Contribution of human metapneumovirus to influenza-like infections in North Greece, 2005-2008.

Following its detection in 2001, human metapneumovirus (hMPV) has repeatedly been reported as a respiratory pathogen, especially in children. This study was aimed at determining the proportion of hMPV infections in patients with influenza-like illness (ILI) during the three influenza seasons 2005-6, 2006-7, 2007-8 in northern Greece. We collected 380 nasopharyngeal swabs or aspirates from ILI patients during the winter seasons 2005-2008 and examined them for influenza viruses and hMPV by one-step real time RT-PCR and nested RT-PCR. Influenza viruses were detected in 151 of the 380 specimens (39.7%) and hMPV in 23 of them (6.05%). Co-infections with hMPV and influenza viruses were observed in seven cases. The majority of the ILI patients (60.5%) were 0-18 years-old. However, the incidence of influenza was slightly higher in the age group of 19-60-year-olds, while the incidence of hMPV infections was higher in the age group of 0-18-year-olds. We conclude that hMPV plays an important role as a contributor in influenza-like infections, especially in children. It circulates in the community during influenza seasons and its clinical appearance can be confused with influenza symptoms. However, further research is needed to elucidate the quantitative and qualitative importance of hMPV infections.

Rubella immunity and vaccination coverage of the population of northern Greece in 2006.

This study was prompted by two rubella outbreaks that occurred in northern Greece in the last decade (1993 and 1999) and by periodic changes to the immunisation strategy. It was designed to determine the current status of rubella immunity and vaccination coverage in this region, eight years after the last outbreak in 1999 and seven years after the last epidemiological study in the area. Among the 685 subjects studied the seroprevalence was 83.7% and the total vaccination rate was 31.3%. In people born before the introduction in 1989 of the measles/mumps/rubella (MMR) vaccine into the national immunisation programme, higher rates of rubella seropositivity (88.1%) were observed compared to those born after 1989 (77.1%). The vaccination rates for these age groups were 14.8% and 58.1%, respectively. The reason for this difference is the lack of vaccination at the time these people were children, and it underlines the need for a vaccination strategy targeting older people as well. Among women of reproductive age (16-40 years), who represented 44.8% of the study population, 13.9% were susceptible to rubella and only 18.5% were vaccinated. These results indicate that there is a great need for a comprehensive policy designed to protect mostly young adults and women of childbearing age in order to prevent congenital rubella infections. This policy should also include competent surveillance systems for rubella and congenital rubella syndrome and an evaluation of existing immunisation programmes.

Seroepidemiology of rubella in northern Greece.

In light of two rubella outbreaks in northern Greece during the last decade (1993 and 1999) and periodic changes to the immunization strategy, the present study was conducted to determine the current status of rubella immunity in this region. Among the 729 subjects studied the total vaccination rate was 30.4% and the seroprevalence rate was 82.4% (odds ratio, 0.618; 95% confidence interval, 0.415-0.921). A higher seroprevalence (83.2%) was observed among people born before 1989, when the national rubella immunization program was introduced, compared to the individuals born after 1989 (67.1%; P=0.000). Among women of reproductive age (i.e. 16-40 years), who represented 69.6% of the study population, 10.3% were susceptible to rubella and only 16.4% were vaccinated. The results indicate a comprehensive policy is still needed in order to eliminate rubella and congenital rubella syndrome in Greece.

Influenza vaccination in children with chronic rheumatic diseases and long-term immunosuppressive therapy.

OBJECTIVE: To study the immunogenicity, safety and efficacy of influenza vaccine in children with chronic rheumatic diseases (CRD) receiving long-term immunosuppressive therapy. METHODS: Seventy children (F:M 51:19) with CRD (JIA = 49, SLE = 11, other = 10) aged 4-17 yrs and 5 healthy siblings of the patients (aged < 11 yrs) received a "split type" influenza vaccine (Fluarix SB) licensed for the 1999-2000 winter season. Clinical and laboratory evaluation were performed at study entry and at 1, 3 and 6 months after vaccination. Blood samples were collected before and one month after vaccination and antibody titers to A/Beijing, A/Sydney and B/Beijing influenza antigens were measured using a standardized hemagglutination inhibition assay. RESULTS: Patients were assigned to groups according to the therapeutic regimen [prednisone (PDN), PDN plus 1 disease modifying antirheumatic drug (DMARD), PDN plus 2 DMARDs and 1 or 2 DMARDs without PDN]. 5/70 patients reported local (3) or systemic (2) reactions and 1/5 siblings local reaction. Nine more patients reported mild upper respiratory tract symptoms 1-4 weeks post-vaccination. No patient was found to fulfill criteria for deterioration or flare of the underlying disease. At completion of vaccination 97.14% of patients developed protective HI titers to A/Beijing, 100% to A/Sydney and 80% to B/Beijing. No significant difference in the mean geometric titers was found between patients with different therapeutic regimens or age or between those with JIA or SLE. Disease activity was not related with response or non-response to B/Beijing. No patient reported "flu-like" symptoms during the 6-month period of follow-up. CONCLUSION: The results of our study indicate that children with CRD receiving long-term immunosuppressive therapy at conventional doses respond to influenza vaccination similarly to healthy children without serious adverse reactions or disease flares regardless of their age, type of CRD or therapeutic regimen.

Poliovirus antibody in Northern Greece.

In order to study the serological status of the Northern Greek population to poliovirus, 881 sera from healthy people were examined for neutralizing antibody by the micrometabolic inhibition test. The people under examination were aged from 1 day to 70 years old. Overall, of the 881 sera examined, 704 (80%) had antibodies (titre greater than or equal to 4) to poliovirus 1, 742 (84%) had antibodies to poliovirus 2 and 715 (81%) had antibodies to poliovirus 3. Fifty-five per cent of the sera had antibodies to all three polioviruses while 3.3% had no poliovirus antibody at all. There was no statistically significant difference in the rates of seropositivity to the various poliovirus types or between males and females. However the rates of seropositivity did vary with age.

Distribution of influenza viruses in Northern Greece during 1972-1983.

Observations on the circulation of influenza viruses in Northern Greece during the winters of 1972/3 to 1982/3 are presented. Influenza A viruses were detected every winter with the exception of those of 1973/4 and 1981/2, when neither type A nor type B was isolated. The strains of type A isolated during the study period were similar to those circulating world-wide over the same time scale. Influenza B viruses were isolated only during the winters of 1972/3 and 1979/80; influenza A viruses were also circulating in the community at those times. The B strains detected were similar to those recorded world-wide during the period of study.