19 research outputs found
The importance of an active case detection (Acd) programme for malaria among migrants from malaria endemic countries: The greek experience in a receptive and vulnerable area
Greecehasbeenmalaria-freesince1974. InOctober2011,followinganoutbreakof36locally acquired malaria (LAM) cases in Evrotas Municipality, a Pro-Active Case Detection (PACD) program for malaria was implemented among migrants from malaria-endemic countries, to support early diagnosis and treatment of cases. We evaluated the PACD program for the years 2012–2017 using indicatorssuchasthenumberoflocallyacquiredcases,thedetectionrate/sensitivityandthetimeliness of diagnosis and treatment. We visited each migrant home every 7–15 days to screen migrants for malaria symptoms, performing Rapid Diagnostic Tests (RDTs) and blood smears on symptomatic patients. We estimated: (i) the number of malaria cases detected by the PACD, divided by the total number of reported malaria cases during the same period among the same population; (ii) the time betweenonsetofsymptoms,diagnosisandinitiationoftreatment. Thetotalnumberofmigrantswho were screened for malaria symptoms for the years 2012–2017 was 5057 with 84,169 fever screenings conducted, while 2288 RDTs and 1736 blood smears were performed. During the same period, 53 imported P. vivax malaria cases were detected, while incidence of malaria among migrants was estimated at 1.8% annually. Ten and one LAM cases were also reportedin 2012 and 2015, respectively. Sensitivity of PACD ranged from 86% to 100%; median timeliness between onset of symptoms and diagnosis decreased from 72 h in 2012 to 12 h in 2017 (83% decrease), while timeliness betweendiagnosis and treatment initiation was 0 h. The implementation of PACD could be considered an effective prevention and response tool against malaria re-introduction
Entomological Data and Detection of West Nile Virus in Mosquitoes in Greece (2014-2016), Before Disease Re-Emergence in 2017
West Nile virus (WNV) cases were seasonally recorded in humans and
animals in Greece, from 2010 to 2014, and circulation of the virus was
detected in different Regional Units of the country. Small scale
entomological surveillance activities were carried out by several
regions and regional units in Greece, during 2014-2016, with the
participation of subcontractors for the vector control programs aiming
to record presence/absence of mosquito species, and monitor and control
mosquito populations. Mosquito traps were placed in rural and urban
sites; specimens were collected, morphologically characterized, and
pooled by date of collection, location, and species types. Mosquito
pools containing Culex pipiens, Aedes caspius, and Aedes albopictus were
examined for the presence of WNV and positive pools were detected in
different areas of the country. Sequencing of a selected number of
amplicons revealed WNV lineage 2 partial NS5 gene sequences. In this
study, we present data on the mosquito species composition in the areas
of study and WNV detection from several parts of Greece, in 6, 11, and
26 mosquito pools corresponding to the years 2014, 2015, and 2016,
respectively. A total of 15 WNV human infections were reported to the
public health authorities of the country in 2014, whereas no human cases
were detected for 2015-2016. Taking into consideration the complex
epidemiological profile of WNV and unforeseen changes in its
circulation, re-emergence of WNV human cases in Greece was possible and
expected, thus rendering surveillance activities imperative
Entomological Surveillance Activities in Regions in Greece: Data on Mosquito Species Abundance and West Nile Virus Detection in <i>Culex pipiens</i> Pools (2019–2020)
Human cases of West Nile virus (WNV) infections have been recorded in Greece since 2010, with seasonal outbreaks (summer-autumn) on an almost annual basis, caused mainly by the WNV lineage 2 strain (Nea Santa-Greece-2010). National Public Health Organization (NPHO) in Greece is annually implementing enhanced surveillance of human WNV infection, in order to promptly identify human cases of WNV infection and monitor distribution in terms of time and place. Entomological surveillance activities were carried out on a national basis in 2019 and 2020, under NPHO coordination and the collaboration of several private subcontractors, along with the Unit of Medical Entomology, Laboratory for Surveillance of Infectious Diseases (LSID). The aim was to monitor mosquito species composition, abundance, and WNV circulation in mosquito pools of Culex pipiens s.l. species. Adult mosquito traps were placed in selected sites; collected samples were morphologically characterized and pooled by date of collection, location, and species types. Female Culex pipiens s.l. pools were tested for WNV and WNV infection rates (MIR and MLE) were estimated. Highest mean number of female Culex pipiens s.l. species was recorded in Central Macedonia both for 2019 and 2020. Six hundred and fifty-nine mosquito pools (147 in 2019 and 512 in 2020) of female Culex pipiens s.l. were examined for WNV presence. The highest MLE was detected in Western Macedonia in 2019 and in Thessaly in 2020. Here, we present data on the mosquito species composition in the studied areas and WNV detection in mosquitoes from areas in Greece where the specific national mosquito surveillance program was implemented, for two years, 2019 and 2020
Records of Aedes albopictus (Skuse, 1894) (Diptera; Culicidae) and Culex tritaeniorhynchus (Diptera; Culicidae) Expansion in Areas in Mainland Greece and Islands
Annual entomological surveillance programs aiming to monitor mosquito
populations and record presence and absence of mosquito species have
been performed in Greece. We report, in this study, new records and
expansion of Aedes albopictus in the islands of Lesvos (region of North
Aegean), Crete (region of Crete), and the regional units of Rodopi in
East Macedonia-Thrace. Furthermore, Culex tritaeniorhynchus was recorded
for the first time in Arta (region of Epirus) in northwestern Greece
Genetic Spatiotemporal Anatomy of Plasmodium vivax Malaria Episodes in Greece, 2009–2013
An influx of immigrants is contributing to the reemergence of Plasmodium vivax malaria in Greece; 1 persistent focus of transmission is in Laconia, Pelopónnese. We genotyped archived blood samples from a substantial proportion of malaria cases recorded in Greece in 2009–2013 using 8 microsatellite markers and a PvMSP-3α gene fragment and plotted their spatiotemporal distribution. High parasite genetic diversity with low multiplicity of infection was observed. A subset of genetically identical/related parasites was restricted to 3 areas in migrants and Greek residents, with some persisting over 2 consecutive transmission periods. We identified 2 hitherto unsuspected additional foci of local transmission: Kardhítsa and Attica. Furthermore, this analysis indicates that several cases in migrants initially classified as imported malaria were actually locally acquired. This study shows the potential for P. vivax to reestablish transmission and counsels public health authorities about the need for vigilance to achieve or maintain sustainable malaria elimination
West Nile Virus Circulation in Mosquitoes in Greece (2010-2013)
Background of the Study. Following a large West Nile virus (WNV)
epidemic in Northern Greece in 2010, an active mosquito surveillance
system was implemented, for a 3-year period (2011, 2012, and 2013).
Description of the Study Site and Methodology. Using mainly CO2 mosquito
traps, mosquito collections were performed. Samples were pooled by date
of collection, location, and species and examined for the presence of
WNV. Results. Positive pools were detected in different areas of the
country. In 2010, MIR and MLE values of 1.92 (95% CI: 0.00-4.57) and
2.30 (95% CI: 0.38-7.49) were calculated for the Serres Regional Unit
in Central Macedonia Region. In 2011, the highest MIR value of 3.71(95%
CI: 1.52-5.91) was recorded in the Regions of Central Greece and
Thessaly. In 2012, MIR and MLE values for the whole country were 2.03
(95% CI: 1.73-2.33) and 2.15 (95% CI: 1.86-2.48), respectively, for
Cx. pipiens. In 2013, in the Regional Unit of Attica, the one outbreak
epicenter, MIR and MLE values for Cx. pipiens were 10.75 (95% CI:
7.52-13.99) and 15.76 (95% CI: 11.66-20.65), respectively. Significance
of Results/Conclusions. The contribution of a mosquito-based
surveillance system targeting WNV transmission is highlighted through
the obtained data, as in most regions positive mosquito pools were
detected prior to the date of symptom onset of human cases.
Dissemination of the results on time to Public Health Authorities
resulted in planning and application of public health interventions in
local level
Genetic Spatiotemporal Anatomy of Plasmodium vivax Malaria Episodes in Greece, 2009-2013
An influx of immigrants is contributing to the reemergence of Plasmodium
vivax malaria in Greece; 1 persistent focus of transmission is in
Laconia, Peloponnese. We genotyped archived blood samples from a
substantial proportion of malaria cases recorded in Greece in 2009-2013
using 8 microsatellite markers and a PvMSP-3 alpha gene fragment and
plotted their spatiotemporal distribution. High parasite genetic
diversity with low multiplicity of infection was observed. A subset of
genetically identical/related parasites was restricted to 3 areas in
migrants and Greek residents, with some persisting over 2 consecutive
transmission periods. We identified 2 hitherto unsuspected additional
foci of local transmission: Kardhitsa and Attica. Furthermore, this
analysis indicates that several cases in migrants initially classified
as imported malaria were actually locally acquired. This study shows the
potential for P. vivax to reestablish transmission and counsels public
health authorities about the need for vigilance to achieve or maintain
sustainable malaria elimination
Field Application of SD Bioline Malaria Ag Pf/ Pan Rapid Diagnostic Test for Malaria in Greece Field Application of SD Bioline Malaria Ag Pf/ Pan Rapid Diagnostic Test for Malaria in Greece
Abstract Greece, a malaria-free country since 1974, has experienced re-emergence of Plasmodium vivax autochthonous malaria cases in some agriculture areas over the last three years. In early 2012, an integrated control programme (MALWEST Project) was launched in order to prevent re-establishment of the disease. In the context of this project, the rapid diagnostic tests (RDT) of SD Bioline Malaria Ag Pf/Pan that detects hrp-2 and pan-LDH antigens were used. The aim of this study was to assess the field application of the RDT for the P. vivax diagnosis in comparison to light microscopy and polymerase chain reaction (PCR). A total of 955 samples were tested with all three diagnostic tools. Agreement of RDT against microscopy and PCR for the diagnosis of P. vivax was satisfactory (K value: 0.849 and 0.976, respectively). The sensitivity, specificity and positive predictive value of RDT against PCR was 95.6% (95% C.I.: 84.8-99.3), 100% (95% C.I.: 99.6-100.0) and 100% (95% CI: 91.7-100.0) respectively, while the sensitivity, specificity and positive predictive value of RDT against microscopic examination was 97.4% (95% C.I.: 86.1-99.6), 99.4% (95% C.I.: 98.6-99.8) and 86.1% (95% CI: 72.1-94.7), respectively. Our results indicate that RDT performed satisfactory in a non-endemic country and therefore is recommended for malaria diagnosis, especially in areas where health professionals lack experience on light microscopy
Imported Chikungunya fever case in Greece in June 2014 and public health response
We report about the first imported case of Chikungunya fever in Greece
in a Greek traveler returning from the Dominican Republic and the
associated public health response. We investigated the case and
performed focused epidemiological and entomological investigation in all
areas the patient visited during the infectious period, to identify the
targeted interventions needed. Entomological investigation revealed the
occurrence of the competent vector Aedes albopictus (Diptera: Culicidae)
in the environment surrounding the hospital where the patient was
admitted and in her workplace. All captured mosquitoes tested negative
for Chikungunya virus. We further conducted clinical and laboratory
examination of the patient's co-travelers, gave advice on appropriate
personal preventive measures against mosquito bites to the patient and
co-travelers and on vector control, and raised awareness among health
professionals throughout Greece. The risk of introduction and local
transmission of Chikungunya and other arboviruses in Greece and other
European countries is present, as the competent vector exists in many
parts of Europe. Public health professionals, travel medicine
specialists and clinicians should maintain awareness regarding this
possibility of importation of arbovirus cases in order to provide the
appropriate advice, seek the prompt diagnosis, and implement appropriate
interventions. Mobilization of various stakeholders will lead to
enhanced epidemiological and entomological surveillance that will allow
for improved risk assessment in each area