Space-time scan statistics of 2007-2013 dengue incidence in Cimahi City, Indonesia

Four dengue serotypes threatened more than 200 million people and has spread to over 400 districts in Indonesia. Furthermore, 26 districts in most densely populated province, West Java, have been declared as hyperendemic areas. Cimahi is an endemic city with the highest population (14,969 people per square kilometer). Evidence on distribution pattern of dengue cases is required to discover the spread of dengue cases in Cimahi. A study has been conducted to detect clusters of dengue incidence during 2007-2013. A temporal spatial analysis was performed using SaTScan™ software incorporated confirmed dengue monthly data from the Municipality Health Office and population data from a local Bureau of Statistics. A retrospective space-time analysis with a Poisson distribution model and monthly precision was performed. Our results revealed a significant most likely cluster (p<0.001) throughout period of study. The most likely cluster was detected in the centre of the city and moved to the northern region of Cimahi. Cimahi, Karangmekar, and Cibabat village were most likely cluster in 2007-2010 (p <0.001; RR = 2.16-2.98; pop at risk 12% total population); Citeureup were detected as the most likely cluster in 2011-2013 (p <0.001; RR 5.77), respectively. Temporaly, clusters were detected in the first quarter of each year each. In conclusion, a dynamic spread of dengue initiated from the centre to its surrounding areas during the period 2007-2013. Our study suggests the use of GIS to strengthen case detection and surveillance. An in-depth investigation to relevant risk factors in high-risk areas in Cimahi city is encouraged.