Climate extremes increase dengue risk along elevation and socio-economic gradients in Colombia

Globally, urban settlements face increases in the frequency, magnitude, and duration of extreme climate events and shifts in their timing and spatial extent. Variation in temperature and rainfall conditions affect the temporal onset of dengue transmission. However, there is a need to understand how climate related patterns and disease transmission mechanisms vary by location, particularly for topographically complex landscapes. In this investigation, we used dengue cases from 1,120 municipalities and five regions across Colombia during 2008 2019, and analyzed associations with extreme climate covariates generated from fine scale, daily-level meteorological data, accounting for varying landscape and socio economic properties. Using Bayesian spatio-temporal hierarchical models, we determined that high-intensity warm spells (with positive temperature anomalies of 8 12 C above mean monthly conditions) resulted in an earlier onset of dengue transmission risk in high elevation settlements compared to low elevation settlements. Furthermore, the risk of dengue transmission after extremely dry conditions was greater and extended for a longer duration in highly urbanized municipalities compared to those with a low urban population. Our findings highlight that meteorological hazards affect disease transmission in urban settlements differently based on elevation and socio economic conditions. Additionally, our analysis adds to increasing evidence of the vulnerability of mountainous urban communities to extreme weather and vector borne diseases. Overall, we emphasize the need for monitoring and forecasting the occurrence and intensity of meteorological hazards and associations with emerging climate sensitive disease threats. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Wellcome Trust funded project IDExtremes(226069/Z/22/Z). NSF Geography and Spatial Sciences Doctoral Dissertation Improvement Grant ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript