Thursday, 19 March 2026

The interaction of air pollution and Dengue fever mortality

   

A recent international paper (Khan et al, 2026) looked at Dengue fever mortality, and air pollution in the same countries at the same time. Twenty Dengue - endemic countries around the world were compared. Dengue fever case mortality rates (CFR) were derived from national data or the World Health Organization's (WHO) global dengue surveillance platform - importantly these are not cases of Dengue, but deaths from Dengue. Particulate air pollution (PM2.5) was derived from satellite data.

 

All countries examined showed a mean annual ambient PM2.5 exposure over the WHO air quality guideline of 5 μg/m3 (range: 7.4–77.5 μg/m3).

 

Strikingly, countries exceeding 35 μg/m3 PM2.5 such as Bangladesh, Burkina Faso and Indonesia recorded 3-5 times higher mortality than countries below 15 μg/m3 such as Brazil, Ecuador, and Costa Rica (p < 0.001).

 

At first glance it might appear to be a coincidence of economics - poorer countries are likely to have less stringent pollution regulations, less well funded health services and less effective vector control programmes. And higher GDP per capita was indeed protective. But it was maybe more complicated than that. For example, the huge dry season pollution in Bangladesh (PM2.5 125 μg/m3) was associated with nearly doubled Dengue mortality compared to the rainy season (50 μg/m3), despite there being fewer Dengue cases overall in the dry season. Whereas in Brazil there was minimal seasonal variability in both air quality and dengue fatality.

 

So what is going on?

 

Prolonged exposure to PM2.5 concentrations exceeding 35 μg/m3 has been linked to many cardiovascular, respiratory, and malignant diseases (WHO 2021). Fine particles can promote systemic inflammation, and exacerbate vascular permeability, processes central to Dengue pathogenesis. The authors speculate that in the context of Dengue fever, immunomodulatory effects may exaggerate symptoms such as cytokine production, leading to more severe symptoms such as Dengue Haemorrhagic Fever. In other words, air pollution multiplies the body's response to Dengue, and that is what kills you (Lin et al., 2018; Monoson et al., 2023).

 

As the authors admit, there are some limitations to this study. For example, only Bangladesh and Brazil had complete and reliable monthly datasets for both PM2.5 and Dengue available for the period 2020–2024. And specific Dengue serotypes may have varied across continents. But reducing air pollution has multiple health benefits, and one of those may be your survival of Dengue fever infection.

 

References

 

Khan, S., Haider, N., Yahiro, T., Akbar, S.M.F., Khan, F., Hasan, M.N., Al Mahtab, M., Hashimoto, T., Kimitsuki, K., Tachibana, T., Watanabe, K., Nishizono, A. 2026. Ambient PM2.5 exposure and increased dengue case fatality: a global multi-country analysis. Environ Pollut., 394:127731. doi: 10.1016/j.envpol.2026.127731.

 

Lin, C.L., Tsai, C.H., Sun, Y.L. et al. 2018. Instillation of PM2.5 induced acute lung injury in ACE2 knockout mice. Int. J. Biol. Sci., 14, 253-265.

 

Monoson, A., Schott, E., Ard, K. et al. 2023. Air pollution and respiratory infections

Toxicol. Sci., 192 , 3-14.

 

World Health Organization. 2021. WHO global air quality guidelines: Particulate matter (PM2.5 and PM10), ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide. Geneva: World Health Organization.

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