Revealing two dynamic dengue epidemic clusters in Thailand.

Background: Thailand is home to around 69 million individuals. Dengue is hyper-endemic and all 4 serotypes are in active circulation in the country. Dengue outbreaks occur almost annually within Thailand in at least one province but the spatio-temporal and environmental interface of these outbreaks has not been studied.

Methods: We develop Bayesian regime switching (BRS) models to characterize outbreaks, their persistence and infer their likelihood of occurrence across time for each administrative province where dengue case counts are collected. BRS was compared against two other classification tools and their agreement is assessed. We further examine how these spatio-temporal clusters of outbreak clusters arise by comparing reported dengue case counts, urban population, urban land cover, climate and flight volumes on the province level.

Results: Two dynamic dengue epidemic clusters were found nationally. One cluster consists of 47 provinces and is highly outbreak prone. Provinces with a large number of case counts, urban population, urban land cover and incoming flight passengers are associated to the epidemic prone cluster of dengue. Climate has an effect on determining the probability of outbreaks over time within provinces, but have less influence on whether provinces belong to the epidemic prone cluster. BRS found high agreement with other classification tools.

Conclusions: Importation and urbanization drives the risk of outbreaks across regions strongly. In provinces estimated to have high epidemic persistence, more resource allocation to vector control should be applied to those localities as heightened transmission counts are likely to occur over a longer period of time. Clustering of epidemic and non-epidemic prone areas also highlights the need for prioritization of resource allocation for disease mitigation over provinces in Thailand.