Data reported for the period 2000–2011 among the different racial groups living in Malaysia demonstrated that the distribution of dengue disease by race broadly reflected the racial distribution of the country as a whole, except in the years 2003 and 2004 [12], [13].
Other epidemiological features (socio-demographic and seasonal patterns)
A case–control study conducted in Johor Bahru in south peninsular Malaysia demonstrated that the only socio-demographic factors linked significantly to dengue disease were unmarried status (p = 0.006), not wearing long-sleeved clothes (p = 0.047), and not having window screens (p = 0.002). There was no relationship demonstrated among the patients with dengue disease for age, sex, race, educational level, or type of occupation [24]. However, in one study conducted in the Klang Valley, foreign workers represented a higher proportion of people with acute DF compared with those without dengue disease (10·5% vs 3·5%) [25].
Regional studies conducted throughout Malaysia showed that the amount of rainfall, temperature, and humidity were all directly linked to dengue disease outbreaks [11], [13], [24], [26], [27]. Peak months for reported dengue disease cases tended to cluster around January to March and June to November (i.e., mostly during the two monsoon seasons of high rainfall) [12], [13]. However, national and local monthly surveillance demonstrated that dengue disease can occur all year round [12]. Several geographical monitoring and modelling studies have demonstrated that the increasing urbanization in Malaysia was a major risk factor for the recent rise in dengue disease incidence in the country [26], [28]–[30].
Regional epidemiology
For 2007, dengue disease incidence data were available for all 14 Malaysian states. Regionally, the west peninsular states of Malaysia were most affected by dengue disease. Incidence rates in Kuala Lumpur, Selangor, Kelantan, and Penang areas were 455·7, 320·3, 224·5, and 204·5 per 100,000 population, respectively; with the exception of Pahang (179·1 per 100,000 population) the remaining states were less affected (<140 per 100,000 population) and incidence rates in south peninsular area (Malacca and Johor) and the Borneo states were <105 per 100,000 population [3]. In 2008, 63% of the national total of reported dengue disease cases occurred in the Klang Valley, which includes the state of Selangor and the Federal Territory of Kuala Lumpur [31].
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