Can Human Movements Explain Heterogeneous Propagation of Dengue Fever in Cambodia?

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Teurlai, Magali ; Huy, Rekol ; Cazelles, Bernard ; Duboz, Raphaël ; Baehr, Christophe ; Vong, Sirenda (2012)
  • Publisher: Public Library of Science
  • Journal: PLoS Neglected Tropical Diseases, volume 6, issue 12, page e1957 (issn: 1935-2735, eissn: 1935-2735)
  • Related identifiers: pmc: PMC3516584, doi: 10.1371/journal.pntd.0001957
  • Subject: Research Article | Mathematics | Infectious Disease Control | Infectious Diseases | Infectious Disease Epidemiology | Epidemiology | Epidemiological Methods | Neglected Tropical Diseases | E51 - Population rurale | Disease Ecology | Public Health | Flavivirus | Biostatistics | | Medicine | Transmission des maladies | L73 - Maladies des animaux | RC955-962 | Dengue Fever | RA1-1270 | Public aspects of medicine | Genre humain | | Migration | | | Arctic medicine. Tropical medicine | Statistics |

Background: Determining the factors underlying the long-range spatial spread of infectious diseases is a key issue regarding their control. Dengue is the most important arboviral disease worldwide and a major public health problem in tropical areas. However the determinants shaping its dynamics at a national scale remain poorly understood. Here we describe the spatial-temporal pattern of propagation of annual epidemics in Cambodia and discuss the role that human movements play in the observed pattern. Methods and Findings: We used wavelet phase analysis to analyse time-series data of 105,598 hospitalized cases reported between 2002 and 2008 in the 135 (/180) most populous districts in Cambodia. We reveal spatial heterogeneity in the propagation of the annual epidemic. Each year, epidemics are highly synchronous over a large geographic area along the busiest national road of the country whereas travelling waves emanate from a few rural areas and move slowly along the Mekong River at a speed of ,11 km per week (95% confidence interval 3-18 km per week) towards the capital, Phnom Penh. Conclusions: We suggest human movements - using roads as a surrogate - play a major role in the spread of dengue fever at a national scale. These findings constitute a new starting point in the understanding of the processes driving dengue spread. (Résumé d'auteur)
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