1691. An outbreak of P. vivax Malaria in the Evrotas area, Greece, 2011
Session: Poster Abstract Session: Travel Medicine, Malaria, and other Parasitic Infections
Saturday, October 20, 2012
Room: SDCC Poster Hall F-H
  • IDSA2012malaria.pdf (1.1 MB)
  • Background: Greece was declared malaria free by the World Health Organisation in 1974. In 2009 a cluster of eight cases of P. vivax was reported from the small (20km2) agricultural area of the Evrotas delta, Lakonia, Southern Greece, where a large number of migrant workers from malaria endemic countries reside. In summer 2011 a cluster of malaria cases was reported from the same area. Field investigation was initiated in order to identify new cases and to determine the potential source of infection.

    Methods: Malaria is a notifiable disease. All malaria cases are interviewed using a structured questionnaire, gathering information on potential modes of transmission and other clinical and epidemiological data including detailed travel history. Active case finding (periodic house to house visits) was conducted in the Evrotas region aiming to the early detection of new cases via screening of febrile cases. Diagnosis was performed by microscopy; all positive samples were confirmed by PCR. Entomological surveys were conducted in the areas, where human cases were reported.

    Results: Overall, 57 malaria cases with P. vivax infection were identified in Evrotas in 2012; 27 in Greek citizens without travel history to an endemic country; 30 in seasonal migrant farm workers (23 from malaria endemic countries). Disease onset ranged from 23/05/2011 to 18/10/2011 with a peak (13 cases) during the first two weeks of September. One death occurred in an elderly patient with comorbidities. All other cases were mild. The most likely implicated mosquito vector was Anopheles sacharovi. Six more autochthonous cases with no epidemiological link to the Evrotas cases were reported in Greeks citizens from distant geographical areas.  Migrant agricultural workers from malaria endemic countries resided in all the affected areas


    Local transmission of P. vivax may have occurred in 2011 in a de-limited geographical area in Greece. Control measures included increasing awareness of health professionals, active case-finding and treatment and intensified vector control. Research on the behaviour of the implicated mosquito vector is needed to better understand the transmission dynamics and allow further targeted control measures.

    Kostas Danis, MD1, Agoritsa Baka, MD2, Sotorios Tsiodras, MD, PhD, Assistant Professor3, Maria Tseroni, RN, MSc4, Marios Detsis, MD1, Danai Pervanidou, MD1, Irene Terzaki, RN1, Evangelia Papanikolaou, RN1, Georgios Dougas, DVM5, Sandra Gewehr6, Chrisovalando Kefaloudi, MSc7, Asimina Balaska, MD, MSc7, Nikolaos Vakalis, MD8, Stefanos Bonovas, MD2 and Jenny Kremastinou, MD, PhD7, (1)Epidemiology and Intervention, Hellenic Centre for Disease Control and Prevention, Marousi, Greece, (2)Hellenic Ctr for Disease Control & Prevention (HCDCP), Marousi, Greece, (3)4th Dept. of Internal Med., Attikon Univ.Gen.Hosp., Athens, Greece, Athens, Greece, (4)Hellenic Center for Disease Control and Prevention, Marousi, Greece, (5)Epidemiology and Intervention, Hellenic Ctr for Disease Control & Prevention (HCDCP), Marousi, Greece, (6)Ecodevelopment, SA, Thessaloniki, Greece, (7)Hellenic Centre for Disease Control and Prevention, Marousi, Greece, (8)National School of Public Health, Athens, Greece


    K. Danis, None

    A. Baka, None

    S. Tsiodras, None

    M. Tseroni, None

    M. Detsis, None

    D. Pervanidou, None

    I. Terzaki, None

    E. Papanikolaou, None

    G. Dougas, None

    S. Gewehr, None

    C. Kefaloudi, None

    A. Balaska, None

    N. Vakalis, None

    S. Bonovas, None

    J. Kremastinou, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 17th with the exception of research findings presented at the IDWeek press conferences.