Spatiotemporal patterns of dengue outbreaks in Sri Lanka

Background: Dengue occurs epidemically in Sri Lanka and every year, when the monsoon season begins, health authorities warn on rising numbers of dengue cases. The popular belief is that dengue epidemics are driven by the two monsoons which feed different parts of the country over different time periods. We analysed the time series of weekly dengue cases in all districts of Sri Lanka from 2007 to 2019 to identify the spatiotemporal patterns of dengue outbreaks and to explain how they are associated with the climatic, geographic and demographic variations around the country.Methods: We used time-series plots, statistical measures such a community-wide synchrony and Kendall-W and a time-varying graph method to understand the spatiotemporal patterns and links.Results and conclusions: The southwest wet zone and surrounding areas which receive rainfall in all four seasons usually experience two epidemic waves per year. The northern and eastern coastal region in the dry zone which receives rainfall in only two seasons experiences one epidemic wave per year. The wet zone is a highly synchronised epidemic unit while the northern and eastern districts have more independent epidemic patterns. The epidemic synchrony in the wet zone may be associated with the frequent mobility of people in and out of the wet zone hot spot Colombo. The overall epidemic pattern in Sri Lanka is not a sole outcome of the two monsoons but the regional epidemic patterns are collectively shaped by monsoon an inter-monsoon rains, human mobility, geographical proximity and other climate and topographical factors.