title: Imported dengue cases, weather variation and autochthonous dengue incidence in Cairns, Australia.
abstract: BACKGROUND
  Dengue fever (DF) outbreaks often arise from imported DF cases in Cairns, Australia. Few studies have incorporated imported DF cases in the estimation of the relationship between weather variability and incidence of autochthonous DF. The study aimed to examine the impact of weather variability on autochthonous DF infection after accounting for imported DF cases and then to explore the possibility of developing an empirical forecast system.
  Data on weather variables, notified DF cases (including those acquired locally and overseas), and population size in Cairns were supplied by the Australian Bureau of Meteorology, Queensland Health, and Australian Bureau of Statistics. A time-series negative-binomial hurdle model was used to assess the effects of imported DF cases and weather variability on autochthonous DF incidence. Our results showed that monthly autochthonous DF incidences were significantly associated with monthly imported DF cases (Relative Risk (RR):1.52; 95% confidence interval (CI): 1.01-2.28), monthly minimum temperature ((o)C) (RR: 2.28; 95% CI: 1.77-2.93), monthly relative humidity (%) (RR: 1.21; 95% CI: 1.06-1.37), monthly rainfall (mm) (RR: 0.50; 95% CI: 0.31-0.81) and monthly standard deviation of daily relative humidity (%) (RR: 1.27; 95% CI: 1.08-1.50). In the zero hurdle component, the occurrence of monthly autochthonous DF cases was significantly associated with monthly minimum temperature (Odds Ratio (OR): 1.64; 95% CI: 1.01-2.67).
  
  
  CONCLUSIONS
  Our research suggested that incidences of monthly autochthonous DF were strongly positively associated with monthly imported DF cases, local minimum temperature and inter-month relative humidity variability in Cairns. Moreover, DF outbreak in Cairns was driven by imported DF cases only under favourable seasons and weather conditions in the study.
authors.affiliation: School of Population Health, the University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Huang
authors.affiliation: School of Population Health, the University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Gail
authors.initials: G
authors.lastname: Williams
authors.affiliation: School of Population Health, the University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Archie C A
authors.initials: AC
authors.lastname: Clements
authors.affiliation: School of Population Health, the University of Queensland, Brisbane, Queensland, Australia ; School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia.
authors.forename: Wenbiao
authors.initials: W
authors.lastname: Hu
mesh_terms: D000330:Aedes / Q000821:virology*; D000818:Animals; D003715:Dengue / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D004196:Disease Outbreaks; D006801:Humans; D006813:Humidity; D007303:Insect Vectors; D015233:Models, Statistical; D011793:Queensland / Q000453:epidemiology; D012044:Regression Analysis; D012621:Seasons; D013696:Temperature