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7 September 2012

Locally acquired dengue: Greece (Agrinio)

The Hellenic Centre for Disease Control and Prevention has reported a probable case of autochthonous (locally acquired) dengue fever on mainland Greece. The case was an 84 year old male resident of Agrinio, in the municipality of Aetolia-Acarnania, who died on 30 August 2012. Although his illness and diagnosis was complicated by underlying chronic medical conditions, the presence of a high titer of IgM dengue antibodies in a serum sample has been confirmed supporting the diagnosis of probable dengue fever[1].

There was no history of international travel to dengue fever endemic areas or of blood transfusion before the onset of illness.

This isolated case is the first case of locally acquired dengue fever to be reported in Greece since an outbreak that occurred in the country between 1927 and 1928 [2].

The main vector of dengue fever worldwide, the Aedes aegypti mosquito, is not present in Greece. Aedes albopictus, an effective secondary mosquito vector known to cause outbreaks, is known to be present in parts of Greece [2-3], although there is no information to indicate A. albopictus is present in the area where this case lived. Mosquito control and personal protection measures are already actively promoted in Greece.  Additional public health responses are underway including enhanced surveillance and raising awareness in both health professionals and the public of signs and symptoms of dengue fever [1].

Advice for travellers

The risk of travellers acquiring dengue fever in Greece is extremely low, however, all travellers should practise mosquito bite avoidance when visiting areas in Greece where Aedes mosquitoes are present (see map [4]). Aedes mosquitoes bite in the day, particularly around dawn and dusk. More information about mosquito bite avoidance is available on the NaTHNaC website.

There is no vaccine available to protect against dengue.

Further information about dengue fever can be found on the NaTHNaC Health Information Sheet on Dengue Fever.

Advice for health professionals

In 2010, 460 cases of imported dengue fever were reported in England, Wales and Northern Ireland, compared to 166 cases during 2009.  Most cases were associated with travel to Asia, the Americas, Africa and the Caribbean; and none were associated with travel to Europe [5]. Health professionals who suspect a case of dengue fever should send appropriate samples for testing (with full travel and clinical history) to the Health Protection Agency, Rare and Imported Pathogens Laboratory.

References

1. European Centre for Disease Prevention and Control, Epidemiological update: Possible local transmission of dengue virus in Greece, 7 September 2012. [Accessed 7 September, 2012]. Available at: http://ecdc.europa.eu/en/press/news/Lists/News/ECDC_Disp

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=720&RootFolder=%2Fen%2Fpress%2Fnews%2FLists%2

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2. Centers for Disease Control and Prevention . Emerging Infectious Diseases. Daily Newspaper View of Dengue Fever Epidemic, Athens, Greece, 1927–1931. 2012;18(1). Epidemiological update: Possible local transmission of dengue virus in Greece, 6 September 2012 [Accessed 7 September, 2012]. Available at: http://wwwnc.cdc.gov/eid/article/18/1/11-0191_article.htm

3. Medlock JM, Hansford KM, Schaffner F, Versteirt V, Hendrickx G, Zeller H, Bortel VW, A Review of the Invasive Mosquitoes in Europe: Ecology, Public Health Risks, and Control Options. Vector-Borne and Zoonotic Diseases, 2012;12(6), 2012. [Accessed 7 September, 2012]. Available at: http://online.liebertpub.com/doi/pdfplus/10.1089/vbz.2011.0814

4. ECDC. VBORNET Exotic mosquitoes distribution, June 2012 [Accessed 7 September, 2012]. Available at: http://ecdc.europa.eu/en/activities/diseaseprogrammes/

emerging_and_vector_borne_diseases/Pages/VBORNET_

maps.aspx

5. Health Protection Agency. Dengue fever in England, Wales and Northern Ireland: 2009/10[Accessed 7 September 2012]. Available at: http://www.hpa.org.uk/hpr/archives/2011/hpr1811.pdf

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