Effects of high temperatures and heatwaves on dengue fever: a systematic review and meta-analysis

Yohannes Tefera Damtew; Michael Tong; Blesson Mathew Varghese; Olga Anikeeva; Alana Hansen; Keith Dear; Ying Zhang; Geoffrey Morgan; Tim Driscoll; Tony Capon; Peng Bi

doi:10.1016/j.ebiom.2023.104582

Effects of high temperatures and heatwaves on dengue fever: a systematic review and meta-analysis

EBioMedicine. 2023 May:91:104582. doi: 10.1016/j.ebiom.2023.104582. Epub 2023 Apr 21.

Authors

Yohannes Tefera Damtew¹, Michael Tong², Blesson Mathew Varghese³, Olga Anikeeva⁴, Alana Hansen⁵, Keith Dear⁶, Ying Zhang⁷, Geoffrey Morgan⁸, Tim Driscoll⁹, Tony Capon¹⁰, Peng Bi¹¹

Affiliations

¹ School of Public Health, The University of Adelaide, Adelaide, South Australia, 5005, Australia; College of Health and Medical Sciences, Haramaya University, P.O.BOX 138, Dire Dawa, Ethiopia. Electronic address: yohannestefera.damtew@adelaide.edu.au.
² National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, The Australian National University, Canberra ACT, 2601, Australia. Electronic address: Michael.Tong@anu.edu.au.
³ School of Public Health, The University of Adelaide, Adelaide, South Australia, 5005, Australia. Electronic address: blesson.varghese@adelaide.edu.au.
⁴ School of Public Health, The University of Adelaide, Adelaide, South Australia, 5005, Australia. Electronic address: olga.anikeeva@adelaide.edu.au.
⁵ School of Public Health, The University of Adelaide, Adelaide, South Australia, 5005, Australia. Electronic address: alana.hansen@adelaide.edu.au.
⁶ School of Public Health, The University of Adelaide, Adelaide, South Australia, 5005, Australia. Electronic address: keith.dear@adelaide.edu.au.
⁷ School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, 2006, Australia. Electronic address: ying.zhang@sydney.edu.au.
⁸ School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, 2006, Australia. Electronic address: geoffrey.morgan@sydney.edu.au.
⁹ School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, 2006, Australia. Electronic address: tim.driscoll@sydney.edu.au.
¹⁰ Monash Sustainable Development Institute, Monash University, Melbourne, Victoria, Australia. Electronic address: tony.capon@monash.edu.
¹¹ School of Public Health, The University of Adelaide, Adelaide, South Australia, 5005, Australia. Electronic address: peng.bi@adelaide.edu.au.

Abstract

Background: Studies have shown that dengue virus transmission increases in association with ambient temperature. We performed a systematic review and meta-analysis to assess the effect of both high temperatures and heatwave events on dengue transmission in different climate zones globally.

Methods: A systematic literature search was conducted in PubMed, Scopus, Embase, and Web of Science from January 1990 to September 20, 2022. We included peer reviewed original observational studies using ecological time series, case crossover, or case series study designs reporting the association of high temperatures and heatwave with dengue and comparing risks over different exposures or time periods. Studies classified as case reports, clinical trials, non-human studies, conference abstracts, editorials, reviews, books, posters, commentaries; and studies that examined only seasonal effects were excluded. Effect estimates were extracted from published literature. A random effects meta-analysis was performed to pool the relative risks (RRs) of dengue infection per 1 °C increase in temperature, and further subgroup analyses were also conducted. The quality and strength of evidence were evaluated following the Navigation Guide systematic review methodology framework. The review protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO).

Findings: The study selection process yielded 6367 studies. A total of 106 studies covering more than four million dengue cases fulfilled the inclusion criteria; of these, 54 studies were eligible for meta-analysis. The overall pooled estimate showed a 13% increase in risk of dengue infection (RR = 1.13; 95% confidence interval (CI): 1.11-1.16, I² = 98.0%) for each 1 °C increase in high temperatures. Subgroup analyses by climate zones suggested greater effects of temperature in tropical monsoon climate zone (RR = 1.29, 95% CI: 1.11-1.51) and humid subtropical climate zone (RR = 1.20, 95% CI: 1.15-1.25). Heatwave events showed association with an increased risk of dengue infection (RR = 1.08; 95% CI: 0.95-1.23, I² = 88.9%), despite a wide confidence interval. The overall strength of evidence was found to be "sufficient" for high temperatures but "limited" for heatwaves. Our results showed that high temperatures increased the risk of dengue infection, albeit with varying risks across climate zones and different levels of national income.

Interpretation: High temperatures increased the relative risk of dengue infection. Future studies on the association between temperature and dengue infection should consider local and regional climate, socio-demographic and environmental characteristics to explore vulnerability at local and regional levels for tailored prevention.

Funding: Australian Research Council Discovery Program.

Keywords: Arboviral infections; Climate change; Dengue fever; Emerging infectious disease; Heatwave; High temperature.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Australia
Dengue* / epidemiology
Humans
Risk
Temperature