Regional variability in relationships between climate and dengue/DHF in Indonesia

Since 1970, the worldwide distribution, frequency and intensity of epidemics of dengue and dengue haemorrhagic fever (DHF) have increased dramatically. In Indonesia, as elsewhere, the geographic distribution and behaviour of the two main vectors – Aedes aegypti and Aedes albopictus – and the consequent transmission dynamics of the disease are strongly influenced by climate. Monthly incidence data were examined in relation to monthly data for temperature, rainfall, rainfall anomalies, humidity and the Southern Oscillation Index for 1992–2001. Focusing on eight provinces, significant Pearson correlations were observed between dengue/DHF incidence and at least one climate variable ( r  = ±0.2 to ±0.43; P  < 0.05). Multiple regression analyses showed that 12.9–24.5 per cent of variance in incidence was explained by two or three climate variables in each province ( P  < 0.1–0.01). Rainfall appears to be the principal climatic agent affecting the geographic distribution and temporal pattern of incidence while temperature appears to play a critical role in outbreak intensity. Wide regional and temporal variations in the strength and nature of the observed associations led to the identification of three groups of provinces where increases in dengue/DHF incidence were variously associated with increased rainfall, decreased rainfall and/or high susceptibility to climate variability. Although climatic factors play an important role in explaining the timing and intensity of dengue/DHF outbreaks, a wide range of other factors specific to local environments also appear to be involved – information that may assist in the prediction and mitigation of regional dengue/DHF outbreaks.