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Humans, as dead-end hosts of the virus, may suffer West Nile Fever (WNF), which sometimes leads to death. In Europe, the first large-scale epidemic of WNF occurred in 1996 in Romania. Since then, human cases have increased in the continent, where the highest number of cases occurred in 2018. Using the location of WNF cases in 2017 and favorability models, we developed two risk models, one environmental and the other spatio-environmental, and tested their capacity to predict in 2018: 1) the location of WNF; 2) the intensity of the outbreaks (i.e. the number of confirmed human cases); and 3) the imminence of the cases (i.e. the Julian week in which the first case occurred). We found that climatic variables (the maximum temperature of the warmest month and the annual temperature range), human-related variables (rain-fed agriculture, the density of poultry and horses), and topo-hydrographic variables (the presence of rivers and altitude) were the best environmental predictors of WNF outbreaks in Europe. The spatio-environmental model was the most useful in predicting the location of WNF outbreaks, which suggests that a spatial structure, probably related to bird migration routes, has a role in the geographical pattern of WNF in Europe. Both the intensity of cases and their imminence were best predicted using the environmental model, suggesting that these features of the disease are linked to the environmental characteristics of the areas. We highlight the relevance of river basins in the propagation dynamics of the disease, as outbreaks started in the lower parts of the river basins, from where WNF spread towards the upper parts. Therefore, river basins should be considered as operational geographic units for the public health management of the disease.<\/jats:p>","DOI":"10.1371\/journal.pntd.0009022","type":"journal-article","created":{"date-parts":[[2021,1,7]],"date-time":"2021-01-07T19:03:09Z","timestamp":1610046189000},"page":"e0009022","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":59,"title":["Predicting the spatio-temporal spread of West Nile virus in Europe"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2754-9162","authenticated-orcid":true,"given":"Jos\u00e9-Mar\u00eda","family":"Garc\u00eda-Carrasco","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio-Rom\u00e1n","family":"Mu\u00f1oz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jes\u00fas","family":"Olivero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8125-7980","authenticated-orcid":true,"given":"Marina","family":"Segura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raimundo","family":"Real","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,1,7]]},"reference":[{"key":"pntd.0009022.ref001","doi-asserted-by":"crossref","DOI":"10.1155\/2015\/376230","article-title":"The global ecology and epidemiology of West Nile virus","volume":"2015","author":"C Chancey","year":"2015","journal-title":"Biomed Res Int"},{"key":"pntd.0009022.ref002","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1089\/vbz.2007.0266","article-title":"Vector Competence of Some French Culex and Aedes Mosquitoes for West Nile Virus","volume":"8","author":"T Balenghien","year":"2008","journal-title":"Vector-Borne Zoonotic Dis"},{"key":"pntd.0009022.ref003","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1001\/jama.2013.8042","article-title":"West Nile virus: Review of the literature","volume":"310","author":"LR Petersen","year":"2013","journal-title":"JAMA\u2014J Am Med Assoc"},{"key":"pntd.0009022.ref004","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pone.0185962","article-title":"Geographic variations of the bird-borne structural risk of West Nile virus circulation in Europe","volume":"12","author":"B Durand","year":"2017","journal-title":"PLoS One"},{"key":"pntd.0009022.ref005","doi-asserted-by":"crossref","DOI":"10.2807\/1560-7917.ES.2019.24.16.1800349","article-title":"One Health approach for West Nile virus surveillance in the European Union: relevance of equine data for blood safety","volume":"24","author":"JJ Young","year":"2019","journal-title":"Eurosurveillance"},{"key":"pntd.0009022.ref006","doi-asserted-by":"crossref","first-page":"1999","DOI":"10.1016\/S1474-4422(07)70030-3","article-title":"West Nile virus","volume":"6","author":"LD Kramer","year":"2007","journal-title":"Lancet Neurol"},{"key":"pntd.0009022.ref007","doi-asserted-by":"crossref","first-page":"2337","DOI":"10.1080\/21645515.2019.1621149","article-title":"West Nile virus vaccines\u2013current situation and future directions","volume":"15","author":"S. 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