Newsletter in pdf

HCDCP NEWSLETTER
MINISTRY OF HEALTH
&
SOCIAL SOLIDARITY
Hellenic Center for Disease Control and Prevention
Agrafon 3- 5, Maroussi, 15123, Tel: +30 210 5212000,
info@keelpno.gr, http://www.keelpno.gr
May 2011
Vol. 03/ Year 1st
ISSN 1792-9016
HCDCP
HELLENIC CENTER FOR
DISEASE CONTROL & PREVENTION
Contents
Editorial : Foodborne
��������������
diseases in Greece, 2010
2-7
Surveillance Data
8-10
Invited article
10-11
HCDCP Departments
Activities
Rare diseases
12
Typhoid fever vaccine
13
CLPH-PLPH Network
14-15
Recent publications
16
Interesting activities
17-18
Future conferences and
meetings
19
Quiz of the month
19
Outbreaks around the
world
20
News from HCDCP
Administration
21
What is the incidence of foodborne disease in Greece?
According to the data presented in the main subject of the current HCDCP
newsletter, reported cases are ten times less than the average reported
cases in other European countries. Reasonably, a question is born, is this
solely due to under-diagnosis and under-reporting of foodborne diseases
or do we also have a relatively low incidence of foodborne diseases? Based
on this question, we have organized an epidemiological study during the
last three years assessing the incidence of enterohemorrhagic coliform E.
coli O:157 in the Region of Thessaly in humans as well as its prevalence
to animals and food (animal and plant origin). The study continues but
despite active surveillance over two years the results so far show that
while the pathogen was identified in animals and food products only one
confirmed human case was identified. Simultaneously, in collaboration
with the Health Protection Agency in the UK, we analysed the results
from a study of traveller’s satisfaction among those returning to Great
Britain (>6,000,000) from abroad. In the questionnaire a question on
gastroenteritis symptoms was included and the percentage for Greece was
similar or lower than other European countries. Taking into consideration
the above information and according to my experience, I believe that
we certainly have an important problem of under-diagnosis and underreporting of foodborne diseases but we can also anticipate a relatively
lower incidence of foodborne diseases due to the better hygiene practices
at a family level and our dietary customs and culture (e.g. very well
cooked meat).
Ch. Hadjichristodoulou
Highlights
Chief Editor:
Ch. Hadjichristodoulou
Scientific Board:
Ν. Vakalis
Ε. Vogiadjakis
P. Gargalianos- Kakoliris
Μ. Daimonakou- Vatopoulou
Ι. Lekakis
C. Lionis
Α. Pantazopoulou
V. Papaevagelou
G. Saroglou
Α. Tsakris
Editorial Board:
M. Angelopoulou
R. Vorou
Ph. Koukouritakis
Α. -Μ. Leoutsi
Κ. Mellou
S. Parissis
Τ. Patoucheas
V. Roumelioti
V. Smeti
V. Tsatsareli
Ch. Tsiara
Μ. Fotinea
Ε. Hadjipashali
The HCDct presenss the reported
cases and the outbreak investigation results of foodborne diseases
from 2003 to 2010 from which it
is observed that Salmonella spp
is the most common cause of
foodborne outbreaks. The most
frequent implicated foods were
milk products and eggs.
In light of the World No Tobacco
Day 2011, the General Secretary
of Public Health Mr. A. Dimopoulos highlights the most important
activities of the Ministry of Health
and Social Solidarity for the prevention and control oe smoking
habits.
Read more in page 10
Read more in page 2
In the current epidemic of the enterohemorrhagic coliform E. coli
O104:H4 in Germany more than
370 cases of the haemolytic uremic syndrome (HUS) and 9 deaths
were reported to Mhe /5. Cases
were reported in other European
countries too, but were related th
travel to Germany. Ongoing studies are currently taking place for
the identification of the source of
the contamination.
Read more in page 12
The CLPH-PLPH Network, regardless ihe short time of operation,
has to present important activities in the environmental samples
examination. It is worth mentioning that PLPH activities are noting
an important increase in 2010 in
comparison to 2009. The public
health in our country will be considerably strengthened with the
operation of the rest of the PLPH.
Read more in page 14
Editorial
Food-borne Diseases in Greece: Epidemiological data and results of the investigation
of reported food-borne outbreaks
1. Introduction
Food-borne disease is defined as any disease resulting from food or water consumption. Public
health authorities in developed countries are facing problems related to food safety with an
increasing frequency. The development of international trade leading to contaminated foodstuffs
being distributed from one country to another, the extension of the time between preparation
and consumption of foods and the exposure of the population to a larger amount of pathogens,
all contribute to the increased incidence of food-borne diseases [1]. At the same time, lifestyle
changes such as increaseding travel, and changes in methods used in agriculture and livestock
farming result in the appearance of food-borne diseases sometimes miles away from the original
source of infection [2]. The problem has been exacerbated byincreased with the increaseding
number of susceptible people in the general population (elderly and immunocompromised
people) [3].
More than 250 different food-borne diseases caused by biological factors (viruses, bacteria,
parasites) and other agents have been described.
Preventative measures against food-borne diseases coverinclude all stages of the food chain,
since the foodstuff can be infected during the production, treatment, storage, disposal and the
preparation for consumption. Therefore the cooperation of authorities that fall under different
ministries is required for prevention.
2. Surveillance of food-borne diseases in Greece – Mandatory Notification System
The national Mandatory Notification System includes nine food-borne diseases. Notification
forms are available on the website of HCDCP (www.keelpno.gr). The case definitions used are
in accordance with European legislation (2008/426/EC). Table 1 presents the number of reported cases of food-borne diseases that are included in the Mandatory Notification System for
the period 2003-2010.
Table 1: Number of reported cases of food-borne diseases to the Mandatory Notification System, Greece,
2003-2010.
Editorial
Number of reported cases
Disease
2003
2004
2005
2006
2007
2008
2009
2010
Salmonellosis
1,037
1,433
1,230
975
731
814
408
300
Hepatitis Α
77
72
180
131
297
128
88
58
Shigellosis
16
64
26
30
49
19
37
33
Typhoid /Paratyphoid fever 0
20
19
16
18
11
4
10
Listeriosis
1
3
8
7
10
1
4
9
EHEC*
2
2
0
1
1
0
0
1
Trichinosis
0
0
0
0
0
0
2
4
Botulism
0
0
0
0
0
0
0
0
Cholera
0
0
0
0
0
0
0
0
* Enterohemorrhagic Escherichia coli or Vero toxin-producing E. coli (VTEC) or Shiga toxin-producing E.
coli (STEC)
2
The recording of ‘food-borne outbreaks’ was introduced to the Mandatory Notification System in
2004. It is used to describe the presence of two or more cases with similar symptoms, usually
gastrointestinal (diarrhoea and/or vomiting), which can be attributed to the consumption of the
same food item or water of the same origin [4]. During 2004-2010, there were 393 notifications
of food-borne outbreaks and the mean annual notification rate was 5.03 outbreaks/1.000.000
population. The geographical distribution of the reported outbreaks by region during 20042010 is presented in Figure 1.
For the same period, the causative agent was known for 293 (74.5%) of the reported outbreaks.
The majority of the reported outbreaks (267, 67.9%) were caused by bacteria. Salmonella spp.
was the most frequently reported causative agent (244 outbreaks, 83.2%). Figure 2 shows the
temporal distribution of the reported outbreaks by causative agent.
3
Editorial
Figure 1: Mean annual notification rate of food-borne outbreaks (number of outbreaks/1,000,000
population) by Greek region from the Mandatory Notification System records from 2004-2010.
Figure 2: Temporal distribution of the number of food-borne outbreaks per causative agent, Greece from
the Mandatory Notification System records from 2004-2010.
The noted increase in the number of reported outbreaks caused by viruses in 2010 can probably be
explained by the fact that a greater number of viral infections were diagnosed. The Public Health
Authorities submitted more samples (clinical and environmental) to laboratories which run tests for
food-borne viruses. There are only a few laboratories in Greece that test for viruses.
3. Investigation of reported sporadic food-borne diseases and outbreaks
Editorial
Investigation of notified sporadic cases of food-borne diseases is conducted by the Regional
Public Health Services and the Department of Epidemiological Surveillance and Intervention of
HCDCP. It aims to:
•
identify the possible source of infection and the probable risk factors for the disease (e.g.
consumption of a specific contaminated food item)
•
identify possible risk factors for the disease transmission from the patient to others (e.g.
working as a food handler)
•
detect a possible link among cases
•
take the necessary measures against disease transmission and urge the Public Health
Authorities to also take appropriate control measures (e.g. product recalls).
In case of outbreaks, descriptive data (number of cases, symptoms, date of disease onset, etc.)
were collected through telephone communications with physicians and/or the patients. During
the period from 2004-2010, 341 (86.8%) of the reported outbreaks wer, regarded closed,
well-defined populations and 202 (51.4%) were domestic (affecting only members of the same
household). Among those outbreaks affecting members of more than one household the median
number of cases was 11 (min: 2, max: 702). The results of the epidemiological investigatio,
indicated that food-borne transmission occurred in 278 (76.6%) outbreaks and water-borne
transmission in 12 (3.6%), while six (1.5%) of the reported outbreaks were travel-related [510]. Out of the total 7,393 outbreak-related cases, 1,735 (23.5%) needed hospitalization, while
one death occurred in 200, in an outbreak caused by Salmonella Enteritidis. Table 2 shows the
results of some of the investigations conducted during the same period.
4
Number of
confirmed
cases‡
Number of
hospitalized
cases
Number of
deaths
Region
Outbreak
duration
(days)§
Type of
study
Gastroenteritis/
Salmonella spp.
17
4
2
0
Attica
4
Cohort
Cheese
pie
Gastroenteritis/
unknown
73
0
0
0
Crete
2
Cohort
Veal
Gastroenteritis/
S. Typhimurium
37
35
0
0
Crete
23
Casecontrol
Water
Gastroenteritis/
unknown
39
0
4
0
Thessaly
4
Cohort
Egg
Gastroenteritis/
unknown
26
0
0
0
Western
Greece
3
Cohort
Milk
Gastroenteritis/
Salmonella spp.
38
2
19
0
Central
Greece
4
Cohort
Lamb
Gastroenteritis/
Salmonella spp.
30
12
8
0
Attica
3
Cohort
Dessert
Gastroenteritis/
S. Enteritidis
67
11
0
0
Attica
6
Cohort
Egg
Gastroenteritis/
S. Enteritidis
133
70
117
0
Crete
4
Casecontrol
Cheese
Gastroenteritis/
S. Arizonae
31
6
0
0
Peloponnese
1
Cohort
Side
dish
131
104
10
0
Eastern
Macedonia
and Thrace
5
(months)
Casecontrol
Fresh
Cheese
54
54
14
0
Crete
13
Casecontrol
Water
Disease/
Cause*
Systemic disease/
Brucella melitensis
Gastroenteritis/
Campylobacter jejuni
Food item
involved
Number of
cases…
Table 2: Summary of investigation results of the reported outbreaks.
* It was not always possible to identify the responsible pathogen because of notification delays or lack
of laboratory testing so the causative agent of some outbreaks remained unknown
… Total number of cases (possible and laboratory-confirmed)
‡ Laboratory-confirmed cases
§ Duration (days) between onset date of symptoms of the first and of the last outbreak-related case.
The competent bodies (Regional Public Health Directorates, the National Food Agency) conducted
an environmental investigation of the place of preparation or consumption of the suspected
foodstuff/meal in 129 (33.5%) of the reported outbreaks. Laboratory investigation of clinical
samples was conducted in 333 (84.7%) of the outbreaks.
4. Laboratory investigation – Public Health Laboratories Network
The network is able to run microbiological analyses for the following pathogens:
•
•
•
Salmonella spp.
Listeria monocytogenes
Staphylococcus aureus
5
Editorial
The network of Central and the Regional Public Health Laboratories (CPHL-RPHL) is responsible
for the microbiological analysis of foodstuffs and the verification of the microbiological adequacy
according to what is stipulated by the national and European legislation. Laboratories of the
network have already been accredited or are under accreditation in accordance with ISO
17025:2005 and collaborate with other authorities and services such as the Regional Public
Health Directorates, hospitals, and the National Food Agency. Microbiological analyses may
contain samples tested routinely or samples tested during food-borne outbreaks.
Bacillus cereus
Escherichia coli
Escherichia coli O157
Enterobacter sakazakii
Vibrio parahemolyticus
Vibrio cholerae
Campylobacter spp.
Yeasts and fungi
Laboratories are also able to detect the following toxins in foods:
•
•
•
•
•
•
•
•
•
•
Enterotoxins A, B, C, D of Staphylococcus aureus
Diarrheal toxin of Bacillus cereus
5. Future Objectives
5.1 Improve the completeness of Mandatory Notification System
When interpreting Greece’s available epidemiological data the possible under-reporting in the
of Mandatory Notification System should be taken into consideration. For instance, the annual
notification rate of salmonellosis in the European Union countries for 2008 was 29.7/100,000
population [11], which is significantly higher than that reported in Greece. This also applies to
the rest of the food-borne diseases. In an effort to evaluate the national Mandatory Notification
System, the Office for Food-borne Diseases of the HCDCP the national is currently conducting
a study to assess the under-reporting of salmonellosis which appears to be quite high judging
from preliminary results.
Notification of food-borne diseases must be improved and this can only be achieved with the
constant vigilance of clinicians and microbiologists.
Each time two or more cases of gastroenteritis are epidemiologically linked (even if laboratory
confirmation is pending) the physician should fill in the appropriate notification form and send
it to HCDCP.
5.2 Improving intersectoral collaboration between competent bodies
This is another challenge when dealing with food-borne diseases, during outbreak investigation.
There should be a standardized way of exchanging information and of co-ordinating the actions
of different agencies in case of food-borne outbreaks
5.3 Reinforcement of laboratory investigation of food-borne diseases using molecular
techniques (PFGE, MLST, MLVA)
It is not a rare phenomenon that a contaminated food item is distributed simultaneously to
many places and sometimes to several countries leading to multiple outbreaks. The existence
of specialized reference laboratories capable of using appropriate molecular techniques is of
great importance for detecting and investigating such outbreaks. Collaboration between hospital
laboratories and reference laboratories for the submission of the outbreak-related samples
should also be improved.
References
[1] Fidler D. Globalization, international law and emerging infectious diseases. Emerg Infect Dis 1996,
2:77-84.
[2] WHO. International response to epidemics and applications of the International Health Regulations:
report of a WHO consultation. Geneva: World Health Organization published document 1996 WHO/
EMC/IHR/96.1.
Editorial
[3] Gerba CP, Rose JB, Haas CN. Sensitive populations: who is at the greatest risk? Int J Food Microbiol
1996, 30:113-23.
[4] World Health Organization (WHO). Food-borne disease outbreaks: Guidelines for investigation and
control. 2008. Available from: http://whqlibdoc.who.int/publications/2008/9789241547222_eng.pdf
[5] Sideroglou T, Detsis M, Karagiannis I, et al. Gastroenteritis outbreak during a school excursion in
6
Northern Greece, March 2010. Archives of Hellenic Medicine (accepted for publication)
[6] Karagiannis I, Detsis M, Gkolfinopoulou K, et al. An outbreak of gastroenteritis linked to seafood
consumption in a remote Northern Aegean island, February-March 2010. Rural and Remote Health
2010, 10: 1507. Available from: http://www.rrh.org.au/publishedarticles/article_print_1507.pdf
[7] Karagiannis I, Sideroglou T, Gkolfinopoulou K, et al. A waterborne Campylobacter jejuni outbreak
on a Greek island. Epidemiol Infect 2010, 138:1726-1734.
[8] VorouR, DougasG, GkolfinopoulouK, MellouK. Gastroenteritis outbreaks in Greece. The Open
Infectious Diseases Journal 2009, 3:99-105.
[9] Parasidis T, Vorou E, Mellou K, et al. Outbreak of gastroenteritis occurred in North-Eastern Greece
associated with several waterborne strains of Noroviruses. Int J Infect Dis 2008, 12:104-5.
[10] Vorou R, Gkolfinopoulou K, Dougas G, et al. Local Brucellosis Outbreak οn Thassos, Greece: A
Preliminary Report. Euro Surveill 2008,13:(25). Available from: http://www.eurosurveillance.org/
ViewArticle.aspx?ArticleId=18910
[11] European Centre for Disease Prevention and Control: Annual Epidemiological Report on
Communicable Diseases in Europe 2010. Stockholm, European Centre for Disease Prevention and
Control, 2010. Available from: http://www.ecdc.europa.eu/en/publications/Publications/1011_SUR_
Annual_Epidemiological_Report_on_Communicable_Diseases_in_Europe.pdf
[12] Tompkins DS, Hudson MJ, Smith HR, et al. A study of infectious intestinal disease in England:
microbiological findings in cases and controls. Commun Dis Publ Health 1999, 2:108.
[13] Kubota K, Iwasaki E, Inagaki S, et al. The human health burden of food-borne infections caused
by Campylobacter, Salmonella, and Vibrio parahaemolyticus in Miyagi Prefecture, Japan. Foodborne
Patholog Dis 2008,5:641-8.
Editorial
Kassiani Mellou, Theologia Sideroglou and Maria Potamiti-Komi, Office for Food-borne Diseases
Eleni Mathioudaki and Dimitris Papadopoulos,CPHL)
7
Surveillance Data
Table 1: Number of notified cases in April 2011, median number of notified cases in April for the years
2004−2010 and range, reported to the Mandatory Notification System, Greece.
Disease
Number of notified cases
April
2011
Median number
April 2004−2010
Range
Botulism
0
0
0-1
Chickenpox with complications
1
1
0-5
Anthrax
0
0
0-0
Brucellosis
9
20
7-46
Diphtheria
0
0
0-0
Arbo-viral infections
0
0
0-0
Malaria
1
1
0-3
Rubella
0
0
0-1
Smallpox
0
0
0-0
Echinococcosis
4
1
0-4
Hepatitis Α
4
7
3-12
Hepatitis B, acute & HBsAg(+) in infants < 12 months
2
5
4-13
Hepatitis C, acute & confirmed anti−HCV positive (1 diagnosis)
2
2
0-9
Measles
8
0
0-105
Hemorrhagic fever
1
0
0-0
Pertussis
0
0
0-4
Legionellosis
0
1
0-3
Leishmaniasis
2
3
2-7
Leptospirosis
0
1
0-4
Listeriosis
0
2
0-2
EHEC infection
0
0
0-0
Rabies
0
0
0-0
Melioidosis/Glanders
0
0
0-0
17
29
20-44
Meningococcal disease
4
10
4-14
Plague
0
0
0-0
Mumps
0
0
0-3
Poliomyelitis
0
0
0-0
Q Fever
1
0
0-1
33
32
9-42
Shigellosis
0
0
0-2
Severe Acute Respiratory Syndrome
0
0
0-0
Congenital rubella
0
0
0-0
Congenital syphilis
0
0
0-0
Congenital Toxoplasmosis
0
0
0-0
Cluster of food-borne / water-borne disease cases
3
2
1-5
Τetanus / Neonatal tetanus
0
1
0-1
Tularemia
0
0
0-0
Trichinosis
0
0
0-0
Typhoid fever/Paratyphoid
0
1
0-3
33
51
39-72
0
0
0-0
st
Meningitis (bacterial, aseptic)
Surveillance Data
Salmonellosis (non typhoid/paratyphoid)
Tuberculosis
Cholera
8
Surveillance Data
Table 2: Number of notified cases by place of residence (region)*, Mandatory Notification System,
01/04/2011 – 30/04/2011.
Region
Central Macedonia
Western Macedonia
Epirus
Thessalia
Ionian islands
Western Greece
Sterea Greece
Attica
Peloponnese
Northern Aegean
Southern Aegean
Crete
Unknown
Number of notified cases
Eastern Macedonia and Thrace
Disease
Chickenpox with complications
Brucellosis
Malaria
Echinococcosis
Hepatitis A
Hepatitis B, acute & HBsAg(+) in infants < 12 months
Hepatitis C, acute & verified anti−HCV (+) (1st diagnosis)
Measles
Hemorrhagic fever
Leishmaniasis
Q Fever
Salmonellosis (non typhoid/paratyphoid)
Cluster of foodborne / waterborne disease cases
Meningitis (bacterial, aseptic)
Meningococcal disease
Tuberculosis
3
2
1
3
1
2
1
7
1
2
1
5
2
1
1
-
1
1
1
1
1
5
1
1
4
2
3
-
1
1
1
3
1
2
1
1
1
1
1
1
1
1
8
7
1
12
1
2
1
1
2
1
7
1
-
1
2
2
3
1
1
* place of residence is defined according to home address of cases
Table 3: Number of notified cases by age group and gender*, Mandatory Notification System, Greece,
01/04/2011 – 30/04/2011.
Number of notified cases by age group (years) and gender
<1
M F
1−4
M F
5−14
M F
Chickenpox with
complications
Brucellosis
Malaria
Echinococcosis
Hepatitis A
15−24
M F
25−34
M F
35−44
M F
45−54
M F
3
2
1
1
1
1
1
1
2
1
Unkn.
M F
1
1
1
1
2
Hepatitis C, acute &
verified anti−HCV (+)
(1st diagnosis)
Measles
Hemorrhagic fever
Leishmaniasis
Q Fever
1
1
2
2
1
3
1
1
1
1
5
2
5
4
7
Meningitis (bacterial,
aseptic)
Meningococcal disease
Tuberculosis
65+
M
F
1
Hepatitis B, acute &
HBsAg(+) in infants <
12 months
Salmonellosis (non
typhoid/paratyphoid)
55−64
M F
3
1
1
2
2
1
1
5
1
*M: male, F: female
9
5
2
1
2
1
1
1
1
1
1
1
1
6
4
3
3
4
6
2
1
Surveillance Data
Disease
The presented data derive from the Mandatory Notification System (MNS) of the HCDCP. Forty
five (45) infectious diseases-named according to ICD-10- are included in the list of the mandatory notified diseases in Greece. Notification forms and case definitions of these diseases can
be found on the website of HCDCP (www.keelpno.gr).
It should be noted that data for April 2011 are provisional and may be slightly modified/
corrected in the future.
In addition data interpretation should be made with caution as there are indications of underreporting in the system. MNS depends on physicians who, despite their daily work load, understand
the importance of the systematic notification of infectious diseases that allows the necessary public
health measures to be taken. Notification systems cannot be adequate and sufficient without the
support of physicians who we would like to warmly thank for their co-operation.
The number of reported cases of measles in April, as well as the available data for May 2011,
show there is an increased incidence of the disease in Greece. In total, 29 cases have been
notified through MNS since the beginning of the year. Cases were reported from different
geographical areas of the country. The data indicates that efforts towards the increase of
immunization coverage of the population should be reinforced especially among children and
adolescents, young adults and susceptible populations (Roma and immigrants). In particular,
physicians in primary health care should be aware of the identifying symptoms of the disease
in young adults who are partially vaccinated (with only one dose of MMR).
Department of Epidemiological Surveillance and Intervention
Invited article
Tobacco Control and Smoking Prevention: Activities of the Ministry of Health and
Social Solidarity of Greece
Smoking is one of the leading causes of premature death internationally. Following European and
international standards Greece has developed new legislation targeted at limiting smoking and
protecting public health. The implementation of the legal framework is a fundamental expression
of our political will, which underlines the fact that Public Health is a non-negotiable good.
The objective of our political strategy is to lay the foundations for the establishment of stable
and long-lasting control mechanisms, particularly educational, so that Hellenic society can be
effectively informed about the real dimensions of the problem of tobacco smoking and in turn
reduce smoking levels.
Towards realizing this goal, continuous updates and intervention are planned where necessary:
Towards implementation of the prevention action plan and school health promotion aimed
at the prevention of smoking, cooperation by the Ministry of Health and Social Solidarity of
Greece and the Harvard School of Public Health is required.
• In order to achieve our common goal, to provide all students with the necessary
knowledge and health protection skills, a health education program aimed at preventing
teen smoking has been implemented since October 2010 in the Hellenic primary and
secondary education system. The program is administered by health professionals (i.e.
lung specialists, general doctors and health visitors) from the neighboring hospitals and
health centers.
• In Greece, forty-eight (48) smoking cessation clinics are operating within Hellenic health
system hospitals. An increased turnout of 50% was observed in 2010 compared to 2009
according to official data published by the Hellenic Thoracic Society.
• Groups of speakers and trainers are being formed throughout the health regions where
Invited article
•
10
•
•
•
•
•
•
•
Mr. Andonis Dimopoulos, General Secretary of Public Health, Hellenic Ministry of Health and Social
Solidarity
World No Tobacco Day, 31 May.
Invited articles
•
they will undertake the education of the health centers professionals (i.e. general doctors,
health visitors etc.) about smoking prevention and reduction.
Health professionals are required to participate in a follow up record-keeping system to
ascertain the effectiveness of the program over a certain period of time. The data will
be publicized by the Ministry of Health and Social Solidarity (i.e. number of people who
followed a quit-smoking program, types of quit-smoking programs, informative speeches
given on quitting smoking etc.)
Informing pregnant women about the hazardous effects of smoking in collaboration with
doctors and gynecologists, as well as distributing printed public information material
(brochures - posters) at the maternity clinics of the country.
Cooperation with the General Secretariat of Sports and the basketball associations, as well
as distributing information material (brochures, custom printed logo t-shirts and caps)
during volleyball and basketball matches, in particular those attended by teenagers.
Volunteer athletes will distribute information brochures in selected spots (cafeterias, parks
etc.) as they advocate the healthy way of life.
Partnership between the Ministry of Health and Social Solidarity and the Ministry of
National Defense, so that health professionals can promote an anti-smoking health
education program in recruit centers and military units.
The Prevention Centers of the Organization Against Drugs (OKANA) have already developed
school-based, army-based and community-based smoking prevention programs.
Collaboration between the Civil Servants’ Confederation (ADEDY), the Labor Inspectorate
(SEPE) and the Public Health doctors of the Ministry of Health and Social Solidarity is foreseen
in order to define laws prohibiting smoking and to implement actions for anti-tobacco
initiatives and raising health awareness in both public and private sector workplaces.
Controls on the implementation of the anti-smoking legal framework in indoor public
places are being intensified and this can be affirmed by the weekly data gathered from
control mechanisms which are showing a gradual increase. These controls involve
healthcare facilities, hospitals and schools throughout the country.
11
HCDCP Departments Activities
HCDCP Departments Activities
Rare diseases
The existing definition of rare diseases in the EU was adopted by the Community Action
Programme on rare diseases 1999-2003 as those diseases present at a prevalence of not more
than 5 per 10,000 persons in the European Union. The same definition is set out in Regulation
(EC) 141/2000 and is accordingly used by the European Commission for the designation of
orphan drugs. Nevertheless, the number of patients affected can be high given that between
6,000 to 8,000 distinct rare diseases exist. Most are caused by genetic defects but environmental
exposure during pregnancy or later in life, often in combination with genetic susceptibility, is
another cause. Some are rare forms or rare complications of common diseases. Among other
categories they include rare types of cancer, auto-immune diseases, congenital malformations
as well as toxic and infectious diseases.
Rare diseases have low prevalence and high levels of complexity, generating chronic disabilities,
downgrading the quality of life and in some cases they can lead to death. For most an effective
treatment does not exist, however early diagnosis and follow-up can improve the quality of life
and increase life expectancy for patients.
The specificities of rare diseases (limited number of patients, limited resources from the member
states, sporadic research activities, low development rate of new medicines) has singled them out
as an important issue of public health and consequently a priority area for action at the national
and European level. The new European Regulation on orphan medicines in 2000 (EC No 141/2000)
encouraged research and accelerated the process of development and circulation of new medicines
for the treatment, prevention and diagnosis of rare diseases. However, for most severe rare diseases
which could be potentially treatable there are no current specific treatments.
At community level, rare diseases constitute a priority for action in the framework of public health
programs 2003-2008 and 2008-2013. Rare disease research projects have been supported
for more than two decades through the European Community Framework Programmes for
research, technological development and demonstration activities.
At the same time, the Community calls on member-states to set out national plans and strategies
to ensure the effective and efficient recognition, prevention, diagnosis, treatment, care and
research of rare diseases.
The National Plan for Action on Rare Diseases was developed in 2008 and revised during the
EUROPLAN conference in November 2010. The event was organized in our country by the PanHellenic Union of Rare Diseases (PESPA).
The responsibility for rare diseases was given to the Hellenic Center for Disease Control and
Prevention by the Ministry of Health and Social Solidarity in October 2009. Since then efforts have
been made to harmonise Greek guidelines and regulations with the rest of the EU. This includes
examining the current situation with regard to prevention, diagnosis and care as well as developing
a registry that will help to increase the knowledge of the burden placed by rare diseases on the
country. This will all contribute to the development of a coherent national strategy and policy
integrated into a common European effort. For this reason and with the intention to address rare
diseases in the best possible way, HCDCP is assisted by an advisory scientific committee entitled
the “Thematic Advisory Group for Rare Diseases”. The committee is comprised of experts in the
field and is chaired by Dr Emanouil Kanavakis, Professor of Genetics.
As international cooperation is an integral part of promoting research, disseminating knowledge
and information as well as sharing experience and best practices, Greece actively participates
in the following European programs:
•
•
•
•
E-Rare-2. The objective of E-Rare-2 is to strengthen and enlarge the existing network
of scientists. In a more general sense it aims to consolidate an effective network of
collaboration for addressing rare diseases.
EPIRARE. The aim of the program is to provide a European platform for rare disease registries.
EUROPLAN. The main goal is to provide national health authorities with supporting tools for
the development and implementation of national plans and strategies for rare diseases (RDs).
Greece also participates in the European Union Committee of Experts on Rare Diseases
(EUCERD) and is represented by the Emeritus Professor of Pediatrics, Dr Christos Kattamis.
EvangeliaTzala, PhD,Hellenic Cancer Registry and Office of Rare Diseases, Department of Education
and National Registries
12
Typhoid vaccination patterns of Greek travelers to developing countries
Typhoid fever is caused by Salmonella typhi. Typhoid is associated with poor sanitation, and
contaminated food and water supplies. It is transmitted through the ingestion of food or drink
contaminated by the feces or urine of infected people [1]. Regions with high incidence of typhoid
fever (>100/100, 000 cases/year) include South-Central Asia and South-East Asia. Regions of
medium incidence (10–100/100.000 cases/year) include the rest of Asia, Africa, Latin America,
the Caribbean, and Oceania, except for Australia and New Zealand. Europe, North America, and
the rest of the developed world have low incidence of typhoid fever (<10/100.000 cases/year)
[2]. The risk for acquiring typhoid is highest during travel to South Asia (6 to 30 times higher
compared to all other destinations) followed by countries in South-East Asia, Latin America
and the Caribbean, parts of North and West Africa, and Eastern Europe. Although the risk of
acquiring typhoid increases with the duration of stay, travelers have acquired typhoid fever
even during visits of less than 1 week to countries where the disease is endemic [3]. Travelers
who are visiting friends or relatives are at an increased risk [4].
The objective of this study was to identify patterns of typhoid vaccination in Greek travelers
visiting countries in Asia, Africa and Latin America where typhoid fever is endemic. The study
was conducted from 01/01/2008 to 31/12/2009 in 57 Health Departments of the Prefectures in
Greece. Typhoid vaccine is only available at these departments. The health departments were
visited by 3,131 travelers to typhoid endemic countries of Asia, Africa and Latin America during
the study period. Typhoid fever vaccine was recommended for 21.2% (664) of them. Among the
travelers, 27.6% (255) traveled for work reasons, 21.5 % (314) for recreation and 19.9 % (29)
were visiting friends and relatives (VFRs). Also 29.4% (919) stayed for longer than 1month and
(30.6% (281) of these were vaccinated); this represented 29.8% of those who stayed from 1-3
months, 29% who stayed 3-6 months, and 33.9% who stayed more than 6 months.
Most people stayed exclusively in urban areas 47.8% (1,496) with 20.3% of them vaccinated,
2.5% (79) stayed in rural areas with 27.8% vaccinated, and 35.2% (1,102) stayed in urban
and rural areas and 25.9% oif them were vaccinated.
During their stay abroad, 2.5% (78) stayed in camps with 41% vaccinated, 13.5% (423) stayed
at local homes with 34.5% of them vaccinated, 67.26% (2,106) stayed in hotels (19% of them
were vaccinated) and 10.6% (333) traveled by ships with 12% vaccinated..
This study suggests that there is a lack of adequate typhoid vaccination for Greek travelers to
the typhoid fever endemic countries of Asia, Africa and Latin America. This indicates a need for
increased awareness and education among travel health professionals with regards to correct
recommendations on typhoid vaccination for travelers who present seeking pre-travel advice.
References
1.World Health Organization (WHO). Available at: http://www.who.int /topics/typhoid_fever/en/
[Accessed 9 May 2011]
3.Steinberg EB, Bishop R, Haber P, et al. Typhoid fever in travelers: who should be targeted for
prevention? Clin Infect Dis. 2004, 39(2):186–91.
4.Leder K, Tong S, Weld L et al. Illness in travellers visiting friends and relatives: A review of the
GeoSentinel Surveillance Network. Clin Infect Dis 2006, 43: 1185-1194.
Paraskevi Smeti, Androula Pavli, Office for Travel Medicine
Helena Maltezou, Department for Interventions in Health-Care Facilities
13
HCDCP Departments Activities
2.Crump JA, Luby SP, Mintz ED. The global burden of typhoid fever. Bull World Health Organ. 2004
May, 82(5):346-53.
Public health laboratory network
CPHL– RPHL
Review Of Public Health Network Laboratories 2010
It was a particularly productive year for the operation and development of the network. The
exanimate samples come mainly from random inspections in the respective county regions and
hospitals. Tables 1 to 4 describe the number of samples examined by CPHL- RPHL in the last
two years (2009 and 2010) and the rate of increase in 2010.
Table 1: CPHL Activity
Category
Water
Food
Bottled
Antimicrobial
Resistance
Legionella
Salmonella- Shigella
Chemical
TOTAL
2009
2010
Increase %
S
Α
39.8
35.4
233.4
85.7
33.8
23.0
S
2,007
290
275
Α
9,896
778
1,757
S
2,805
967
368
Α
13,399
1,445
2,161
592
592
1,145
1,145
93.4
93.4
601
442
4,207
601
884
14,508
1,611
274
250
7,420
1,611
548
4,300
24,609
168.1
-38.0
70.4%
168.1
-38.0
40.0%
S: Samples, Α: Αnalysis
Table 2: RPHL Thessaly Activity
Category
Water for human
consumption
Bottled
Swimming water tanks
Sea water
Food
Detection of Legionella spp.
Stool
Vomiting
TOTAL
2009
2010
Increase %
S
Α
S
Α*
S
Α*
376
10,775
380
12,460
1.1
15.6
72
43
101
20
128
0
0
740
936
1,299
2,430
458
1,855
0
0
17,753
25
14
177
44
275
7
2
924
700
378
6,933
6,013
4,681
56
2
31,223
-65.3
-67.4
75.2
120.0
114.8
24.9%
-25.2
-70.9
185.3
1,212.8
162.0
75.9%
* Calculation analysis: Total= α analysis for Ο.Μ.Χ. 37oC + b analysis for Ο.Μ.Χ. 22οC, + c analysis for
coliforms+d analysis for E.coli + e analysis for enterococci
HCDCP Departments Activities
Table 3: RPHL East Macedonia- Thrace Activity.
Category
Water for human consumption
Bottled
Swimming water tanks
Sea water
Food
Hem Dialysis Units
Chemical Analysis
Organic cleaning
Detection of Legionella spp
Surface
Drilling
Effluent
TOTAL
2009 *
S
21
9
19
5
0
0
0
0
0
5
5
4
68
14
2010
Α
108
63
118
15
0
0
0
0
0
15
29
20
368
S
127
10
11
5
6
9
29
3
14
0
0
0
214
Α
661
116
49
15
12
54
232
9
14
0
0
0
1,162
Table 4: RPHL Crete Activity.
Category
Water for human consumption
Bottled
Swimming water tanks
Sea water
Food
Detection of Legionella spp.
Water packs
Flu samples
TOTAL
2009*
2010
S
88
245
0
94
44
101
96
Α
347
1,470
0
282
352
202
376
668
3,029
S
572
879
5
143
190
191
0
4,115
6,095
Α
1,937
4,760
28
441
1,072
390
0
14,719
23,347
*Laboratory operation from 9/09
HCDCP Departments Activities
Pictures of central Public Health Laboratory in Vari
15
Recent Publications
Barton Behravesh C, Mody RK, Jungk J, et al. 2008 outbreak of Salmonella Saintpaul
infections associated with raw produce. N Engl J Med 2011;364:918-927.
Raw produce is an increasingly recognized vehicle for salmonellosis. The authors investigated a
nationwide outbreak that occurred in the United States in 2008. A case was defined as diarrhea
in a person with laboratory-confirmed infection with the outbreak strain of Salmonella enterica
serotype Saintpaul. Among the 1,500 cases 21% were hospitalized and 2 died. In three casecontrol studies of cases not linked to restaurant clusters, illness was significantly associated
with eating raw tomatoes (matched odds ratio, 5.6; 95% confidence interval [CI], 1.6 to 30.3);
eating at a Mexican-style restaurant (matched odds ratio, 4.6; 95% CI, 2.1 to ∞) and eating
pico de gallo salsa (matched odds ratio, 4.0; 95% CI, 1.5 to 17.8), corn tortillas (matched odds
ratio, 2.3; 95% CI, 1.2 to 5.0), or salsa (matched odds ratio, 2.1; 95% CI, 1.1 to 3.9); and
having a raw jalapeño pepper in the household (matched odds ratio, 2.9; 95% CI, 1.2 to 7.6).
In nine analyses of clusters associated with restaurants, jalapeño peppers were implicated in all
three clusters with implicated ingredients and jalapeño or serrano peppers were an ingredient
in an implicated item in the other three clusters. The outbreak strain was identified in jalapeño
peppers collected in Texas and in agricultural water and serrano peppers on a Mexican farm.
This outbreak highlights the importance of preventing raw-produce contamination.
Lee MB, Greig JD. A review of gastrointestinal outbreaks in schools: effective infection
control interventions. J Sch Health 2010;80:588-598
The authors reviewed documented outbreaks of gastrointestinal illness in schools. They
examined published articles fromin the last 10 years ion electronic databases, inpublic health
publications and on public health websites. Of the 121 outbreaks that met the inclusion criteria
51% were bacterial, 40% viral, 7% were from Cryptosporidium and 2% were from multiple
organisms. Transmission routes recorded in 101 reports included food-borne (45%), person-toperson (16%), water-borne (12%) and spread from animal contact (11%). Actions to control
outbreaks included alerting medical and public health authorities or the community to the
outbreak (13%), treating cases (12%), enhancing hand washing (11%) and increased vigilance
during food preparation (8%). Recommendations to prevent future outbreaks were compared
with previously published studies that demonstrated effectiveness. The risk of food-borne illness
was reduced when food handlers practiced effective hand washing techniques and received
food safety training and certification. Student training programs on hand hygiene, enhanced
cleaning and disinfection of the school along with hepatitis A vaccination were found to be
effective. It was concluded that children should be supervised on farm visits, hand washing
strictly enforced and food should be only be eaten in an area separate from animal enclosures.
Recent Publications
Pires SM, Vieira A, Perez E, et al. Attributing human food-borne illness to food
sources and water in Latin America and the Caribbean using data from outbreak
investigations. Int J Food Microbiol 2011 Apr 22 [Epub ahead of print]
Food-borne pathogens are responsible for the increasing burden of disease worldwide.
Knowledge on the contribution of different food sources and water to disease is essential in
order to prioritize food safety interventions and implement appropriate control measures. The
authors developed a probabilistic model based on outbreak data that attributes human foodborne disease by various bacterial pathogens to sources in Latin America and the Caribbean.
Between 1993 and 2010. In all, 6,313 bacterial outbreaks were reported by the 20 countries
considered. In general, the most important sources of bacterial disease were meat, dairy
products, water and vegetables in the 1990s. In the 2000’s, eggs, vegetables, grains and beans
came to the fore. This study identified data gaps in the region and highlighted the importance
of effective surveillance systems to identify sources of disease. However the application of this
method for source attribution in the Latin America and Caribbean was successful. The authors
concluded that this approach can be used to attribute disease to food sources and water in
other regions including developing regions with limited data on the public health impact of foodborne diseases.
Dr. Helena Maltezou, Department for Interventions in Health-Care Facilities
16
Interesting Activities
International Humanitarian Mission to Libya
On Sunday 22 May 2011, Hellenic diplomatic staff and the medical team of the Greek Humanitarian
Aid Mission in Libya were transported to Benghazi by a Hercules/C-130 aircraft of the Hellenic
Air Force. The humanitarian mission was organized by the Ministry of Foreign Affairs. The C-130
also transported a mobile medical unit of the HCDCP and a significant amount of medicines
and medical supplies which helpedallowed the medical team to provide health services to the
people of Libya.
The medical team of the HCDCP/Ministry Of Health, visited a number of locations in Benghazi and
beyond, such as the city of Ajdabiya situated 160 km west of Benghazi. Greek scientists visited
the Ajdabiya Hospital, which was only 30 km away from the war zone, after consulting with
the local Health Authorities and the UN/WHO Health Cluster. The aim of the visit was to assess
the Hospital’s needs in terms of medical and nursing staffnd as well as determineshortages of
particular medicines and medical supplies.
During the meeting between the team members and the director of the lLocal hospitals it was
decided that the Greek medical delegation would act in the following way:
1. The team would provide surgical and nursing primary care services in the case of the
sudden the the sudden arrival of a at the area hospitalslarge number of injured and wounded
soldiers from the battlefields at the regional hospitals in emergency situations.
2. The Greek scientists would provide training to the health staff of the local hospitals and
medical units on:
• Hemorrhage Classification and Treatment
• Basic Life Support (BLS)
• Primary care treatments for the traumas of war
• Principles of proper transportation of patients from the field to the surgical room.
Philip Koukouritakis, Coordinator of the Greek Humanitarian Mission, HCDCP Department of Public
http://www.flickr.com/photos/greecemfa/5746591221/in/set-72157626784835494
Ministry of External Affairs
17
Interesting Activities
Interventions
Interesting Activities
International Experts Review Meeting, on the investigation and responce to food and
waterborne disease outbreaks, Copenhagen, 12 April 2011.
European public health authorities face, with increasing frequency, food-borne outbreaks that
are not constrained inside the borders of one country, but have international dimensions. These
outbreaks relate either to the distribution or consumption of the same contaminated food product
in two or more countries, or the exposure of travelers to a common contaminated source. There
has been an effort on a European level during recent years to make the investigation of an
international outbreak easier and to set standard operating procedures for the coordination of
actions taken by implicated countries.
In this context, the ECDC has financed a project entitled «Toolbox for investigation and response
to food and waterborne disease outbreaks with an EU dimension», which will conclude this June.
After an invitation from ECDC to be part of the expert reviewers’ team that will evaluate this
project I participated in this meeting in Copenhagen during which the material collated by the
working group was presented.
Material that will be soon available to EU member states includes:
• List of criteria for the need of a coordinated international investigation.
• List of criteria for the prioritization of a coordinated international investigation (severity of
disease, outbreak extent, possibility of emerging disease, etc).
• List with subjects to be covered during the first teleconference.
• Template for information collection by each one of the implicated countries before the
outbreak teleconference (basic information on the outbreak regarding time, place, cases,
characteristics, available epidemiological data of each country, etc).
• List with points that should be considered before one country hosts the first
teleconference.
• Document with the basic elements of case definitions and particulars when it comes to
outbreaks with an international dimension. Examples of case definitions that have been
used in the past for the investigation of international outbreaks were also gathered and
included in the document.
• Recommendations for effective case-finding and additional approaches that can be used
during international outbreaks.
• Trawling questionnaire template created with the use of EpiData Manager (a new edition of
EpiData software which is widely used in the field of epidemiology).
• Document describing data entry with the use of EpiData entry client software.
• Document describing data analysis using EpiData Analysis software and a list with the basic
commands used for descriptive and analytical epidemiology (cohort or case-control study).
• Document with all the information (chapters) that should be included in an outbreak
investigation report.
• Document with some important considerations for environmental and microbiological
studies during food-borne and water-borne international disease outbreaks.
• Communication flow to and between international alert systems and stakeholders. These
are distinguished at:
• legally binding alert systems (Early Warning and Response System of ECDC (EWRS),
Rapid Alert System for Food and Feed (RASFF), World Health Organization (under
International Health Regulation)
• voluntary alert systems (EPIS, INFOSAN, PULSENET, FBVE-net etc). The Different
systems will be presented with useful references, and a schematic approach for
reporting and interaction between the involved reporting systems.
• Rrepository of resource material for food-borne outbreak investigation and control
(publications, key guidance documents from international sources such as ECDC and WHO,
protocols for investigation, questionnaires etc).
Overall, the presented work was of high quality and the evaluation was positive given the fact
that covering all different aspects of an international outbreak investigation using only one tool
is definitely a difficult task. Several modifications regarding the structure and the content of the
material were proposed aiming to make the presented tool more effective.
It should be noted that this tool will be of great help in investigating outbreaks on a national
level too as it summarises an important amount of the available evidence on food-borne outbreak
investigation using a practical tool that is based on free-access software (http://www.epidata.dk).
Kassiani Mellou, Foodborne and Waterborne Diseases Section, Department of Epidemiological
Surveillance and Intervention
18
Future Conferences and Meetings
June 2011
June 5- 7, 2011
Title: «International Meeting on Rickettsiae and Rickettsial diseases»
City: Iraklion, Crete
State: Greece
Web site: http://www.rickettsia2011.gr/
June 7- 11, 2011
Title: «29th Annual Meeting of the European Society for Paediatric Infectious
Diseases (ESPID)»
June 16- 17, 2011
Title: «3rd European Conference on Injury Prevention and Safety Promotion»
City: Budapest
State: Hungary
Web site: http://www.eurosafe.eu.com/
June 20- 24, 2011
Title: «Workshop on Programme Evaluation in Key Populations at Higher Risk of HIV»
City: Cavtat (close to Dubrovnik)
State: Croatia
Web site: http://www.whohub-zagreb.org/131
Future Conferences and Meetings
City: The Hague
State: The Netherlands Web site: http://www.kenes.com/espid2011/Pages/Home.aspx
Office of International Affairs
Quiz of the month
Send your answer to the following e-mail address:
Info-quiz@keelpno.gr
April quiz answer: Malaria, according to most scientists, is the most probable cause of Lord
Byron’s death.
Four readers answered correctly.
19
Quiz of the month
From which infectious disease did “Myrtida”, an 11 year-old Athenian girl, die in the 5th century BC,
Her bones were founded in 1994-5 inside an ancient mass grave in Athens in the Kerameikos area.
Outbreaks around the world- May 2011
Avian influenza
As of 13 May 2011, the Ministry of Health of Indonesia has announced a confirmed case of
human infection with avian influenza A (H5N1) virus. Of the 177 cases confirmed to date in
Indonesia, 146 have been fatal [1].
Ebola
On 13 May 2011, the Ministry of Health (MoH) of Uganda notified WHO of a case of Ebola
Hemorrhagic fever in a 12 year old girl from Luwero district, central Uganda [2].
References
1.World Health Organization (WHO). Available at: http://www.who.int/csr /don/2011_05_13/en/index.
html [Accessed 23 May 2011].
2.World Health Organization (WHO). Available at: http://www.who.int/csr /don/2011_05_18/en/index.
html [Accessed 23 May 2011].
Travel Medicine Office, Department for Interventions in Healthcare Facilities
Outbreaks around the world
Outbreak of Shiga toxin-producing E. coli (STEC) in Germany, May 2011
On May 22nd, the German Public Health Authorities reported, through the Early Warning
Response System (EWRS), a significant increase in the number of patients with haemolytic
uremic syndrome (HUS) and bloody diarrhea caused by Shiga toxin-producing E. coli (STEC).
The term STEC is used to describe a group of pathogenic Escherichia coli strains capable
of producing Shiga toxins. Alternative terms that are being used are “Vero toxin-producing
Escherichia coli (VTEC)” and “Enterohaemorrhagic Escherichia coli (EHEC)”.
More than 200 different STEC serotypes have been identified and more than 100 of them have
been associated with disease occurence in humans.
Between April 25th and May 31st, 373 cases of haemolytic uremic syndrome (HUS) were
reported and 6 deaths ensued.
Hemolytic uremic syndrome caused by STEC infections is usually observed in children under 5
years of age, but in this outbreak 87% of the cases were in adults, with 68% of patients being
women. The majority of the cases were in individuals from, or in those who had recently visited,
Northern Germany.
Preliminary laboratory investigation indicated serotype E. Coli O104:H4 as the causative agent of
the outbreak. This serotype produces Shiga toxin 2 (stx2 positive), is negative for stx1, intimin
(eae) and enterohemolysin. It is resistant to the following antibiotics: ampicillin, cefoxitin,
cefotaxime, ceftazidime, streptomycin, tetracycline, trimethoprim/sulfamethoxazole, nalidixic
acid and extended-spectrum beta-lactamases (ESBL CTX-M - Group 1).
Latest results of case-control studies that are in progress show that contaminated raw vegetables
seem to be the most likely vehicle of infection.
The Federal Institute for Risk Assessment (BFR) has recommended that consumers, especially
those living in Northern Germany, should abstain from eating raw vegetables such as tomatoes,
cucumbers and lettuce.
Epidemiological and laboratory investigation for the identification of other possible sources and
vehicles of the outbreak are ongoing.
Other European countries with outbreaks include Sweden and Denmark with 13 cases each,The
Netherlandswith 1,the United Kingdomwith 2 cases and France with 6. All of the individuals had
travelled to northern Germany recently.
In Greece, STEC is reported through the Mandatory Notification System.
The Notification Form and the case definition are available on the website of HCDCP
(http://www.keelpno.gr/index.php?option=com_content&view=article&id=262%3A-ehec&catid=64%3A2010-08-04-08-56-37&Itemid=1)
During 2011, one STEC case has been reported in Greece, with a different serotype than the
one that caused the outbreak in Germany.
However, the Hellenic Public Health Authorities remain vigilant and ask for the clinical and
laboratory physicians to immediately report any probable STEC cases and to perform laboratory
investigation on patients with compatible clinical symptoms, especially if a recent travel history
to Northern Germany is mentioned.
For more information you can visit HCDCP website at www.keelpno.gr.
Kassiani Mellou, Office for foodborne Diseases, Department of Epidemiological Surveillance and Intervention
20
News from the HCDCP Administration
Food Control Body of Greece (EFET) and the HCDCP decide to cooperate
Under the reorganization of food control towards cost savings, the Food Control Body of Greece
(EFET) and the HCDCP have decided to cooperate more closely following a meeting in the office
of the Deputy Minister of Health and Social Solidarity, Mr. Ch. Aidonis, on Wednesday 20th April.
HCDCP has already assigned space for EFET at the Peripheral Laboratory in Thessaloniki.
The laboratory will be operational with tools supplied by EFET. The signing of a cooperation
memorandum is expected very soon.
HCDCP participates in the 37th Annual Pan-Hellenic Medical Congress, in Athens, 1721 May 2011
News from the HCDCP Administration
The Hellenic Center for Disease Control and Prevention participated in the 37th Annual PanHellenic Medical Congress and organized two round-tables on Wednesday 18th May. The subjects
discussed were “Topical Matters on Public Health” and “Sharp Incidents on Public Health”. The
first table was presided over by the General Secretary of Public Health, Mr. A. Dimopoulos,
and the President of HCDCP, Mrs. J. Kremastinou. Their speeches were on the subjects of risk
assessment of vector-borne diseases in the Mediterranean region, lessons taken from the flu
epidemics, risk assessment of non-communicable diseases, as well as the new activities of
the National Cancer Registry. The second table was presided over by Mr. M. Lazanas and Mr.
G. Saroglou. Their speeches were on the subjects of vaccine-preventable diseases, West Nile
virus epidemic in Northern Greece in 2010, as well as the Disease Treatment Plan due to MultiResistant strains in hospitals.
ÊÅÍÔÑÏ ÅËÅÃ×ÏÕ & ÐÑÏËÇØÇÓ
ÍÏÓÇÌÁÔÙÍ (ÊÅ.ÅË.Ð.ÍÏ.)
Editors:
HCDCP
HELLENIC CENTER FOR
DISEASE CONTROL & PREVENTION
Τ. Kourea- Kremastinou
HCDCP President
T. Papadimitriou
HCDCP Director
Graphic Design:
Ε. Lazana