Spatiotemporal and Demographic Patterns of West Nile Neuroinvasive Disease in Vojvodina, Serbia, 2012–2025

West Nile neuroinvasive disease (WNND) causes substantial morbidity in endemic regions, yet data on its burden in Serbia remain limited. We conducted a retrospective, population-based study of WNND cases reported in Vojvodina Province, Serbia, from 2012 to 2025. Incidence and mortality trends were analysed by year, residence, age, sex, and week of symptom onset. Multivariable logistic regression was used to identify predictors of fatal outcome. Of 1337 suspected cases, 557 (41.66%) met the WNND case definition (530 confirmed, 27 probable cases) and 98.9% were autochthonous. The mean annual incidence was 2.17/100,000 (95% CI 0.60-3.75), ranging from 0.48/100,000 (2015) to 10.31/100,000 (2018), with additional peaks in 2013 and 2022. Cases clustered predominantly in epidemiological weeks 31-34. The mean mortality was 0.28/100,000 (95% CI 0.02-0.53) and the mean case fatality rate was 12.93% (95% CI 10.14-15.71%). Incidence increased with age, peaking at 5.97/100,000 in those 70-79 years; highest mortality occurred in ≥80 years (1.78/100,000). All districts reported cases, with the highest incidence and mortality in South Banat. Higher Charlson Comorbidity Index, cardiovascular disease, diabetes and malignancy independently predicted fatal outcome. WNND remains a significant public health problem in Vojvodina, requiring improved surveillance, targeted prevention, and early treatment of high-risk patients.