Spatial and temporal dynamics of dengue fever in Peru: 1994–2006

SUMMARY The weekly number of dengue cases in Peru, South America, stratified by province for the period 1994–2006 were analysed in conjunction with associated demographic, geographic and climatological data. Estimates of the reproduction number, moderately correlated with population size (Spearman r=0 . 28, P=0 . 03), had a median of 1 . 76 (IQR 0 . 83–4 . 46). The distributions of dengue attack rates and epidemic durations follow power-law (Pareto) distributions (coefficient of determination >85%, P<0 . 004). Spatial heterogeneity of attack rates was highest in coastal areas followed by mountain and jungle areas. Our findings suggest a hierarchy of transmission events during the large 2000–2001 epidemic from large to small population areas when serotypes DEN-3 and DEN-4 were first identified (Spearman r=x0 . 43, P=0 . 03). The need for spatial and temporal dengue epidemic data with a high degree of resolution not only increases our understanding of the dynamics of dengue but will also generate new hypotheses and provide a platform for testing innovative control policies.