Epidemiological dynamics of dengue in Peru: Temporal and spatial drivers between 2000 and 2022.

Dengue, a vector-borne disease driven by climate change, urbanization, and the adaptation of its vector, Aedes aegypti, poses a significant public health challenge. This study analyzed 23 years (2000-2022) of epidemiological data from Peru to examine the temporal and spatial drivers influencing dengue reported cases. Using secondary data from the Peruvian Ministry of Health, 501,027 cases were stratified by clinical severity, gender, geographic distribution, and temporal trends. The Amazonian and coastal regions, particularly Loreto, Ucayali, and Piura, bore the highest burden, collectively accounting for more than 60% of cases during epidemic years. Seasonal spikes in transmission consistently aligned with the rainy season, underscoring the dependence of Aedes aegypti proliferation on climatic conditions. The analysis revealed progressive geographic expansion of dengue into previously low-risk areas, including Andean highlands and peri-urban zones, driven by climatic shifts and unregulated urbanization. Gender-based comparisons indicated a higher overall case burden among females, though severe forms of dengue were unequally observed in males, particularly in rural areas. Clinical classifications highlighted that 78% of cases presented without warning signs, 18% with warning signs, and 4% as severe dengue. Socioeconomic factors, such as inadequate sanitation, urban slums, and water storage practices, contributed significantly to vector breeding in high-burden areas. Moreover, the role of extreme climatic events, including El Niño, exacerbated outbreak intensity and duration. The findings emphasize the urgent need for innovative approaches and provides actionable insights into regional dynamics and highlights critical areas for research, including predictive climate-disease modeling and the integration of molecular surveillance. These strategies are essential to mitigating the growing dengue burden and strengthening public health systems in Peru and similar endemic regions.