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In 2010, the first outbreak of West Nile virus (WNV) infection in Greece was recorded, the largest in Europe since 1996. After 2010, outbreaks continued to occur in different areas of the country. Enhanced surveillance was implemented during transmission periods (June to October). We investigated the 2012 outbreak to determine its extent and identify risk factors for severe disease using regression models. Of 161 cases recorded in 2012, 109 had neuroinvasive disease (WNND). Two outbreak epicentres were identified: the southern suburbs of Athens in July and a rural area in East Macedonia T 95% CI: 2.2-22) and chronic renal failure (adjusted RR: 4.5; 95% CI: 2.7-7.5) were independently associated with WNND-related death. In three PCR-positive samples, sequencing revealed WNV lineage 2 identical to the 2010 strain. The occurrence of human cases in three consecutive years suggests that WNV lineage 2 has become established in Greece. Raising awareness among physicians and susceptible populations (elderly people and persons with co-morbidities) throughout Greece is critical to reduce the disease impact. .

West Nile virus outbreak in humans, Greece, 2012: third consecutive year of local transmission