The influence of geographic and climate factors on the timing of dengue epidemics in Perú, 1994-2008

Based on the weekly number of dengue cases in Perú by province, we investigated the association between dengue incidence during the period 1994-2008 and demographic and climate factors across geographic regions of the country.Our findings support the presence of significant differences in the timing of dengue epidemics between jungle and coastal regions, with differences significantly associated with the timing of the seasonal cycle of mean temperature.Dengue is highly persistent in jungle areas of Perú where epidemics peak most frequently around March when rainfall is abundant. Differences in the timing of dengue epidemics in jungle and coastal regions are significantly associated with the seasonal temperature cycle. Our results suggest that dengue is frequently imported into coastal regions through infective sparks from endemic jungle areas and/or cities of other neighboring endemic countries, where propitious environmental conditions promote year-round mosquito breeding sites. If jungle endemic areas are responsible for multiple dengue introductions into coastal areas, our findings suggest that curtailing the transmission of dengue in these most persistent areas could lead to significant reductions in dengue incidence in coastal areas where dengue incidence typically reaches low levels during the dry season.Dengue fever is the most prevalent vector borne disease in the Americas and the second most prevalent in the world after malaria with 50-100 million annual dengue infections in tropical and subtropical regions [1]. Dengue is caused by four serotypes (DENV-1, DENV-2, DENV-3, and DENV-4) of the genus Flavivirus [1] and is transmitted by the mosquito species Aedes aegypti and Aedes albopictus. The severity of dengue disease ranges from asymptomatic, clinically non-specific with flu-like symptoms, dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS) [1,2].In Perú, dengue serotype DENV-1 was identified in 1990 [3], and it was followed