Assessing health burden risk and control effect on dengue fever infection in the southern region of Taiwan

Abstract

Background: The high prevalence of dengue in Taiwan and the consecutive large dengue outbreaks in the period 2014-2015 suggest that current control interventions are suboptimal. Understanding the effect of control effort is crucial to inform future control strategies. Objectives: We developed a framework to measure season-based health burden risk from 2001 to 2014. We reconstructed various intervention coverage to assess the attributable effect of dengue infection control efforts. Materials and methods: A dengue-mosquito-human transmission dynamic was used to quantify the vector-host interactions and to estimate the disease epidemics. We used disability adjusted life years (DALYs) to assess health burden risk. A temperature-basic reproduction number (R-0)-DALYs relationship was constructed to examine the potential impacts of temperature on health burden. Finally, a health burden risk model linked a control measure model to evaluate the effect of dengue control interventions. Results: We showed that R-0 and DALYs peaked at 25 degrees C with estimates of 2.37 and 1387, respectively. Results indicated that most dengue cases occurred in fall with estimated DALYs of 323 (267-379, 95% CI) at 50% risk probability. We found that repellent spray had by far the largest control effect with an effectiveness of similar to 71% in all seasons. Pesticide spray and container clean-up have both made important contributions to reducing prevalence/incidence. Repellent, pesticide spray, container clean-up together with Wolbachia infection suppress dengue outbreak by similar to 90%. Conclusion: Our presented modeling framework provides a useful tool to measure dengue health burden risk and to quantify the effect of dengue control on dengue infection prevalence and disease incidence in the southern region of Taiwan.