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

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.