The driver of dengue fever incidence in two high-risk areas of China: A comparative study.

In China, the knowledge of the underlying causes of heterogeneous distribution pattern of dengue fever in different high-risk areas is limited. A comparative study will help us understand the influencing factors of dengue in different high-risk areas. In the study, we compared the effects of climate, mosquito density and imported cases on dengue fever in two high-risk areas using Generalized Additive Model (GAM), random forests and Structural Equation Model (SEM). GAM analysis identified a similar positive correlation between imported cases, density of Aedes larvae, climate variables and dengue fever occurrence in the studied high-risk areas of both Guangdong and Yunnan provinces. Random forests showed that the most important factors affecting dengue fever occurrence were the number of imported cases, BI and the monthly average minimum temperature in Guangdong province; whereas the imported cases, the monthly average temperature and monthly relative humidity in Yunnan province. We found the rainfall had the indirect effect on dengue fever occurrence in both areas mediated by mosquito density; while the direct effect in high-risk areas of Guangdong was dominated by temperature and no obvious effect in Yunnan province by SEM. In total, climate factors and mosquito density are the key drivers on dengue fever incidence in different high-risk areas of China. These findings could provide scientific evidence for early warning and the scientific control of dengue fever in high-risk areas