HCDCP NEWSLETTER

Hellenic Center for Disease Control and PreventionAgrafon 3- 5, Maroussi, 15123, Tel: +30 210 5212000,info@keelpno.gr, http://www.keelpno.gr

May 2011 ISSN 1792-9016Vol. 03/ Year 1stHCDCP

HELLENIC CENTER FORDISEASE CONTROL & PREVENTION

MINISTRY OF HEALTH &

SOCIAL SOLIDARITY

The HCDct presenss the reported cases and the outbreak investiga-tion 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.

Read more in page 2

In light of the World No Tobacco Day 2011, the General Secretary of Public Health Mr. A. Dimopou-los highlights the most important activities of the Ministry of Health and Social Solidarity for the pre-vention and control oe smoking habits.

Read more in page 10

In the current epidemic of the en-terohemorrhagic coliform E. coli O104:H4 in Germany more than 370 cases of the haemolytic ure-mic 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 stud-ies are currently taking place for the identification of the source of the contamination.

Read more in page 12

The CLPH-PLPH Network, regard-less ihe short time of operation, has to present important activi-ties in the environmental samples examination. It is worth mention-ing that PLPH activities are noting an important increase in 2010 in comparison to 2009. The public health in our country will be con-siderably strengthened with the operation of the rest of the PLPH.

Read more in page 14

Highlights

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 under-reporting 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

Chief Editor:

Ch. Hadjichristodoulou

Scientific Board:

Ν. VakalisΕ. VogiadjakisP. Gargalianos- KakolirisΜ. Daimonakou- VatopoulouΙ. LekakisC. LionisΑ. PantazopoulouV. PapaevagelouG. SaroglouΑ. Tsakris

Editorial Board:

M. Angelopoulou

R. VorouPh. KoukouritakisΑ. -Μ. LeoutsiΚ. MellouS. ParissisΤ. PatoucheasV. RoumeliotiV. SmetiV. TsatsareliCh. TsiaraΜ. FotineaΕ. Hadjipashali

ContentsEditorial : Foodborne dis-Foodborne dis-eases in Greece, 2010 2-7Surveillance Data 8-10Invited article 10-11HCDCP Departments Activities

Rare diseases 12Typhoid fever vaccine 13CLPH-PLPH Network 14-15

Recent publications 16Interesting activities 17-18Future conferences and meetings 19Quiz of the month 19Outbreaks around the world 20News from HCDCP Administration 21

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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 re-ported 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.

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)

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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 2004-2010 is presented in Figure 1.

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.

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.

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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

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 [5-10]. 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.

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Table 2: Summary of investigation results of the reported outbreaks.

Disease/Cause*

Nu

mb

er

of

case

s…

Nu

mb

er

of

con

firm

ed

ca

ses‡

Nu

mb

er

of

ho

spit

alize

d

case

s

Nu

mb

er

of

death

s

Reg

ion

Ou

tbre

ak

du

rati

on

(d

ays)

§

Typ

e o

f st

ud

y

Fo

od

ite

m

invo

lved

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 Case-

control 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 Case-

control Cheese

Gastroenteritis/ S. Arizonae 31 6 0 0 Peloponnese 1 Cohort Side

dish

Systemic disease/Brucella melitensis 131 104 10 0

EasternMacedoniaand Thrace

5 (months)

Case-control

FreshCheese

Gastroenteritis/ Campylobacter jejuni 54 54 14 0 Crete 13 Case-

control Water

* 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 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.

The network is able to run microbiological analyses for the following pathogens:

• Salmonella spp.• Listeria monocytogenes• Staphylococcus aureus

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• Bacillus cereus• Escherichia coli • Escherichia coli O157• Enterobacter sakazakii• Vibrio parahemolyticus • Vibrio cholerae• Campylobacter spp.• Yeasts and fungiLaboratories 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.

[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

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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.

Kassiani Mellou, Theologia Sideroglou and Maria Potamiti-Komi, Office for Food-borne DiseasesEleni Mathioudaki and Dimitris Papadopoulos,CPHL)

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Data

Surveillance DataTable 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 (1st 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

Meningitis (bacterial, aseptic) 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

Salmonellosis (non typhoid/paratyphoid) 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

Tuberculosis 33 51 39-72

Cholera 0 0 0-0

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Data

Surveillance DataTable 2: Number of notified cases by place of residence (region)*, Mandatory Notification System,

01/04/2011 – 30/04/2011.

Disease Number of notified cases

Region

Eas

tern

Mac

edonia

and T

hra

ce

Cen

tral

Mac

edonia

Wes

tern

Mac

edonia

Epirus

Thes

salia

Ionia

n isl

ands

Wes

tern

Gre

ece

Ste

rea

Gre

ece

Att

ica

Pelo

ponnes

e

Nort

her

n A

egea

n

South

ern A

egea

n

Cre

te

Unkn

ow

n

Chickenpox with complications - - - - - - 1 - - - - - - -Brucellosis - - - 1 5 - - 1 1 1 - - - -Malaria - - - - - - - - 1 - - - - -Echinococcosis - 1 2 - - - - - 1 - - - - -Hepatitis A - - - - - - - 2 1 - 1 - - -Hepatitis B, acute & HBsAg(+) in infants < 12 months - - - - 1 - 1 - - - - - - -Hepatitis C, acute & verified anti−HCV (+) (1st diagnosis) - 2 - - - - - - - - - - - -Measles 3 1 - 1 - - - - 1 2 - - - -Hemorrhagic fever - - - 1 - - - - - - - - - -Leishmaniasis - - - - 1 - - - 1 - - - - -Q Fever - - - - - - - - 1 - - - - -Salmonellosis (non typhoid/paratyphoid) 2 7 1 1 4 - 1 - 8 - 7 - 2 -Cluster of foodborne / waterborne disease cases - 1 - - - - - - - - - - 2 -Meningitis (bacterial, aseptic) - 2 1 - 2 - - - 7 1 1 - 3 -Meningococcal disease 1 1 - - - - - - 1 1 - - - -Tuberculosis 3 5 - 1 3 - 3 1 12 2 - 1 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.

Disease Number of notified cases by age group (years) and gender

<1 1−4 5−14 15−24 25−34 35−44 45−54 55−64 65+ Unkn.M F M F M F M F M F M F M F M F M F M F

Chickenpox with complications

1

Brucellosis 3 2 1 1 1 1Malaria 1Echinococcosis 2 1 1Hepatitis A 1 1 1 1

Hepatitis B, acute & HBsAg(+) in infants < 12 months

2

Hepatitis C, acute & verified anti−HCV (+) (1st diagnosis)

1 1

Measles 1 2 2 3Hemorrhagic fever 1Leishmaniasis 1 1Q Fever 1

Salmonellosis (non typhoid/paratyphoid)

5 2 5 4 7 3 1 1 2 3

Meningitis (bacterial, aseptic)

1 1 1 1 1 1 1 4 6

Meningococcal disease 1 2 1Tuberculosis 2 2 5 1 5 2 1 1 3 1 6 4

*M: male, F: female

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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

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 manda-tory 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 under-reporting 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

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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.

Mr. Andonis Dimopoulos, General Secretary of Public Health, Hellenic Ministry of Health and Social Solidarity

World No Tobacco Day, 31 May.

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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 Pan-Hellenic 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

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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]

2. Crump JA, Luby SP, Mintz ED. The global burden of typhoid fever. Bull World Health Organ. 2004 May, 82(5):346-53.

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 MedicineHelena Maltezou, Department for Interventions in Health-Care Facilities

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Public health laboratory networkCPHL– 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 2009 2010 Increase % S Α S Α S ΑWater 2,007 9,896 2,805 13,399 39.8 35.4Food 290 778 967 1,445 233.4 85.7Bottled 275 1,757 368 2,161 33.8 23.0Antimicrobial Resistance 592 592 1,145 1,145 93.4 93.4

Legionella 601 601 1,611 1,611 168.1 168.1Salmonella- Shigella 442 884 274 548 -38.0 -38.0Chemical - - 250 4,300 - -TOTAL 4,207 14,508 7,420 24,609 70.4% 40.0%

S: Samples, Α: ΑnalysisTable 2: RPHL Thessaly Activity

Category 2009 2010 Increase % S Α* S Α* S ΑWater for human consumption 376 10,775 380 12,460 1.1 15.6

Bottled 72 936 25 700 -65.3 -25.2Swimming water tanks 43 1,299 14 378 -67.4 -70.9Sea water 101 2,430 177 6,933 75.2 185.3Food 20 458 44 6,013 120.0 1,212.8Detection of Legionella spp. 128 1,855 275 4,681 114.8 162.0Stool 0 0 7 56 - -Vomiting 0 0 2 2 - -TOTAL 740 17,753 924 31,223 24.9% 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

Table 3: RPHL East Macedonia- Thrace Activity.

Category 2009 * 2010 S Α S ΑWater for human consumption 21 108 127 661Bottled 9 63 10 116Swimming water tanks 19 118 11 49Sea water 5 15 5 15Food 0 0 6 12Hem Dialysis Units 0 0 9 54Chemical Analysis 0 0 29 232Organic cleaning 0 0 3 9Detection of Legionella spp 0 0 14 14Surface 5 15 0 0Drilling 5 29 0 0Effluent 4 20 0 0TOTAL 68 368 214 1,162

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Table 4: RPHL Crete Activity.

Category 2009* 2010 S Α S ΑWater for human consumption 88 347 572 1,937Bottled 245 1,470 879 4,760Swimming water tanks 0 0 5 28Sea water 94 282 143 441Food 44 352 190 1,072Detection of Legionella spp. 101 202 191 390Water packs 96 376 0 0Flu samples 4,115 14,719TOTAL 668 3,029 6,095 23,347

*Laboratory operation from 9/09

Pictures of central Public Health Laboratory in Vari

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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 case-control 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-to-person (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.

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 food-borne 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 food-borne diseases.

Dr. Helena Maltezou, Department for Interventions in Health-Care Facilities

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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 Interventions

http://www.flickr.com/photos/greecemfa/5746591221/in/set-72157626784835494Ministry of External Affairs

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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

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Future Conferences and Meetings

June 2011

June 5- 7, 2011

Title: «International Meeting on Rickettsiae and Rickettsial diseases»

City: Iraklion, CreteState: Greece Web site: http://www.rickettsia2011.gr/

June 7- 11, 2011

Title: «29th Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID)»

City: The HagueState: The Netherlands Web site: http://www.kenes.com/espid2011/Pages/Home.aspx

June 16- 17, 2011

Title: «3rd European Conference on Injury Prevention and Safety Promotion»

City: BudapestState: HungaryWeb 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

Office of International Affairs

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.

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.

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Outbreaks around the world- May 2011

Avian influenzaAs 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].

EbolaOn 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].

References1. 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

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

HCDCP

HELLENIC CENTER FORDISEASE CONTROL & PREVENTION

ÊÅÍÔÑÏ ÅËÅÃ×ÏÕ & ÐÑÏËÇØÇÓÍÏÓÇÌÁÔÙÍ (ÊÅ.ÅË.Ð.ÍÏ.)

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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, 17-21 May 2011

The Hellenic Center for Disease Control and Prevention participated in the 37th Annual Pan-Hellenic 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 Multi-Resistant strains in hospitals.

Graphic Design:Ε. Lazana

Editors:Τ. Kourea- KremastinouHCDCP President

T. PapadimitriouHCDCP Director