Climate change, migration, and infectious disease vulnerability at Europe's southern border: Lampedusa as a sentinel interface

BACKGROUND: The Mediterranean basin is warming faster than the global average, reshaping ecological niches for vector-borne, water-borne, and environmentally linked pathogens. Concurrent climate shocks across the Sahel, West Africa, and the Horn of Africa-combined with conflict, food and water insecurity, and fragile health systems-drive sustained mobility toward North Africa and Europe. Frontline entry points along the Central Mediterranean route often capture early clinical signals of these pressures. METHODS: We conducted a narrative, expert-informed evidence synthesis integrating peer-reviewed literature and institutional reports from WHO, ECDC, UNHCR, IOM, MSF, IPCC, and MedECC published between 2000 and 2025. We reviewed climate-sensitive pathogen dynamics in the Euro-Mediterranean region, infectious disease burdens in major regions of origin, transit-related exposures, and clinical patterns observed at first medical contact. Evidence was synthesised into a Climate-Migration-Infection sentinel framework. FINDINGS: Mediterranean warming increases ecological suitability for Aedes mosquitoes, intensifies West Nile virus activity, and promotes Vibrio proliferation. Climate shocks in regions of origin are associated with higher burdens of malaria, cholera, meningococcal disease, respiratory and dermatological infections, and antimicrobial resistance. Transit through North African hubs amplifies vulnerability through overcrowding, unsafe water, malnutrition, trauma, and disrupted access to care. Clinical presentations at first European entry points reflect cumulative deprivation and pose a generally low public-health risk to Europe under typical post-arrival conditions. INTERPRETATION: Central Mediterranean entry points such as Lampedusa function as sentinel interfaces for climate-driven infectious vulnerability. Strengthening syndromic surveillance and climate-informed preparedness at these sites could enhance early-warning capacity at Europe's southern border.