Last Updated

31 May 2019

Integrated surveillance and control programme for West Nile virus and malaria in Greece (MALWEST)

Objectives

The aim of the project is the development of an Integrated Control programme related to West Nile virus (surveillance for human cases, mosquito surveillance, avian surveillance, and equine surveillance) and malaria (surveillance for human cases, mosquito surveillance). 

The main objectives of the programme are:

  1. the detection of the West Nile virus and malaria Plasmodium activity and their impact on public health,
  2. the detection of the geographic regions with the greatest risk and the development of risk assessment tools by using Geographical Information Systems (GIS),
  3. the prediction of spreading of the disease and
  4. the assessment of appropriate interventions.

Specific activities: 

Prevention of Malaria Resurgence in Greece through the Association of Mass Drug Administration (MDA) to Immigrants from Malaria-Endemic Regions and Standard Control Measures.

Despite a significant decrease in the number of malaria cases in 2012, a mass drug administration (MDA) program was considered as an additional measure to prevent reestablishment of the disease in the area with the following specific objectives:

  • To treat most of the immigrants in the region to eliminate the carriage of hypnozoite  
  • To prevent relapses among immigrants and transmission among immigrants to immigrants and from immigrants to Greek residents 

Genotyping of archived blood samples from a substantial proportion of malaria cases recorded in Greece in 2009–2013 using 8 microsatellite markers and a PvMSP-3α gene fragment and plotted their spatiotemporal distribution.

Principal Institution(s)

Principal Investigator
Rationale and Abstract

Specific activities:

Prevention of Malaria Resurgence in Greece through the Association of Mass Drug Administration (MDA) to Immigrants from Malaria-Endemic Regions and Standard Control Measures

Greece was declared malaria-free in 1974 after a long antimalarial fight. In 2011–2012, an outbreak of Pvivax malaria was reported in Evrotas, an agricultural area in Southern Greece, where a large number of immigrants from endemic countries live and work. A total of 46 locally acquired and 38 imported malaria cases were detected. Despite a significant decrease in the number of malaria cases in 2012, a mass drug administration (MDA) program was considered as an additional measure to prevent reestablishment of the disease in the area. During 2013 and 2014, a combination of 3-day chloroquine and 14-day primaquine treatment was administered under direct observation to immigrants living in the epicentre of the 2011 outbreak in Evrotas. Adverse events were managed and recorded on a daily basis. The control measures implemented since 2011 continued during the period of 2013–2014 as a part of a national integrated malaria control program that included active case detection (ACD), vector control measures and community education. The MDA program was started prior to the transmission periods (from May to December). One thousand ninety-four (1094) immigrants successfully completed the treatment, corresponding to 87.3% coverage of the target population. A total of 688 adverse events were recorded in 397 (36.2%, 95% C.I.: 33.4–39.1) persons, the vast majority minor, predominantly dizziness and headache for chloroquine (284 events) and abdominal pain (85 events) for primaquine. A single case of primaquine-induced hemolysis was recorded in a person whose initial G6PD test proved incorrect. No malaria cases were recorded in Evrotas, Laconia, in 2013 and 2014, though three locally acquired malaria cases were recorded in other regions of Greece in 2013. Preventive antimalarial MDA to a high-risk population in a low transmission setting appears to have synergized with the usual antimalarial activities to achieve malaria elimination.

Genetic Spatiotemporal Anatomy of Plasmodium vivax Malaria Episodes in Greece, 2009–2013

Study Design

Type: Interventional
Allocation: Non-randomized
Intervention model: Single group 
Masking: None (open label)
Primary purpose: Treatment