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Spatio-temporal patterns of dengue in Malaysia: combining address and sub-district level

Cheong Y. Ling, Oliver Gruebner, Alexander Krämer, Tobia Lakes
  • Cheong Y. Ling
    Geoinformation Science Lab, Geography Department, Humboldt-Universität zu Berlin, Berlin, Germany; Medical Research Resource Centre, Institute for Medical Research, Jalan Pahang, Kuala Lumpur, Malaysia |
  • Oliver Gruebner
    Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, United States
  • Alexander Krämer
    Department of Public Health Medicine, University of Bielefeld, Bielefeld, Germany
  • Tobia Lakes
    Geoinformation Science Lab, Geography Department, Humboldt-Universität zu Berlin, Berlin, Germany


Spatio-temporal patterns of dengue risk in Malaysia were studied both at the address and the sub-district level in the province of Selangor and the Federal Territory of Kuala Lumpur. We geocoded laboratory-confirmed dengue cases from the years 2008 to 2010 at the address level and further aggregated the cases in proportion to the population at risk at the sub-district level. Kulldorff’s spatial scan statistic was applied for the investigation that identified changing spatial patterns of dengue cases at both levels. At the address level, spatio-temporal clusters of dengue cases were concentrated at the central and south-eastern part of the study area in the early part of the years studied. Analyses at the sub-district level revealed a consistent spatial clustering of a high number of cases proportional to the population at risk. Linking both levels assisted in the identification of differences and confirmed the presence of areas at high risk for dengue infection. Our results suggest that the observed dengue cases had both a spatial and a temporal epidemiological component, which needs to be acknowl- edged and addressed to develop efficient control measures, including spatially explicit vector control. Our findings highlight the importance of detailed geographical analysis of disease cases in heterogeneous environments with a focus on clustered populations at different spatial and temporal scales. We conclude that bringing together information on the spatio-temporal distribution of dengue cases with a deeper insight of linkages between dengue risk, climate factors and land use constitutes an important step towards the development of an effective risk management strategy.


dengue, spatial and space-time scan statistics, relative risk, address and aggregation level, Malaysia.

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Submitted: 2014-12-09 10:43:40
Published: 2014-11-01 00:00:00
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Copyright (c) 2014 Cheong Y. Ling, Oliver Gruebner, Alexander Krämer, Tobia Lakes

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