The Epidemic Risk of Dengue Fever in Japan: Climate Change and Seasonality.

Dengue fever is a leading cause of illness and death in the tropics and subtropics, and the disease has become a threat to many nonendemic countries where the competent vectors such as Aedes albopictus and Aedes aegypti are abundant. The dengue epidemic in Tokyo, 2014, poses the critical importance to accurately model and predict the outbreak risk of dengue fever in nonendemic regions. Using climatological datasets and traveler volumes in Japan, where dengue was not seen for 70 years by 2014, we investigated the outbreak risk of dengue in 47 prefectures, employing the temperature-dependent basic reproduction number and a branching process model. Our results show that the effective reproduction number varies largely by season and by prefecture, and, moreover, the probability of outbreak if an untraced case is imported varies greatly with the calendar time of importation and location of destination. Combining the seasonally varying outbreak risk with time-dependent traveler volume data, the unconditional outbreak risk was calculated, illustrating different outbreak risks between southern coastal areas and northern tourist cities. As the main finding, the large travel volume with nonnegligible risk of outbreak explains the reason why a summer outbreak in Tokyo, 2014, was observed. Prefectures at high risk of future outbreak would be Tokyo again, Kanagawa or Osaka, and highly populated prefectures with large number of travelers.