PloS one · 2026
The emergence of hyperendemic dengue in Bangladesh: An ecological study of structural breaks and transmission regime shifts, 2008-2025.
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Hasan Pratyay, Khan Tazdin Delwar, Arifuzzaman Mohd, Islam Md Saiful, Haque Mohammad Emdadul
Аннотация
BACKGROUND: Dengue fever in Bangladesh has escalated from sporadic outbreaks to a persistent, nationwide health crisis. Traditional epidemiological analyses often assume a constant transmission regime, potentially overlooking fundamental shifts driven by viral, environmental, or societal factors. This population-level ecological time-series observational study aimed to identify and characterize significant structural breaks in the time series of dengue admissions in Bangladesh to define distinct epidemiological phases.
METHODS: Monthly dengue hospital admission data (January 2008─October 2025) were obtained from the Institute of Epidemiology, Disease Control and Research (IEDCR) and Directorate General of Health Services (DGHS) public archives. Analyses included STL seasonal-trend decomposition, the Zivot-Andrews unit root test (primary break detection), multi-algorithm breakpoint detection (PELT, Binary Segmentation, Window-based), K-means clustering (optimal at 3 clusters, silhouette score 0.867), and Markov regime-switching models.
FINDINGS: Ten structural breaks were identified through a consensus ranking approach. The most prominent break occurred in May 2021 (consensus score = 3). The Markov regime-switching model delineated three distinct transmission regimes: 1) a Low Baseline Regime (2008─2023) with a mean of 47 monthly cases (95% CI: 36─57); 2) an Intermediate Regime (2008─2025) with a mean of 1,288 monthly cases (95% CI: 927─1,648); and 3) a Hyperendemic Regime (2019─2025) with a mean of 26,127 monthly cases (95% CI: 17,207─35,048), representing a 556-fold increase over the low baseline. Seasonality strength was moderate (0.335), but the peak-to-trough seasonal ratio approached 180, indicating pronounced annual epidemic cycles superimposed on the substantially elevated baseline.
INTERPRETATION: Bangladesh has experienced an established regime shift to sustained hyperendemic dengue transmission (persistent as of October 2025) necessitating a fundamental shift from outbreak-response to sustained, year-round control strategies. It is most likely influenced by viral, environmental, and societal factors including documented serotype redistribution. Public health strategies must transition from outbreak-response to sustained high-transmission management, including year-round vector control with pre-monsoon intensification.
METHODS: Monthly dengue hospital admission data (January 2008─October 2025) were obtained from the Institute of Epidemiology, Disease Control and Research (IEDCR) and Directorate General of Health Services (DGHS) public archives. Analyses included STL seasonal-trend decomposition, the Zivot-Andrews unit root test (primary break detection), multi-algorithm breakpoint detection (PELT, Binary Segmentation, Window-based), K-means clustering (optimal at 3 clusters, silhouette score 0.867), and Markov regime-switching models.
FINDINGS: Ten structural breaks were identified through a consensus ranking approach. The most prominent break occurred in May 2021 (consensus score = 3). The Markov regime-switching model delineated three distinct transmission regimes: 1) a Low Baseline Regime (2008─2023) with a mean of 47 monthly cases (95% CI: 36─57); 2) an Intermediate Regime (2008─2025) with a mean of 1,288 monthly cases (95% CI: 927─1,648); and 3) a Hyperendemic Regime (2019─2025) with a mean of 26,127 monthly cases (95% CI: 17,207─35,048), representing a 556-fold increase over the low baseline. Seasonality strength was moderate (0.335), but the peak-to-trough seasonal ratio approached 180, indicating pronounced annual epidemic cycles superimposed on the substantially elevated baseline.
INTERPRETATION: Bangladesh has experienced an established regime shift to sustained hyperendemic dengue transmission (persistent as of October 2025) necessitating a fundamental shift from outbreak-response to sustained, year-round control strategies. It is most likely influenced by viral, environmental, and societal factors including documented serotype redistribution. Public health strategies must transition from outbreak-response to sustained high-transmission management, including year-round vector control with pre-monsoon intensification.