Differential Impacts of Extreme Weather Events on Vector-Borne Disease Transmission Across Urban and Rural Settings:...

Background/Objectives: Climate change is intensifying vector-borne disease (VBD) transmission globally, causing over 700,000 annual deaths, yet systematic evidence comparing climate-health pathways across urban and rural settlements remains fragmented. This scoping review aimed to synthesize evidence on the differential impacts of extreme weather events on vector-borne disease transmission between urban and rural environments and identify settlement-specific prevention and healthcare preparedness strategies. Methods: A scoping review following PRISMA-ScR guidelines searched PubMed, EMBASE, Web of Science, and Scopus databases for studies examining climate-vector-borne disease relationships across settlement types. Sixteen empirical studies were analyzed using narrative synthesis, with urban-rural comparisons largely inferential given limited direct comparative studies. Results: From 6493 records identified, 4875 were screened after duplicate removal, yielding 16 studies for analysis. Studies covered multiple vector-borne diseases, including malaria, dengue, leishmaniasis, chikungunya, and Zika, across diverse geographic regions. Urban environments demonstrated infrastructure-mediated transmission dynamics characterized by heat island amplification exceeding vector survival thresholds, drainage system vulnerabilities creating breeding habitats, and density-driven epidemic spread affecting healthcare surge capacity. Rural settings exhibited ecosystem-mediated pathways involving diverse vector communities, agricultural breeding sites, and seasonal spillover from wildlife reservoirs, with healthcare accessibility challenges during extreme weather events. Critical research gaps included a limited number of longitudinal comparative studies and geographic variations in evidence generation. Conclusions: Extreme weather events create fundamentally distinct vector-borne disease transmission pathways across urban-rural gradients, necessitating settlement-specific prevention strategies and healthcare preparedness approaches. Evidence-based recommendations include urban infrastructure improvements, rural early warning systems, and cross-sectoral coordination frameworks to enhance the adaptive capacity for climate-resilient vector-borne disease prevention.