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Published Date: 2011-10-30 16:21:49
Subject: PRO/EDR> Malaria, P. vivax - Greece (07) autochthonous
Archive Number: 20111030.3226

MALARIA, P. VIVAX - GREECE (07): AUTOCHTHONOUS
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Date: Mon 26 Oct 2011
Source: CDC [edited]
http://www.cdc.gov/malaria/malariagreece.htm

New Malaria Recommendations for Greece
--------------------------------------
Malaria prophylaxis is now indicated for Lakonia region of Greece. A
travel notice titled "New Malaria Recommendations for Greece" has been
added to the site. New recommendations for Greece are also reflected
in the Yellow Book's country-specific malaria information and the
Greece destination page.

The Centers for Disease Control and Prevention (CDC) has received
updated information on malaria cases in Greece. According to a recent
publication by Greek health authorities [K Danis, A Baka, A Lenglet, W
Van Bortel, et al. Autochthonous Plasmodium vivax malaria in Greece,
2011. Eurosurveillance. 2011 Oct 20, 16(42)], since 27 Sep 2011, a
total of 20 malaria cases have been reported in persons with no
history of travel to a malaria-endemic area. An additional 16 cases
have been identified in persons from malaria endemic countries in whom
importation versus local transmission of malaria could not be
determined. All cases were confirmed to be _P. vivax_. The majority
(20 cases) occurred in the southern region of the country,
specifically in the Laconia district in the south. Other cases
occurred in the Evia/Euboea (island east of the Central Greece
region), Eastern Attiki, Voitia, and Larissa districts (see map on:
http://www.cdc.gov/malaria/malariagreece.htm).

The Hellenic CDC of Greece continues to work with the European CDC and
has responded by enhancing its surveillance system and intensifying
mosquito control in affected areas, raising awareness among health
care providers and hospitals about early malaria diagnosis and
treatment, and educating the public about prevention of mosquito
bites.

Because of the ongoing evidence of malaria transmission in Laconia
district, CDC is recommending that travelers to Laconia district in
Greece take anti-malarial medicines to prevent malaria. Recommended
antimalarials include one of the following: atovaquone-proguanil
(Malarone TM), chloroquine, doxycycline, mefloquine, or primaquine.
Note that primaquine is contraindicated in people with
glucose-6-phosphate dehydrogenase (G6PD) deficiency. If primaquine is
chosen, the traveler must be screened for G6PD deficiency prior to
use.

For the districts of Evia/Euboea, Eastern Attiki, Voitia, and Larissa,
anti-malarials are not recommended at this time because there have
only been a limited number of cases.

Measures to prevent mosquito bites should also be taken for all of
these districts with malaria. These measures include using insect
repellent when outdoors, and staying in an air-conditioned or
well-screened area, or sleeping under an insecticide treated bed net
during the peak biting period for mosquitoes (dusk and dawn).

This notice will be updated as new information becomes available.

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[The situation in Greece has been thoroughly investigated and the data
presented in Eurosurveillance edition 2011; 16(42)
(http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19993).

When recommending malaria prophylaxis to a given area the risk of
infection should be balanced to the risk of serious side effects from
the drugs used for malaria prophylaxis.

Laconia region is in the Southern part of the Peleponnes peninsula and
a popular tourist destination during summer. Of the 20 cases reported,
16 came from malaria endemic countries in Southeast Asia and are most
probably infected before arriving in Greece. The four patients
infected in Greece worked in close relation with the patients
presumably infected outside Greece.
Thus the risk of infection at present seems very limited to tourist in
the area.

The CDC recommended "antimalarials include one of the following:
atovaquone-proguanil (Malarone TM), chloroquine, doxycycline,
mefloquine, or primaquine. Note that primaquine is contraindicated in
people with glucose-6-phosphate dehydrogenase (G6PD) deficiency. If
primaquine is chosen, the traveler must be screened for G6PD
deficiency prior to use."

HealthMap location: http://healthmap.org/r/1nLG. - Mod.EP]

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