Climate and The Incidence of Dengue Fevers in Iligan City, The Philippines

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Climate and the incidence of dengue fevers in Iligan City, the Philippines
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Asia-Pacific Journal of Social Science
Special Issue No.2, December 2011
ISSN 2229-5801(Print) / ISSN 0975-5942 (Electronic)
© International Society for Asia-Pacific Studies [ISAPS]
Climate and the Incidence of Dengue Fevers in Iligan City,

the Philippines
Edward Laurence L. Opena and Franco G. Teves
Abstract
As previously observed, climatic factors were found to have a significant role in the progress of both
dengue fever (DF) and dengue hemorrhagic fever (DHF). Yet there have been no profound data where
DF and DHF were individually linked to climate. Therefore, this paper focuses on the possible
relationship of temperature, humidity, rainfall and maximum sea level pressure (MSLP) with these
diseases. Using Poisson Regression Model, results showed that rainfall, highest MSLP, lowest
temperature is highly significant (<0.001), and significant (<0.010) for high temperature for DF. On
the other hand, rainfall and highest MSLP showed high significance (<0.001) and high temperature
showed significance (<0.050) in their relationship with DHF. These findings support the conclusion
that the increase and decrease of the incidence of DF and DHF distinctively responds to different
climatic factors. Hence, future studies should treat DF and DHF as individual variables against
climate.
Keywords: dengue fever, dengue hemorrhagic fever, climate
Introduction Climatic conditions and dengue outbreaks

should be rigorously tested for possible links
In the Asia Pacific Region, dengue haS become a
(Kuhn et al, 2005).Dengue diseases, topping the
major public health burden and currently a major
list of mosquito-borne diseases, may worsen with
epidemiological threat for over 2.5 billion
global warming. Researches projected that global
population spreading over 100 countries. It is
warming can increase the number of people at
spread by insect vector, Aedes spp, and can
risk of dengue epidemics since warmer
potentially result to epidemic outbreaks (Hii et al,
temperatures and varying rainfall conditions
2009; Cattand et al, 2005). The dengue virus is
expand both areas suitable for these vectors and
transmitted to humans through the bite of
its length of transmission, especially in temperate
infected Aedes aegypti. These mosquitoes are
regions (Knowlton et al, 2009). As noted by many
usually found in the tropical regions. A 2009
scientists, the rise of the global temperature can
report said that dengue fever and its
disturb a sensitive equilibrium and can contribute
complications have 50 to 100 million infections,
to new epidemics of vector-borne diseases
500,000 hospitalizations and 22,000 deaths yearly
(Brower, 2001) and that there could be hazardous
in more than 100 countries, which include Africa,
impacts of climate factors in the severity of
South and Central America, the Carribbean, India
dengue cases (Hii et al, 2009).
and Southeast Asia (Knowlton et al, 2009). Four
serotypes of dengue viruses had been identified: In the last 30 years, the wide geographic spread of
DEN-1, DEN-2, DEN-3, and DEN-4 (Ponsumpun, both dengue vectors and viruses has led to the
2006).
Asia-Pacific Journal of Social Sciences, Special Issue No.2, December 2011, pp. 114-131 114
Climate and the Incidence of Dengue Fevers in Iligan City, the Philippines
development of hyperendemicity in several on humans during daylight hours is their

urban areas in the tropical regions. The reversal of preference. Two biting activity peaks had been
the increasing trends of the many cases of DF and identified: early morning for 2 to 3 hours after
DHF are the major challenges faced by the health daybreak and in the afternoon for several hours
communities globally (Dengue Bulletin, 2002). before dark, though they feed all day indoors and
Amid several campaigns against dengue fever on overcast days. Female mosquitoes are
and dengue hemorrhagic fever, the diseases still sensitive feeders since their feeding are disrupted
are a major health problem (Nakhapakorn and at the slightest movement, and later return to the
Tripathi, 2005) due to the rapid change of the same or different person to continue feeding. This
epidemiology of dengue that has been detected. behavior then leads to multiple infections, if the
The recurrence of dengue infections every year mosquito is infective, in a short time even if they
has made it an endemic disease (Gupta et al, only prove without taking blood. Thus, it is not
2006). Hence, it is deemed necessary to conduct surprising to see several family members of the
surveys of disease prevalence for prevention and same household being infected with dengue virus
control. It is also important to monitor and predict within 24- to 36-hour time frame, where infection
dengue incidence in facilitating early health from a single mosquito is not impossible. During
responses and thereby to minimize morbidity infection, the virus undergoes an incubation
and mortality (Wiwanitkit, 2005; Lu et al, 2009). period of 3 to 14 days, after which the person may
The forecasting of diseases plays a crucial part for experience acute onset of fever with various
a timely and effective planning of operational nonspecific signs and symptoms. During this
control programs (Anyamba et al, 2006). acute febrile period that would lasts from 2 to 10
days, dengue viruses may circulate in the
Dengue fever and dengue hemorrhagic fevers are peripheral blood. If other A. aegypti mosquitoes
classified as classic viral hemorrhagic fevers bite the ill person during this febrile viremic
caused about by Aedes spp. The former is milder stage, the mosquito may be infected and
and is most common in the Caribbean and South subsequently transmit the virus to other
America, while the later can induce shock in the uninfected persons (Gubler, 1998).
victim (usually a child) and cause can death
among Southeast Asian children (Tortora et al., Dengue studies have been conducted in different
2001). localities like Thailand, the Mexico-Texas border,
Puerto Rico, Indonesia and the Philippines,
An epidemic transmission cycle may occur where each locality is differently focusing on the
among human populations living in rural villages microevolution of the different strains, clinical
or islands. Viruses that are introduced quickly diagnosis, household-based sereoepidemiologic
infect the majority of susceptible persons in these survey, and the epidemiology of the disease in
areas, and the increasing herd immunity causes local residents (Carlos et al., 2005; Ramos et al.,
the virus to disappear from the population. 2008; Porter et al., 2005; Perez et al., 2001; Jarman
Depending on the geographical area, Aedes spp. et al., 2008).
may act as vectors. By the bite of an infected
mosquito, humans are infected with dengue There are four virus serotypes responsible for
viruses. A. aegypti, the principal vector, and a dengue fevers. Infection of one of the serotypes
highly domesticated tropical mosquito that provides lifelong immunity to that virus, yet
prefers laying its eggs in artificial containers there has been no cross-protective immunity to
commonly found in and around homes (flower the other serotypes. This makes a person living in
vases, automobile tires, etc). Adult mosquitoes dengue endemic communities potentially
tend to rest indoors, unobtrusive, where feeding infected with three, and probably four dengue
serotypes in their lifetime (Gubler, 1988; as cited Materials and Method

by Gubler, 1998).
Study Area: An urbanized city located at the
DF, or classical dengue fever, is mainly affecting northern part of Lanao del Norte in the Island of
older children and adults. The sudden onset of Mindanao (Region X), Iligan City, has a
fever and varying nonspecific signs and population of 399,061 as per the 2007 Census. Due
symptoms, which include frontal headache, to its geographical location being outside the
retro-orbital pain, body aches, nausea and typhoon belt, Iligan City, lying 795 km. southwest
vomiting, joint pains, weakness and rash of Manila, does not experience either cold
(Anonymous, 1986; Hayes and Gubler, 1992; weather or strong weather disturbances, largely
Sabin, 1952; Siler et al, 1926; Waterman and cause of the mountainous areas with 23 waterfalls
Gubler, 1989; as cited by Gubler, 1998). surrounding the city. To its north lies the Iligan
DHF attacks mainly children, though it occurs in Bay, as can be gleened from Figure 1. The city's
adults. Sudden onset of fever, usually lasting for 2 annual mean temperature varies from 22ᵒ C to
to 7 days; and a variety of nonspecific signs and 27ᵒ C and the typical annual rainfall from 115mm
symptoms are its characteristics. During the acute to 190mm. Hence, Iligan City's type of climate is
phase of the illness, it can be difficult to n o t v e r y p r o n o u n c e d
differentiate DHF from DF. During this phase (http://en.wikipedia.org/wiki/Iligan).
differential diagnosis should include measles, Collection of Data
rubella, influenza, typhoid, leptospirosis, malaria
and any other hemorrhagic fevers. There has been Climate Data: Climate-data on was obtained
no pathonogmonic sign or symptom for DHF in relative humidity (rh), rainfall, maximum sea
the acute stage. However, as fever remits, level pressure, and maximum/minimum
manifestiations of plasma leakage are evident, temperature on an average basis per month has
thus making accurate diagnosis possible for been collected from the Philippine Atmospheric,
several cases (Anonymous, 1986 and Dietz et al, Geophysical and Astronomical Services
1996; as cited by Gubler, 1998). Administration (PAG-ASA) Region X office.
DF and DHF are commonly categorized as Reported Cases: The data on the number of
childhood diseases and become leading causes of dengue cases in Iligan City has been procured
pediatric hospitalization and death. Globally, 80- from the medical records of the following
90% of deaths take place before age 15; and yet, hospitals and health institutions: Mindanao
recent report found an incrreasing frequency in Sanitarium and Hospital, Dr. Uy Hospital, Iligan
adult with DHF (Cattand et al, 2005). Medical Center College Hospital, Gregorio T.
Lluch Memorial Medical Center and the Iligan
Generally, reports on dengue cases were not City Health Office.
classified in terms of type of dengue infection
occurring at a certain locality. This scenario poses
a possibility in undermining the exact
relationship of the occurrence of DF and DHF
with weather variables. Hence, this paper focuses
on the independent relationship of these diseases
to local weather variables such as temperature,
sea level pressure, humidity and rainfall.
Figure 1: Geographical Location of Iligan City (research locale/coordinates: 8ᵒ

13'N 124ᵒ
14,E)
ᵒ
ᵒ
Statistical Analyses: The Poisson Regression (59.4 mm). Following a decline in august, rainfall
model is the statistical method employed in again starts increasing in September. With a slight
treating the data. This method can predict the increase-decrease was noted in October and
significance of two variables, thus creating November, there is another drop in rainfall in
predictive values for the occurrence of dengue December. A dramatic decrease of rainfall is
cases in relation to climate. Graphical observed in the first two months of the year
representation is acquired using Microsoft Excel (January and February), a most probable signal
2007. The statistical tools used were Statistica 8 that the region's dry season is about to commence.
and SPSS 13. With further progressive decline continued in the
next two months (March and April), April is the
Results and Discussion
driest month with an average rainfall of 20.7 mm.
Climatic Data: As retrieved from the Philippine
Puerto Rico, also experiences the rainfall
Atmospheric, Geophysical and Astronomical
increasing from May to November (Stephenson,
Space Administration (PAG-ASA) Region X's
2008), as if demonstrating the same pattern is true
office, the monthly average rainfall from a 12-year
to all tropical regions. The period from November
period (1988-2011), as can be noted from the
to January records highest humidity with 84.3%,
graphical representation (Figure 2), showed that
84.5% and 84.8% respectively. February shows
the rainy season commencing May (44.8 mm),
the sign of decline, and a slight decrease, but the
gradually increases to its highest peak in July
March experiences high dramatic decline in the its increasing level commencing May with its
humidity level, the trend of which continues to hit discernible peak observed first in August and
the lowest in April (77.4%). The humidity revives then to the highest peak in January (see Figure 3).
Figure 2: Monthly Average Rainfall (mm) from 1988-2011 (January and February only).
(Data retrieved from Philippine Atmospheric, Geophysical and Astronomical Space
Administration PAG-ASA) Region X (see Appendix A for raw data)
Figure 3: Monthly Average Relative Humidity from 2006-2010. (Data retrieved from Philippine
Atmospheric, Geophysical and Astronomical Space Administration PAG-ASA) Region X, see
Appendix B for raw data)
Figure 4 portrays the monthly average Changing of temperature has been detected in
temperature from 2006-2010. February is the different regions around the globe (Stephenson,
coldest month (25.9ᵒ C); and May has the 2009). This could then be a probable basis for
distinction of being the hottest month with an change of climate in the region. In the near future,
average temperature of 28.3ᵒ C. A consistent the observed ongoing global climate change
drop of temperature is observable for a long poses a potential increase of the burden of dengue
period of 8 months (June-January). Conclusively, infections (Hii et al, 2009).
the cooler months for this region start in
November and end in February.
Figure 4. Reported monthly average temperature from 2006-2010. (Data retrieved from Philippine
Atmospheric, Geophysical and Astronomical Space Administration (PAG-ASA) Region X)(see
Appendix C for raw data)
Figure 5. Reported monthly average maximum sea level pressure (millibars/mm) from 2006-2010. (Data
retrieved from Philippine Atmospheric, Geophysical and Astronomical Space Administration
(PAG-ASA) Region X)(see Appendix D for raw data)
Another climatic factor included in this study is The cases for DF peaked every July (96 cases); its
the Maximum Sea Level Pressure (MSLP) decline is obvious towards December (34 cases)
recorded by PAG-ASA Region X. The data, can be (also, having the lowest record). Inconsistency is
noted from Figure 5, reveals slight increases and well pronounced during the period of January to
decreases during the February December period, April. On the other hand, August to October
although January being credited with the lowest seemed to be the peak months for DHF (with 58,
(934.0 mlbr). The significance of this climatic 56 and 59 cases respectively), Followed by a
variable is yet to be well established, and hence consistent decrease commencing November until
validation of this data is highly recommended for April (being the lowest record for DHF with 16
further investigation. cases). A gradual increase can also be observed
Dengue Fever (DF) and Dengue Hemorrhagic from May to June.
Fever (DHF): The average monthly cases is based Per observation, the lowest in rainfall and
on the pooled data from Mindanao Sanitarium humidity (Figures 2 and 3) levels in April coincide
and Hospital, Iligan Medical Center Hospital, Dr. with the lowest cases of both DF and DHF. Table 3
Uy Hospital and Gregorio T. Lluch Memorial presents the non-significance of humidity in
Medical Center. In Figure 5, it revealed that for a relation to pooled data for both diseases as well as
6-year period observation, DF and DHF cases no significant relationship between dengue cases
tend to exhibit similar pattern of occurrence and temperature (detailed discussion on the data
(except in December where DHF is a case higher in Table 3 can be found later in this paper).
then DF). Implicitly, both diseases could have the A probable proponent for this development of the
same “triggering” factors; climate, in this case. disease is the geographical set-up of Iligan City.
Further, it denotes that these diseases are As previously mentioned, the city has 23
endemic to this locality since it is present all year waterfalls which may provide breeding grounds
round(Gupta et al, 2006). for the dengue vector, besides contribution of
singnificantly large area of mountain terrain
surrounding Iligan City.
Figure 6: Average Monthly Incidence of Dengue Fever and Dengue Hemorrhagic Fever from 2005-2010.
As can be noted from Figure 7a, 2010 topped the Regression of the cases commences on the month
medical charts in terms of highest number of DF of August and gradual decrease has been
cases consecutively for over 10 months observed until the end of the last quarter. DHF
commencing January. This period had the DF also topped the medical records for the year 2010,
cases had increased by 80-100 percent over 2009 of with its peak in July. Its regression almost
the same period. This increase is validated by conforms to that of DF (Figure 7b).
Crisostomo (2010) stating that the Philippine's This can be accredited to the extensive effort in the
Department of Health recorded a 98.9% increase implementation of eradication program of the
in the number of dengue cases in the first three health department in pursuit of preventing DF
quarters of the year comparing to same period in and DHF. This includes the 4S strategy in
the previous year. Yet, the decrease in April combating dengue: (1) Search and Destroy
though linked to the climatic factors (as discussed involves the cleaning up of the surroundings and
earlier), points to the complacency of local health the removal of stagnant water that is potent
agencies advocating programs for the control (or breeding ground for the deadly mosquitoes; (2)
prevention) of such disease. A possible proof for Seed Protective Garment the prescribing the use
this complacency is the significant rise of the of long garments, mosquito nets along with the
disease in the coming months. July, for instance, use of insect repellants to protect the body from
has recorded highest number of cases, an increase mosquito bites; (3) Secure Immediate Medical
of more than 100 per cent over the previous year. Consultation people with dengue fever
At the national level, the peak of DF was observed symptoms are advised to seek medical attention;
in August followed by a decline, as it is the natural and (4) Say No to Indiscriminate Fumigation and
course of the disease (Crisostomo, 2010).In Say Yes to Fumigation only in times of Outbreak
Mexico, peaks for local dengue epidemics occur (Moralde, 2011).
between the 24th and 35th week of the calendar
year viz., June-September (Chowell et al, 2007).
Figure 7a: Average Monthly Cases of Dengue Fever (DF) from 2005-2010.
Figure 7b: Average Monthly Cases of Dengue Hemorrhagic Fever (DHF) from 2005-2010.
Statistical Treatment:
Table 1 Poisson Regression Model Results of Monthly Dengue
Fever Cases (2005-2010)
α = 0.05
Projected in Table 1 is the Poisson Regression factors are responsible for the development of
Model result of monthly dengue fever (DF) cases dengue cases by increasing the habitat
from 2005-2010 in relation to climatic factors. environment and hastening the vector, Aedes
Significance level is set at 0.05. Basing on the aegypti's physiological growth and development;
projected data, the p-value for rainfall, maximum and (2) the rise of these climatic factors is directly
sea level pressure (MSLP-high) and temperature proportional to the progress of dengue fever
minimum (Temp-low) versus dengue fever cases cases.
is <0.001. Thus, a highly significant difference is On the other hand, a “not-significant difference”
detected among these climatic factors and the is noted in the relationship between humidity,
number of dengue fever cases. Also, a significant lowest recorded maximum sea level pressure (p-
difference (p-value = <0.10) is noted on the values 0.200 and 0.115 respectively) and dengue
temperature maximum. Due to this significance, fever. Below is the model for the linear
two inferences can be drawn: (1) these climatic relationship of dengue fever cases and climate.
Poisson Regression Model:

Log (dengue fever)
= 342.201 + 0.005(Rainfall) + 0.328(M - high) + 0.139(Temp - high)
+ 0.211(Temp - low)
Dengue Fever = e342.201xe0.005(Rainfall)xe0.328(M - high)xe0.139(Temp - high)xe0.211(Temp - low)
This model then strongly establish a predictive temperature can create an environment
data that the increase of rainfall, sea level becoming conducive to the progress and
pressure, and the decrease and increase of development of DF.
Table 2 Poisson Regression Model Results of Monthly Dengue

Hemorrhagic Fever Cases (2006-2010)
Highly significant difference was observed temperature, whose p-value is 0.304, and the
between climatic factors such as rainfall and number of DHF cases (if compared to DF). This
highest recorded maximum sea level and number leads to a postulation that DHF regresses with
of dengue hemorrhagic fever (DHF) cases (with lower temperature.
p-value <0.001), and a significant difference Other climatic factors that showed no possible
between highest observed temperature and DHF responsibility to the development of DHF are
cases. Hence, these recorded climatic factors, can humidity (0.120) and lowest recorded MSLB
be theorized that, like DF cases, are major factors (Table 2). Lu et al (2009) have identified that
to be considered in the incidence of DHF. minimum temperature and humidity and dengue
Another notable observation is the “not- outbreaks are positively associated in the
significant” result between the lowest recorded subtropical areas only.
Table 3 Poisson Regression Model Results of Monthly Dengue Cases (2006-2010)
Pooling now the data from dengue cases (DF and incidence in larger part of the Southeast Asia,
DHF) and the climatic variables, it revealed that Africa and South America has been supported by
rainfall, highest recorded MSLP, highest a near drop in cases mostly in all affected
recorded temperature and lowest recorded countries shortly after the decline of El Nino
temperature showed a very high significant Southern Oscillation (ENSO) (Bangs et al 2006;
difference (<0.001) (Table 3). This data then Githeko et al, 2000; Gubler and Kuno, 1997 and
confirmed the above mentioned inferences that Reiter et al 2003 as cited by Brunkard et al, 2007).
these climatic factors (except humidity and Per definition, ENSO (or El Nino) is a weather
lowest recorded MSLP since they are not phenomenon that brings a prolonged dry spell
statistically significant with respective p-values (Aurelio et al, 2010, quoting Dr. Eric Tayag of the
of 0.057 and 0.087) have strong relationship with National Epidemiology Center).
dengue fever incidence (see Figure 10). Johansson et al (2009), in their analysis of the
Consistency of the non significance of humidity relationship between ENSO, local weather and
and lowest MSLP has also been observed (Tables dengue incidence in Puerto Rico, Mexico and
1 and 2). It can then be established that since these Thailand used wavelet analysis in identifying
two climatic variables are not associated with time and frequency-specific association. In
dengue incidence, they can be eliminated as Puerto Rico, ENSO (transiently) and local
variables for similar studies in the future. temperature are associated with dengue
Elevated temperature has been identified to be in incidence; in Thailand, ENSO, precipitation and
great connection with DF and DHF outbreaks temperature; while in Mexico, none of the
(Kuhn et al, 2005). In Singapore, Hii et al (2009) variables is in association of dengue outbreaks.
monitored the weekly mean temperature and Basing on this study, it can be concluded that
precipitation from 2004-2007. Their results weather conditions of different regions vary, so
signified a highly dangerous impact of these with its association with dengue epidemics. This
climatic factors on the increase of the magnitude difference could be a basis that every region
and intensity of dengue cases. They have should exhaustively investigate their respective
predicted that the continuing worldwide climate outbreaks due to weather differences. Recent
change can potentially increase the severity of development of El Nino made significant
dengue fever infections in the coming implications for global public health (Anyamba et
years.Increase in temperature also extends the al, 2006).
transmission season for dengue hemorrhagic Research on the relevance of lowest and highest
fever, dengue fever and dengue shock syndrome recorded MSLP is very scarce. Hence it is
and increase mosquitoes' development rate, presumed that this research is the first to integrate
adding more infectious bites per year (Brower, sea level pressure and incidence of dengue in this
2001). Other study suggests that temperature and region. As previously mentioned, there is a
rainfall, whose data are readily available, are statistically high significant relation between
variables likely to predict climate (Kuhn et al, highest recorded MSLP and both dengue cases, it
2005). can then be concluded that a possible rise in sea
Though some research suggest that dengue level pressure can increase the incidence of DF
outbreaks are not entirely attributable to such and DHF, or contributes to the diseases'
dramatic changes in weather patterns, since epidemiological significance.
temporal coincidence and biological factors Basing on these data, four climatic variables need
cannot be ruled out, the obvious overlapping of serious consideration for the local (probably
climate variation and the increase in dengue national) occurrence of dengue epidemics due to
their very high significance: rainfall, highest Therefore, early warning system for the increase
MSLP, low temperature, and high temperature. of these parameters must be developed to ensure
This further suggest that regardless the the safety of the health of the public.
temperature, dengue outbreaks are still possible.
Table 5 Poisson Regression Model Results of Yearly Dengue Cases Versus Rainfall (1988-2010)
Poisson Regression Model between pooled Farther, rainfall's role in these epidemics remains
number of dengue cases and rainfall for a 10-year unevaluated, but the increase in precipitation has
period showed a highly significant result (p- been suspected to be the primary driving factor
value <0.001). This further affirms the significant behind epidemics since it increases the number of
role of rainfall in the progress of dengue cases in mosquito breeding sites (Kuhn et al,
Iligan City. According to Kuhn et al (2005) and 2005).Droughts encourage people to store
Winawitkit (2005), outbreaks of dengue fever and drinking water, while high rainfall expands
dengue hemorrhagic fever have strongly been mosquito populations. Either way, these provide
associated with high rainfalls. Changing patterns new breeding grounds for Aedes spp. mosquitoes
of rainfalls are expected to vary the geographical (Brower, 2001). This then implies that future
distribution of insect vectors that spread investigation of the relevance of dengue
infectious diseases (Stephenson, 2008). outbreaks and weather should include
precipitation as a variable.
a DF b DF
Rainfall Humidity
160 200
140 180
160
120
140
100 120
80 100
60 80
60
40
40
20 20
0 0
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
c 0 DF d DF
Temp.-High Temp.-Low
140 140
120 120
100 100
80 80
60 60
40 40
20 20
0 0
e f
DF MSLP-High DF MSLP-Low
1200 1200
1000 1000
800 800
600 600
400 400
200 200
0 0
Figure 8. Established observable trend between the number of dengue fever cases (DF) and climatic variables: (a)
rainfall; (b) humidity; (c) highest recorded temperature; (d) lowest recorded temperature; (e) highest
recorded maximum sea level pressure (MSLP); and (f) lowest recorded MSLP. (2006-2010).
Source: (dengue fever cases) Mindanao Sanitarium and Hospital, Dr. Uy Hospital, Gregorio T. Lluch
Memorial Medical Center, Iligan Medical Center Hospital; (climatic variables) PAG-ASA X.
a DHF Rainfall b DHF Humidity

120 160
140
100
120
80
100
60 80
60
40
40
20
20
0 0
c DHF Temp-High d DHF Temp-High

100 90
90 80
80 70
70
60
60
50
50
40 40
30 30
20 20
10 10
0 0
e DF MSLP-High f DF MSLP-Low
1200 1200
1000 1000
800 800
600 600
400 400
200 200
0 0
Figure 9. Established observable trend between the number of dengue hemorrhagic fever cases (DHF) and climatic
variables: (a) rainfall; (b) humidity; (c) highest recorded temperature; (d) lowest recorded temperature; (e) highest
recorded maximum sea level pressure (MSLP); and (f) lowest recorded MSLP. (2006-2010).
Source: (dengue cases) Mindanao Sanitarium and Hospital, Dr. Uy Hospital, Gregorio T. Lluch Memorial Medical
Center, Iligan Medical Center Hospital; (climatic variables) PAG-ASA X.
a Pooled Data Rainfall b Pooled Data Humidity

250 250
200 200
150 150
100 100
50 50
0 0
c Pooled Data Temp.-High d Pooled Data Temp.-Low

200 180
180 160
160 140
140
120
120
100
100
80
80
60
60
40 40
20 20
0 0
e Pooled Data MSLP-High f Pooled Data MSLP-Low
1400 1400
1200 1200
1000 1000
800 800
600 600
400 400
200 200
0 0
Figure 10. Established observable trend between the number of pooled data for dengue fever (DF) and dengue
hemorrhagic fever cases (DHF) and climatic variables: (a) rainfall; (b) humidity; (c) highest recorded
temperature; (d) lowest recorded temperature; (e) highest recorded maximum sea level pressure (MSLP); and
(f) lowest recorded MSLP. (2006-2010).
Source: (dengue cases) Mindanao Sanitarium and Hospital, Dr. Uy Hospital, Gregorio T. Lluch Memorial Medical
Center, Iligan Medical Center Hospital; (climatic variables) PAG-ASA X.
Summary, Conclusion, and Recommendations 2005-2010. The climatic variables that were tested
The disease is a major public health concern in the for its relationship in the occurrence of the
tropical and subtropical regions of the world diseases are as follows: lowest and highest
(Johansson et al, 2009). This study focuses on the temperatures, lowest and highest maximum sea
climatic factors' influence on the occurrence of level pressure (MSLP), relative humidity, and
dengue fever (DF) and dengue hemorrhagic fever rainfall. The data for the first five variables started
(DHF). Data for the climate has been obtained from 2005-2010, while for the rainfall from 1988-
from the Philippine Atmospheric, Geophysical 2010 (depends on the availability of the data from
and Astronomical Space Administration (PAG- PAG-ASA).
ASA) Region X; while for the dengue incidence, 4 Data revealed that in this region, April has the
hospitals in the city had submitted their data from lowest rainfall while the July has the highest (20.7
mm and 59.4 mm respectively). In terms of MSLP, lowest and highest temperatures showed
humidity, November to February turned out to be a very highly significant role in the progress of
the most humid months and April as the least dengue in the locality (p-value <0.001). Relative
humid month (77.4%). May to August are humidity and lowest MSLP are not significant at
observed to be the hottest (28.0 ᵒ C to 28.3ᵒC) all.
months for 6 years and February as the coldest In the Philippines set-up, these climatic factors
(25.9ᵒ C). For the MSLP, only January showed the and its relationship with the development of
lowest observed pressure (934.0 mlbr) while the dengue diseases is not well investigated; thus,
rest of the months have mlbr ranging from 1007.8 sufficient information regarding this important
mlbr to 1009.2. relationships (especially those showing very high
The increase and decrease of both DF and DHF is significance) is not well established. It is
“paired”; should there be increase/decrease in noteworthy that the potentials of the Philippines-
DF, so with DHF. DF peaks at July and gradually climate should not be underestimated in
declines until December, and seems to resurge at developing the discussed diseases; and thus
the start of the year, and ultimately will decline. prevention, control and research should be given
For DHF, it peaks in October and declines until equal importance as that of diseases presently
April (lowest incidence; also true for DF), and given priority (Clark et al, 2005). This then calls
then increase again until August. 2010 showed an for more studies to affirm its validity.
increase in the number of dengue fever cases Since the success or failure of vector control
more than 100%, comparing to 2009, with the plainly rests on the cooperation and behavioral
month of July that has been found out with the response of the exposed populations (Setbon and
highest number of admission. Raude, 2009), designs formulated by health
Poisson regression model of the possible agencies and the government should also focused
relationship between the climatic factors and on the education of the local communities.
dengue incidence showed that rainfall, highest
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http://en.wikipedia.org/wiki/Iligan
http://iligancity.ph/iligan/?p=54
Edward Laurence L. Opena

Cebu Normal University, Cebu City, Philippines
Franco G. Teves
MSU Iligan Institute of Technology, Iligan City, Philippines
Corresponding author: aidwourd@gmail.com
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Article · December 2011

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Climate and the Incidence of Dengue Fevers in Iligan City,

Introduction Climatic conditions and dengue outbreaks

development of hyperendemicity in several on humans during daylight hours is their

serotypes in their lifetime (Gubler, 1988; as cited Materials and Method

Figure 1: Geographical Location of Iligan City (research locale/coordinates: 8ᵒ

Poisson Regression Model:

Dengue Fever = e342.201xe0.005(Rainfall)xe0.328(M - high)xe0.139(Temp - high)xe0.211(Temp - low)

Table 2 Poisson Regression Model Results of Monthly Dengue

Table 3 Poisson Regression Model Results of Monthly Dengue Cases (2006-2010)

a DHF Rainfall b DHF Humidity

c DHF Temp-High d DHF Temp-High

a Pooled Data Rainfall b Pooled Data Humidity

c Pooled Data Temp.-High d Pooled Data Temp.-Low

e Pooled Data MSLP-High f Pooled Data MSLP-Low

KNOWLTON, K, G SOLOMON and M ROTKIN-ELLMAN (2009). Mosquito-borne dengue fever threat

Edward Laurence L. Opena

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