Synchronized dynamics of dengue across the Americas.

Dengue is endemic throughout the tropical areas of the Americas, but little is known about its regional dynamics. We examined seasonal and multiannual dengue trends across the Americas and possible underlying mechanisms using monthly dengue surveillance data from 14 countries. We collected monthly dengue case data from 241 subnational locations in 14 countries, ranging from 1985 to 2018 (6 to 22 years), and used wavelet analysis to isolate seasonal (8 to 16 months) and multiannual (17+ months) patterns. For each location, we assessed seasonal and multiannual dynamics as well as coherence and differences in timing of dengue cycles between 22,578 location pairs. We assessed patterns in coherence over time and space and compared these patterns to variations in temperature, rainfall, and El Niño Southern Oscillation patterns. Strong synchrony in dengue dynamics was identified across the region at the seasonal and multiannual scales. Seasonal dengue dynamics were associated with local climate patterns and dengue dynamics in nearby locations. High synchrony at multiannual scales indicated that large dengue epidemics were shared across the region, with an average temporal lag of only 6 months at distances of up to 10,000 kilometers. Synchrony of these epidemics likely reflects both regional climate variability and human movement. Observed dengue dynamics were not unique to individual countries in the Americas but rather extended across the region reflecting climatic and nonclimatic drivers. These findings can support the development of better early warning tools to support epidemic preparedness and response and underscore the importance of working collaboratively across borders.