Abstract
Bhutan experienced its largest and first nation-wide dengue epidemic in 2019. The cases in 2019 were greater than the total number of cases in all the previous years. This study aimed to characterize the spatiotemporal patterns and effective reproduction number of this explosive epidemic. Weekly notified dengue cases were extracted from the National Early Warning, Alert, Response and Surveillance (NEWARS) database to describe the spatial and temporal patterns of the epidemic. The time-varying, temperature-adjusted cohort effective reproduction number was estimated over the course of the epidemic. The dengue epidemic occurred between 29 April and 8 December 2019 over 32 weeks, and included 5935 cases. During the epidemic, dengue expanded from six to 44 subdistricts. The effective reproduction number was <3 for most of the epidemic period, except for a ≈1 month period of explosive growth, coinciding with the monsoon season and school vacations, when the effective reproduction number peaked >30 and after which the effective reproduction number declined steadily. Interventions were only initiated 6 weeks after the end of the period of explosive growth. This finding highlights the need to reinforce the national preparedness plan for outbreak response, and to enable the early detection of cases and timely response.
Highlights
Dengue is an emerging vector-borne disease with a rapidly expanding global distribution and an increasing intensity of transmission in affected regions [1]
Economic booms, and unprecedented human travel have contributed to further spread of the dengue epidemic, which continues to encroach on new geographical locations [5,6,7]
The objectives of the study were to explore the spatiotemporal characteristics of the epidemic and estimate the transmissibility of circulating dengue viruses
Summary
Dengue is an emerging vector-borne disease with a rapidly expanding global distribution and an increasing intensity of transmission in affected regions [1]. A global dengue pandemic began in South-East Asia and the Pacific region during and after World War II [4]. War II, along with the destruction of the environment and human settlement has substantially contributed to the spread of dengue viruses and their vectors in these regions [5]. Economic booms (with uncontrolled urbanization and development), and unprecedented human travel have contributed to further spread of the dengue epidemic, which continues to encroach on new geographical locations [5,6,7]. Dengue is endemic in over 140 countries in Africa, the Americas, the Eastern Mediterranean, and Asia [9]
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