# Differential Impacts of Extreme Weather Events on Vector-Borne Disease Transmission Across Urban and Rural Settings: A Scoping Review

## TL;DR

This review explores how extreme weather affects vector-borne diseases differently in cities and rural areas, highlighting the need for tailored prevention strategies.

## Contribution

The study systematically compares urban and rural transmission pathways of vector-borne diseases under extreme weather events.

## Key findings

- Urban areas face heat island effects and drainage issues that amplify disease transmission.
- Rural regions experience ecosystem-driven transmission linked to agriculture and wildlife.
- Few longitudinal studies exist, and geographic disparities in evidence are noted.

## Abstract

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.