Association between heavy rainfall and flooding events and infectious diseases in Europe: a rapid review, 2018 to 2025

Europe is facing a growing public health challenge. Climate change – driven by greenhouse gas emissions from fossil fuel combustion, deforestation and intensive livestock farming [1] – is not only altering long-term temperature and weather patterns but is also reshaping the continent’s epidemiological landscape. In the past decade, Europe has experienced an increase in extreme weather events, including floods [2]. According to the 2024 European climate risk assessment, Europe is facing escalating extreme weather events, including heavy rain and flooding [3].

These changes can potentially lead to a rising incidence of infectious diseases, including food- and waterborne diseases, such as campylobacteriosis and leptospirosis [4], and may also facilitate the expansion of vector habitats and boost vector replication rates [5]. Additionally, stagnant water following heavy rainfall or flooding offers ideal breeding sites for mosquitoes, raising the risk of vector-borne diseases such as dengue and West Nile fever [6,7].

Heavy rainfall and flooding are among the most frequent natural disasters in Europe, particularly affecting low-lying coastal areas [3]. Warmer air contains more water vapour, which can be released as extreme rainfall [2] or intensify storms [3], especially in central and northern Europe [2,8]. These extreme weather events have been documented across the European continent [3]. Fluvial floods can transport animal faeces from soil into water supplies and expose people to zoonotic pathogens, while pluvial floods in urban areas may cause sewage overflows that can expose populations to waterborne pathogens and gastrointestinal infections. Moreover, infrastructure damage from such events can indirectly facilitate the spread of infectious diseases [5,6].

A previous European-wide review, reporting on articles published from 2005 to 2018, linked flooding with leptospirosis, anthrax, as well as infections with West Nile virus, Cryptosporidium hominis, Escherichia coli, Campylobacter jejuni, Giardia lamblia, Sindbis virus, Batai virus, Tahyna virus and norovirus, and also with unspecified gastrointestinal, influenza-like illness and dermatological complaints [5]. The European continent has experienced several heavy rainfall and flooding events since 2018, calling for an update of the evidence base to inform and guide infectious disease preparedness and public health response. This article seeks to do so by presenting findings from a rapid review examining the associations between heavy rainfall and flooding events and infectious diseases among humans in Europe.