Abstract
BackgroundSingapore experiences endemic dengue, with 2013 being the largest outbreak year known to date, culminating in 22,170 cases. Given the limited resources available, and that vector control is the key approach for prevention in Singapore, it is important that public health professionals know where resources should be invested in. This study aims to stratify the spatial risk of dengue transmission in Singapore for effective deployment of resources.Methodology/principal findingsRandom Forest was used to predict the risk rank of dengue transmission in 1km2 grids, with dengue, population, entomological and environmental data. The predicted risk ranks are categorized and mapped to four color-coded risk groups for easy operation application. The risk maps were evaluated with dengue case and cluster data. Risk maps produced by Random Forest have high accuracy. More than 80% of the observed risk ranks fell within the 80% prediction interval. The observed and predicted risk ranks were highly correlated (≥0.86, P <0.01). Furthermore, the predicted risk levels were in excellent agreement with case density, a weighted Kappa coefficient of more than 0.80 (P <0.01). Close to 90% of the dengue clusters occur in high risk areas, and the odds of cluster forming in high risk areas were higher than in low risk areas.ConclusionsThis study demonstrates the potential of Random Forest and its strong predictive capability in stratifying the spatial risk of dengue transmission in Singapore. Dengue risk map produced using Random Forest has high accuracy, and is a good surveillance tool to guide vector control operations.
Highlights
Dengue is a viral infection caused by one of the four closely related yet antigenically distinct virus serotypes (DENV-1, Dengue virus (DENV)-2, DENV-3 and DENV-4), and transmitted by Aedes mosquitoes, primarily the Ae. aegypti and Ae. albopictus [1,2]
This study demonstrates the potential of Random Forest and its strong predictive capability in stratifying the spatial risk of dengue transmission in Singapore
Infection confers lifelong immunity to the infecting serotype [3]. It increases risk for dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS), a deadly form that present with severe complications, in subsequent infections [4]
Summary
Dengue is a viral infection caused by one of the four closely related yet antigenically distinct virus serotypes (DENV-1, DENV-2, DENV-3 and DENV-4), and transmitted by Aedes mosquitoes, primarily the Ae. aegypti and Ae. albopictus [1,2]. Infection confers lifelong immunity to the infecting serotype [3] It increases risk for dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS), a deadly form that present with severe complications, in subsequent infections [4]. Since the publication of the GBD 2010, it was estimated that 390 million dengue infections occur each year globally, of which 500,000 develop into DHF [5,6]. Though intensive vector control efforts have successfully suppressed the Aedes population, from an Aedes house index of over 50% in the 1960’s to the present 1–2%, Singapore remains susceptible to dengue outbreaks [10,11,12]. The estimated economic and disease burden of dengue were 9–14 disability-adjusted life years (DALYs) per 100,000 population and US$41.5 million per annum [16]. This study aims to stratify the spatial risk of dengue transmission in Singapore for effective deployment of resources.
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