Quantifying the impact of dengue containment activities using high-resolution observational data

Dengue virus causes over 96 million cases worldwide per year and is expanding rapidly in geographic range, especially in urban areas. Containment activities are an essential part of reducing the public health burden caused by dengue, but systematic evidence on the comparative efficacy of activities from the field is lacking. To our knowledge, the effect of containment activities on local (sub-city) scale disease dynamics has never been systematically characterized using empirical containment and case data. We combine data from a comprehensive dengue containment monitoring system with confirmed dengue case data from the local government hospitals to estimate the efficacy of seven common containment activities in two urban areas in Pakistan. We use a modified version of the time series Suspected Infected Recovered framework to estimate how the reproductive number, R 0 , of the outbreak changed in relation to deployment of each containment activity. We also estimate the spatial dependence of cases based on deployment of each containment activity. Both analyses suggest that activities aimed at the adult phase of the mosquito lifecycle have the highest efficacy, with fogging having the largest quantifiable effect in reducing cases immediately after deployment. In examining the efficacy of containment activities contemporaneously deployed in the same locations, results here can guide recommendations for future deployment of resources during dengue outbreaks in urban settings.