Imported Dengue Case Numbers and Local Climatic Patterns Are Associated with Dengue Virus Transmission in Florida, USA

SIMPLE SUMMARY: Dengue virus transmission from Aedes aegypti mosquitoes to humans is a growing issue in the state of Florida in the United States of America. The majority of cases have occurred in the southernmost counties, even though Ae. aegypti are present throughout much of Florida. To understand this geographic partitioning of dengue fever cases in Florida, we compiled ten years (2009–2019) of county-level data on human, environmental, and vector elements and identified risk factors for laboratory-confirmed cases of dengue virus incidence in the state. Counties with the highest average temperatures, highest minimum temperatures, and lowest maximum temperatures were significantly more likely to have local dengue virus transmission. Additionally, moderate rainfall and an increasing number of travel-related dengue cases were also significantly associated with local transmission. This is the first study of its kind to identify county-level risk factors for dengue incidence in Florida. This study provides a parsimonious model that may be useful for prediction of future dengue occurrence based on routinely collected, publicly available data sources. Our findings also highlight the importance of travel-related dengue fever cases to the state as well as environmental conditions that promote dengue virus transmission in Florida by Ae. aegypti. ABSTRACT: Aedes aegypti mosquitoes are the main vector of dengue viruses globally and are present throughout much of the state of Florida (FL) in the United States of America. However, local transmission of dengue viruses in FL has mainly occurred in the southernmost counties; specifically Monroe and Miami-Dade counties. To get a better understanding of the ecologic risk factors for dengue fever incidence throughout FL, we collected and analyzed numerous environmental factors that have previously been connected to local dengue cases in disease-endemic regions. We analyzed these factors for each county-year in FL, between 2009–2019, using negative binomial regression. Monthly minimum temperature of 17.5–20.8 °C, an average temperature of 26.1–26.7 °C, a maximum temperature of 33.6–34.7 °C, rainfall between 11.4–12.7 cm, and increasing numbers of imported dengue cases were associated with the highest risk of dengue incidence per county-year. To our knowledge, we have developed the first predictive model for dengue fever incidence in FL counties and our findings provide critical information about weather conditions that could increase the risk for dengue outbreaks as well as the important contribution of imported dengue cases to local establishment of the virus in Ae. aegypti populations.