Battling dengue in a warming world: How climate and urbanization shape transmission in low- and middle-income countries (a rapid review)

Dengue fever is a globally prevalent vector-borne disease, with low- and middle-income countries (LMICs) experiencing a disproportionate burden. Transmission patterns are increasingly influenced by rising global temperatures and rapid urbanization, yet no recent review has synthesized how these environmental factors are reshaping dengue dynamics in LMICs.

We conducted a rapid systematic review following a registered protocol (PROSPERO: CRD42025635982). Six databases (MEDLINE, Embase, Global Health, SciELO, Global Index Medicus and Web of Science) were searched for peer-reviewed studies published between January 2020 and November 2024. Studies were screened for climate or urbanization factors affecting dengue transmission in LMICs. Study quality was assessed using the Mixed Methods Appraisal Tool for empirical studies and a structured assessment for modeling studies. Findings were synthesized narratively.

Of the 65 included studies, 65% reported a positive association between rising temperatures and increased dengue transmission, often attributed to intensified mosquito activity and longer transmission seasons. Urbanization was assessed in 35% of studies, with unplanned growth, informal settlements, and inadequate infrastructure frequently associated with increased risk. Several studies reported geographic expansion into highland and peri-urban areas, as well as seasonal shifts, including earlier onset and prolonged transmission periods. Urban heat islands and land-use change were commonly associated with localized transmission hotspots. Government responses were documented in 29% of studies, though many were hindered by fragmented surveillance systems, limited cross-sector coordination, or insufficient integration of climate data into public health planning.

Climate change and urbanization are reshaping the spatial and temporal dynamics of dengue in LMICs. Adaptive responses require strengthened surveillance and climate-informed planning in resilient urban infrastructure to reduce future transmission risks.