title: Predicting unprecedented dengue outbreak using imported cases and climatic factors in Guangzhou, 2014.
abstract: BACKGROUND
  Dengue is endemic in more than 100 countries, mainly in tropical and subtropical regions, and the incidence has increased 30-fold in the past 50 years. The situation of dengue in China has become more and more severe, with an unprecedented dengue outbreak hitting south China in 2014. Building a dengue early warning system is therefore urgent and necessary for timely and effective response.
  
  
  RESULTS
  In the study we developed a time series Poisson multivariate regression model using imported dengue cases, local minimum temperature and accumulative precipitation to predict the dengue occurrence in four districts of Guangzhou, China. The time series data were decomposed into seasonal, trend and remainder components using a seasonal-trend decomposition procedure based on loess (STL). The time lag of climatic factors included in the model was chosen based on Spearman correlation analysis. Autocorrelation, seasonality and long-term trend were controlled in the model. A best model was selected and validated using Generalized Cross Validation (GCV) score and residual test. The data from March 2006 to December 2012 were used to develop the model while the data from January 2013 to September 2014 were employed to validate the model. Time series Poisson model showed that imported cases in the previous month, minimum temperature in the previous month and accumulative precipitation with three month lags could project the dengue outbreaks occurred in 2013 and 2014 after controlling the autocorrelation, seasonality and long-term trend.
  
  
  CONCLUSIONS
  Together with the sole transmission vector Aedes albopictus, imported cases, monthly minimum temperature and monthly accumulative precipitation may be used to develop a low-cost effective early warning system.
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong, People's Republic of China.
authors.forename: Shaowei
authors.initials: S
authors.lastname: Sang
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, People's Republic of China.
authors.forename: Shaohua
authors.initials: S
authors.lastname: Gu
authors.affiliation: School of Population Health, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Peng
authors.initials: P
authors.lastname: Bi
authors.affiliation: Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China.
authors.forename: Weizhong
authors.initials: W
authors.lastname: Yang
authors.affiliation: Guangzhou Center for Disease Control and Prevention, Guangzhou, People's Republic of China.
authors.forename: Zhicong
authors.initials: Z
authors.lastname: Yang
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, People's Republic of China.
authors.forename: Lei
authors.initials: L
authors.lastname: Xu
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, People's Republic of China.
authors.forename: Jun
authors.initials: J
authors.lastname: Yang
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, People's Republic of China.
authors.forename: Xiaobo
authors.initials: X
authors.lastname: Liu
authors.affiliation: National Climate Center, China Meteorological Administration, Beijing, People's Republic of China.
authors.forename: Tong
authors.initials: T
authors.lastname: Jiang
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, People's Republic of China.
authors.forename: Haixia
authors.initials: H
authors.lastname: Wu
authors.affiliation: Centre for Environment and Population Health, Nathan Campus, Griffith University, Queensland, Nathan, Australia.
authors.forename: Cordia
authors.initials: C
authors.lastname: Chu
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong, People's Republic of China; Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China; Centre for Environment and Population Health, Nathan Campus, Griffith University, Queensland, Nathan, Australia.
authors.forename: Qiyong
authors.initials: Q
authors.lastname: Liu
mesh_terms: D000330:Aedes / Q000821:virology; D000818:Animals; D002681:China / Q000453:epidemiology; D002980:Climate; D003715:Dengue / Q000453:epidemiology* / Q000635:transmission; D003716:Dengue Virus / Q000502:physiology*; D004196:Disease Outbreaks; D006801:Humans; D015994:Incidence; D007303:Insect Vectors / Q000821:virology; D016012:Poisson Distribution; D011891:Rain; D012044:Regression Analysis; D015203:Reproducibility of Results; D012621:Seasons; D013696:Temperature