{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T19:55:19Z","timestamp":1789415719236,"version":"build-2803163510"},"reference-count":52,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2021,2,10]],"date-time":"2021-02-10T00:00:00Z","timestamp":1612915200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>Dengue is the most rapidly spreading vector-borne disease globally, with a 30-fold increase in global incidence over the last 50 years. In Bhutan, dengue incidence has been on the rise since 2004, with numerous outbreaks reported across the country. The aim of this study was to identify and map areas that are vulnerable to dengue in Bhutan.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methodology\/Principal findings<\/jats:title><jats:p>We conducted a multicriteria decision analysis (MCDA) using a weighted linear combination (WLC) to obtain a vulnerability map of dengue. Risk factors (criteria) were identified and assigned with membership values for vulnerability according to the available literature. Sensitivity analysis and validation of the model was conducted to improve the robustness and predictive ability of the map. Our study revealed marked differences in geographical vulnerability to dengue by location and season. Low-lying areas and those located along the southern border were consistently found to be at higher risk of dengue. The vulnerability extended to higher elevation areas including some areas in the Capital city Thimphu during the summer season. The higher risk was mostly associated with relatively high population density, agricultural and built-up landscapes and relatively good road connectivity.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Conclusions<\/jats:title><jats:p>Using MCDA, our study identified vulnerable areas in Bhutan during specific seasons when and where the transmission of dengue is most likely to occur. This study provides evidence for the National Vector-borne Disease Control programme to optimize the use of limited public health resources for surveillance and vector control, to mitigate the public health threat of dengue.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pntd.0009021","type":"journal-article","created":{"date-parts":[[2021,2,10]],"date-time":"2021-02-10T20:02:38Z","timestamp":1612987358000},"page":"e0009021","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":26,"title":["Dengue risk assessment using multicriteria decision analysis: A case study of Bhutan"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8071-5721","authenticated-orcid":true,"given":"Tsheten","family":"Tsheten","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Archie C. A.","family":"Clements","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren J.","family":"Gray","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kinley","family":"Wangdi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,2,10]]},"reference":[{"key":"pntd.0009021.ref001","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1016\/S1473-3099(16)00026-8","article-title":"The global burden of dengue: an analysis from the Global Burden of Disease Study 2013","volume":"16","author":"JD Stanaway","year":"2016","journal-title":"Lancet Infect Dis"},{"key":"pntd.0009021.ref002","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1016\/S0140-6736(16)31678-6","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990\u20132015: a systematic analysis for the Global Burden of Disease Study 2015","volume":"388","year":"2016","journal-title":"Lancet"},{"key":"pntd.0009021.ref003","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1016\/S0140-6736(16)31012-1","article-title":"Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980\u20132015: a systematic analysis for the Global Burden of Disease Study 2015","volume":"388","year":"2016","journal-title":"Lancet"},{"key":"pntd.0009021.ref004","doi-asserted-by":"crossref","first-page":"674","DOI":"10.4161\/hv.7.6.14985","article-title":"Vaccines for the prevention of dengue: development update","volume":"7","author":"SJ Thomas","year":"2011","journal-title":"Human vaccines"},{"key":"pntd.0009021.ref005","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1038\/nature12060","article-title":"The global distribution and burden of dengue","volume":"496","author":"S Bhatt","year":"2013","journal-title":"Nature"},{"key":"pntd.0009021.ref006","doi-asserted-by":"crossref","first-page":"77","DOI":"10.4103\/0972-9062.117470","article-title":"Emerging and re-emerging arboviral diseases in Southeast Asia","volume":"50","author":"AP Dash","year":"2013","journal-title":"J Vector Borne Dis"},{"key":"pntd.0009021.ref007","unstructured":"World Health Organization. Comprehensive guideline for prevention and control of dengue and dengue haemorrhagic fever. 2011."},{"key":"pntd.0009021.ref008","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1177\/0962280216649216","article-title":"A Bayesian approach for estimating under-reported dengue incidence with a focus on non-linear associations between climate and dengue in Dhaka, Bangladesh","volume":"27","author":"S Sharmin","year":"2018","journal-title":"Stat Methods Med Res"},{"key":"pntd.0009021.ref009","doi-asserted-by":"crossref","first-page":"201","DOI":"10.4103\/jgid.jgid_108_17","article-title":"Hospital-based Surveillance: Accuracy, Adequacy, and Timeliness of Dengue Case Report in Bandung, West Java, Indonesia of 2015","volume":"10","author":"R Adrizain","year":"2018","journal-title":"J Glob Infect Dis"},{"key":"pntd.0009021.ref010","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s12942-019-0187-7","article-title":"A new combination rule for Spatial Decision Support Systems for epidemiology","volume":"18","author":"LMM de Lima","year":"2019","journal-title":"Int J Health Geogr"},{"key":"pntd.0009021.ref011","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1017\/S0031182009006222","article-title":"Remote sensing, geographical information system and spatial analysis for schistosomiasis epidemiology and ecology in Africa","volume":"136","author":"C Simoonga","year":"2009","journal-title":"Parasitology"},{"key":"pntd.0009021.ref012","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1111\/j.1365-3156.2006.01594.x","article-title":"Bayesian spatial analysis and disease mapping: tools to enhance planning and implementation of a schistosomiasis control programme in Tanzania","volume":"11","author":"AC Clements","year":"2006","journal-title":"Trop Med Int Health"},{"key":"pntd.0009021.ref013","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/S0169-4758(98)01285-X","article-title":"From predicting mosquito habitat to malaria seasons using remotely sensed data: practice, problems and perspectives","volume":"14","author":"SI Hay","year":"1998","journal-title":"Parasitology today (Personal ed)"},{"key":"pntd.0009021.ref014","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/1476-072X-5-57","article-title":"Application of knowledge-driven spatial modelling approaches and uncertainty management to a study of Rift Valley fever in Africa","volume":"5","author":"ACA Clements","year":"2006","journal-title":"International journal of health geographics"},{"key":"pntd.0009021.ref015","doi-asserted-by":"crossref","DOI":"10.1002\/9781118644898","volume-title":"Multi-Criteria Decision Analysis: Methods and Software","author":"A Ishizaka","year":"2013"},{"key":"pntd.0009021.ref016","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.cageo.2009.05.011","article-title":"Using the fuzzy majority approach for GIS-based multicriteria group decision-making","volume":"36","author":"S Boroushaki","year":"2010","journal-title":"Computers & Geosciences"},{"key":"pntd.0009021.ref017","unstructured":"Royal Society for Protection of Nature. Geography of Bhutan [Accessed on 10\/6\/2019]. Available from: http:\/\/www.rspnbhutan.org\/geography-of-bhutan-2\/."},{"key":"pntd.0009021.ref018","unstructured":"National Statistical Bureau. Statistical Yearbook of Bhutan 2018. Thimphu2018."},{"key":"pntd.0009021.ref019","unstructured":"Ministry of Health (Bhutan). NEWARS. 2014."},{"key":"pntd.0009021.ref020","doi-asserted-by":"crossref","first-page":"4302","DOI":"10.1002\/joc.5086","article-title":"WorldClim 2: new 1-km spatial resolution climate surfaces for global land areas","volume":"37","author":"SE Fick","year":"2017","journal-title":"International journal of climatology"},{"key":"pntd.0009021.ref021","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/1476-072X-8-38","article-title":"Spatial analysis of plague in California: niche modeling predictions of the current distribution and potential response to climate change","volume":"8","author":"AC Holt","year":"2009","journal-title":"Int J Health Geogr"},{"key":"pntd.0009021.ref022","doi-asserted-by":"crossref","first-page":"170004","DOI":"10.1038\/sdata.2017.4","article-title":"WorldPop, open data for spatial demography","volume":"4","author":"AJ Tatem","year":"2017","journal-title":"Sci Data"},{"key":"pntd.0009021.ref023","first-page":"299","article-title":"Epidemiology of dengue: past, present and future prospects","volume":"5","author":"NE Murray","year":"2013","journal-title":"Clin Epidemiol."},{"key":"pntd.0009021.ref024","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s13071-017-2588-4","article-title":"Spatial and temporal patterns of dengue infections in Timor-Leste, 2005\u20132013.","volume":"11","author":"K Wangdi","year":"2018","journal-title":"Parasit Vectors"},{"key":"pntd.0009021.ref025","doi-asserted-by":"crossref","first-page":"e2016052","DOI":"10.4178\/epih.e2016052","article-title":"Empirical model for estimating dengue incidence using temperature, rainfall, and relative humidity: a 19-year retrospective analysis in East Delhi","volume":"38","author":"VG Ramachandran","year":"2016","journal-title":"Epidemiol Health"},{"key":"pntd.0009021.ref026","first-page":"115","article-title":"Vector dynamics and transmission of dengue virus: implications for dengue surveillance and prevention strategies: vector dynamics and dengue prevention","volume":"338","author":"TW Scott","year":"2010","journal-title":"Current topics in microbiology and immunology"},{"key":"pntd.0009021.ref027","doi-asserted-by":"crossref","first-page":"11","DOI":"10.4269\/ajtmh.2000.62.11","article-title":"Transmission thresholds for dengue in terms of Aedes aegypti pupae per person with discussion of their utility in source reduction efforts","volume":"62","author":"DA Focks","year":"2000","journal-title":"The American journal of tropical medicine and hygiene"},{"key":"pntd.0009021.ref028","first-page":"278","article-title":"Spatiotemporal distribution of dengue vectors & identification of high risk zones in district Sonitpur, Assam, India","volume":"140","author":"M Das","year":"2014","journal-title":"Indian J Med Res"},{"key":"pntd.0009021.ref029","doi-asserted-by":"crossref","first-page":"6319","DOI":"10.3390\/ijerph10126319","article-title":"Assessing weather effects on dengue disease in Malaysia","volume":"10","author":"YL Cheong","year":"2013","journal-title":"Int J Environ Res Public Health"},{"key":"pntd.0009021.ref030","doi-asserted-by":"crossref","first-page":"e34651","DOI":"10.1371\/journal.pone.0034651","article-title":"Effects of extreme precipitation to the distribution of infectious diseases in Taiwan, 1994\u20132008","volume":"7","author":"MJ Chen","year":"2012","journal-title":"PLoS One"},{"key":"pntd.0009021.ref031","article-title":"Ecological Niche Modeling Identifies Fine-Scale Areas at High Risk of Dengue Fever in the Pearl River Delta, China","volume":"14","author":"Q Li","year":"2017","journal-title":"Int J Environ Res Public Health"},{"key":"pntd.0009021.ref032","doi-asserted-by":"crossref","first-page":"S685","DOI":"10.4081\/gh.2014.297","article-title":"Mapping urban and peri-urban breeding habitats of Aedes mosquitoes using a fuzzy analytical hierarchical process based on climatic and physical parameters","volume":"8","author":"MS Sarfraz","year":"2014","journal-title":"Geospat Health"},{"key":"pntd.0009021.ref033","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1128\/CMR.11.3.480","article-title":"Dengue and dengue hemorrhagic fever","volume":"11","author":"DJ Gubler","year":"1998","journal-title":"Clin Microbiol Rev"},{"key":"pntd.0009021.ref034","doi-asserted-by":"crossref","first-page":"820","DOI":"10.4269\/ajtmh.2007.76.820","article-title":"Habitat segregation of dengue vectors along an urban environmental gradient","volume":"76","author":"J Cox","year":"2007","journal-title":"Am J Trop Med Hyg"},{"key":"pntd.0009021.ref035","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1186\/s13071-019-3691-5","article-title":"Applying fuzzy logic to assess the biogeographical risk of dengue in South America","volume":"12","author":"D Romero","year":"2019","journal-title":"Parasit Vectors"},{"key":"pntd.0009021.ref036","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1186\/1471-2458-12-853","article-title":"Analyzing the spatio-temporal relationship between dengue vector larval density and land-use using factor analysis and spatial ring mapping","volume":"12","author":"MS Sarfraz","year":"2012","journal-title":"BMC Public Health"},{"key":"pntd.0009021.ref037","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1111\/tmi.13248","article-title":"Forest cover and climate as potential drivers for dengue fever in Sumatra and Kalimantan 2006\u20132016: a spatiotemporal analysis","volume":"24","author":"Z Husnina","year":"2019","journal-title":"Trop Med Int Health"},{"key":"pntd.0009021.ref038","doi-asserted-by":"crossref","first-page":"e0004159","DOI":"10.1371\/journal.pntd.0004159","article-title":"The Effects of Socioeconomic and Environmental Factors on the Incidence of Dengue Fever in the Pearl River Delta, China, 2013","volume":"9","author":"X Qi","year":"2015","journal-title":"PLoS Negl Trop Dis."},{"key":"pntd.0009021.ref039","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.actatropica.2018.03.026","article-title":"Spatiotemporal responses of dengue fever transmission to the road network in an urban area","volume":"183","author":"Q Li","year":"2018","journal-title":"Acta Trop"},{"key":"pntd.0009021.ref040","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1016\/j.apgeog.2012.03.003","article-title":"Spatio-temporal patterns of dengue fever cases in Kaoshiung City, Taiwan, 2003\u20132008","volume":"34","author":"Y-H Hsueh","year":"2012","journal-title":"Appl Geogr"},{"key":"pntd.0009021.ref041","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1046\/j.1365-3156.2001.00703.x","article-title":"Epidemiological and ecological characteristics of past dengue virus infection in Santa Clara, Peru","volume":"6","author":"MH Reiskind","year":"2001","journal-title":"Trop Med Int Health"},{"key":"pntd.0009021.ref042","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1603\/0022-2585-39.1.143","article-title":"Epidemiological significanceof subterranean Aedes aegypti (Diptera: Culicidae) breeding sites to dengue virus infection in Charters Towers, 1993","volume":"39","author":"BM Russell","year":"2002","journal-title":"J Med Entomol"},{"key":"pntd.0009021.ref043","first-page":"21","article-title":"Flooding and communicable diseases fact sheet.","volume":"80","author":"World Health Organization","year":"2005","journal-title":"Weekly Epidemiological Record = Relev\u00e9 \u00e9pid\u00e9miologique hebdomadaire"},{"key":"pntd.0009021.ref044","volume-title":"GIS and multicriteria decision analysis","author":"J Malczewski","year":"1999"},{"key":"pntd.0009021.ref045","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/j.cageo.2007.04.003","article-title":"Implementing an extension of the analytical hierarchy process using ordered weighted averaging operators with fuzzy quantifiers in ArcGIS","volume":"34","author":"S Boroushaki","year":"2008","journal-title":"Computers & Geosciences"},{"key":"pntd.0009021.ref046","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.sste.2012.11.002","article-title":"Modeling habitat suitability for occurrence of highly pathogenic avian influenza virus H5N1 in domestic poultry in Asia: a spatial multicriteria decision analysis approach","volume":"4","author":"KB Stevens","year":"2013","journal-title":"Spat Spatiotemporal Epidemiol"},{"key":"pntd.0009021.ref047","first-page":"121","article-title":"An heuristic approach for mapping landslide hazard by integrating fuzzy logic with analytic hierarchy process","volume":"35","author":"PV Gorsevski","year":"2006","journal-title":"Control and Cybernetics"},{"key":"pntd.0009021.ref048","doi-asserted-by":"crossref","first-page":"e0006947","DOI":"10.1371\/journal.pntd.0006947","article-title":"Geostatistical mapping of the seasonal spread of under-reported dengue cases in Bangladesh","volume":"12","author":"S Sharmin","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0009021.ref049","doi-asserted-by":"crossref","first-page":"3516284","DOI":"10.1155\/2019\/3516284","article-title":"Dengue Situation in Bangladesh: An Epidemiological Shift in terms of Morbidity and Mortality","volume":"2019","author":"P Mutsuddy","year":"2019","journal-title":"Can J Infect Dis Med Microbiol"},{"key":"pntd.0009021.ref050","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1016\/j.renene.2018.09.090","article-title":"An integrated GIS-based Ordered Weighted Averaging analysis for solar energy evaluation in Iran: Current conditions and future planning","volume":"136","author":"MK Firozjaei","year":"2019","journal-title":"Renewable Energy"},{"key":"pntd.0009021.ref051","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1007\/s10661-017-6225-7","article-title":"Forest fire risk assessment-an integrated approach based on multicriteria evaluation","volume":"189","author":"E Goleiji","year":"2017","journal-title":"Environ Monit Assess"},{"key":"pntd.0009021.ref052","doi-asserted-by":"crossref","first-page":"e63584","DOI":"10.1371\/journal.pone.0063584","article-title":"Developing a vulnerability mapping methodology: applying the water-associated disease index to dengue in Malaysia","volume":"8","author":"SK Dickin","year":"2013","journal-title":"PLoS One"}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0009021","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,24]],"date-time":"2024-08-24T00:39:58Z","timestamp":1724459998000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0009021"}},"subtitle":[],"editor":[{"given":"Elvina","family":"Viennet","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,2,10]]},"references-count":52,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,2,10]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0009021","relation":{},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,10]]}}}