Growing water insecurity and dengue burden in the Americas (Akanda, A.S. and Johnson,K. May 2018, The Lancet Planetary Health)

A review of the influence of public health interventions and local-level responsiveness on the prevalence of dengue fever in recent disaster scenarios in Mexico, the Caribbean and Central America.

In addition to rising temperatures and changes in rainfall distribution, the frequency of extreme weather events driven by climate change and human-motivated factors (eg, migration, population density, water insecurity, sanitation, rapid urbanisation) support the expansion of mosquito habitats, creating conditions that could allow the establishment of new endemic populations. 

Dengue disease management requires the elimination of Aedes aegypti mosquito reservoirs in population dense urban environments. Interventions that are based on education and treatment are unlikely to be successful in the absence of more effective water-distribution systems, and in regions where an absence of trust characterises the relationship between government agencies and the population.

With extreme climate events, such as the flooding that accompanied Hurricane Harvey in Houston, TX, USA, urban areas in the USA could become susceptible to endemic mosquito populations since reconstruction and remediation could take years, with some localities abandoned as standing ruins.

Emerging megacities outside of the Americas could be in similarly vulnerable positions, in which water insecurity is a chronic problem amid a growing trend of informal settlements and migrant populations. In regions that are at risk of developing endemic populations, the development of large-scale surveillance capabilities to identify water insecurity and disease prevalence hotspots, aided by both hydroclimatic and sociopolitical information, and coupled with urban drainage and sanitation strategies, are crucial.

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