Health Professionals

Clinical Updates

2 November 2011

Malaria: Prefectures of Lakonia (Peloponnese) and Evoia (Euboea), Greece – update

This report updates the NaTHNaC Clinical Update Malaria: Prefectures of Lakonia (Peloponnese) and Evoia (Euboea), Greece, 23 August 2011.

Between 21 May and 26 October 2011, 61 cases of Plasmodium vivax malaria have been reported in Greece. Of these, 33 cases (including one death) were in local residents with no history of travel to a malaria endemic country [1, 2]. The majority of the locally acquired cases (27) were reported from Evrotas, a river delta area in Lakonia in Peloponnese, southern Greece. The other six cases were reported from the municipalities of Attiki (2), Evoia (2), Viotia (1) and Larissa (1). 

Twenty-eight of the P. vivax cases occurred in migrants working in the area of Evrotas in Lakonia. The majority of the migrant farm workers originated from malaria endemic countries of Pakistan (19) and Afghanistan (2). Of the remaining seven cases, five were from Romania, one from Morocco and one from Poland, and are assumed to have acquired their infection in Greece [1]. 

This cluster of cases is consistent with local transmission of malaria. Anopheles spp. mosquitoes are indigenous to parts of southern Europe including this area of Greece [3]. The presence of migrant workers from malaria endemic countries and a suitable vector is likely to have led to this outbreak. Sporadic cases of locally acquired malaria have been reported in Greece annually since 2009 [4].

Advice for travellers

The risk of malaria in travellers to these areas of Greece is low and the use of chemoprophylaxis is not recommended [1]. Awareness of risk and insect bite avoidance measures particularly during the evening and night hours are recommended. The number of cases has declined, and mosquito activity has decreased as the weather has become colder [1].

Advice for health professionals – the returned traveller

Health professionals who see febrile travellers from these areas of Greece should be alert to the possibility of malaria [5]. An algorithm for the initial assessment and management of malaria in adults is available.

References

1. European Centre for Disease Prevention and Control. Epidemiological update: Malaria in Greece, October 2011. 28 October 2011. [Accessed 2 November 2011]. Available at:

http://ecdc.europa.eu/en/press/news/Lists/News/ECDC_Disp

Form.aspx?List=32e43ee8-e230-4424-a783-85742124029a&ID=511&RootFolder=%2Fen%2Fpress%2

Fnews%2FLists%2FNews

2. Danis K, Baka A, Lenglet A et al. Autochthonous Plasmodium vivax malaria in Greece, 2011. Eurosurveillance;2011; 20 October; 16(42). [Accessed 2 November 2011]. Available at: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19993

3. European Centre for Disease Prevention and Control. Public health importance of the invasive mosquitoes of Europe. January 2010. [Accessed 2 November 2011]. Available at: http://ecdc.europa.eu/en/activities/sciadvice/Lists/ECDC%20

Reviews/ECDC_DispForm.aspx?List=512ff74f%2D77d4%2D

4ad8%2Db6d6%2Dbf0f23083f30&ID=759&RootFolder=%2Fe

n%2Factivities%2Fsciadvice%2FLists%2FECDC%20Reviews

4. Andropoulous P, Okionomopou A, Rigaki K et al. An outbreak of Plasmodium Vivax malaria in Lakonia, southern Greece August – October, 2009. Abstract of 20th European Congress of Clinical Microbiology and Infectious Diseases, Vienna, Austria, April 2010. [Accessed 2 November 2011]. Available at: http://www.blackwellpublishing.com/eccmid20/abstract.asp

?id=84490

5. The Ill Returned Traveller, Ch. 4.2. In: Field VF, Ford L, Hill DR (Eds). Health Information for Overseas Travel. National Travel Health Network and Centre. London, UK. 2010.

Links