Journal of Mosquito Research 2015, Vol.5, No.

17, 1-10
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Research Article Open Access

Ento-epidemiological characterization of Dengue in Uttarakhand (India)
Manas Sarkar1,2 , Kaushal Kumar1, AK Sharma1, Avanish K Gupta3
1
Centre for Medical Entomology and Vector Management, National Centre for Disease Control, 22-Sham Nath Marg, Delhi 110054, India
3
Integrated Disease Surveillance Project (State Surveillance Unit), Dehradun, Uttarakhand, India
1,2
Corresponding author current address: Research & Development Division, Godrej Consumer Products Ltd. Vikhroli (East), Mumbai-400079, INDIA
Corresponding author email: sarkar79@gmail.com
Journal of Mosquito Research, 2015, Vol.5, No.17 doi: 10.5376/jmr.2015.05.0017
Received: 24 Aug., 2015
Accepted: 12 Oct., 2015
Published: 26 Oct., 2015
Copyright 2015 Sarkar et al., This is an open access article published under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original work is properly cited.
Preferred citation for this article:
Sarkar M., Kumar K., Sharma AK., and Gupta A K., 2015, Ento-epidemiological characterization of Dengue in Uttarakhand (India), Journal of Mosquito
Research, Vol.5, No.17 1-10 (doi: 10.5376/jmr.2015.05.0017)

Abstract OBJECTIVES: Dengue/Dengue Hemorrhagic Fever (DHF) is the most rapidly spreading vector-borne infection all over
the world. Uttarakhand (India) is the prime destination for national and international tourists. Here we assessed the epidemiological
characteristics and entomological parameters of dengue/DHF in Uttarakhand (India) using in-depth statistical methods to measure
risk of dengue epidemics.

METHODS: we surveyed total 11 localities each in Nainital and Dehradun districts and calculated different entomological indices
and analyzed epidemiological characteristics of Dengue in these areas.

RESULTS: There was an epidemic of dengue during 2010 with total 4140 laboratory-confirmed dengue cases, about 5347% increase
of cases compared to preceding years. Out of six dengue-prone districts of Uttarakhand, Nainital and Dehradun were the worst
affected districts during this epidemic (Nainital = 862 and Dehradun = 2913; Total = 3775 cases), an incidence rate of 142.5 per
100000 population. The incidence rate in male (169.9 per 100000) is higher than in female (112.3 per 100000) and dengue cases were
predominant in the age group 21-30 years. Dehradun (77% of total cases) was more dengue prone area than Nainital. However, all
entomological indices are relatively higher in Nainital than Dehradun. Nevertheless, this difference in the indices is not significant
(p>0.05).

CONCLUSIONS: Therefore, we hypothesize that the epidemic intensity or severity of 2010-dengue outbreak in Nainital and
Dehradun are independent of entomological indices.
Keywords Dengue; Aedes; vector borne diseases; entomological index; India

Introduction Kittayapong 2002). Vector control remains the only

Dengue and Dengue Hemorrhagic Fever (DHF) is the
most rapidly spreading vector borne infection all over
the world. Its occurrence has been registered in 124
countries with 3.61 billion people are at risk for
infection and 500 million people infected each year. It
was estimated that nearly 36 million cases of dengue
fever and 2.1 million cases of severe DHF occur
annually, and nearly 21,000 deaths are likely attributable
to dengue. It also exerts huge societal and economic
costs to endemic countries, where mostly vector
control strategies have been unsuccessful.
Dengue virus commonly transmitted by the adult
female Aedes aegypti L. mosquitoes. However, the
virus is sometime transmitted by Aedes albopictus (Skuse)
in some locations around the globe (cf Strickman &
way to prevent dengue transmission (Guzman &
Kouri 2002; Deen 2004; Guzman et al. 2004).
Entomological surveillance of dengue has been
standardized on different indices based on the simple
determination of the presence or absence of Aedes
larvae either in each container or somewhat in each
house (Tun-Lin et al. 1996; Focks 2003). The house
index (HI, percentage of houses positive for larvae),
container index (CI, percentage of containers positive
for larvae) and Breteau index (BI, number of positive
containers per 100 houses) have become the most
widely used indices (Reiter & Gubler 1997).
Dengue is described as endemic in many countries in
the South East Asian region which means that cases
occur every year, although there is a significant

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variation between countries and within each country.
In 2010, World Health Organization (WHO) stratified
the current situation of Dengue/DHF in India under
category A (earlier it was under category B up to
2009), which means a major public health problem, a
leading cause of hospitalization and death among
children, shows cyclical epidemics in urban centers
spreading to rural areas with multiple virus serotypes
circulating. In India, National Vector Borne Disease
Control Program (NVBDCP) reported 28292
laboratory-confirmed dengue cases in 2010 from 31
out of 35 states in India (highest ever in a year). In
2011, 18,860 confirmed dengue cases were reported
and 169 deaths and in 2012, total 37,070 cases and
227 deaths were attributable to dengue in India
(NVBDCP 2012).
The northern states of India are badly affected by
dengue, although the intensity of transmission varies
every 2-4 years. Uttarakhand is one of the dengue
prone states in northern India, which has a history of
dengue epidemics since long with a heavy epidemic of
dengue/DHF in 2010. Moreover, Uttarakhand (India)
is the prime destination of tourists from all over the
world. This also increases the travelers health risk.
Cultural tradition, socio-environmental conditions,
and household circumstances often result in the
absence or in the irregularity of water supply for a
significant part of the population in Uttarakhand,
causing the need to store water in reservoirs (Singh et
al. 2010). Moreover, due to a relatively dry climate in
summer seasons, people use water coolers (a cooling
device made up of metal/plastic having a water tank)
in their houses. These coolers are the potential place
for Aedes mosquito breeding. Furthermore, because of
irregular garbage collection in many areas, other
breeding sites like plastic container, tin containers,
bottles, water storage tanks, tire, and many unusual
breeding sites.
In this study, epidemiological characteristics of
dengue/DHF and the entomological parameters were
assessed during the epidemic of dengue in 2010 to
determine the epidemic risk of dengue in Uttarakhand,
India with the aim to establish better policies to
control the dengue epidemics in these areas (e.g.,
improvement of water supply to minimize the
requirement of storage water, which are found to the
breeding place of Aedes aegypti; establish a local
2
threshold of HI, BI & CI for forecast the outbreak
etc.). The results of above study are presented in this
manuscript.
Methods
Study Area and its eco-environmental settings
Initially, the study was conducted in different parts of
Uttarakhand, however, finally, we focused our
epidemiological and entomological surveillance in
Nainital and Dehradun, the two districts badly hit by
dengue epidemics in 2010. We analyzed the
epidemiological history of dengue in the entire
Uttarakhand state, and selected Nainital (exhibited a
low-middle epidemics in September 2009 with 51
confirmed dengue cases) and Dehradun (exhibited an
early signal of epidemics on August 2010 with 19
confirmed dengue cases) districts for investigations of
entomological measures of risk of dengue. The
localities within these two districts for the
entomological survey were picked out based on
dengue suspected cases reported during 2009-2010.
Total 11 localities each in Nainital (viz. Forest
compound, Kotdwar Rd., Khatyari, Gular Ghati,
Perumdara, 25 acres Colony, CCPM colony, Nageena
Colony, bungalow colony, Bindukhatta, Indiranagar)
and Dehradun (viz. Patel Nagar, Vikas Nagar,
Chandreshwar Nagar, Kailash gate, Shyampur,
Aadarsh gram, Rani Pokhari, Reetha Mandi, Deep
Nagar, Kedar Purum, Indra colony) districts were
chosen.
Topography: Uttarakhand lies within the Himalayan
region, with three distinct topographical belts - the
Shivaliks within the sub Himalayan tract [300-600 m
Above Mean Sea Level, (AMSL)], the Himachal
ranges within the lower Himalayan region (1,500-2,700
m AMSL), and the Himadri ranges within the upper
Himalayan region (4,800-6,000 m AMSL). The lower
hilly region, ranging between 600 m-1,800 m, and it is
within the region where the majority of the human
populations live. Major parts of our study sites are
located in this region.
General Climate: The climatic conditions change
with the increase of altitude, extending from sub-zero
temperatures at high altitudes in winter to moderate
temperatures in the lower tracts in summer. The
territory has three distinct seasons - monsoon (June -
September), winter (October- February) and summer
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(March - May). Snowfall occurs between January and
March within the upper and lower Himalayan ranges.
Temperature and rainfall: Monthly maximum,
minimum, and average temperatures and rainfall data
of Uttarakhand were collected from Indian Meteorological
Department. In this article, we have included the
temperature and rainfall data of Nainital and Dehradun
districts only, as entomological surveys were carried
in these two districts only. Temperature and rainfall
data based on mean of the last 25 years (monthly
arithmetic averages) are presented graphically in the
result section.
Population: The Uttarakhand has a population of
approximately 10,116,752 inhabitants. Nainital and
Dehradun are having an estimated population of
955,128 (494,115 males and 461,013 females) and
1,698,560 (893,222 males & 805,338 females)
inhabitants respectively (data source: Census India)
(data source: Census of India 2011).
Dengue fever and Epidemiological data
collection
We worked in collaboration with the Department of
Health, Govt. of Uttarakhand for this study. The dengue
case definition was adopted as per the recommendation of
World Health Organization Regional Office (Southeast
Asia Regional Office 1999). Only the serologically
confirmed dengue cases, diagnosed using Rapid
Detection kit (NS1 Ag Ab Combo) and enzyme-linked
immunosorbent assay in 2010 by different sentinel
laboratories of the Department of Health, Govt. of
Uttarakhand were included in the analysis reported
here. All duplicate notifications were removed before
analysis. We have also tried our level best to identify
cases with a history of travel within 10 preceding days
of the onset of illness to states where dengue also
occurred were classified as imported and were not
included in the analysis. We have collected the
epidemiological report of dengue cases in Uttarakhand
for the last five years (2006 to 2010) from the
Department of Health, Govt. of Uttarakhand. During
epidemic in 2010, suspected cases were identified and
a sero-epidemiologic survey was conducted in
Nainital and Dehradun districts through state health
services for laboratory-confirmation of suspected
cases. The denominator for the calculation of total and
sex wise incidence rates of reported indigenous cases
3
of dengue were based on the estimated mid-year total
population and male/female population obtained from
the Office of Registrar General and Census Commissioner
(Uttarakhand State), India.
Entomological Surveillance
We have chosen 11 localities each in Nainital and
Dehradun as mentioned above for entomological
survey. In these areas, we surveyed all potential
breeding sites in monsoon and post-monsoon months
from September to November 2010, immediately after
confirmations of an early outbreak of dengue in
August 2010 with 19 confirmed dengue cases. All
non-hermetically closed containers containing any
volume of water were considered as potential breeding
sites. All water-holding containers were examined.
Either the name/type of the containers (viz. Tire,
cooler, fridge etc.) or construction materials (viz. Tin,
cement tank, clay pots, and plastic container)
classified the breeding sites. We recorded the number
of houses inspected, positive containers (with Aedes
pupae or larvae) and houses with 1 positive
container.
Statistical Analysis
For all statistical analysis, we performed Kolmogorov-
Smirnov (with Dallal- Wilkinson-Lilliefor P value),
D'Agostino & Pearson Omnibus and Shapiro-Wilk
normality test to see whether the data follow a
Gaussian distribution and implemented appropriate
statistical tests and calculated the corresponding P
values. We calculated the total as well as sex wise
incidence rates of reported indigenous cases of dengue
(combined of Nainital & Dehradun) based on the
estimated mid-year total population and male/female
population respectively. We analyzed larval survey
data of different breeding sites based on the name/type
of the containers (viz. Tire, cooler, fridge, etc.);
construction materials (viz. Tin, cement tank, clay
pots, and plastic container) and three sigma limits
were applied to judge the significance of chance of
getting Aedes larvae. The three sigma limits were
applied to alert vector control operation process
regarding potential dangerous container for mosquito
breeding following statistical quality measurement.
For all areas, we calculated different entomological
indices, viz. HI, CI, and BI and performed the
Spearman rank correlation coefficient between the
different indices in all inspected areas. This statistical
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test was aimed to verify whether the ranks of variables

(HI, CI & BI) co-vary. The entomological indices
from Nainital and Dehradun districts were transformed to
approximately normal distribution (by using square
root transformation) for calculating means, standard
deviation (SD), and 95% confidence intervals (CI).
After performing the descriptive statistical test on a
transformed variable, we have back-transformed the
outcome statistics (mean, SD and 95% CI) into a
count by squaring it to get a feel for the precision of
the magnitude. Statistical comparisons in the
distribution of entomological indices (HI, CI, & BI) in
Nainital and Dehradun districts were made by performing
pair-wise comparisons with Mann-Whitney U non
-parametric test. This statistical test was aimed to
verify whether the ranks of variables (HI, CI & BI) are
same in these two districts and the differences we
observed are just coincidence.

Results
The history of dengue epidemics in last five years
(2006 to 2010) in Uttarakhand is presented in Table 1
and Figure 1, which show an epidemic of dengue
during 2010 with total 4140 laboratory-confirmed
dengue cases, which means about 5347% increase of
dengue cases (Table 1). We observed that both numbers
of dengue cases and numbers of deaths due to dengue
are gradually increasing from 2006 to 2010. However,
percentage death rates due to dengue exhibit a
fluctuating trend (Table 1), although, Figure 1 shows
the direction towards the actual flow of dengue
epidemics in Uttarakhand during the past few years.
During the 2010 epidemic, our survey revealed that
Figure 1 Dengue cases and deaths in Uttarakhand (India)
out of six dengue prone districts of Uttarakhand state, during last five years. Both the number of cases and death has
Nainital (862 cases) and Dehradun (2913 cases) were been increased during last five years. However, the percentage
the worst dengue affected districts during the of deaths has decreased.
epidemics followed by Haridwar (257 cases), Pouri
Garwal (73 cases), Udham Singh Nagar (55 cases) and per 100000). Dengue cases are predominant in the age
Tehri Garwal (04 cases) (Figure 2). Total 3775 group 21-30 years (Table 2).
laboratory-confirmed dengue cases were registered
Monthly weather data in Nainital and Dehradun districts
from Nainital and Dehradun districts in 2010, an
(Figure 3) shows that temperature variation during the
incidence rate of 142.5 per 100000 populations (Table
year is moderate; Nainital has a relatively colder
2). It shows about 91.19% of total dengue cases in climate than Dehradun. However, rainfall variation
Uttarakhand were reported from these two districts. throughout the year is great. Although the rainy season
Table 2 summarizes the age and sex-specific distribution begins each year in late May or early June, most
of dengue cases in Nainital and Dehradun (combined) rainfall occurs in July and August and gradually
during 2010. The incidence rate in male (169.9 per decreases in September and October. February and
100000) is significantly higher than in female (112.3 NovemberJanuary was dry, with very little or no rain

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Table 1 Dengue cases and deaths in Uttarakhand in last five years (2006 to 2010)
Year Cases Death Death (%) Increase (+/-) Cases (%) Increase (+/-) Death (%)

2006 12 1 8.3% NA NA
2007 21 0 0.0% 75% -100%
2008 140 4 2.9% 567% 0%
2009 76 7 9.2% -46% 75%
2010 4140 8 0.2% 5347% 14%
NA, Not Applicable; Table shows the percentage of increase (+/-) of cases and deaths every year in respect to the preceding year.

Table 2 Age and sex specific distribution of dengue cases in Nainital and Dehradun (combined) in 2010
Sex No. of cases in different age groups (years) Total Incidence Rate
0-10 yrs. 11-20 yrs. 21-30 yrs. 31-40 yrs. 41-50 yrs. 51-60 yrs. 61-70 yrs. cases (per 100000)

Male 108 395 695 489 315 242 110 2354 169.9
Female 100 197 345 275 227 195 82 1421 112.3
Total 208 592 1040 764 542 437 192 3775 142.5

seven different types (e.g., tires, coolers, tin-containers,

Figure 2 Month wise distribution of dengue cases in
Uttarakhand during epidemics in 2010. The dengue epidemic
rises during late August and continues up to November
at all. The warmest minimum and maximum temperatures
were recorded in June and the lowest in January.
The classical approach of probability shows that
Dehradun is more dengue prone area than Nainital as
77% of cases are recorded from Dehradun, whereas
Nainital registered 23% cases, but large amount of
containers with mosquito breeding were found in
Nainital (Table 3). We determined that 41% and 23%
of total containers surveyed are found positive for
mosquito breeding in Nainital and Dehradun
respectively (Table 3). We classified breeding sites in
cement tanks, clay pots, plastic containers, and Fridge
vessels). Among these different containers, tires (95%),
tin containers (51%), cement tanks (44%), and plastic
containers (41%) show the maximum potential for
breeding in Nainital, whereas, in the Dehradun
maximum breeding of Aedes mosquitoes were found
in fridge vessels (43%) followed by coolers (27%),
plastic containers (25%) and cement tanks (23%)
(Table 3). Distribution of seven types of positive
containers in different surveyed localities is
summarized in Table 4 and Table 5 for Nainital and
Dehradun respectively. In terms of mosquito breeding
in different localities, Khatyari, Gular Ghati and
Forest compound in Nainital, on the other hand,
Reetha Mandi and Deep Nagar in Dehradun are the
high alert areas (Table 4 and Table 5).
We calculated that the overall mean values of all
entomological indices are relatively higher in Nainital
(HI = 32.33, CI = 25.92 and BI = 124.99) than
Dehradun (HI = 28.68, CI = 17.93 and BI = 77.33)
(Table 6). Distribution of these indices in different
localities is presented in Figure 4. A pairwise
comparison of these indices (HI, CI, and BI) with
Mann-Whitney U nonparametric test reveals that the
observed ranking difference of these indices in Nainital
and Dehradun is not statistically significant (p>0.05).

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Table 3 Summary of distribution of observed breeding sites for Aedes larvae and dengue cases in Nainital and Dehradun
Type of Container Nainital Dehradun Total
Tires 95% 20% 54%
Coolers 18% 27% 21%
Tin containers 51% 0% 51%
Cement tanks 44% 23% 31%
Clay pots 30% 19% 23%
Plastic containers 41% 25% 31%
Fridge vessels 0% 43% 43%
Total 41% 23% 30%
No of Dengue Cases 862 2913 3775
% cases 23% 77% 100%
Collection of all the data points (breeding sites) are independent in nature and do not feature the dependency over dengue cases or
deaths in the study area.

Table 4 Percentage distribution of positive container and influence of types of containers for breeding of Aedes mosquitoes at
different localities surveyed in Nainital
Areas/ Localities Chances to be getting Aedes Larvae/pupae in different types of containers
Case (%)=23% Tires Coolers Tin containers Cement tanks Clay pots Plastic containers Fridge Total
Forest compound 0% 18% 0% 0% 100% 25% 0% 60%
Kotdwar Rd. 50% 33% 40% 33% 13% 0% 0% 24%
Khatyari 80% 30% 100% 91% 86% 90% 0% 87%
Gular Ghati 100% 0% 100% 0% 100% 100% 0% 100%
Perumdara 0% 20% 17% 0% 20% 0% 0% 12%
25 acers Colony 0% 20% 0% 38% 11% 11% 0% 14%
CCPM colony 0% 14% 11% 0% 24% 37% 0% 24%
Nageena Colony 0% 8% 10% 0% 8% 0% 0% 8%
bangali colony 0% 0% 33% 13% 3% 7% 0% 9%
Bindukhatta 0% 0% 0% 0% 14% 7% 0% 10%
Indiranagar 0% 0% 0% 8% 9% 7% 0% 8%
Nainital Total 95% 18% 51% 44% 30% 41% 0% 41%
Variance = 10% , 3 Sigma limit = 70%
Table indicates high-risk containers in terms of Aedes breeding; Digits in bold font highlight the highest percentage of containers
found positive for Aedes breeding in a given localities.

We observed a very high correlation between overall
HI and BI values (r 0.92, p<0.01). In most positive
houses, more than one container with Aedes
larvae/pupae was found.
Discussion
Dengue has been on the rise since the year 2010 with
epidemics reported in as many as 50 countries in 2010
(WHO-South East Asian Regional Office 2010). In
this article, we analyzed the dengue transmission
dynamics in Uttarakhand in the last few years,
investigating the dengue/DHF epidemic in 2010 and
exploring how different types of containers act on the
mosquito proliferation and how all this knowledge
may help in establishing better policies to control the
dengue epidemics. Apparently, the effective vector
control may be possible but not easy. In many
developing countries limited infrastructural facilities
in programs to control the Aedes mosquitoes has

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Table 5 Percentage distribution of positive container and influence of types of containers for breeding of Aedes mosquitoes at
different localities surveyed in Dehradun
Areas/Localities Chances to be getting Aedes Larvae/pupae in different types of containers
Case (%) = 77% Tires Coolers Tin containers Cement tanks Clay pots Plastic Fridge Total
containers
Patel nagar 46% 0% 0% 41% 25% 12% 40% 26%
Vikas Nagar 0% 0% 0% 4% 3% 2% 0% 3%
Chandreshwar Nagar 25% 0% 0% 0% 17% 7% 14% 12%
Kailash gate 0% 0% 0% 0% 0% 0% 0% 0%
Shyampur 0% 0% 0% 0% 16% 14% 0% 14%
Aadarsh gram 0% 0% 0% 0% 26% 20% 0% 23%
Rani Pokhari 0% 0% 0% 0% 16% 10% 0% 14%
Reetha Mandi 0% 50% 0% 0% 52% 0% 74% 61%
Deep Nagar 0% 8% 0% 25% 7% 70% 29% 44%
Kedar Purum 10% 0% 0% 0% 13% 0% 37% 17%
Indra colony 0% 0% 0% 0% 0% 3% 0% 2%
Dehradun Total 20% 27% 0% 23% 19% 25% 43% 23%
Variance = 3%, 3 Sigma limit = 32%
Table indicates high-risk containers in terms of Aedes breeding; Digits in bold font highlight the highest percentage of containers
found positive for Aedes breeding in a given localities.

Figure 3 Summary of weather data from Nainital and Dehradun districts of Uttarakhand. Temperature (C) and rainfall (mm) data
based on mean of the last 25 years (monthly arithmetic averages).

resulted in a huge expansion of dengue vectors in
urban as well as rural habitats (Tauil 2002; Barcellos
et al. 2005; Medronho et al. 2009).
Here, we should acknowledge that technically the present
study might have few missing values and limitations.
7
The existence of detailed entomological surveillance
data before, during, and after the dengue epidemic in
study sites may offer a unique opportunity to analyze
cause and effect relationship. The entomological
data collection has been limited to
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Figure 4 Comparisons of entomological indices (HI, CI, and BI) in different localities in Nainital and Dehradun
water collections in artificial containers, which may
ignore the natural breeding sites of Ae. albopictus.
Moreover, we may not able to identify all imported
dengue cases, or detect asymptomatic dengue cases.
However, our study successfully describes the dengue
endemicity in Uttarakhand, characterizes the dengue
epidemics in 2010, and investigates the entomological
measures of risk of dengue.
We observed that both numbers of dengue cases and
numbers of deaths due to dengue are gradually
increasing from 2006 to 2010. This increase may be
associated with several reasons like increasing population,
unhygienic living, climate change, developed disease
reporting systems, better diagnostic facilities etc.
Interestingly, it is evident from the month wise
distribution of dengue cases (Figure 2) that a dengue
epidemic was more severe from September to
November, just after the highest rainfall, probably
8
reflecting the cultural habit of collecting rainwater,
and the abundance of unmanaged water sources.
These findings are consistent with those of Strickman
and Kittayapong (2002).
We studied the prevalence of Aedes larvae in context
to dengue epidemics in Uttarakhand. During our
survey, all non-hermetically closed containers containing
any volume of water were considered potential for
mosquito breeding; the highest percentage of positive
containers for larvae/pupae has shown up in tires, tin
containers, Fridge vessels, Cement tanks and Plastic
containers. Interestingly, the majority of these positive
containers is related to water supply and garbage
collections. These findings are in line with those
reported by Focks & Chadee (1997) and Medronho et
al. (2009). It is worth noting that in some areas we
found 100% of surveyed containers are positive for
mosquito breeding (Table 4).
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Table 6 Mean House Index (HI), Container Index (CI) and Breteau Index (BI) in Nainital and Dehradun during 2010 dengue epidemics
Statistics House Index (HI)
Nainital Dehradun
Mean 32.33 28.61
Std. Deviation 6.21 7.312
Std. Error 0.56 0.6649
Lower 95% CI 16.11 12.48
Upper 95% CI 54.15 51.35
Table also shows Standard Deviation, Standard Error of Mean and 95% Confidence Interval limits for the entomological indices
We found very high entomological indices (HI, CI,
and BI) for all areas. However, it is difficult to give a
precise threshold level of entomological indices in
epidemiological context. Dengue outbreak had previously
been recorded even in very low entomological indices
in Cuba (Pelaez et al. 2004), and Singapore (cf
Sanchez et al. 2006). In this present study, we found
that Dehradun (77% of cases) is more dengue prone
area than Nainital (23% cases) (Table 3). However, all
entomological indices are relatively higher in Nainital
than Dehradun (Table 6, and Figure 4). Moreover,
Mann-Whitney U nonparametric test revealed that the
observed differences of these indices (HI, CI, and BI)
between Nainital and Dehradun is not statistically
significant (p>0.05). Therefore, we hypothesize that
the epidemic intensity or severity of 2010-dengue
epidemic in Nainital and Dehradun are independent of
the rate of entomological indices. However, the layout
of housing structures differs between these two
districts; population density is higher or more
clustered in Dehradun than the Nainital, which could
also make Dehradun more dengue prone than Nainital.
There is always the possibility that other factors may
influence the relationship between entomological
indices and intensity of dengue epidemics. These
factors may be vector competence, vector bionomics
and composition, virulence of the virus, immunity
status of the population as whole or local health
authorities in reporting correct epidemic status. Some
studies have shown that entomological indices do
not seem to reliably assess dengue transmission risks
(Bang & Pant 1972; Kay et al. 1987; Reiter & Gubler
1997; Focks et al. 2000), other programs have used
them successfully (Pontes et al. 2000) or continue to
recommend their use (WHO 1999).
We believe that where it is difficult to generalize the
interpretation of the threshold indices at the global
Container Index (CI) Breteau Index (BI)
Nainital Dehradun Nainital Dehradun
25.91 17.93 124.99 77.33
7.17 3.51 74.63 11.49
0.65 0.32 6.79 1.045
10.84 8.86 28.92 42.47
47.44 30.16 288.66 122.54
level or even country level, the threshold level of
entomological indices for an outbreak of dengue
should be set up locally at district or even city level
since all vector borne diseases are focal and local in
nature. However, entomological indices are very
useful to understand the actual man-mosquito contact,
abundance of adult mosquitoes, monitoring vector
control programs and use as a tool for forecasting
outbreak, pinpointing and mapping high-risk areas.
We observed a very high correlation between overall
HI and BI values. A high correlation and divergence of
HI and BI were also observed in West Indies
(Thongcharoen 1993), where it was also noticed that
at low rate of Aedes infestation, the HI and BI were
nearly the same, whereas at higher infestation rate, a
divergence between the indices was observed. Therefore,
the high correlation and divergence between HI and
BI in the present study indicated high rates of Aedes
infestation, which may ultimately responsible for the
dengue epidemics in these areas.
Finally, Dengue/DHF is a burning health problem
throughout India, and cases and deaths were reported
from 31 states out of 35 during 2010. The results of
this study reinforce the practical importance of
entomological surveillance in measuring the risk of
dengue epidemics. Moreover, we have successfully
analyzed the epidemic characteristics of dengue/DHF,
which indicates the association of dengue with the
cultural habit of collecting rainwater due to irregular
water supply and the abundance of unmanaged water
sources due to the irregular garbage collection. Therefore,
improving these public services can improve the
dengue situation.
Acknowledgment
We are thankful to LS Chauhan, Director NCDC for
giving us the opportunity to carry out the study. We
9
 Journal of Mosquito Research 2015, Vol.5, No.17, 1-10
http://jmr.biopublisher.ca
are also thankful to the Director, Health Services,
Uttarakhand for providing all logistic and administrative
support during the study. We also acknowledge the
effort of all field staff of IDSP (SSU, Uttarakhand) for
their help during the fieldwork.
Funding: Ministry of Health and Family Welfare
(Govt. of India), Delhi, India Competing interests:
None Ethical approval: Not required An authorship
statement: MS conceived the study, carried out
experiments, analyzed all data, and drafted the
manuscript. KK conceived the study, supervised the
study, analyzed data and revising the manuscript
critically for intellectual content. AKG contributed in
data collection, compilation, analysis and revising
manuscript. All authors read and approved the manuscript.
KK, AKG and MS are guarantors of the paper.
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