title: Climate Factors as Important Determinants of Dengue Incidence in Curaçao.
abstract: Macro- and microclimates may have variable impact on dengue incidence in different settings. We estimated the short-term impact and delayed effects of climate variables on dengue morbidity in Curaçao. Monthly dengue incidence data from 1999 to 2009 were included to estimate the short-term influences of climate variables by employing wavelet analysis, generalized additive models (GAM) and distributed lag nonlinear models (DLNM) on rainfall, temperature and relative humidity in relation to dengue incidence. Dengue incidence showed a significant irregular 4-year multi-annual cycle associated with climate variables. Based on GAM, temperature showed a U-shape, while humidity and rainfall exhibited a dome-shaped association, suggesting that deviation from mean temperature increases and deviation from mean humidity and rainfall decreases dengue incidence, respectively. Rainfall was associated with an immediate increase in dengue incidence of 4.1% (95% CI: 2.2-8.1%) after a 10-mm increase, with a maximum increase of 6.5% (95% CI: 3.2-10.0%) after 1.5 month lag. A 1 °C decrease of mean temperature was associated with a RR of 17.4% (95% CI: 11.2-27.0%); the effect was inversed for a 1°C increase of mean temperature (RR= 0.457, 95% CI: 0.278-0.752). Climate variables are important determinants of dengue incidence and provide insight into its short-term effects. An increase in mean temperature was associated with lower dengue incidence, whereas lower temperatures were associated with higher dengue incidence.
authors.affiliation: Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Limper
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: K T D
authors.initials: KT
authors.lastname: Thai
authors.affiliation: Epidemiology and Research Unit, Medical & Public Health Service (GGD) of Curaçao, Willemstad, Curaçao.
authors.forename: I
authors.initials: I
authors.lastname: Gerstenbluth
authors.affiliation: Department of Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: A D M E
authors.initials: AD
authors.lastname: Osterhaus
authors.affiliation: Red Cross Blood Bank Foundation Curaçao, Willemstad, Curaçao.
authors.forename: A J
authors.initials: AJ
authors.lastname: Duits
authors.affiliation: Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.|Department of Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: E C M
authors.initials: EC
authors.lastname: van Gorp
mesh_terms: D002980:Climate; D003715:Dengue / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D009426:Netherlands / Q000453:epidemiology; D012044:Regression Analysis; D012307:Risk Factors; D012621:Seasons; D014887:Weather
keywords: Dengue fever; climate factors; epidemiology