{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T19:09:42Z","timestamp":1784920182727,"version":"3.55.0"},"reference-count":43,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"2","license":[{"start":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T00:00:00Z","timestamp":1754438400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,6]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Dengue, which was first reported as a travel case in Nepal in 2004, was initially confined to the lower plains but has spread to higher elevations. Large outbreaks in 2022 and 2023 (54,784 and 51,243 cases, respectively), reached every district (\n                    <jats:italic>n<\/jats:italic>\n                    = 77). We calculated the district-wise incidence for 2022 and 2023 by digitizing case data from Nepal\u2019s Ministry of Health and Population and 2021 census data from the National Statistics Office. The incidence and peak incidence months for each year were mapped, and spatial clusters (hotspots and cold spots) and outliers of incidence rates were identified using Local Moran\u2019s I. In 2022, district-wise peak cases occurred from August to October. One hotspot (high\u2013high cluster), with high values surrounded by high-value neighbors, including six districts around Kathmandu, and one cold spot (low\u2013low cluster), with low values surrounded by low-value neighbors, comprising eight high-elevation districts in Nepal\u2019s northwest region were identified. In 2023, cases peaked from March to November, indicating more distributed peaks that started earlier; hotspots shifted to the north-central and eastern regions, and a low\u2013high outlier district in the central region was identified. Identifying the timing of peaks and spatial clusters of dengue incidence can inform targeted management, thereby improving effectiveness and cost-efficiency. A baseline examination of recent dengue incidence in Nepal, highlighting timing and spatial clustering in incidence, is provided in this study. The mountainous northwest cold spots align with expectations of fewer mosquitoes because of the geography and climate. However, the 2022 dengue incidence peaked across all 77 districts in 3 months, suggesting that ecological and climatic factors may no longer be effective barriers.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.24-0747","type":"journal-article","created":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T15:28:40Z","timestamp":1749569320000},"page":"366-373","source":"Crossref","is-referenced-by-count":5,"title":["Spatial Patterns of Dengue Incidence in Nepal During Record Outbreaks in 2022 and 2023: Implications for Public Health Interventions"],"prefix":"10.4269","volume":"113","author":[{"given":"Simrik","family":"Bhandari","sequence":"first","affiliation":[{"name":"Quantitative Disease Ecology and Conservation Lab, Department of Geography, University of Florida, Gainesville, Florida;"},{"name":"Emerging Pathogens Institute, University of Florida, Gainesville, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason K.","family":"Blackburn","sequence":"additional","affiliation":[{"name":"Emerging Pathogens Institute, University of Florida, Gainesville, Florida;"},{"name":"Spatial Ecology and Epidemiology Research Laboratory, Department of Geography, University of Florida, Gainesville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadie J.","family":"Ryan","sequence":"additional","affiliation":[{"name":"Quantitative Disease Ecology and Conservation Lab, Department of Geography, University of Florida, Gainesville, Florida;"},{"name":"Emerging Pathogens Institute, University of Florida, Gainesville, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Nature","first-page":"504","article-title":"The global distribution and burden of dengue","volume":"496","author":"Bhatt","year":"2013"},{"key":"b2","series-title":"Lung","first-page":"389","article-title":"Dengue hemorrhagic fever: A state-of-the-art review focused in pulmonary involvement","volume":"195","author":"Rocha de Almeida","year":"2017"},{"key":"b3","series-title":"Dengue Guidelines for Diagnosis, Treatment, Prevention and Control","year":"2009"},{"key":"b4","series-title":"Trends Microbiol","first-page":"100","article-title":"Epidemic dengue\/dengue hemorrhagic fever as a public health, social and economic problem in the 21st century","volume":"10","author":"Gubler","year":"2002"},{"key":"b5","series-title":"Nat Rev Microbiol","first-page":"S7","article-title":"Dengue: A continuing global threat","volume":"8","author":"Guzman","year":"2010"},{"key":"b6","series-title":"Clin Microbiol Rev","first-page":"480","article-title":"Dengue and dengue hemorrhagic fever","volume":"11","author":"Gubler","year":"1998"},{"key":"b7","series-title":"J Infect Dis","first-page":"979","article-title":"Dengue viruses and lifelong immunity: Reevaluating the conventional wisdom","volume":"214","author":"Forshey","year":"2016"},{"key":"b8","series-title":"Parasit Vectors","first-page":"213","article-title":"Distribution and pyrethroid resistance status of Aedes aegypti and Aedes albopictus populations and possible phylogenetic reasons for the recent invasion of Aedes aegypti in Nepal","volume":"13","author":"Kawada","year":"2020"},{"key":"b9","series-title":"PLoS Negl Trop Dis","first-page":"e3035","article-title":"Spatio-temporal distribution of dengue and lymphatic filariasis vectors along an altitudinal transect in central Nepal","volume":"8","author":"Dhimal","year":"2014"},{"key":"b10","series-title":"BMC Res Notes","first-page":"131","article-title":"Climatic factors influencing dengue incidence in an epidemic area of Nepal","volume":"12","author":"Tuladhar","year":"2019"},{"key":"b11","series-title":"BMC Public Health","first-page":"849","article-title":"Spatiotemporal analysis of dengue fever in Nepal from 2010 to 2014","volume":"16","author":"Acharya","year":"2016"},{"key":"b12","series-title":"Trans R Soc Trop Med Hyg","first-page":"775","article-title":"Persistent dengue emergence: The seven years surrounding the 2010 epidemic in Nepal","volume":"109","author":"Pandey","year":"2015"},{"key":"b13","series-title":"PLoS Negl Trop Dis","first-page":"e3301","article-title":"Urbanization increases Aedes albopictus larval habitats and accelerates mosquito development and survivorship","volume":"8","author":"Li","year":"2014"},{"key":"b14","series-title":"Sci Rep","first-page":"15335","article-title":"Urbanization creates diverse aquatic habitats for immature mosquitoes in urban areas","volume":"9","author":"Wilke","year":"2019"},{"key":"b15","series-title":"Int J Surg Glob Health","first-page":"1","article-title":"Frequent outbreaks of dengue in Nepal \u2013 Causes and solutions: A narrative review","volume":"6","author":"Pokharel","year":"2023"},{"key":"b16","series-title":"Emerg Microbes Infect","first-page":"676","article-title":"Establishment and recent surge in spatio-temporal spread of dengue in Nepal","volume":"9","author":"Acharya","year":"2020"},{"key":"b17","series-title":"Epidemiol Infect","first-page":"e196","article-title":"Has COVID-19 suppressed dengue transmission in Nepal?","volume":"150","author":"Pandey","year":"2022"},{"key":"b18","series-title":"J Travel Med","first-page":"taad112","article-title":"Nepal\u2019s worst dengue outbreak is a wake-up call for action","volume":"30","author":"Bijukchhe","year":"2023"},{"key":"b19","series-title":"Viruses","first-page":"507","article-title":"Co-circulation of dengue virus serotypes 1, 2, and 3 during the 2022 dengue outbreak in Nepal: A cross-sectional study","volume":"15","author":"Rimal","year":"2023"},{"key":"b20","series-title":"Viruses","first-page":"594","article-title":"Molecular and entomological characterization of 2023 dengue outbreak in Dhading District, central Nepal","volume":"16","author":"Rimal","year":"2024"},{"key":"b21","series-title":"Front Trop Dis","first-page":"1217939","article-title":"A major dengue epidemic in 2022 in Nepal: Need of an efficient early-warning system","volume":"4","author":"Dhoubhadel","year":"2023"},{"key":"b22","series-title":"Annu Rev Public Health","first-page":"107","article-title":"A review of spatial methods in epidemiology, 2000\u20132010","volume":"33","author":"Auchincloss","year":"2012"},{"key":"b23","series-title":"Acta Trop","first-page":"219","article-title":"Spatial analysis for epidemiology","volume":"91","author":"Graham","year":"2004"},{"key":"b24","series-title":"Rev Bras Epidemiol","first-page":"907","article-title":"Geospatial analysis applied to epidemiological studies of dengue: A systematic review","volume":"16","author":"de Oliveira","year":"2013"},{"key":"b25","series-title":"Am J Trop Med Hyg","first-page":"149","article-title":"Spatiotemporal tools for emerging and endemic disease hotspots in small areas: An analysis of dengue and chikungunya in Barbados, 2013\u20132016","volume":"103","author":"Lippi","year":"2020"},{"key":"b26","article-title":"National Population and Housing Census 2021","year":"2023"},{"key":"b27","series-title":"Appl Geogr","first-page":"626","article-title":"Assessing the accuracy and applied use of satellite-derived precipitation estimates over Nepal","volume":"34","author":"Duncan","year":"2012"},{"key":"b28","series-title":"Theor Appl Climatol","first-page":"799","article-title":"New climatic classification of Nepal","volume":"125","author":"Karki","year":"2016"},{"key":"b29","series-title":"Intl Journal of Climatology","first-page":"4296","article-title":"Spatio-temporal variability of extreme precipitation in Nepal","volume":"38","author":"Talchabhadel","year":"2018"},{"key":"b30","article-title":"2023_12_15 Dengue Situation Update","year":"2023"},{"key":"b31","article-title":"Situation Update of Dengue 2022 (As of 31th Dec, 2022)","year":"2022"},{"key":"b32","article-title":"National Population and Housing Census 2011","year":"2012"},{"key":"b33","article-title":"ArcGIS Pro","year":"2023"},{"key":"b34","year":"2016"},{"key":"b35","series-title":"Big Earth Data","first-page":"108","article-title":"Global spatio-temporally harmonised datasets for producing high-resolution gridded population distribution datasets","volume":"3","author":"Lloyd","year":"2019"},{"key":"b36","series-title":"Geogr Anal","first-page":"5","article-title":"GeoDa: An introduction to spatial data analysis","volume":"38","author":"Anselin","year":"2006"},{"key":"b37","series-title":"PLoS One","first-page":"e0273398","article-title":"The epidemiology of diphtheria in Haiti, December 2014\u2013June 2021: A spatial modeling analysis","volume":"17","author":"Ikejezie","year":"2022"},{"key":"b38","series-title":"Diseases","first-page":"16","article-title":"Early detection for dengue using local indicator of spatial association (LISA) analysis","volume":"4","author":"Parra-Amaya","year":"2016"},{"key":"b39","series-title":"Geogr Anal","first-page":"93","article-title":"Local indicators of spatial association\u2014LISA","volume":"27","author":"Anselin","year":"1995"},{"key":"b40","series-title":"Urbana","first-page":"61801","article-title":"Rate transformations and smoothing","volume":"51","author":"Anselin","year":"2006"},{"key":"b41","article-title":"Nepal Climate Summary 2023","year":"2023"},{"key":"b42","article-title":"Preliminary Precipitation Summary: Monsoon Season (June\u2013September), 2022","year":"2022"},{"key":"b43","article-title":"Climate Change Knowledge Portal","year":"2025"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/113\/2\/article-p366.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/113\/2\/article-p366.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/113\/2\/article-p366.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T18:58:35Z","timestamp":1784919515000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/113\/2\/article-p366.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,6]]},"references-count":43,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.24-0747","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2024.11.06.24316870","asserted-by":"object"}]},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,6]]}}}