The Journal of Infectious Diseases
VIEWPOINT
Climate Change and Contagion: The Circuitous Impacts
From Infectious Diseases
Jan C. Semenza1,2
1
Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden; and 2Heidelberg Institute of Global Health, University of Heidelberg,
Heidelberg, Germany
The 8 most recent years have been the
warmest on record [1]. In 2022, the glob­
al 10-year average temperature soared to
1.15 °C above preindustrial levels. The
climate change impacts from heat waves,
floods, and droughts are more apparent
and direct when compared with the circu­
itous and indirect climate change impacts
from infectious diseases (Figure 1). Yet,
their contagious nature and epidemic po­
tential pose a latent threat to public health,
particularly to marginalized and vulnera­
ble populations. These groups, despite
contributing the least to greenhouse gas
emissions, are disproportionately affected
by the consequences of climate disrup­
tion. The transmission potential of many
vector-, water-, and foodborne infections
is determined by the nexus of climate haz­
ards, vulnerability, and exposure [2].
Some of these complex relationships are
discussed here.
VECTOR-BORNE DISEASES
Dengue is a viral infection transmitted to
humans through the bite of infected
Received 07 December 2023; editorial decision 07
December 2023; published online 15 March 2024
Correspondence: Jan C. Semenza, PhD, MPH, Department
of Public Health and Clinical Medicine Section of
Sustainable Health University Hospital, Building 1A, 4 st.
Umeå University, 901 87 Umeå, Sweden (SwedenJan.
Semenza@lateralPHC.com).
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https://doi.org/10.1093/infdis/jiad571
Aedes mosquitoes. About half the world’s
population is now at risk of dengue due
to accelerating rates of urbanization, mo­
bility, and climate change. Dengue trans­
missibility cannot be explained without
climatic variables, which need to be inte­
grated into climate change projections
[3]. Rising global temperature is project­
ed to improve the climatic suitability of
dengue mosquito vectors and expand its
global distribution and abundance [4].
Thus, areas of transmission are projected
to move toward higher altitudes and tem­
perate regions, where naive populations
have no immunity and the health system
is unprepared [5].
West Nile virus (WNV) is transmitted
to people through the bites of infected
mosquitoes, although wild birds are the
principal hosts. The majority of human
infections occur in the summer and early
fall. WNV epidemiology is determined to
a large extent by ambient temperature
because it accelerates WNV replication
rates in the mosquito, boosts vector pop­
ulation growth rates, and decreases the
interval between blood meals. However,
other climatic and environmental deter­
minants affect WNV transmission [2].
Spring temperature (Tmax and Tmin of
the second quarter) is a strong predictor
of WNV transmission in Europe [6]. A
recent study using an ensemble climate
model and multiscenario approach re­
vealed a 5-fold elevated risk of WNV in­
fections for 2040–2060 vs 2000–2020 in
Europe, depending on geographic region
and climate scenario [7]. Western
Europe appears to be facing the largest
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increase in the outbreak risk of WNV
across scenarios.
FOODBORNE DISEASES
Temperature can accelerate the replica­
tion rate of certain pathogens and
thus reduce the shelf-life of food.
Epidemiologically, Salmonella infections
are climate sensitive, with more frequent
infections in the summer months [8].
The temporal and geographic distribution
of Campylobacter in Northern Europe is
associated with increases in temperature
and heavy rainfall, which may augment
the number of cases reported the follow­
ing week [9]. Under climate change pro­
jections, the number of Campylobacter
cases is projected to increase by almost
200% by 2100 [10]. This means nearly
6000 excess Campylobacter cases per
year, which could be attributed to an ex­
tension of the transmission season and
other changes to the climate.
WATERBORNE DISEASES
Annually, 1.4 million people lose their
lives due to illnesses linked to the absence
of safe water, sanitation, and basic hy­
giene in households, health care centers,
and schools (Figure 1) [11]. Climate
change can exacerbate these conditions
through cascading risk pathways, leading
to outbreaks of waterborne diseases [12].
Mounting global temperature accelerates
the evaporation process from the oceans
and augments the moisture content in
the atmosphere. This, in turn, triggers
heavy rainfall and floods, often linked
to widespread outbreaks of disease
VIEWPOINT • JID • 1
 Climate
Hazards
Heat
Drought
Rain
Flood
Figure 1. The nexus of hazard, vulnerability, and exposure and how adaptation can attenuate vulnerabilities and minimize exposure to pathogens.
[13]. Global estimates suggest that
temperature-attributable excess deaths
from enteric infections could range be­
tween 10 000 and nearly 75 000 per year
by 2050–2065, considering optimistic
and pessimistic scenarios, respectively
[14].
Ocean warming has continued un­
abated, owing to mounting global tem­
perature. Vibrio pathogens, such as
V parahaemolyticus and V vulnificus,
are marine bacteria present in brackish
water that have expanded their habitat
due to the warming of the oceans [15].
Vibrio infections can cause sporadic but
potentially severe gastrointestinal illness­
es and wound infections, which can ad­
vance to outcomes such as necrotizing
fasciitis, septicemia, and death. In the
Baltic Sea, climate change projections in­
dicate a marked upward trend during
the summer months and an increase in
the relative risk of these infections
in the coming decades [15]. Similarly,
in the United States, V vulnificus is pro­
jected to expand to every US state along
2 • JID • VIEWPOINT
Vulnerabilities Adaptation
Bio-medical
Demographic
Geographic
Socio-
economic
Infrastructure
the seaboard by 2080 under medium- to
high-emissions scenarios [16].
CLIMATE CHANGE ADAPTATION
THROUGH A CONTINUUM OF
SURVEILLANCE
Traditional surveillance systems are not
designed to capture these circuitous cli­
mate change impacts from infectious dis­
eases, much less so in areas populated by
socially and economically marginalized
groups, where not only health data tend
to be missing (due to a lack of access to
health care) but also climate and environ­
mental data (due to a lack of monitoring
stations) [2]. Monitoring epidemic pre­
cursors of disease can tackle some of
these challenges through early warning
systems [12]. The risk from climate chan­
ge is determined by climate hazard, vul­
nerability, and exposure (Figure 1) [2].
These 3 aspects of risk can be monitored
across human, animal, and environmen­
tal health [17]. In the age of big data, nov­
el data sources can be explored to capture
some of these complex and nonlinear
Pathogens
Foodborne
Waterborne
Vectorborne
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Exposure
Disease
interactions. Indicator- and event-based
surveillance can be combined with ani­
mal, environmental, and climatic data.
For example, air passenger volume can
capture human mobility, and activity
space data can help quantify potential ex­
posure in human populations; traditional
surveillance data can be combined with
entomologic data of arthropod vectors,
such as mosquitoes and ticks, collected
through citizen science; smart traps that
employ mosquito sensors with machine
learning algorithms and bioacoustic re­
cordings of live insects can help identify
indigenous or invasive vectors species;
and pathogen monitoring of wastewater
can detect community transmission pri­
or to clinical detection [17].
A continuum of surveillance, across
disciplines, takes advantage of big data
at relatively low cost, high speed, and vol­
ume [12]. The usefulness of such analyses
can be validated against traditional sur­
veillance systems. Thus, monitoring epi­
demic precursors from environmental,
animal, and human health, through a
continuum of surveillance, can help tack­
le the circuitous climate change impacts
from infectious disease.
Notes
Financial support. Funding received
from the European Union’s Horizon
Europe research and innovation pro­
gramme under Grant Agreements No.
101057554 for project ID Alert No.
101060568 for project BEPREP.
Potential conflict of interest. Author
certifies no potential conflicts of interest.
The author has submitted the ICMJE
Form for Disclosure of Potential
Conflicts of Interest. Conflicts that the
editors consider relevant to the content
of the manuscript have been disclosed.
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VIEWPOINT • JID • 3