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. 2022 Mar 14;106(5):1515-1521.
doi: 10.4269/ajtmh.21-0409. Online ahead of print.

Cluster Analysis of Dengue Morbidity and Mortality in Mexico from 2007 to 2020: Implications for the Probable Case Definition

Carlos M Baak-Baak  1 , Nohemi Cigarroa-Toledo  2 , Jose F Pinto-Castillo  3 , Rosa C Cetina-Trejo  1 , Oswaldo Torres-Chable  4 , Bradley J Blitvich  5 , Julian E Garcia-Rejon  1
Affiliations

Cluster Analysis of Dengue Morbidity and Mortality in Mexico from 2007 to 2020: Implications for the Probable Case Definition

Carlos M Baak-Baak et al. Am J Trop Med Hyg. .

Abstract

Dengue cases and deaths occur frequently in Mexico, although the trend is not uniform across the country. We performed a Spatio-temporal analysis of dengue cases and deaths in Mexico from 2007 to 2020, and clustered states according to whether there was a low, moderate, or high risk of dengue. A total of 501,600 confirmed dengue cases were registered from 2007 to 2020, with 378,122 cases classified as dengue fever (DF) and 123,478 cases classified as dengue hemorrhagic fever (DHF). For each confirmed case, there were 4.68 probable cases. There were 1,230 dengue deaths, with highest numbers reported in 2009, 2012, 2013, and 2019. The number of deaths had a significant correlation (P ≤ 0.01) with DF (r = 0.82), DHF (r = 0.94), and probable dengue cases (r = 0.84). States were clustered using Machine Learning technique according to select indices associated with dengue. Cluster 1 (low risk) primarily contained states in the northwest, northcentral, and east. Cluster 2 (moderate risk) includes states in the northeast. Cluster 3 (high risk) mostly contained coastal states in the southeast, southwest, and west. The generation of the clusters was supported by the Kruskal-Wallis test. A significant difference was found in the incidence, mortality rates, and case-fatality rates of dengue among the clusters (P ≤ 0.01). Notably, cluster 3 contributed 71.4% of the confirmed cases and 89.2% of the deaths. Public health and vector control strategies designed to mitigate the burden of dengue in Mexico should consider the states in cluster 3 as high priority areas.

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Figures

Figure 1.
Figure 1.
A correlation matrix of dengue morbidity and mortality in Mexico (2007–2020). On the bottom of the diagonal, the bivariate scatter plots with a fitted line are displayed. On the top of the diagonal, the value of the correlation (scale 0–1). Significance level (P ≤ 0.001). This figure appears in color at www.ajtmh.org.
Figure 2.
Figure 2.
The spatial distribution of dengue morbidity and mortality in Mexico (2007–2020). This figure appears in color at www.ajtmh.org.
Figure 3.
Figure 3.
The k-medoids analysis produced a cluster plot of dengue morbidity and mortality in Mexico. The two major components are represented by the x (dimension 1) and y (dimension 2) axes, which account for 66.7% and 17.6% of the variation in the data, respectively. This figure appears in color at www.ajtmh.org.
Figure 4.
Figure 4.
A representation of the Mexican states based on the risk of dengue transmission.
See this image and copyright information in PMC

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