Liu K-K, Wang T, Huang X-D, Wang G-L, Xia Y, Zhang Y-T, Jing Q-L, Huang J-W, Liu X-X, Lu J-H, Hu W-B
School of Public Health,Key Laboratory of Tropical Disease Control of Ministry of Education,Sun Yat-Sen University,Guangzhou,PR China.
Zhongshan Research Institute of Public Health,School of Public Health,Sun Yat-Sen University,Zhonghsan,PR China.
Epidemiol Infect. 2017 Feb;145(3):451-461. doi: 10.1017/S095026881600265X. Epub 2016 Nov 22.
Dengue fever (DF) is the most prevalent and rapidly spreading mosquito-borne disease globally. Control of DF is limited by barriers to vector control and integrated management approaches. This study aimed to explore the potential risk factors for autochthonous DF transmission and to estimate the threshold effects of high-order interactions among risk factors. A time-series regression tree model was applied to estimate the hierarchical relationship between reported autochthonous DF cases and the potential risk factors including the timeliness of DF surveillance systems (median time interval between symptom onset date and diagnosis date, MTIOD), mosquito density, imported cases and meteorological factors in Zhongshan, China from 2001 to 2013. We found that MTIOD was the most influential factor in autochthonous DF transmission. Monthly autochthonous DF incidence rate increased by 36·02-fold [relative risk (RR) 36·02, 95% confidence interval (CI) 25·26-46·78, compared to the average DF incidence rate during the study period] when the 2-month lagged moving average of MTIOD was >4·15 days and the 3-month lagged moving average of the mean Breteau Index (BI) was ⩾16·57. If the 2-month lagged moving average MTIOD was between 1·11 and 4·15 days and the monthly maximum diurnal temperature range at a lag of 1 month was <9·6 °C, the monthly mean autochthonous DF incidence rate increased by 14·67-fold (RR 14·67, 95% CI 8·84-20·51, compared to the average DF incidence rate during the study period). This study demonstrates that the timeliness of DF surveillance systems, mosquito density and diurnal temperature range play critical roles in the autochthonous DF transmission in Zhongshan. Better assessment and prediction of the risk of DF transmission is beneficial for establishing scientific strategies for DF early warning surveillance and control.
登革热（DF）是全球最普遍且传播迅速的蚊媒疾病。登革热的防控受到病媒控制和综合管理方法方面障碍的限制。本研究旨在探究本地登革热传播的潜在风险因素，并估计风险因素之间高阶相互作用的阈值效应。应用时间序列回归树模型来估计2001年至2013年中国中山报告的本地登革热病例与潜在风险因素之间的层次关系，这些潜在风险因素包括登革热监测系统的及时性（症状出现日期与诊断日期之间的中位时间间隔，MTIOD）、蚊虫密度、输入病例和气象因素。我们发现MTIOD是本地登革热传播中最具影响力的因素。当MTIOD的2个月滞后移动平均值>4.15天且平均布雷图指数（BI）的3个月滞后移动平均值⩾16.57时，每月本地登革热发病率增加36.02倍[相对风险（RR）36.02，95%置信区间（CI）25.26 - 46.78，与研究期间的平均登革热发病率相比]。如果MTIOD的2个月滞后移动平均值在1.11至4.15天之间且滞后1个月的月最高日温差<9.6℃，则每月本地登革热平均发病率增加14.67倍（RR 14.67，95% CI 8.84 - 20.51，与研究期间的平均登革热发病率相比）。本研究表明，登革热监测系统的及时性、蚊虫密度和日温差在中山本地登革热传播中起关键作用。更好地评估和预测登革热传播风险有利于制定登革热早期预警监测与控制的科学策略。
