Analysis of Bordetella pertussis clinical isolates circulating in European countries during the period 1998-2012.

Despite more than 50 years of vaccination, pertussis is still an endemic disease, with regular epidemic outbreaks. With the exception of Poland, European countries have replaced whole-cell vaccines (WCVs) by acellular vaccines (ACVs) in the 1990s. Worldwide, antigenic divergence in vaccine antigens has been found between vaccine strains and circulating strains. In this work, 466 Bordetella pertussis isolates collected in the period 1998-2012 from 13 European countries were characterised by multi-locus antigen sequence typing (MAST) of the pertussis toxin promoter (ptxP) and of the genes coding for proteins used in the ACVs: pertussis toxin (Ptx), pertactin (Prn), type 2 fimbriae (Fim2) and type 3 fimbriae (Fim3). Isolates were further characterised by fimbrial serotyping, multi-locus variable-number tandem repeat analysis (MLVA) and pulsed-field gel electrophoresis (PFGE). The results showed a very similar B. pertussis population for 12 countries using ACVs, while Poland, which uses a WCV, was quite distinct, suggesting that ACVs and WCVs select for different B. pertussis populations. This study forms a baseline for future studies on the effect of vaccination programmes on B. pertussis populations.

Infectious diseases prioritisation for event-based surveillance at the European Union level for the 2012 Olympic and Paralympic Games.

In 2012, London hosted the Olympic and Paralympic Games (the Games), with events occurring throughout the United Kingdom (UK) between 27 July and 9 September 2012. Public health surveillance was performed by the Health Protection Agency (HPA). Collaboration between the HPA and the European Centre for Disease Prevention and Control (ECDC) was established for the detection and assessment of significant infectious disease events (SIDEs) occurring outside the UK during the time of the Games. Additionally, ECDC undertook an internal prioritisation exercise to facilitate ECDC's decisions on which SIDEs should have preferentially enhanced monitoring through epidemic intelligence activities for detection and reporting in daily surveillance in the European Union (EU). A team of ECDC experts evaluated potential public health risks to the Games, selecting and prioritising SIDEs for event-based surveillance with regard to their potential for importation to the Games, occurrence during the Games or export to the EU/European Economic Area from the Games. The team opted for a multilevel approach including comprehensive disease selection, development and use of a qualitative matrix scoring system and a Delphi method for disease prioritisation. The experts selected 71 infectious diseases to enter the prioritisation exercise of which 27 were considered as priority for epidemic intelligence activities by ECDC for the EU for the Games.

A methodology for optimal MSW management, with an application in the waste transportation of Attica Region, Greece.

The paper describes a software system capable of formulating alternative optimal Municipal Solid Wastes (MSWs) management plans, each of which meets a set of constraints that may reflect selected objections and/or wishes of local communities. The objective function to be minimized in each plan is the sum of the annualized capital investment and annual operating cost of all transportation, treatment and final disposal operations involved, taking into consideration the possible income from the sale of products and any other financial incentives or disincentives that may exist. For each plan formulated, the system generates several reports that define the plan, analyze its cost elements and yield an indicative profile of selected types of installations, as well as data files that facilitate the geographic representation of the optimal solution in maps through the use of GIS. A number of these reports compare the technical and economic data from all scenarios considered at the study area, municipality and installation level constituting in effect sensitivity analysis. The generation of alternative plans offers local authorities the opportunity of choice and the results of the sensitivity analysis allow them to choose wisely and with consensus. The paper presents also an application of this software system in the capital Region of Attica in Greece, for the purpose of developing an optimal waste transportation system in line with its approved waste management plan. The formulated plan was able to: (a) serve 113 Municipalities and Communities that generate nearly 2 milliont/y of comingled MSW with distinctly different waste collection patterns, (b) take into consideration several existing waste transfer stations (WTS) and optimize their use within the overall plan, (c) select the most appropriate sites among the potentially suitable (new and in use) ones, (d) generate the optimal profile of each WTS proposed, and (e) perform sensitivity analysis so as to define the impact of selected sets of constraints (limitations in the availability of sites and in the capacity of their installations) on the design and cost of the ensuing optimal waste transfer system. The results show that optimal planning offers significant economic savings to municipalities, while reducing at the same time the present levels of traffic, fuel consumptions and air emissions in the congested Athens basin.

Cold spells and health: prevention and warning.

OBJECTIVES: The aim of this paper is to point out the kinds of measures that should be implemented to protect the population from the health effects of cold and when to put them into action, thanks to meteorological thresholds. STUDY DESIGN: The authors used pertinence criteria to determine if an alert system would be relevant to trigger preventive measures. METHODS: The pertinence criteria included ability to prevent health impact through specific measures, simplicity, reactivity, adaptability, and the possibility to find indicators able to predict a health impact of cold. This was investigated in two pilot cities, using time-series models to identify mortality-relevant thresholds, if any. RESULTS: Short-term measures are mainly directed at homeless people while actions focussing on the general population are mostly limited to providing advice on how to protect oneself from exposure to cold. The main long-term measures are housing insulation and heating. Combined minimum and maximum temperatures are the best indicators to predict the health impact of cold temperatures on mortality. Associated optimal thresholds for action in Paris were -9 °C and -2 °C for minimum and maximum temperatures respectively while thresholds in Marseille were -3 °C and +4 °C. When both thresholds are reached in a given city, the risk of excess mortality is greater than 15%. CONCLUSION: Simple meteorological indicators could be used to improve the detection of dangerous cold episodes and promote communication. Nevertheless, long-term housing improvement and financial aids for home heating remain the best means to prevent the adverse effects of cold weather on community health.

Malaria in Greece, 1975 to 2010.

Malaria, which was endemic in Greece in the past, was officially eliminated in 1974. Since that time and up to 2010, a number of imported cases (ranging from 19 to 76) have been annually reported. The total number of reported laboratory-confirmed cases between 1975 and 2010 was 1,419. Plasmodium falciparum was identified in 628 (44%) of these cases, while P. vivax was found in 524 (37%). Of the total cases, 1,123 (79%) were male (ratio males vs. females: 3.78). Age was only available for 490 cases, of which 352 (72%) belonged to the 18-40 year-age group. Of the 382 malaria cases reported from 1999 to 2010 for which the region/country of acquisition was known, 210 (55%) were from Africa and 142 (37%) from Asia. The massive introduction of economic migrants, in the period from 1990 to 1991 and from 2006 onwards, mainly from countries where malaria is endemic, resulted in the appearance of introduced sporadic cases. In Peloponnese, Central and East Macedonia, Thrace and East Attica, mosquitoes of the genus Anopheles (e.g. Anopheles sacharovi, A. superpictus and A. maculipenis) that can act as plasmodia vectors are abundant and during the summer of 2011, 27 P. vivax cases were reported in Greek citizens residing in the agricultural area of Evrotas in Lakonia and without travel history. As further P. vivax malaria cases occurred in the Lakonia and East Attica areas in 2012, it is becoming urgent to strengthen surveillance and perform integrated mosquito control that will help eliminate the potential risk of malaria reintroduction and reestablishment.

Ongoing outbreak of dengue type 1 in the Autonomous Region of Madeira, Portugal: preliminary report.

Following the identification of two autochthonous cases of dengue type 1 on 3 October 2012, an outbreak of dengue fever has been reported in Madeira, Portugal. As of 25 November, 1,891 cases have been detected on the island where the vector Aedes aegypti had been established in some areas since 2005. This event represents the first epidemic of dengue fever in Europe since 1928 and concerted control measures have been initiated by local health authorities.

Assessment of public health issues of migrants at the Greek-Turkish border, April 2011.

A joint mission to assess the public health situation of migrants in Greek detention centres was undertaken in April 2011 by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) Regional Office for Europe. The assessment visit follows the increased migration to the Evros prefecture, Eastern Macedonia and Thrace region, at the Greek-Turkish border where large numbers of migrants are entering Greece via the Evros River, a natural border. Migrants are housed in local detention centres. The main problem in detention centres are the substandard hygiene conditions, especially overcrowding and lack of personal hygiene facilities, lack of basic supplies and lack of access to fresh air and physical exercise. As the migration route via the Evros region is increasingly used since 2009, and due to the unstable political situation in North Africa and the Middle East, an increased influx of migrants was to be expected with the falling water levels of the Evros River in summer, resulting in further deterioration of the already critical situation in the Thrace region's detention centres.

Autochthonous Plasmodium vivax malaria in Greece, 2011.

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.

Non-neuroinvasive West Nile virus infections during the outbreak in Greece.

A major outbreak of West Nile virus (WNV) infections took place in 2010 in Greece. Apart from the neuroinvasive cases, many additional cases without involvement of the nervous system were observed, characterized by high fever, myalgia, rash, leukopenia, and long-lasting recovery. West Nile non-neuroinvasive disease is a distinct clinical syndrome, and is not always mild.

Atypical Chikungunya virus infections: clinical manifestations, mortality and risk factors for severe disease during the 2005-2006 outbreak on Réunion.

In April 2005, an outbreak of Chikungunya fever occurred on the island of Réunion in the Indian Ocean. During winter 2005, six patients developed meningoencephalitis and acute hepatitis due to Chikungunya virus. Our objectives were to determine the incidence and mortality of atypical Chikungunya viral infections and to identify risk factors for severe disease. A hospital-based surveillance system was established to collect data on atypical Chikungunya cases. Case reports, medical records and laboratory results were reviewed and analysed. We defined an atypical case as one in which a patient with laboratory-confirmed Chikungunya virus infection developed symptoms other than fever and arthralgia. We defined a severe atypical case as one which required maintenance of at least one vital function. We recorded 610 atypical cases of Chikungunya fever: 222 were severe cases, 65 affected patients died. Five hundred and forty-six cases had underlying medical conditions (of which 226 suffered from cardiovascular, 147 from neurological and 150 from respiratory disorders). Clinical features that had never been associated with Chikungunya fever were recorded, such as bullous dermatosis, pneumonia, and diabetes mellitus. Hypertension, and underlying respiratory or cardiological conditions were independent risk factors for disease severity. The overall mortality rate was 10.6% and it increased with age. This is the first time that severe cases and deaths due to Chikungunya fever have been documented. The information presented in this article may assist clinicians in identifying the disease, selecting the treatment strategy, and anticipating the course of illness.