Implications of the COVID-19 lockdown on dengue transmission in Malaysia

The impact of movement restrictions during the COVID-19 lockdown on the existing endemic infectious disease dengue fever has generated considerable research interest. We compared the Malaysia weekly epidemiological records of dengue incidences during the period of lockdown to the trend of previous years (2015 to 2019) and a simulation at the corresponding period that expected no movement restrictions. We found that the dengue incidence declined significantly with a greater magnitude at phase 1 of lockdown, with a negative gradient of 3.2-fold steeper than the trend observed in previous years and 6.5-fold steeper than the simulation, indicating that the control of population movement did reduce dengue transmission. However, starting from phase 2 of lockdown, the dengue incidences demonstrated an elevation and earlier rebound by at least 4 weeks and grew with an exponential pattern compared to the simulation and previous years. Together with our data on Aedes mosquitoes from a district of Penang, Malaysia, we revealed that Aedes albopictus is the predominant species for both indoor and outdoor environments. The abundance of the mosquito was increasing steadily during the period of lockdown, and demonstrated strong correlation with the locally reported dengue incidences; therefore, we proposed the possible diffusive effect of vector that led to a higher acceleration of incidence rate. These findings would help authorities review the direction and efforts of the vector control strategy.