hcdcp e-bulleting july 2012
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DESCRIPTIONHCDCP e-bulleting July 2012
Hellenic Center for Disease Control and PreventionAgrafon 3- 5, Maroussi, 15123, Tel: +30 210 5212000,[email protected], http://www.keelpno.gr
July 2012 ISSN 1792-9016Vol. 17/ Year 2nd
MINISTRY OF HEALTH
HELLENIC CENTER FORDISEASE CONTROL & PREVENTION
MINISTRY OF HEALTH
Beautiful and crystal-clear Greek bathing waters and beachesIn the developed world, psychological (i.e. stress) and social (i.e. economic difficulties/unemployment) determinants of health play a large part in defining the health status of the population. Within this framework, a persons close contact with nature and living, even for a short while, amid the beauty of a clean and safe natural environment, play a major, some might say crucial, role in maintaining a level of good health for the individual, and society in general. Escaping from the everyday routine, the fresh air of the countryside, bathing and playing in the crystal-clear sea contribute decisively to mental calmness, relaxation and psychological and physical detoxification of the modern individual, and therefore are essential for the protection and improvement of a persons health status. Taking the above into consideration, we have decided to deviate slightly from the strictly public health topics of the e-bulletin, and dedicate the second summer edition of this years e-bulletin to the beauties of the Greek countryside and, more specifically to the wonderful, clean and safe Greek beaches. So, we hope to provide a more refreshing and calming experience for our readers.
It is well known that Greece has very mild climate conditions and is blessed with outstanding areas near the sea, thus it is not difficult to offer our readers a short trip to some of the most picturesque seashores in our country, through photographs that have been taken by members of the editorial board.
This trip to beautiful and very clean sandy beaches and crystal-clear waters starts in the Ionian Sea, from the islands of Ithaca, Kefallinia and Antipaxoi, crosses to the mainland in the Thesprotia region, to Chalkidiki and Pelion to Foinikounta and Mani in the south Peloponnesus, moves to the Aegean Sea from the island of Evvoia to Samos, Chios and Nisyros, and finally ends up in the Cyclades, the islands of Amorgos and Koufonisia, to Kithira and Crete.
On the other hand, public health is defined as the collective action for sustained population-wide health improvement. Meaning that the natural environmental treasure comprising the Greek beaches should be monitored continuously and protected through well-organized actions and interventions in order to maintain its unique value for peoples good health and well-being. For these reasons, the Greek state, and more specifically the Special Secretariat for Bathing Waters of the Ministry of Environment and the Public Health Laboratories Network of HCDCP (Ministry of Health), stay vigilant and perform regular sampling of the bathing waters across the country to monitor and secure their quality. The excellent results, in terms of quality and safety, of these assessments are presented in this e-bulletin and rank Greece bathing waters among the best two or three in Europe (see the relevant map on page 6).
We wish you all a good holiday: enjoy the summer and the Greek beaches, and always respect the safety rules for activities in and around the water!
Editorial: Bathing water quality in Greece 2
Our favourite Greek beaches 8
Surveillance Data 22
HCDCP s Departments Activities 26
Outbreaks around the world 27
News from the HCDCPs administration 28
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Bathing water quality in Greece
The quality of bathing water in Greece has been monitored systematically since 1990 according to Directive 76/160/EEC On the quality of bathing waters under a program organized and coordinated by the Ministry of Environment, Energy and Climate Change (MEECC). Since 2010, the quality of bathing water has been monitored in accordance with the new Directive 2006/7/EC Concerning the management of bathing water quality as translated into Greek legislation with JMD 8600/416/E103/2009 (GG 356V/2009) under the Countrys monitoring program for bathing water quality.
Bathing water quality assessments are carried out:
in relation to each body of bathing water after the end of each bathing season on the basis of the bathing water quality data compiled in relation to that current bathing
season and the three preceding seasons. The quality parameters monitored are grouped into two categories.
Visually monitored: tarry residues, glass, plastics, rubber or any other waste. Microbiological: Coliform bacteria (Escherichia coli) and Enterococci (intestinal
enterococci), which are used for the classification and quality status of bathing waters according to Table 1.
Parameter Excellent quality Good qualitySufficient quality
Reference methods of analysis
Escherichia coli (CFU/100 mL) 250* 500* 500**
ISO 9308-3 or ISO 9308-2
Intestinal enterococci (CFU/100 mL)
100* 200* 185** ISO 7899-1 or ISO 7899-2
*Based on a 95percentile evaluation. **Based on a 90percentile evaluation.
Bathing waters are classified as excellent, good and sufficient quality:
if, in the body of bathing water quality data for the last assessment period, the percentile values for microbiological enumerations are equal to or better than the respective values set out in Table 1, and
if the bathing water is subject to short-term pollution, on condition that adequate management measures are being taken, including surveillance, early warning
systems and monitoring, with a view to preventing bathers exposure, by means of a warning or, where necessary, a bathing prohibition
adequate management measures are being taken to prevent, reduce or eliminate the causes of pollution, and
the number of samples disregarded because of short-term pollution during the last assessment period represented no more than 15% of the total number of samples provided for the monitoring calendars established for that period, or no more than one sample per bathing season, whichever is the greater.
The bathing water quality for 2011 was monitored and assessed within the framework of the Monitoring program of bathing water quality that was implemented under the supervision of the Special Secretariat for Water of MEECC. Specifically, during the bathing season for 2011 (1 June 201131 October 2011) 2,149 coastal bathing waters were monitored, of which 2,041 (94.71%) were of excellent quality, 87 (4.04%) were of good quality, 16 (0.74%) were of sufficient quality and only five (0.23%) were of poor quality, as shown in the following map. These excellent results rank Greece bathing waters among the best two or three in Europe.
During 2012, the Registry of Bathing Water Profiles will be completed and disseminated through an interactive website to ensure that, by the end of the 2015 bathing season, all bathing waters are of at least sufficient quality.
In the context of assessing the bathing water quality, the Central Public Health Laboratory analyzed, during the time period 200811 June 2012, 2,748 bathing water samples, of which 96.4% were of excellent quality, 3.3% were of good quality and 0.3% were of poor quality, as shown in Tables 2 and 3.
Table 2: Distribution of bathing water samples during the time period 200811 June 2012
2008 2009 2010 2011 2012 200811 June 2012Number of samples 610 480 568 721 369 2748
Table 3: Results of the assessment of the quality of bathing water samples during the time period 200811 June 2012
Number of samples Quality Percentage
2,649 Excellent 96.490 Good 3.39 Poor 0.3
Joanna Spiliopoulou, Doctor Biopathologist
Some preventive rules for safe activities in or around the water are:
1. We do not swim alone but only accompanied by others and in areas supervised by a lifeguard.
2. We do not swim earlier than 3 hours after the last meal or having consumed alcohol.
3. We do not swim far from the land, beyond the marked with buoys area, neither we overestimate our personal limits.
4. We always supervise young children.
5. If someone is in danger, we call 166 or 112 for help.
6. The correct sun protection requires the use of sunscreen, hat, remaining under the shade and the consumption of water or juices.
The Kimi coast in North Evia, the balcony of the Aegean Sea, as described by the famous carver Galanis. Kimi is also the origin of the great George Papanikolaou Mr Pap Test.
Kimi Ithaca/ Kefalonia
Ithaca was the final destination of the ancient Greek hero Odysseus and the subject of a famous poem by the Greek poet Kavafis: Once you start travelling to Ithaca. Ithaca is an island next to Kefallinia in Greece, and both of them share wonderful, clean and numerous yellow and red sandy seashores.
Myrtos beach in Kefallinia has a rare type of very deep and turquoise water.
It is so nice to combine art with the sea. Have a beautiful summer.
Kavourotrypes, Chalkidiki Foinikounta/ Kythira/Amorgos
Foinikounta hosted most of my childhood summer vacations. The essence of sage follows you from the first moment you arrive.
An old Greek song says well never manage to reach Kithira and to that I add that if we ever do well go straight for a sip of fatourada (the local spirit)!!
It was not by chance that they filmed The Big Blue here. Plakes (= plates) beach on Amor-gos island is quite far removed from what we normally think of a beach, but it rewards any tourist who decides to visit the Small Cyclades.
Sea water gently touches the earth. The majestic sky is watching from above.The wildness is make-believe. Because there, the absolutely pure and the real peace rule everything. Northern and southern Crete, sometime during the year, at the beginning of the 21st century.
North and south Crete Perdika, Thesprotia
Agia Paraskevi, Perdika/ Thesprotia
Karavostasi, Perdika/ Thesprotia
Samos Mani, South Peloponnesus
Driving from Vathi to Karlovassi, just after Kokkari village, we parked the car under some pine trees and walked down the little pathway to the sea. Shortly after, we reached the reddish, sugary beach of Tsamadou.
This is where Virgin Mary holds the sea inside her apron
Deep blue, refreshing water, soft sand, many luxuries.
Chios, Mavra Volia Chiliadou beach, Evia
Two big black pebbles safe the shutters of the blue window, always giving and never asking back, that is the place to live along with the immortals and the flowers into the glass
Poet Manos Eleftheriou (Music adaptation by Pantelis Thalassinos)
Chiliadou beach on the island of Evia is a beautiful beach with pebbles. The deep water is a deep blue.
It is an ideal place for relaxation, carefree holidays and a lot of diving.
Happy holidays to everybody! This year we stay in Greece!!
Pachia Ammos (Rich Sand), Nisyros Mani, Pelion
According to Greek mythology, during the Clash of Titans, Neptune was chasing the Titan Polivotis across the Aegean Sea. Neptune then caught a huge piece of the island of Kos with his trident and threw it against the Titan. The rock crushed him and shaped the island of Nisyros on top of him. Where the mouth of Polivotis has lain ever since, a volcano formed ages ago, and when the entombed Titan moves his shoulders and roars, the whole of Nisyros is shaken by earthquakes.
To reach the beautiful beach of Pachia Ammos, you need take a 10-minute walk along a picturesque path. The beach is full of dark-colored, volcanic sand.
Gnospi beach, Agios Nikolaos, Mani: Unprecedented dives from perfect rocky beaches with crystal-clear waters!
Paou beach, Pelion: The sheltered beach in Pagasitikos bay rewards each visitor.
On the way to Trikeri, Pelion: The mountain of the Centaurs with its enchanting clear blue waters ...
These are not exotic beaches far, far away They are Greek sandy beaches in Koufonisia and Agistri. Enjoy them!!
Surveillance data Surveillance data
Table 1. Number of notified cases in June 2012, median number of notified cases in June for the years 20042011 and range, Mandatory Notification System, Greece.
Disease Number of notified cases
June 2012 Median number June 20042011 Range
Botulism 0 0 0-1Chickenpox with complications 1 3 0-11Anthrax 1 0 0-1Brucellosis 11 21.5 659Diphtheria 0 0 0Arbo-viral infections 0 0 0Malaria 11 2.5 15Rubella 0 0 0Smallpox 0 0 0Echinococcosis 0 1.5 04Hepatitis 1 4.5 114Hepatitis B, acute & HBsAg(+) in infants < 12 months 7 6 1-20
Hepatitis C, acute & confirmed antiHCV positive (1st diagnosis) 1 2.5 0-8
Measles 1 0.5 052Haemorrhagic fever 0 0 0-2Pertussis 5 2.5 0-12Legionellosis 2 1.5 04Leishmaniasis 4 4.5 2-9Leptospirosis 1 0 0-2Listeriosis 2 0 0-2EHEC infection 0 0 0-1Rabies 0 0 0-1Melioidosis/Glanders 0 0 0Meningitis
aseptic 38 23.5 9234bacterial (except meningococcal disease) 13 18 6-28unknown aetiology 0 2 1-6
Meningococcal disease 2 5 014Plague 0 0 0Mumps 1 1 0-6Poliomyelitis 0 0 0Q Fever 0 0.5 0-2Salmonellosis (non typhoid/paratyphoid) 24 73.5 23-138Shigellosis 3 2 0-6Severe Acute Respiratory Syndrome 0 0 0Congenital rubella 0 0 0Congenital syphilis 0 0 0-1Congenital Toxoplasmosis 0 0 0-1
Cluster of foodborne / waterborne disease cases 0 5 2-8
etanus / Neonatal tetanus 1 0 0-1Tularaemia 0 0 0Trichinosis 0 0 0-1Typhoid fever/Paratyphoid 0 0.5 0-1Tuberculosis 47 68.5 4192Cholera 0 0 0
Table 2. Number of notified cases by place of residence (region)*, Mandatory Notification System, June 2012.Disease Number of notified cases
Chickenpox with complications 0 1 0 0 0 0 0 0 0 0 0 0 0 0Anthrax 0 0 0 1 0 0 0 0 0 0 0 0 0 0Brucellosis 0 0 0 1 2 0 2 1 3 2 0 0 0 0Malaria 0 0 0 1 0 0 0 1 5 4 0 0 0 0Hepatitis 0 0 0 0 0 0 0 0 0 0 0 0 0 1Hepatitis B, acute & HBsAg(+) in infants < 12 months 0 2 0 0 0 0 0 0 3 0 2 0 0 0
Hepatitis C, acute & confirmed antiHCV positive (1st diagnosis)
0 0 0 0 0 0 0 0 0 0 0 0 0 1
Measles 0 1 0 0 0 0 0 0 0 0 0 0 0 0Pertussis 0 0 0 0 0 0 0 0 1 1 2 1 0 0Legionellosis 0 0 0 1 0 0 0 0 1 0 0 0 0 0Leishmaniasis 0 0 0 0 2 0 0 0 0 2 0 0 0 0Leptospirosis 0 0 0 0 0 0 0 0 0 0 1 0 0 0Listeriosis 0 0 0 1 0 0 0 0 0 1 0 0 0 0Meningitis aseptic 5 14 0 0 1 0 6 5 3 0 0 0 4 0 bacterial (except meningococcal disease) 1 3 0 0 1 0 1 0 5 0 0 1 1 0Meningococcal disease 0 1 0 0 0 0 0 1 0 0 0 0 0 0Mumps 0 0 0 0 0 0 0 0 1 0 0 0 0 0Salmonellosis (non typhoid/paratyphoid) 0 7 0 0 2 1 2 0 9 0 3 0 0 0Shigellosis 0 0 0 0 3 0 0 0 0 0 0 0 0 0etanus / Neonatal tetanus 0 0 0 1 0 0 0 0 0 0 0 0 0 0Tuberculosis 1 11 0 2 5 3 5 2 13 1 1 0 2 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, June 2012.Disease Number of notified cases by age group (years) and gender
Surveillance data Surveillance data
The presented data derive from the Mandatory Notification System (MNS) of the Hellenic Centre for Diseases Control and Prevention (HCDCP). Forty five (45) infectious diseases are included in the list of the mandatory notified diseases in Greece. Notification forms and case definitions can be found at the website of HCDCP (www.keelpno.gr).
It should be noted that data for June 2012 are provisional, and can be slightly modified/corrected in the future and also that data interpretation should be made with caution, as there are indications of under0reporting to the system.
Department of Epidemiological Surveillance and Intervention
Viral meningitis outbreak in Northern Greece, MayJuly 2012During the period 23/5/2012 to 23/7/2012, an outbreak of viral meningitis in Northern Greece was recorded, in particular at the regions of Central Macedonia, Western Macedonia, Eastern Macedonia and Thrace.
Forty seven (47) cases of viral meningitis were reported through the mandatory notifiable system, and were hospitalized at three (3) hospitals of Thessaloniki (General Hospital Papageorgiou, GN Papanikolaou and N.E.P.TH) and at the county hospitals of Alexandroupolis, and Kozani. During the same period, one (1) case and thirteen (13) cases of viral meningitis from Northern Greece were reported in 2011 and 2010 respectively.
The cases (30 males and 17 females) had mostly mild clinical presentation which was characterized by low grade fever (usually
Outbreaks around the world
Outbreaks around the world, July 2012
Cholera (Democratic Republic of Congo)
The Democratic Republic of Congo (DRC) has reported a sharp increase in the number of reported cholera cases in the armed conflict area of North Kivu; 368 new cases were reported for epidemiological weeks 24 (1117 June) to 26 (25 June1 July), mainly in the areas of Birambizo, Goma, Karisimbi, Kiroshe, Mutwanga, Mweso and Rwanguba.
There is concern that the security situation will increase the difficulty in accessing healthcare facilities and could increase the number of severe and fatal cases. The current armed conflict in North Kivu also poses a risk of spread of the disease to neighboring countries such as Burundi, Rwanda, South Sudan and Uganda.
Epidemiological investigations conducted by national authorities and partners, including Mdecins Sans Frontires (MSF), Merlin and the International Rescue Committee (IRC), indicate that insufficient access to a safe water supply remains the main cause of the epidemic in North Kivu.
Hand Foot and Mouth Disease (HFMD) (Cambodia)
On 13 July 2012, the Ministry of Health of Cambodia reported that the cause of the severe illness causing deaths and affecting very young children was a severe form of hand, foot and mouth disease (HFMD).
A total of 78 cases has been identified. These include the initial 62 cases reported by Kantha Bopha hospital, and cases reported from other hospitals.
In response, health centers have been instructed by the Ministry of Health to report all patients with HFMD. In addition, the Ministry of Health, assisted by the World Health Organization (WHO), has begun enhanced surveillance for neurorespiratory syndrome, a key syndrome observed among patients with severe HFMD, caused by EV71. It is expected that the enhanced surveillance will identify occasional new cases of the severe form of the disease in the coming months.
1. World Health Organization (WHO). Available at http://www.who.int/csr/don/2012_07_23/en/index.html [accessed July 2012]
Travel Medicine Office, Department for Intervention in Health Care Facilities
Drowning Prevention Rules
Worldwide, one person dies by drowning each minute. In Greece, the fatal drowning has double rates of those taking place within European Union. In Greece, like in abroad, the male: female drowning rates are 8:2. This underlines the reckless attitude, the overestimation of the personal limits and the risk taking behavior of the male population.
As the PSA of the Hellenic CDC states, each person may avoid become a drowning statistic while going for swimming, if consideration to the below safety tips will be given:
We do not swim alone but only accompanied by others and in areas supervised by a lifeguard.
We do not swim earlier than 3 hours after the last meal or having consumed alcohol.
We do not swim far from the land, beyond the marked with buoys area, neither we overestimate our personal limits.
We always supervise young children.
If someone is in danger, we call 166 or 112 for help.
The correct sun protection requires the use of sunscreen, hat, remaining under the shade and the consumption of water or juices.
Dr Stathis Avramidis, CPHL
HCDCPs departments activities
News from the HCDCP Administraion
Summer Camp Program Hygiene, Water Safety and Lifesaving
The Hellenic Center for Disease Control (CDC), as part of its preventive strategy for public health, organizes educational presentations throughout the summer, on hygiene, water safety and lifesaving in the water. So far, about 3,000 campers and camp councilors have attended this popular and entertaining program, which covers hygiene guidelines and water protection, safety rules, rescue and self-rescue methods, and an answerquestion game followed by the presentation of a certification of attendance.
The summer camps that have attended the program so far are:
29 June 2012, Xeniasto Melissi (950 people)
2 July 2012, Evangeliki Kataskinosi (160 people)
6 July 2012, Ouranoupoli (120 people)
10 July 2012, Evangeliki Kataskinosi (80 people)
18 July 2012, (125 people)
20 July 2012, Christianoupoli (200 people)
23 July 2012, Folia tou Paidiou (350 people)
24 July 2012, Evangeliki Kataskinosi (90 people)
25 July 2012, Xeniasto Melissi (600 people)
27 July 2012, Pediki Exohi Kerateas (240 people).
Dr Stathis Avramidis, CPHL
Chief Editor:Ch. Hadjichristodoulou
Scientific Board:. Vakalis. VogiatzakisP. Gargalianos- Kakoliris. Daimonakou Vatopoulou. LekakisC. Lionis. PantazopoulouV. PapaevagelouG. Saroglou. Tsakris
Editors:. Kourea KremastinouHCDCP President
T. PapadimitriouHCDCP Director
M. AngelopoulouR. VorouPh. Koukouritakis. MellouD. Papaventsis. PatoucheasV. RoumeliotiV. SmetiCh. Tsiara. Fotinea. Hadjipashali
E. KaratampaniP. Koukouritakis