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Proc Natl Acad Sci U S A. 2015 Oct 20;112(42):13069-74. doi: 10.1073/pnas.1501375112. Epub 2015 Oct 5.

Region-wide synchrony and traveling waves of dengue across eight countries in Southeast Asia.

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Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15261;
Laboratoire Maladies Infectieuses et Vecteurs Écologie, Génétique, Évolution et Controle, Unité Mixte de Recherche 224 Centre National de la Recherche Scientifique-Institut de Recherche pour le Développement-Université de Montpellier, Institut de Recherche pour le Développement Montpellier, 34394 Montpellier, France; Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, National Hospital for Tropical Diseases, Hanoi 100000, Vietnam;
Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15261;
Bureau of Epidemiology, Thailand Ministry of Public Health, Bangkok 10220, Thailand;
High Impact Research, University of Malaya, 50603 Kuala Lumpur, Malaysia;
Disease Control Division, Malaysia Ministry of Health, 62590 Putrajaya, Malaysia;
Western Sussex Hospitals National Health Service Trust, Worthing Hospital, West Sussex BN11 2DH, United Kingdom;
Department of Communicable Disease Control, Ministry of Health, Vientiane 0100, Lao People's Democratic Republic;
National Center for Laboratory and Epidemiology, Ministry of Health, Vientiane 0100, Lao People's Democratic Republic;
National Dengue Control Program, Cambodia Ministry of Health, Phnom Penh 12000, Cambodia;
Department of Epidemiology, Vietnam National Institute of Hygiene and Epidemiology, Hanoi 100000, Vietnam;
Centers for Disease Control, Taiwan Ministry of Health and Welfare, Taipei City 10050, Taiwan;
Environmental Health Institute, Singapore National Environment Agency, Singapore 228231;
National Epidemiology Center, Philippines Department of Health, Manila 1003, Philippines;
National Center for Disease Prevention and Control, Philippines Department of Health, Manila 1003, Philippines;
Viral Disease Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910;
Department of Virology, US Armed Forces Research Institute of Medical Sciences, Bangkok 10400, Thailand;
Dengue Vaccine Initiative, International Vaccine Institute, Seoul, 08826 Korea;
Department of Biology, University of Florida, Gainesville, FL 32610; Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610.


Dengue is a mosquito-transmitted virus infection that causes epidemics of febrile illness and hemorrhagic fever across the tropics and subtropics worldwide. Annual epidemics are commonly observed, but there is substantial spatiotemporal heterogeneity in intensity. A better understanding of this heterogeneity in dengue transmission could lead to improved epidemic prediction and disease control. Time series decomposition methods enable the isolation and study of temporal epidemic dynamics with a specific periodicity (e.g., annual cycles related to climatic drivers and multiannual cycles caused by dynamics in population immunity). We collected and analyzed up to 18 y of monthly dengue surveillance reports on a total of 3.5 million reported dengue cases from 273 provinces in eight countries in Southeast Asia, covering ∼ 10(7) km(2). We detected strong patterns of synchronous dengue transmission across the entire region, most markedly during a period of high incidence in 1997-1998, which was followed by a period of extremely low incidence in 2001-2002. This synchrony in dengue incidence coincided with elevated temperatures throughout the region in 1997-1998 and the strongest El Niño episode of the century. Multiannual dengue cycles (2-5 y) were highly coherent with the Oceanic Niño Index, and synchrony of these cycles increased with temperature. We also detected localized traveling waves of multiannual dengue epidemic cycles in Thailand, Laos, and the Philippines that were dependent on temperature. This study reveals forcing mechanisms that drive synchronization of dengue epidemics on a continental scale across Southeast Asia.


Southeast Asia; dengue; dynamics; epidemiology; surveillance data

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