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Dougas G, Vorou R, Katsiolis A, Kalotychou D, Katerelos P, Tsiodras S, Mellou K. A Multidisciplinary "One Health" Tool for Tackling Brucellosis. Vector Borne Zoonotic Dis 2024. [PMID: 38573214 DOI: 10.1089/vbz.2023.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Introduction: The Epizootiological Investigation Form (EIF) is a document issued for every notified human brucellosis case, with the aim to convey information from public health to veterinary authorities for farm animals epidemiologically linked with the patient. We assessed the integration of EIF to the routine collaboration among stakeholders and the efficiency in directing the veterinary efforts to identify Brucella-infected animals. Methods: EIFs were evaluated for the implementation, timeliness, and completeness of the shared information provided by the public health and the veterinary authorities. The efficiency of EIFs in identifying infected farms was compared with the Brucella infection rate of routinely screened farms in the frame of the national brucellosis program. Results: During 2017-2022, 344 EIFs were issued for equal number of human brucellosis cases and 118 (34.3%) were circulated successfully among all stakeholders, whereas 226 (65.7%) went missing. The highest rate of intersectoral circulation occurred in May (47.8%, p = 0.007). Veterinary investigation was performed, and result was provided in 62 (57.4%) of the 108 circulated EIFs that disclosed the contact details of the epidemiologically linked animal farms. Brucella was detected at a significantly higher rate (51.7%) in the investigated sheep and goats' farms than the infection rate (2.7%) of the national brucellosis program (p < 0.00001). Among the screened bovine herds, two were found infected of the eight tested (25%). The circulation among all competent authorities of EIFs with a farm screening outcome required a median (interquartile range) of 50 days (22, 88). The likelihood of a "complete" EIF per human case differed among geographic Regions (p = 0.010), and was higher for patients diagnosed in April (p = 0.001) and occupied as stockbreeders (p = 0.025). Conclusions: EIF is a useful tool for pinpointing suspected animals for brucellosis screening. Training of the collaborating personnel is essential for improving the implementation of EIF in the everyday practice.
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Affiliation(s)
- Georgios Dougas
- Zoonoses Department, National Public Health Organization, Athens, Greece
| | - Regina Vorou
- Zoonoses Department, National Public Health Organization, Athens, Greece
| | - Aristomenis Katsiolis
- General Veterinary Directorate, Hellenic Ministry of Rural Development and Food, Athens, Greece
| | - Danai Kalotychou
- Zoonoses Department, National Public Health Organization, Athens, Greece
| | | | - Sotirios Tsiodras
- Zoonoses Department, National Public Health Organization, Athens, Greece
- National and Kapodistrian University of Athens School of Medicine, 4th Department of Internal Medicine, Attikon University Hospital, Athens, Greece
| | - Kassiani Mellou
- Zoonoses Department, National Public Health Organization, Athens, Greece
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Beauté J, Innocenti F, Aristodimou A, Špačková M, Eves C, Kerbo N, Rimhanen-Finne R, Picardeau M, Faber M, Dougas G, Halldórsdóttir AM, Jackson S, Leitēna V, Vergison A, Borg ML, Pijnacker R, Sadkowska-Todys M, Martins JV, Rusu LC, Grilc E, Estévez-Reboredo RM, Niskanen T, Westrell T. Epidemiology of reported cases of leptospirosis in the EU/EEA, 2010 to 2021. Euro Surveill 2024; 29:2300266. [PMID: 38362624 PMCID: PMC10986659 DOI: 10.2807/1560-7917.es.2024.29.7.2300266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 11/09/2023] [Indexed: 02/17/2024] Open
Abstract
BackgroundLeptospirosis is a zoonotic disease caused by bacteria of the genus Leptospira. Humans are infected by exposure to animal urine or urine-contaminated environments. Although disease incidence is lower in Europe compared with tropical regions, there have been reports of an increase in leptospirosis cases since the 2000s in some European countries.AimWe aimed to describe the epidemiology of reported cases of leptospirosis in the European Union/European Economic Area (EU/EEA) during 2010-2021 and to identify potential changes in epidemiological patterns.MethodsWe ran a descriptive analysis of leptospirosis cases reported by EU/EEA countries to the European Centre for Disease Prevention and Control with disease during 2010-2021. We also analysed trends at EU/EEA and national level.ResultsDuring 2010-2021, 23 countries reported 12,180 confirmed leptospirosis cases corresponding to a mean annual notification rate of 0.24 cases per 100,000 population. Five countries (France, Germany, the Netherlands, Portugal and Romania) accounted for 79% of all reported cases. The highest notification rate was observed in Slovenia with 0.82 cases per 100,000 population. Overall, the notification rate increased by 5.0% per year from 2010 to 2021 (95% CI: 1.2-8.8%), although trends differed across countries.ConclusionThe notification rate of leptospirosis at EU/EEA level increased during 2010-2021 despite including the first 2 years of the COVID-19 pandemic and associated changes in population behaviours. Studies at (sub)national level would help broaden the understanding of differences at country-level and specificities in terms of exposure to Leptospira, as well as biases in diagnosis and reporting.
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Affiliation(s)
- Julien Beauté
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Francesco Innocenti
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Epidemiology Unit, Regional Health Agency of Tuscany, Florence, Italy
| | | | - Michaela Špačková
- Centre for Epidemiology and Microbiology, Department of Infectious Diseases Epidemiology, National Institute of Public Health, Prague, Czechia
| | - Caroline Eves
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Natalia Kerbo
- Department of Communicable Diseases Epidemiology, Health Board, Tallinn, Estonia
| | - Ruska Rimhanen-Finne
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mathieu Picardeau
- Institut Pasteur, Unité Biologie des spirochètes, Centre National de Référence de la Leptospirose, Paris, France
| | - Mirko Faber
- Department of Infectious Disease Epidemiology, Robert Koch-Institute (RKI), Berlin, Germany
| | - Georgios Dougas
- Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization, Athens, Greece
| | | | - Sarah Jackson
- Health Protection Surveillance Centre, Dublin, Ireland
| | | | | | - Maria Louise Borg
- Infectious Disease Prevention and Control Unit, Health Promotion and Disease Prevention Directorate, Pieta, Malta
| | - Roan Pijnacker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | - João Vieira Martins
- Directorate of Information and Analysis, Directorate-General of Health, Lisbon, Portugal
| | - Lavinia Cipriana Rusu
- National Centre for Surveillance and Control if Communicable Diseases, National Institute of Public Health, Bucharest, Romania
| | - Eva Grilc
- National Institute of Public Health, Ljubljana, Slovenia
| | | | - Taina Niskanen
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Therese Westrell
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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Kefaloudi C, Mellou K, Dougas G, Vorou R, Mitrou K, Kontopidou F. Human Brucellosis in Greece, 2005-2020: A Persistent Public Health Problem. Vector Borne Zoonotic Dis 2022; 22:163-169. [PMID: 35319918 DOI: 10.1089/vbz.2021.0050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Brucellosis remains an important zoonosis in various parts of the world. In Greece, brucellosis is endemic in sheep and goats. Since 1998, animal control measures include vaccination of sheep and goats older than 3 months of age in the mainland (vaccination zone) and slaughtering of infected livestock on the islands (eradication zone). We retrieved data from the mandatory notification system for 2005-2020 to describe the epidemiology in humans and assess current public health measures. Overall, 1786 notifications and an additional 111 cases related to an outbreak in 2008 (eradication zone) were recorded. The mean annual notification rate was 0.9/100,000 population (standard deviation [SD]: 0.35). A substantial mean annual decline in notification rate was reported in 2019 and 2020. A statistically significant decreasing trend of brucellosis notification rate was observed over the whole 16-year period (p < 0.001). The mean annual notification rate was significantly higher in the vaccination zone (1.2/100,000) (SD: 036) compared with the eradication zone (0.2/100,000) (SD: 0.14) (p < 0.001). Seventy percent of cases was male (n = 1175) and the highest mean notification rate was recorded in the 45-64 age group (1.3/100,000). The majority of cases (71%) reported animal contact and almost half of the cases (49%) were stockbreeders by occupation. Consumption of unpasteurized dairy products, mainly of their own production, was reported by 57% of cases; for 115 (6.5%) cases, animal exposure or consumption of unpasteurized dairy products were not recorded. Despite animal control measures, brucellosis remains endemic in Greece with cases in the vaccination zone, as well as the eradication zone. We recommend re-evaluation and strengthening of animal control programs and training of people working in stock breeding regarding disease transmission in co-operation with local farmers' associations.
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Affiliation(s)
- Chrysovaladou Kefaloudi
- Department of Vector-Borne Diseases, Epidemiological Surveillance, and Intervention for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Kassiani Mellou
- Department of Foodborne and Waterborne Diseases, and Epidemiological Surveillance, and Intervention for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Georgios Dougas
- Directorate of Zoonosis, Epidemiological Surveillance, and Intervention for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Rengina Vorou
- Directorate of Zoonosis, Epidemiological Surveillance, and Intervention for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Kostas Mitrou
- Department of Mobile Population, Directorate of Preparedness and Response, National Public Health Organization, Athens, Greece
| | - Flora Kontopidou
- Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization, Athens, Greece
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Dougas G, Tsakris A, Billinis C, Beleri S, Patsoula E, Papaparaskevas J. Molecular detection of Rickettsia felis in common fleas in Greece and comparative evaluation of genotypic methods. J Microbiol Methods 2020; 180:106104. [PMID: 33217484 DOI: 10.1016/j.mimet.2020.106104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/14/2020] [Accepted: 11/14/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Rickettsia felis is the causative agent of flea-borne spotted fever (FBSF), an emerging zoonosis. Although there is evidence of FBSF in Greece, fleas, the classic vectors of R. felis, have not been adequately studied. Thus, the aim of this study was to detect and characterize bacteria of genus Rickettsia and especially R. felis from common fleas parasitizing domestic cats and dogs in Greece and evaluate the efficiency of established molecular techniques. MATERIALS AND METHODS DNA of flea-pools (samples) by animal-host was investigated by quantitative real-time PCRs (qPCR), and 16S metagenomics (16S). Determination of Rickettsia spp., Rickettsia felis-like organisms (RFLOs), and R. felis was based on a combination of qPCRs targeting gltA and ompB genes, 16S automated metagenomics and manual comparison of 16S sequences for >99% similarity with the publicly available 16S R. felis GenBank sequences using the Basic Local Alignment Search Tool (BLAST>99). Information for the animal-hosts was available and statistically analyzed. RESULTS Among 100 flea-pools, R. felis was detected in 14 samples with a combination of six, five and three assays in 10, two and two samples, respectively. The sensitivity of the assays for Rickettsia genus (16S, and genus specific qPCRs) ranged from 62.5% to 93.8% and the specificity from 65.0% to 100%. R. felis-targeting qPCRs for gltA and ompB demonstrated sensitivity and specificity of 92.9% and 100%, and 100.0% and 87.5%, respectively. 16S metagenomics using the assay software was not able to identify R. felis positive specimens, although manual BLAST>99 did identify the species, but demonstrated sensitivity of 92.9% and specificity of 65.0%. No association of the detection rate of Rickettsia genus or R. felis, with the epidemiological data collected, was identified. CONCLUSIONS These observations suggest the occurrence of R. felis in fleas from pets in Attica, Greece, but PCR and sequencing assays varied considerably in sensitivity and specificity and a consensus methodology for assigning the positivity status is required to be established.
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Affiliation(s)
- Georgios Dougas
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece; National Public Health Organization, Athens, Greece
| | - Athanassios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Billinis
- Department of Microbiology and Parasitology, Faculty of Veterinary Science, University of Thessaly, Karditsa, Greece
| | - Stavroula Beleri
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Eleni Patsoula
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Joseph Papaparaskevas
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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Dougas G, Mavrouli M, Tsakris A, Billinis C, Papaparaskevas J. Serosurvey of IgG Antibodies against Bartonella henselae and Rickettsia typhi in the Population of Attica, Greece. Trop Med Infect Dis 2020; 5:tropicalmed5030145. [PMID: 32947795 PMCID: PMC7559870 DOI: 10.3390/tropicalmed5030145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 08/31/2020] [Accepted: 09/09/2020] [Indexed: 12/28/2022] Open
Abstract
Rickettsia typhi and Bartonella henselae are the causative agents of murine typhus and cat-scratch disease, respectively. A small-scale survey (N = 202) was conducted in the Attica region, Greece, for determining the prevalence rates of IgG antibodies against B. henselae and R. typhi by indirect fluorescence antibody test. IgG against B. henselae and R. typhi were present in 17.8% (36/202) and 4.5% (9/202) of the participants, respectively; co-occurring IgG against both B. henselae and R. typhi were detected in 3.5% (7/202), whereas only anti-B. henselae IgG in 14.3% (29/202), and only anti-R. typhi IgG in 1.0% (2/202). Titres 1/64, 1/128, 1/256, and 1/512, of anti-B. henselae IgG were identified in 6.4%, 4.5%, 4.5%, and 2.4%, whereas titres 1/40 and 1/80 of anti-R. typhi IgG were detected in 4.0%, and 0.5%, respectively. A positive association of anti-B. henselae IgG prevalence with a coastal area featuring a major seaport (p = 0.009) and with younger age (p = 0.046) was identified. The findings of this survey raise concern for exposure of the population of Attica to B. henselae and R. typhi, which should be considered in the differential diagnosis when compatible symptoms are present. Our results also suggest that seaports may represent high-risk areas for exposure to Bartonella spp.
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Affiliation(s)
- Georgios Dougas
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.M.); (A.T.); (J.P.)
- Correspondence:
| | - Maria Mavrouli
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.M.); (A.T.); (J.P.)
| | - Athanassios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.M.); (A.T.); (J.P.)
| | - Charalambos Billinis
- Department of Microbiology and Parasitology, Faculty of Veterinary Science, University of Thessaly, 43100 Karditsa, Greece;
| | - Joseph Papaparaskevas
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.M.); (A.T.); (J.P.)
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Dougas G, Tsakris A, Beleri S, Patsoula E, Billinis C, Papaparaskevas J. Evidence of Brucella melitensis DNA in the Microbiome of Ctenocephalides felis from Pet Cats in Greece. Vector Borne Zoonotic Dis 2020; 20:390-392. [PMID: 31905103 DOI: 10.1089/vbz.2019.2510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Cat fleas (Ctenocephalides felis) are the most prevalent ectoparasites of pet animals with cosmopolitan distribution, obligatory hematophagous, and may prey on humans to receive bloodmeals. We studied the microbiota of 100 flea-pools, containing C. felis, and collected from equal number of cats and dogs in the region of Attica, Greece, including Athens. The 16S metagenomics technique detected Brucella spp. nucleotide sequence that was identified as Brucella melitensis DNA by a real-time PCR, in five flea-pools, corresponding to five cats, one owned and the remaining four stray, residing in semiurban and urban areas, respectively. No definite conclusions can be drawn as to the pathway that led to the presence of B. melitensis in common fleas parasitizing cats. We suspect flea or cat contact with wild rodents, ubiquitous in various environments, which participate in the B. melitensis biology. The proximity of the cats and their fleas with humans and previous observations of flea potential to transmit B. melitensis in laboratory animals warrant a more elaborate research as to the vectorial dynamics, the ecological pathways resulting in pathogen carriage, and the risk for public health.
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Affiliation(s)
- Georgios Dougas
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,National Public Health Organization (NPHO), Athens, Greece
| | - Athanassios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula Beleri
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Eleni Patsoula
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Charalambos Billinis
- Department of Microbiology and Parasitology, Faculty of Veterinary Science, University of Thessaly, Karditsa, Greece
| | - Joseph Papaparaskevas
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Dougas G, Mavrouli M, Vrioni G, Lytras T, Mellou K, Metallidis S, Istikoglou I, Mitrou K, Tzani M, Georgopoulou I, Tsalikoglou F, Garetsou E, Poulakou G, Giannitsioti E, Moschopoulos C, Baka A, Georgakopoulou T, Tsiodras S, Tsakris A. Antibody Response Following Pre-Exposure Immunization Against Rabies in High-Risk Professionals. Vector Borne Zoonotic Dis 2019; 20:303-309. [PMID: 31794689 DOI: 10.1089/vbz.2019.2526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Vaccination against rabies and routine antibody testing of subjects participating in programs for the surveillance and control of rabies in animals is strongly recommended. The scope of this study is to describe the antibody level as measured by a commercial enzyme-linked immunosorbent assay (ELISA) after primary and booster intramuscular vaccination with a purified vero-cell rabies vaccine (PVRV) in high-risk professionals and to determine the influence of an array of factors on antibody level, that is, time elapsed since primary immunization series and booster dose, sex, age, pathologic conditions, high-risk occupation, and peak antibody level after initial scheme and booster dose. A primary series of three doses of PVRV was administered and a commercial ELISA was recommended 14 days postimmunization with continuous repetition at 6 months and yearly intervals for the laboratory personnel and the rest of the professionals, respectively. The protective antibody titer was defined as a minimum of 0.5 equivalent units/mL (EU/mL) (seroconvertion) and a booster dose was applied if the titer was determined nonprotective. The seroconversion rate (SCR) after primary vaccination was 100%, with a geometric mean titer (GMT) of 2.90 EU/mL (interquartile range [IQR]: 1.85-3.45). After booster vaccination due to nonprotective titer, the SCR was 100% and the GMT increased by 678% (95% confidence interval [CI]: 514-887) reaching 4.25 EU/mL (IQR: 4.00-4.60), 2.5 times higher than the GMT elicited by the primary vaccine scheme in the respective recipients. The titer dropped by 1.20% per month (95% CI: 0.52-1.89) regardless of booster administration or any other factor. Women had 51% higher titer compared with men (95% CI: 6-116). High-risk professionals should be verified for adequate antibody titers, but routine administration of a single booster dose of PVRV 1 year after the primary series could be considered; more evidence is needed to support the benefit in terms of immunity and logistics.
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Affiliation(s)
| | - Maria Mavrouli
- Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | - Georgia Vrioni
- Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | | | | | - Symeon Metallidis
- Infectious Diseases Division, 1st Internal Medicine Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Istikoglou
- Infection Control Committee, "AHEPA" University Hospital, Thessaloniki, Greece
| | | | - Myrsini Tzani
- Department of Zoonoses, Animal Health Directorate, Directorate General of Veterinary Services, Ministry of Rural Development and Food, Athens, Greece
| | - Ioanna Georgopoulou
- Department of Zoonoses, Animal Health Directorate, Directorate General of Veterinary Services, Ministry of Rural Development and Food, Athens, Greece
| | | | | | - Garyfallia Poulakou
- "Attikon" Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Efthymia Giannitsioti
- "Attikon" Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Charalampos Moschopoulos
- "Attikon" Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Agoritsa Baka
- European Centre for Disease Prevention and Control, Solna, Sweden
| | | | - Sotirios Tsiodras
- National Public Health Organization, Athens, Greece.,"Attikon" Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Athanassios Tsakris
- Department of Microbiology, Medical School, University of Athens, Athens, Greece
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Dougas G, Mellou K, Mitrou K, Kontopidou F, Georgakopoulou T, Tsiodras S. 1413. Surveillance of Variant Creutzfeldt Jakob Disease, Based on the Non-confirmatory Diagnostic Criteria of the EU Case Definition, Greece, 2014–2018. Open Forum Infect Dis 2019. [PMCID: PMC6809159 DOI: 10.1093/ofid/ofz360.1277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Variant Creutzfeldt–Jakob disease (vCJD), is a form of CJD associated with consumption of tissues from cattle infected with bovine spongiform encephalopathy. Confirmation requires cerebral histopathologic examination, ascertaining spongiform change and extensive prion protein deposition with florid plaques. In Greece, the disease has been included in the Mandatory Notification System since 2004 however no reference laboratory has been available since 2009 due to low global occurrence. In 2014, the surveillance system was strengthened to also include possible and probable cases based on the non-confirmatory diagnostic criteria of the EU case definition. Hereby we present the results of the surveillance for 2014–2018. Methods A new reporting form for CJD was introduced at the national level, including fields aligned with EU case definition criteria for vCJD (preconditions, clinical, diagnostic, and epidemiological). The non-confirmatory diagnostic criteria for the classification of probable and possible vCJD cases were based on examinations routinely available at hospitals, namely EEG and cerebral MRI. Reported CJD cases were assessed according to the fulfillment of required combinations of EU criteria for possible, probable, and confirmed vCJD cases. Results From 2014 to 2018, 37 CJD cases were reported, with a median age of 67 years (IQR: 58–73) concerning mostly females (71.3%, 95% CI: 56.7–85.9%). Among the reported cases, 6 (16.2%) fulfilled only the preconditions, 8 (21.6%) fulfilled the preconditions and the clinical criteria, 21 (56.8%) had a compatible EEG, and 7 (18.9%) had a compatible MRI brain scan. Confirmatory examination was not performed to any of the CJD cases; however, no case was classified as possible or probable vCJD based on the EU case definition. Conclusion Notification of CJD patients from 2014 to 2018 in Greece, yielded no vCJD cases. The possible re-emergence of vCJD renders continuous surveillance of the disease imperative. Current EU case definition can support the surveillance of vCJD, by screening CJD patients for possible and probable vCJD cases with the utilization of conventional diagnostic examinations, available in most hospitals. Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | | | | | | | | | - Sotirios Tsiodras
- Athens Medical School, National and Kapodistrian University of Athens, Athens, Attiki, Greece
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Dougas G, Mellou K, Kostoulas P, Billinis C, Georgakopoulou T, Tsiodras S. Brucellosis underreporting in Greece: assessment based on aggregated laborato-ry data of culture-confirmed cases from public hospitals. Hippokratia 2019; 23:106-110. [PMID: 32581495 PMCID: PMC7307503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Brucella spp. isolation is one of the mainstays of brucellosis diagnosis. Simultaneously, the true brucellosis disease rate may be underrepresented in notification systems. This study aims at assessing the nosocomial capacity for Brucella spp. isolation and the underreporting rate of brucellosis cases in Greece. METHODS Data for Brucella spp. culture capacity and the number of isolations were collected annually from public hospitals nationwide, during 2015-2018. The number of unreported cases was estimated after subtracting the National Mandatory Notification System cases from the survey-captured isolations, matched by hospital and year. RESULTS Feedback was provided by 112 public hospitals (response rate: 97.4 %). Brucella spp. isolation capacity was completely absent in 27.7 % of hospitals; during the four years of the study, 11.3 %, 13.9 %, 20.0 %, and 25.2 % of the hospitals had isolation competence for one, two, three, or four years, respectively. Underreporting assessment was possible in hospitals that declared at least one Brucella spp. isolation (n =35) and unreported cases were identified in 19 (54 %). Α mean underreporting of 28.9 % of total cases was estimated for the whole period of the study ranging annually from 24.1 % to 35.0 %. The number of unreported cases per hospital ranged from one to 12 per year (median: 2, IQR: 5). CONCLUSIONS Interventions for improving diagnosis and reporting of the disease are recommended. Assessment of brucellosis underreporting by comparing raw numerical data of survey-captured isolations and officially notified cases lacks the case by case specificity, however, keeping required data to a minimum achieves high feedback rate from hospitals and provides a tentative estimation of the notification deficit. HIPPOKRATIA 2019, 23(3): 106-110.
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Affiliation(s)
- G Dougas
- Zoonoses Unit, Hellenic National Public Health Organization, Athens, Greece
| | - K Mellou
- Zoonoses Unit, Hellenic National Public Health Organization, Athens, Greece
| | - P Kostoulas
- Department of Veterinary Epidemiology, Faculty of Veterinary Science, University of Thessaly, Karditsa, Greece
| | - C Billinis
- Department of Microbiology & Parasitology, Faculty of Veterinary Science, University of Thessaly, Karditsa, Greece
| | - T Georgakopoulou
- Zoonoses Unit, Hellenic National Public Health Organization, Athens, Greece
| | - S Tsiodras
- Zoonoses Unit, Hellenic National Public Health Organization, Athens, Greece
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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10
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Dougas G, Konte V, Mitrou K, Christodoulou E, Stavrakakis M, Baka A, Georgakopoulou T, Metallidis S, Istikoglou I, Pargiana C, Liona A, Tsalikoglou F, Tzani M, Korou M, Tasioudi K, Mavrouli M, Vrioni G, Tsiodras S. 661. Surveillance of Rabies Prophylactic Treatments After Exposure to Animals: 5 Years Experience. Open Forum Infect Dis 2018. [PMCID: PMC6255578 DOI: 10.1093/ofid/ofy210.668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Rabies re-emerged in Greek fauna in October 2012, 25 years after the last report in animals. Hellenic Center for Disease Control & Prevention developed a semi-active surveillance system to monitor the medical management of potentially exposed persons to rabies. This study aims to providing insight on the biologicals administered and the epidemiological characteristics of the cases where post-exposure prophylaxis was initiated after contact with animals. Methods Data received from November 2012 to December 2017 on demographics, exposure event, animal species involved, category of exposure (COE) according to WHO, vaccination history, the veterinary evaluation of the animal and the type of treatment administered, were analyzed with Epidata Analysis V.2.2.2.180. Results A total of 1,616 cases (63.2% males) received rabies post-exposure prophylaxis. In 94.7% of cases cleansing of the wound before visiting a medical practitioner took place during the first 3 hours after the exposure whereas 75.1% of victims presented at a healthcare setting during the first 24 hours; COE III cases had shorter time interval (P < 0.01), before arrival at a hospital (mdn = 1.3 hours) compared with COE II (mdn = 3.6 hours) or COE I (mdn = 88.2 hours) (Figure 1); ![]()
55.1% were initiated on a vaccine series, 43.1% received both vaccine and immunoglobulin and 1.7% immunoglobulin alone. Exposure to stray dogs represented 67.3% of all incidents (Table 1). No human case was recorded. Conclusion The vast majority of the reported treatments involved stray dogs as Greek legislation permits free roaming of ownerless companion animals in urban settings. Bat was the fourth most frequently reported species in our treatment series. Surveillance of post-exposure prophylaxis represents a valuable tool for outlining the epidemiological profile of treated cases and for planning of effective policies for the management of rabies. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Georgios Dougas
- Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Vasileia Konte
- Hellenic Center for Disease Control and Prevention, Athens, Greece
| | | | - Emmanuel Christodoulou
- Department of Internal Medicine, Papanikolaou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Michail Stavrakakis
- Department of Internal Medicine, Papanikolaou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Agoritsa Baka
- Hellenic Center for Disease Control and Prevention, Athens, Greece
| | | | - Symeon Metallidis
- Internal Medicine Department, Infectious Diseases Division, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Istikoglou
- Infection Control Committee, “AHEPA” University Hospital, Thessaloniki, Greece
| | - Chrysa Pargiana
- Infectious Diseases Hospital of Thessaloniki, Thessaloniki, Greece
| | - Aikaterini Liona
- Hellenic Center for Disease Control and Prevention, Athens, Greece
| | | | - Myrsini Tzani
- Department of Zoonoses, Animal Health Directorate, Directorate General of Veterinary Services, Ministry of Rural Development and Food, Athens, Greece
| | - Marilina Korou
- Department of Zoonoses, Animal Health Directorate, Directorate General of Veterinary Services, Ministry of Rural Development and Food, Athens, Greece
| | - Konstantia Tasioudi
- Virology Laboratory – National Reference Laboratory for Rabies in animals, Department of Molecular Diagnostics, FMD, Virological, Rickettsial & Exotic Diseases, Athens Veterinary Center, Ministry of Rural Development and Food, Athens, Greece
| | - Maria Mavrouli
- Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | - Georgia Vrioni
- Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | - Sotirios Tsiodras
- National and Kapodistrian University of Athens Medical School, Athens, Greece
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11
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Dougas G, Konte V, Mitrou K, Georgakopoulou T, Baka A, Liona A, Tatsiou D, Metallidis S, Istikoglou I, Christodoulou E, Stavrakakis M, Pargiana C, Tsalikoglou F, Tzani M, Korou LM, Tasioudi K, Mavrouli M, Vrioni G, Tsiodras S. Surveillance of Rabies Postexposure Prophylaxis in Greece: 4 Years Experience. Vector Borne Zoonotic Dis 2018; 19:295-301. [PMID: 30251935 DOI: 10.1089/vbz.2018.2344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Rabies reemerged in Greek fauna during October 2012, 25 years after the last report in animals and 42 after the last human case. This study examined the administration of rabies postexposure prophylaxis (PEP) in humans over the period 2012-2016. A total of 1,454 individuals (62.6% males) received PEP. The vast majority (92.3%) of regimens was initiated in high risk for animal rabies areas (11.1 PEP per 100,000 residents per year). Among the exposed, 77.0% presented at a healthcare setting during the first 24 h after the incident; more severe injuries were associated with faster presentation (p < 0.05). A vaccine series was administered in 54.5% of exposed persons whereas 43.7% received both vaccine and immunoglobulin and 1.7% immunoglobulin only. Exposure to stray dogs represented 68.4% of all incidents. In exposures occurring in nonhigh risk for rabies areas, bat was the second most frequently involved animal (13.4% of incidents). All dogs and cats evaluated by a veterinarian and laboratory-confirmed rabid were initially deemed suspect for rabies during clinical examination or according to history. No human rabies cases were recorded during the period of the study. Surveillance of PEP represents a valuable tool for aiding assessment of present and future demands in prophylaxis biologicals, outlining the epidemiological profile of exposures and planning effective policies for the management of exposure incidents.
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Affiliation(s)
- Georgios Dougas
- 1 Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Vasileia Konte
- 1 Hellenic Center for Disease Control and Prevention, Athens, Greece
| | | | | | - Agoritsa Baka
- 1 Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Aikaterini Liona
- 1 Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Dimitra Tatsiou
- 1 Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Symeon Metallidis
- 2 First Internal Medicine Department, Infectious Diseases Division, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Istikoglou
- 3 Infection Control Committee, "AHEPA" University Hospital, Thessaloniki, Greece
| | - Emmanuel Christodoulou
- 4 Department of Internal Medicine, "G. Papanikolaou" General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Michalis Stavrakakis
- 4 Department of Internal Medicine, "G. Papanikolaou" General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Chrysa Pargiana
- 5 Infectious Diseases Hospital of Thessaloniki, Thessaloniki, Greece
| | | | - Myrsini Tzani
- 7 Department of Zoonoses, Animal Health Directorate, Directorate General of Veterinary Services, Ministry of Rural Development and Food, Athens, Greece
| | - Laskarina-Maria Korou
- 7 Department of Zoonoses, Animal Health Directorate, Directorate General of Veterinary Services, Ministry of Rural Development and Food, Athens, Greece
| | - Konstantia Tasioudi
- 8 Virology Laboratory - National Reference Laboratory for Rabies in Animals, Department of Molecular Diagnostics, FMD, Virological, Rickettsial & Exotic Diseases, Athens Veterinary Center, Ministry of Rural Development and Food, Athens, Greece
| | - Maria Mavrouli
- 9 Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | - Georgia Vrioni
- 9 Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | - Sotirios Tsiodras
- 10 National and Kapodistrian University of Athens Medical School, Athens, Greece
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12
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Pervanidou D, Detsis M, Danis K, Mellou K, Papanikolaou E, Terzaki I, Baka A, Veneti L, Vakali A, Dougas G, Politis C, Stamoulis K, Tsiodras S, Georgakopoulou T, Papa A, Tsakris A, Kremastinou J, Hadjichristodoulou C. West Nile virus outbreak in humans, Greece, 2012: third consecutive year of local transmission. ACTA ACUST UNITED AC 2014; 19. [PMID: 24721540 DOI: 10.2807/1560-7917.es2014.19.13.20758] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
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Affiliation(s)
- D Pervanidou
- Hellenic Center for Disease Control & Prevention, Athens, Greece
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13
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Gkolfinopoulou K, Bitsolas N, Patrinos S, Veneti L, Marka A, Dougas G, Pervanidou D, Detsis M, Triantafillou E, Georgakopoulou T, Billinis C, Kremastinou J, Hadjichristodoulou C. Epidemiology of human leishmaniasis in Greece, 1981-2011. Euro Surveill 2013. [DOI: 10.2807/1560-7917.es2013.18.29.20532] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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14
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Gkolfinopoulou K, Bitsolas N, Patrinos S, Veneti L, Marka A, Dougas G, Pervanidou D, Detsis M, Triantafillou E, Georgakopoulou T, Billinis C, Kremastinou J, Hadjichristodoulou C. Epidemiology of human leishmaniasis in Greece, 1981-2011. Euro Surveill 2013; 18:20532. [PMID: 23929118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Leishmaniasis is endemic and mandatorily notifiable in Greece. Epidemiological surveillance data for leishmaniasis in Greece between 1981 and 2011 are presented. In 1998, the notification system began distinguishing between visceral and cutaneous leishmaniasis. The mean annual incidence of reported leishmaniasis cases between 1998 and 2011 was 0.36 per 100,000 population. Of a total 563 leishmaniasis cases reported after 1998, 523 (93%) were visceral leishmaniasis cases. Incidence of reported visceral leishmaniasis cases fluctuated during this period, generally decreasing after 2007, with a small re-increase in 2011. The mean annual incidence rate of reported visceral leishmaniasis cases was significantly higher in less than four year-olds (p <0.001). Leishmaniasis cases occurred both in the country mainland and islands. Between 1998 and 2011, Attica concentrated almost half of the reported visceral leishmaniasis cases, with incidence rates in western Attica and western Athens above 12.00 per 100,000 population. Compared to visceral leishmaniasis, cutaneous leishmaniasis had a rather sporadic distribution, with many prefectures appearing free of cases. From 2004, the notification also included risk factors and of 287 cases with known immune status, 44 (15%) were immunocompromised. Moreover having a dog at home was reported by 209 of 312 leishmaniasis cases (67%), whereas 229 of 307 cases (75%) reported the presence of stray dogs near their residence. Linking clinical surveillance data with laboratory data and improving collaboration with the veterinary public health sector are some of the future challenges for leishmaniasis surveillance in Greece.
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Affiliation(s)
- K Gkolfinopoulou
- Department of Epidemiological Surveillance and Intervention, Hellenic Center for Disease Control and Prevention, Athens, Greece.
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15
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Gkolfinopoulou K, Bitsolas N, Patrinos S, Veneti L, Marka A, Dougas G, Pervanidou D, Detsis M, Triantafillou E, Georgakopoulou T, Billinis C, Kremastinou J, Hadjichristodoulou C. Epidemiology of human leishmaniasis in Greece, 1981-2011. Euro Surveill 2013. [DOI: 10.2807/1560-7917.es2013.18.28.20532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Leishmaniasis is endemic and mandatorily notifiable in Greece. Epidemiological surveillance data for leishmaniasis in Greece between 1981 and 2011 are presented. In 1998, the notification system began distinguishing between visceral and cutaneous leishmaniasis. The mean annual incidence of reported leishmaniasis cases between 1998 and 2011 was 0.36 per 100,000 population. Of a total 563 leishmaniasis cases reported after 1998, 523 (93%) were visceral leishmaniasis cases. Incidence of reported visceral leishmaniasis cases fluctuated during this period, generally decreasing after 2007, with a small re-increase in 2011. The mean annual incidence rate of reported visceral leishmaniasis cases was significantly higher in less than four year-olds (p <0.001). Leishmaniasis cases occurred both in the country mainland and islands. Between 1998 and 2011, Attica concentrated almost half of the reported visceral leishmaniasis cases, with incidence rates in western Attica and western Athens above 12.00 per 100,000 population. Compared to visceral leishmaniasis, cutaneous leishmaniasis had a rather sporadic distribution, with many prefectures appearing free of cases. From 2004, the notification also included risk factors and of 287 cases with known immune status, 44 (15%) were immunocompromised. Moreover having a dog at home was reported by 209 of 312 leishmaniasis cases (67%), whereas 229 of 307 cases (75%) reported the presence of stray dogs near their residence. Linking clinical surveillance data with laboratory data and improving collaboration with the veterinary public health sector are some of the future challenges for leishmaniasis surveillance in Greece.
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Affiliation(s)
- K Gkolfinopoulou
- Department of Epidemiological Surveillance and Intervention, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - N Bitsolas
- Department of Hygiene and Epidemiology, Medical Faculty, University of Thessaly, Larissa, Greece
| | - S Patrinos
- Department of Epidemiological Surveillance and Intervention, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - L Veneti
- Department of Epidemiological Surveillance and Intervention, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - A Marka
- Department of Hygiene and Epidemiology, Medical Faculty, University of Thessaly, Larissa, Greece
| | - G Dougas
- Department of Epidemiological Surveillance and Intervention, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - D Pervanidou
- Department of Epidemiological Surveillance and Intervention, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - M Detsis
- Department of Epidemiological Surveillance and Intervention, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - E Triantafillou
- Department of Epidemiological Surveillance and Intervention, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - T Georgakopoulou
- Department of Epidemiological Surveillance and Intervention, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - C Billinis
- Department of Microbiology and Parasitology, Faculty of Veterinary Medicine, University of Thessaly, Karditsa, Greece
| | - J Kremastinou
- Department of Epidemiological Surveillance and Intervention, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - C Hadjichristodoulou
- Department of Hygiene and Epidemiology, Medical Faculty, University of Thessaly, Larissa, Greece
- Department of Epidemiological Surveillance and Intervention, Hellenic Center for Disease Control and Prevention, Athens, Greece
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16
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Tsiodras S, Dougas G, Baka A, Billinis C, Doudounakis S, Balaska A, Georgakopoulou T, Rigakos G, Kontos V, Tasioudi KE, Tzani M, Tsarouxa P, Iliadou P, Mangana-Vougiouka O, Iliopoulos D, Sapounas S, Efstathiou P, Tsakris A, Hadjichristodoulou C, Kremastinou J. Re-emergence of animal rabies in northern Greece and subsequent human exposure, October 2012 – March 2013. Euro Surveill 2013. [DOI: 10.2807/ese.18.18.20474-en] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Greece has been rabies-free since 1987 with no human cases since 1970. During 2012 to 2013, rabies has re-emerged in wild and domestic animals in northern Greece. By end March 2013, rabies was diagnosed in 17 animals including 14 red foxes, two shepherd dogs and one cat; 104 subsequent human exposures required post-exposure prophylaxis according to the World Health Organization criteria. Human exposures occurred within 50 km radius of a confirmed rabies case in a wild or domestic animal, and most frequently stray dogs were involved.
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Affiliation(s)
- S Tsiodras
- National and Kapodistrian University of Athens Medical School, Athens, Greece
- Hellenic Center for Disease Control and Prevention (KEELPNO), Ministry of Health, Athens, Greece
| | - G Dougas
- Hellenic Center for Disease Control and Prevention (KEELPNO), Ministry of Health, Athens, Greece
| | - A Baka
- Hellenic Center for Disease Control and Prevention (KEELPNO), Ministry of Health, Athens, Greece
| | - C Billinis
- School of Veterinary Medicine, University of Thessaly, Karditsa, Greece
| | - S Doudounakis
- Directorate General of Veterinary Services / Animal Health Directorate, Ministry of Rural Development and Food, Athens, Greece
| | - A Balaska
- Hellenic Center for Disease Control and Prevention (KEELPNO), Ministry of Health, Athens, Greece
| | - T Georgakopoulou
- Hellenic Center for Disease Control and Prevention (KEELPNO), Ministry of Health, Athens, Greece
| | - G Rigakos
- Hellenic Center for Disease Control and Prevention (KEELPNO), Ministry of Health, Athens, Greece
| | - V Kontos
- National School of Public Health, Athens, Greece
| | - K E Tasioudi
- Virology Department, Institute of Infectious and Parasitic Diseases, Athens Center of Veterinary Institutes, Ministry of Rural Development and Food, Athens, Greece
| | - M Tzani
- Department of Zoonoses, Animal Health Directorate, General Veterinary Directorate, Ministry of Rural Development and Food, Athens, Greece
| | - P Tsarouxa
- Department of Zoonoses, Animal Health Directorate, General Veterinary Directorate, Ministry of Rural Development and Food, Athens, Greece
| | - P Iliadou
- Virology Department, Institute of Infectious and Parasitic Diseases, Athens Center of Veterinary Institutes, Ministry of Rural Development and Food, Athens, Greece
| | - O Mangana-Vougiouka
- Virology Department, Institute of Infectious and Parasitic Diseases, Athens Center of Veterinary Institutes, Ministry of Rural Development and Food, Athens, Greece
| | - D Iliopoulos
- Hellenic Center for Disease Control and Prevention (KEELPNO), Ministry of Health, Athens, Greece
| | - S Sapounas
- Hellenic Center for Disease Control and Prevention (KEELPNO), Ministry of Health, Athens, Greece
| | - P Efstathiou
- National Health Operations Center of the Ministry of Health (EKEPY), Athens, Greece
| | - A Tsakris
- National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - C Hadjichristodoulou
- Department of Hygiene and Epidemiology, University of Thessaly, School of Medicine, Larissa, Greece
| | - J Kremastinou
- National School of Public Health, Athens, Greece
- Hellenic Center for Disease Control and Prevention (KEELPNO), Ministry of Health, Athens, Greece
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17
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Tsiodras S, Dougas G, Baka A, Billinis C, Doudounakis S, Balaska A, Georgakopoulou T, Rigakos G, Kontos V, Tasioudi KE, Tzani M, Tsarouxa P, Iliadou P, Mangana-Vougiouka O, Iliopoulos D, Sapounas S, Efstathiou P, Tsakris A, Hadjichristodoulou C, Kremastinou J. Re-emergence of animal rabies in northern Greece and subsequent human exposure, October 2012 - March 2013. Euro Surveill 2013; 18:20474. [PMID: 23725773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Greece has been rabies-free since 1987 with no human cases since 1970. During 2012 to 2013, rabies has re-emerged in wild and domestic animals in northern Greece. By end March 2013, rabies was diagnosed in 17 animals including 14 red foxes, two shepherd dogs and one cat; 104 subsequent human exposures required post-exposure prophylaxis according to the World Health Organization criteria. Human exposures occurred within 50 km radius of a confirmed rabies case in a wild or domestic animal, and most frequently stray dogs were involved.
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Affiliation(s)
- S Tsiodras
- Hellenic Center for Disease Control and Prevention (KEELPNO), Ministry of Health, Athens, Greece.
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18
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Karagiannis I, Mellou K, Gkolfinopoulou K, Dougas G, Theocharopoulos G, Vourvidis D, Ellinas D, Sotolidou M, Papadimitriou T, Vorou R. Outbreak investigation of brucellosis in Thassos, Greece, 2008. Euro Surveill 2012. [DOI: 10.2807/ese.17.11.20116-en] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- I Karagiannis
- Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - K Mellou
- Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - K Gkolfinopoulou
- Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - G Dougas
- Hellenic Center for Disease Control and Prevention, Athens, Greece
| | | | - D Vourvidis
- Ministry of Rural Development and Food, Athens, Greece
| | - D Ellinas
- Primary Health Care Center of Prinou, Thassos, Greece
| | - M Sotolidou
- Primary Health Care Center of Prinou, Thassos, Greece
| | - T Papadimitriou
- Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - R Vorou
- Hellenic Center for Disease Control and Prevention, Athens, Greece
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19
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Karagiannis I, Mellou K, Gkolfinopoulou K, Dougas G, Theocharopoulos G, Vourvidis D, Ellinas D, Sotolidou M, Papadimitriou T, Vorou R. Outbreak investigation of brucellosis in Thassos, Greece, 2008. Euro Surveill 2012; 17:20116. [PMID: 22449868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
In spring 2008, the Hellenic Center for Disease Control and Prevention was notified about human brucellosis cases in Thassos, a Greek island that had been up to that point under a brucellosis eradication programme. Following the verification of the outbreak a 1:1 case– control study was conducted in the island. The study revealed that consumption of locally produced raw cheese was a risk factor for Brucella melitensis infection (odds ratio (OR): 15.1, 95% confidence interval (CI): 6.56–34.7). Brucella melitensis biotype 3 was identified in two clinical samples. As a result of the outbreak, the island is no longer officially considered as an area with farms free of brucellosis and is currently under a brucellosis control programme. The investigation of this outbreak demonstrated that control and eradication of brucellosis is not only a question of designing a strategy, but rather of ensuring its continuous, strict implementation. Furthermore, it revealed the lack of appropriate education of the public regarding the risks associated with raw, non heat-treated cheese consumption.
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Affiliation(s)
- I Karagiannis
- Hellenic Center for Disease Control and Prevention, Athens, Greece
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20
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Danis K, Papa A, Theocharopoulos G, Dougas G, Athanasiou M, Detsis M, Baka A, Lytras T, Mellou K, Bonovas S, Panagiotopoulos T. Outbreak of West Nile virus infection in Greece, 2010. Emerg Infect Dis 2012; 17:1868-72. [PMID: 22000357 PMCID: PMC3310677 DOI: 10.3201/eid1710.110525] [Citation(s) in RCA: 139] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
During 2010, an outbreak of West Nile virus infection occurred in Greece. A total of 197 patients with neuroinvasive disease were reported, of whom 33 (17%) died. Advanced age and a history of heart disease were independently associated with death, emphasizing the need for prevention of this infection in persons with these risk factors.
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Affiliation(s)
- Kostas Danis
- Hellenic Centre for Disease Control and Prevention, Athens, Greece.
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21
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Danis K, Baka A, Lenglet A, Van Bortel W, Terzaki I, Tseroni M, Detsis M, Papanikolaou E, Balaska A, Gewehr S, Dougas G, Sideroglou T, Economopoulou A, Vakalis N, Tsiodras S, Bonovas S, Kremastinou J. Autochthonous Plasmodium vivax malaria in Greece, 2011. Euro Surveill 2011. [DOI: 10.2807/ese.16.42.19993-en] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Between May and September 2011, twenty cases of Plasmodium vivax infection were reported in Greek citizens without reported travel history. The vast majority of those cases were confined to a delimited agricultural area of Evrotas, Lakonia. Conditions favouring locally acquired transmission of malaria, including the presence of competent vectors and migrants from endemic countries exist in Greece, underscoring the need for the development of an integrated preparedness and response plan for malaria prevention.
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Affiliation(s)
- K Danis
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - A Baka
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - A Lenglet
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - W Van Bortel
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - I Terzaki
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - M Tseroni
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - M Detsis
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - E Papanikolaou
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - A Balaska
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - S Gewehr
- Ecodevelopment S.A., Thessaloniki, Greece
| | - G Dougas
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - T Sideroglou
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - A Economopoulou
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - N Vakalis
- National School of Public Health, Athens, Greece
| | - S Tsiodras
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - S Bonovas
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - J Kremastinou
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
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22
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Danis K, Baka A, Lenglet A, Van Bortel W, Terzaki I, Tseroni M, Detsis M, Papanikolaou E, Balaska A, Gewehr S, Dougas G, Sideroglou T, Economopoulou A, Vakalis N, Tsiodras S, Bonovas S, Kremastinou J. Autochthonous Plasmodium vivax malaria in Greece, 2011. Euro Surveill 2011; 16:19993. [PMID: 22027375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Between May and September 2011, twenty cases of Plasmodium vivax infection were reported in Greek citizens without reported travel history. The vast majority of those cases were confined to a delimited agricultural area of Evrotas, Lakonia. Conditions favouring locally acquired transmission of malaria, including the presence of competent vectors and migrants from endemic countries exist in Greece, underscoring the need for the development of an integrated preparedness and response plan for malaria prevention.
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Affiliation(s)
- K Danis
- Hellenic Centre for Disease Control and Prevention, Athens, Greece.
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23
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Danis K, Papa A, Theocharopoulos G, Dougas G, Athanasiou M, Detsis M, Baka A, Lytras T, Mellou K, Bonovas S, Panagiotopoulos T. Outbreak of West Nile Virus Infection in Greece, 2010. Emerg Infect Dis 2011. [DOI: 10.3201/eid1710.110525_article.htm] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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24
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Danis K, Papa A, Papanikolaou E, Dougas G, Terzaki I, Baka A, Vrioni G, Kapsimali V, Tsakris A, Kansouzidou A, Tsiodras S, Vakalis N, Bonovas S, Kremastinou J. Ongoing outbreak of West Nile virus infection in humans, Greece, July to August 2011. Euro Surveill 2011; 16:19951. [PMID: 21903037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Between 16 July and 21 August 2011, 31 cases of West Nile neuroinvasive disease were reported from four regions in Greece. Of these, 17 occurred in districts that had not been affected in 2010. The reoccurrence of human cases in two consecutive years (following the large 2010 outbreak) and the spread of the virus in new areas suggest that West Nile virus is established in Greece, and its transmission may continue to occur in the future.
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Affiliation(s)
- K Danis
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
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25
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Danis K, Papa A, Papanikolaou E, Dougas G, Terzaki I, Baka A, Vrioni G, Kapsimali V, Tsakris A, Kansouzidou A, Tsiodras S, Vakalis N, Bonovas S, Kremastinou J. Ongoing outbreak of West Nile virus infection in humans, Greece, July to August 2011. Euro Surveill 2011. [DOI: 10.2807/ese.16.34.19951-en] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Between 16 July and 21 August 2011, 31 cases of West Nile neuroinvasive disease were reported from four regions in Greece. Of these, 17 occurred in districts that had not been affected in 2010. The reoccurrence of human cases in two consecutive years (following the large 2010 outbreak) and the spread of the virus in new areas suggest that West Nile virus is established in Greece, and its transmission may continue to occur in the future.
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Affiliation(s)
- K Danis
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - A Papa
- Department of Microbiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E Papanikolaou
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - G Dougas
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - I Terzaki
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - A Baka
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - G Vrioni
- Department of Microbiology, National and Kapodistrian University of Athens, Athens, Greece
| | - V Kapsimali
- Department of Microbiology, National and Kapodistrian University of Athens, Athens, Greece
| | - A Tsakris
- Department of Microbiology, National and Kapodistrian University of Athens, Athens, Greece
| | - A Kansouzidou
- Department of Microbiology, Infectious Disease Hospital, Thessaloniki, Greece
| | - S Tsiodras
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - N Vakalis
- National School of Public Health, Athens, Greece
| | - S Bonovas
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - J Kremastinou
- National School of Public Health, Athens, Greece
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
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26
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Papa A, Danis K, Baka A, Bakas A, Dougas G, Lytras T, Theocharopoulos G, Chrysagis D, Vassiliadou E, Kamaria F, Liona A, Mellou K, Saroglou G, Panagiotopoulos T. Ongoing outbreak of West Nile virus infections in humans in Greece, July-August 2010. ACTA ACUST UNITED AC 2010; 15. [PMID: 20807489 DOI: 10.2807/ese.15.34.19644-en] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- A Papa
- Reference Laboratory for Arboviruses, First Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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27
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Vorou R, Gkolfinopoulou K, Dougas G, Mellou K, Pierroutsakos IN, Papadimitriou T. Local brucellosis outbreak on Thassos, Greece: a preliminary report. Euro Surveill 2008. [DOI: 10.2807/ese.13.25.18910-en] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Brucellosis is a zoonosis resulting in reproductive failure in wild and domestic animals and febrile disease and occasionally severe infections of the central nervous system and endocarditis in humans. In animals and humans alike, it is found worldwide, including southeastern Europe, the Mediterranean basin (Portugal, Spain, southern France, Italy, Greece, Turkey, northern Africa), parts of Mexico, Central and Latin America, Asia, and Africa [1]. Human brucellosis represents a professional hazard, being acquired via ingestion, inhalation in laboratories or abattoirs, conjunctiva and skin trauma contamination with infected animal tissues and products [1,2]. Symptoms can appear as acute or insidious onset, after five to 60 days and last for days, months and occasionally as long as a year. Relapses can also occur. Treatment is effective with antibiotics. Untreated brucellosis can lead to death (case-fatality ratio around 2%), usually by heart complications.
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Affiliation(s)
- R Vorou
- Hellenic Center for Disease Control and Prevention, Ministry of Health and Social Solidarity, Athens, Greece
| | - K Gkolfinopoulou
- Hellenic Center for Disease Control and Prevention, Ministry of Health and Social Solidarity, Athens, Greece
| | - G Dougas
- Hellenic Center for Disease Control and Prevention, Ministry of Health and Social Solidarity, Athens, Greece
| | - K Mellou
- Hellenic Center for Disease Control and Prevention, Ministry of Health and Social Solidarity, Athens, Greece
| | - IN Pierroutsakos
- Hellenic Center for Disease Control and Prevention, Ministry of Health and Social Solidarity, Athens, Greece
| | - T Papadimitriou
- Hellenic Center for Disease Control and Prevention, Ministry of Health and Social Solidarity, Athens, Greece
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