The bilateral relationship between tourism and dengue occurrence: evidence from Aruba

This study estimates the bilateral effects between seasonal patterns of dengue incidences and the recurring fluctuations of both stay-over tourism and cruise tourism. Seasonal patterns were first isolated from the series using the Census X-12 decomposition method, after which the analysis included panel data unit root testing, panel data regression, and Mahalanobis distance calculation. The results show that cruise tourism increases dengue cases in Aruba, while dengue cases themselves had no influence on the number of stay-over and cruise visitors in Aruba. The study hints for an economical duality in cruise tourism in Aruba: (1) On one hand, cruise tourists who arrive at the harbor contribute to the economy of Aruba due to their spending activities; and (2) On the other hand, cruise tourists can induce costs by increasing the risk of spreading dengue. The Mahalanobis distance showed that the sensitivity of dengue cases to cruise tourism was the strongest during February, April-July, October, and November.