title: Multiyear climate variability and dengue--El Niño southern oscillation, weather, and dengue incidence in Puerto Rico, Mexico, and Thailand: a longitudinal data analysis.
abstract: BACKGROUND
  The mosquito-borne dengue viruses are a major public health problem throughout the tropical and subtropical regions of the world. Changes in temperature and precipitation have well-defined roles in the transmission cycle and may thus play a role in changing incidence levels. The El Niño Southern Oscillation (ENSO) is a multiyear climate driver of local temperature and precipitation worldwide. Previous studies have reported varying degrees of association between ENSO and dengue incidence.
  
  
  RESULTS
  We analyzed the relationship between ENSO, local weather, and dengue incidence in Puerto Rico, Mexico, and Thailand using wavelet analysis to identify time- and frequency-specific association. In Puerto Rico, ENSO was transiently associated with temperature and dengue incidence on multiyear scales. However, only local precipitation and not temperature was associated with dengue on multiyear scales. In Thailand, ENSO was associated with both temperature and precipitation. Although precipitation was associated with dengue incidence, the association was nonstationary and likely spurious. In Mexico, no association between any of the variables was observed on the multiyear scale.
  
  
  CONCLUSIONS
  The evidence for a relationship between ENSO, climate, and dengue incidence presented here is weak. While multiyear climate variability may play a role in endemic interannual dengue dynamics, we did not find evidence of a strong, consistent relationship in any of the study areas. The role of ENSO may be obscured by local climate heterogeneity, insufficient data, randomly coincident outbreaks, and other, potentially stronger, intrinsic factors regulating transmission dynamics.
authors.affiliation: Dengue Branch, Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico, United States of America. mjohansson@cdc.gov
authors.forename: Michael A
authors.initials: MA
authors.lastname: Johansson
authors.forename: Derek A T
authors.initials: DA
authors.lastname: Cummings
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Glass
mesh_terms: D002980:Climate; D003715:Dengue / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008800:Mexico; D011647:Puerto Rico; D011891:Rain; D013696:Temperature; D013785:Thailand; D014887:Weather