West Nile virus in the Iberian Peninsula: using equine cases to identify high-risk areas for humans

Background: West Nile virus (WNV) is a flavivirus with an enzootic cycle between birds and mosquitoes; humans and horses are incidental dead-end hosts. In 2020, the largest outbreak of West Nile virus infection in the Iberian Peninsula occurred, with 141 clusters in horses and 77 human cases. Aim: We analysed which drivers influence spillover from the cycle to humans and equines and identified areas at risk for WNV trans-mission. Methods: Based on data on WNV cases in horses and humans in 2020 in Portugal and Spain, we developed logistic regression models using environ-mental and anthropic variables to highlight risk areas. Models were adapted to a high-resolution risk map. Results: Cases of WNV in horses could be used as indicators of viral activity and thus predict cases in humans. The risk map of horses was able to define high-risk areas for previous cases in humans and equines in Portugal and Spain, as well as predict human and horse cases in the transmission seasons of 2021 and 2022. We found that the spatial patterns of the favourable areas for outbreaks correspond to the main hydrographic basins of the Iberian Peninsula, jointly affecting Portugal and Spain. Conclusion: A risk map highlighting the risk areas for potential future cases could be cost-effective as a means of promoting preventive measures to decrease incidence of WNV infection in Europe, based on a One Health surveillance approach.