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Pathogens (Basel, Switzerland)2026; 15(3); 298; doi: 10.3390/pathogens15030298

West Nile Virus in Europe: Epidemiology, Vector Ecology, Environmental Drivers, and the Role of Equine Sentinel Surveillance in a One Health Framework.

Abstract: West Nile virus (WNV) is a mosquito-borne flavivirus that remains an important public and veterinary health concern across Europe. Periodic outbreaks affecting humans, horses, and wildlife highlight the complex ecological interactions underlying viral circulation. This narrative review aims to synthesize current knowledge regarding WNV epidemiology, transmission dynamics, and surveillance strategies in Europe, with particular attention to the Romanian context. Available surveillance data indicate recurrent seasonal transmission in several European regions; however, reported case numbers may be influenced by differences in diagnostic capacity, reporting practices, and surveillance intensity among countries. Recent studies suggest that environmental variability, vector adaptation, and host community composition play important roles in shaping regional transmission risk, although the relative contribution of these factors remains incompletely quantified. Despite expanding surveillance networks and One Health initiatives, important knowledge gaps persist regarding the integration of environmental risk indicators, vector ecology, and operational preparedness into coherent risk-assessment frameworks. This review therefore examines current epidemiological patterns, evaluates surveillance approaches, and discusses emerging drivers of WNV transmission in Europe. As a narrative synthesis based on published literature and surveillance reports, this review is subject to limitations related to heterogeneity in available data and differences in national reporting systems. Nevertheless, a clearer understanding of these interacting factors may support improved surveillance strategies and more adaptive public health responses to future WNV transmission events. Reported surveillance data should be interpreted cautiously, as differences in national surveillance intensity, diagnostic capacity, and reporting frameworks across Europe may influence notified case numbers. Consequently, reported outbreaks do not necessarily reflect proportional differences in transmission intensity.
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Publication Date: 2026-03-10 PubMed ID: 41901751PubMed Central: PMC13028643DOI: 10.3390/pathogens15030298Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This narrative review synthesizes what is known about how West Nile virus spreads in Europe, the mosquitoes and animals involved, the environmental conditions that raise risk, and how surveillance—especially in horses—can guide public health action. It emphasizes that differences in national surveillance and diagnostics can distort apparent patterns, and argues for better One Health integration to improve early warning and response.

What the review set out to do and why it matters

  • Summarize current evidence on West Nile virus (WNV) epidemiology, transmission ecology, and surveillance across Europe, with special attention to Romania.
  • Explain how environmental variability, vector adaptation, and host communities interact to shape regional transmission risk.
  • Assess how One Health surveillance—linking human, veterinary, wildlife, entomological, and environmental data—can provide earlier, more reliable risk assessment.
  • Clarify limitations in existing data and methods that make inter-country comparisons challenging and can misrepresent true transmission intensity.

Key epidemiological patterns in Europe

  • Geographic footprint: Recurrent seasonal WNV transmission is established in southern, central, and parts of eastern Europe, with hotspots along major river basins (e.g., Danube, Po), wetlands, and peri-urban/urban interfaces.
  • Seasonality: Human and equine cases typically occur from late summer into early autumn, reflecting cumulative warm-season mosquito abundance and viral amplification in birds.
  • Viral lineages: WNV lineage 2, introduced to Europe in the 2000s, is now widely established and has driven several large outbreaks; lineage 1 also circulates but has been relatively less prominent in recent European epidemics.
  • Outbreak variability: Years with heat anomalies and drought (e.g., 2010, 2018) have coincided with continent-wide surges in human and equine cases, suggesting strong climate sensitivity of transmission.
  • Under-ascertainment: Because most human infections are asymptomatic or mild and diagnostics vary, notified case counts underestimate infections; country-level differences in surveillance intensity further complicate comparisons.
  • Public health relevance: Blood safety measures (e.g., nucleic acid testing triggers) and vector control responses are often activated based on detected human cases, reinforcing the need for earlier environmental and veterinary signals.

Transmission cycle and vector ecology

  • Core cycle: WNV circulates primarily between ornithophilic mosquitoes (notably Culex species) and birds; mammals (including humans and horses) are usually dead-end hosts but serve as epidemiologic indicators.
  • Principal vectors: The Culex pipiens complex (including Cx. pipiens forms and hybrids) is the dominant vector in much of Europe; Cx. modestus and other Culex spp. contribute locally, especially in wetlands and rice-growing areas.
  • Bridge transmission: Hybridization and ecological plasticity in Culex populations increase mammal feeding, facilitating spillover to humans and horses in peri-urban and rural settings.
  • Overwintering: Virus likely persists via overwintering infected adult mosquitoes (diapause) and possibly low-level bird infections; timing of spring emergence and temperature-driven replication affect early-season risk.
  • Host communities: Passerine birds (e.g., corvids) are key amplifying hosts; migratory flyways can introduce or reseed virus, while local resident birds sustain transmission through summer.
  • Vector competence and behavior: Temperature accelerates extrinsic incubation in mosquitoes; urban heat islands and nutrient-rich breeding habitats (e.g., storm drains) can enhance vectorial capacity in cities.

Environmental and anthropogenic drivers of risk

  • Temperature: Warmer conditions shorten viral incubation in mosquitoes and increase biting rates, amplifying transmission intensity.
  • Hydrology and drought: Droughts concentrate birds and mosquitoes around remaining water sources and can elevate organic content in breeding sites, often preceding outbreaks.
  • Rainfall patterns: Early-season rainfall may expand breeding habitats; late-season drought can shift species composition and host–vector contact rates.
  • Land use: Wetlands, rice paddies, irrigated agriculture, and peri-urban green infrastructure create stable breeding habitats for Culex mosquitoes.
  • Urbanization: Urban heat islands and infrastructure (e.g., basements, stormwater systems) favor Cx. pipiens complex, especially anthropophilic forms, increasing spillover risk.
  • Bird ecology: Migration timing, stopover ecology, and local community composition modulate virus introduction and amplification.
  • Climate change: Increasing frequency of heatwaves, altered precipitation regimes, and extended warm seasons are likely to expand the duration and geography of risk.
  • Socio-environmental factors: Water management, vector control capacity, housing quality, and human outdoor activity patterns influence exposure and observed case counts.

Surveillance strategies within a One Health framework

  • Human health surveillance: Case reporting (neuroinvasive disease, fever), laboratory confirmation (PCR, IgM/IgG serology), and blood donor screening provide outcome-based indicators but often lag transmission.
  • Veterinary surveillance: Equine clinical reporting and serology can give earlier signals in rural and peri-urban areas; wildlife mortality (e.g., corvid carcass testing) helps detect transmission foci.
  • Entomological surveillance: Mosquito trapping, species identification, abundance monitoring, and WNV PCR testing in pools yield direct measures of transmission potential but require sustained resourcing.
  • Environmental monitoring: Remote sensing indicators (e.g., land surface temperature, vegetation indices, surface water extent, soil moisture) and hydrological data can predict favorable conditions weeks in advance.
  • Integrated risk assessment: Combining entomological, veterinary, human, and environmental indicators improves early warning and can inform targeted vector control and blood safety policies.
  • Data platforms: Regional systems (e.g., ECDC mapping, Copernicus environmental services, national surveillance dashboards) support cross-border situational awareness but vary in granularity and timeliness.

Equine sentinel surveillance: rationale, strengths, and caveats

  • Why horses: Horses are highly susceptible to clinical WNV, often present with neurologic disease, and live near vector habitats, making them sensitive indicators of local transmission.
  • Sentinel value: Equine seroconversion and case clusters can precede or accompany human cases, offering lead time for public health alerts and vector control escalation.
  • Methods: Approaches include passive clinical reporting from veterinarians, targeted serosurveys (IgM for recent infection; IgG for exposure history), and longitudinal monitoring of sentinel herds.
  • Operational uses: Signals can trigger enhanced mosquito control, risk communication, blood safety interventions, and focused human diagnostic testing.
  • Limitations: Vaccination (where used) complicates serologic interpretation; horse distribution may not represent urban populations; care-seeking and diagnostic access vary.
  • Integration: Best used alongside mosquito infection data, avian surveillance, and environmental indicators to reduce false alarms and improve spatial targeting.

Romanian context highlighted by the review

  • Epidemiological history: Romania has experienced notable WNV activity, including a large urban outbreak in the 1990s and recurrent transmission since the 2010s, with lineage 2 playing a key role.
  • Ecological settings: The Danube Delta, floodplains, irrigated agriculture, and expanding peri-urban zones provide diverse Culex habitats (e.g., Cx. pipiens complex, Cx. modestus).
  • Surveillance landscape: National systems capture human neuroinvasive cases and donor screening signals; veterinary and entomological surveillance are expanding but uneven across regions.
  • Equine evidence: Serosurveys in horses in the Danube corridor and southern Romania have documented exposure, supporting their utility as sentinels in rural and wetland-adjacent areas.
  • Operational needs: Priority areas include standardized diagnostic algorithms, sustained mosquito monitoring, integration of environmental early warning, and clear thresholds for response activation.

Interpreting surveillance data and its limitations

  • Heterogeneity: Case definitions, testing algorithms, and reporting practices differ among countries, affecting comparability of notified cases.
  • Diagnostic capacity: Access to PCR, IgM testing, and confirmatory assays varies, influencing sensitivity and timing of detection.
  • Surveillance intensity: Regions with stronger surveillance may appear to have higher incidence even when true transmission is similar to under-surveilled areas.
  • Biases: Asymptomatic infections and mild cases rarely present for care; wildlife and mosquito surveillance are often spatially clustered around research hubs.
  • Implication: Reported outbreaks should not be interpreted as strictly proportional to transmission intensity without adjusting for surveillance effort and context.

Knowledge gaps and research priorities

  • Quantifying drivers: Disentangle the relative contributions of temperature, hydrology, land use, vector adaptation, and host community structure to transmission risk.
  • Vector ecology: Improve understanding of local vector competence, feeding behavior, overwintering success, and the role of Culex hybrids across eco-climatic zones.
  • Host dynamics: Assess how migratory and resident bird communities modulate amplification, including the timing and routes relevant to Romania and neighboring regions.
  • Early warning metrics: Validate environmental indicators and combine them with entomological/veterinary data to set actionable thresholds with known lead times.
  • Standardization: Harmonize surveillance definitions, laboratory methods, and reporting formats across Europe to enable robust comparisons and modeling.
  • Intervention evaluation: Rigorously assess integrated vector management strategies, communication approaches, and equine vaccination policies for effectiveness and cost-effectiveness.

Implications for policy and preparedness

  • One Health integration: Formalize data sharing among public health, veterinary services, wildlife agencies, and environmental monitoring teams to enable joint risk assessments.
  • Tiered surveillance: Couple routine human case detection with targeted mosquito testing, equine sentinel programs, and environmental monitoring in high-risk areas.
  • Early action triggers: Define clear thresholds (e.g., WNV-positive mosquito pools, equine IgM seroconversions, environmental risk scores) for escalating vector control and blood safety measures.
  • Capacity building: Invest in laboratory diagnostics, entomological field capacity, and standardized training, especially in under-resourced regions.
  • Risk communication: Provide timely, locally tailored guidance on personal protection, animal health, and vector habitat reduction before peak transmission.
  • Cross-border coordination: Align surveillance calendars, data standards, and response protocols across neighboring countries along shared river basins and flyways.

Overall conclusions the review supports

  • WNV transmission in Europe arises from interacting ecological and environmental processes that vary by place and year, making simple comparisons of case counts misleading.
  • Equine sentinel surveillance is a practical, informative component of a broader One Health approach, offering earlier and geographically specific signals of risk.
  • Integrating environmental indicators with vector and host surveillance can shift response from reactive to anticipatory, improving protection of human and animal health.
  • Progress depends on harmonized surveillance, better quantification of drivers, and sustained operational preparedness tailored to local ecologies, including in Romania.

Cite This Article

APA
(2026). West Nile Virus in Europe: Epidemiology, Vector Ecology, Environmental Drivers, and the Role of Equine Sentinel Surveillance in a One Health Framework. Pathogens, 15(3), 298. https://doi.org/10.3390/pathogens15030298

Publication

Pathogens (Basel, Switzerland)
ISSN: 2076-0817
NlmUniqueID: 101596317
Country: Switzerland
Language: English
Volume: 15
Issue: 3
PII: 298

Researcher Affiliations

MeSH Terms

  • Animals
  • West Nile Fever / epidemiology
  • West Nile Fever / veterinary
  • West Nile Fever / transmission
  • West Nile Fever / virology
  • Europe / epidemiology
  • West Nile virus / physiology
  • Horses
  • Humans
  • Sentinel Surveillance / veterinary
  • One Health
  • Mosquito Vectors / virology
  • Disease Outbreaks
  • Horse Diseases / epidemiology
  • Horse Diseases / virology
  • Horse Diseases / transmission

Conflict of Interest Statement

The authors declare no conflicts of interest.

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