Climate and dengue fever : early warning based on temperature and rainfall

Abstract: Background: Dengue is a viral infectious disease that is transmitted by mosquitoes. The disease causes a significant health burden in tropical countries, and has been a public health burden in Singapore for several decades. Severe complications such as hemorrhage can develop and lead to fatal outcomes. Before tetravalent vaccine and drugs are available, vector control is the key component to control dengue transmission. Vector control activities need to be guided by surveillance of outbreak and implement timely action to suppress dengue transmission and limit the risk of further spread. This study aims to explore the feasibility of developing a dengue early warning system using temperature and rainfall as main predictors. The objectives were to 1) analyze the relationship between dengue cases and weather predictors, 2) identify the optimal lead time required for a dengue early warning, 3) develop forecasting models, and 4) translate forecasts to dengue risk indices.Methods: Poisson multivariate regression models were established to analyze relative risks of dengue corresponding to each unit change of weekly mean temperature and cumulative rainfall at lag of 1-20 weeks. Duration of vector control for localized outbreaks was analyzed to identify the time required by local authority to respond to an early warning. Then, dengue forecasting models were developed using Poisson multivariate regression. Autoregression, trend, and seasonality were considered in the models to account for risk factors other than temperature and rainfall. Model selection and validation were performed using various statistical methods. Forecast precision was analyzed using cross-validation, Receiver Operating Characteristics curve, and root mean square errors. Finally, forecasts were translated into stratified dengue risk indices in time series formats.Results: Findings showed weekly mean temperature and cumulative rainfall preceded higher relative risk of dengue by 9-16 weeks and that a forecast with at least 3 months would provide sufficient time for mitigation in Singapore. Results showed possibility of predicting dengue cases 1-16 weeks using temperature and rainfall; whereas, consideration of autoregression and trend further enhance forecast precision. Sensitivity analysis showed the forecasting models could detect outbreak and non-outbreak at above 90% with less than 20% false positive. Forecasts were translated into stratified dengue risk indices using color codes and indices ranging from 1-10 in calendar or time sequence formats. Simplified risk indices interpreted forecast according to annual alert and outbreak thresholds; thus, provided uniform interpretation.Significance: A prediction model was developed that forecasted a prognosis of dengue up to 16 weeks in advance with sufficient accuracy. Such a prognosis can be used as an early warning to enhance evidence-based decision making and effective use of public health resources as well as improved effectiveness of dengue surveillance and control. Simple and clear dengue risk indices improve communications to stakeholders.