The influence of geographic and climate factors on the timing of dengue epidemics in Peru, 1994-2008

Background: Dengue fever is a mosquito-borne disease that affects between 50 and 100 million people each year. Increasing our understanding of the heterogeneous transmission patterns of dengue at different spatial scales could have considerable public health value by guiding intervention strategies. Methods: Based on the weekly number of dengue cases in Peru by province, we investigated the association between dengue incidence during the period 1994-2008 and demographic and climate factors across geographic regions of the country. Results: Our findings support the presence of significant differences in the timing of dengue epidemics between jungle and coastal regions, with differences significantly associated with the timing of the seasonal cycle of mean temperature. Conclusions: Dengue is highly persistent in jungle areas of Peru where epidemics peak most frequently around March when rainfall is abundant. Differences in the timing of dengue epidemics in jungle and coastal regions are significantly associated with the seasonal temperature cycle. Our results suggest that dengue is frequently imported into coastal regions through infective sparks from endemic jungle areas and/or cities of other neighboring endemic countries, where propitious environmental conditions promote year-round mosquito breeding sites. If jungle endemic areas are responsible for multiple dengue introductions into coastal areas, our findings suggest that curtailing the transmission of dengue in these most persistent areas could lead to significant reductions in dengue incidence in coastal areas where dengue incidence typically reaches low levels during the dry season.