206 words 26 Long term surveillance of vectors and arboviruses is an integral aspect of disease prevention and 27 control systems in countries affected by increasing risk. Yet, little effort has been made to adjust space-28 time risk estimation by integrating disease case counts with vector surveillance data, which may result in 29 inaccurate risk projection when several vector species are present, and little is known about their likely 30 role in local transmission. Here, we integrate 13 years of dengue case surveillance and associated Aedes 31 occurrence data across 462 localities in 63 districts to estimate the risk of infection in the Republic of 32 Panama. Our space-time modelling approach detected the presence of five clusters, which varied by 33 duration, relative risk, and spatial extent after incorporating vector species as covariates. Dengue 34 prevalence (n = 49,910) was predicted by the presence of resident Aedes aegypti alone, while all other 35 covariates exhibited insignificant statistical relationships with it, including the presence and absence of 36invasive Aedes albopictus. Furthermore, the Ae. aegypti model contained the highest number of districts 37 with more dengue cases than would be expected given baseline population levels. This implies that 38 arbovirus case surveillance coupled with entomological surveillance can affect cluster detection and risk 39 estimation, improving efforts to understand outbreak dynamics at national scales. 40 41 Author Summary 42 Dengue cases have increased in tropical regions worldwide owing to climate change, 43 urbanization, and globalization facilitating the spread of Aedes mosquito vectors. National surveillance 44 programs monitor trends in dengue fever and inform the public about epidemiological scenarios where 45 outbreak preventive actions are most needed. Yet, most estimations of dengue risk so far derive only 46from disease case data, ignoring Aedes occurrence as a key aspect of dengue transmission dynamic.
47Here we illustrate how incorporating vector presence and absence as a model covariate can considerably 48 alter the characteristics of space-time cluster estimations of dengue cases. We further show that Ae.3 49 aegypti has likely been a greater driver of dengue infection in high risk districts of Panama than Ae. 50 albopictus, and provide a discussion of possible public health implications of both spatial and non-51 spatial model outcomes. 52 Text Word Count: 3658 53 Introduction 54 Dengue fever, a disease transmitted to humans by Aedes mosquitoes, is endemic to 128 55 countries, with 3.9 billion people considered at-risk [1]. Dengue fever cases have increased dramatically 56 worldwide throughout the previous several decades [2], likely a result of climate change [3], 57 urbanization [4], globalization [5], and the spread of the invasive Aedes albopictus [6]. As a result of 58 both recent and historical risk, many countries employ national surveillance programs to monitor trends 59 in dengue fever and inform local health authorities to the pl...