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Intervention Measures, Turning Point, and Reproduction Number for Dengue, Singapore, 2005

The 2005 dengue outbreak in Singapore cumulated in > 14,000 cases and 27 reported dengue deaths. We fit the single-phase Richards model to weekly dengue notification numbers to detect the turning point for the outbreak, which enables us to study the impact of intervention measures relating to the turning point. The results indicate that turning point had most likely occurred in late August or early September, before large-scale intervention measures were implemented. The "initial" reproduction number for the outbreak is estimated to be ~1.89–2.23 (95% confidence interval: 1.15–3.00). One of the lessons learned from the 2003 severe acute respiratory syndrome (SARS) outbreak is that multiple phases of outbreak were observed in some affected countries when efforts to intensify intervention or to sustain vigilance were compromised. Intensive and continuing efforts in the implementation of control measures are essential in reducing further dengue occurrences during any resurgence of dengue.

Received May 9, 2008. Accepted for publication September 18, 2008.

Acknowledgments: The authors thank the referees for constructive comments that significantly improved this paper.

Financial support: YHH is supported by Grant 96-2115-M-039-002 from the National Science Council of Taiwan.

^* Address correspondence to Ying-Hen Hsieh, Department of Public Health and Biostatistics Center, China Medical University, 91 Hsueh-Shih Road, Taichung 40402, Taiwan. E-mail: hsieh{at}mail.cmu.edu.tw

Authors’ addresses: Ying-Hen Hsieh, Department of Public health and Biostatistics Center, China Medical University, Taichung, Taiwan. Stefan Ma, Epidemiology and Disease Control Division, Ministry of Health Singapore, Singapore.