{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T01:12:06Z","timestamp":1783127526188,"version":"3.54.6"},"reference-count":43,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2021,1,5]],"date-time":"2021-01-05T00:00:00Z","timestamp":1609804800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Bhutan experienced its largest and first nation-wide dengue epidemic in 2019. The cases in 2019 were greater than the total number of cases in all the previous years. This study aimed to characterize the spatiotemporal patterns and effective reproduction number of this explosive epidemic. Weekly notified dengue cases were extracted from the National Early Warning, Alert, Response and Surveillance (NEWARS) database to describe the spatial and temporal patterns of the epidemic. The time-varying, temperature-adjusted cohort effective reproduction number was estimated over the course of the epidemic. The dengue epidemic occurred between 29 April and 8 December 2019 over 32 weeks, and included 5935 cases. During the epidemic, dengue expanded from six to 44 subdistricts. The effective reproduction number was &lt;3 for most of the epidemic period, except for a \u22481 month period of explosive growth, coinciding with the monsoon season and school vacations, when the effective reproduction number peaked &gt;30 and after which the effective reproduction number declined steadily. Interventions were only initiated 6 weeks after the end of the period of explosive growth. This finding highlights the need to reinforce the national preparedness plan for outbreak response, and to enable the early detection of cases and timely response.<\/jats:p>","DOI":"10.3390\/ijerph18010354","type":"journal-article","created":{"date-parts":[[2021,1,5]],"date-time":"2021-01-05T21:18:57Z","timestamp":1609881537000},"page":"354","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Epidemiological Analysis of the 2019 Dengue Epidemic in Bhutan"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8071-5721","authenticated-orcid":false,"given":"Tsheten","family":"Tsheten","sequence":"first","affiliation":[{"name":"Research School of Population, Australian National University, Acton, Canberra, ACT 2601, Australia"},{"name":"Royal Centre for Disease Control, Ministry of Health, Thimphu 11001, Bhutan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angus","family":"Mclure","sequence":"additional","affiliation":[{"name":"Research School of Population, Australian National University, Acton, Canberra, ACT 2601, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Archie C. A.","family":"Clements","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia"},{"name":"Telethon Kids Institute, Nedlands, WA 6009, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren J.","family":"Gray","sequence":"additional","affiliation":[{"name":"Research School of Population, Australian National University, Acton, Canberra, ACT 2601, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tenzin","family":"Wangdi","sequence":"additional","affiliation":[{"name":"Vector-Borne Disease Control Program, Ministry of Health, Gelephu 31102, Bhutan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonam","family":"Wangchuk","sequence":"additional","affiliation":[{"name":"Royal Centre for Disease Control, Ministry of Health, Thimphu 11001, Bhutan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8857-2665","authenticated-orcid":false,"given":"Kinley","family":"Wangdi","sequence":"additional","affiliation":[{"name":"Research School of Population, Australian National University, Acton, Canberra, ACT 2601, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,1,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1128\/CMR.11.3.480","article-title":"Dengue and dengue hemorrhagic fever","volume":"11","author":"Gubler","year":"1998","journal-title":"Clin. 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