Malaria in Greece

Until 1960, Greece was a malaria endemic country. During 1946-1960, an intense national malaria elimination programme was implemented and thus in 1974, Greece was declared malaria-free by the WHO. During the period 1975-2005, 30-50 malaria cases were reported anually, mainly imported form malaria endemic countries.  Locally transmitted malaria cases were only sporadically reported in 1991, 1999, 2000, 2009, 2010. During 2005-2009, 171 malaria cases were reported in total. The largeest proportion where returning travelers and immigrants from endemic countries. In 2009, 8 cases were reported; two of them were imported and the rest six were autochthonous.  In 2010, a total number of 44 cases were recorded. Forty of them were immigrant from malaria endemic countries, while the rest four were cases with no travel history to malaria endemic regions.  In 2011, a total number of 96 cases were reported. Forty two (42)  of them were autochthonous and 54 of them were imported. Fifty nine (59) of all cases were infected in Evrotas municipality, Lakonia district; 23 of them were immigrant workers, while the rest 36 were autochthonous cases (no travel history to malaria endemic countries). In addition, there were six (6) sporadic autochthonous cases throughout the country. In 2012, a total number of 93 cases were recorded. Twenty (20) of them were locally acquired cases; 10 of them took place in Evrotas (Lakonia) and the rest 10 were sporadic cases throughout the greek territory.  Since 02/10/11, active case detection (fever screening, laboratory examination, RDT, personal interviews) is being implemented in immigrant populations that live and work there.  *Imported case: a case that is diagnosed in a non-endemic country, but the infection took place outside the country (e.g. returning traveler from endemic country, immigrant coming from endemic country) *Local/autochthonous case: a case in which the infection and the diagnosis takes place in a non-endemic country. It may have strong epidemiological link to an imported case (introduced) or no link to an imported case (indigenous). The Hellenic Center for Disease Control and Prevention, in collaboration with the MalWest project, has separated the greek territory in four malaria risk levels (0, 1, 2, 3) according to the estimated risk for local malaria transmission and re-establishment of the disease (Table 1). Risk level Characteristics - Risk factors existence  Regions   0  Regions without local transmission risk factors for the last three years, including areas where only an increased presence of malaria parasites in humans (importation of the parasites from malaria endemic countries, e.g. through infected immigrants or travellers) or the presence of mosquito-vectors is observed (or environmental factors favoring their proliferation).    1  Regions with local transmission risk factors: areas where increased presence of parasites in humans is observed (importation of the parasites from malaria endemic countries) and anopheles mosquitoes are present (or environmental factors favoring their proliferation). Ilia district, Achaia district, Aitoloakarnania district, Messinia district, Argolida district, Korinthia district, Evros district  2  Regions where at least one sporadic case was recorded with local transmission indications during last three years. Orchomenos municipality (Viotia district), Thebes municipality (Viotia district), Chalkida municipality (Evia district), Marathon and Markopoulo municipality (East Attica district), Agia municipality (Larissa district), Avdiros municipality (Xanthi district)  3  Regions with cluster of cases with local transmission indications during last three years or continuing transmission indications from year to year (new cases in the area during at least two years in a raw). In these areas, it is considered that transmission conditions exist and re-establishment of the disease is possible.  Evrotas municipality (Lakonia district) Sophades municipality (Karditsa district)