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ECDC: Local Malaria Acquisition In Greece

 

 

 

# 5775

 

 

While malaria was once common across much of Europe, by the middle of the last century better mosquito control measures had nearly eliminated the scourge from almost all of Europe.

 

In recent years most reported cases have been imported by travelers returning from regions where the parasite is endemic, or in a few cases were the result of what is termed `airport malaria’.

 

Airport Malaria (see report `Airport malaria' -- cause for concern in the US) occurs when an infected mosquito is transported aboard an airliner from a malaria-endemic country and it survives long enough to seek blood meals from and transmit the disease to ,those in or around an airport.

 

There remain a few European countries where malaria remains endemic, and the World Health Organization  hopes to eliminate the disease by the 2015.

 

 

Elimination from the WHO European Region by 2015

The WHO European Region aims to interrupt the transmission of malaria and eliminate the disease from the remaining 5 countries affected by malaria by 2015: Azerbaijan, Kyrgyzstan, Tajikistan, Turkey, and Uzbekistan. The number of reported cases has dropped dramatically, from 90 712 in 1995 to only 176 in 2010.

 

Eliminating malaria from the Region by 2015 is a realistic and attainable goal. Turkmenistan attained malaria-free status in 2010, and Armenia is expected to follow in 2011.

 

But every once in awhile, a few cases of malaria show up in areas where the disease has been declared eradicated, as is the case this summer in Greece.

 

While not considered to be an area at high risk, earlier this week the CDC issued a travel announcement regarding a few cases of autochthonous P. Vivax malaria transmission that have been reported over the past couple of months.

 

Announcement Malaria Cases: Greece

The Centers for Disease Control and Prevention (CDC) has received a report, from the GeoSentinel Surveillance system of a confirmed case of Plasmodium vivax malaria in a person who traveled to Elos and Skala in southern Greece around the last week of July.  The traveler had no history of travel to any malaria-endemic areas.

 

Greece has been malaria free since 1974; however according to Greek health authorities, since June 2011, a total of 6 malaria cases have been reported in persons with no history of travel to a malaria-endemic area.  All cases were confirmed to be P. vivax and occurred in the southern region (Peloponnesus) of the country, specifically in Laconia and Evoia districts.

 

The Hellenic CDC of Greece 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 malaria risk in Greece is limited, and the country has implemented control measures, at this time CDC is not recommending that travelers to Greece take an antimalarial drug.  However, measures to prevent mosquito bites should be taken, such as 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.

 

 

Today, the ECDC issued a four-page risk assessment on these cases, and concurs that the risk is relatively low, and pretty much confined to Evrotas in the district of Lakonia (and potentially Chalkida in Evoia).

 

 

Technical reports - 23 Aug 2011

Rapid Risk Assessment Malaria Greece

Available as PDF 

ABSTRACT

Greece reports six cases of Plasmodium vivax infection in Evrotas, Lakonia, Peloponnese region, and Chalkida in Evoia since June 2011. The main risk related to the current event is to persons living in, visiting and working in the particular area of Evrotas in the district of Lakonia (and potentially Chalkida in Evoia, though more information is needed) in Greece. The local transmission of P. vivax malaria to humans is believed to have occurred here over the last three years and is likely to continue producing annual clusters of human cases. However, the risk for further extension of malaria transmission into the EU related to this event is considered low at present.

 

 

In recent years we’ve also seen a few scattered cases of locally acquired malaria in places like Germany, France, and Spain.

 

Given the repeated introductions of the malaria parasite into Europe via international travel, and the availability of reasonably competent vectors across the region, rare local transmission is not completely unexpected.

 

And it isn’t just malaria.

 

Dengue, West Nile Virus, Chikungunya, and yellow fever all have the potential for limited spread in Europe.

 

You may recall, in 2007 we saw an outbreak of Chikungunya in Northern Italy.

 

I told the story in It's A Smaller World After All, but the crux of the story was a traveler, returning from India, brought the virus back to Italy which led to more than 290 cases being reported in the province of Ravenna, which is in northeast Italy.

 

In March of 2010 the journal Eurosurveillance carried a series of articles on vector borne diseases and their potential to impact those living in Europe. One of the articles, Yellow fever and dengue: a threat to Europe? by P. Reiter, had this to say about the future of vector-borne illnesses in Europe.

 

The history of dengue and yellow fever in Europe is evidence that conditions are already suitable for transmission. The establishment of Ae. albopictus has made this possible, and the possibility will increase as the species expands northwards, or if Ae. aegypti is re-established.

 

The epidemic of chikungunya in northern Italy in 2007 [8,49] confirms that Ae. albopictus is capable of supporting epidemic transmission, although laboratory studies indicate that the strain of virus involved was particularly adapted to this species [50,51].

 

Nevertheless, it is not unreasonable to assume that climatic conditions that permit malaria transmission will also support transmission of yellow fever and dengue, in which case transmission could extend into northern Europe [52].

As these tropical viruses and parasites are continually being introduced back into the EU (along with the United States, and many other countries) by way of international travel, that increases the chances that one could someday become established in a new territory.

 

Reason enough to take basic precautions against mosquitoes, no matter where you are in the world.

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