West Nile virus (WNV) primarily infects birds and mosquitoes but has also caused over 2,000 human deaths, and >50,000 reported human cases in the United States. Expected numbers of WNV neuroinvasive cases for the present were described for the Northeastern United States, using a negative binomial model. Changes in temperature‐based suitability for WNV due to climate change were examined for the next decade using a temperature‐trait model. WNV suitability was generally expected to increase over the next decade due to changes in temperature, but the changes in suitability were generally small. Many, but not all, populous counties in the northeast are already near peak suitability. Several years in a row of low case numbers is consistent with a negative binomial, and should not be interpreted as a change in disease dynamics. Public health budgets need to be prepared for the expected infrequent years with higher‐than‐average cases. Low‐population counties that have not yet had a case are expected to have similar probabilities of having a new case as nearby low‐population counties with cases, as these absences are consistent with a single statistical distribution and random chance.