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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (31 October 2018) | Viewed by 63481

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Special Issue Editor

Prof. Dr. Antonio López-Quílez

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Guest Editor

Department of Statistics and Operational Research, University of Valencia, Dr. Moliner 50, 46100 Burjassot, Spain
Interests: spatial statistics; bayesian statistics; environmental statistics; biostatistics; epidemiology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

A Special Issue on spatio-temporal analysis of infectious diseases is being organized in the International Journal of Environmental Research and Public Health. For detailed information on the journal, I refer you to https://0-www-mdpi-com.brum.beds.ac.uk/journal/ijerph.

Epidemiological research on the pathogenesis, diagnosis, and treatment of infectious diseases is a broad field of work with renewed validity in the face of social changes and new threats. The spatiotemporal distribution is central in the knowledge of the development, transmission, spread and dynamics of these diseases.

New technologies and GIS methods together with highly structured mathematical and statistical techniques have a special utility in describing and analyzing infectious disease incidence. Specifically, Bayesian inference methods allow the analysis of models with complex and flexible structures suitable to represent the diverse characteristics present in each geographical environment and disease.

Tuberculosis, hepatitis, HIV, influenza, malaria, dengue, zika and other vector-borne diseases are a constant concern for health authorities, practitioners and patients. A variety of environmental, climatic and socio-economic factors underlie their spatiotemporal patterns. In addition, factors such as changes in climate, habits or land use intervene and complicate the understanding of these processes.

This Special Issue invites contributions on spatio-temporal analysis of infectious diseases and related themes. The keywords listed below provide an outline of some of the possible areas of interest.

Prof. Dr. Antonio López-Quílez
Guest Editor

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

spatio-temporal modeling
infectious disease epidemiology
geographical pattern
spatial heterogeneity
transmission dynamics
emerging infectious diseases
neglected tropical diseases
environmental factors
climate change

Published Papers (12 papers)

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Editorial

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2 pages, 226 KiB

Open AccessEditorial

Spatio-Temporal Analysis of Infectious Diseases

by Antonio López-Quílez

Int. J. Environ. Res. Public Health 2019, 16(4), 669; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16040669 - 25 Feb 2019

Cited by 9 | Viewed by 3559

Abstract

Epidemiological research on the pathogenesis, diagnosis, and treatment of infectious diseases is a broad field of study with renewed validity in the face of social changes and new threats [...] Full article

(This article belongs to the Special Issue Spatio-Temporal Analysis of Infectious Diseases)

Research

Jump to: Editorial

53 pages, 8395 KiB

Open AccessArticle

Advanced Hepatitis C Virus Replication PDE Models within a Realistic Intracellular Geometric Environment

by Markus M. Knodel, Paul Targett-Adams, Alfio Grillo, Eva Herrmann and Gabriel Wittum

Int. J. Environ. Res. Public Health 2019, 16(3), 513; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16030513 - 12 Feb 2019

Cited by 5 | Viewed by 3760

Abstract

The hepatitis C virus (HCV) RNA replication cycle is a dynamic intracellular process occurring in three-dimensional space (3D), which is difficult both to capture experimentally and to visualize conceptually. HCV-generated replication factories are housed within virus-induced intracellular structures termed membranous webs (MW), which are derived from the Endoplasmatic Reticulum (ER). Recently, we published 3D spatiotemporal resolved diffusion–reaction models of the HCV RNA replication cycle by means of surface partial differential equation (sPDE) descriptions. We distinguished between the basic components of the HCV RNA replication cycle, namely HCV RNA, non-structural viral proteins (NSPs), and a host factor. In particular, we evaluated the sPDE models upon realistic reconstructed intracellular compartments (ER/MW). In this paper, we propose a significant extension of the model based upon two additional parameters: different aggregate states of HCV RNA and NSPs, and population dynamics inspired diffusion and reaction coefficients instead of multilinear ones. The combination of both aspects enables realistic modeling of viral replication at all scales. Specifically, we describe a replication complex state consisting of HCV RNA together with a defined amount of NSPs. As a result of the combination of spatial resolution and different aggregate states, the new model mimics a cis requirement for HCV RNA replication. We used heuristic parameters for our simulations, which were run only on a subsection of the ER. Nevertheless, this was sufficient to allow the fitting of core aspects of virus reproduction, at least qualitatively. Our findings should help stimulate new model approaches and experimental directions for virology. Full article

(This article belongs to the Special Issue Spatio-Temporal Analysis of Infectious Diseases)

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13 pages, 5856 KiB

Open AccessArticle

Epidemiological Trend of Typhoid and Paratyphoid Fevers in Zhejiang Province, China from 1953 to 2014

by Hua Gu, Congcong Yan, Zhenggang Jiang, Xiuyang Li, Enfu Chen, Jianmin Jiang, Qingwu Jiang and Yibiao Zhou

Int. J. Environ. Res. Public Health 2018, 15(11), 2427; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15112427 - 01 Nov 2018

Cited by 6 | Viewed by 3423

Abstract

Background: The incidences of typhoid and paratyphoid remain high and these diseases still pose a public health problem in China and in Zhejiang Province in particular. This study aimed to investigate the trend of typhoid and paratyphoid in Zhejiang Province from 1953 to 2014 and to provide a theoretical basis for the prevention and control of these diseases. Methods: Included in this study were compiled epidemiological data of typhoid and paratyphoid cases in Zhejiang from 1953 to 2003 and epidemiological data of those from 2004 to 2014 registered in the China Information System for Diseases Control and Prevention. Description methods were employed to explore the epidemiological characteristics, including long-term trend, gender distribution, age distribution, and occupation distribution. Incidence maps were made to represent the annual average incidences for each municipality. Spearman’s rank correlation was performed to detect the correlation between incidence and average elevation, and circular distribution was calculated to identify the seasonality and peak days of the diseases. A p-value of <0.05 was considered statistically significant. Results: A total of 182,602 typhoid and paratyphoid cases were reported in Zhejiang Province from 1953 to 2014, and the average annual incidence was 7.89 per 100,000 population. The incidence in 2014 decreased by 93.82% compared with that in 1953 and by 95.00% compared with the highest incidence rate. The average incidence before 2003 was negatively correlated with the average elevation of each region in Zhejiang province (r < 0, p < 0.05), but there was no statistically significant correlation from 2003. The peak period of diseases fell in the months from April to October every year. The incidence among the population group aged over 35 rose gradually but declined sharply among those between 20 and 34. Conclusions: The incidence of typhoid and paratyphoid decreased in Zhejiang Province from 1953 to 2014 but remained high in some regions. Proper measures for prevention and control are warranted in the southeast coast areas and for high-risk populations. Full article

(This article belongs to the Special Issue Spatio-Temporal Analysis of Infectious Diseases)

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17 pages, 4023 KiB

Open AccessArticle

Agent-Based Modeling for Super-Spreading Events: A Case Study of MERS-CoV Transmission Dynamics in the Republic of Korea

by Yunhwan Kim, Hohyung Ryu and Sunmi Lee

Int. J. Environ. Res. Public Health 2018, 15(11), 2369; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15112369 - 26 Oct 2018

Cited by 40 | Viewed by 5254

Abstract

Super-spreading events have been observed in the transmission dynamics of many infectious diseases. The 2015 MERS-CoV outbreak in the Republic of Korea has also shown super-spreading events with a significantly high level of heterogeneity in generating secondary cases. It becomes critical to understand the mechanism for this high level of heterogeneity to develop effective intervention strategies and preventive plans for future emerging infectious diseases. In this regard, agent-based modeling is a useful tool for incorporating individual heterogeneity into the epidemic model. In the present work, a stochastic agent-based framework is developed in order to understand the underlying mechanism of heterogeneity. Clinical (i.e., an infectivity level) and social or environmental (i.e., a contact level) heterogeneity are modeled. These factors are incorporated in the transmission rate functions under assumptions that super-spreaders have stronger transmission and/or higher links. Our agent-based model has employed real MERS-CoV epidemic features based on the 2015 MERS-CoV epidemiological data. Monte Carlo simulations are carried out under various epidemic scenarios. Our findings highlight the roles of super-spreaders in a high level of heterogeneity, underscoring that the number of contacts combined with a higher level of infectivity are the most critical factors for substantial heterogeneity in generating secondary cases of the 2015 MERS-CoV transmission. Full article

(This article belongs to the Special Issue Spatio-Temporal Analysis of Infectious Diseases)

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14 pages, 1594 KiB

Open AccessArticle

Tuberculosis among Full-Time Teachers in Southeast China, 2005–2016

by Hongdan Bao, Kui Liu, Zikang Wu, Chengliang Chai, Tieniu He, Wei Wang, Fei Wang, Ying Peng, Xiaomeng Wang, Bin Chen and Jianmin Jiang

Int. J. Environ. Res. Public Health 2018, 15(9), 2024; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15092024 - 17 Sep 2018

Cited by 5 | Viewed by 3081

Abstract

Objective: To explore the incidence rate and characteristics of tuberculosis (TB) among full-time teachers from 2005 to 2016 in southeast China and to provide a basis for TB prevention and control measures in schools. Methods: Information about full-time teachers with TB was obtained from the National Tuberculosis Information Management System (NTIMS). Population data were collected from the Zhejiang Statistical Yearbook and the Zhejiang Education Yearbook. The TB incidence rates and epidemiological characteristics of full-time teachers were analyzed and the Chi-square test was used to analyze influencing factors of epidemiological characteristics and clinical characteristics, case-finding delay, and treatment outcomes. Results: A total of 1795 teachers with TB were reported from 2005 to 2016, and the annual incidence rate was 28.87 per 100,000. The average annual PTB (pulmonary TB) incidence rate among full-time teachers was 25.43/100,000 from 2005 to 2016 and the average annual PTB incidence rate among students was 15.40/100,000 from 2005 to 2016. The highest average incidence rates were observed in the QZ (Quzhou) and HZ (Hangzhou) districts. The male-to-female ratio of the patients was 0.95:1. Approximately half of the patients were 15–40 years old. The mean case-finding interval was 45.3 days. Multivariable logistic regression analysis of TB case-finding delay among full-time teachers revealed that the older (OR = 1.44, 95% CI = 1.18–1.76, p < 0.01), not local (OR = 1.81, 95% CI = 1.20–2.73, p < 0.01), retreatment (OR = 2.06, 95% CI = 1.39–3.08, p < 0.01) and extra-pulmonary tuberculosis (OR = 1.71, 95% CI = 1.13–2.61, p = 0.01) cases were at high risk of case-finding delay. Compared to physical examination, patients detected by referrals and tracking (OR = 2.26, 95% CI = 1.16–4.38, p = 0.02) and patients who directly visited the designated TB hospital (OR = 2.00, 95% CI = 1.03–3.88, p = 0.04) were more prone to case-finding delay. The cure rate of full-time teachers with TB was 77.10%. The cure rates differed significantly between groups classified based on age, case-finding patterns, diagnostic results, treatment classifications, and strategies of patient management. Conclusion: The TB incidence rate among full-time teachers decreased from 2005 to 2016, but teachers suffered a higher risk of TB than students. Western Zhejiang was a hotspot for TB incidence among full-time teachers. Female teacher and young and middle-aged teacher cases account for the majority of the reported patients. There was a case-finding delay among full-time teachers with TB. We should conduct regular physical examinations and strengthen full-course supervision to reduce the risk of TB patients with case-finding delay and increase the TB cure rate. Full article

(This article belongs to the Special Issue Spatio-Temporal Analysis of Infectious Diseases)

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14 pages, 4361 KiB

Open AccessArticle

Spatiotemporal Characteristics of Bacillary Dysentery from 2005 to 2017 in Zhejiang Province, China

by Congcong Yan, Yijuan Chen, Ziping Miao, Shuwen Qin, Hua Gu and Jian Cai

Int. J. Environ. Res. Public Health 2018, 15(9), 1826; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15091826 - 24 Aug 2018

Cited by 13 | Viewed by 4397

Abstract

Background: This study aimed to analyze the epidemiological and spatiotemporal characteristics of bacillary dysentery in Zhejiang Province and to provide the basis for its monitoring, prevention and control. Methods: This study included cases registered in China Information System for Diseases Control and Prevention from 1 January 2005 to 31 December 2017 in Zhejiang. Descriptive methods were employed to investigate the long trend of this disease: gender distribution, high-risk population, seasonality, and circular distribution was explored to detect the peak period; incidence maps were made to show the incidence trend of disease at county level; spatial autocorrelation was explored and the regions with autocorrelation were detected; and spatiotemporal scan was conducted to map out the high-risk regions of disease and how long they lasted. Statistical significance was assumed at p value of <0.05. Results: A total of 105,577 cases of bacillary dysentery were included, the incidence declining sharply from 45.84/100,000 to 3.44/100,000 with an obvious seasonal peak from July to October. Males were more predisposed to the infection than females. Pre-education children had the highest proportion among all occupation categories. Incidence in all age groups were negatively correlated with the year (p < 0.001), and the incidences were negatively correlated with the age groups in 2005–2008 (p = 0.022, 0.025, 0.044, and 0.047, respectively). Local autocorrelation showed that counties in Hangzhou were high-risk regions of bacillary dysentery. The spatiotemporal scan indicated that all clusters occurred before 2011, and the most likely cluster for disease was found in Hangzhou, Jiaxing and Huzhou. Conclusions: The incidence of bacillary dysentery in Zhejiang from 2005 to 2017 featured spatiotemporal clustering, and remained high in some areas and among the young population. Findings in this study serve as a panorama of bacillary dysentery in Zhejiang and provide useful information for better interventions and public health planning. Full article

(This article belongs to the Special Issue Spatio-Temporal Analysis of Infectious Diseases)

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15 pages, 1188 KiB

Open AccessArticle

Geographical Environment Factors and Risk Mapping of Human Cystic Echinococcosis in Western China

by Duan Huang, Rendong Li, Juan Qiu, Xiangdong Sun, Ruixia Yuan, Yuanyuan Shi, Yubing Qu and Yingnan Niu

Int. J. Environ. Res. Public Health 2018, 15(8), 1729; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15081729 - 12 Aug 2018

Cited by 25 | Viewed by 5097

Abstract

The study aimed to reveal the risk factors and predict the prevalence of human cystic echinococcosis (CE) in Western China. To do this, we analyzed county-wide data relating to the prevalence of human CE in seven provinces of Western China, along with associated human, natural geographical environmental data. We then used spatial analysis and multiple regression analysis to investigate the correlation between the prevalence of human CE and associated environmental factors and to create a risk map of the disease in the seven provinces. Our analysis showed that grassland area ratio and Tibetan population ratio were independent variables positively correlated with the prevalence of human CE and that gross domestic product (GDP) and land surface temperature (LST; Spring) were negative independent variables. We also created a predictive risk map of human CE that revealed that the high-risk areas were mainly located in the south of Qinghai, the Northwest of Sichuan and most of the Tibet Autonomous Region. Knowledge of the spatial distribution and risk factors associated with human CE could help to prevent and control echinococcosis in China. Full article

(This article belongs to the Special Issue Spatio-Temporal Analysis of Infectious Diseases)

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16 pages, 2155 KiB

Open AccessArticle

Risk Assessment and Mapping of Hand, Foot, and Mouth Disease at the County Level in Mainland China Using Spatiotemporal Zero-Inflated Bayesian Hierarchical Models

by Chao Song, Yaqian He, Yanchen Bo, Jinfeng Wang, Zhoupeng Ren and Huibin Yang

Int. J. Environ. Res. Public Health 2018, 15(7), 1476; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15071476 - 12 Jul 2018

Cited by 29 | Viewed by 6797

Abstract

Hand, foot, and mouth disease (HFMD) is a worldwide infectious disease, prominent in China. China’s HFMD data are sparse with a large number of observed zeros across locations and over time. However, no previous studies have considered such a zero-inflated problem on HFMD’s spatiotemporal risk analysis and mapping, not to mention for the entire Mainland China at county level. Monthly county-level HFMD cases data combined with related climate and socioeconomic variables were collected. We developed four models, including spatiotemporal Poisson, negative binomial, zero-inflated Poisson (ZIP), and zero-inflated negative binomial (ZINB) models under the Bayesian hierarchical modeling framework to explore disease spatiotemporal patterns. The results showed that the spatiotemporal ZINB model performed best. Both climate and socioeconomic variables were identified as significant risk factors for increasing HFMD incidence. The relative risk (RR) of HFMD at the local scale showed nonlinear temporal trends and was considerably spatially clustered in Mainland China. The first complete county-level spatiotemporal relative risk maps of HFMD were generated by this study. The new findings provide great potential for national county-level HFMD prevention and control, and the improved spatiotemporal zero-inflated model offers new insights for epidemic data with the zero-inflated problem in environmental epidemiology and public health. Full article

(This article belongs to the Special Issue Spatio-Temporal Analysis of Infectious Diseases)

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18 pages, 15603 KiB

Open AccessArticle

Spatio-Temporal Modeling of Zika and Dengue Infections within Colombia

by Daniel Adyro Martínez-Bello, Antonio López-Quílez and Alexander Torres Prieto

Int. J. Environ. Res. Public Health 2018, 15(7), 1376; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15071376 - 30 Jun 2018

Cited by 16 | Viewed by 5542

Abstract

The aim of this study is to estimate the parallel relative risk of Zika virus disease (ZVD) and dengue using spatio-temporal interaction effects models for one department and one city of Colombia during the 2015–2016 ZVD outbreak. We apply the integrated nested Laplace approximation (INLA) for parameter estimation, using the epidemiological week (EW) as a time measure. At the departmental level, the best model showed that the dengue or ZVD risk in one municipality was highly associated with risk in the same municipality during the preceding EWs, while at the city level, the final model selected established that the high risk of dengue or ZVD in one census sector was highly associated not only with its neighboring census sectors in the same EW, but also with its neighboring sectors in the preceding EW. The spatio-temporal models provided smoothed risk estimates, credible risk intervals, and estimation of the probability of high risk of dengue and ZVD by area and time period. We explore the intricacies of the modeling process and interpretation of the results, advocating for the use of spatio-temporal models of the relative risk of dengue and ZVD in order to generate highly valuable epidemiological information for public health decision making. Full article

(This article belongs to the Special Issue Spatio-Temporal Analysis of Infectious Diseases)

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15 pages, 3785 KiB

Open AccessArticle

The Social and Spatial Ecology of Dengue Presence and Burden during an Outbreak in Guayaquil, Ecuador, 2012

by Catherine A. Lippi, Anna M. Stewart-Ibarra, Ángel G. Muñoz, Mercy J. Borbor-Cordova, Raúl Mejía, Keytia Rivero, Katty Castillo, Washington B. Cárdenas and Sadie J. Ryan

Int. J. Environ. Res. Public Health 2018, 15(4), 827; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15040827 - 23 Apr 2018

Cited by 37 | Viewed by 8410

Abstract

Dengue fever, a mosquito-borne arbovirus, is a major public health concern in Ecuador. In this study, we aimed to describe the spatial distribution of dengue risk and identify local social-ecological factors associated with an outbreak of dengue fever in the city of Guayaquil, Ecuador. We examined georeferenced dengue cases (n = 4248) and block-level census data variables to identify social-ecological risk factors associated with the presence/absence and burden of dengue in Guayaquil in 2012. Local Indicators of Spatial Association (LISA), specifically Anselin’s Local Moran’s I, and Moran’s I tests were used to locate hotspots of dengue transmission, and multimodel selection was used to identify covariates associated with dengue presence and burden at the census block level. We identified significant dengue transmission hotspots near the North Central and Southern portions of Guayaquil. Significant risk factors for presence of dengue included poor housing conditions, access to paved roads, and receipt of remittances. Counterintuitive positive correlations with dengue presence were observed with several municipal services such as garbage collection and access to piped water. Risk factors for increased burden of dengue included poor housing conditions, garbage collection, receipt of remittances, and sharing a property with more than one household. Social factors such as education and household demographics were negatively correlated with increased dengue burden. These findings elucidate underlying differences with dengue presence versus burden, and suggest that vulnerability and risk maps could be developed to inform dengue prevention and control; this is information that is also relevant for emerging epidemics of chikungunya and Zika viruses. Full article

(This article belongs to the Special Issue Spatio-Temporal Analysis of Infectious Diseases)

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17 pages, 21923 KiB

Open AccessArticle

Spatio-Temporal Epidemiology of Viral Hepatitis in China (2003–2015): Implications for Prevention and Control Policies

by Bin Zhu, Jinlin Liu, Yang Fu, Bo Zhang and Ying Mao

Int. J. Environ. Res. Public Health 2018, 15(4), 661; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15040661 - 02 Apr 2018

Cited by 44 | Viewed by 7166

Abstract

Viral hepatitis, as one of the most serious notifiable infectious diseases in China, takes heavy tolls from the infected and causes a severe economic burden to society, yet few studies have systematically explored the spatio-temporal epidemiology of viral hepatitis in China. This study aims to explore, visualize and compare the epidemiologic trends and spatial changing patterns of different types of viral hepatitis (A, B, C, E and unspecified, based on the classification of CDC) at the provincial level in China. The growth rates of incidence are used and converted to box plots to visualize the epidemiologic trends, with the linear trend being tested by chi-square linear by linear association test. Two complementary spatial cluster methods are used to explore the overall agglomeration level and identify spatial clusters: spatial autocorrelation analysis (measured by global and local Moran’s I) and space-time scan analysis. Based on the spatial autocorrelation analysis, the hotspots of hepatitis A remain relatively stable and gradually shrunk, with Yunnan and Sichuan successively moving out the high-high (HH) cluster area. The HH clustering feature of hepatitis B in China gradually disappeared with time. However, the HH cluster area of hepatitis C has gradually moved towards the west, while for hepatitis E, the provincial units around the Yangtze River Delta region have been revealing HH cluster features since 2005. The space-time scan analysis also indicates the distinct spatial changing patterns of different types of viral hepatitis in China. It is easy to conclude that there is no one-size-fits-all plan for the prevention and control of viral hepatitis in all the provincial units. An effective response requires a package of coordinated actions, which should vary across localities regarding the spatial-temporal epidemic dynamics of each type of virus and the specific conditions of each provincial unit. Full article

(This article belongs to the Special Issue Spatio-Temporal Analysis of Infectious Diseases)

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12 pages, 4098 KiB

Open AccessArticle

Epidemiological Characteristics and Space-Time Analysis of the 2015 Dengue Outbreak in the Metropolitan Region of Tainan City, Taiwan

by Ting-Wu Chuang, Ka-Chon Ng, Thi Luong Nguyen and Luis Fernando Chaves

Int. J. Environ. Res. Public Health 2018, 15(3), 396; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15030396 - 26 Feb 2018

Cited by 17 | Viewed by 5313

Abstract

The metropolitan region of Tainan City in southern Taiwan experienced a dengue outbreak in 2015. This manuscript describes basic epidemiological features of this outbreak and uses spatial and temporal analysis tools to understand the spread of dengue during the outbreak. The analysis found that, independently of gender, dengue incidence rate increased with age, and proportionally affected more males below the age of 40 years but females above the age of 40 years. A spatial scan statistic was applied to detect clusters of disease transmission. The scan statistic found that dengue spread in a north-south diffusion direction, which is across the North, West-Central and South districts of Tainan City. Spatial regression models were used to quantify factors associated with transmission. This analysis indicated that neighborhoods with high proportions of residential area (or low wetland cover) were associated with dengue transmission. However, these association patterns were non-linear. The findings presented here can help Taiwanese public health agencies to understand the fundamental epidemiological characteristics and diffusion patterns of the 2015 dengue outbreak in Tainan City. This type of information is fundamental for policy making to prevent future uncontrolled dengue outbreaks, given that results from this study suggest that control interventions should be emphasized in the North and West-Central districts of Tainan city, in areas with a moderate percentage of residential land cover. Full article

(This article belongs to the Special Issue Spatio-Temporal Analysis of Infectious Diseases)

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