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Zika virus (ZIKV) infections have impacted public health in Brazil since 2015, primally due to Congenital Zika Virus Syndrome (CZVS) cases, which may lead to microcephaly and other clinical manifestations, such as hearing and visual impairments. More than ten years after the first diagnosis of Zika in Brazil, some progress has been made and the epidemiological scenario has improved considerably. However, despite these advances, more than a thousand ZIKV infections are reported annually in Brazil and new CZVS cases continue to be observed. Herein, we performed a retrospective and prospective analysis to assess the progress made and identify gaps and challenges that still need to be addressed. Overall, we believe that future ZIKV control efforts in Brazil must include: enhanced vector control measures; surveillance for potential vertebrate reservoirs; medical care for pregnant women, including prevention of infection and vertical transmission; sensitive and specific intrauterine CZVS diagnosis; ongoing support for children and families with CZVS cases; expansion of the national diagnostic network for arboviruses, including encouraging healthcare professionals to perform laboratory tests; assessment of the impactof the dengue vaccine, recently implemented in Brazil, on ZIKV infections; and affordable, sensitive and specific multiplex diagnostic strategies adequately validated for cross-reactivity with other arboviruses circulating in Brazil.

Background In 2024, Brazil experienced its largest dengue virus (DENV) epidemic alongside the widest spread of Oropouche virus (OROV) to date. This scenario may have strongly impacted public health surveillance efforts, as DENV and OROV infections often lead to similar clinical signs and symptoms, making clinical differential diagnosis challenging. Herein, we investigated whether the co-circulation of DENV and OROV in Brazil in 2024 may have hampered OROV detection and tracking, potentially contributing to possible underdiagnosis. Methods The number of confirmed cases of dengue and Oropouche in 2024, as well as the probable states of infection, were collected on June 9, 2025, from the Brazilian Ministry of Health database. For dengue, cases were analyzed according to the diagnostic approach: laboratory testing or diagnosis by clinical-epidemiological criteria. All Oropouche cases considered here were confirmed by laboratory testing. Finally, dengue and Oropouche cases were grouped by state and epidemiological week, and their temporal-spatial overlap was assessed to discuss its potential negative effect on OROV reporting. Results A total of 5,956,257 dengue cases were recorded in Brazil, of which only 2,191,326 were laboratory confirmed. All states, including the Federal District, registered dengue cases, with highest number in São Paulo and Minas Gerais states (Southeast region). Dengue peaks occurred in early 2024 for Brazil overall and for individual states. Regarding Oropouche, 13,856 cases were recorded in 22 states, the majority in Espírito Santo (Southeast region) and Amazonas (North region). Oropouche cases in Brazil (total cases) showed two peaks: a smaller one at the beginning of 2024 and a higher one at the end of the year. On the other hand, OROV peaked in different periods depending on the state analyzed. In general, Oropouche cases were described close to the dengue reporting period, mainly in Amazonas, Pará and Rondônia states (northern Brazil), where there was evident overlap between the dengue and Oropouche curves. Conclusion DENV and OROV co-circulated in most of Brazil in 2024. Furthermore, most dengue diagnoses were based on clinical-epidemiological criteria. This approach, combined with the clinical and temporal-spatial overlap between dengue and Oropouche cases, may have contributed to misdiagnoses, potentially hindering OROV detection and tracking. These findings reinforce the importance of laboratory testing for accurate arbovirus identification and surveillance in Brazil.

BackgroundInfectious intracranial aneurysms (IIAs) are highly morbid vascular lesions, and the comparative effectiveness of medical management (MM), surgery, and endovascular treatment (EVT) remains uncertain.ObjectiveTo perform a systematic review and network meta-analysis comparing the three main interventions for IIAs: MM, open surgery, and EVT.MethodsA systematic review and frequentist network meta-analysis were conducted. Studies comparing MM, open surgery, and EVT in patients with IIAs were included. The primary outcome was treatment success, defined according to study-specific definitions and operationally harmonized as the absence of treatment failure. Secondary outcomes included mortality, rupture or re-rupture, recurrence, neurological deficits, and complications. Random-effects models estimated odds ratios (ORs) with 95% confidence intervals (CIs). Treatment ranking was assessed using P scores, and heterogeneity was quantified using I².ResultsThirteen observational studies were included. In an exploratory network meta-analysis, both EVT (OR=2.51; 95% CI 1.22 to 5.15) and surgery (OR=7.29; 95% CI 2.00 to 26.55) were associated with higher odds of treatment success compared with MM. EVT was associated with a lower risk of aneurysm rupture or re-rupture compared with MM (OR=0.42; 95% CI 0.18 to 0.96), whereas no statistically significant differences were observed between EVT and surgery. Given the non-randomized nature of the evidence and methodological heterogeneity across studies, these findings should be interpreted with caution.ConclusionsEVT and surgery were associated with higher odds of treatment success compared with MM, whereas EVT was additionally associated with a lower risk of rupture or re-rupture. These findings should be interpreted cautiously given the observational nature of the available evidence.