Statistical modeling of the effect of rainfall flushing on dengue transmission in Singapore

nnDengue transmission is sensitive to fluctuations in rainfall and other weather conditions because it is transmitted by the Aedes mosquito. Recent studies have identified that extreme rainfall can result in mosquito breeding site flushing. However, these rainfall conditions have neither been described nor evaluated for their potential effect on dengue transmission. In this study, we applied machine learning and regression approaches to identify rainfall thresholds associated with mosquito breeding site flushing in Singapore. We then estimated the association between the number of flushing events per week and dengue outbreaks in the following weeks. Here we demonstrate that flushing events are accurately predicted by historical rainfall patterns. We also show that flushing events are associated with a statistically significant reduction in dengue outbreak risk up to six weeks after the flushing events occurred. This research suggests that dengue predictive and early warning systems must consider hydrological conditions and other contributing factors to accurately predict near-term dengue risk.nn