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Open Access Highly Accessed Research article

The influence of geographic and climate factors on the timing of dengue epidemics in Perú, 1994-2008

Gerardo Chowell12*, Bernard Cazelles34, Hélène Broutin25 and Cesar V Munayco6

Author Affiliations

1 Mathematical and Computational Modeling Sciences Center, School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, USA

2 Division of Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA

3 UMR 7625, UPMC-CNRS-ENS, Ecole Normale Superieure, 46 rue d'Ulm, 75230, Paris cedex 05, France

4 UMMISCO, UMI 209, IRD-UPMC, 32 avenue Henri Varagnat, 93142 Bondy cedex, France

5 MIVEGEC, UMR CNRS 5290-IRD 224-UM1-UM2, 911 Avenue Agropolis, BP 64501, 34394 Montpellier Cédex 5, France

6 Dirección General de Epidemiología, Ministry of Health. Calle Rivero de Ustariz 251. Jesús María-Lima 11, Perú

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BMC Infectious Diseases 2011, 11:164  doi:10.1186/1471-2334-11-164

Published: 8 June 2011

Abstract

Background

Dengue fever is a mosquito-borne disease that affects between 50 and 100 million people each year. Increasing our understanding of the heterogeneous transmission patterns of dengue at different spatial scales could have considerable public health value by guiding intervention strategies.

Methods

Based on the weekly number of dengue cases in Perú by province, we investigated the association between dengue incidence during the period 1994-2008 and demographic and climate factors across geographic regions of the country.

Results

Our findings support the presence of significant differences in the timing of dengue epidemics between jungle and coastal regions, with differences significantly associated with the timing of the seasonal cycle of mean temperature.

Conclusions

Dengue is highly persistent in jungle areas of Perú where epidemics peak most frequently around March when rainfall is abundant. Differences in the timing of dengue epidemics in jungle and coastal regions are significantly associated with the seasonal temperature cycle. Our results suggest that dengue is frequently imported into coastal regions through infective sparks from endemic jungle areas and/or cities of other neighboring endemic countries, where propitious environmental conditions promote year-round mosquito breeding sites. If jungle endemic areas are responsible for multiple dengue introductions into coastal areas, our findings suggest that curtailing the transmission of dengue in these most persistent areas could lead to significant reductions in dengue incidence in coastal areas where dengue incidence typically reaches low levels during the dry season.

Keywords:
Dengue; dynamics; community size; wavelet analysis; wavelet coherence; epidemic timing; climatic factors; Perú