West Nile virus in Greece: One Health surveillance for early warning

West Nile virus (WNV) has emerged as a significant public health threat in Greece since 2010. Central Macedonia was the epicentre of the 2010 and 2022 outbreaks, whereas Attica, Eastern Macedonia and Thrace, and Thessaly predominated in other seasons. Climate change and environmental factors are amplifying transmission dynamics, necessitating integrated surveillance approaches. This narrative review synthesizes current evidence on the epidemiology of WNV in Greece, examines the role of climate change in transmission dynamics, and evaluates the implementation of One Health surveillance and early warning systems. It draws on the peer-reviewed literature, official surveillance reports of the National Public Health Organization (EODY) and European surveillance data for 2010–2025. Since 2010, WNV has become seasonally endemic in Greece, with 2184 locally acquired cases, 1547 cases of neuroinvasive disease and 301 deaths recorded during 2010–2025, including major seasons in 2010 (262 cases), 2018 (317), 2022 (286) and 2024 (220). Climate variability, particularly elevated temperatures and altered precipitation patterns, significantly influences Culex vector dynamics and virus transmission. Current surveillance integrates human, animal, avian and entomological monitoring but faces challenges in data harmonization, real-time integration and resource allocation, and public health action is still triggered mainly by human cases. We propose an operational One Health architecture that fuses multimodal data streams in near-real time, applies statistical and artificial intelligence (AI)-based signal detection and probabilistic forecasting, and links predefined alert levels to automated escalation and coordinated surge response. Together with strengthened interdisciplinary collaboration, capacity-building and sustained political commitment, such a system could shift WNV control in Greece from reactive to anticipatory and serve as a model for the Mediterranean region.