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Am. J. Trop. Med. Hyg., 79(3), 2008, pp. 344-352
Copyright © 2008 by The American Society of Tropical Medicine and Hygiene

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Two Clustering Diffusion Patterns Identified from the 2001–2003 Dengue Epidemic, Kaohsiung, Taiwan

Chih-Chun Kan, Pei-Fen Lee, Tzai-Hung Wen, Day-Yu Chao, Min-Huei Wu, Neal H. Lin, Scott Yan-Jang Huang, Chuin-Shee Shang, I-Chun Fan, Pei-Yun Shu, Jyh-Hsiung Huang, Chwan-Chuen King*, AND Lu Pai
Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China; Institute of Ecology and Evolutionary Biology, College of Life Science, National Taiwan University, Taipei, Taiwan, Republic of China; Center for Geographic Information Science, Academia Sinica, Taipei, Taiwan, Republic of China; Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan, Republic of China; Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan, Republic of China; Center for Disease Control in Taiwan, Department of Health, Executive Yuan, Taipei, Taiwan, Republic of China; Graduate Institute of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China

This study analyzed the spatio-temporal patterns of 4,587 (94% of the total) confirmed dengue cases in Kaohsiung and Fengshan Cities (a two-city area) that occurred in Taiwan from 2001 to 2003. The epidemic had two simultaneous distinct diffusion patterns. One was a contiguous pattern, mostly limited to 1 km from an initial cluster, reflecting that there was a rapid dispersal of infected Aedes aegypti and viremic persons. The second followed a relocation pattern, involving clusters of cases that diffused over 10 weeks starting from the southern and moving to the northern parts of the two-city area. The virus from one clustering site jumped to several distant areas where it rapidly dispersed through a series of human–mosquito transmission cycles to several localities. In both patterns, transmission of disease quickly enlarged the epidemic areas. Future dengue control efforts would benefit from a timely syndromic surveillance system plus extensive public education on how to avoid further transmission.

Acknowledgments: We thank the staff of Kaohsiung City and County Health Bureau and the Center for Disease Control in Taiwan (Taiwan-CDC) for their efforts in surveillance and vector control during the hard time of the 2002 dengue epidemic. We also acknowledge the contributions of Tsung-Shu Joseph Wu at the Institute of Epidemiology, College of Public Health, for assistance in data collection, generated metadata, and help in discussion. The administrative assistance by Shu-Huei Tseng, and Dr. Ih-Jen Su at Taiwan-CDC is greatly appreciated. We also thank the late Dr. Andrew Spielman at the School of Public Health, Harvard University, Dr. Amy Morrison at the Department of Entomology, University of California at Riverside, and our American native speaking English editor James Steed for his help in the critical review of this manuscript.

Financial support: This study was supported by a grant from National Health Research Institute, Taipei, Taiwan (NHRI-CN-CL9302P).

* Address correspondence to Chwan-Chuen King, Institute of Epidemiology, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Road Section 1, Taipei (10020), Taiwan, ROC. E-mail: cc_king99{at}hotmail.com

Authors’ addresses: Chih-Chun Kan, Graduate Institute of Life Sciences, National Defense Medical Center, No. 161, Section 6, Min-Chuan East Road, Taipei (114), Taiwan, Republic of China (ROC), Tel: 886-2-8792-3100. Pei-Fen Lee, Institute of Ecology and Evolutionary Biology, College of Life Science, National Taiwan University, No. 1, Sec. 4, Roosevelt Road, Taipei (10617), Taiwan, ROC, Tel: 886-2-3366-3366. Tzai-Hung Wen, Day-Yu Chao, Min-Huei Wu, Neal H. Lin, Chuin-Shee Shang, and Chwan-Chuen King, Institute of Epidemiology, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Road, Section 1, Taipei (10020), Taiwan, ROC, Tel: 8862-3322-8034, Fax: 8862-2351-1955, E-mail: cc_king99{at}hotmail.com. Scott Yan-Jang Huang, Department of Public Health, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Road, Section 1, Taipei (10020), Taiwan ROC, Tel: 8862-3322-8034. Tzai-Hung Wen and I-Chun Fan, Center for Geographic Information Science, Academia Sinica, No. 128, Academia Road, Section 2, Nankang, Taipei (115), Taiwan, ROC, Tel: 8862-2782-2120. Pei-Yun Shu and Jyh-Hsiung Huang, Center for Disease Control in Taiwan, Department of Health, Executive Yuan, Taipei, Taiwan, ROC, Tel: 8862-2785-0513. Lu Pai, Graduate Insitute of Public Health, National Defense Medical Center, No. 161, Section 6, Min-Chuan East Road, Taipei (114), Taiwan, ROC, Tel: 886-2-8792-3100.

Reprint requests: Chwan-Chuen King, Institute of Epidemiology, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Road, Section 1, Taipei (10020), Taiwan, ROC, E-mail: cc_king99{at}hotmail.com.






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