Is temperature the main cause of dengue rise in non-endemic countries? The case of Argentina

BACKGROUND: Dengue cases have increased during the last decades, particularly in non-endemic areas, and Argentina was no exception in the southern transmission fringe. Although temperature rise has been blamed for this, human population growth, increased travel and inefficient vector control may also be implicated. The relative contribution of geographic, demographic and climatic of variables on the occurrence of dengue cases was evaluated. METHODS: According to dengue history in the country, the study was divided in two decades, a first decade corresponding to the reemergence of the disease and the second including several epidemics. Annual dengue risk was modeled by a temperature-based mechanistic model as annual days of possible transmission. The spatial distribution of dengue occurrence was modeled as a function of the output of the mechanistic model, climatic, geographic and demographic variables for both decades. RESULTS: According to the temperature-based model dengue risk increased between the two decades, and epidemics of the last decade coincided with high annual risk. Dengue spatial occurrence was best modeled by a combination of climatic, demographic and geographic variables and province as a grouping factor. It was positively associated with days of possible transmission, human population number, population fall and distance to water bodies. When considered separately, the classification performance of demographic variables was higher than that of climatic and geographic variables. CONCLUSIONS: Temperature, though useful to estimate annual transmission risk, does not fully describe the distribution of dengue occurrence at the country scale. Indeed, when taken separately, climatic variables performed worse than geographic or demographic variables. A combination of the three types was best for this task.