Human Brucellosis in Greece, 2005-2020: A Persistent Public Health Problem.

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.

Indoor Air Quality Evaluation Using Mechanical Ventilation and Portable Air Purifiers in an Academic Dentistry Clinic during the COVID-19 Pandemic in Greece.

The coronavirus disease 2019 (COVID-19), which is mainly transmitted through droplets without overlooking other sources of transmission, rendered attention on the air quality in indoor areas and more specifically in healthcare settings. The improvement of indoor air quality (IAQ) is ensured by frequent changes of the air that must be carried out in healthcare areas and with assistance from special devices that undertake the filtration of the air and its purification through special filters and lamps. In this research, the performance of air purifiers is assessed in terms of the limitation of PM2.5, PM10, VOCs and CO2 in a postgraduate clinic of the Dentistry School of the National and Kapodistrian University of Athens in parallel with mechanical ventilation. Our findings indicate that the use of mechanical ventilation plays a key role on the results, retaining good IAQ levels within the clinic and that air purifiers show a positive impact on IAQ by mainly reducing the levels of PM2.5 and secondly of TVOC.

Preparing dental schools to refunction safely during the COVID-19 pandemic: an infection prevention and control perspective.

In late 2019 a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in China and spread throughout the world over a short period of time causing a pandemic of a respiratory disease named coronavirus disease 2019 (COVID-19). SARS-CoV-2 is easily transmitted from person to person through respiratory droplets and direct contact. The scarce available data indicate that dental healthcare personnel are at increased risk for acquisition of infection. Following the lockdown lifting, dental schools should be prepared to refunction safely and provide essential educational and healthcare services while protecting their students, patients, and personnel. The generation of aerosols in dental practice, in association with the high-transmissibility of SARS-CoV-2 through aerosol-generation procedures, the simultaneous provision of dental services to patients in the same areas, and the fact that asymptomatic and pre-symptomatic infected persons may transmit the virus, render the implementation of specific infection prevention and control measures imperative for dental schools. Herein we review the few evidence-based data available to guide infection prevention and control measures for COVID-19 in dental schools.

Association Between Upper Respiratory Tract Viral Load, Comorbidities, Disease Severity, and Outcome of Patients With SARS-CoV-2 Infection.

BACKGROUND: There is limited information on the association between upper respiratory tract (URT) viral loads, host factors, and disease severity in SARS-CoV-2-infected patients. METHODS: We studied 1122 patients (mean age, 46 years) diagnosed by polymerase chain reaction (PCR). URT viral load, measured by PCR cycle threshold, was categorized as high, moderate, or low. RESULTS: There were 336 (29.9%) patients with comorbidities; 309 patients (27.5%) had high, 316 (28.2%) moderate, and 497 (44.3%) low viral load. In univariate analyses, compared to patients with moderate or low viral load, patients with high viral load were older, more often had comorbidities, developed Symptomatic disease (COVID-19), were intubated, and died. Patients with high viral load had longer stay in intensive care unit and longer intubation compared to patients with low viral load (P values < .05 for all comparisons). Patients with chronic cardiovascular disease, hypertension, chronic pulmonary disease, immunosuppression, obesity, and chronic neurological disease more often had high viral load (P value < .05 for all comparisons). In multivariate analysis high viral load was associated with COVID-19. Level of viral load was not associated with any other outcome. CONCLUSIONS: URT viral load could be used to identify patients at higher risk for morbidity or severe outcome.

Transmission dynamics of SARS-CoV-2 within families with children in Greece: A study of 23 clusters.

There is limited information on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection clustering within families with children. We aimed to study the transmission dynamics of SARS-CoV-2 within families with children in Greece. We studied 23 family clusters of coronavirus disease 2019 (COVID-19). Infection was diagnosed by reverse-transcriptase polymerase chain reaction in respiratory specimens. The level of viral load was categorized as high, moderate, or low based on the cycle threshold values. There were 109 household members (66 adults and 43 children). The median attack rate per cluster was 60% (range: 33.4%-100%). An adult member with COVID-19 was the first case in 21 (91.3%) clusters. Transmission of infection occurred from an adult to a child in 19 clusters and/or from an adult to another adult in 12 clusters. There was no evidence of child-to-adult or child-to-child transmission. In total 68 household members (62.4%) tested positive. Children were more likely to have an asymptomatic SARS-CoV-2 infection compared to adults (40% vs 10.5%; P = .021). In contrast, adults were more likely to develop a severe clinical course compared with children (8.8% vs 0%; P = .021). In addition, infected children were significantly more likely to have a low viral load while adults were more likely to have a moderate viral load (40.7% and 18.6% vs 13.8% and 51.7%, respectively; P = .016). In conclusion, while children become infected by SARS-CoV-2, they do not appear to transmit infection to others. Furthermore, children more frequently have an asymptomatic or mild course compared to adults. Further studies are needed to elucidate the role of viral load on these findings.

Zika virus, vectors, reservoirs, amplifying hosts, and their potential to spread worldwide: what we know and what we should investigate urgently.

OBJECTIVES: The widespread epidemic of Zika virus infection in South and Central America and the Caribbean in 2015, along with the increased incidence of microcephaly in fetuses born to mothers infected with Zika virus and the potential for worldwide spread, indicate the need to review the current literature regarding vectors, reservoirs, and amplification hosts. VECTORS: The virus has been isolated in Africa in mosquitoes of the genera Aedes, Anopheles, and Mansonia, and in Southeast Asia and the Pacific area in mosquitoes of the genus Aedes. Aedes albopictus has invaded several countries in Central Africa and all Mediterranean countries, and continues to spread throughout Central and Northern Europe. The wide distribution of the virus in animal hosts and vectors favors the emergence of recombinants. ANIMAL HOSTS: The virus has been isolated in monkeys, and antibodies have been detected in domestic sheep, goats, horses, cows, ducks, rodents, bats, orangutans, and carabaos. CONCLUSIONS: It is a public health imperative to define the domestic and wild animal reservoirs, amplification hosts, and vector capacity of the genera Aedes, Anopheles, and Mansonia. These variables will define the geographic distribution of Zika virus along with the indicated timing and scale of the environmental public health interventions worldwide.

Cowpox virus infection: an emerging health threat.

PURPOSE OF REVIEW: Human cowpox, a rare zoonotic infection, evokes a self-limited disease, except for immunocompromised and eczematous patients, particularly children, where it can become severe. The causative agent, cowpox virus, is distributed in Europe, west former USSR, and adjacent areas of Northern and Central Asia, with an increasing number of reports in Europe. The purpose of this paper is to review cowpox with an emphasis on its epidemiology and management. RECENT FINDINGS: Numerous reports of human cowpox affecting young people in Europe indicate that lack of smallpox vaccination, which has been abandoned since 1977, may render the population more vulnerable to cowpox virus. The ownership of wild and exotic animal pets is becoming more popular, and the range of recognized wild and domestic animal hosts is expanding, SUMMARY: Cowpox as a human emerging zoonotic hazard raises public health concerns as well as a question about the production of effective vaccine and antiviral agents.