The focus of this work is on small municipalities (population below 50 thousand inhabitants) that cover around 87% of the territory of the Brazilian Legal Amazon (BLA). Based on a comprehensive integrated analysis approach using the three components hazard (climate extremes from CMIP6 future scenarios), exposure (directly affected population), and vulnerability (subdimensions of susceptibility and coping/adaptive capacity by using multidimensional indicators), the latter two using current datasets provided by the official Census IBGE 2022, we document a quantitative assessment of the risk R of natural disasters in the BLA region. We evidenced a worrying and imminent intensification of the curve of R in most Amazonian municipalities over the next two 25-year periods. The overall results of the highest proportions of R (total municipalities affected) pointed out the Amazonas, Roraima, Pará, and Maranhão as the main states, presenting projected categories of R high in the near future (2015 to 2039) and very high in the far future (2040 to 2064). The detailed assessment of the susceptibility and coping/adaptive capacity allowed us to elucidate the principal indicators that aggravate the degree of vulnerability: economy, the precariousness of urban infrastructure, medical services, communication, and urban mobility, whose combined factors, unfortunately, reveal a widespread poverty profile along the small Amazonian municipalities. Our scientific findings can assist decision makers in targeted strategies planning and public policies to minimize and mitigate ongoing and future climate change.

Background: The Amazon biome exhibits complex arboviral transmission dynamics influenced by accelerating deforestation, climate change, and socioeconomic inequities. Objectives/Methods: This study integrates official epidemiological records with socioeconomic, environmental, and climate variables by applying advanced geostatistical methods (Moran’s I, SaTScan, kernel density estimation) combined with principal component analysis and negative binomial regression to assess the spatiotemporal dynamics of dengue incidence and its association with socio-environmental determinants across municipalities in Pará state (eastern Brazilian Amazon) from 2010 to 2024. Results: Dengue incidence showed an overall decline but with marked epidemic peaks in 2010–2012, 2016, and 2024. The spatial analysis revealed significant clustering (Moran’s I = 0.221, p < 0.01), with persistent high-risk hotspots across most of Pará. Of 144 municipalities, 104 exhibited significant dengue risk, while 58 maintained sustained transmission. Negative binomial regression model identified key determinants: illiteracy, low urbanization, reduced GDP, and climate variables. Conclusions: Dengue transmission in the Amazon is driven by synergistic socio-environmental disruptions, necessitating intersectoral policies that bridge public health surveillance, sustainable land-use governance, and poverty alleviation. Priority actions include targeted vector control in high-risk clusters, coupled with integrated deforestation and climate monitoring to predict outbreak risks. The findings emphasize the urgency of implementing multisectoral interventions tailored to the territorial and socio-environmental complexities of vulnerable Amazonian regions for effective dengue control.

Background: The Amazon region possesses vast natural and anthropogenic ecosystems within a hydroclimatic environment conducive to the proliferation of arboviruses associated with infectious diseases in the human population, notably dengue fever, which poses a recurrent and significant public health challenge. Objective and Methods: We wished to update the dengue mapping for the state of Pará (eastern Amazon) using municipality-level secondary data between 2010 and 2024, including epidemiological information. Furthermore, the seasonal effects of soil and atmospheric meteorological variables (ERA5 reanalysis) on the annual municipal incidence of dengue were statistically analyzed through correlation and cluster-based regression methods. Results: Dengue mapping identified key areas over the central, southwest, and southeast parts of Pará, with eleven municipalities exhibiting extreme dengue counts exceeding 300 cases per 100,000 inhabitants. The epidemiological profile in these cities with worsening transmission showed a higher incidence in adults aged 20–39 years old (39%) and a predominance among women (54%). The majority of dengue cases occur during the rainy season (January to May), accounting for 69% of annual cases, when the climate conditions maximize vector proliferation. The statistical analyses highlighted the significant and spatially heterogeneous influence of regional climate variables on the dengue transmission cycle. Conclusions: This study advances our understanding of climatic drivers of dengue in the Amazon and provides relevant evidence to support region-specific surveillance and control strategies.

One of the main gaps in characterizing the congenital Zika syndrome (CZS) up to now is the small number of participants in individual studies. Pooling the data together overcomes the sample size-related limitations of individual studies and provides an opportunity for investigating heterogeneity between studies and, as appropriate, to better characterize the CZS . This study aims to describe adverse anthropometric, clinical, and neuroimaging outcomes in Brazilian children with Zika-related microcephaly.Individual participant data meta-analysis of 12 cohorts of the Zika Brazilian Cohorts Consortium (ZBC-Consortium), using primary data from children with Zika-related microcephaly, born between January/2015 and July/2018. We included 843 children with microcephaly at birth, at first evaluation, or over follow-up. Of 601 children with microcephaly at birth, 217 (36.1%) had moderate and 384 (63.9%) had severe microcephaly. Postnatal microcephaly occurred in 172 (20.4%) children. There was heterogeneity across studies. Severe microcephaly ranged from 11-87.5%; prematurity from 10-20% in most sites; low birth weight from 10-43.8%. Deficit of social attention, hyperreflexia, and persistence of primitive reflexes were reported in at least 50% of the children in the larger cohorts. Epilepsy ranged from 30-80% of the children and dysphagia, from 22.2-67.7%. Calcifications and ventriculomegaly were the most consistent and frequent abnormality (around 80%). Cortical atrophy or other development disorders were reported in around 50% of the children. The frequency of fundal, optical nerve and hearing abnormalities ranged from 0-67.1%, 0-36.5% and 0–50%, respectively. This large sample size allowed us to describe the spectrum of severity and of manifestations of Congenital Zika Syndrome.