Clinical Updates
11 August, 2010
West Nile virus (humans): Central Macedonia, Greece
Public health authorities in Greece have confirmed an outbreak of West Nile virus (WNV) on the Greek mainland [1]. As of 10 August 2010, 21 cases have been confirmed in the periphery of Central Macedonia. There have been two deaths, one of which occurred in the capital of the region, Thessaloniki [2-5]. Although WNV has been previously identified in animals, these are the first reports of human cases from Greece [6].
West Nile virus
WNV is caused by a flavivirus; the primary hosts are birds and horses and the virus is transmitted by Culex sp. mosquitoes. WNV is an emerging disease in southern Europe [7-11]; a small number of human cases have been reported in the European Union since 1966 [11].
The majority of WNV infections (around 80%) are asymptomatic. Less than 20% will experience a mild, self-limited illness with fever, headache, myalgias, and rash. Less than 1% of those infected will develop a more severe neurological syndrome of meningitis and/or encephalitis.
Advice for travellers
There is a very low risk of contracting WNV during travel to Greece or the rest of Europe. Individuals over 50 years of age are at highest risk of developing severe neurological disease following WNV infection [11].
During travel to risk areas, individuals should take mosquito bite avoidance measures. There are no vaccines that prevent WNV in humans.
Physicians who see travellers with a characteristic febrile illness, who have returned from WNV endemic areas, should be alert to the possibility of WNV infection. Relevant samples for testing together with a full clinical and travel history should be submitted to the Health Protection Agency Special Pathogens Reference Unit.
References
1. Greek Democracy. Ministry of Health. [Accessed 11 August 2010]. Available at: http://www.keelpno.gr/home/
2. Centre of Control and Prevention of Disease. Athens, Greece. Daily Report of Epidemiological Surveillance of West Nile Virus Infection in Greece. 8 August 2010. (In Greek.) [Accessed 11 August 2010]. Available at: http://www.keelpno.gr/keelpno/2010/id990/daily_report_
3. Centre of Control and Prevention of Disease. Athens, Greece. Daily Report of Epidemiological Surveillance of West Nile Virus Infection in Greece.9 August 2010. (In Greek.) [Accessed 11 August 2010]. Available at: http://www.keelpno.gr/keelpno/2010/id990/daily_report_
4. Centre of Control and Prevention of Disease. Athens, Greece. Daily Report of Epidemiological Surveillance of West Nile Virus Infection in Greece. 10 August 2010. (In Greek.) [Accessed 11 August 2010]. Available at: http://www.keelpno.gr/keelpno/2010/id990/daily_report_
5. Centre of Control and Prevention of Disease. Athens, Greece. Daily Report of Epidemiological Surveillance of West Nile Virus Infection in Greece. 11 August 2010. (In Greek.) [Accessed 11 August 2010]. Available at: http://www.keelpno.gr/keelpno/2010/id990/daily_report_
6. Kantzanou M N, Moschiddis ZM, Kremastinou G, et al. Searching for West Nile virus (WNV) in Greece. Transfusion Med. 20: 113–117, 2010.
7. Hubalek Z, Halouzka J. West Nile Fever – a re-emerging mosquito-borne viral disease in Europe. Emerg Inf Dis.:5:643-650, 1999.
8. Del Giudice P, Schuffenecker I, Vandenbos F, et. al. Human West Nile Virus, France (letter). Emerg Inf Dis . 10: 1885-1886, 2004.
9. Bakonyi T, Ivanics E, Erdélyi K, et al. Lineage 1 and 2 strains of encephalitic West Nile virus, Central Europe. Emerg Infect Dis.12: 618–623, 2006.
10. Health Protection Agency. West Nile virus activity in Southern Europe. [Accessed 11 August 2010]. Available at: http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb
11. European Centre for Disease Prevention and Control. West Nile Fever fact sheet. [Accessed 11 August 2010]. Available at: http://ecdc.europa.eu/en/healthtopics/Pages/West_Nile_Fever
Links
European Centre for Disease Prevention and Control. West Nile Fever factsheet
Health Protection Agency: West Nile virus - Advice for Health Professionals
Health Protection Agency: Special Pathogens Reference Unit
Health Protection Agency: West Nile Virus
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