# Gaps Between Awareness and Prevention of West Nile Virus Among Horse Owners in an Endemic Country: A Cross-Sectional Study from Romania

## TL;DR

A survey of Romanian horse owners shows limited knowledge about West Nile virus transmission and prevention, highlighting a need for better education and veterinary communication.

## Contribution

This study identifies gaps in knowledge and preventive practices among horse owners in a WNV-endemic region and emphasizes the need for targeted education and veterinary guidance.

## Key findings

- Only 49.8% of horse owners correctly identified mosquitoes as the main transmission route for West Nile virus.
- Just 4.0% of respondents reported vaccinating their horses against West Nile virus despite its availability.
- Environmental mosquito control measures like removing standing water were rarely implemented by horse owners.

## Abstract

West Nile virus is spread by mosquitoes and can cause severe neurological disease in horses. In Romania, the virus has been present for many years, but prevention depends largely on the decisions and daily practices of horse owners, supported by veterinary advice. We conducted an online survey between May and November 2025 among 227 horse owners from different regions of Romania to assess what they know about the virus, how they perceive the risk, and what preventive measures they use. Although many respondents had heard of West Nile virus, fewer correctly identified mosquitoes as the main route of infection, and many could not recognize typical clinical signs in horses. Awareness of an available vaccine was low, and only a small number reported vaccinating their horses. Most prevention actions focused on insecticides in stables and repellents on horses, while environmental measures, such as removing standing water, were less common. Only a minority had discussed the topic with a veterinarian. These results show a clear gap between awareness and effective prevention and support the need for targeted education combined with structured veterinary communication in endemic areas.

West Nile virus (WNV) circulates endemically in Romania, yet prevention of WNV infection in horses largely depends on owner-driven decisions that require accurate risk perception and veterinary guidance. A cross-sectional online survey was carried out between May and November 2025 to evaluate the knowledge, attitudes, and preventive practices (KAP) regarding WNV among 227 horse owners from various Romanian regions. In total, 67.4% of respondents had previously heard of WNV. The main transmission route was correctly identified as mosquito bites by 49.8% of participants, while 32.2% answered “don’t know” or presented misconceptions: horse-to-horse contact (9.3%), tick bites (10.6%) and blood transfusion (0.4%). Recognition of clinical signs was limited, with fever (31.3% of respondents) and gait abnormalities or ataxia (24.7% of respondents) being most frequently mentioned, followed by inappetence (19.4% of respondents), seizures (18.1% of respondents), coughing (8.8% of respondents), and abortions (10.6% of respondents); 47.6% of respondents were unable to identify any specific signs. Awareness of the existence of an equine WNV vaccine was reported by 23.8% of respondents, while only 4.0% indicated that their horses had been vaccinated. The most common preventive measures included the use of insecticides in stables (61.2%) and topical repellents on horses (55.5%), whereas environmental control actions such as removing standing water (14.1%) or avoiding swampy areas (11.9%) were less frequent; 19.4% reported taking no preventive measures. Veterinary communication was limited, with only 17.2% of respondents having received information about WNV from a veterinarian, and 21.6% perceiving a real risk of infection in Romania. Overall, the data show a marked disconnect between awareness and actionable prevention (particularly vaccination and environmental mosquito control), indicating that targeted owner education must be paired with structured veterinary communication to translate knowledge into preventive uptake in endemic settings.