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Doctors Without Borders Fight Malaria in Lakonia

It may sound weird to talk about malaria cases in a European country in the year 2012. And it is even more weird to have regions that are facing the need of a medical programme to cure the disease. But ever since last year the incidents of malaria in Lakonia, Greece, especially to those who had no travel record to an affected country, warned the NGO ”Doctors Without Borders” of the necessity for one. Apostolos Veizis, Head of Medical Operational Support Unit Athens, talks to about it and about the causes of this strange outbreak.
Why was it necessary to create a plan against malaria in these regions?
Between 21 May and 5 December 2011, 63 cases of Plasmodium vivax infection have been reported in Greece. 57 out of the 63 cases  were reported in the area of Evrotas, a 20 km2 river delta area, located in the district of Lakonia in the Peloponnese, in southern Greece. 27 of these cases were reported among Greek citizens without a travel history to malaria-endemic regions, 23 malaria cases identified in migrant farm workers from endemic countries (mostly Pakistan and Afghanistan) and seven cases in migrant farm workers from non-endemic countries (i.e. one from Morocco, one from Poland and five from Romania, two of whom were diagnosed after they returned back to Romania). The six remaining cases were reported in the municipalities of Attiki ,Evia , Viotia and Larissa among Greek citizens with no travel history to malaria endemic areas.
Isn’t it strange to talk about malaria cases in Greece?
It may sound weird, but this is the reality today. We do witness the come back of this ‘forgotten’ disease in Greece – with the last cases to have been recorded almost 40 years ago. Malaria was officially eliminated from Greece in 1974, following an intense national malaria eradication programme that was implemented between 1946 and 1960. Between 1975 and 2005, approximately 50 malaria cases were reported every year, with the vast majority coming from countries endemic to malaria. However, sporadic cases of mosquito-transmitted malaria, which could have been acquired locally, were reported in 1991, 1999 and 2000. Between 2005 and 2009, 171 cases of malaria were reported in Greece with a mean number of 34 cases per year. Of those, 98% in people that likely acquired the infection in endemic countries and 78% of all cases were in migrants from those countries. In addition to this, between early August and October 2009, a cluster of eight malaria cases were identified in the Evrotas area of the Lakonia district, in the south of the Peloponnese. The first two cases reported were among migrant workers from Pakistan and Afghanistan who reportedly arrived in Greece during the summer of 2009 and who were working in the agricultural holdings in this particular area. Four of the remaining six cases belonged to the local Roma community and the other two were Greek citizens residing in the area. None of those six cases reported having a travel history to a malaria endemic country. In 2010, another malaria case (in the Roma community) was detected in the same area of Evrotas,. Additionally, two Roma children with malaria were notified in Viotia with disease onset on 25 and 30 August 2010 and an unclear travel history.
In your opinion what are the causes of this phenomenon? Many may claim that the advent of immigrants is responsible for the reappearance of diseases that had almost disappeared in our country. What do you think about it?
Since the malaria eradication in 1974 in Greece, sporadic cases of probable local mosquito-borne transmission have occurred. Because of its climate, proximity of human and mosquito populations, Greece and possibly other Mediterranean countries might be vulnerable to the re-establishment of endemic malaria.The gaps identified in  the management system of malaria from the healthcare system, the mosquito control and public health programmes that cover all aspects from surveillance, clinical management, laboratory diagnosis, entomological surveillance, to the vector control and communication are identified as some of the  factors of malaria’s reappearance in the country.
Describe the efforts of ”Doctors Without Borders” for dealing with the problem.
Following the reappearance of this ‘forgotten’ disease in Greece, the MSF started providing support to the Hellenic Centre for Disease Control and Prevention (HCDCP) for the development of a national malaria-response plan.
MSF teams in Sparta and Evros regions, in collaboration with HCDCP and the local authorities, have started implementing projects contributing to the prevention, epidemiological surveillance, clinical management, laboratory diagnosis and vector control of the disease. Since late March 2012, MSF has had a continuous presence in the Municipality of Evrotas, paying periodic visits to local homes to provide active screenings for malaria cases.From the beginning of the intervention till the end of May, we have conducted 1,470 fever screenings and 38 malaria rapid tests to the population, including people from malaria-endemic countries and the Roma community. Moreover, the MSF team has provided 121 primary health care consultations, seeing people suffering mainly from respiratory infections, skin diseases, and muscular-skeletal complaints. In addition to this, the MSF team, in collaboration with  HCDCP, is offering education sessions to local communities to increase the awareness of malaria, as well as how to take preventative measures against it. To date, 25 sessions have been completed. MSF is planning to distribute mosquito nets and repellents to high risk populations in an effort to enforce protection from malaria and support the local health institutions by providing rapid diagnostic tests, microscopes and trainings to the local health personnel respectively.

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