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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.


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