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Published Date: 2011-10-31 17:42:39
Subject: PRO/EDR> Malaria, P. vivax - Greece (08): autochthonous, comments
Archive Number: 20111031.3236

MALARIA, P. VIVAX - GREECE (08): AUTOCHTHONOUS, COMMENTS
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Comments on _P. vivax_ malaria in Greece
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[1]
Date: Mon 31 Oct 2011
From: Tony Ellam <tonypj@meadlane.freeserve.co.uk> [edited]

The posting Malaria, P. vivax - Greece (07) autochthonous
20111030.3226 misinterprets the data contained in the original
article, and in doing so understates the potential risk of ongoing
transmission to local residents and tourists. The ProMED post states:

"Of the 20 cases reported, 16 came from malaria endemic countries in
Southeast Asia and are most probably infected before arriving in
Greece. The 4 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."

This is not so, however. There were in fact a total of 36 cases
reported from this region. While 16 were in migrant workers from
endemic countries, and as ProMED correctly notes, may well have been
infected in their country of origin -- mainly Pakistan -- there were
20 other cases reported which were NOT in migrant workers.

"As of 27 Sep 2011, 20 malaria cases were reported in Greece,
affecting Greek citizens who did not have any reported history of
travel to a country endemic for malaria."

The ProMED report thus implies there were only 4 people infected in
Greece, an incorrect statement which significantly underplays the real
risk, which is represented by a total of 20 infections.

--
Dr Tony Ellam
Consultant in Communicable Disease Control (retired)
London

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[2]
Date: Mon 31 Oct 2011
From: Denis Coulombier <denis.coulombier@ecdc.europa.eu> [edited]

Regarding ProMED-mail post Malaria, P. vivax - Greece (07)
autochthonous 20111030.3226, ECDC has updated on 28 Oct 2011 its
epidemiological assessment. It can be found at
http://ecdc.europa.eu/en/press/news/Lists/News/ECDC_DispForm.aspx?List=32e43ee8%2De230%2D4424%2Da783%2D85742124029a&ID=511.

On the basis of this assessment, ECDC is currently "not recommending
chemoprophylaxis for malaria for visitors to the area. The use of
standard mosquito biting prevention measures continues to be
encouraged."

--
Denis Coulombier
Head of Unit for Surveillance and Response Support
European Centre for Disease Prevention and Control (ECDC)
Tomtebodavagen 11A
171 83 Stockholm, Sweden
<denis.coulombier@ecdc.europa.eu>
http://www.ecdc.europa.eu

[ProMED-mail thanks Dr Tony Ellam and Dr Denis Coulombier for their
comments. We agree that the report in Eurosurveillance reported 36
cases of which 20 had never travelled outside Greece, and we apologize
(http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19993).
The Eurosurveillance report concludes:

Up to 27 Sep 2011, the HCDCP (Hellenic Centre for Disease Control and
Prevention) has received reports of 20 cases of _Plasmodium vivax_
infection in Greek citizens who did not report travel to an endemic
country. The majority of those cases (n=14) reside in the agricultural
area of Evrotas, Lakonia district (Table, Figure 1; available at the
URL above). The remaining 6 Greek cases were reported from 4 other
prefectures, namely Eastern Attiki (n=2), Evia (n=2), Viotia (n=1),
and Larissa (n=1). From the area of Evrotas were further reported 16
cases of _P. vivax_ infection in migrant workers from endemic
countries (mainly from Pakistan) for whom no clear malaria importation
status can be determined. In addition, 2 Romanian workers who had been
working and living in the area of Evrotas developed symptoms in July
2011 and were diagnosed with _P. vivax_ infection upon their return to
Romania. These 2 cases are not included in further analysis because
not all the epidemiological information is available. All 36 cases
have been confirmed as _P. vivax_ infections, by both microscopy and
PCR at the MRL (National Malaria Reference Laboratory). None of the
cases had a history of recent blood transfusion or tissue/organ
transplantation.

A HealthMap/ProMED-mail interactive map of Greece can be seen at
http://healthmap.org/r/1nLG. - Mod.EP]

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