BackgroundRainfall patterns are one of the main drivers of dengue transmission as mosquitoes require standing water to reproduce. However, excess rainfall can be disruptive to the Aedes reproductive cycle by “flushing out” aquatic stages from breeding sites. We developed models to predict the occurrence of such “flushing” events from rainfall data and to evaluate the effect of flushing on dengue outbreak risk in Singapore between 2000 and 2016.MethodsWe used machine learning and regression models to predict days with “flushing” in the dataset based on entomological and corresponding rainfall observations collected in Singapore. We used a distributed lag nonlinear logistic regression model to estimate the association between the number of flushing events per week and the risk of a dengue outbreak.ResultsDays with flushing were identified through the developed logistic regression model based on entomological data (test set accuracy = 92%). Predictions were based upon the aggregate number of thresholds indicating unusually rainy conditions over multiple weeks. We observed a statistically significant reduction in dengue outbreak risk one to six weeks after flushing events occurred. For weeks with five or more flushing events, compared with weeks with no flushing events, the risk of a dengue outbreak in the subsequent weeks was reduced by 16% to 70%.ConclusionsWe have developed a high accuracy predictive model associating temporal rainfall patterns with flushing conditions. Using predicted flushing events, we have demonstrated a statistically significant reduction in dengue outbreak risk following flushing, with the time lag well aligned with time of mosquito development from larvae and infection transmission. Vector control programs should consider the effects of hydrological conditions in endemic areas on dengue transmission.

In dengue-endemic areas, transmission shows both a seasonal and interannual variability. To investigate how rainfall impacts dengue seasonality in Singapore, we carried out a longitudinal survey in the Geylang neighborhood from August 2014 to August 2015. The survey comprised of twice-weekly random inspections to outdoor breeding habitats and continuous monitoring for positive ones. In addition, observations of rainstorms were collected. Out of 6824 inspected habitats, 67 contained Aedes aegypti, 11 contained Aedes albopictus and 24 contained Culex spp. The main outdoors habitat of Aedes aegypti was storm drains (54/67). We found that 80% of breeding sites in drains (43/54) were lost after intense rainstorms related to the wet phase of the Northeast monsoon (NE) between November 2014 and early January 2015. Subsequently, 95% (41/43) of these flushed drains had dried out during the dry phase of the NE in late January-February 2015. A return in the outdoor breeding of Aedes aegypti was observed after the onset of Southwest monsoon (SW) between May and August 2015. There was also a reduction in productivity of breeding habitats for larvae and pupae after the onset of the NE. In wet equatorial regions like Singapore, rainfall varies with the monsoons. A monsoon-driven sequence of flushing and drying shapes the outdoor seasonal abundance of Aedes aegypti. This finding can be used to optimize vector control strategies and better understand dengue in the context of climate change.

BackgroundDengue is an emerging health problem in several coastlines along the Red Sea. The objective of the present work is to elucidate spatial and temporal patterns of dengue transmission in Port Sudan.Methods/FindingsA longitudinal study with three cross-sectional surveys was carried out in upper, middle and lower class neighborhoods, from November 2008 to October 2009. Monthly, entomological surveys were followed by serological surveys in dengue vector-positive houses. Meteorological records were obtained from two weather stations in the city during the same time. Overall, 2825 houses were inspected. Aedes aegypti represented 65% (35,714/54,944) and 68% (2526/3715) of the collected larvae and pupae, respectively. Out of 4640 drinking water containers, 2297 were positive for Ae. aegypti. Clay-pots “Zeirr” followed by plastic barrels were key productive containers for pupae of dengue vector, 63% (n = 3959) and 26% (n = 1651), respectively. A total of 791 blood samples were tested using PanBio Capture/Indirect IgM ELISA. Overall, the sero-prevalence rate of dengue ranged between 3%–8% (41/791), compared to an incidence of 29–40 new cases per 10,000 (193/54886) in the same examined population. Lower and middle class neighborhoods had higher entomological indices compared with upper class ones (p<0.001). Although, dengue incidence rate was significantly lower in the middle and lower class neighborhoods (F = 73.97, d.f. = 2, p<0.001), no difference in IgM prevalence was shown. The city is subject to two transmission peaks in the winter (i.e. November–January), and summer (i.e. June–August). The serological peaks of dengue are preceded by entomological peaks that occur before the onset of winter (November) and summer (March) respectively.ConclusionDengue incidence is heterogeneously distributed across the neighborhoods of Port Sudan and exhibits a bi-cyclic intra-annual pattern. Hence, it should be feasible to carry out timely vector control measures to prevent or reduce dengue transmission.