Establishment and cryptic transmission of Zika virus in Brazil and the Americas

Transmission of Zika virus (ZIKV) in the Americas was first confirmed in May 2015 in northeast Brazil1. Brazil has had the highest number of reported ZIKV cases worldwide (more than 200,000 by 24 December 20162) and the most cases associated with microcephaly and other birth defects (2,366 confirmed by 31 December 20162). Since the initial detection of ZIKV in Brazil, more than 45 countries in the Americas have reported local ZIKV transmission, with 24 of these reporting severe ZIKV-associated disease3. However, the origin and epidemic history of ZIKV in Brazil and the Americas remain poorly understood, despite the value of this information for interpreting observed trends in reported microcephaly. Here we address this issue by generating 54 complete or partial ZIKV genomes, mostly from Brazil, and reporting data generated by a mobile genomics laboratory that travelled across northeast Brazil in 2016. One sequence represents the earliest confirmed ZIKV infection in Brazil. Analyses of viral genomes with ecological and epidemiological data yield an estimate that ZIKV was present in northeast Brazil by February 2014 and is likely to have disseminated from there, nationally and internationally, before the first detection of ZIKV in the Americas. Estimated dates for the international spread of ZIKV from Brazil indicate the duration of pre-detection cryptic transmission in recipient regions. The role of northeast Brazil in the establishment of ZIKV in the Americas is further supported by geographic analysis of ZIKV transmission potential and by estimates of the basic reproduction number of the virus

Stratification, mixing and transport processes in Lake Kivu

This chapter summarizes the knowledge on mixing and transport processes in Lake Kivu. Seasonal mixing, which varies in intensity from year to year, influences the top â¼65 m. Below, the lake is permanently stratified, with density increasing stepwise from â¼998 kg mâ3 at the surface to â¼1,002 kg mâ3 at the maximum depth of 485 m. The permanently stratified deep water is divided into two distinctly different zones by a main gradient layer. This gradient is maintained by a strong inflow of relatively fresh and cool water entering at â¼250 m depth which is the most important of several subaquatic springs affecting the density stratification. The springs drive a slow upwelling of the whole water column with a depth-dependent rate of 0.15â0.9 m yearâ1. This upwelling is the main driver of internal nutrient recycling and upward transport of dissolved gases. Diffusive transport in the deep water is dominated by double-diffusive convection, which manifests in a spectacular staircase of more than 300 steps and mixed layers. Double diffusion allows heat to be removed from the deep zone faster than dissolved substances, supporting the stable stratification and the accumulation of nutrients and gases over hundreds of years. The stratification in the lake seems to be near steady-state conditions, except for a warming trend of â¼0.01°C yearâ1

Drug insight: aspirin resistance- fact or fashion

The term aspirin resistance has been used increasingly in clinical studies. The aim of this Review is to analyze the origin of this term, to discuss the biochemical, functional and clinical correlates of the phenomenon and to offer a conceptual framework to redefine the major determinants of variability between individuals in response to aspirin. Awareness needs to be increased of factors that might interfere with the desired antiplatelet effect of aspirin, particularly in terms of patients' adherence to treatment and avoidable drug interactions with some traditional NSAIDs. Gaining such knowledge could result in improved care of patients and might avoid the requesting of unnecessary platelet function tests of unproven clinical significance