Reader AN comments that the potential for plagues could cause some reverse urbanization trend in the region. There are at least two possibilities here.
The first is that a single pandemic causes one or several cities to clear out as people try to escape the health problem. That would be a variation on the earthquake catastrophe, but very different in that most infrastructure would remain unharmed. These would also be isolated incidents and likely reversed once the health problem was fixed.
The second, which goes to the dengue comment, would be a trend against urbanization as certain persistant diseases hit urban environments hard. Rather than a single crisis causing a panicked fleeing, this would be more of a slow social change as people collectively decided that rural areas are healthier than urban areas. That may be hard to believe today as urban areas are generally healthier and less prone to certain diseases than rural areas, plus they have better medical infrastructure for treatment. However, imagining a scenario with some disease that creates that sort of social change over the next 20 years is possible.
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