The interplay of climate, intervention and imported cases as determinants of the 2014 dengue outbreak in Guangzhou

PLoS Negl Trop Dis. 2017 Jun 22;11(6):e0005701. doi: 10.1371/journal.pntd.0005701. eCollection 2017 Jun.

Abstract

Dengue is a fast spreading mosquito-borne disease that affects more than half of the population worldwide. An unprecedented outbreak happened in Guangzhou, China in 2014, which contributed 52 percent of all dengue cases that occurred in mainland China between 1990 and 2015. Our previous analysis, based on a deterministic model, concluded that the early timing of the first imported case that triggered local transmission and the excessive rainfall thereafter were the most important determinants of the large final epidemic size in 2014. However, the deterministic model did not allow us to explore the driving force of the early local transmission. Here, we expand the model to include stochastic elements and calculate the successful invasion rate of cases that entered Guangzhou at different times under different climate and intervention scenarios. The conclusion is that the higher number of imported cases in May and June was responsible for the early outbreak instead of climate. Although the excessive rainfall in 2014 did increase the success rate, this effect was offset by the low initial water level caused by interventions in late 2013. The success rate is strongly dependent on mosquito abundance during the recovery period of the imported case, since the first step of a successful invasion is infecting at least one local mosquito. The average final epidemic size of successful invasion decreases exponentially with introduction time, which means if an imported case in early summer initiates the infection process, the final number infected can be extremely large. Therefore, dengue outbreaks occurring in Thailand, Singapore, Malaysia and Vietnam in early summer merit greater attention, since the travel volumes between Guangzhou and these countries are large. As the climate changes, destroying mosquito breeding sites in Guangzhou can mitigate the detrimental effects of the probable increase in rainfall in spring and summer.

MeSH terms

  • Animals
  • China / epidemiology
  • Climate Change*
  • Climate*
  • Culicidae / virology
  • Dengue / epidemiology*
  • Dengue Virus / isolation & purification
  • Disease Outbreaks / statistics & numerical data*
  • Humans
  • Malaysia
  • Models, Theoretical
  • Seasons*
  • Singapore
  • Thailand
  • Travel*
  • Vietnam

Grants and funding

This research was partially supported by the Cyrus Tang Foundation (Grant No. 202006). QJ is funded by Guangdong Natural Science Foundation (No. S2013010013637, No. 2015A030313784) and the Medical Scientific Research Foundation of Guangdong Province (No. A2017481). ZY is supported by National Natural Science Foundation of China (NSFC) (No.81273139), the Project for Key Medicine Discipline Construction of Guangzhou Municipality (2017-2019-04), the Collaborative innovation project of Bureau of Science and technology of Guangzhou Municipality (No.201508020263). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.