An outbreak of Plasmodium vivax malaria in Lakonia, southern Greece, August-October 2009
Andriopoulos P., Oikonomopoulou A., Rigaki K., Kaplanis N., Rebelou D., Assimakopoulos G.
20th European Congress of Clinical Microbiology and Infectious Diseases, Vienna, Austria, 10-13 April 2010, Abstract #1391

Malaria is considered to be eradicated in Europe. Only sporadic cases from travellers in endemic areas are occasionally reported. A cluster of Vivax malaria infected patients from Lakonia Greece is presented. Methods: 8 patients were hospitalized from August to October 2009 in Sparta General Hospital with Plasmodium vivax malaria. Epidemiological data, clinical symptoms, diagnosis and treatment are described. Results: Two patients, 24 and 28 years old, immigrants from Pakistan and Afghanistan accordingly were admitted because of fever, jaundice and abdominal pain. The latter was treated for malaria with a 3-day regiment of chloroquine a year ago. Two weeks later and during a period of two months, six more patients, natives of Lakonia and living in different regions of the state from the first two, were admitted with similar symptoms. Blood smear tests were positive for all patients for plasmodium vivax which was verified with PCR testing. Sensitivity tests showed that all the strains were chloroquine-sensitive. All patients had irregular fever patterns, haemolytic anemia, thrombocytopenia, transient neutropenia, splenomegaly and elevated liver function tests. They were treated with combined regiment of chloroquine followed by primaquine and completed the treatment uneventfully. Conclusion: A re-emergence of malaria may become a growing concern since populations migrate from Asia to Europe in poor sanitary conditions causing occasional local transmission. Surveillance and prevention are crucial in order to prevent further epidemics.

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Albania / Malaria
Bulletin Hebdomadaire International N°247, 9 juin 2010 – 15 juin 2010

On May 18, 2010, the ministry of Health of Albania declared a case of malaria in a 17 years-old Albanese. Vector-control measures were implemented around the case. The patient has stayed in Greece (Peloponnese) from June to December 2009 with other immigrants from malaria-endemic areas, in precarious conditions. Considering the autochthonous cases reported in 2009 from the same region in Greece, it is not excluded that he get infected there.

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VBORNET comment: 2010-06-30
Malaria is still endemic in Turkey and in far eastern countries (Russian Federation and other former USSR countries). Also a few autochthonous (locally acquired) malaria cases have occurred in declared malaria-free countries of Europe during the last 20 years in Bulgaria, France, Germany, Greece, Italy, and Spain (see Vbornet Newsletter 01 for more details). Recently in 2009 a case of ‘autochthonous’ malaria infection has been reported from Italy (ProMED-mail; Archive Number 20091107.3849), but the local transmission was not proved. Beside these cases transmitted by indigenous infected mosquitoes, also imported infected mosquitoes may provoke cases of so-called airport malaria or baggage malaria. Between 1977 and 1999, 75 cases of malaria associated with airport were recorded in Western Europe (Mouchet, Euro Surveill. 2000).

Here a cluster of P. vivax cases is reported from Greece as well as one case from Albania. In Greece, 6 cases are suspected to have been locally acquired during summer/fall 2009 and the Albanese patient has stayed in the same region of Greece at this time or the year. Several Anopheline vector species are known to breed in Greece, including some of the historically most important vectors in Europe: An. atroparvus, An. sacharovi and An. superpictus that are competent for P. vivax. The movements of tourists, immigrants, soldiers and seasonal workers increase the numbers of malaria cases imported into Europe, creating reservoirs of Plasmodium strains. However, transmission needs favourable climatic conditions, as Plasmodium extrinsic cycle requests 8 to 35 days, depending to Plasmodium species and temperature (Heymann, Control of Communicable Diseases Manual 2004). This report from Greeceindicates that this remains possible and stresses the need for surveillance and prevention also by improving sanitary conditions of seasonal workers, in order to prevent local malaria transmission in combination with vector monitoring activities.