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HCDCP, Weekly report 30-Oct-2013
Weekly Epidemiological Report for the West Nile virus disease, Greece, 2013
- 30 October 2013 –
This weekly epidemiological report aims to present briefly the reported cases of West Nile Virus (WNV)
infection in Greece for the period 2013, and is updated weekly.
Data presented in this report are derived from the notifications of laboratory confirmed and probable cases
of WNV infection sent to the Hellenic Centre for Disease Control and Prevention (HCDCP-KEELPNO) by the
treating physicians and from the daily communication with specific laboratories: i) the Reference
Laboratory for Arboviruses, Aristotelian University of Thessaloniki, ii) the Department of Microbiology,
School of Medicine, University of Athens, iii) the Department of Microbiology, Infectious Disease Hospital of
Thessaloniki, iv) the Hellenic Pasteur Institute and v) private microbiological laboratories performing
diagnostic tests. The Department of Epidemiological Surveillance and Intervention of the HCDCP
undertakes a verification procedure through communication with the treating physicians and the patients,
as necessary.
From the beginning of 2013 until 30/10/2013 (11:00am), 86 laboratory diagnosed cases of WNV infection
have been reported to KEELPNO (including 8 deaths), of which 51 presented with neuro-invasive disease
(WNND, encephalitis and/or meningitis and/or acute flaccid paralysis) and 35 cases with mild symptoms
(febrile syndrome) (Table 1). One more death in a patient with WNND was attributed to other causes.
Table 1. Number of reported cases with laboratory diagnosed WNV disease, Greece, period 2013, until
30.10.2013 (11:00am)
Cases diagnosed by
30.10.2013 (11:00am)
1.
2.
Number of cases
with central nervous
system manifestations
Number of cases
without central nervous
system manifestations
Total
number
of cases
Number of
deaths [1]
51
35
86
8 [2]
The number of deaths is included in the total number of cases
One more death in a patient with WNND was attributed to other causes.
Until 30/10/2013, 11:00am, 72 patients with WNV disease have been discharged from the hospital and two
are still hospitalized, including one in an Intensive Care Unit (ICU) (Table 2).
Office for Vector Borne Diseases
Department for Surveillance and Intervention
HELLENIC CENTRE FOR DISEASE CONTROL AND PREVENTION (HCDCP)
210 8899 052, 210 8899 071, 210 8899 072
1
HCDCP, Weekly report 30-Oct-2013
Table 2. Current status of patients with laboratory diagnosed WNV infection until 30.10.2013 (11.00am)
Current status of patients
Number of cases
Hospitalized in clinics
1
Hospitalized in ICU
1
Total number of patients that are being hospitalized
2
Total number of patients that have been discharged
from the hospital
72
Total number of patients that were not hospitalized
3
Number of deaths attributed to WNV disease
8
Number of deaths attributed to other causes
1
Total number of cases
86
2
Figure 1 shows the reported WNND cases by week of symptom onset. The first diagnosed case of WNV
infection for the transmission period 2013 reported onset of symptoms on 2nd July 2013 (wk 27).
Figure 1. Number of laboratory diagnosed WNND cases by week of symptom onset, Greece, 2013, until
30.10.2013, 11.00am (n=51)*
* The blue dotted line = WNND cases reported in 2010, the red dotted line = WNND cases reported in 2011 and the black dotted
line = WNND cases reported in 2012. Each blue box represents one laboratory diagnosed case of WNND reported to KEELPNO in
transmission period 2013.
Office for Vector Borne Diseases
Department for Surveillance and Intervention
HELLENIC CENTRE FOR DISEASE CONTROL AND PREVENTION (HCDCP)
210 8899 052, 210 8899 071, 210 8899 072
HCDCP, Weekly report 30-Oct-2013
Age of patients ranges between 17–100 years, while the median age of WNND cases is 76 years (17-95
years).
Table 3 and Figures 2 and 3 show the geographic distribution of the notified cases with laboratory
diagnosed WNV disease at the level of suspected Municipalities of exposure. The patient’s suspected place
of exposure is a rough indicator of the area of WNV circulation.
For one particular case, the suspected place of exposure is undetermined due to a complicated travel
history during the incubation period.
According to a serosurvey conducted in 2010 by the HCDCP and the National School of Public Health, at the
epicentre of the WNV outbreak in Central Macedonia, WNND disease develops in 1:140 infected persons.
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Table 2. Reported cases with laboratory diagnosed WNV disease (with and without WNND) by suspected
Municipality of exposure, Greece, transmission period 2013, until 30.10.2013 (11:00am)
Regional Unit
East Attica
Number of
cases with
WNND
Incidence of WNND per
100.000 population *
Number of
cases without
WNND
Spata- Artemida
1
2,96
1
Pallini
3
5,51
3
Rafina- Pikermi
1
4,93
0
Markopoulo Mesogeas
3
14,97
1
Peania
1
3,75
0
Vari- Voula- Vouliagmeni
1
2,07
0
Vrilissia
2
6,51
1
Chalandri
3
4,04
0
Penteli
1
2,86
0
1
2,01
0
Agia Paraskevi
3
5,02
0
Filothei-Psichiko
0
0
2
Papagou - Cholargou
0
0
1
Maroussi
1
1,38
1
2
3,37
0
Suspected Municipality
of exposure
North Section Heraklion
of Athens
Central Section Galatsi
Office for Vector Borne Diseases
Department for Surveillance and Intervention
HELLENIC CENTRE FOR DISEASE CONTROL AND PREVENTION (HCDCP)
210 8899 052, 210 8899 071, 210 8899 072
HCDCP, Weekly report 30-Oct-2013
of Athens
1
2,81
0
South Section
Glifada
of Athens
0
0
1
Imathia
Alexandria
1
2,41
2
Delta
1
2,18
1
Ambelokipoi - Menemeni
0
0
1
Oreokastro
0
0
1
Chalkidona
1
2,97
0
Kordelio- Evosmos
1
0,98
0
Pella
1
1,58
3
Xanthi
2
3,07
3
Avdira
2
10,52
3
Topeiros
2
17,32
4
Nestos
5
22,39
4
Kavala
0
0
2
Sintiki
1
4,51
0
Visaltia
4
19,97
0
Heraklia
2
9,46
0
Serres
1
1,30
0
Ileia
Andravida - Killini
1
4,63
0
Corfu
Corfu
1
0,97
0
Thessaloniki
Pella
Xanthi
Philadelphia-Chalkidona
Kavala
Serres
Undetermined place of exposure
1
Total Greece
51
*
0
0,47
Calculations based on census data 2011 (Hellenic Statistical Authority).
Office for Vector Borne Diseases
Department for Surveillance and Intervention
HELLENIC CENTRE FOR DISEASE CONTROL AND PREVENTION (HCDCP)
210 8899 052, 210 8899 071, 210 8899 072
35
4
HCDCP, Weekly report 30-Oct-2013
Figure 2: Map showing the suspected place of exposure of reported cases with laboratory diagnosed
WNV disease, Greece, 2013, until 30.10.2013 (11.00am) (n=85*).**
5
Source: HCDCP
* For one particular case, the suspected place of exposure is undetermined
**Each red dot represents one case with WNND and each blue triangle a case with mild symptoms (without WNND).
Office for Vector Borne Diseases
Department for Surveillance and Intervention
HELLENIC CENTRE FOR DISEASE CONTROL AND PREVENTION (HCDCP)
210 8899 052, 210 8899 071, 210 8899 072
HCDCP, Weekly report 30-Oct-2013
Figure 3: Map showing the suspected place of exposure of reported cases with laboratory diagnosed
WNV disease, Region of Attiki, 2013, until 30.10.2013 (11.00am) (n=35).*
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Source: HCDCP
*Each red dot represents one case with WNND and each blue triangle a WNV case with mild symptoms (without
WNND)
CONCLUSIONS
For the fourth consecutive transmission period, human West Nile virus infection cases are being recorded
in Greece. It is expected that cases will continue appearing until the fall, both in the same areas where they
were recorded in the past 3 years, as well as in new areas of WNV circulation.
Until 30.10.2013, human WNV cases were recorded from the regional units of Attiki, Thessaloniki, Imathia,
Xanthi, Kavala, Serres, Corfu and Pella, where the circulation of WNV is known from previous years, as well
as from the regional unit of Ileia, new area of the virus circulation.
In Europe, during transmission period 2013 (up to 17.10.2013) cases of WNV disease have also been
recorded in Israel, Russia, Serbia, F.Y.R.O.M., Italy, Romania, Hungary, Montenegro, Ukraine, Croatia,
Bosnia & Herzegovina and Tunisia (source: ECDC).
Epidemiological surveillance of disease, systematic and early implementation of mosquito control programs
and personal protective measures against mosquito bites are the most appropriate measures for the
control of the disease.
Office for Vector Borne Diseases
Department for Surveillance and Intervention
HELLENIC CENTRE FOR DISEASE CONTROL AND PREVENTION (HCDCP)
210 8899 052, 210 8899 071, 210 8899 072
HCDCP, Weekly report 30-Oct-2013
PUBLIC HEALTH MEASURES SUPPORTED BY THE HCDCP - 2013
The following public health measures have been implemented by the Hellenic CDC and other involved
stakeholders:
1. Enhanced surveillance for encephalitis and WNV disease in humans.
i.
Enhancing awareness of physicians about the surveillance of encephalitis and suspected cases:
testing for West Nile virus infection in suspected cases (such as cases with encephalitis, aseptic
meningitis, acute flaccid paralysis, fever of undetermined etiology) was recommended. .
ii.
Daily communication and information exchange with laboratories conducting diagnostic testing for
West Nile virus.
iii.
The Department of Epidemiological Surveillance and Intervention of HCDCP -within 24 hoursundertakes the investigation of every reported case of West Nile virus disease in order to
determine the likely place of exposure, the risk factors and the severity of the disease.
iv.
Daily update of stakeholders on the diagnosed cases (Ministry of Health, Ministry of Rural
Development and Food, Regions, Directorate of Public Health and Social Welfare, National Centre
for Blood Donations, National Transplant Organization, laboratories).
2. Awareness raising among health professionals by providing guidelines for the recognition and
diagnosis of WNV disease and the recommended laboratory investigation of suspected cases (e.g.
encephalitis cases). The Hellenic CDC website includes updated information for health professionals
(case definition, instructions for samples, laboratory diagnosis, management) www.keelpno.gr.
3. Communication and health promotion activities for the public (schools, healthcare facilities) in
various areas around the country. The Hellenic CDC website includes educational material for the
public regarding the disease and the recommended protective measures against mosquito bites.
4. Coordination of a multisector Working Group (WG) on the definition of affected areas by vector
borne diseases. This WG considers all available entomological and epidemiological data and decides
on the characterization of affected areas, for the implementation of blood safety measures. The list is
published on our website (www.keelpno.gr) and updated regularly.
5. Communication to the National Centre for Blood Donations (www.ekea.gr) of the list of affected
areas in order to issue the necessary blood safety measures to the blood donation units in all hospitals.
6. Entomological surveillance: In 2013, the HCDCP in collaboration with the Department of Parasitology,
Entomology and Tropical Diseases of the National School of Public Health is implementing a targeted
entomological surveillance program, in the Attica region. According to our findings, we recorded the
circulation of West Nile virus in the area since the end of May 2013. Organized expansion of
entomological surveillance nationwide has been planned in cooperation with local authorities and the
subcontractors of the local mosquito control programs.
7. Collaboration and exchange of information with the Veterinary Public Health (VPH) services of the
Ministry of Agriculture, especially regarding WNV infection in equidae.
8. HCDCP is collaborating with the University of Thessaly for the project: “Control of West Nile Virus and
Malaria- Strengthening of Surveillance in the Greek territory”, funded by the NSRF (2007-2013). The
various work packages include the development of geographical information systems (GIS), the
strengthening of epidemiological surveillance for both diseases, the mapping of mosquito habitats and
mosquito sampling from high-risk areas, the strengthening of wild bird and horse monitoring for WNV
transmission, informative campaigns addressing the public, especially high-risk groups, and health
professionals who are involved directly with the control and treatment of both diseases.
In the context of this program the following actions are being implemented:
Office for Vector Borne Diseases
Department for Surveillance and Intervention
HELLENIC CENTRE FOR DISEASE CONTROL AND PREVENTION (HCDCP)
210 8899 052, 210 8899 071, 210 8899 072
7
HCDCP, Weekly report 30-Oct-2013
a) The Veterinary School, Aristotelian University of Thessaloniki is undertaking a sero-epidemiological
surveillance of household poultry (<6 mos old) in north Greece (circulation of WNV was recorded
in Central Macedonia in June 2013).
b) The Veterinary School, University of Thessaly undertakes surveillance of wild birds in various areas
in Greece.
c) E- learning platform for health professionals (www.malwest.gr).
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Office for Vector Borne Diseases
Department for Surveillance and Intervention
HELLENIC CENTRE FOR DISEASE CONTROL AND PREVENTION (HCDCP)
210 8899 052, 210 8899 071, 210 8899 072