Abstract
BackgroundAustralia is one of the few high-income countries where dengue transmission regularly occurs. Dengue is a major health threat in North Queensland (NQ), where the vector Aedes aegypti is present. Whether NQ should be considered as a dengue endemic or epidemic region is an ongoing debate. To help address this issue, we analysed the characteristics of locally-acquired (LA) and imported dengue cases in NQ through time and space. We describe the epidemiology of dengue in NQ from 1995 to 2011, to identify areas to target interventions. We also investigated the timeliness of notification and identified high-risk areas.MethodsData sets of notified cases and viraemic arrivals from overseas were analysed. We developed a time series based on the LA cases and performed an analysis to capture the relationship between incidence rate and demographic factors. Spatial analysis was used to visualise incidence rates through space and time.ResultsBetween 1995 and 2011, 93.9% of reported dengue cases were LA, mainly in the ‘Cairns and Hinterland’ district; 49.7% were males, and the mean age was 38.0 years old. The sources of imported cases (6.1%) were Indonesia (24.6%), Papua New Guinea (23.2%), Thailand (13.4%), East Timor (8.9%) and the Philippines (6.7%), consistent with national data. Travellers importing dengue were predominantly in the age groups 30–34 and 45–49 years old, whereas the age range of patients who acquired dengue locally was larger. The number of LA cases correlated with the number of viraemic importations. Duration of viraemia of public health importance was positively correlated with the delay in notification. Dengue incidence varied over the year and was typically highest in summer and autumn. However, dengue activity has been reported in winter, and a number of outbreaks resulted in transmission year-round.ConclusionsThis study emphasizes the importance of delay in notification and consequent duration of viraemia of public health importance for dengue outbreak duration. It also highlights the need for targeted vector control programmes and surveillance of travellers at airports as well as regularly affected local areas. Given the likely increase in dengue transmission with climate change, endemicity in NQ may become a very real possibility.Electronic supplementary materialThe online version of this article (doi:10.1186/1756-3305-7-379) contains supplementary material, which is available to authorized users.
Highlights
Australia is one of the few high-income countries where dengue transmission regularly occurs
Dengue outbreaks occurred in the Torres Strait islands in 1996–1997, 2003–2005 [10], the outbreaks were not included in this study because we wanted to consider the transmission in densely populated major centres of North Queensland (NQ) rather than in small island communities, disease burden being far greater in the former areas
Descriptive analysis A total of 2576 dengue cases were reported in NQ from 1995 to 2011, and 1937 were locally-acquired (LA), 158 were imported (IMP) and the remaining 481 cases (99.2% from 1995–1999) had no origin recorded (NO)
Summary
Australia is one of the few high-income countries where dengue transmission regularly occurs. Dengue is a major health threat in North Queensland (NQ), where the vector Aedes aegypti is present. While not yet considered endemic, dengue case notification occurs throughout the year in Australia. The risk of endemicity is currently restricted to the north of the state of Queensland, where Aedes aegypti (L.), the most important vector, is present. Larger and more frequent epidemics can be expected, which could result in northern Australia becoming endemic This threat is mainly potentiated by international travel, domestic mobility and behaviour patterns in NQ. Locally-acquired dengue transmission only occurs in urban areas of NQ from Townsville north through the Torres Strait, where the vector is present. Increased public knowledge and the use of molecular diagnostic tools may have increased the number of dengue notifications, but it is unlikely that these factors fully explain the observed increase
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