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The emergence of hyperendemic dengue in Bangladesh: An ecological study of structural breaks and transmission regime shifts, 2008–2025

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  • Pratyay Hasan
  • Tazdin Delwar Khan
  • Mohd Arifuzzaman
  • Md Saiful Islam
  • Mohammad Emdadul Haque

Abstract

Background: Dengue fever in Bangladesh has escalated from sporadic outbreaks to a persistent, nationwide health crisis. Traditional epidemiological analyses often assume a constant transmission regime, potentially overlooking fundamental shifts driven by viral, environmental, or societal factors. This population-level ecological time-series observational study aimed to identify and characterize significant structural breaks in the time series of dengue admissions in Bangladesh to define distinct epidemiological phases. Methods: Monthly dengue hospital admission data (January 2008─October 2025) were obtained from the Institute of Epidemiology, Disease Control and Research (IEDCR) and Directorate General of Health Services (DGHS) public archives. Analyses included STL seasonal-trend decomposition, the Zivot-Andrews unit root test (primary break detection), multi-algorithm breakpoint detection (PELT, Binary Segmentation, Window-based), K-means clustering (optimal at 3 clusters, silhouette score 0.867), and Markov regime-switching models. Findings: Ten structural breaks were identified through a consensus ranking approach. The most prominent break occurred in May 2021 (consensus score = 3). The Markov regime-switching model delineated three distinct transmission regimes: 1) a Low Baseline Regime (2008─2023) with a mean of 47 monthly cases (95% CI: 36─57); 2) an Intermediate Regime (2008─2025) with a mean of 1,288 monthly cases (95% CI: 927─1,648); and 3) a Hyperendemic Regime (2019─2025) with a mean of 26,127 monthly cases (95% CI: 17,207─35,048), representing a 556-fold increase over the low baseline. Seasonality strength was moderate (0.335), but the peak-to-trough seasonal ratio approached 180, indicating pronounced annual epidemic cycles superimposed on the substantially elevated baseline. Interpretation: Bangladesh has experienced an established regime shift to sustained hyperendemic dengue transmission (persistent as of October 2025) necessitating a fundamental shift from outbreak-response to sustained, year-round control strategies. It is most likely influenced by viral, environmental, and societal factors including documented serotype redistribution. Public health strategies must transition from outbreak-response to sustained high-transmission management, including year-round vector control with pre-monsoon intensification.

Suggested Citation

  • Pratyay Hasan & Tazdin Delwar Khan & Mohd Arifuzzaman & Md Saiful Islam & Mohammad Emdadul Haque, 2026. "The emergence of hyperendemic dengue in Bangladesh: An ecological study of structural breaks and transmission regime shifts, 2008–2025," PLOS ONE, Public Library of Science, vol. 21(2), pages 1-15, February.
    • Handle: RePEc:plo:pone00:0343246
    DOI: 10.1371/journal.pone.0343246
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    References listed on IDEAS

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    1. Waheed, Muhammad & Alam, Tasneem & Ghauri, Saghir Pervaiz, 2006. "Structural breaks and unit root: evidence from Pakistani macroeconomic time series," MPRA Paper 1797, University Library of Munich, Germany.
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