title: Prevention of Malaria Resurgence in Greece through the Association of Mass Drug Administration (MDA) to Immigrants from Malaria-Endemic Regions and Standard Control Measures.
abstract: Greece was declared malaria-free in 1974 after a long antimalarial fight. In 2011-2012, an outbreak of P. vivax 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 of 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 epicenter 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. This study suggests that judicious use of MDA can be a useful addition to the antimalarial armamentarium in areas threatened with the reintroduction of the disease.
authors.affiliation: Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Larissa, Greece.|Hellenic Center for Disease Control & Prevention (HCDCP), Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Tseroni
authors.affiliation: Hellenic Center for Disease Control & Prevention (HCDCP), Athens, Greece.
authors.forename: Agoritsa
authors.initials: A
authors.lastname: Baka
authors.affiliation: Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Larissa, Greece.
authors.forename: Christina
authors.initials: C
authors.lastname: Kapizioni
authors.affiliation: Sorbonne Universités, Paris, France.|Centre d'Immunologie et de Maladies Infectieuses (CIMI)-Paris, Institut National de la Santé et de la Recherche Médicale (Inserm)-Centre National de la Recherche Scientifique (CNRS), Paris, France.
authors.forename: Georges
authors.initials: G
authors.lastname: Snounou
authors.affiliation: Hellenic Center for Disease Control & Prevention (HCDCP), Athens, Greece.
authors.forename: Sotirios
authors.initials: S
authors.lastname: Tsiodras
authors.affiliation: Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Larissa, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Charvalakou
authors.affiliation: Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Larissa, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Georgitsou
authors.affiliation: Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Larissa, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Panoutsakou
authors.affiliation: Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Larissa, Greece.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Psinaki
authors.affiliation: Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Larissa, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Tsoromokou
authors.affiliation: Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Larissa, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Karakitsos
authors.affiliation: Hellenic Center for Disease Control & Prevention (HCDCP), Athens, Greece.
authors.forename: Danai
authors.initials: D
authors.lastname: Pervanidou
authors.affiliation: Hellenic Center for Disease Control & Prevention (HCDCP), Athens, Greece.
authors.forename: Annita
authors.initials: A
authors.lastname: Vakali
authors.affiliation: Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Larissa, Greece.
authors.forename: Varvara
authors.initials: V
authors.lastname: Mouchtouri
authors.affiliation: Hellenic Center for Disease Control & Prevention (HCDCP), Athens, Greece.
authors.forename: Theano
authors.initials: T
authors.lastname: Georgakopoulou
authors.affiliation: Department of Biochemistry and Biotechnology, University of Thessaly, Larissa, Greece.
authors.forename: Zissis
authors.initials: Z
authors.lastname: Mamuris
authors.affiliation: Laboratory of Entomology and Agricultural Zoology, School of Agricultural Sciences, Department of Agriculture Crop Production and Rural Environment, University of Thessaly, Volos, Greece.
authors.forename: Nikos
authors.initials: N
authors.lastname: Papadopoulos
authors.affiliation: Benaki Phytopathological Institute (BPI), Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Koliopoulos
authors.affiliation: Benaki Phytopathological Institute (BPI), Athens, Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Badieritakis
authors.affiliation: Municipality of Evrotas, Laconia Regional Unit, Tripoli, Greece.
authors.forename: Vasilis
authors.initials: V
authors.lastname: Diamantopoulos
authors.affiliation: Department of Microbiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Tsakris
authors.affiliation: Hellenic Center for Disease Control & Prevention (HCDCP), Athens, Greece.
authors.forename: Jenny
authors.initials: J
authors.lastname: Kremastinou
authors.affiliation: Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Larissa, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Hadjichristodoulou
mesh_terms: D000962:Antimalarials / Q000008:administration & dosage*; D003140:Communicable Disease Control / Q000379:methods*; D021821:Communicable Diseases, Emerging / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D004358:Drug Therapy / Q000379:methods; D054242:Emigrants and Immigrants; D006115:Greece / Q000453:epidemiology; D006801:Humans; D008288:Malaria / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D055815:Young Adult
chemical_list: D000962:Antimalarials