Travelling waves in the occurrence of dengue haemorrhagic fever in Thailand

Abstract

Dengue fever is a mosquito-borne virus that infects 50–100 million people each year1. Of these infections, 200,000–500,000 occur as the severe, life-threatening form of the disease, dengue haemorrhagic fever (DHF)2. Large, unanticipated epidemics of DHF often overwhelm health systems3. An understanding of the spatial–temporal pattern of DHF incidence would aid the allocation of resources to combat these epidemics. Here we examine the spatial–temporal dynamics of DHF incidence in a data set describing 850,000 infections occurring in 72 provinces of Thailand during the period 1983 to 1997. We use the method of empirical mode decomposition4 to show the existence of a spatial–temporal travelling wave in the incidence of DHF. We observe this wave in a three-year periodic component of variance, which is thought to reflect host–pathogen population dynamics5,6. The wave emanates from Bangkok, the largest city in Thailand, moving radially at a speed of 148 km per month. This finding provides an important starting point for detecting and characterizing the key processes that contribute to the spatial–temporal dynamics of DHF in Thailand.

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Figure 1: Example of the EMD sifting process.
Figure 2: Monthly DHF incidence in each of the 72 provinces of Thailand.
Figure 3: The 3-yr periodic mode for each of the 72 provinces of Thailand.
Figure 4: Spatial synchrony of DHF incidence (blue) and the 3-yr periodic mode of variance (red) across 72 provinces of Thailand with 95% C.I. envelopes (see Methods).
Figure 5: Cross-correlation coefficients between the 3-yr oscillatory mode of DHF incidence in Bangkok and the same mode of DHF incidence in the 71 other provinces of Thailand.

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Acknowledgements

We thank O. Bjornstad for making R code available.This work was supported by grants from the National Oceanic and Atmospheric Administration's Joint Program on Climate Variability and Human Health (a consortium including the EPA, NASA, NSF and EPRI), and the Bill and Melinda Gates Foundation.

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Correspondence to Donald S. Burke.

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Cummings, D., Irizarry, R., Huang, N. et al. Travelling waves in the occurrence of dengue haemorrhagic fever in Thailand. Nature 427, 344–347 (2004). https://doi.org/10.1038/nature02225

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