{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T17:54:34Z","timestamp":1791309274904,"version":"4.3.1"},"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.ploscompbiol.org"],"crossmark-restriction":false},"short-container-title":["PLoS Comput Biol"],"abstract":"\n Introduction<\/jats:title>\n \n Human mobility across the Brazilian Amazon\u2014shaped by frontier development, land-use change, mining activity, and climatic shocks\u2014remains a major barrier to malaria elimination. Brazil aims to eliminate\n Plasmodium falciparum (Pf)<\/jats:italic>\n by 2030 and\n Plasmodium vivax (Pv)<\/jats:italic>\n by 2035, yet malaria incidence has plateaued since 2020. We quantify parasite-specific mobility and assess how importations drive malaria reintroduction and reestablishment in areas approaching elimination.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We analyzed 5,521,411 de-identified malaria cases from Sivep-Malaria (2003\u20132023) across 808 municipalities in the nine-state Brazilian Amazon. We (i) used multivariable monthly sequence analysis to classify \u201cMunicipal Malaria Importation Trajectories\u201d (MMITs) using local\/imported composition, incidence per 1,000, and source\/sink network typologies; (ii) characterized mobility networks by parasite species and locality type (rural, urban, settlement, indigenous, mining); and (iii) developed a parasite-specific rule-based classification procedure to identify reintroduction, and defined reestablishment as sustained local transmission.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Sequence analysis produced five MMIT clusters, spanning municipalities nearing elimination to areas with sustained high local transmission and distinct profiles of declining transmission with intense vs. moderate importation. Overall, 959,281 cases (17.38%) were imported. Cases were predominantly\n Pv<\/jats:italic>\n (81.68%), with\n Pf<\/jats:italic>\n comprising 17.15%;\n Pf<\/jats:italic>\n was more common among imported than locally acquired infections. Mobility patterns shifted after mid-2020: by 2023,\u2009>\u200950% of exported cases originated in mining localities despite ~0.2% land coverage, with\n Pf<\/jats:italic>\n importation increasingly concentrated in municipalities overlapping the Yanomami Indigenous Land. From 2006\u20132023, we identified 63\n Pf<\/jats:italic>\n and 221\n Pv<\/jats:italic>\n reintroduced locally acquired cases following \u22653 years of zero local transmission, leading to reestablishment in 6 and 23 municipalities, respectively, and generating 864 subsequent\n Pf<\/jats:italic>\n and 6,524 subsequent\n Pv<\/jats:italic>\n cases. Post-reintroduction transmission persisted for long periods (mean 762 days for\n Pf<\/jats:italic>\n ; 815 days for\n Pv<\/jats:italic>\n ).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Malaria elimination in Brazil is increasingly hindered by parasite-specific mobility, especially linked to mining\u2013indigenous confluences, and by repeated reintroduction in receptive municipalities nearing elimination (notably along the arc of deforestation). Mobility-informed surveillance and targeted reactive strategies are essential to achieve and sustain Brazil\u2019s malaria elimination goals.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pcbi.1014843","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T17:32:31Z","timestamp":1791307951000},"page":"e1014843","update-policy":"https:\/\/doi.org\/10.1371\/journal.pcbi.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mobility hinders malaria elimination goals in the Brazilian Amazon"],"prefix":"10.1371","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7794-3424","authenticated-orcid":true,"given":"Nicholas J.","family":"Arisco","sequence":"first","affiliation":[{"name":"Center for Environmental Studies, Williams College","place":["Williamstown, Massachusetts, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo S.","family":"Fontoura","sequence":"additional","affiliation":[{"name":"National Malaria Prevention and Control Program \u2013 Ministry of Health of Brazil","place":["Bras\u00edlia, Distrito Federal, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassio","family":"Peterka","sequence":"additional","affiliation":[{"name":"Minist\u00e9rio da Sa\u00fade","place":["Bras\u00edlia, Distrito Federal, Brazil"],"department":["Secretaria de Vigil\u00e2ncia em Sa\u00fade e Ambiente"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4606-2795","authenticated-orcid":true,"given":"Marcia C.","family":"Castro","sequence":"additional","affiliation":[{"name":"Harvard T.H. 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