West Nile virus (WNV) has historically been considered among the least virulent members of the Japanese serogroup complex (family Flaviviridae, genus Flavivirus). The WNV natural cycle involves birds as the main amplifying hosts and several species of mosquito as vectors. Many outbreaks occurred during the past decade, causing severe human encephalitis in the Old World, and the virus has become established in many European countries. Emergence of WNV is difficult to predict and even more difficult to prevent. In this review, the latest information on the epidemiology, transmission dynamics and clinical aspects of WNV is presented, with particular focus on specific factors likely to trigger changes in the distribution of the disease in Europe, such as climate changes and their consequences on the potential vectors of WNV or bird migration routes. The control of some anthropogenic and environmental factors could help prevent extension and re-emergence of WNV epidemics.