 0.267 0.267 0.267 rg BT 560.533 344.556 Td /F4 8.7 Tf [(3)] TJ ET 0.271 0.267 0.267 rg BT 565.351 343.049 Td /F1 9.8 Tf [( . )] TJ ET BT 26.250 331.144 Td /F1 9.8 Tf [(Over the last 50 years, CHIKV has spread beyond its African heartlands and caused explosive outbreaks comprising millions of )] TJ ET BT 26.250 319.239 Td /F1 9.8 Tf [(cases in Indian Ocean islands and Asia.)] TJ ET 0.267 0.267 0.267 rg BT 199.127 320.747 Td /F4 8.7 Tf [(4)] TJ ET 0.271 0.267 0.267 rg BT 203.946 319.239 Td /F1 9.8 Tf [(The virus is mosquito-borne and transmission is associated with the vector species )] TJ ET BT 26.250 307.335 Td /F5 9.8 Tf [(Aedes albopictus)] TJ ET BT 100.496 307.335 Td /F1 9.8 Tf [( and )] TJ ET BT 122.180 307.335 Td /F5 9.8 Tf [(Ae. aegypti)] TJ ET BT 170.959 307.335 Td /F1 9.8 Tf [(, which are responsible for transmission cycles in urban and peri-urban environments)] TJ ET 0.267 0.267 0.267 rg BT 537.257 308.842 Td /F4 8.7 Tf [(5)] TJ ET 0.271 0.267 0.267 rg BT 542.076 307.335 Td /F1 9.8 Tf [(. )] TJ ET BT 26.250 295.430 Td /F1 9.8 Tf [(Clinical symptoms include polyarthralgia, rash, high fever and severe headaches)] TJ ET 0.267 0.267 0.267 rg BT 373.594 296.937 Td /F4 8.7 Tf [(6)] TJ ET 0.271 0.267 0.267 rg BT 378.412 295.430 Td /F1 9.8 Tf [( and outbreaks are often characterized by a )] TJ ET BT 26.250 283.525 Td /F1 9.8 Tf [(rapid spread and high morbidity, resulting in losses in productivity)] TJ ET 0.267 0.267 0.267 rg BT 308.025 285.032 Td /F4 8.7 Tf [(7)] TJ ET 0.271 0.267 0.267 rg BT 312.844 283.525 Td /F1 9.8 Tf [(. To date, four distinct CHIKV genotypes have been )] TJ ET BT 26.250 271.620 Td /F1 9.8 Tf [(identified. Two genotypes the East-Central-South African \(ECSA\) and the West African genotypes occupy a basal position )] TJ ET BT 26.250 259.716 Td /F1 9.8 Tf [(in the phylogeny of CHIKV)] TJ ET 0.267 0.267 0.267 rg BT 140.598 261.223 Td /F4 8.7 Tf [(8)] TJ ET 0.271 0.267 0.267 rg BT 145.417 259.716 Td /F1 9.8 Tf [( and are mostly enzootic in Africa. Of the remaining two genotypes, the Asian genotype is )] TJ ET BT 26.250 247.811 Td /F1 9.8 Tf [(predominant in Southeast Asia, whilst the more recent Indian Ocean lineage spread from the Comoros islands in 2004 and )] TJ ET BT 26.250 235.906 Td /F1 9.8 Tf [(caused a large outbreak in India and Southeast Asia in 2005-2008.)] TJ ET BT 26.250 216.501 Td /F1 9.8 Tf [(In October 2013, the Asian genotype was first reported in the Americas, in the island of Saint Martin in the Caribbean)] TJ ET 0.267 0.267 0.267 rg BT 529.701 218.009 Td /F4 8.7 Tf [(9)] TJ ET 0.271 0.267 0.267 rg BT 534.520 216.501 Td /F1 9.8 Tf [(. By the )] TJ ET BT 26.250 204.597 Td /F1 9.8 Tf [(end of December 2015, nearly 1 million cases had been notified in the Americas, resulting in 71 deaths, and autochthonous )] TJ ET BT 26.250 192.692 Td /F1 9.8 Tf [(transmission has been reported in more than 50 territories)] TJ ET 0.267 0.267 0.267 rg BT 276.601 194.199 Td /F4 8.7 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 286.238 192.692 Td /F1 9.8 Tf [(. In September 2014 the Brazilian Ministry of Health confirmed )] TJ ET BT 26.250 180.787 Td /F1 9.8 Tf [(autochthonous transmission of CHIKV in the Amap federal state, which borders French Guiana in northern Brazil, and in Feira )] TJ ET BT 26.250 168.882 Td /F1 9.8 Tf [(de Santana \(FSA\), a well-connected municipality and the second largest city \(617,528 inhabitants in 2015, www.ibge.gov.br\) of )] TJ ET BT 26.250 156.978 Td /F1 9.8 Tf [(Bahia federal state \(BA, northeast of Brazil, where both )] TJ ET BT 266.870 156.978 Td /F5 9.8 Tf [(Aedes)] TJ ET BT 294.512 156.978 Td /F1 9.8 Tf [( vectors circulate)] TJ ET 0.267 0.267 0.267 rg BT 367.656 158.485 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 377.293 156.978 Td /F1 9.8 Tf [(. Genome sequencing revealed that the Asian )] TJ ET BT 26.250 145.073 Td /F1 9.8 Tf [(genotype was circulating in the north of the country. However, 3 genomes sampled from FSA revealed that a distinct lineage, )] TJ ET BT 26.250 133.168 Td /F1 9.8 Tf [(the ECSA genotype, had entered the Americas for the first time)] TJ ET 0.267 0.267 0.267 rg BT 298.841 134.675 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 308.478 133.168 Td /F1 9.8 Tf [(. The ECSA genotype in FSA is closely related to CHIKV )] TJ ET BT 26.250 121.263 Td /F1 9.8 Tf [(strains circulating in Angola. Despite sparse data on CHIKV in Angola, there are recent reports of CHIKV cases exported from )] TJ ET BT 26.250 109.359 Td /F1 9.8 Tf [(Angola to other locations)] TJ ET 0.267 0.267 0.267 rg BT 133.558 110.866 Td /F4 8.7 Tf [(13)] TJ ET 0.271 0.267 0.267 rg BT 143.196 109.359 Td /F1 9.8 Tf [(. Angola is climatically suitable for )] TJ ET BT 291.659 109.359 Td /F5 9.8 Tf [(Aedes)] TJ ET BT 319.300 109.359 Td /F1 9.8 Tf [( spp. mosquitoes)] TJ ET 0.267 0.267 0.267 rg BT 393.001 110.866 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 402.638 113.247 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 405.047 110.866 Td /F4 8.7 Tf [(14)] TJ ET 0.271 0.267 0.267 rg BT 414.685 109.359 Td /F1 9.8 Tf [( and CHIKV was previously isolated )] TJ ET BT 26.250 97.454 Td /F1 9.8 Tf [(from )] TJ ET BT 48.460 97.454 Td /F5 9.8 Tf [(Aedes aegypti)] TJ ET BT 110.246 97.454 Td /F1 9.8 Tf [( in Luanda)] TJ ET 0.267 0.267 0.267 rg BT 155.779 98.961 Td /F4 8.7 Tf [(15)] TJ ET 0.271 0.267 0.267 rg BT 165.416 97.454 Td /F1 9.8 Tf [(. As a result of the two independent introductions of distinct CHIKV genotypes into Brazil, )] TJ ET BT 26.250 85.549 Td /F1 9.8 Tf [(epidemiological analysis suggests that ~94% of the Brazilian population is at risk of CHIKV infection)] TJ ET 0.267 0.267 0.267 rg BT 455.708 87.056 Td /F4 8.7 Tf [(12)] TJ ET 0.271 0.267 0.267 rg BT 465.346 85.549 Td /F1 9.8 Tf [(. In 2015, the Brazilian )] TJ ET BT 26.250 73.644 Td /F1 9.8 Tf [(Ministry of Health has notified a total of 20,661 CHIKV suspected cases 7,823 \(38%\) of these have been confirmed with )] TJ ET BT 26.250 61.740 Td /F1 9.8 Tf [(clinical \(35%\) and laboratory \(3%\) confirmation)] TJ ET 0.267 0.267 0.267 rg BT 228.348 63.247 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 237.985 61.740 Td /F1 9.8 Tf [( across 84 cities in Brazil of which Feira de Santana has notified by far the )] TJ ET BT 26.250 49.835 Td /F1 9.8 Tf [(greatest number of cases \(4,088 only in 2015\). It is likely that these numbers represent only a fraction of the individuals infected )] TJ ET BT 26.250 37.930 Td /F1 9.8 Tf [(because CHIKV cases based on clinical diagnosis may be mistaken for dengue virus \(DENV\) or Zika virus \(ZIKV\) infection. )] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(1)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Outbreaks)] TJ ET Q endstream endobj 8 0 obj << /Type /Font /Subtype /Type1 /Name /F1 /BaseFont /Helvetica /Encoding /WinAnsiEncoding >> endobj 9 0 obj << /Type /Font /Subtype /Type1 /Name /F2 /BaseFont /Times-Bold /Encoding /WinAnsiEncoding >> endobj 10 0 obj << /Type /Font /Subtype /Type1 /Name /F3 /BaseFont /Times-Italic /Encoding /WinAnsiEncoding >> endobj 11 0 obj << /Type /Font /Subtype /Type1 /Name /F4 /BaseFont /Helvetica-Bold /Encoding /WinAnsiEncoding >> endobj 12 0 obj << /Type /Font /Subtype /Type1 /Name /F5 /BaseFont /Helvetica-Oblique /Encoding /WinAnsiEncoding >> endobj 13 0 obj << /Type /XObject 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Also, autochthonous transmission of ZIKV has recently been reported in several Brazilian )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(federal states)] TJ ET 0.267 0.267 0.267 rg BT 84.779 745.174 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 94.417 743.667 Td /F1 9.8 Tf [(, and although the origins of the virus remain less understood)] TJ ET 0.267 0.267 0.267 rg BT 358.339 745.174 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 367.977 743.667 Td /F1 9.8 Tf [(, recent surveys indicate autochthonous )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(transmission of ZIKV in 19 out of 27 federal states in Brazil.)] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(The Brazilian surveillance health system \(Sistema Nacional de Notificao de Agravos, www.saude.gov.br/sinanweb\) defines a )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(CHIKV suspected/notified case as an individual presenting with a sudden fever \(>38.5 C\) and arthralgia or intense acute )] TJ ET BT 26.250 688.548 Td /F1 9.8 Tf [(arthritis that cannot be explained by other conditions, with the patient being either a resident or having visited endemic or )] TJ ET BT 26.250 676.643 Td /F1 9.8 Tf [(epidemic areas two weeks prior to the onset of symptoms. A CHIKV confirmed case involves either epidemiological or )] TJ ET BT 26.250 664.738 Td /F1 9.8 Tf [(laboratory confirmation through IgM serology, virus isolation, RT-PCR, or ELISA. In FSA, following the first RT-PCR and ELISA )] TJ ET BT 26.250 652.833 Td /F1 9.8 Tf [(confirmed CHIKV cases in June 2014, CHIKV incidence was determined by epidemiological criteria on the basis of severe )] TJ ET BT 26.250 640.929 Td /F1 9.8 Tf [(polyarthralgia or on the chronic evolution of symptoms, which enabled the municipal epidemiological surveillance teams to )] TJ ET BT 26.250 629.024 Td /F1 9.8 Tf [(distinguish CHIKV from DENV and ZIKV infection.)] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(We analysed temporal changes in CHIKV incidence among 21 urban districts of FSA between 1st June 2014 and 1st )] TJ ET BT 26.250 597.714 Td /F1 9.8 Tf [(September 2015)] TJ ET 0.267 0.267 0.267 rg BT 98.332 599.222 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 107.969 597.714 Td /F1 9.8 Tf [(. The data show evidence of a shift from a phase of epidemic establishment \(June 2014 to December 2014\) )] TJ ET BT 26.250 585.810 Td /F1 9.8 Tf [(towards a pattern of transmission behaviour that matches well the annual incidence of DENV \()] TJ ET BT 432.133 585.810 Td /F4 9.8 Tf [(Fig. 1a)] TJ ET BT 463.021 585.810 Td /F1 9.8 Tf [(\). Epidemiological surveys )] TJ ET BT 26.250 573.905 Td /F1 9.8 Tf [(indicate that the ECSA index case visited the local polyclinic after arriving in the George Amrico \(GA\) urban district in FSA on )] TJ ET BT 26.250 562.000 Td /F1 9.8 Tf [(the 29th May 2014. The individual presented high fever and polyarthralgia and tested negative for DENV and malaria. Several )] TJ ET BT 26.250 550.095 Td /F1 9.8 Tf [(family members and neighbours of the index case presented CHIKV-like symptoms in June 2014. As expected for a newly-)] TJ ET BT 26.250 538.191 Td /F1 9.8 Tf [(emergent epidemic, we find that travelling time from the inferred epidemic origin \(GA\) to other locations, measured as the )] TJ ET BT 26.250 526.286 Td /F1 9.8 Tf [(driving time in minutes from GA to the centre of each urban district, is inversely associated with incidence during the earliest )] TJ ET BT 26.250 514.381 Td /F1 9.8 Tf [(stages of the outbreak. Specifically, we find a strong and significant correlation between travelling time and incidence during )] TJ ET BT 26.250 502.476 Td /F1 9.8 Tf [(2014 \(R)] TJ ET BT 60.931 506.365 Td /F1 8.7 Tf [(2)] TJ ET BT 65.749 502.476 Td /F1 9.8 Tf [(=0.84; p-value<0.0001; )] TJ ET BT 168.739 502.476 Td /F4 9.8 Tf [(Fig. 1b)] TJ ET BT 200.163 502.476 Td /F1 9.8 Tf [(\). However, during the second epidemic wave in 2015, the relationship between )] TJ ET BT 26.250 490.572 Td /F1 9.8 Tf [(incidence and travelling time to the epidemic origin is considerably weaker and more diffuse \(R)] TJ ET BT 434.278 494.460 Td /F1 8.7 Tf [(2)] TJ ET BT 439.096 490.572 Td /F1 9.8 Tf [(=0.1014; p-value=0.16; )] TJ ET BT 542.086 490.572 Td /F4 9.8 Tf [(Fig. 1c)] TJ ET BT 26.250 478.667 Td /F1 9.8 Tf [(\). Further, the incidence time series for 2015 has shifted towards the annual pattern typically observed for DENV \()] TJ ET BT 515.583 478.667 Td /F4 9.8 Tf [(Fig. 1a)] TJ ET BT 546.471 478.667 Td /F1 9.8 Tf [(\), )] TJ ET BT 26.250 466.762 Td /F1 9.8 Tf [(which is driven primarily by seasonal cycles in vector abundance)] TJ ET 0.267 0.267 0.267 rg BT 304.759 468.269 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 314.396 466.762 Td /F1 9.8 Tf [(. This supports the hypothesis that CHIKV has transitioned )] TJ ET BT 26.250 454.857 Td /F1 9.8 Tf [(from epidemic establishment caused by spatial dissemination from the location into which the virus was introduced to a pattern )] TJ ET BT 26.250 442.953 Td /F1 9.8 Tf [(in which multiple neighbourhoods are now acting as secondary foci of transmission.)] TJ ET 0.965 0.965 0.965 rg 26.250 -232.178 555.000 665.250 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 433.072 m 581.250 433.072 l 581.250 432.322 l 26.250 432.322 l f q 450.000 0 0 649.500 35.250 -226.178 cm /I3 Do Q q 35.250 -232.178 537.000 0.000 re W n Q Q q 15.000 -232.178 577.500 1009.178 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(DENV is hyperendemic in the country, with serotypes 1 to 3 being re-introduced every 7 to 10 years from other South American )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(countries and the Caribbean)] TJ ET 0.267 0.267 0.267 rg BT 148.730 757.079 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 158.367 759.460 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 160.776 757.079 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 170.414 755.571 Td /F1 9.8 Tf [(. Also, autochthonous transmission of ZIKV has recently been reported in several Brazilian )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(federal states)] TJ ET 0.267 0.267 0.267 rg BT 84.779 745.174 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 94.417 743.667 Td /F1 9.8 Tf [(, and although the origins of the virus remain less understood)] TJ ET 0.267 0.267 0.267 rg BT 358.339 745.174 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 367.977 743.667 Td /F1 9.8 Tf [(, recent surveys indicate autochthonous )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(transmission of ZIKV in 19 out of 27 federal states in Brazil.)] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(The Brazilian surveillance health system \(Sistema Nacional de Notificao de Agravos, www.saude.gov.br/sinanweb\) defines a )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(CHIKV suspected/notified case as an individual presenting with a sudden fever \(>38.5 C\) and arthralgia or intense acute )] TJ ET BT 26.250 688.548 Td /F1 9.8 Tf [(arthritis that cannot be explained by other conditions, with the patient being either a resident or having visited endemic or )] TJ ET BT 26.250 676.643 Td /F1 9.8 Tf [(epidemic areas two weeks prior to the onset of symptoms. A CHIKV confirmed case involves either epidemiological or )] TJ ET BT 26.250 664.738 Td /F1 9.8 Tf [(laboratory confirmation through IgM serology, virus isolation, RT-PCR, or ELISA. In FSA, following the first RT-PCR and ELISA )] TJ ET BT 26.250 652.833 Td /F1 9.8 Tf [(confirmed CHIKV cases in June 2014, CHIKV incidence was determined by epidemiological criteria on the basis of severe )] TJ ET BT 26.250 640.929 Td /F1 9.8 Tf [(polyarthralgia or on the chronic evolution of symptoms, which enabled the municipal epidemiological surveillance teams to )] TJ ET BT 26.250 629.024 Td /F1 9.8 Tf [(distinguish CHIKV from DENV and ZIKV infection.)] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(We analysed temporal changes in CHIKV incidence among 21 urban districts of FSA between 1st June 2014 and 1st )] TJ ET BT 26.250 597.714 Td /F1 9.8 Tf [(September 2015)] TJ ET 0.267 0.267 0.267 rg BT 98.332 599.222 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 107.969 597.714 Td /F1 9.8 Tf [(. The data show evidence of a shift from a phase of epidemic establishment \(June 2014 to December 2014\) )] TJ ET BT 26.250 585.810 Td /F1 9.8 Tf [(towards a pattern of transmission behaviour that matches well the annual incidence of DENV \()] TJ ET BT 432.133 585.810 Td /F4 9.8 Tf [(Fig. 1a)] TJ ET BT 463.021 585.810 Td /F1 9.8 Tf [(\). Epidemiological surveys )] TJ ET BT 26.250 573.905 Td /F1 9.8 Tf [(indicate that the ECSA index case visited the local polyclinic after arriving in the George Amrico \(GA\) urban district in FSA on )] TJ ET BT 26.250 562.000 Td /F1 9.8 Tf [(the 29th May 2014. The individual presented high fever and polyarthralgia and tested negative for DENV and malaria. Several )] TJ ET BT 26.250 550.095 Td /F1 9.8 Tf [(family members and neighbours of the index case presented CHIKV-like symptoms in June 2014. As expected for a newly-)] TJ ET BT 26.250 538.191 Td /F1 9.8 Tf [(emergent epidemic, we find that travelling time from the inferred epidemic origin \(GA\) to other locations, measured as the )] TJ ET BT 26.250 526.286 Td /F1 9.8 Tf [(driving time in minutes from GA to the centre of each urban district, is inversely associated with incidence during the earliest )] TJ ET BT 26.250 514.381 Td /F1 9.8 Tf [(stages of the outbreak. Specifically, we find a strong and significant correlation between travelling time and incidence during )] TJ ET BT 26.250 502.476 Td /F1 9.8 Tf [(2014 \(R)] TJ ET BT 60.931 506.365 Td /F1 8.7 Tf [(2)] TJ ET BT 65.749 502.476 Td /F1 9.8 Tf [(=0.84; p-value<0.0001; )] TJ ET BT 168.739 502.476 Td /F4 9.8 Tf [(Fig. 1b)] TJ ET BT 200.163 502.476 Td /F1 9.8 Tf [(\). However, during the second epidemic wave in 2015, the relationship between )] TJ ET BT 26.250 490.572 Td /F1 9.8 Tf [(incidence and travelling time to the epidemic origin is considerably weaker and more diffuse \(R)] TJ ET BT 434.278 494.460 Td /F1 8.7 Tf [(2)] TJ ET BT 439.096 490.572 Td /F1 9.8 Tf [(=0.1014; p-value=0.16; )] TJ ET BT 542.086 490.572 Td /F4 9.8 Tf [(Fig. 1c)] TJ ET BT 26.250 478.667 Td /F1 9.8 Tf [(\). Further, the incidence time series for 2015 has shifted towards the annual pattern typically observed for DENV \()] TJ ET BT 515.583 478.667 Td /F4 9.8 Tf [(Fig. 1a)] TJ ET BT 546.471 478.667 Td /F1 9.8 Tf [(\), )] TJ ET BT 26.250 466.762 Td /F1 9.8 Tf [(which is driven primarily by seasonal cycles in vector abundance)] TJ ET 0.267 0.267 0.267 rg BT 304.759 468.269 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 314.396 466.762 Td /F1 9.8 Tf [(. This supports the hypothesis that CHIKV has transitioned )] TJ ET BT 26.250 454.857 Td /F1 9.8 Tf [(from epidemic establishment caused by spatial dissemination from the location into which the virus was introduced to a pattern )] TJ ET BT 26.250 442.953 Td /F1 9.8 Tf [(in which multiple neighbourhoods are now acting as secondary foci of transmission.)] TJ ET 0.965 0.965 0.965 rg 26.250 -232.178 555.000 665.250 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 433.072 m 581.250 433.072 l 581.250 432.322 l 26.250 432.322 l f q 450.000 0 0 649.500 35.250 -226.178 cm /I3 Do Q q 35.250 -232.178 537.000 0.000 re W n Q Q q 15.000 -232.178 577.500 1009.178 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(DENV is hyperendemic in the country, with serotypes 1 to 3 being re-introduced every 7 to 10 years from other South American )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(countries and the Caribbean)] TJ ET 0.267 0.267 0.267 rg BT 148.730 757.079 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 158.367 759.460 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 160.776 757.079 Td /F4 8.7 Tf [(18)] TJ ET 0.271 0.267 0.267 rg BT 170.414 755.571 Td /F1 9.8 Tf [(. Also, autochthonous transmission of ZIKV has recently been reported in several Brazilian )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(federal states)] TJ ET 0.267 0.267 0.267 rg BT 84.779 745.174 Td /F4 8.7 Tf [(16)] TJ ET 0.271 0.267 0.267 rg BT 94.417 743.667 Td /F1 9.8 Tf [(, and although the origins of the virus remain less understood)] TJ ET 0.267 0.267 0.267 rg BT 358.339 745.174 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 367.977 743.667 Td /F1 9.8 Tf [(, recent surveys indicate autochthonous )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(transmission of ZIKV in 19 out of 27 federal states in Brazil.)] TJ ET BT 26.250 712.357 Td /F1 9.8 Tf [(The Brazilian surveillance health system \(Sistema Nacional de Notificao de Agravos, www.saude.gov.br/sinanweb\) defines a )] TJ ET BT 26.250 700.452 Td /F1 9.8 Tf [(CHIKV suspected/notified case as an individual presenting with a sudden fever \(>38.5 C\) and arthralgia or intense acute )] TJ ET BT 26.250 688.548 Td /F1 9.8 Tf [(arthritis that cannot be explained by other conditions, with the patient being either a resident or having visited endemic or )] TJ ET BT 26.250 676.643 Td /F1 9.8 Tf [(epidemic areas two weeks prior to the onset of symptoms. A CHIKV confirmed case involves either epidemiological or )] TJ ET BT 26.250 664.738 Td /F1 9.8 Tf [(laboratory confirmation through IgM serology, virus isolation, RT-PCR, or ELISA. In FSA, following the first RT-PCR and ELISA )] TJ ET BT 26.250 652.833 Td /F1 9.8 Tf [(confirmed CHIKV cases in June 2014, CHIKV incidence was determined by epidemiological criteria on the basis of severe )] TJ ET BT 26.250 640.929 Td /F1 9.8 Tf [(polyarthralgia or on the chronic evolution of symptoms, which enabled the municipal epidemiological surveillance teams to )] TJ ET BT 26.250 629.024 Td /F1 9.8 Tf [(distinguish CHIKV from DENV and ZIKV infection.)] TJ ET BT 26.250 609.619 Td /F1 9.8 Tf [(We analysed temporal changes in CHIKV incidence among 21 urban districts of FSA between 1st June 2014 and 1st )] TJ ET BT 26.250 597.714 Td /F1 9.8 Tf [(September 2015)] TJ ET 0.267 0.267 0.267 rg BT 98.332 599.222 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 107.969 597.714 Td /F1 9.8 Tf [(. The data show evidence of a shift from a phase of epidemic establishment \(June 2014 to December 2014\) )] TJ ET BT 26.250 585.810 Td /F1 9.8 Tf [(towards a pattern of transmission behaviour that matches well the annual incidence of DENV \()] TJ ET BT 432.133 585.810 Td /F4 9.8 Tf [(Fig. 1a)] TJ ET BT 463.021 585.810 Td /F1 9.8 Tf [(\). Epidemiological surveys )] TJ ET BT 26.250 573.905 Td /F1 9.8 Tf [(indicate that the ECSA index case visited the local polyclinic after arriving in the George Amrico \(GA\) urban district in FSA on )] TJ ET BT 26.250 562.000 Td /F1 9.8 Tf [(the 29th May 2014. The individual presented high fever and polyarthralgia and tested negative for DENV and malaria. Several )] TJ ET BT 26.250 550.095 Td /F1 9.8 Tf [(family members and neighbours of the index case presented CHIKV-like symptoms in June 2014. As expected for a newly-)] TJ ET BT 26.250 538.191 Td /F1 9.8 Tf [(emergent epidemic, we find that travelling time from the inferred epidemic origin \(GA\) to other locations, measured as the )] TJ ET BT 26.250 526.286 Td /F1 9.8 Tf [(driving time in minutes from GA to the centre of each urban district, is inversely associated with incidence during the earliest )] TJ ET BT 26.250 514.381 Td /F1 9.8 Tf [(stages of the outbreak. Specifically, we find a strong and significant correlation between travelling time and incidence during )] TJ ET BT 26.250 502.476 Td /F1 9.8 Tf [(2014 \(R)] TJ ET BT 60.931 506.365 Td /F1 8.7 Tf [(2)] TJ ET BT 65.749 502.476 Td /F1 9.8 Tf [(=0.84; p-value<0.0001; )] TJ ET BT 168.739 502.476 Td /F4 9.8 Tf [(Fig. 1b)] TJ ET BT 200.163 502.476 Td /F1 9.8 Tf [(\). However, during the second epidemic wave in 2015, the relationship between )] TJ ET BT 26.250 490.572 Td /F1 9.8 Tf [(incidence and travelling time to the epidemic origin is considerably weaker and more diffuse \(R)] TJ ET BT 434.278 494.460 Td /F1 8.7 Tf [(2)] TJ ET BT 439.096 490.572 Td /F1 9.8 Tf [(=0.1014; p-value=0.16; )] TJ ET BT 542.086 490.572 Td /F4 9.8 Tf [(Fig. 1c)] TJ ET BT 26.250 478.667 Td /F1 9.8 Tf [(\). Further, the incidence time series for 2015 has shifted towards the annual pattern typically observed for DENV \()] TJ ET BT 515.583 478.667 Td /F4 9.8 Tf [(Fig. 1a)] TJ ET BT 546.471 478.667 Td /F1 9.8 Tf [(\), )] TJ ET BT 26.250 466.762 Td /F1 9.8 Tf [(which is driven primarily by seasonal cycles in vector abundance)] TJ ET 0.267 0.267 0.267 rg BT 304.759 468.269 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 314.396 466.762 Td /F1 9.8 Tf [(. This supports the hypothesis that CHIKV has transitioned )] TJ ET BT 26.250 454.857 Td /F1 9.8 Tf [(from epidemic establishment caused by spatial dissemination from the location into which the virus was introduced to a pattern )] TJ ET BT 26.250 442.953 Td /F1 9.8 Tf [(in which multiple neighbourhoods are now acting as secondary foci of transmission.)] TJ ET 0.965 0.965 0.965 rg 26.250 -232.178 555.000 665.250 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 433.072 m 581.250 433.072 l 581.250 432.322 l 26.250 432.322 l f q 450.000 0 0 649.500 35.250 -226.178 cm /I3 Do Q q 35.250 -232.178 537.000 0.000 re W n Q Q q 450.000 0 0 649.500 35.250 -226.178 cm /I3 Do Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(2)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Outbreaks)] TJ ET Q endstream endobj 179 0 obj << /Type /Annot /Subtype /Link /A 180 0 R /Border [0 0 0] /H /I /Rect [ 148.7295 756.2769 158.3668 765.0952 ] >> endobj 180 0 obj << /Type /Action >> endobj 181 0 obj << /Type /Annot /Subtype /Link /A 182 0 R /Border [0 0 0] /H /I /Rect [ 160.7762 756.2769 170.4135 765.0952 ] >> endobj 182 0 obj << /Type /Action >> endobj 183 0 obj << /Type /Annot /Subtype /Link /A 184 0 R /Border [0 0 0] /H /I /Rect [ 84.7792 744.3722 94.4166 753.1905 ] >> endobj 184 0 obj << /Type /Action >> endobj 185 0 obj << /Type /Annot /Subtype /Link /A 186 0 R /Border [0 0 0] /H /I /Rect [ 358.3393 744.3722 367.9767 753.1905 ] >> endobj 186 0 obj << /Type /Action >> endobj 187 0 obj << /Type /Annot /Subtype /Link /A 188 0 R /Border [0 0 0] /H /I /Rect [ 98.3317 598.4199 107.9691 607.2382 ] >> endobj 188 0 obj << /Type /Action >> endobj 189 0 obj << /Type /Annot /Subtype /Link /A 190 0 R /Border [0 0 0] /H /I /Rect [ 304.7588 467.4677 314.3961 476.2860 ] >> endobj 190 0 obj << /Type /Action >> endobj 191 0 obj << /Type /Annot /Subtype /Link /A 192 0 R /Border [0 0 0] /H /I /Rect [ 35.2500 -226.1782 485.2500 423.3218 ] >> endobj 192 0 obj << /Type /Action /S /URI /URI (http://currents.plos.org/outbreaks/files/2015/09/Figure_03_12_151.jpg) >> endobj 193 0 obj << /Type /XObject /Subtype /Image /Width 600 /Height 866 /ColorSpace /DeviceRGB /Filter /DCTDecode /BitsPerComponent 8 /Length 103745>> stream JFIF;CREATOR: gd-jpeg v1.0 (using IJG JPEG v62), quality = 90 C     C   bX" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?R8|R)Ş8v}Occ6@1yw(ݨ<]xQt/Zӵ-CME}kiuڹ *%U`:J֯͏^ տdo/}3nkG`x|1k4QEQEQGj3@Q@ KFi(h4PIKFh4QEfG4zQ3Fhњ=h4f Fhzњ3@4f (֏J3FhfE4QFh(Q3@Q@fE (4QFhQEQ3@f(E4QEQFh5$'oc}sgmn, mPvu2\$5Tycv9|+Hzo/+t;vt7_ٮR[c?>[_El%ۍwݍ8XG-wtpG-~G-w((O_ ?K]G-wp~G-Gmw?_ ?Kr_ ?K]wW  Q  PyEpc((|0/Z?~0/Z((|~aE_<Q\/Q%_9G/Q%_9@aE_<aE_<Q\?yk(?yk(?_ ?Kr_ ?Kr;+?yk(G-wW  Q  PyEp~G-~G-wW>?|0/Z?|0/Z(5_<aE_<Q\/߆Q%_9G/Q%_9@aE_<`?Kr;+?yk(?yk(?_ ?Kr_ ?Kr;+G-~G-wW  Q  PyEp~G-~~0/Z?~0/Z(WMt :24N RNs$av 3Q^3~ լ| {=7ROnGm4╙$yYPE SĚŇjZ旦jMWMFET2I$B*xb=J((((PREQ(((x?ŽoJ+x?ŽoJ(OV->k H9$HbA+ǖ[O$uRDVed8WNJW%-:j*k"k wHA!xSU]':^lnrmV_ܹuGw1ekA^ƭGզNׂfe̱20@,957I[  OpѠ}MQYZ4E_̷.7NիRՁ4AEfŠ((Q@Q@z;cs0P;^UuxkwqLx:"WEzQڊ((Z(EPEPGj(((Q@Q@ ( (QEy{SOé.=^w[It-߲Nz爴tV;K("%^χ?}]|_>9k>!?Cŭ-l/.gFd{em EKOxB4/jZ^.[]]e[!Vbx- a&1.&ѸLPli 5lslQ@Q@j( ( (EQJZ(EQGz3Eb8=gK[J=gK[Jr?xK-7S(y[$MG'cHq|JV kpoxdm7 0]2{guv։sz,o"‚ggnb~Ǻ!ka[$\C=NNyL'BںiPm]3)AڝID{P~_Vk|x/tXNYXC+uC!r-ѿ4e>9#ZZ ˥p9K H~HݿkT$t{-YxMn${GDzc*#aif*t2{WIP7dtL` x'+^ifU.eHa z t=L]Y^6JCj3̺oJgbwYm>sjac{WG% 6?;:}t}U5[A 8t5~Sāi.~R%lOpzt#f#d+ѕvS%+(EQEQEv(;PEPEPE((@Q@Q@v8?Ls_HW_)I(QEQ^KzP{~5}C%nȤ03ޮ )iMSB4M3`:o f$mY#ߛkdzGj((JZ1EG,cX@&(o6o "f. k]>̐BvTvPSF+ĵOZV`j!ܗ yFHутp,Q^ e]#߆4ڥŸEpYJ{$f0Nݣ *VpzoطV]pzoطV]r_bѮgq:#tEWu}WOgf%(ad VK8Ď2EH%[}zc uMwXO<\ԭ?j6,DDZx߻E>]LJeo}4&&!dw*uٟmϣj-RٔVvy+o>mJd[=KN!R(;2vRliBApI [JffT1~t}>\ծ$յ-+V6q-D@Y<͹9'dM{+h+HƮ#OQIڀQEb((9 hחwlt9i_}kRe-ʃ:T2|]Ro hM =VpUBJMzJ*mԟWR60[ a@:ڽIzfUY=Y@ DҗJ v>JЬV} MAX[ģ 좰o qKLE'xt4W,dZL/5 kƚɩZ'p?uSq+վxĚ]Ņ^F&Q}Gb oxDl_i~?xd? 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_Z(4Q@zNŠ(}h(ފ(; _Z(4Q@zNŠ(}h(ފ(; SEzRvSފ(J(J{EQE(Ҋ(;RQ@Q@'j(=袊(NԧPEP endstream endobj 194 0 obj << /Type /Annot /Subtype /Link /A 195 0 R /Border [0 0 0] /H /I /Rect [ 148.7295 756.2769 158.3668 765.0952 ] >> endobj 195 0 obj << /Type /Action >> endobj 196 0 obj << /Type /Annot /Subtype /Link /A 197 0 R /Border [0 0 0] /H /I /Rect [ 160.7762 756.2769 170.4135 765.0952 ] >> endobj 197 0 obj << /Type /Action >> endobj 198 0 obj << /Type /Annot /Subtype /Link /A 199 0 R /Border [0 0 0] /H /I /Rect [ 84.7792 744.3722 94.4166 753.1905 ] >> endobj 199 0 obj << /Type /Action >> endobj 200 0 obj << /Type /Annot /Subtype /Link /A 201 0 R /Border [0 0 0] /H /I /Rect [ 358.3393 744.3722 367.9767 753.1905 ] >> endobj 201 0 obj << /Type /Action >> endobj 202 0 obj << /Type /Annot /Subtype /Link /A 203 0 R /Border [0 0 0] /H /I /Rect [ 98.3317 598.4199 107.9691 607.2382 ] >> endobj 203 0 obj << /Type /Action >> endobj 204 0 obj << /Type /Annot /Subtype /Link /A 205 0 R /Border [0 0 0] /H /I /Rect [ 304.7588 467.4677 314.3961 476.2860 ] >> endobj 205 0 obj << /Type /Action >> endobj 206 0 obj << /Type /Annot /Subtype /Link /A 207 0 R /Border [0 0 0] /H /I /Rect [ 35.2500 -226.1782 485.2500 423.3218 ] >> endobj 207 0 obj << /Type /Action /S /URI /URI (http://currents.plos.org/outbreaks/files/2015/09/Figure_03_12_151.jpg) >> endobj 208 0 obj << /Type /Annot /Subtype /Link /A 209 0 R /Border [0 0 0] /H /I /Rect [ 148.7295 756.2769 158.3668 765.0952 ] >> endobj 209 0 obj << /Type /Action >> endobj 210 0 obj << /Type /Annot /Subtype /Link /A 211 0 R /Border [0 0 0] /H /I /Rect [ 160.7762 756.2769 170.4135 765.0952 ] >> endobj 211 0 obj << /Type /Action >> endobj 212 0 obj << /Type /Annot /Subtype /Link /A 213 0 R /Border [0 0 0] /H /I /Rect [ 84.7792 744.3722 94.4166 753.1905 ] >> endobj 213 0 obj << /Type /Action >> endobj 214 0 obj << /Type /Annot /Subtype /Link /A 215 0 R /Border [0 0 0] /H /I /Rect [ 358.3393 744.3722 367.9767 753.1905 ] >> endobj 215 0 obj << /Type /Action >> endobj 216 0 obj << /Type /Annot /Subtype /Link /A 217 0 R /Border [0 0 0] /H /I /Rect [ 98.3317 598.4199 107.9691 607.2382 ] >> endobj 217 0 obj << /Type /Action >> endobj 218 0 obj << /Type /Annot /Subtype /Link /A 219 0 R /Border [0 0 0] /H /I /Rect [ 304.7588 467.4677 314.3961 476.2860 ] >> endobj 219 0 obj << /Type /Action >> endobj 220 0 obj << /Type /Annot /Subtype /Link /A 221 0 R /Border [0 0 0] /H /I /Rect [ 35.2500 -226.1782 485.2500 423.3218 ] >> endobj 221 0 obj << /Type /Action /S /URI /URI (http://currents.plos.org/outbreaks/files/2015/09/Figure_03_12_151.jpg) >> endobj 222 0 obj << /Type /Page /Parent 3 0 R /Annots [ 224 0 R 226 0 R 228 0 R 230 0 R 232 0 R 234 0 R 236 0 R 238 0 R 240 0 R 242 0 R 244 0 R 246 0 R 248 0 R 250 0 R 252 0 R 254 0 R 256 0 R 258 0 R 260 0 R 262 0 R 264 0 R 266 0 R 268 0 R 270 0 R 272 0 R 274 0 R 276 0 R 278 0 R 280 0 R 282 0 R 284 0 R 286 0 R 288 0 R 290 0 R 292 0 R 294 0 R 296 0 R 298 0 R 300 0 R 302 0 R 304 0 R 306 0 R 308 0 R 310 0 R 312 0 R 314 0 R 316 0 R 318 0 R 320 0 R 322 0 R 324 0 R 326 0 R 328 0 R 330 0 R 332 0 R 334 0 R 336 0 R 338 0 R 340 0 R 342 0 R 344 0 R 346 0 R 348 0 R 350 0 R 352 0 R 354 0 R ] /Contents 223 0 R >> endobj 223 0 obj << /Length 35218 >> stream q 15.000 28.725 577.500 748.275 re W n 0.965 0.965 0.965 rg 26.250 616.719 555.000 160.281 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 616.719 m 581.250 616.719 l 581.250 617.469 l 26.250 617.469 l f q 35.250 627.969 537.000 149.031 re W n 0.271 0.267 0.267 rg BT 35.250 767.476 Td /F4 9.8 Tf [(Fig. 1: Dynamics of Chikungunya in Feira de Santana, Bahia, Brazil, in 2014-2015)] TJ ET BT 35.250 748.106 Td /F1 9.8 Tf [(Incidence of CHIKV, DENV and ZIKV \(number of clinically confirmed cases\) in Feira de Santana \(FSA\) district, Bahia state, )] TJ ET BT 35.250 734.370 Td /F1 9.8 Tf [(Brazil. The red curve shows CHIKV incidence between weeks 13 and 53 in 2014 \(an arrow indicates the arrival date of the )] TJ ET BT 35.250 720.634 Td /F1 9.8 Tf [(index case to George Amrico, GA, district\)\). The blue curve shows incidence between weeks 1 and 35 in 2015. For )] TJ ET BT 35.250 706.897 Td /F1 9.8 Tf [(comparison, the numbers of DENV \(dark grey\) and ZIKV \(light grey\) cases in 2015 are shown)] TJ ET 0.267 0.267 0.267 rg BT 438.403 709.870 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 448.040 706.897 Td /F1 9.8 Tf [(. Curve fitting to incidence )] TJ ET BT 35.250 693.161 Td /F1 9.8 Tf [(time-series data was performed using Poisson-smoothing in R software)] TJ ET 0.267 0.267 0.267 rg BT 343.019 696.134 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 352.656 693.161 Td /F1 9.8 Tf [(. Panel \(b\) shows the correlation \(R)] TJ ET BT 505.458 698.881 Td /F1 8.7 Tf [(2)] TJ ET BT 510.277 693.161 Td /F1 9.8 Tf [( and p-value\) )] TJ ET BT 35.250 679.425 Td /F1 9.8 Tf [(between the estimated travel time \(minutes\) from GA to the geographic centre of each other urban district of residence in )] TJ ET BT 35.250 665.689 Td /F1 9.8 Tf [(FSA presenting more than 10 cases in either 2014 or 2015, against the 2015 CHIKV incidence for each district in FSA. )] TJ ET BT 35.250 651.952 Td /F1 9.8 Tf [(Panel \(c\) shows the equivalent results for 2014. Only urban districts with >10 reported cases in either year were considered. )] TJ ET BT 35.250 638.216 Td /F1 9.8 Tf [(A map of Feira de Santana is shown with the number of cases per district of residence for 2014 \(d\) and 2015 \(e\).)] TJ ET Q BT 26.250 599.695 Td /F1 9.8 Tf [(Current data gives no indication that an endemic cycle will not be repeated in future years, as it is for DENV. Even if after the )] TJ ET BT 26.250 587.790 Td /F1 9.8 Tf [(second cycle of CHIKV in FSA transmission is halted, as in the 2005-2006 outbreak in La Reunion)] TJ ET 0.267 0.267 0.267 rg BT 449.488 589.298 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 459.125 587.790 Td /F1 9.8 Tf [(, it is likely that the virus will )] TJ ET BT 26.250 575.886 Td /F1 9.8 Tf [(continue to spread in geographic areas with immunologically nave hosts and an abundance of )] TJ ET BT 436.501 575.886 Td /F5 9.8 Tf [(Ae. aegypti)] TJ ET BT 485.280 575.886 Td /F1 9.8 Tf [( and/or )] TJ ET BT 518.342 575.886 Td /F5 9.8 Tf [(Ae. albopictus)] TJ ET BT 26.250 563.981 Td /F1 9.8 Tf [(. Both species are widely present in Brazil)] TJ ET 0.267 0.267 0.267 rg BT 206.693 565.488 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 216.331 563.981 Td /F1 9.8 Tf [( and are suitable vectors for the ECSA and Asian genotypes)] TJ ET 0.267 0.267 0.267 rg BT 475.924 565.488 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 485.562 563.981 Td /F1 9.8 Tf [(. Future CHIKV )] TJ ET BT 26.250 552.076 Td /F1 9.8 Tf [(transmission cycles are expected to be in phase with dengue and ZIKV seasonal epidemics, peaking when temperature, )] TJ ET BT 26.250 540.171 Td /F1 9.8 Tf [(precipitation and humidity are propitious for )] TJ ET BT 215.371 540.171 Td /F5 9.8 Tf [(Aedes)] TJ ET BT 243.012 540.171 Td /F1 9.8 Tf [(-mediated transmission)] TJ ET 0.267 0.267 0.267 rg BT 343.788 541.679 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 353.425 540.171 Td /F1 9.8 Tf [(. In addition, there is the potential for CHIKV to )] TJ ET BT 26.250 528.267 Td /F1 9.8 Tf [(become endemic in the region, with occasional epidemics in humans. There is some evidence that CHIKV maintains an )] TJ ET BT 26.250 516.362 Td /F1 9.8 Tf [(enzootic cycle in Southeast Asia involving nonhuman primates and forest-dwelling mosquitoes)] TJ ET 0.267 0.267 0.267 rg BT 432.669 517.869 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 442.306 516.362 Td /F1 9.8 Tf [(, similar to the transmission of )] TJ ET BT 26.250 504.457 Td /F1 9.8 Tf [(yellow fever virus in the Amazon and Orinoco river basin )] TJ ET 0.267 0.267 0.267 rg BT 272.252 505.964 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 281.890 504.457 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 485.052 Td /F1 9.8 Tf [(Since the establishment of CHIKV in FSA, the city has been experiencing a near-collapse of the public health system. The )] TJ ET BT 26.250 473.148 Td /F1 9.8 Tf [(number of reported cases has already surpassed 5,363 but the local health care officials suspect that only 20% of cases are )] TJ ET BT 26.250 461.243 Td /F1 9.8 Tf [(being notified. Although no treatment is available, several compounds and vaccines are currently under development)] TJ ET 0.267 0.267 0.267 rg BT 529.155 462.750 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 538.792 461.243 Td /F1 9.8 Tf [(. More )] TJ ET BT 26.250 449.338 Td /F1 9.8 Tf [(generally, the establishment of the ECSA genotype in Brazil is an unprecedented event in the Americas. This lineage is known )] TJ ET BT 26.250 437.433 Td /F1 9.8 Tf [(to have acquired several adaptive mutations to )] TJ ET BT 230.561 437.433 Td /F5 9.8 Tf [(Aedes albopictus)] TJ ET BT 304.808 437.433 Td /F1 9.8 Tf [(. For example, a single amino acid mutation in its glycoprotein )] TJ ET BT 26.250 425.529 Td /F1 9.8 Tf [(E1 \(A226V\) has been shown to confer 50-100 fold increases in transmissibility in this species)] TJ ET 0.267 0.267 0.267 rg BT 427.248 427.036 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 436.885 425.529 Td /F1 9.8 Tf [(. Continued epidemiological and )] TJ ET BT 26.250 413.624 Td /F1 9.8 Tf [(genetic surveillance and classification of CHIKV genotypes in Brazil and elsewhere in the Americas will be essential to monitor )] TJ ET BT 26.250 401.719 Td /F1 9.8 Tf [(virus diversity, the acquisition of mutations related to viral reproductive success and vector specificity. In addition, along with )] TJ ET BT 26.250 389.814 Td /F1 9.8 Tf [(ongoing DENV transmission, ZIKV is also spreading rapidly throughout northern Brazil)] TJ ET 0.267 0.267 0.267 rg BT 397.978 391.322 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 407.616 393.703 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 410.025 391.322 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 419.663 389.814 Td /F1 9.8 Tf [(, and 1,459 suspected ZIKV cases )] TJ ET BT 26.250 377.910 Td /F1 9.8 Tf [(have been reported until the 23 November 2015 in FSA)] TJ ET 0.267 0.267 0.267 rg BT 265.252 379.417 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 274.889 377.910 Td /F1 9.8 Tf [(. The patterns of ZIKV match relatively well the epidemic cycles of )] TJ ET BT 26.250 366.005 Td /F1 9.8 Tf [(DENV and CHIKV in 2015 and molecular epidemiological analyses are confirm that the CHIKV-ECSA strain has been )] TJ ET BT 26.250 354.100 Td /F1 9.8 Tf [(circulating in Bahia state during 2015 \(unpublished findings\). Notably, the seasonal 2015 patterns of the arboviruses appear )] TJ ET BT 26.250 342.195 Td /F1 9.8 Tf [(synchronized, especially in terms of their annual demise. These patterns reflect natural temperature cycles \()] TJ ET BT 491.179 342.195 Td /F4 9.8 Tf [(Fig. 1a)] TJ ET BT 522.067 342.195 Td /F1 9.8 Tf [(\), which )] TJ ET BT 26.250 330.291 Td /F1 9.8 Tf [(severely affect entomological and viral factors. Particularly, vector capacity is reduced when the temperature drops below 20 )] TJ ET BT 26.250 318.386 Td /F1 9.8 Tf [(degrees Celsius, and transmission is completely disrupted once the temperature reaches 15 degrees Celsius)] TJ ET 0.267 0.267 0.267 rg BT 496.063 319.893 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 505.701 322.274 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 508.110 319.893 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 26.250 298.981 Td /F1 9.8 Tf [(Other outbreaks of infectious disease have benefited from the use of digital surveillance for enhanced detection and response. )] TJ ET BT 26.250 287.076 Td /F1 9.8 Tf [(Human mobility underlies many phenomena, including the spread of infectious diseases)] TJ ET 0.267 0.267 0.267 rg BT 405.038 288.584 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 414.675 290.965 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 417.084 288.584 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 426.722 287.076 Td /F1 9.8 Tf [( and high-resolution datasets that )] TJ ET BT 26.250 275.172 Td /F1 9.8 Tf [(represent regional human population density and global mosquito vector densities have recently become available)] TJ ET 0.267 0.267 0.267 rg BT 518.313 276.679 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 527.950 279.060 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 530.360 276.679 Td /F4 8.7 Tf [(33)] TJ ET 0.271 0.267 0.267 rg BT 539.997 275.172 Td /F1 9.8 Tf [(. We )] TJ ET BT 26.250 263.267 Td /F1 9.8 Tf [(have shown here that even the simplest mobility measures may be highly informative of virus spread. Anonymous mobile phone )] TJ ET BT 26.250 251.362 Td /F1 9.8 Tf [(data may also provide a valuable source of information about patterns of human travel and could contribute to better forecasting )] TJ ET BT 26.250 239.457 Td /F1 9.8 Tf [(of disease spread through space and time. Prediction of the dynamics and future disease burden of CHIKV in Brazil would )] TJ ET BT 26.250 227.553 Td /F1 9.8 Tf [(benefit from the inclusion of temperature and precipitation variables that affect vector distributions)] TJ ET 0.267 0.267 0.267 rg BT 446.231 229.060 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 455.869 231.441 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 458.278 229.060 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 467.915 231.441 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 470.325 229.060 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 479.962 227.553 Td /F1 9.8 Tf [(. In addition, high-)] TJ ET BT 26.250 215.648 Td /F1 9.8 Tf [(resolution maps of the )] TJ ET BT 124.881 215.648 Td /F5 9.8 Tf [(Aedes albopictus)] TJ ET BT 199.127 215.648 Td /F1 9.8 Tf [( vector could complement LIRAa \(Levantamento Rpido do Indice de Infestao por )] TJ ET BT 26.250 203.743 Td /F5 9.8 Tf [(Aedes aegypti)] TJ ET BT 88.036 203.743 Td /F1 9.8 Tf [(, http://portalsaude.saude.gov.br/\), which is currently focused on mapping the infestation by )] TJ ET BT 483.652 203.743 Td /F5 9.8 Tf [(Aedes aegypti)] TJ ET BT 545.438 203.743 Td /F1 9.8 Tf [(. )] TJ ET BT 26.250 191.838 Td /F1 9.8 Tf [(Finally, we note that it is exceptional for CHIKV, DENV and ZIKV to be all simultaneously circulating in one single city with < 1 )] TJ ET BT 26.250 179.934 Td /F1 9.8 Tf [(million people. Such a scenario calls for national and international efforts to understand drivers of transmission, curb arbovirus )] TJ ET BT 26.250 168.029 Td /F1 9.8 Tf [(transmission, train public health professionals to provide health care for the infected and effectively control mosquito populations )] TJ ET BT 26.250 156.124 Td /F1 9.8 Tf [(in this municipality and beyond.)] TJ ET BT 26.250 119.522 Td /F4 12.0 Tf [(Competing Interests)] TJ ET BT 26.250 99.567 Td /F1 9.8 Tf [(We declare we have no conflict of interests.)] TJ ET Q q 15.000 28.725 577.500 748.275 re W n 0.965 0.965 0.965 rg 26.250 616.719 555.000 160.281 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 616.719 m 581.250 616.719 l 581.250 617.469 l 26.250 617.469 l f q 35.250 627.969 537.000 149.031 re W n 0.271 0.267 0.267 rg BT 35.250 767.476 Td /F4 9.8 Tf [(Fig. 1: Dynamics of Chikungunya in Feira de Santana, Bahia, Brazil, in 2014-2015)] TJ ET BT 35.250 748.106 Td /F1 9.8 Tf [(Incidence of CHIKV, DENV and ZIKV \(number of clinically confirmed cases\) in Feira de Santana \(FSA\) district, Bahia state, )] TJ ET BT 35.250 734.370 Td /F1 9.8 Tf [(Brazil. The red curve shows CHIKV incidence between weeks 13 and 53 in 2014 \(an arrow indicates the arrival date of the )] TJ ET BT 35.250 720.634 Td /F1 9.8 Tf [(index case to George Amrico, GA, district\)\). The blue curve shows incidence between weeks 1 and 35 in 2015. For )] TJ ET BT 35.250 706.897 Td /F1 9.8 Tf [(comparison, the numbers of DENV \(dark grey\) and ZIKV \(light grey\) cases in 2015 are shown)] TJ ET 0.267 0.267 0.267 rg BT 438.403 709.870 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 448.040 706.897 Td /F1 9.8 Tf [(. Curve fitting to incidence )] TJ ET BT 35.250 693.161 Td /F1 9.8 Tf [(time-series data was performed using Poisson-smoothing in R software)] TJ ET 0.267 0.267 0.267 rg BT 343.019 696.134 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 352.656 693.161 Td /F1 9.8 Tf [(. Panel \(b\) shows the correlation \(R)] TJ ET BT 505.458 698.881 Td /F1 8.7 Tf [(2)] TJ ET BT 510.277 693.161 Td /F1 9.8 Tf [( and p-value\) )] TJ ET BT 35.250 679.425 Td /F1 9.8 Tf [(between the estimated travel time \(minutes\) from GA to the geographic centre of each other urban district of residence in )] TJ ET BT 35.250 665.689 Td /F1 9.8 Tf [(FSA presenting more than 10 cases in either 2014 or 2015, against the 2015 CHIKV incidence for each district in FSA. )] TJ ET BT 35.250 651.952 Td /F1 9.8 Tf [(Panel \(c\) shows the equivalent results for 2014. Only urban districts with >10 reported cases in either year were considered. )] TJ ET BT 35.250 638.216 Td /F1 9.8 Tf [(A map of Feira de Santana is shown with the number of cases per district of residence for 2014 \(d\) and 2015 \(e\).)] TJ ET Q BT 26.250 599.695 Td /F1 9.8 Tf [(Current data gives no indication that an endemic cycle will not be repeated in future years, as it is for DENV. Even if after the )] TJ ET BT 26.250 587.790 Td /F1 9.8 Tf [(second cycle of CHIKV in FSA transmission is halted, as in the 2005-2006 outbreak in La Reunion)] TJ ET 0.267 0.267 0.267 rg BT 449.488 589.298 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 459.125 587.790 Td /F1 9.8 Tf [(, it is likely that the virus will )] TJ ET BT 26.250 575.886 Td /F1 9.8 Tf [(continue to spread in geographic areas with immunologically nave hosts and an abundance of )] TJ ET BT 436.501 575.886 Td /F5 9.8 Tf [(Ae. aegypti)] TJ ET BT 485.280 575.886 Td /F1 9.8 Tf [( and/or )] TJ ET BT 518.342 575.886 Td /F5 9.8 Tf [(Ae. albopictus)] TJ ET BT 26.250 563.981 Td /F1 9.8 Tf [(. Both species are widely present in Brazil)] TJ ET 0.267 0.267 0.267 rg BT 206.693 565.488 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 216.331 563.981 Td /F1 9.8 Tf [( and are suitable vectors for the ECSA and Asian genotypes)] TJ ET 0.267 0.267 0.267 rg BT 475.924 565.488 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 485.562 563.981 Td /F1 9.8 Tf [(. Future CHIKV )] TJ ET BT 26.250 552.076 Td /F1 9.8 Tf [(transmission cycles are expected to be in phase with dengue and ZIKV seasonal epidemics, peaking when temperature, )] TJ ET BT 26.250 540.171 Td /F1 9.8 Tf [(precipitation and humidity are propitious for )] TJ ET BT 215.371 540.171 Td /F5 9.8 Tf [(Aedes)] TJ ET BT 243.012 540.171 Td /F1 9.8 Tf [(-mediated transmission)] TJ ET 0.267 0.267 0.267 rg BT 343.788 541.679 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 353.425 540.171 Td /F1 9.8 Tf [(. In addition, there is the potential for CHIKV to )] TJ ET BT 26.250 528.267 Td /F1 9.8 Tf [(become endemic in the region, with occasional epidemics in humans. There is some evidence that CHIKV maintains an )] TJ ET BT 26.250 516.362 Td /F1 9.8 Tf [(enzootic cycle in Southeast Asia involving nonhuman primates and forest-dwelling mosquitoes)] TJ ET 0.267 0.267 0.267 rg BT 432.669 517.869 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 442.306 516.362 Td /F1 9.8 Tf [(, similar to the transmission of )] TJ ET BT 26.250 504.457 Td /F1 9.8 Tf [(yellow fever virus in the Amazon and Orinoco river basin )] TJ ET 0.267 0.267 0.267 rg BT 272.252 505.964 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 281.890 504.457 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 485.052 Td /F1 9.8 Tf [(Since the establishment of CHIKV in FSA, the city has been experiencing a near-collapse of the public health system. The )] TJ ET BT 26.250 473.148 Td /F1 9.8 Tf [(number of reported cases has already surpassed 5,363 but the local health care officials suspect that only 20% of cases are )] TJ ET BT 26.250 461.243 Td /F1 9.8 Tf [(being notified. Although no treatment is available, several compounds and vaccines are currently under development)] TJ ET 0.267 0.267 0.267 rg BT 529.155 462.750 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 538.792 461.243 Td /F1 9.8 Tf [(. More )] TJ ET BT 26.250 449.338 Td /F1 9.8 Tf [(generally, the establishment of the ECSA genotype in Brazil is an unprecedented event in the Americas. This lineage is known )] TJ ET BT 26.250 437.433 Td /F1 9.8 Tf [(to have acquired several adaptive mutations to )] TJ ET BT 230.561 437.433 Td /F5 9.8 Tf [(Aedes albopictus)] TJ ET BT 304.808 437.433 Td /F1 9.8 Tf [(. For example, a single amino acid mutation in its glycoprotein )] TJ ET BT 26.250 425.529 Td /F1 9.8 Tf [(E1 \(A226V\) has been shown to confer 50-100 fold increases in transmissibility in this species)] TJ ET 0.267 0.267 0.267 rg BT 427.248 427.036 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 436.885 425.529 Td /F1 9.8 Tf [(. Continued epidemiological and )] TJ ET BT 26.250 413.624 Td /F1 9.8 Tf [(genetic surveillance and classification of CHIKV genotypes in Brazil and elsewhere in the Americas will be essential to monitor )] TJ ET BT 26.250 401.719 Td /F1 9.8 Tf [(virus diversity, the acquisition of mutations related to viral reproductive success and vector specificity. In addition, along with )] TJ ET BT 26.250 389.814 Td /F1 9.8 Tf [(ongoing DENV transmission, ZIKV is also spreading rapidly throughout northern Brazil)] TJ ET 0.267 0.267 0.267 rg BT 397.978 391.322 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 407.616 393.703 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 410.025 391.322 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 419.663 389.814 Td /F1 9.8 Tf [(, and 1,459 suspected ZIKV cases )] TJ ET BT 26.250 377.910 Td /F1 9.8 Tf [(have been reported until the 23 November 2015 in FSA)] TJ ET 0.267 0.267 0.267 rg BT 265.252 379.417 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 274.889 377.910 Td /F1 9.8 Tf [(. The patterns of ZIKV match relatively well the epidemic cycles of )] TJ ET BT 26.250 366.005 Td /F1 9.8 Tf [(DENV and CHIKV in 2015 and molecular epidemiological analyses are confirm that the CHIKV-ECSA strain has been )] TJ ET BT 26.250 354.100 Td /F1 9.8 Tf [(circulating in Bahia state during 2015 \(unpublished findings\). Notably, the seasonal 2015 patterns of the arboviruses appear )] TJ ET BT 26.250 342.195 Td /F1 9.8 Tf [(synchronized, especially in terms of their annual demise. These patterns reflect natural temperature cycles \()] TJ ET BT 491.179 342.195 Td /F4 9.8 Tf [(Fig. 1a)] TJ ET BT 522.067 342.195 Td /F1 9.8 Tf [(\), which )] TJ ET BT 26.250 330.291 Td /F1 9.8 Tf [(severely affect entomological and viral factors. Particularly, vector capacity is reduced when the temperature drops below 20 )] TJ ET BT 26.250 318.386 Td /F1 9.8 Tf [(degrees Celsius, and transmission is completely disrupted once the temperature reaches 15 degrees Celsius)] TJ ET 0.267 0.267 0.267 rg BT 496.063 319.893 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 505.701 322.274 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 508.110 319.893 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 26.250 298.981 Td /F1 9.8 Tf [(Other outbreaks of infectious disease have benefited from the use of digital surveillance for enhanced detection and response. )] TJ ET BT 26.250 287.076 Td /F1 9.8 Tf [(Human mobility underlies many phenomena, including the spread of infectious diseases)] TJ ET 0.267 0.267 0.267 rg BT 405.038 288.584 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 414.675 290.965 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 417.084 288.584 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 426.722 287.076 Td /F1 9.8 Tf [( and high-resolution datasets that )] TJ ET BT 26.250 275.172 Td /F1 9.8 Tf [(represent regional human population density and global mosquito vector densities have recently become available)] TJ ET 0.267 0.267 0.267 rg BT 518.313 276.679 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 527.950 279.060 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 530.360 276.679 Td /F4 8.7 Tf [(33)] TJ ET 0.271 0.267 0.267 rg BT 539.997 275.172 Td /F1 9.8 Tf [(. We )] TJ ET BT 26.250 263.267 Td /F1 9.8 Tf [(have shown here that even the simplest mobility measures may be highly informative of virus spread. Anonymous mobile phone )] TJ ET BT 26.250 251.362 Td /F1 9.8 Tf [(data may also provide a valuable source of information about patterns of human travel and could contribute to better forecasting )] TJ ET BT 26.250 239.457 Td /F1 9.8 Tf [(of disease spread through space and time. Prediction of the dynamics and future disease burden of CHIKV in Brazil would )] TJ ET BT 26.250 227.553 Td /F1 9.8 Tf [(benefit from the inclusion of temperature and precipitation variables that affect vector distributions)] TJ ET 0.267 0.267 0.267 rg BT 446.231 229.060 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 455.869 231.441 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 458.278 229.060 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 467.915 231.441 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 470.325 229.060 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 479.962 227.553 Td /F1 9.8 Tf [(. In addition, high-)] TJ ET BT 26.250 215.648 Td /F1 9.8 Tf [(resolution maps of the )] TJ ET BT 124.881 215.648 Td /F5 9.8 Tf [(Aedes albopictus)] TJ ET BT 199.127 215.648 Td /F1 9.8 Tf [( vector could complement LIRAa \(Levantamento Rpido do Indice de Infestao por )] TJ ET BT 26.250 203.743 Td /F5 9.8 Tf [(Aedes aegypti)] TJ ET BT 88.036 203.743 Td /F1 9.8 Tf [(, http://portalsaude.saude.gov.br/\), which is currently focused on mapping the infestation by )] TJ ET BT 483.652 203.743 Td /F5 9.8 Tf [(Aedes aegypti)] TJ ET BT 545.438 203.743 Td /F1 9.8 Tf [(. )] TJ ET BT 26.250 191.838 Td /F1 9.8 Tf [(Finally, we note that it is exceptional for CHIKV, DENV and ZIKV to be all simultaneously circulating in one single city with < 1 )] TJ ET BT 26.250 179.934 Td /F1 9.8 Tf [(million people. Such a scenario calls for national and international efforts to understand drivers of transmission, curb arbovirus )] TJ ET BT 26.250 168.029 Td /F1 9.8 Tf [(transmission, train public health professionals to provide health care for the infected and effectively control mosquito populations )] TJ ET BT 26.250 156.124 Td /F1 9.8 Tf [(in this municipality and beyond.)] TJ ET BT 26.250 119.522 Td /F4 12.0 Tf [(Competing Interests)] TJ ET BT 26.250 99.567 Td /F1 9.8 Tf [(We declare we have no conflict of interests.)] TJ ET Q q 15.000 28.725 577.500 748.275 re W n 0.965 0.965 0.965 rg 26.250 616.719 555.000 160.281 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 616.719 m 581.250 616.719 l 581.250 617.469 l 26.250 617.469 l f q 35.250 627.969 537.000 149.031 re W n 0.271 0.267 0.267 rg BT 35.250 767.476 Td /F4 9.8 Tf [(Fig. 1: Dynamics of Chikungunya in Feira de Santana, Bahia, Brazil, in 2014-2015)] TJ ET BT 35.250 748.106 Td /F1 9.8 Tf [(Incidence of CHIKV, DENV and ZIKV \(number of clinically confirmed cases\) in Feira de Santana \(FSA\) district, Bahia state, )] TJ ET BT 35.250 734.370 Td /F1 9.8 Tf [(Brazil. The red curve shows CHIKV incidence between weeks 13 and 53 in 2014 \(an arrow indicates the arrival date of the )] TJ ET BT 35.250 720.634 Td /F1 9.8 Tf [(index case to George Amrico, GA, district\)\). The blue curve shows incidence between weeks 1 and 35 in 2015. For )] TJ ET BT 35.250 706.897 Td /F1 9.8 Tf [(comparison, the numbers of DENV \(dark grey\) and ZIKV \(light grey\) cases in 2015 are shown)] TJ ET 0.267 0.267 0.267 rg BT 438.403 709.870 Td /F4 8.7 Tf [(20)] TJ ET 0.271 0.267 0.267 rg BT 448.040 706.897 Td /F1 9.8 Tf [(. Curve fitting to incidence )] TJ ET BT 35.250 693.161 Td /F1 9.8 Tf [(time-series data was performed using Poisson-smoothing in R software)] TJ ET 0.267 0.267 0.267 rg BT 343.019 696.134 Td /F4 8.7 Tf [(22)] TJ ET 0.271 0.267 0.267 rg BT 352.656 693.161 Td /F1 9.8 Tf [(. Panel \(b\) shows the correlation \(R)] TJ ET BT 505.458 698.881 Td /F1 8.7 Tf [(2)] TJ ET BT 510.277 693.161 Td /F1 9.8 Tf [( and p-value\) )] TJ ET BT 35.250 679.425 Td /F1 9.8 Tf [(between the estimated travel time \(minutes\) from GA to the geographic centre of each other urban district of residence in )] TJ ET BT 35.250 665.689 Td /F1 9.8 Tf [(FSA presenting more than 10 cases in either 2014 or 2015, against the 2015 CHIKV incidence for each district in FSA. )] TJ ET BT 35.250 651.952 Td /F1 9.8 Tf [(Panel \(c\) shows the equivalent results for 2014. Only urban districts with >10 reported cases in either year were considered. )] TJ ET BT 35.250 638.216 Td /F1 9.8 Tf [(A map of Feira de Santana is shown with the number of cases per district of residence for 2014 \(d\) and 2015 \(e\).)] TJ ET Q BT 26.250 599.695 Td /F1 9.8 Tf [(Current data gives no indication that an endemic cycle will not be repeated in future years, as it is for DENV. Even if after the )] TJ ET BT 26.250 587.790 Td /F1 9.8 Tf [(second cycle of CHIKV in FSA transmission is halted, as in the 2005-2006 outbreak in La Reunion)] TJ ET 0.267 0.267 0.267 rg BT 449.488 589.298 Td /F4 8.7 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 459.125 587.790 Td /F1 9.8 Tf [(, it is likely that the virus will )] TJ ET BT 26.250 575.886 Td /F1 9.8 Tf [(continue to spread in geographic areas with immunologically nave hosts and an abundance of )] TJ ET BT 436.501 575.886 Td /F5 9.8 Tf [(Ae. aegypti)] TJ ET BT 485.280 575.886 Td /F1 9.8 Tf [( and/or )] TJ ET BT 518.342 575.886 Td /F5 9.8 Tf [(Ae. albopictus)] TJ ET BT 26.250 563.981 Td /F1 9.8 Tf [(. Both species are widely present in Brazil)] TJ ET 0.267 0.267 0.267 rg BT 206.693 565.488 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 216.331 563.981 Td /F1 9.8 Tf [( and are suitable vectors for the ECSA and Asian genotypes)] TJ ET 0.267 0.267 0.267 rg BT 475.924 565.488 Td /F4 8.7 Tf [(24)] TJ ET 0.271 0.267 0.267 rg BT 485.562 563.981 Td /F1 9.8 Tf [(. Future CHIKV )] TJ ET BT 26.250 552.076 Td /F1 9.8 Tf [(transmission cycles are expected to be in phase with dengue and ZIKV seasonal epidemics, peaking when temperature, )] TJ ET BT 26.250 540.171 Td /F1 9.8 Tf [(precipitation and humidity are propitious for )] TJ ET BT 215.371 540.171 Td /F5 9.8 Tf [(Aedes)] TJ ET BT 243.012 540.171 Td /F1 9.8 Tf [(-mediated transmission)] TJ ET 0.267 0.267 0.267 rg BT 343.788 541.679 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 353.425 540.171 Td /F1 9.8 Tf [(. In addition, there is the potential for CHIKV to )] TJ ET BT 26.250 528.267 Td /F1 9.8 Tf [(become endemic in the region, with occasional epidemics in humans. There is some evidence that CHIKV maintains an )] TJ ET BT 26.250 516.362 Td /F1 9.8 Tf [(enzootic cycle in Southeast Asia involving nonhuman primates and forest-dwelling mosquitoes)] TJ ET 0.267 0.267 0.267 rg BT 432.669 517.869 Td /F4 8.7 Tf [(26)] TJ ET 0.271 0.267 0.267 rg BT 442.306 516.362 Td /F1 9.8 Tf [(, similar to the transmission of )] TJ ET BT 26.250 504.457 Td /F1 9.8 Tf [(yellow fever virus in the Amazon and Orinoco river basin )] TJ ET 0.267 0.267 0.267 rg BT 272.252 505.964 Td /F4 8.7 Tf [(27)] TJ ET 0.271 0.267 0.267 rg BT 281.890 504.457 Td /F1 9.8 Tf [(.)] TJ ET BT 26.250 485.052 Td /F1 9.8 Tf [(Since the establishment of CHIKV in FSA, the city has been experiencing a near-collapse of the public health system. The )] TJ ET BT 26.250 473.148 Td /F1 9.8 Tf [(number of reported cases has already surpassed 5,363 but the local health care officials suspect that only 20% of cases are )] TJ ET BT 26.250 461.243 Td /F1 9.8 Tf [(being notified. Although no treatment is available, several compounds and vaccines are currently under development)] TJ ET 0.267 0.267 0.267 rg BT 529.155 462.750 Td /F4 8.7 Tf [(28)] TJ ET 0.271 0.267 0.267 rg BT 538.792 461.243 Td /F1 9.8 Tf [(. More )] TJ ET BT 26.250 449.338 Td /F1 9.8 Tf [(generally, the establishment of the ECSA genotype in Brazil is an unprecedented event in the Americas. This lineage is known )] TJ ET BT 26.250 437.433 Td /F1 9.8 Tf [(to have acquired several adaptive mutations to )] TJ ET BT 230.561 437.433 Td /F5 9.8 Tf [(Aedes albopictus)] TJ ET BT 304.808 437.433 Td /F1 9.8 Tf [(. For example, a single amino acid mutation in its glycoprotein )] TJ ET BT 26.250 425.529 Td /F1 9.8 Tf [(E1 \(A226V\) has been shown to confer 50-100 fold increases in transmissibility in this species)] TJ ET 0.267 0.267 0.267 rg BT 427.248 427.036 Td /F4 8.7 Tf [(29)] TJ ET 0.271 0.267 0.267 rg BT 436.885 425.529 Td /F1 9.8 Tf [(. Continued epidemiological and )] TJ ET BT 26.250 413.624 Td /F1 9.8 Tf [(genetic surveillance and classification of CHIKV genotypes in Brazil and elsewhere in the Americas will be essential to monitor )] TJ ET BT 26.250 401.719 Td /F1 9.8 Tf [(virus diversity, the acquisition of mutations related to viral reproductive success and vector specificity. In addition, along with )] TJ ET BT 26.250 389.814 Td /F1 9.8 Tf [(ongoing DENV transmission, ZIKV is also spreading rapidly throughout northern Brazil)] TJ ET 0.267 0.267 0.267 rg BT 397.978 391.322 Td /F4 8.7 Tf [(19)] TJ ET 0.271 0.267 0.267 rg BT 407.616 393.703 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 410.025 391.322 Td /F4 8.7 Tf [(30)] TJ ET 0.271 0.267 0.267 rg BT 419.663 389.814 Td /F1 9.8 Tf [(, and 1,459 suspected ZIKV cases )] TJ ET BT 26.250 377.910 Td /F1 9.8 Tf [(have been reported until the 23 November 2015 in FSA)] TJ ET 0.267 0.267 0.267 rg BT 265.252 379.417 Td /F4 8.7 Tf [(17)] TJ ET 0.271 0.267 0.267 rg BT 274.889 377.910 Td /F1 9.8 Tf [(. The patterns of ZIKV match relatively well the epidemic cycles of )] TJ ET BT 26.250 366.005 Td /F1 9.8 Tf [(DENV and CHIKV in 2015 and molecular epidemiological analyses are confirm that the CHIKV-ECSA strain has been )] TJ ET BT 26.250 354.100 Td /F1 9.8 Tf [(circulating in Bahia state during 2015 \(unpublished findings\). Notably, the seasonal 2015 patterns of the arboviruses appear )] TJ ET BT 26.250 342.195 Td /F1 9.8 Tf [(synchronized, especially in terms of their annual demise. These patterns reflect natural temperature cycles \()] TJ ET BT 491.179 342.195 Td /F4 9.8 Tf [(Fig. 1a)] TJ ET BT 522.067 342.195 Td /F1 9.8 Tf [(\), which )] TJ ET BT 26.250 330.291 Td /F1 9.8 Tf [(severely affect entomological and viral factors. Particularly, vector capacity is reduced when the temperature drops below 20 )] TJ ET BT 26.250 318.386 Td /F1 9.8 Tf [(degrees Celsius, and transmission is completely disrupted once the temperature reaches 15 degrees Celsius)] TJ ET 0.267 0.267 0.267 rg BT 496.063 319.893 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 505.701 322.274 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 508.110 319.893 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 26.250 298.981 Td /F1 9.8 Tf [(Other outbreaks of infectious disease have benefited from the use of digital surveillance for enhanced detection and response. )] TJ ET BT 26.250 287.076 Td /F1 9.8 Tf [(Human mobility underlies many phenomena, including the spread of infectious diseases)] TJ ET 0.267 0.267 0.267 rg BT 405.038 288.584 Td /F4 8.7 Tf [(31)] TJ ET 0.271 0.267 0.267 rg BT 414.675 290.965 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 417.084 288.584 Td /F4 8.7 Tf [(32)] TJ ET 0.271 0.267 0.267 rg BT 426.722 287.076 Td /F1 9.8 Tf [( and high-resolution datasets that )] TJ ET BT 26.250 275.172 Td /F1 9.8 Tf [(represent regional human population density and global mosquito vector densities have recently become available)] TJ ET 0.267 0.267 0.267 rg BT 518.313 276.679 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 527.950 279.060 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 530.360 276.679 Td /F4 8.7 Tf [(33)] TJ ET 0.271 0.267 0.267 rg BT 539.997 275.172 Td /F1 9.8 Tf [(. We )] TJ ET BT 26.250 263.267 Td /F1 9.8 Tf [(have shown here that even the simplest mobility measures may be highly informative of virus spread. Anonymous mobile phone )] TJ ET BT 26.250 251.362 Td /F1 9.8 Tf [(data may also provide a valuable source of information about patterns of human travel and could contribute to better forecasting )] TJ ET BT 26.250 239.457 Td /F1 9.8 Tf [(of disease spread through space and time. Prediction of the dynamics and future disease burden of CHIKV in Brazil would )] TJ ET BT 26.250 227.553 Td /F1 9.8 Tf [(benefit from the inclusion of temperature and precipitation variables that affect vector distributions)] TJ ET 0.267 0.267 0.267 rg BT 446.231 229.060 Td /F4 8.7 Tf [(11)] TJ ET 0.271 0.267 0.267 rg BT 455.869 231.441 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 458.278 229.060 Td /F4 8.7 Tf [(21)] TJ ET 0.271 0.267 0.267 rg BT 467.915 231.441 Td /F1 8.7 Tf [(,)] TJ ET 0.267 0.267 0.267 rg BT 470.325 229.060 Td /F4 8.7 Tf [(25)] TJ ET 0.271 0.267 0.267 rg BT 479.962 227.553 Td /F1 9.8 Tf [(. In addition, high-)] TJ ET BT 26.250 215.648 Td /F1 9.8 Tf [(resolution maps of the )] TJ ET BT 124.881 215.648 Td /F5 9.8 Tf [(Aedes albopictus)] TJ ET BT 199.127 215.648 Td /F1 9.8 Tf [( vector could complement LIRAa \(Levantamento Rpido do Indice de Infestao por )] TJ ET BT 26.250 203.743 Td /F5 9.8 Tf [(Aedes aegypti)] TJ ET BT 88.036 203.743 Td /F1 9.8 Tf [(, http://portalsaude.saude.gov.br/\), which is currently focused on mapping the infestation by )] TJ ET BT 483.652 203.743 Td /F5 9.8 Tf [(Aedes aegypti)] TJ ET BT 545.438 203.743 Td /F1 9.8 Tf [(. )] TJ ET BT 26.250 191.838 Td /F1 9.8 Tf [(Finally, we note that it is exceptional for CHIKV, DENV and ZIKV to be all simultaneously circulating in one single city with < 1 )] TJ ET BT 26.250 179.934 Td /F1 9.8 Tf [(million people. Such a scenario calls for national and international efforts to understand drivers of transmission, curb arbovirus )] TJ ET BT 26.250 168.029 Td /F1 9.8 Tf [(transmission, train public health professionals to provide health care for the infected and effectively control mosquito populations )] TJ ET BT 26.250 156.124 Td /F1 9.8 Tf [(in this municipality and beyond.)] TJ ET BT 26.250 119.522 Td /F4 12.0 Tf [(Competing Interests)] TJ ET BT 26.250 99.567 Td /F1 9.8 Tf [(We declare we have no conflict of interests.)] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(3)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Outbreaks)] TJ ET Q endstream endobj 224 0 obj << /Type /Annot /Subtype /Link /A 225 0 R /Border [0 0 0] /H /I /Rect [ 438.4028 709.0682 448.0401 717.8865 ] >> endobj 225 0 obj << /Type /Action >> endobj 226 0 obj << /Type /Annot /Subtype /Link /A 227 0 R /Border [0 0 0] /H /I /Rect [ 343.0185 695.3319 352.6558 704.1502 ] >> endobj 227 0 obj << /Type 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/F1 9.8 Tf [(We thank the organisers and participants of a symposium held in July 2015 by the Municipal Health Services in Feira de )] TJ ET BT 26.250 718.419 Td /F1 9.8 Tf [(Santana, and to Atlio Moreira \(SEOMA, Salvador, Bahia\).)] TJ ET BT 26.250 689.317 Td /F4 12.0 Tf [(References)] TJ ET BT 26.250 661.863 Td /F1 9.8 Tf [(1.)] TJ ET BT 38.132 661.863 Td /F1 9.8 Tf [(Voss JE, Vaney MC, Duquerroy S, Vonrhein C, Girard-Blanc C, et al. \(2010\) Glycoprotein organization of Chikungunya virus )] TJ ET BT 26.250 649.958 Td /F1 9.8 Tf [(particles revealed by X-ray crystallography. 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Bull World Health Organ. 1973;49\(1\):37-40)] TJ ET BT 26.250 204.125 Td /F1 9.8 Tf [(16.)] TJ ET BT 43.553 204.125 Td /F1 9.8 Tf [(BRASIL \(2016\) Monitoramento dos casos de dengue e febre de chikungunya at a Semana Epidemiolgica 52, 2015: )] TJ ET BT 26.250 192.220 Td /F1 9.8 Tf [(Secretaria de Vigilncia em Sade ? Ministrio da Sade. vol 43, 3:1-8)] TJ ET BT 26.250 172.815 Td /F1 9.8 Tf [(17.)] TJ ET BT 43.553 172.815 Td /F1 9.8 Tf [(Nunes MR, Faria NR, Vasconcelos HB, Medeiros DB, Silva de Lima CP, et al. \(2012\) Phylogeography of dengue virus )] TJ ET BT 26.250 160.911 Td /F1 9.8 Tf [(serotype 4, Brazil, 2010-2011. Emerg Infect Dis 18: 1858-1864.)] TJ ET BT 26.250 141.506 Td /F1 9.8 Tf [(18.)] TJ ET BT 43.553 141.506 Td /F1 9.8 Tf [(Nunes MR, Palacios G, Faria NR, Sousa EC, Jr., Pantoja JA, et al. \(2014\) Air travel is associated with intracontinental )] TJ ET BT 26.250 129.601 Td /F1 9.8 Tf [(spread of dengue virus serotypes 1-3 in Brazil. PLoS Negl Trop Dis 8: e2769.)] TJ ET BT 26.250 110.196 Td /F1 9.8 Tf [(19.)] TJ ET BT 43.553 110.196 Td /F1 9.8 Tf [(Campos GS, Bandeira AC, Sardi SI. Zika Virus Outbreak, Bahia, Brazil. Emerg Infect Dis. 2015 Oct;21\(10\):1885-6)] TJ ET BT 26.250 90.792 Td /F1 9.8 Tf [(20.)] TJ ET BT 43.553 90.792 Td /F1 9.8 Tf [(Feira de Santana, Secretaria Municipal de Sade, Boletim Epidemiolgico. Ed. 15, 2015. Available at )] TJ ET BT 26.250 78.887 Td /F1 9.8 Tf [(www.feiradesantana.ba.gov.br. Accessed on 17/09/2015.)] TJ ET BT 26.250 59.482 Td /F1 9.8 Tf [(21.)] TJ ET BT 43.553 59.482 Td /F1 9.8 Tf [(Lourenco J, Recker M \(2014\) The 2012 Madeira dengue outbreak: epidemiological determinants and future epidemic )] TJ ET BT 26.250 47.577 Td /F1 9.8 Tf [(potential. PLoS Negl Trop Dis 8: e3083.)] TJ ET Q q 15.000 37.696 577.500 739.304 re W n 0.271 0.267 0.267 rg BT 26.250 750.278 Td /F4 12.0 Tf [(Acknowledgements)] TJ ET BT 26.250 730.324 Td /F1 9.8 Tf [(We thank the organisers and participants of a symposium held in July 2015 by the Municipal Health Services in Feira de )] TJ ET BT 26.250 718.419 Td /F1 9.8 Tf [(Santana, and to Atlio Moreira \(SEOMA, Salvador, Bahia\).)] TJ ET BT 26.250 689.317 Td /F4 12.0 Tf [(References)] TJ ET BT 26.250 661.863 Td /F1 9.8 Tf [(1.)] TJ ET BT 38.132 661.863 Td /F1 9.8 Tf [(Voss JE, Vaney MC, Duquerroy S, Vonrhein C, Girard-Blanc C, et al. \(2010\) Glycoprotein organization of Chikungunya virus )] TJ ET BT 26.250 649.958 Td /F1 9.8 Tf [(particles revealed by X-ray crystallography. Nature 468: 709-712.)] TJ ET BT 26.250 630.553 Td /F1 9.8 Tf [(2.)] TJ ET BT 38.132 630.553 Td /F1 9.8 Tf [(Tsetsarkin KA, Chen R, Sherman MB, Weaver SC \(2011\) Chikungunya virus: evolution and genetic determinants of )] TJ ET BT 26.250 618.648 Td /F1 9.8 Tf [(emergence. Curr Opin Virol 1: 310-317.)] TJ ET BT 26.250 599.244 Td /F1 9.8 Tf [(3.)] TJ ET BT 38.132 599.244 Td /F1 9.8 Tf [(Weaver SC, Forrester NL \(2015\) Chikungunya: Evolutionary history and recent epidemic spread. Antiviral Res 120: 32-39.)] TJ ET BT 26.250 579.839 Td /F1 9.8 Tf [(4.)] TJ ET BT 38.132 579.839 Td /F1 9.8 Tf [(Weaver SC, Lecuit M \(2015\) Chikungunya virus and the global spread of a mosquito-borne disease. N Engl J Med 372: 1231-)] TJ ET BT 26.250 567.934 Td /F1 9.8 Tf [(1239.)] TJ ET BT 26.250 548.529 Td /F1 9.8 Tf [(5.)] TJ ET BT 38.132 548.529 Td /F1 9.8 Tf [(Weaver SC, Osorio JE, Livengood JA, Chen R, Stinchcomb DT \(2012\) Chikungunya virus and prospects for a vaccine. )] TJ ET BT 26.250 536.625 Td /F1 9.8 Tf [(Expert Rev Vaccines 11: 1087-1101.)] TJ ET BT 26.250 517.220 Td /F1 9.8 Tf [(6.)] TJ ET BT 38.132 517.220 Td /F1 9.8 Tf [(Schwartz O, Albert ML \(2010\) Biology and pathogenesis of chikungunya virus. Nat Rev Microbiol 8: 491-500.)] TJ ET BT 26.250 497.815 Td /F1 9.8 Tf [(7.)] TJ ET BT 38.132 497.815 Td /F1 9.8 Tf [(Sissoko D, Malvy D, Giry C, Delmas G, Paquet C, et al. \(2008\) Outbreak of Chikungunya fever in Mayotte, Comoros )] TJ ET BT 26.250 485.910 Td /F1 9.8 Tf [(archipelago, 2005-2006. Trans R Soc Trop Med Hyg 102: 780-786.)] TJ ET BT 26.250 466.506 Td /F1 9.8 Tf [(8.)] TJ ET BT 38.132 466.506 Td /F1 9.8 Tf [(Volk SM, Chen R, Tsetsarkin KA, Adams AP, Garcia TI, et al. \(2010\) Genome-scale phylogenetic analyses of chikungunya )] TJ ET BT 26.250 454.601 Td /F1 9.8 Tf [(virus reveal independent emergences of recent epidemics and various evolutionary rates. J Virol 84: 6497-6504.)] TJ ET BT 26.250 435.196 Td /F1 9.8 Tf [(9.)] TJ ET BT 38.132 435.196 Td /F1 9.8 Tf [(Leparc-Goffart I, Nougairede A, Cassadou S, Prat C, de Lamballerie X \(2014\) Chikungunya in the Americas. Lancet 383: 514.)] TJ ET BT 26.250 415.791 Td /F1 9.8 Tf [(10.)] TJ ET BT 43.553 415.791 Td /F1 9.8 Tf [(PAHO/WHO Date MaS \(2015w - Cumulative cases\) Number of reported cases of Chikungunya Fever in the Americas - )] TJ ET BT 26.250 403.887 Td /F1 9.8 Tf [(EW3 \(January, 2016\))] TJ ET BT 26.250 384.482 Td /F1 9.8 Tf [(11.)] TJ ET BT 43.553 384.482 Td /F1 9.8 Tf [(Kraemer MUG, Sinka, M. E., Duda, K. A., Mylne, A., Shearer,F. M., Barker, C. M., Moore, C. G., Carvalho, R. G., Coelho, )] TJ ET BT 26.250 372.577 Td /F1 9.8 Tf [(G. E., Bortel, W. V., Hendrickx, G., Schaffner, F., Elyazar, I. R. F., Teng, H. J., Brady, O. J., Messina, J. P., Pigott, D., M., Scott, )] TJ ET BT 26.250 360.672 Td /F1 9.8 Tf [(T. W., Smith, D. L., Wint, GR. W., Golding, N., Hay, S. I. \(2015\) The global distribution of the arbovirus vectors Aedes aegypti )] TJ ET BT 26.250 348.768 Td /F1 9.8 Tf [(and Ae. albopictus. eLife 10.7554)] TJ ET BT 26.250 329.363 Td /F1 9.8 Tf [(12.)] TJ ET BT 43.553 329.363 Td /F1 9.8 Tf [(Nunes MR, Faria NR, de Vasconcelos JM, Golding N, Kraemer MU, et al. \(2015\) Emergence and potential for spread of )] TJ ET BT 26.250 317.458 Td /F1 9.8 Tf [(Chikungunya virus in Brazil. BMC Med 13: 102.)] TJ ET BT 26.250 298.053 Td /F1 9.8 Tf [(13.)] TJ ET BT 43.553 298.053 Td /F1 9.8 Tf [(Parreira R, Centeno-Lima S, Lopes A, Portugal-Calisto D, Constantino A, et al. \(2014\) Dengue virus serotype 4 and )] TJ ET BT 26.250 286.149 Td /F1 9.8 Tf [(chikungunya virus coinfection in a traveller returning from Luanda, Angola, January 2014. Euro Surveill 19)] TJ ET BT 26.250 266.744 Td /F1 9.8 Tf [(14.)] TJ ET BT 43.553 266.744 Td /F1 9.8 Tf [(Jaenisch T, Junghanss T, Wills B, Brady OJ, Eckerle I, et al. \(2014\) Dengue expansion in Africa-not recognized or not )] TJ ET BT 26.250 254.839 Td /F1 9.8 Tf [(happening? Emerg Infect Dis 20)] TJ ET BT 26.250 235.434 Td /F1 9.8 Tf [(15.)] TJ ET BT 43.553 235.434 Td /F1 9.8 Tf [(Filipe AF, Pinto MR. Arbovirus studies in Luanda, Angola. 2. Virological and serological studies during an outbreak of )] TJ ET BT 26.250 223.530 Td /F1 9.8 Tf [(dengue-like disease caused by the Chikungunya virus. Bull World Health Organ. 1973;49\(1\):37-40)] TJ ET BT 26.250 204.125 Td /F1 9.8 Tf [(16.)] TJ ET BT 43.553 204.125 Td /F1 9.8 Tf [(BRASIL \(2016\) Monitoramento dos casos de dengue e febre de chikungunya at a Semana Epidemiolgica 52, 2015: )] TJ ET BT 26.250 192.220 Td /F1 9.8 Tf [(Secretaria de Vigilncia em Sade ? Ministrio da Sade. vol 43, 3:1-8)] TJ ET BT 26.250 172.815 Td /F1 9.8 Tf [(17.)] TJ ET BT 43.553 172.815 Td /F1 9.8 Tf [(Nunes MR, Faria NR, Vasconcelos HB, Medeiros DB, Silva de Lima CP, et al. \(2012\) Phylogeography of dengue virus )] TJ ET BT 26.250 160.911 Td /F1 9.8 Tf [(serotype 4, Brazil, 2010-2011. Emerg Infect Dis 18: 1858-1864.)] TJ ET BT 26.250 141.506 Td /F1 9.8 Tf [(18.)] TJ ET BT 43.553 141.506 Td /F1 9.8 Tf [(Nunes MR, Palacios G, Faria NR, Sousa EC, Jr., Pantoja JA, et al. \(2014\) Air travel is associated with intracontinental )] TJ ET BT 26.250 129.601 Td /F1 9.8 Tf [(spread of dengue virus serotypes 1-3 in Brazil. PLoS Negl Trop Dis 8: e2769.)] TJ ET BT 26.250 110.196 Td /F1 9.8 Tf [(19.)] TJ ET BT 43.553 110.196 Td /F1 9.8 Tf [(Campos GS, Bandeira AC, Sardi SI. Zika Virus Outbreak, Bahia, Brazil. Emerg Infect Dis. 2015 Oct;21\(10\):1885-6)] TJ ET BT 26.250 90.792 Td /F1 9.8 Tf [(20.)] TJ ET BT 43.553 90.792 Td /F1 9.8 Tf [(Feira de Santana, Secretaria Municipal de Sade, Boletim Epidemiolgico. Ed. 15, 2015. Available at )] TJ ET BT 26.250 78.887 Td /F1 9.8 Tf [(www.feiradesantana.ba.gov.br. Accessed on 17/09/2015.)] TJ ET BT 26.250 59.482 Td /F1 9.8 Tf [(21.)] TJ ET BT 43.553 59.482 Td /F1 9.8 Tf [(Lourenco J, Recker M \(2014\) The 2012 Madeira dengue outbreak: epidemiological determinants and future epidemic )] TJ ET BT 26.250 47.577 Td /F1 9.8 Tf [(potential. PLoS Negl Trop Dis 8: e3083.)] TJ ET Q q 15.000 37.696 577.500 739.304 re W n 0.271 0.267 0.267 rg BT 26.250 750.278 Td /F4 12.0 Tf [(Acknowledgements)] TJ ET BT 26.250 730.324 Td /F1 9.8 Tf [(We thank the organisers and participants of a symposium held in July 2015 by the Municipal Health Services in Feira de )] TJ ET BT 26.250 718.419 Td /F1 9.8 Tf [(Santana, and to Atlio Moreira \(SEOMA, Salvador, Bahia\).)] TJ ET BT 26.250 689.317 Td /F4 12.0 Tf [(References)] TJ ET BT 26.250 661.863 Td /F1 9.8 Tf [(1.)] TJ ET BT 38.132 661.863 Td /F1 9.8 Tf [(Voss JE, Vaney MC, Duquerroy S, Vonrhein C, Girard-Blanc C, et al. \(2010\) Glycoprotein organization of Chikungunya virus )] TJ ET BT 26.250 649.958 Td /F1 9.8 Tf [(particles revealed by X-ray crystallography. Nature 468: 709-712.)] TJ ET BT 26.250 630.553 Td /F1 9.8 Tf [(2.)] TJ ET BT 38.132 630.553 Td /F1 9.8 Tf [(Tsetsarkin KA, Chen R, Sherman MB, Weaver SC \(2011\) Chikungunya virus: evolution and genetic determinants of )] TJ ET BT 26.250 618.648 Td /F1 9.8 Tf [(emergence. Curr Opin Virol 1: 310-317.)] TJ ET BT 26.250 599.244 Td /F1 9.8 Tf [(3.)] TJ ET BT 38.132 599.244 Td /F1 9.8 Tf [(Weaver SC, Forrester NL \(2015\) Chikungunya: Evolutionary history and recent epidemic spread. Antiviral Res 120: 32-39.)] TJ ET BT 26.250 579.839 Td /F1 9.8 Tf [(4.)] TJ ET BT 38.132 579.839 Td /F1 9.8 Tf [(Weaver SC, Lecuit M \(2015\) Chikungunya virus and the global spread of a mosquito-borne disease. N Engl J Med 372: 1231-)] TJ ET BT 26.250 567.934 Td /F1 9.8 Tf [(1239.)] TJ ET BT 26.250 548.529 Td /F1 9.8 Tf [(5.)] TJ ET BT 38.132 548.529 Td /F1 9.8 Tf [(Weaver SC, Osorio JE, Livengood JA, Chen R, Stinchcomb DT \(2012\) Chikungunya virus and prospects for a vaccine. )] TJ ET BT 26.250 536.625 Td /F1 9.8 Tf [(Expert Rev Vaccines 11: 1087-1101.)] TJ ET BT 26.250 517.220 Td /F1 9.8 Tf [(6.)] TJ ET BT 38.132 517.220 Td /F1 9.8 Tf [(Schwartz O, Albert ML \(2010\) Biology and pathogenesis of chikungunya virus. Nat Rev Microbiol 8: 491-500.)] TJ ET BT 26.250 497.815 Td /F1 9.8 Tf [(7.)] TJ ET BT 38.132 497.815 Td /F1 9.8 Tf [(Sissoko D, Malvy D, Giry C, Delmas G, Paquet C, et al. \(2008\) Outbreak of Chikungunya fever in Mayotte, Comoros )] TJ ET BT 26.250 485.910 Td /F1 9.8 Tf [(archipelago, 2005-2006. Trans R Soc Trop Med Hyg 102: 780-786.)] TJ ET BT 26.250 466.506 Td /F1 9.8 Tf [(8.)] TJ ET BT 38.132 466.506 Td /F1 9.8 Tf [(Volk SM, Chen R, Tsetsarkin KA, Adams AP, Garcia TI, et al. \(2010\) Genome-scale phylogenetic analyses of chikungunya )] TJ ET BT 26.250 454.601 Td /F1 9.8 Tf [(virus reveal independent emergences of recent epidemics and various evolutionary rates. J Virol 84: 6497-6504.)] TJ ET BT 26.250 435.196 Td /F1 9.8 Tf [(9.)] TJ ET BT 38.132 435.196 Td /F1 9.8 Tf [(Leparc-Goffart I, Nougairede A, Cassadou S, Prat C, de Lamballerie X \(2014\) Chikungunya in the Americas. Lancet 383: 514.)] TJ ET BT 26.250 415.791 Td /F1 9.8 Tf [(10.)] TJ ET BT 43.553 415.791 Td /F1 9.8 Tf [(PAHO/WHO Date MaS \(2015w - Cumulative cases\) Number of reported cases of Chikungunya Fever in the Americas - )] TJ ET BT 26.250 403.887 Td /F1 9.8 Tf [(EW3 \(January, 2016\))] TJ ET BT 26.250 384.482 Td /F1 9.8 Tf [(11.)] TJ ET BT 43.553 384.482 Td /F1 9.8 Tf [(Kraemer MUG, Sinka, M. E., Duda, K. A., Mylne, A., Shearer,F. M., Barker, C. M., Moore, C. G., Carvalho, R. G., Coelho, )] TJ ET BT 26.250 372.577 Td /F1 9.8 Tf [(G. E., Bortel, W. V., Hendrickx, G., Schaffner, F., Elyazar, I. R. F., Teng, H. J., Brady, O. J., Messina, J. P., Pigott, D., M., Scott, )] TJ ET BT 26.250 360.672 Td /F1 9.8 Tf [(T. W., Smith, D. L., Wint, GR. W., Golding, N., Hay, S. I. \(2015\) The global distribution of the arbovirus vectors Aedes aegypti )] TJ ET BT 26.250 348.768 Td /F1 9.8 Tf [(and Ae. albopictus. eLife 10.7554)] TJ ET BT 26.250 329.363 Td /F1 9.8 Tf [(12.)] TJ ET BT 43.553 329.363 Td /F1 9.8 Tf [(Nunes MR, Faria NR, de Vasconcelos JM, Golding N, Kraemer MU, et al. \(2015\) Emergence and potential for spread of )] TJ ET BT 26.250 317.458 Td /F1 9.8 Tf [(Chikungunya virus in Brazil. BMC Med 13: 102.)] TJ ET BT 26.250 298.053 Td /F1 9.8 Tf [(13.)] TJ ET BT 43.553 298.053 Td /F1 9.8 Tf [(Parreira R, Centeno-Lima S, Lopes A, Portugal-Calisto D, Constantino A, et al. \(2014\) Dengue virus serotype 4 and )] TJ ET BT 26.250 286.149 Td /F1 9.8 Tf [(chikungunya virus coinfection in a traveller returning from Luanda, Angola, January 2014. Euro Surveill 19)] TJ ET BT 26.250 266.744 Td /F1 9.8 Tf [(14.)] TJ ET BT 43.553 266.744 Td /F1 9.8 Tf [(Jaenisch T, Junghanss T, Wills B, Brady OJ, Eckerle I, et al. \(2014\) Dengue expansion in Africa-not recognized or not )] TJ ET BT 26.250 254.839 Td /F1 9.8 Tf [(happening? Emerg Infect Dis 20)] TJ ET BT 26.250 235.434 Td /F1 9.8 Tf [(15.)] TJ ET BT 43.553 235.434 Td /F1 9.8 Tf [(Filipe AF, Pinto MR. Arbovirus studies in Luanda, Angola. 2. Virological and serological studies during an outbreak of )] TJ ET BT 26.250 223.530 Td /F1 9.8 Tf [(dengue-like disease caused by the Chikungunya virus. Bull World Health Organ. 1973;49\(1\):37-40)] TJ ET BT 26.250 204.125 Td /F1 9.8 Tf [(16.)] TJ ET BT 43.553 204.125 Td /F1 9.8 Tf [(BRASIL \(2016\) Monitoramento dos casos de dengue e febre de chikungunya at a Semana Epidemiolgica 52, 2015: )] TJ ET BT 26.250 192.220 Td /F1 9.8 Tf [(Secretaria de Vigilncia em Sade ? Ministrio da Sade. vol 43, 3:1-8)] TJ ET BT 26.250 172.815 Td /F1 9.8 Tf [(17.)] TJ ET BT 43.553 172.815 Td /F1 9.8 Tf [(Nunes MR, Faria NR, Vasconcelos HB, Medeiros DB, Silva de Lima CP, et al. \(2012\) Phylogeography of dengue virus )] TJ ET BT 26.250 160.911 Td /F1 9.8 Tf [(serotype 4, Brazil, 2010-2011. Emerg Infect Dis 18: 1858-1864.)] TJ ET BT 26.250 141.506 Td /F1 9.8 Tf [(18.)] TJ ET BT 43.553 141.506 Td /F1 9.8 Tf [(Nunes MR, Palacios G, Faria NR, Sousa EC, Jr., Pantoja JA, et al. \(2014\) Air travel is associated with intracontinental )] TJ ET BT 26.250 129.601 Td /F1 9.8 Tf [(spread of dengue virus serotypes 1-3 in Brazil. PLoS Negl Trop Dis 8: e2769.)] TJ ET BT 26.250 110.196 Td /F1 9.8 Tf [(19.)] TJ ET BT 43.553 110.196 Td /F1 9.8 Tf [(Campos GS, Bandeira AC, Sardi SI. Zika Virus Outbreak, Bahia, Brazil. Emerg Infect Dis. 2015 Oct;21\(10\):1885-6)] TJ ET BT 26.250 90.792 Td /F1 9.8 Tf [(20.)] TJ ET BT 43.553 90.792 Td /F1 9.8 Tf [(Feira de Santana, Secretaria Municipal de Sade, Boletim Epidemiolgico. Ed. 15, 2015. Available at )] TJ ET BT 26.250 78.887 Td /F1 9.8 Tf [(www.feiradesantana.ba.gov.br. Accessed on 17/09/2015.)] TJ ET BT 26.250 59.482 Td /F1 9.8 Tf [(21.)] TJ ET BT 43.553 59.482 Td /F1 9.8 Tf [(Lourenco J, Recker M \(2014\) The 2012 Madeira dengue outbreak: epidemiological determinants and future epidemic )] TJ ET BT 26.250 47.577 Td /F1 9.8 Tf [(potential. PLoS Negl Trop Dis 8: e3083.)] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(4)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Outbreaks)] TJ ET Q endstream endobj 358 0 obj << /Type /Page /Parent 3 0 R /Contents 359 0 R >> endobj 359 0 obj << /Length 12268 >> stream 0.271 0.267 0.267 rg q 15.000 374.381 577.500 402.619 re W n 0.271 0.267 0.267 rg BT 26.250 759.976 Td /F1 9.8 Tf [(22.)] TJ ET BT 43.553 759.976 Td /F1 9.8 Tf [(R Core Team \(2014\). R: A language and environment for statistical computing. R Foundation for Statistical Computing, )] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(Vienna, Austria)] TJ ET BT 26.250 728.667 Td /F1 9.8 Tf [(23.)] TJ ET BT 43.553 728.667 Td /F1 9.8 Tf [(Gerardin P, Guernier V, Perrau J, Fianu A, Le Roux K, et al. \(2008\) Estimating Chikungunya prevalence in La Reunion )] TJ ET BT 26.250 716.762 Td /F1 9.8 Tf [(Island outbreak by serosurveys: two methods for two critical times of the epidemic. BMC Infect Dis 8: 99.)] TJ ET BT 26.250 697.357 Td /F1 9.8 Tf [(24.)] TJ ET BT 43.553 697.357 Td /F1 9.8 Tf [(Vega-Rua A, Zouache K, Girod R, Failloux AB, Lourenco-de-Oliveira R \(2014\) High level of vector competence of Aedes )] TJ ET BT 26.250 685.452 Td /F1 9.8 Tf [(aegypti and Aedes albopictus from ten American countries as a crucial factor in the spread of Chikungunya virus. J Virol )] TJ ET BT 26.250 673.548 Td /F1 9.8 Tf [(88\(11\):6294-306)] TJ ET BT 26.250 654.143 Td /F1 9.8 Tf [(25.)] TJ ET BT 43.553 654.143 Td /F1 9.8 Tf [(Feldstein LR, Brownstein JS, Brady OJ, Hay SI, Johansson MA \(2015\) Dengue on islands: a Bayesian approach to )] TJ ET BT 26.250 642.238 Td /F1 9.8 Tf [(understanding the global ecology of dengue viruses. Trans R Soc Trop Med Hyg 109: 303-312.)] TJ ET BT 26.250 622.833 Td /F1 9.8 Tf [(26.)] TJ ET BT 43.553 622.833 Td /F1 9.8 Tf [(Apandi Y, Nazni, W. A., Azleen, Z. A. N., Vythilingam, I., Noorazian, M. Y., Azahari, A. H., Zainah, S., Lee, H. L. \(2009\) The )] TJ ET BT 26.250 610.929 Td /F1 9.8 Tf [(first isolation of chikungunya virus from non-human primates in Malaysia. Journal of General and Molecular Virology 1: 35-39.)] TJ ET BT 26.250 591.524 Td /F1 9.8 Tf [(27.)] TJ ET BT 43.553 591.524 Td /F1 9.8 Tf [(Taylor RM, J FdC, et al. \(1946\) An epidemiological study of jungle yellow fever in an endemic area in Brazil; epidemiology of )] TJ ET BT 26.250 579.619 Td /F1 9.8 Tf [(human infections; investigation of vertebrate hosts and arthropod vectors. Am J Trop Med Hyg 26: 69.)] TJ ET BT 26.250 560.214 Td /F1 9.8 Tf [(28.)] TJ ET BT 43.553 560.214 Td /F1 9.8 Tf [(Lani R, Hassandarvish P, Chiam CW, Moghaddam E, Chu JJ, et al. \(2015\) Antiviral activity of silymarin against )] TJ ET BT 26.250 548.310 Td /F1 9.8 Tf [(chikungunya virus. Sci Rep 5: 11421.)] TJ ET BT 26.250 528.905 Td /F1 9.8 Tf [(29.)] TJ ET BT 43.553 528.905 Td /F1 9.8 Tf [(Tsetsarkin KA, Weaver SC \(2011\) Sequential adaptive mutations enhance efficient vector switching by Chikungunya virus )] TJ ET BT 26.250 517.000 Td /F1 9.8 Tf [(and its epidemic emergence. PLoS Pathog 7: e1002412.)] TJ ET BT 26.250 497.595 Td /F1 9.8 Tf [(30.)] TJ ET BT 43.553 497.595 Td /F1 9.8 Tf [(Zanluca C, de Melo VC, Mosimann AL, Dos Santos GI, Dos Santos CN, et al. \(2015\) First report of autochthonous )] TJ ET BT 26.250 485.691 Td /F1 9.8 Tf [(transmission of Zika virus in Brazil. Mem Inst Oswaldo Cruz 110: 569-572.)] TJ ET BT 26.250 466.286 Td /F1 9.8 Tf [(31.)] TJ ET BT 43.553 466.286 Td /F1 9.8 Tf [(Wesolowski A, Qureshi T, Boni MF, Sundsoy PR, Johansson MA, et al. \(2015\) Impact of human mobility on the emergence )] TJ ET BT 26.250 454.381 Td /F1 9.8 Tf [(of dengue epidemics in Pakistan. Proc Natl Acad Sci U S A.)] TJ ET BT 26.250 434.976 Td /F1 9.8 Tf [(32.)] TJ ET BT 43.553 434.976 Td /F1 9.8 Tf [(Pybus OG, Tatem AJ, Lemey P. \(2015\) Virus evolution and transmission in an ever more connected world. Proc. R. Soc. B )] TJ ET BT 26.250 423.072 Td /F1 9.8 Tf [(282: 20142878)] TJ ET BT 26.250 403.667 Td /F1 9.8 Tf [(33.)] TJ ET BT 43.553 403.667 Td /F1 9.8 Tf [(Sorichetta A, Hornby GM, Stevens FR, Gaughan AE, Linard C, et al. \(2015\) High-resolution gridded population datasets for )] TJ ET BT 26.250 391.762 Td /F1 9.8 Tf [(Latin America and the Caribbean in 2010, 2015, and 2020. Sci Data 2: 150045.)] TJ ET Q q 15.000 374.381 577.500 402.619 re W n 0.271 0.267 0.267 rg BT 26.250 759.976 Td /F1 9.8 Tf [(22.)] TJ ET BT 43.553 759.976 Td /F1 9.8 Tf [(R Core Team \(2014\). R: A language and environment for statistical computing. R Foundation for Statistical Computing, )] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(Vienna, Austria)] TJ ET BT 26.250 728.667 Td /F1 9.8 Tf [(23.)] TJ ET BT 43.553 728.667 Td /F1 9.8 Tf [(Gerardin P, Guernier V, Perrau J, Fianu A, Le Roux K, et al. \(2008\) Estimating Chikungunya prevalence in La Reunion )] TJ ET BT 26.250 716.762 Td /F1 9.8 Tf [(Island outbreak by serosurveys: two methods for two critical times of the epidemic. BMC Infect Dis 8: 99.)] TJ ET BT 26.250 697.357 Td /F1 9.8 Tf [(24.)] TJ ET BT 43.553 697.357 Td /F1 9.8 Tf [(Vega-Rua A, Zouache K, Girod R, Failloux AB, Lourenco-de-Oliveira R \(2014\) High level of vector competence of Aedes )] TJ ET BT 26.250 685.452 Td /F1 9.8 Tf [(aegypti and Aedes albopictus from ten American countries as a crucial factor in the spread of Chikungunya virus. J Virol )] TJ ET BT 26.250 673.548 Td /F1 9.8 Tf [(88\(11\):6294-306)] TJ ET BT 26.250 654.143 Td /F1 9.8 Tf [(25.)] TJ ET BT 43.553 654.143 Td /F1 9.8 Tf [(Feldstein LR, Brownstein JS, Brady OJ, Hay SI, Johansson MA \(2015\) Dengue on islands: a Bayesian approach to )] TJ ET BT 26.250 642.238 Td /F1 9.8 Tf [(understanding the global ecology of dengue viruses. Trans R Soc Trop Med Hyg 109: 303-312.)] TJ ET BT 26.250 622.833 Td /F1 9.8 Tf [(26.)] TJ ET BT 43.553 622.833 Td /F1 9.8 Tf [(Apandi Y, Nazni, W. A., Azleen, Z. A. N., Vythilingam, I., Noorazian, M. Y., Azahari, A. H., Zainah, S., Lee, H. L. \(2009\) The )] TJ ET BT 26.250 610.929 Td /F1 9.8 Tf [(first isolation of chikungunya virus from non-human primates in Malaysia. Journal of General and Molecular Virology 1: 35-39.)] TJ ET BT 26.250 591.524 Td /F1 9.8 Tf [(27.)] TJ ET BT 43.553 591.524 Td /F1 9.8 Tf [(Taylor RM, J FdC, et al. \(1946\) An epidemiological study of jungle yellow fever in an endemic area in Brazil; epidemiology of )] TJ ET BT 26.250 579.619 Td /F1 9.8 Tf [(human infections; investigation of vertebrate hosts and arthropod vectors. Am J Trop Med Hyg 26: 69.)] TJ ET BT 26.250 560.214 Td /F1 9.8 Tf [(28.)] TJ ET BT 43.553 560.214 Td /F1 9.8 Tf [(Lani R, Hassandarvish P, Chiam CW, Moghaddam E, Chu JJ, et al. \(2015\) Antiviral activity of silymarin against )] TJ ET BT 26.250 548.310 Td /F1 9.8 Tf [(chikungunya virus. Sci Rep 5: 11421.)] TJ ET BT 26.250 528.905 Td /F1 9.8 Tf [(29.)] TJ ET BT 43.553 528.905 Td /F1 9.8 Tf [(Tsetsarkin KA, Weaver SC \(2011\) Sequential adaptive mutations enhance efficient vector switching by Chikungunya virus )] TJ ET BT 26.250 517.000 Td /F1 9.8 Tf [(and its epidemic emergence. PLoS Pathog 7: e1002412.)] TJ ET BT 26.250 497.595 Td /F1 9.8 Tf [(30.)] TJ ET BT 43.553 497.595 Td /F1 9.8 Tf [(Zanluca C, de Melo VC, Mosimann AL, Dos Santos GI, Dos Santos CN, et al. \(2015\) First report of autochthonous )] TJ ET BT 26.250 485.691 Td /F1 9.8 Tf [(transmission of Zika virus in Brazil. Mem Inst Oswaldo Cruz 110: 569-572.)] TJ ET BT 26.250 466.286 Td /F1 9.8 Tf [(31.)] TJ ET BT 43.553 466.286 Td /F1 9.8 Tf [(Wesolowski A, Qureshi T, Boni MF, Sundsoy PR, Johansson MA, et al. \(2015\) Impact of human mobility on the emergence )] TJ ET BT 26.250 454.381 Td /F1 9.8 Tf [(of dengue epidemics in Pakistan. Proc Natl Acad Sci U S A.)] TJ ET BT 26.250 434.976 Td /F1 9.8 Tf [(32.)] TJ ET BT 43.553 434.976 Td /F1 9.8 Tf [(Pybus OG, Tatem AJ, Lemey P. \(2015\) Virus evolution and transmission in an ever more connected world. Proc. R. Soc. B )] TJ ET BT 26.250 423.072 Td /F1 9.8 Tf [(282: 20142878)] TJ ET BT 26.250 403.667 Td /F1 9.8 Tf [(33.)] TJ ET BT 43.553 403.667 Td /F1 9.8 Tf [(Sorichetta A, Hornby GM, Stevens FR, Gaughan AE, Linard C, et al. \(2015\) High-resolution gridded population datasets for )] TJ ET BT 26.250 391.762 Td /F1 9.8 Tf [(Latin America and the Caribbean in 2010, 2015, and 2020. Sci Data 2: 150045.)] TJ ET Q q 15.000 374.381 577.500 402.619 re W n 0.271 0.267 0.267 rg BT 26.250 759.976 Td /F1 9.8 Tf [(22.)] TJ ET BT 43.553 759.976 Td /F1 9.8 Tf [(R Core Team \(2014\). R: A language and environment for statistical computing. R Foundation for Statistical Computing, )] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(Vienna, Austria)] TJ ET BT 26.250 728.667 Td /F1 9.8 Tf [(23.)] TJ ET BT 43.553 728.667 Td /F1 9.8 Tf [(Gerardin P, Guernier V, Perrau J, Fianu A, Le Roux K, et al. \(2008\) Estimating Chikungunya prevalence in La Reunion )] TJ ET BT 26.250 716.762 Td /F1 9.8 Tf [(Island outbreak by serosurveys: two methods for two critical times of the epidemic. BMC Infect Dis 8: 99.)] TJ ET BT 26.250 697.357 Td /F1 9.8 Tf [(24.)] TJ ET BT 43.553 697.357 Td /F1 9.8 Tf [(Vega-Rua A, Zouache K, Girod R, Failloux AB, Lourenco-de-Oliveira R \(2014\) High level of vector competence of Aedes )] TJ ET BT 26.250 685.452 Td /F1 9.8 Tf [(aegypti and Aedes albopictus from ten American countries as a crucial factor in the spread of Chikungunya virus. J Virol )] TJ ET BT 26.250 673.548 Td /F1 9.8 Tf [(88\(11\):6294-306)] TJ ET BT 26.250 654.143 Td /F1 9.8 Tf [(25.)] TJ ET BT 43.553 654.143 Td /F1 9.8 Tf [(Feldstein LR, Brownstein JS, Brady OJ, Hay SI, Johansson MA \(2015\) Dengue on islands: a Bayesian approach to )] TJ ET BT 26.250 642.238 Td /F1 9.8 Tf [(understanding the global ecology of dengue viruses. Trans R Soc Trop Med Hyg 109: 303-312.)] TJ ET BT 26.250 622.833 Td /F1 9.8 Tf [(26.)] TJ ET BT 43.553 622.833 Td /F1 9.8 Tf [(Apandi Y, Nazni, W. A., Azleen, Z. A. N., Vythilingam, I., Noorazian, M. Y., Azahari, A. H., Zainah, S., Lee, H. L. \(2009\) The )] TJ ET BT 26.250 610.929 Td /F1 9.8 Tf [(first isolation of chikungunya virus from non-human primates in Malaysia. Journal of General and Molecular Virology 1: 35-39.)] TJ ET BT 26.250 591.524 Td /F1 9.8 Tf [(27.)] TJ ET BT 43.553 591.524 Td /F1 9.8 Tf [(Taylor RM, J FdC, et al. \(1946\) An epidemiological study of jungle yellow fever in an endemic area in Brazil; epidemiology of )] TJ ET BT 26.250 579.619 Td /F1 9.8 Tf [(human infections; investigation of vertebrate hosts and arthropod vectors. Am J Trop Med Hyg 26: 69.)] TJ ET BT 26.250 560.214 Td /F1 9.8 Tf [(28.)] TJ ET BT 43.553 560.214 Td /F1 9.8 Tf [(Lani R, Hassandarvish P, Chiam CW, Moghaddam E, Chu JJ, et al. \(2015\) Antiviral activity of silymarin against )] TJ ET BT 26.250 548.310 Td /F1 9.8 Tf [(chikungunya virus. Sci Rep 5: 11421.)] TJ ET BT 26.250 528.905 Td /F1 9.8 Tf [(29.)] TJ ET BT 43.553 528.905 Td /F1 9.8 Tf [(Tsetsarkin KA, Weaver SC \(2011\) Sequential adaptive mutations enhance efficient vector switching by Chikungunya virus )] TJ ET BT 26.250 517.000 Td /F1 9.8 Tf [(and its epidemic emergence. PLoS Pathog 7: e1002412.)] TJ ET BT 26.250 497.595 Td /F1 9.8 Tf [(30.)] TJ ET BT 43.553 497.595 Td /F1 9.8 Tf [(Zanluca C, de Melo VC, Mosimann AL, Dos Santos GI, Dos Santos CN, et al. \(2015\) First report of autochthonous )] TJ ET BT 26.250 485.691 Td /F1 9.8 Tf [(transmission of Zika virus in Brazil. Mem Inst Oswaldo Cruz 110: 569-572.)] TJ ET BT 26.250 466.286 Td /F1 9.8 Tf [(31.)] TJ ET BT 43.553 466.286 Td /F1 9.8 Tf [(Wesolowski A, Qureshi T, Boni MF, Sundsoy PR, Johansson MA, et al. \(2015\) Impact of human mobility on the emergence )] TJ ET BT 26.250 454.381 Td /F1 9.8 Tf [(of dengue epidemics in Pakistan. Proc Natl Acad Sci U S A.)] TJ ET BT 26.250 434.976 Td /F1 9.8 Tf [(32.)] TJ ET BT 43.553 434.976 Td /F1 9.8 Tf [(Pybus OG, Tatem AJ, Lemey P. \(2015\) Virus evolution and transmission in an ever more connected world. Proc. R. Soc. B )] TJ ET BT 26.250 423.072 Td /F1 9.8 Tf [(282: 20142878)] TJ ET BT 26.250 403.667 Td /F1 9.8 Tf [(33.)] TJ ET BT 43.553 403.667 Td /F1 9.8 Tf [(Sorichetta A, Hornby GM, Stevens FR, Gaughan AE, Linard C, et al. \(2015\) High-resolution gridded population datasets for )] TJ ET BT 26.250 391.762 Td /F1 9.8 Tf [(Latin America and the Caribbean in 2010, 2015, and 2020. 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