The impact of COVID–19 lockdown on dengue transmission in Sri Lanka; A natural experiment for understanding the influence of human mobility

Liyanage, Prasad; Rocklöv, Joacim; Tissera, Hasitha

doi:10.1371/journal.pntd.0009420

Cited by 37 publications

(37 citation statements)

References 20 publications

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“…People staying home due to lockdown may become easy prey for mosquitoes. Interestingly, movement restrictions (lockdowns) resulted higher incidence of dengue cases in Singapore, while the opposite impact was reported in Sri Lanka [ 18 , 19 ].…”

Section: Has the Dengue Outbreak Started In Dhaka City?mentioning

confidence: 99%

COVID-19 onslaught is masking the 2021 dengue outbreak in Dhaka, Bangladesh

2022

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Section: Has the Dengue Outbreak Started In Dhaka City?mentioning

confidence: 99%

COVID-19 onslaught is masking the 2021 dengue outbreak in Dhaka, Bangladesh

2022

View full text Add to dashboard Cite

“…Our study is also inline with a statistical analysis from Brazil finding a positive association of mobility restrictions with dengue cases 20 days later [ 49 ], and is similar to the finding that reductions in mobility due to the effects of fever can increase transmission [ 50 ]. Conversely, a study from Sri Lanka found a decreased risk of dengue during lockdown [ 51 ].…”

Section: Discussionmentioning

confidence: 99%

Pandemic-associated mobility restrictions could cause increases in dengue virus transmission

et al. 2021

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Background The COVID-19 pandemic has induced unprecedented reductions in human mobility and social contacts throughout the world. Because dengue virus (DENV) transmission is strongly driven by human mobility, behavioral changes associated with the pandemic have been hypothesized to impact dengue incidence. By discouraging human contact, COVID-19 control measures have also disrupted dengue vector control interventions, the most effective of which require entry into homes. We sought to investigate how and why dengue incidence could differ under a lockdown scenario with a proportion of the population sheltered at home. Methodology & principal findings We used an agent-based model with a realistic treatment of human mobility and vector control. We found that a lockdown in which 70% of the population sheltered at home and which occurred in a season when a new serotype invaded could lead to a small average increase in cumulative DENV infections of up to 10%, depending on the time of year lockdown occurred. Lockdown had a more pronounced effect on the spatial distribution of DENV infections, with higher incidence under lockdown in regions with higher mosquito abundance. Transmission was also more focused in homes following lockdown. The proportion of people infected in their own home rose from 54% under normal conditions to 66% under lockdown, and the household secondary attack rate rose from 0.109 to 0.128, a 17% increase. When we considered that lockdown measures could disrupt regular, city-wide vector control campaigns, the increase in incidence was more pronounced than with lockdown alone, especially if lockdown occurred at the optimal time for vector control. Conclusions & significance Our results indicate that an unintended outcome of lockdown measures may be to adversely alter the epidemiology of dengue. This observation has important implications for an improved understanding of dengue epidemiology and effective application of dengue vector control. When coordinating public health responses during a syndemic, it is important to monitor multiple infections and understand that an intervention against one disease may exacerbate another.

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“…Another study reported similar ndings in Thailand, but not in Malaysia and Singapore [10]. On the contrary, an overall 88% reduction in risk of dengue (RR 0.12; 95% CI: 0.08-0.17) during the period of mobility restriction was observed in Sri Lanka [11]. Dengue serotype switch [10], increase in time spent inside residence [8], disruption of dengue surveillance and vector control activities due to restricted human movements [12] and compliance with social distancing policies have been suggested as potential factors that could explain the observed ndings.…”

Section: Introductionmentioning

confidence: 78%

Addressing the COVID-19 pandemic challenges for operational adaptations of a a cluster randomized controlled trial on dengue vector control in Malaysia

Saadatian‐Elahi

Nast

Möhlmann³

et al. 2022

Preprint

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Introduction: The COVID-19 pandemic placed an unprecedented overload on healthcare system globally. With all medical resources being dedicated to contain the spread of the disease, the pandemic may have impacted the burden of other infectious diseases such as dengue, particularly in countries endemic for dengue fever. Indeed, the co‐occurrence of COVID‐19 made dengue diagnosis challenging because of some shared clinical manifestations between the two pathogens. Furthermore, the sudden emergence and novelty of this global public health crisis has forced the suspension or slow-down of several research trials due to the lack of sufficient knowledge on how to handle the continuity of research trials during the pandemic. We report on challenges we have faced during the COVID-19 pandemic and measures that were implemented to continue the iDEM project (intervention for Dengue Epidemiology in Malaysia). Methods: This randomized controlled trial aims to assess the effectiveness of Integrated Vector Management (IVM) on the incidence of dengue in urban Malaysia by combining: targeted outdoor residual spraying (TORS), deployment of auto-dissemination devices (ADDs), and active community engagement (CE). Our operational activities started on February 10, 2020, a few weeks before the implementation of non-pharmaceutical interventions to contain the spread of COVID-19 in Malaysia. Results: The three main issues affecting the continuity of the trial were: ensuring the safety of field workers during the interventions; ensuring the planned turnover of TORS application and ADD deployment and services; and maintaining the CE activities as far as possible. Conclusions: Even though the pandemic has created monumental challenges, we ensured the safety of field workers by providing complete personal protective equipment and regular COVID-19 testing. Albeit with delay, we maintained the planned interval time between TORS application and ADDs services by overlapping the intervention cycles instead of having them in a sequential scheme. CE activities continued remotely through several channels (e.g., phone calls and text messages). Sustained efforts of the management team, significant involvement of the Malaysian Ministry of Health and a quick and smart adaptation of the trial organisation according to the pandemic situation were the main factors that allowed the successful continuation of our research.

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The impact of COVID–19 lockdown on dengue transmission in Sri Lanka; A natural experiment for understanding the influence of human mobility

Cited by 37 publications

References 20 publications

COVID-19 onslaught is masking the 2021 dengue outbreak in Dhaka, Bangladesh

COVID-19 onslaught is masking the 2021 dengue outbreak in Dhaka, Bangladesh

Pandemic-associated mobility restrictions could cause increases in dengue virus transmission

Addressing the COVID-19 pandemic challenges for operational adaptations of a a cluster randomized controlled trial on dengue vector control in Malaysia

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