Meteorological indicators of dengue epidemics in non-endemic Northwest Argentina.

In the last two decades dengue cases increased significantly throughout the world, giving place to more frequent outbreaks in Latin America. In the non-endemic city of San Ramón de la Nueva Orán, located in Northwest Argentina, large dengue outbreaks alternate with several years of smaller ones. This pattern, as well as the understanding of the underlying mechanisms, could be essential to design proper strategies to reduce epidemic size. We develop a stochastic model that includes climate variables, social structure, and mobility between a non-endemic city and an endemic area. Climatic variables were input of a mosquito population ecological model, which in turn was coupled to a meta-population, spatially explicit, epidemiological model. Human mobility was included into the model given the high border crossing to the northern country of Bolivia, where dengue transmission is sustained during the whole year. We tested different hypotheses regarding people mobility as well as climate variability by fitting numerical simulations to weekly clinical data reported from 2009 to 2016. After assessing the number of imported cases that triggered the observed outbreaks, our model allows to explain the observed epidemic pattern. We found that the number of vectors per host and the effective reproductive number are proxies for large epidemics. Both proxies are related with climate variability such as rainfall and temperature, opening the possibility to test these meteorological variables for forecast purposes.