Ten Years of Dengue (2013–2022): Epidemiology and Predictors of Outbreaks in Sarawak

Abstract

Dengue is a major public health problem in Sarawak, Malaysia. Since 2011, the Ministry of Health of Malaysia has created an electronic database (e-Dengue) for all dengue cases in Malaysia. This database of cases includes socio-demographic and locality data, clinical symptoms and signs, and results from rapid dengue assays. This study analyses data extracted from this database to describe the epidemiology and determine which factors are more likely to indicate or predict an outbreak of dengue. A total of 14,020 cases from 2013 to 2022 were extracted, with 4,636 cases reported from outbreaks. The highest incidence was 112.22 per 100,000 population in 2016, with 2,773 cases. Over this period, there were 37 deaths, with the highest in 2016 with seven deaths. The case fatality rate ranged from 0.12% to 0.75%. Predictors of outbreaks include younger age (0.984 (0.980–0.989)), female (1.584 (1.387–1.821)), cases from rural areas (0.398 (0.346–0.458)), unemployed (1.179 (1.005–1.383)), students (1.450 (1.163–1.808)). For clinical markers, rash (1.315 (1.056–1.638)) and NS1 antigen test positivity (3.474 (2.952–4.088)) were a predictor of outbreaks, while diarrhoea (0.160 (0.055–0.465)) was a predictor for single cases. Although rainfall, climate change, and population density are known predictors of dengue, socio-demographic factors, clinical signs, and NS1 antigen are additional predictors of dengue that will allow for early detection and control.