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Archive for November, 2012|Monthly archive page

Malaria Re-appears in Greece

In Malaria, Uncategorized on November 15, 2012 at 9:48 am
The Wall Street Journal
Updated November 14, 2012, 4:07 a.m. ET

Health Scourge Hits Greece

Malaria, Once Mostly Eradicated, Returns as Crisis Erodes Government Safety Net


SKALA, Greece—Manolis Giannakakos doesn’t remember how he got to the hospital. What he does recall is a searing pain that felt like someone was driving screws into his skull and then violent chills and delirium.



Doctors told the 56-year-old math teacher in this small town near Sparta he had a dangerous disease mostly eradicated from Greece in 1974: Malaria.

“When I was still in grade school I remember this was a big problem,” Mr. Giannakakos said. “But never in my life did I believe it would return.”

Over the past two years, more than 50 endemic cases of the mosquito-borne parasitic illness and more than 100 imported cases have been identified in Greece. No one has died yet, but the disease can be debilitating and recur for years.

The return of malaria, a scourge in developing countries, to Greece is a disturbing indicator of the nation’s decline since it crashed in 2009 under the weight of a debt binge. Since then, Greece has seen decades of advances in public health rolled back, as a flood of illegal immigrants, a dysfunctional government and budget cuts ravage a once proud health-care system.

Everything from cancer drugs to syringes is in short supply. Doctors and nurses aren’t being paid. Efforts to monitor and contain outbreaks of infectious disease are faltering.

In addition to malaria, public-health officials say they are worried about rises in everything from infectious respiratory-tract diseases and skin conditions to tuberculosis and HIV.

These afflictions comes as people have less cash for health care. Studies show that up to a third of Greeks can no longer afford the drugs and tests prescribed by their doctors; routine checkups and vaccinations for children are falling.

The town of Skala overlooks a 20-square-mile marshy plain where the Evrota River empties into the Aegean Sea. The water is a boon, nourishing the thirsty orange groves. But it also makes the area a perfect breeding ground for mosquitoes, including malaria-carrying anopheles.

For years, Skala has attracted immigrants who come to harvest oranges and olives in the summer and autumn. Recent arrivals have come from Afghanistan, Pakistan and Bangladesh, all countries where malaria is rife.

Officials estimate that 1,500 to 3,000 immigrants—accounting for 15% to 30% of the local population—are crowded into houses, shacks, tent camps and even abandoned stables in Skala and surrounding towns.

It is unclear who first carried the malaria parasite that has spread around Evrota, but epidemiologists said mosquitoes, which have a typical flying range of about 3 miles, likely bit an infected immigrant and then transmitted it to others.

The Greek government was slow to respond to the first cases. Greece’s Center for Disease Control—prodded by European Union health authorities—only stepped in after an outbreak was well under way last year, local officials say.

The local mayor, Jannis Gripiotis, a doctor by training, said he began seeking help from Athens after some malaria cases were discovered in 2008. Instead of acting, Dr. Gripiotis said, Greek officials “decided to cover it up. They called me crazy.”

Greece’s CDC denies any coverup and says it has no record of any malaria cases in 2008 nor is it aware of any warnings issued by the mayor that year.

In 2009, six locally acquired malaria cases were confirmed in Evrota, the municipality that includes Skala, something independent public-health experts said should have triggered preventive measures by Athens. In 2010 there was one further confirmed case of endemic malaria and the next year the overall number of cases in the area jumped to 57, of which 34 were confirmed as being locally acquired.

That same year, 2011, 40 cases of the P.vivax infection—the parasite behind the outbreak—were reported in five different areas of Greece from individuals with no travel history to an endemic country.

“You know that the mosquito that can carry the parasite is present in this country…and you know that there are immigrants arriving from malarial countries,” said Apostolos Veizis, Greek program director for Doctors Without Borders, which began providing free health checks to immigrants in Evrota in March. “What do you have to do to ring the alarm bell and raise the level of surveillance?”

Even as alarms sounded, Greece’s spiraling economic crisis was taking its toll on the country’s public-health services. To help meet debtors’ demands, the government has slashed local-government budgets by 60% over the past three years as it saddled local governments with more health-care responsibilities.

Provincial governments, which used to help control malaria by aerial spraying of insecticides to kill mosquito larvae, were abolished in 2011, leaving it unclear who would take over. Amid the cutbacks, few local governments made it a priority.

In the past two years, Mayor Gripiotis said he appealed to the central government for money to map the local mosquito population, conduct door-to-door health screenings and begin spraying. He said he never received a response. This year he spent €300,000 ($381,000) from his own budget to spray and expects to do the same next year.

“I will find the money somewhere,” he said. “But I’m dying here and the problem is not a local issue, this is a blight on all of Greece.”

In response to questions from The Wall Street Journal, Health Minister Andreas Lycourentzos said recently he would secure funding this year for the municipality in combating the outbreak.

The scourge has begun to ease. Greece’s CDC began doing door-to-door screenings, which has helped bring down the confirmed malaria cases of infection in Evrota to eight this year from 34 last year.

The Greek CDC is weighing sending a second team to Evrota next year, if it has adequate funds, and has developed a national three-year suppression plan for the rest of Greece.

But the disease has now spread to other areas of the country, and it will take several years of spraying and other efforts to eradicate malaria, officials say.

Doctors Without Borders—which normally works in developing countries—is considering setting up a mission in another potential hot spot: the center of Athens, where thousands of immigrants live in crowded, unsanitary conditions and without access to basic health care. “Tuberculosis cases need more attention, there is quite a lot of underreporting of the disease here in Greece,” the group’s Dr. Veizis said.



In Dengue Fever, Uncategorized on November 8, 2012 at 2:46 pm

Country has become the focal point for a mosquito-borne plague that is sweeping globe


Originally published November 7, 2012 at 12:01 a.m., updated November 6, 2012 at 6:07 p.m.

NEW DELHI — An epidemic of dengue fever in India is fostering a growing sense of alarm, even as government officials have publicly refused to acknowledge the scope of a problem experts say is threatening hundreds of millions of people, not just in India but around the world.

India has become the focal point for a mosquito-borne plague that is sweeping the globe. Reported in a handful of countries in the 1950s, dengue is now endemic in half the world’s nations.

“The global dengue problem is far worse than most people know, and it keeps getting worse,” said Raman Velayudhan, the World Health Organization’s lead dengue coordinator.

The tropical disease, though life-threatening for a tiny fraction of those infected, can be extremely painful for many who catch it. Growing numbers of Western tourists are returning from warm-weather vacations with the disease, and it’s pierced the shores of the United States and Europe. Last month, health officials in Miami announced a case of locally acquired dengue infection.

In India’s capital, hospitals are overrun and feverish patients are sharing beds and languishing in hallways. At Kalawati Saran Hospital, a pediatric facility, a large crowd of relatives lay on mats and blankets outside the hospital entrance recently.

Officials say 30,002 people in India had been sickened with dengue fever through October, a 59 percent jump from the 18,860 recorded in 2011. But the real number of Indians who get dengue fever annually is in the millions, several experts said.

“I’d conservatively estimate that there are 37 million dengue infections occurring every year in India, and maybe 227,500 hospitalizations,” said Scott Halstead, a tropical disease expert.

A senior Indian government health official, who agreed to speak about the matter only on the condition of anonymity, acknowledged that official figures represent a mere sliver of dengue’s toll. The government only counts cases of dengue that come from public hospitals and have been confirmed by laboratories, the official said. Such a census, “which was deliberated at the highest levels,” is a small subset that is nonetheless informative and comparable from one year to the next, he said.

“There is no denying that the actual number of cases would be much, much higher,” the official said. “Our interest has not been to arrive at an exact figure.”

The problem with that policy, said Manish Kakkar, a specialist at the Public Health Foundation of India, is that India’s “massive underreporting of cases” has contributed to the disease’s spread. Experts from around the world said that India’s failure to construct an adequate dengue surveillance system has impeded awareness of the illness’s vast reach, discouraged efforts to clean up the sources of the disease and slowed the search for a vaccine.

“When you look at the number of reported cases India has, it’s a joke,” said Harold Margolis, chief of the dengue branch at the Centers for Disease Control and Prevention in Atlanta.

Neighboring Sri Lanka, for instance, reported nearly three times as many dengue cases as India through August, according to WHO, even though India’s population is 60 times larger.

Part of India’s problem is that some officials view reports of dengue infections as politically damaging. A central piece of evidence for those who contend that India suffers hundreds of times more dengue cases than the government acknowledges is a recent and as yet unpublished study of dengue infections in West Bengal that found about the same presence of dengue as in Thailand, where almost every child is infected by dengue at least once before adulthood.

“I would say that anybody over the age of 20 in India has been infected with dengue,” said Timothy Endy, chief of infectious disease at Upstate Medical University in Syracuse.

For those who arrive in India as adults, “you have a reasonable expectation of getting dengue after a few months,” said Joseph Vinetz, a professor of medicine at the University of California San Diego. “If you stay for a longer period, it’s a certainty.”

Twenty years ago, 1 of every 50 tourists who returned from the tropics with fever was infected by dengue; now, it is 1 in 6.

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