Health Professionals

Clinical Updates

23 August 2011

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

Between June and 18 August 2011 six cases of locally acquired Plasmodium vivax malaria have been reported from Greece; four cases from the agricultural wetland area of Evrotas, Lakonia in the Peloponnese, southern Greece and two cases who reside near the city of Chalkida, Evoia, in the east of Greece. All cases were in local residents with no history of travel to a malaria endemic area [1]. 

A confirmed case of P. vivax malaria with disease onset in July 2011 has been reported from Romania in an individual who had worked in the Evrotas area of Lakonia. The person had not visited any malaria endemic countries [1]. 

Anopheles spp. mosquitoes are indigenous to parts of southern Europe and their presence increases the risk of locally acquired mosquito-borne diseases, usually occurring following importation from endemic countries [2]. In the Lakonia area of Greece there are many migrant farm workers, primarily from South Asia.  Sporadic cases of locally acquired malaria have been reported in Greece annually since 2009 [3, 4].

Advice for travellers

The risk of malaria to these areas of Greece is very low. Malaria is transmitted to humans by the bite of a mosquito. Practising insect bite avoidance measures will reduce the risk of travellers acquiring a mosquito-borne disease. Travellers should be aware that Anopheles spp mosquitoes bite during the evening and night. Chemoprophylaxis is not recommended.

Advice for health professionals – the returned traveller

Health professionals who see febrile travellers form 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 Centers for Disease Prevention and Control. Autochthonous Plasmodium vivax malaria in Greece. 23 August 2011. [Accessed 23 August 2011]. Available at: http://ecdc.europa.eu/en/publications/Publications/Forms/ECD

C_DispForm.aspx?ID=720

2. European Centre for Disease Prevention and Control. Public health importance of the invasive mosquitoes of Europe. January 2010. [Accessed 23 August 2011]. Available at: http://ecdc.europa.eu/en/activities/sciadvice/Lists/ECDC%20

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

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

3. Kampen H, Maltezos E, Pagonaki M et. Individual cases of autochthonous malaria in Evros Province, northern Greece: serological aspects. Parasitol Res. 2002 Mar; 88(3):261-6.

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 23 August, 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.

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