Print PageThe population dynamics of endemic cholera in urban environments, in particular the inter-annual variation in the size of seasonal outbreaks, remains poorly understood. The influence of climate variability has been addressed temporally but not spatially, despite the considerable socio-economic and environmental heterogeneity of increasingly large cities. Dhaka, the capital of Bangladesh, is a megacity in which cholera is endemic. With a probabilistic model, we address for Dhaka the role of spatial structure in disease dynamics, in particular its interaction with climate forcing by the El Nino Southern Oscillation (ENSO) and flooding. We utilize a multidimensional inhomogeneous Markov chain (MDIMC) model which we developed; this is a novel approach to disease modeling allowing for a large amount of flexibility in how spatial and temporal covariates can affect cholera dynamics.
Results/Conclusions
We find a significant interaction between the climatological drivers and spatiality: their influence on cholera dynamics is locally differentiated with a subset of districts acting as a susceptible core, and with neighboring effects acting to propagate disease risk in space. The same model we use to test these effects can also be used to accurately forecast disease levels up to 11 months into the future. Additionally, using our MDIMC model we can estimate the distributions of these forecasts. MDIMC models have the potential to be useful for a wide variety of applications, not only for infectious diseases, but for other systems where both temporal and spatial effects are present.
