A systematic review investigating emerging trends between Extreme Weather Events (EWEs) and infectious disease outbreaks in South Africa

Extreme weather events (EWEs) are increasing in frequency and intensity due to climate change, exacerbating health risks, particularly for vulnerable populations. Infectious diseases are climate- sensitive, yet microbial dynamics during and after EWEs remain poorly understood. This systematic review examines emerging trends in infectious disease outbreaks following EWEs in South Africa. A comprehensive search across fifteen electronic databases was conducted using Cochrane systematic review principles. Studies focusing on infectious diseases related to EWEs in South Africa were included, considering all study designs. A PRISMA diagram details the screening process, and quality appraisal was conducted using JBI checklist tools or a mixed-methods assessment tool. No primary studies specifically linking recent infectious disease outbreaks to EWEs in South Africa were identified. Existing literature focuses on symptom presentation rather than microbial identification. However, findings indicate an increase in infectious diseases post-EWEs, with three key themes emerging: (1) climatic impacts on infectious diseases, (2) population vulnerabilities, and (3) the role of infrastructure and policy. The review highlights the need for longitudinal microbiological data to improve outbreak prediction and preparedness. This review underscores a significant research gap and calls for an integrated approach combining environmental monitoring with pathogen diagnostics. Large-scale longitudinal studies and enhanced collaboration between education and healthcare sectors are needed. Early Warning Systems should incorporate climate variables to predict disease outbreaks, and a One Health approach is essential to address climate-driven infectious disease risks effectively.