Infectious diseases
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Dritsas, S. et al. (1996) «Prevalence of hepatitis B and C, HIV-infection and tuberculosis in homeless illegal migrants in Athens». Iatriki, 70(4):347-350. [In Greek]
Abstract
The purpose of the study was to examine the prevalence of hepatitis B and C of HIV infection and tuberculosis in homeless illegal migrants in Athens. Material- Methods 158 foreigners with no residence perm ant were studied (98 men and 60 women). Participants came from countries facing serious social – economic problems. The average age of the participants was 28.9 + 19.8 years old while the average length of stay in Greece was 23 months. The participants were considered homeless as they lived in subway stations, parks, derelict houses and in groups in 4th and 5th class hotels. The source used to access migrants was the Hellenic Red Cross and its social services. The data were analyzed using the χ2. Results A total of 158 (81%) out of 198 migrants agreed to undergo laboratory clinical tests which showed the following: a.16 (10.1%) of participants were carriers of the HBV virus (positive HBSAG) b.Anti-HCV was traced in 10 (6.3%) participants c.Co infection with HBV and HCV was found in 2 (1.2%) participants d.2 (1.2%) were HIV positive From the 102 participants that were examined for tuberculosis, 48 (47%) had a positive dermoreaction to mantoux while a chest x-ray and sputum positive for bacillus KOCH were found in 11 (10.7%) participants
Conclusions: The prevalence of hepatitis B and C, of HIV infection and tuberculosis seems to be significant among the group of people studied an issue which needs to be addressed by the health services of our country.
Kanavaki, S., Karambela, S., Tsagarakis, N., Konstantinidou, E., Ioannidis, P., Pefanis, A., Nikolaou, S. (2007)The evolution of Mycobacterium tuberculosis resistance in Greece during the last decade 1997-2006. Iatriki, 92(5):414-420. [In Greek]
AIM To investigate the isolation frequency, the resistance rate to the first-line drugs, and the multi-drug resistant (MDR) rate in a total of 5244 strains of Mycobacterium tuberculosis (MTB), isolated from sputum cultures, during the last decade.
MATERIAL-METHODS Patients were divided in native Greeks or immigrants and the study period was divided in two time intervals (1997-2001 and 2002-2006).
RESULTS We noticed a gradual increase in the isolation frequency during the first period, and a gradual decrease during the second period of the study. These fluctuations were in parallel with the immigration wave. The resistance rates (INH 6.7% and 13%, RIF 3% and 6.4%, in native Greeks and in immigrants, respectively) and the MDR rate (2.7% and 4.9%, respectively) were higher than that in other Western European countries. We noticed an increase in the MDR rate in the cohort of native Greeks, and a decrease in immigrants. We also investigated the extensively-drug resistant (XDR) rate during the years 2004-2006. XDR represented 0.6% of the total number of MTB isolates, and 22% of the MDR isolates, of the particular period.
CONCLUSIONS The MDR rate in Greece is increasing and thus represents a significant threat to the public health. Key words Mycobacterium tuberculosis, multi-drug resistant, MDR, extensively-drug resistant, XDR, Greeks, immigrants, resistance.
Kanavaki, S., Nikolaou, S., Karampela, S., Papavasiliou, A., Skroumpelou, A., Varonou, E., Papageorgiou, P., Kontos, F., Anagnostou, S., Raftopoulou, A., Koumantakis, P. and Tamvakis, V. (2005) “Changes in the epidemiology of tuberculosis in Greece due to continuing immigration”. Pneumon, 18(1):84-92. [In Greek]
Abstract
Mass immigration from developing countries to industrialized countries entails the risk of spreading resistant strains of mycobacteria, which is associated with serious epidemiological,social and economic consequences. In the face of continuing largescaleimmigration to Greece, we surveyed the number of new bacteriologically confirmed cases of tuberculosis; single resistance to isoniazid or rifampin; and multi-drug resistance, i.e. resistance to at least isoniazid and rifampin, of M.tuberulosis strains that were isolated from the first culture of sputum of immigrants in the period 1993-2002. To allow better insight, immigrants were separated to foreigners coming from South-Eastern Asia and Africa, and Greek emigrants to the Former Soviet Union who returned to their country. Findings were compared to relative data from native Greek patients in the same period. The number of newly diagnosed tuberculosis cases in native Greeks and returning Greek emigrants is constantly decreasing, probably due to higher living standards in Greece, whereas TB incidence among foreigners coming from South Eastern Asia and Africa is rising, which may be attributed to the introduction of more effective surveillance systems in our country. Resistance of M. tuberculosis strains to isoniazid and rifampin is increasing in all three groups, most significantly in repatriated Greeks. Multidrug resistance also shows a significant increase in all three groups, particularly in repatriated Greeks.
Konstantinides, T.Κ., Christaki, P., Tsara, Β., Κapetangiorgis, Α. and Koutsougianopoulos, Β.C. (2000) «Epidemiologic and clinical characteristics of tuberculosis in migrants in North Greece between 1988-97». Pneumon, 13(1):73-83. [In Greek]
Abstract From the middle of the last decade an increase has been observed in tuberculosis mortality and morbidity rates across the globe. One of the reasons for this increase especially in industrialized countries is migration. Greece has seen stable tuberculosis rates followed by a mild increase in epidemiological indicators from the end of the 1980’s decade and onwards a time period during which migration appeared at an increasing rate. In the present study the demographic, clinical and laboratory characteristics of 720 patients with tuberculosis from the Northern region of Greece were studied. Seventy-nine of the patients were migrants (primarily Greeks from ex Soviet Union countries) A statistically significant upward trend over time, of the proportion of immigrants among the total number of patients was shown. The age prototype of migrant patients is stronger in younger ages (20-40 years old) in comparison to Greeks whereas the opposite is observed for cases over then 50 years old. Statistically significant differences with rates obviously higher for migrants are observed in the proportion
Nikolaou, Α. (1995) Prevalence of hepatitis a major problem for Roma in Athens. Archeia Iatrikis, 12(2):138-141. [In Greek]
Abstract
395 Roma who live in Athens were tested for the Hepatitis A and B viruses. It was found that 330 (86,2%) were positive for Ant-Hav, 68 (17,2%) were positive for Hbsag, 22 (5,5%) were positive only for Anti-Hβc, 108 (27,3% were positive for both Anti-Hβs and Anti-Hβc and 197 were positive to Hbv. It can be concluded that prevalence rates of Ηαv and Hbv infection remain very high compared to the general population.
Nikolopoulos, G., Arvanitis, M., Masgala, A. and Paraskeva, D. (2005) "Migration and HIV epidemic in Greece". European Journal of Public Health, 15(3):296-299.
Abstract
Background: Over the last decade, Greece has experienced a massive influx of migrants from countries in South Eastern/Central Europe, the Middle East, Asia and Africa. This study aimed to estimate the percentage and the specific characteristics of HIV-positive migrants reported in Greece, and to describe the secular trend of migrants' proportion among HIV-infected individuals. Methods: Secondary analysis of data reported to the Hellenic Centre for Infectious Diseases Control (HCIDC) during the years 1989–2003. Results: From 1989 to 2003, 6292 HIV-positive cases were reported to HCIDC. Data show that 749 people (439 males, 303 females) originated from countries other than Greece. Most HIV-positive migrants come from Sub-Saharan Africa (32.44%) and nearly 20% from Central and Eastern Europe. In the Greek population, men who have sex with men (MSM) constitute 50.47% of cases, while 16.15% are heterosexuals. The epidemic profile follows a different pattern among migrants (P<0.05). Heterosexual transmission accounts for 41.52% of HIV-positive reported migrants, while 19.09% are MSM. An 11% increase for each subsequent year in the rate of HIV-positive migrants reported in Greece has been estimated using a Poisson regression model fitted to the data (IR 1.11; 95% confidence interval 1.08–1.13). Conclusions: The results suggest an increasing trend of HIV-seropositive migrants in Greece during recent years. Group-based interventions, better access to health care and a comprehensive public approach should be applied to migrants.
Peonidis, A. (1995) Health of children repatriating to Greece. 4nd Dept of Paediatrics, University of Thessaloniki-Greece. Paediatr N Gr, 7:105-109. [In Greek]
Abstract
The level of health services offered to people repatriating to Greece is discussed, while some health indices referring, especially, to children of the Reception Center in Langadikia and the Gymnasium or Greek pupils migrating back to Greece in Thessaloniki are presented. The index of Mycobacterial Infection in children 1-15 years and in adults amounts to 12-26% and 64%, respectively, (diameter of induration of the Mantoux skin test ≥15mm, in cases with previous B.C.G. vaccination) that is 6-7 times higher than in local population. The positive hepatitis B indices in pupils of the Gymnasium go up to 23.5%, while 5.6% of the total number of pupils tested are positive for the HBsAg. The above incidence of hepatitis B indices is 4 and 3 times higher than in local school population of similar age. We conclude that Greek children coming back home have more serious health problems than local children. Medical services offered to them are unorganized and circumstancial. A general practitioner should be appointed to supervise the medical care that Greek people migrating back home, adults and children, urgently need.
Spyridis, P., Tsolia, M., Gelesme, A., Moustaki, M., Spyridis, N., Sinaniotis, C. and Karpathios, T. (2003) “The impact of Greece's childhood tuberculosis screening programme on the epidemiological indexes in the greater Athens area”. The International Journal of Tuberculosis and Lung Disease, 7(3):248-253.
Abstract
SETTING: A hospital referral centre for childhood tuberculosis in Athens. OBJECTIVE: To evaluate the effectiveness of the screening programme implemented for childhood tuberculosis, through its impact on the epidemiological index. DESIGN: In Greece, tuberculosis has been systematically screened for in children since 1991 using the tuberculin skin test. The epidemiological and clinical profiles of all tuberculous children who attended the TB clinic were compared. The children were divided into those who attended in 1982–1990 and those who did so in 1991–1999. RESULTS: A total of 1122 TB patients were screened. In the second period there was an increase in numbers of immigrant children (3% vs. 28%, P = 0.0001), the rate of extra-pulmonary TB decreased (16% vs. 7.6%, P = 0.0001), patients identified by the screening programme increased (19% vs. 57%, P = 0.0001) and the number of symptomatic children fell (51% vs. 16%, P = 0.0001). The proportion of children who failed to attend for regular follow-up was lower during the second period (20% vs. 7%, P = 0.0001). CONCLUSIONS: Our study suggests that the screening programme applied in Greece during the last decade has contributed to the early identification of tuberculosis, and the limitation of symptomatic patients and extra-pulmonary TB cases.
Vakalopoulos, Α., Chologitas, Ε. and Manesis, Ε.Κ. (2004) Prevalence of hepatitis B and D infection in Greece. Recent epidemiological data. Iatriki, 85(5):405-412. [In Greek]
Abstract
AIM
To evaluate the prevalence of hepatitis B (HBV) and D (HDV) virus infection among Greek navy recruits and analyze the results according to geographic location of birth, the educational status of participants and compare our data to those of earlier studies.
MATERIAL-METHODS
2913 male navy recruits were studied between 1989-1990. Their mean age was 21 (18-34) years, participation was voluntary and were excluded only men previously vaccinated for hepatitis B.
RESULTS In 37 (1.27%) recruits the HBsAg was positive (active HBV infection), 12 (32.43%) being HBeAg-positive and 2 (5.41%) anti- HD-positive. Thirty six (1.24%) were HBsAg and anti-HBs negative and anti-HBc and anti-HBe positive (latent HBV infection) and 192 (6.59%) persons HBV-immune. Among the 10 geographic regions of Greece the distribution of active HBV infection and total HBV exposure (any HBV marker positive) differed significantly (P<0.001 for both) being higher in northern Greece (2.38% and 14.07%, respectively) than in the rest of the country (1.06% and 18.16%) (P=0.020 and P<0.00001, respectively). Educational level was not correlated with the prevalence oh HBsAg. In a multivariate analysis, birthplace in Thrace was the only significant risk factor for active HBV infection [hazard ratio (HR) 7.890, P=0.0004], while factors associated with total exposure to HBV, xere birthplace in Thrace (HR: 3.202, P=0.0003) and in Macedonia (HR: 1.533, P=0.016). Compared to similar data of the 1970’s, the prevalence of HBsAg carriage among Greek recruits has decreased by 75%.
CONCLUSIONS The prevalence of HBsAg and the total exposure to HBV among young Greek males has significantly dropped during the last 15 years, but it remains high in northern Greece, especially in Thrace. Our findings are only indicative and they must be confirmed by larger, well-organized epidemiological studies at a national level.
Zacharakis, G., Koskinas, J., Kotsiou, S., Pouliou, E., Papoutselis, M., Tzara, F., Vafeiadis, N., Maltezos, E., Archimandritis, A. and Papoutselis, K. (2007) “Natural history of chronic hepatitis B virus infection in children of different ethnic origins: a cohort study with up to 12 years' follow-up in northern Greece”. J Pediatr Gastroenterol Nutr, 44(1):84-91.
Abstract
AIM: To investigate the mode of transmission and the natural history of chronic hepatitis B virus (HBV) infection in children of different ethnicities in Greece. This study was part of the Interreg I-II EC project. PATIENTS AND METHODS: One hundred seventy-three hepatitis B surface antigen (HBsAg)(+) carriers, median age 6.9 (5-12) y, were prospectively followed-up for a mean period of 5.3 (1-12) y for serological markers of HBV infection, serum alanine aminotransferase (ALT), HBV-DNA, alpha-fetoprotein levels and ultrasonography. RESULTS: Vertical transmission predominates (61.8%) in Moslem children and horizontal (44%) in those born in Russia. At entry, 73 of 173 (42%) HBsAg(+) genotype D children were hepatitis B e antigen (HBeAg)(+), ranging from 27% to 67% among ethnic groups; 55 of 173 (32%) had ALT > 2 x upper normal limit (UNL), ranging from 21% to 39%. Of 100 anti-HBe(+) children, 85 (85%) were inactive carriers. During the follow-up period, seroconversion to anti-HBe was observed in 40 of 73 (55%) children with an annual rate of 11%; 35 of 40 (87.5%) had biochemical remission, and 28 of 35 (80%) lost HBV-DNA. In the anti-HBe(+) group, 27 of 100 (27%) lost HBV-DNA and 9 of 100 (9%) lost HBsAg. The annual seroconversion rate for HBeAg was significantly lower: in children with vertical transmission compared with horizontal (7.7% vs 14.8%, respectively, P < 0.001) and in Muslim children compared with both Christian children and those born in Russia (8.6% vs 12%, respectively, P < 0.001). No differences were found among the ethnic groups after adjusting for the mode of infection. Two of 173 children had progression of liver disease. CONCLUSIONS: The differences in HBeAg(+) status and seroconversion rate among the ethnic groups are related to the time/mode of HBV infection. The majority of children who developed anti-HBe immunity had biochemical remission, and a substantial number of the inactive carriers lost viremia during the observation period of up to 12 y.
