To elucidate the pathogenesis of eastern equine encephalitis (EEE) virus infections, we used histopathology, immunohistochemistry, and in situ hybridization to track the spread and early cellular targets of viral infection in mice. Young mice were inoculated with virulent EEE virus in their right rear footpad and were followed in a time-course study for 4 days. Virulent EEE virus produced a biphasic illness characterized by an early self-limiting replication phase in peripheral tissues followed by an invariably fatal central nervous system (CNS) phase. In the early extraneural phase, there was primary amplifying replication of virus within fibroblasts at the inoculation site and within osteoblasts in active growth areas of bone that resulted in a transient high-titer viremia. Pathological changes and viral infection were observed as early as 12 hours post-infection (PI) in osteoblasts, skeletal muscle myocytes, and in fibroblasts along fascial sheaths. The severity and extent of infection in peripheral tissues peaked at day 1 PI. In the neural phase of infection, virus was first detected in the brain on day 1 PI, with rapid interneuronal spread of infection leading to death by day 4 PI. EEE virus appeared to be directly cytopathic for neurons. The very rapid onset and apparently random and widely dispersed infection in the CNS, with concurrent sparing of olfactory neuroepithelium, strongly suggests that invasion of the CNS by EEE occurs by a vascular route, rather than via peripheral nerves or the olfactory neuroepithelium. Our finding that metaphyseal osteoblasts are an early site of amplifying viral replication may explain the higher-titer viremias and higher incidence of neuroinvasion and fulminant encephalitis seen in the young, and may also explain why mature animals become refractory to encephalitis after peripheral inoculation with EEE virus. Eastern equine encephalitis (EEE) virus is a singlestranded RNA virus in the genus Alphavirus (family Togaviridae) that can cause a severe mosquito-borne encephalitis in humans, horses, and game birds. 1 In North America, EEE virus is prevalent in freshwater swamps along the Atlantic and Gulf coasts of the United States where both its mosquito vector, Culiseta melanura, and its passerine bird reservoir hosts live. 2 The virus has a very wide host range, but as Culiseta mosquitoes rarely feed on mammalian hosts, other bridging mosquito species actually transmit the virus from infected birds to horses, and occasionally, to humans. Most EEE infections in humans are inapparent or produce a low-grade fever followed by malaise, arthralgia, and myalgia. However, in some cases, EEE virus crosses the blood-brain barrier and causes a severe, and often fatal, acute encephalitis, which kills 50 to 75% of infected humans and leaves many survivors with serious neurological sequelae. 1,3 It has long been recognized that EEE infection in children tends to have a more rapid onset and to be more severe. Goldfield et al reported that one in eight young children developed fulminant ence...