Autochthonous dengue transmission in Europe: epidemiology, mechanisms, and modelling insights.

BACKGROUND: Dengue is the most rapidly expanding arboviral infection globally, with rising incidence and widening geographic distribution driven by urbanisation, climate change, vector expansion, and global mobility. Although traditionally confined to tropical and subtropical regions, dengue is increasingly emerging in temperate settings, including Europe. Recent outbreaks in Italy, Spain, and France, together with evidence of under-recognised transmission, indicate a transition from sporadic importation to recurrent autochthonous infection. This shift is facilitated by the establishment of Aedes albopictus, increasing climatic suitability, an increase in case importation from endemic areas and delays in clinical recognition and public health response.

MAIN BODY: In non-endemic regions, dengue presents distinct challenges, including low population immunity, limited clinical awareness, and diagnostic constraints that may hinder early detection. While advances in vaccines, particularly TAK-003, and novel vector control strategies such as Wolbachia-based interventions offer new opportunities, their role in Europe remains context-specific and complementary to strengthened surveillance and preparedness systems. Modelling approaches provide valuable decision support but are constrained by data limitations in emerging settings.

CONCLUSIONS: The emergence of dengue in Europe should be viewed as an early signal of broader changes in vector-borne disease dynamics. Proactive investment in integrated surveillance, diagnostics, vector control, and targeted vaccination strategies will be essential to mitigate future risk and prevent sustained transmission in non-endemic regions.