[Truncated abstract] This study aimed to characterise the dengue epidemic in Malaysia from 2005 to 2010, by analysing 244,618 dengue notifications, laboratory diagnostic methods, confounding illnesses clinically presenting as dengue, and dengue molecular epidemiology. In addition, environmental influences on dengue outbreaks and forecasting future dengue transmission were investigated. Beginning in 2001 Malaysia has experienced sustained and ongoing dengue epidemic activity, peaking in 2008 with 49,355 notified cases. Analysis of dengue notifications from January 2005 to December 2010 showed that the epidemic was predominantly confined to the densely populated and urbanised areas of Peninsular Malaysia. A shift of disease incidence from rural to urban areas was identified, with the rate ratio for dengue notifications between urban and rural areas steadily increasing from 1.36 in 2005, to 1.74 in 2009. The highest rates of dengue notifications were among young adults (20 to 29 years). In addition, higher rates of disease notifications were seen in males, with a rate ratio between males to females of 1.4:1.0. The Indian population in Malaysia was found to have the highest rates of the disease, with rate ratios of 1.1:1.0:1.4 among the three major ethnic groups: Malays, Chinese and Indians. Weather played an important role in the spread of dengue during the study period. For the states studied (Selangor, Negeri Sembilan, Terengganu and Kelantan) peaks of dengue rates coincided with the two monsoon seasons in Malaysia (Northeast monsoon from November to March and Southwest monsoon from May to September). Monthly dengue notification rates were found to be associated with rainfall and temperature. The feasibility and practicality of modelling and forecasting dengue trends was demonstrated. ARIMA (Autoregressive Integrated Moving Average) models generated using dengue notification data and weather variables from 2005 to 2010 forecast the trends of the dengue rates for 2011 within its 95% CI. This study showed that the existing passive dengue surveillance program in Malaysia has the capacity to serve as an effective early warning system for the disease.
|Qualification||Doctor of Philosophy|
|Publication status||Unpublished - 2012|