Outbreak of West Nile Virus Infection in Greece, 2010
01 Oct 2011-Emerging Infectious Diseases (Centers for Disease Control and Prevention)-Vol. 17, Iss: 10, pp 1868-1872
TL;DR: 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, emphasizing the need for prevention of this infection in persons with these risk factors.
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.
Citations
More filters
••
TL;DR: Since its initial isolation in Uganda in 1937 through the present, West Nile virus has become an important cause of human and animal disease worldwide and the known geographic range of WNV transmission and disease has continued to increase over the past 77 years.
Abstract: Since its initial isolation in Uganda in 1937 through the present, West Nile virus (WNV) has become an important cause of human and animal disease worldwide. WNV, an enveloped virus of the genus Flavivirus, is naturally maintained in an enzootic cycle between birds and mosquitoes, with occasional epizootic spillover causing disease in humans and horses. The mosquito vectors for WNV are widely distributed worldwide, and the known geographic range of WNV transmission and disease has continued to increase over the past 77 years. While most human infections with WNV are asymptomatic, severe neurological disease may develop resulting in long-term sequelae or death. Surveillance and preventive measures are an ongoing need to reduce the public health impact of WNV in areas with the potential for transmission.
375 citations
••
TL;DR: The recent global (re)emergence of arthropod-borne viruses (arboviruses), such as chikungunya and Zika virus, was widely reported in the media as though it was a new phenomenon, but this is not the case.
304 citations
••
TL;DR: In a time of economic turmoil, rising health care needs and increasing demand for public services collide with austerity and privatization policies, exposing Greece's population health to further risks.
Abstract: The global economic crisis has affected the Greek economy with unprecedented severity, making Greece an important test of the relationship between socioeconomic determinants and a population's well-being. Suicide and homicide mortality rates among men increased by 22.7% and 27.6%, respectively, between 2007 and 2009, and mental disorders, substance abuse, and infectious disease morbidity showed deteriorating trends during 2010 and 2011. Utilization of public inpatient and primary care services rose by 6.2% and 21.9%, respectively, between 2010 and 2011, while the Ministry of Health's total expenditures fell by 23.7% between 2009 and 2011. In a time of economic turmoil, rising health care needs and increasing demand for public services collide with austerity and privatization policies, exposing Greece's population health to further risks.
222 citations
••
TL;DR: The explosive spread of the lineage 2 WNV in 2008 described here remained not restricted to Hungary and Austria, but this virus dispersed further to the south to various Balkan states and reached northern Greece, where it caused the devastating neuroinvasive WND outbreak in humans in 2010.
194 citations
Cites background from "Outbreak of West Nile Virus Infecti..."
...These concerns became reality in the following year (2010), when this virus caused a severe outbreak of West Nile neuroinvasive disease in the human population of northern Greece, more than 600 km south-east of Hungary, with 197 neuroinvasive human cases and 35 deaths (Danis et al., 2011)....
[...]
02 Apr 2010
TL;DR: The stability in reported incidence of neuroinvasive disease during 2004-2007 might represent an endemic level of WNV transmission and public health education programs should focus on older persons, who are at increased risk for neurologic disease and poor clinical outcomes.
Abstract: Problem/condition West Nile virus (WNV) is an arthropod-borne virus (arbovirus) in the family Flaviviridae and is the leading cause of arboviral disease in the United States. An estimated 80% of WNV infections are asymptomatic. Most symptomatic persons develop an acute systemic febrile illness that often includes headache, myalgia, arthralgia, rash, or gastrointestinal symptoms. Less than 1% of infected persons develop neuroinvasive disease, which typically presents as encephalitis, meningitis, or acute flaccid paralysis. Reporting period 1999-2008. Description of system WNV disease is a nationally notifiable disease with standardized case definitions. State and metropolitan heath departments report cases to CDC through ArboNET, an electronic passive surveillance system. Variables collected include patient age, sex, race, county and state of residence, date of illness onset, clinical syndrome, and outcome of illness. Results During 1999-2008, a total of 28,961 confirmed and probable cases of WNV disease, including 11,822 (41%) WNV neuroinvasive disease cases, were reported to CDC from 47 states and the District of Columbia. No cases were reported from Alaska, Hawaii, Maine, or any U.S. territories. A total of 93% of all WNV patients had illness onset during July-September. The national incidence of WNV neuroinvasive disease peaked in 2002 (1.02 cases per 100,000 population) and was stable during 2004-2007 (mean annual incidence: 0.44; range: 0.39-0.50). In 2008, the incidence was 0.23 per 100,000 population, compared with 0.41 in 2007 and 0.50 in 2006. During 1999-2008, the highest incidence of neuroinvasive disease occurred in West North Central and Mountain states. Neuroinvasive disease incidence increased with increasing age, with the highest incidence (1.35 cases per 100,000 population) occurring among persons aged >or=70 years. The hospitalization rate and case-fatality ratio increased with increasing age among persons with neuroinvasive disease. Interpretation The stability in reported incidence of neuroinvasive disease during 2004-2007 might represent an endemic level of WNV transmission. Whether the incidence reported in 2008 represents a decrease that will continue is unknown; variations in vectors, avian amplifying hosts, human activity, and environmental factors make predicting future WNV transmission levels difficult. Public health action Surveillance of WNV disease is important for detecting and monitoring seasonal epidemics and targeting prevention and control activities. Public health education programs should focus on older persons, who are at increased risk for neurologic disease and poor clinical outcomes. In the absence of an effective human vaccine, WNV disease prevention depends on community-level mosquito control and household and personal protection measures.
194 citations
References
More filters
••
TL;DR: The epidemic in Bucharest reflected increased regional WNF transmission in 1996 and Epidemics of Cx pipiens-borne WNF could occur in other European cities with conditions conducive to transmission.
696 citations
"Outbreak of West Nile Virus Infecti..." refers background in this paper
...The present outbreak was the largest in Europe since 1996, when a large outbreak was observed in Romania (9)....
[...]
...West Nile encephalitis epidemic in southeastern Romania....
[...]
••
TL;DR: Clinicians in the Northeast should maintain a high level of suspicion during the summer when evaluating older patients with febrile illnesses and neurologic symptoms, especially if associated with gastrointestinal complaints or muscle weakness.
Abstract: Outbreaks of West Nile (WN) virus occurred in the New York metropolitan area in 1999 and 2000. Nineteen patients diagnosed with WN infection were hospitalized in New York and New Jersey in 2000 and were included in this review. Eleven patients had encephalitis or meningoencephalitis, and eight had meningitis alone. Ages of patients ranged from 36 to 87 years (median 63 years). Fever and neurologic and gastrointestinal symptoms predominated. Severe muscle weakness on neurologic examination was found in three patients. Age was associated with disease severity. Hospitalized cases and deaths were lower in 2000 than in 1999, although the case-fatality rate was unchanged. Clinicians in the Northeast should maintain a high level of suspicion during the summer when evaluating older patients with febrile illnesses and neurologic symptoms, especially if associated with gastrointestinal complaints or muscle weakness.
234 citations
••
TL;DR: Although further assessment is needed, the long-term neurological and functional sequelae of WNV infection are likely to represent a considerable source of morbidity in patients long after their recovery from acute illness.
Abstract: Since its introduction to North America in 1999, human infection with West Nile virus (WNV) has resulted in considerable acute morbidity and mortality. Although the ongoing epidemic has resulted in a great increase in our understanding of the acute clinical features of human illness and helped to define associated clinical syndromes, far less is known about potential long-term clinical and functional sequelae. Several recent assessments, however, suggest that patients--even those with apparently mild cases of acute disease--frequently have subjective, somatic complaints following WNV infection. Persistent movement disorders, cognitive complaints, and functional disability may occur after West Nile neuroinvasive disease. West Nile poliomyelitis may result in limb weakness and ongoing morbidity that is likely to be long term. Although further assessment is needed, the long-term neurological and functional sequelae of WNV infection are likely to represent a considerable source of morbidity in patients long after their recovery from acute illness.
219 citations
••
TL;DR: The reoccurrence of human cases in two consecutive years 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.
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.
209 citations
••
TL;DR: The West Nile virus detected in Culex pipiens mosquitoes during a severe outbreak of human West Nile disease in Greece 2010 showed closest genetic relationship to the lineage 2 strain that emerged in Hungary in 2004.
Abstract: We conducted a complete genome analysis of a West Nile virus detected in Culex pipiens mosquitoes during a severe outbreak of human West Nile disease in Greece 2010. The virus showed closest genetic relationship to the lineage 2 strain that emerged in Hungary in 2004; increased virulence may be associated with amino acid substitution H249P.
204 citations