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PubMed2000

Molecular epidemiology of penicillin-nonsusceptible Streptococcus pneumoniae among children in Greece.

A total of 145 penicillin-nonsusceptible Streptococcus pneumoniae strains were isolated from young carriers in Greece and analyzed by antibiotic susceptibility testing, serotyping, restriction fragment end labeling (RFEL), and penicillin-binding protein (PBP) genotyping. The serotypes 23A and 23F (54%), 19A and 19F (25%), 9V (5%), 15A, 15B, and 15C (4%), 6A and 6B (4%), and 21 (4%) were most prevalent in this collection. Fifty-three distinct RFEL types were identified. Sixteen different RFEL clusters, harboring 2 to 32 strains each, accounted for 82% of all strains. Eight of these genetic clusters representing 60% of the strains were previously identified in other countries. A predominant lineage of 66 strains (46%) harboring five RFEL types and the serotypes 19F and 23F was closely related to the pandemic clone Spain(23F)-1 (genetic relatedness of > or =85%). Another lineage, representing 11 strains, showed close genetic relatedness to the pandemic clone France(9V)-3. Another lineage of 8 serotype 21 strains was Greece specific since the RFEL types were not observed in an international collection of 193 genotypes from 16 different countries. Characterization of the PBP genes pbp1a, pbp2b, and pbp2x revealed 20 distinct PBP genotypes of which PBP type 1-1-1, initially observed in the pandemic clones 23F and 9V, was predominantly present in 11 RFEL types in this Greek collection of penicillin-nonsusceptible strains (55%). Sixteen PBP types covering 52 strains (36%) were Greece specific. This study underlines the strong contribution of penicillin-resistant international clones to the prevalence and spread of penicillin-nonsusceptible pneumococci among young children in Greece.

Aminoacyltransferases↗

PubMed2003

Epidemiological data of multiple sclerosis in the province of Evros, Greece.

The frequency of multiple sclerosis (MS) in Greece is still debated. Our previous epidemiological field survey with a cross-check study of MS on March 31, 1984, in the province of Evros in north-eastern Greece showed a prevalence rate of 10.1/100,000. In 1990, Milonas et al. recorded a prevalence rate of 29.5/100,000 in northern Greece. So Greece is classified in the medium-frequency zone according to Kurtzke. This study was performed to estimate the prevalence of MS in the province of Evros and the annual incidence rates from 1974 to 1999. Patients were identified from several sources. A clinical follow-up was performed in 95% of the cases, and, if clinically indicated, new paraclinical examinations were performed and cases classified by Poser's criteria. The prevalence rate of the definite MS cases on December 31, 1999, was 38.9/100,000 and places the area in the high-risk zone. The mean annual incidence measured in 5-year intervals increased from 0.66/100,000 in 1974-1978 to 2.36/100,000 in 1994-1999 (p < 0.01). The increase in prevalence can be attributed to other causes than etiological changes, but the increase in the annual incidence rate indicates the possibility of a variation in risk factors of the disease.

Adult↗

PubMed2005

Non-Hodgkin's lymphomas in Greece according to the WHO classification of lymphoid neoplasms. A retrospective analysis of 810 cases.

The purpose of this retrospective study, the largest unselected series in our country, was to illustrate the clinicopathological features of non-Hodgkin's lymphoma (NHL) classified according to the World Health Organization (WHO) classification of lymphoid neoplasms. A retrospective analysis was conducted and clinical features of histological subtypes were established in 810 patients (age > or = 15 years) with NHL who were treated at 8 major centers representative of Greece. There were 435 males and 375 females 95% of them aged >30 years. B symptoms were present in 34% of the patients, while 45.3% had stages I-II and 54.6% had stages III-IV. LDH was increased in 37% of the patients. B cell lymphomas formed 88% of the cases whereas T cell lymphomas formed 12% of the total. Indolent lymphomas accounted for 31.1%, aggressive ones for 66.7% and very aggressive ones for 2.4% of all NHLs. Among indolent lymphomas extranodal ones (MALT B cell lymphoma) were the most common subset while follicular lymphoma grade I and II and small lymphocytic ones presented with equal frequency. Among the aggressive lymphomas diffuse large cell lymphoma (DLCL) was the most common subtype; this entity along with large-cell immunoblastic lymphomas accounted for 45.2% of all B cell lymphomas. Among the T cell lymphomas, peripheral T cell lymphomas and anaplastic large cell lymphomas of the T/null-cell type were the most common subtypes. The most common extranodal presentation was the gastrointestinal tract (GI). Next in frequency were primary extranodal NHL of the head and neck region. MALT B cell lymphomas were found in almost half of the patients with GI tract NHL, whereas in all other extranodal places DLCL was the predominant histological subtype. The median survival for indolent and aggressive NHL was 123.5 and 55.5 months, respectively. This is the first report of a large series of malignant lymphomas in Greece using the WHO classification. It appears that there are no significant differences between NHL in Greece and other large series as far as clinical and extranodal presentation is concerned. The frequency of follicular lymphoma in the current study is comparable to that reported from Asian countries and mainland Europe, but lower than that of US and Northern European series. There were no important differences in the incidence of the remaining histological subtypes between Greece and other European countries.

Adolescent↗

PubMed2004

Hepatitis E virus antibodies in hemodialysis patients: an epidemiological survey in central Greece.

Hepatitis E virus (HEV) is the causative agent for enteric non-A, non-B hepatitis. Transmission is mainly via the fecal-oral route but the possibility of an additional parenteric transmission has been raised. Patients undergoing chronic hemodialysis (HD) have an increased risk of exposure to blood transmitted agents. Previous studies concerning prevalence of antibodies to HEV (anti-HEV) among HD patients gave conflicting results. The aim of the study presented here was to determine the prevalence of anti-HEV among HD patients of a well-defined semi-rural region in central Greece (Thessalia region). All patients (n=351, 234 males, mean age 60+/-14 years) who were being treated in the HD units of central Greece (n=5) during 2001 were tested for anti-HEV antibody. Two commercially available specific solid-phase enzyme-linked immunoassays were applied for anti-HEV detection. Hepatitis B virus markers, antibodies to HCV, HIV and HTLV were also screened in all patients by commercially available assays. Serum aminotransferase (AST, ALT) levels were measured by spectrophotometry. 17 anti-HEV-positive patients were found and prevalence was 4.8%, varying from 1.8 - 9.8% in the various HD units. Prevalence of HBsAg and anti-HCV was 5.7% (2.9 - 15%) and 23.6% (11.5 - 36.2%) respectively. The anti-HEV prevalence was increased compared to healthy blood donors in Greece (0.26%, p < 0.01). The highest prevalence of anti-HEV was seen at the HD unit of the General Hospital of Karditsa (9.8%). Risk factors for anti-HEV antibody were not identified: no association was found between anti-HEV positivity and age or sex, duration of HD, hepatitis B or C virus infection markers, previously elevated aminotransferase levels or history of transfusion. Our investigation of HEV infection in the cohort of HD patients in central Greece showed that the prevalence of anti-HEV was greater than in healthy blood donors. There was no association to blood borne infections (HBV, HCV). The high prevalence of anti-HEV we found in one HD unit was probably related to a local infection in the past. However, long-term prospective studies are needed in an attempt to identify whether intra-unit factors are also responsible for the increased prevalence of serologic markers of HEV infection among HD patients.

Alanine Transaminase↗

PubMed1994

Trends and geographical distribution of childhood leukemia in Greece in relation to the Chernobyl accident.

Parts of Greece have been exposed to fallout radiation from the Chernobyl accident as much as any of the countries boardering with the former Soviet Union, because of the direction of the prevailing winds after the accident. Although fallout radiation did not reach levels expected to be associated with measurable effects, there is widespread concern in Greece that the incidence of childhood leukemia may be rising in the more heavily affected parts of Greece. Patient discharge data from all Greek hospitals treating childhood leukemia were used to calculate the annual incidence of the disease from January 1980 to June 1986 (preaccident period), from July 1986 to June 1988 (immediate postaccident period) and from July 1988 to June 1991 ("relevant" post-accident period, that accommodates the presumed latent period of the disease). Fallout radiation measurements (in Bq/kg Cs-137) were used to create 17 regions of similar (within regions) but highly variable (between regions) levels of fallout deposition. Background radiation (in Bq/kg Ra-226) and annual incidence of childhood leukemia by region were also estimated. There was no evidence of increased incidence of childhood leukemia during the immediate or the "relevant" post-Chernobyl period in any part of the country. Furthermore, regression analyses did not show any significant or suggestive association of childhood leukemia by region with either background or fallout radiation. These results indicate that the Chernobyl accident did not affect noticeably the incidence of childhood leukemia in Greece during the five-year post accident period.

Accidents↗

PubMed2007

Tobacco use among students aged 13-15 years in Greece: the GYTS project.

BACKGROUND: Data on the prevalence of tobacco use among teenagers in Greece are limited. We examined the prevalence of smoking among middle-school students in Greece using the Global Youth Tobacco Survey (GYTS). METHODS: The Global Youth Tobacco Survey was implemented in Greece during the academic year 2004-2005 by the University of Thessaly and the National School of Public Health. Data were collected using the GYTS self-administered anonymous questionnaire, which was distributed by specifically trained field workers to a nationally representative sample of middle-school students aged 13-15 years (through randomly selected schools and classes), randomly selected through a two-stage cluster sample design. Data processing and statistical analyses were performed at the Centers for Disease Control and Prevention (CDC). RESULTS: About one third of the students 32.1% (29.4-35.0) reported that they had tried tobacco in the past, while 16.2% (14.3-18.4) reported being current users of tobacco products. In addition, 1 in 4 of ever smokers reported that they began smoking before the age of 10 years old. Almost 1 in 5 never smokers reported being susceptible to initiate smoking in the next year and about 89.8% (88.3-91.1) of the respondents were exposed to environmental tobacco smoke in their homes and 94.1% (93.2-94.9) in public places. Finally, a strikingly high number of students 95% (89.5-97.7) reported that they were able to buy their own cigarettes without restrictions. CONCLUSION: The results of the GYTS show that the prevalence of smoking in middle-school children is alarmingly high in Greece. Smoking among young people constitutes a significant problem that is destined to worsen in the absence of any comprehensive efforts focused on strict anti-smoking legislation, policies and tobacco control interventions targeting children at a young age.

Adolescent↗

PubMed2006

An analysis of patient house calls in the area of Attica, Greece.

BACKGROUND: Physicians house calls to patients have been declining in many countries of the world. The objective of this study was to describe the patterns of utilization of house call services provided by SOS doctors in the area of Attica, Greece. METHODS: We performed a retrospective analysis of data regarding house call visits of patients in the area of Attica (metropolitan area of Athens and surrounding cities), Greece. Characteristics of patients who received house call services by a physician, including diagnosis, and recommended management plan, including advice for hospitalization were analyzed. RESULTS: SOS doctors in the area of Attica, Greece performed 98,009 house calls during the 5-year study period (1/11/2000-31/10/2005). Patients older than 65 years requested 47.8% of the house calls. Females requested more house calls during the studied period compared to males (59.4% versus 40.6%, p < 0.001). The majority of the diagnoses (18.4%) were infections of the upper and lower respiratory tract. 9.1% of patients were advised after the evaluation at home to be admitted to a hospital to receive inpatient services. CONCLUSION: Our analysis documents the utilization of house calls by SOS doctors in the area of Attica, Greece during a 5-year period. We believe that house calls provided by individual practitioners, physician group practices, or organized companies and organizations should re-gain their well-deserved position in the modern health care systems.

Adolescent↗

PubMed2006

Prevalence of infection by HTLV-I/II among pregnant women and high-risk groups in the Peloponnese peninsula, Greece.

Although screening for human T-cell lymphotropic virus types I and II (HTLV-I/II) antibodies in volunteer blood donors has been systematic in Greece since 1995, the epidemiology and the determinants of HTLV-I/II infection are not well defined among population groups. During 1997-2005, the prevalence of HTLV-I/II infection was investigated in a sample of 2016 pregnant women, 102 multitransfused haematologic and oncologic patients, 93 thalassaemic patients and 57 intravenous drug users originating from four geographic areas of Pelopennese peninsula, Greece. One recipient of HTLV-I infected blood and the relatives of a woman died from adult T-cell leukaemia/lymphoma (ATTL) related to HTLV-I have also been tested. The subjects were initially screened by an enzyme immunoassay whereas Western blot, INNO-LIA HTLV, polymerase chain reaction and nucleotide sequencing confirmed the infection. One thalassaemic patient had proved HTLV-I infection giving an overall prevalence of 11 per 1000. In the recipient of the infected blood and in two of the five relatives of the woman died from ATTL, HTLV-I infection was also detected. In none of the pregnant women, multitransfused patients and intravenous drug users HTLV-I/II infection was confirmed. These data suggest that HTLV-I is present in Greece among populations at high-risk. However, they would not support the need for HTLV-I/II antenatal screening in Greece.

Blotting, Western↗

PubMed2004

Prevalence of COPD in Greece.

OBJECTIVES: The prevalence of COPD in Greece is unknown. The aim of this study was to determine the prevalence and trends of COPD among adults in Greece. METHODS: This study involved 888 randomly identified adults (475 men and 413 women) aged > 35 years, and smokers of at least 100 cigarettes, in a population-based, multiregional, cross-sectional descriptive design. The selected individuals reflected the urban/rural population distribution in Greece and, within each study region, the age group and gender of the community setting. The diagnosis of COPD was based on clinical and spirometric data including reversibility test (DeltaFEV(1) < 15%). RESULTS: The overall prevalence of COPD in the population aged > 35 years with a smoking history of > 100 cigarettes per lifetime was 8.4%. The gender-standardized COPD prevalence was 11.6% for men and 4.8% for women. The COPD prevalence by community setting was as follows: Athens, 6%; other urban areas, 10.1%; semiurban areas, 8.5%; and rural areas, 9.1%. Smoking intensity and age were significantly associated with higher COPD prevalence in both men and women. CONCLUSIONS: COPD is a substantial health problem in Greece, although prevalence rates are lower than expected when the high smoking rates are taken into account. The high proportion of the patients with mild COPD who were unaware of their illness highlights the need to increase public awareness of COPD.

Adult↗

PubMed1995

National data on the epidemiology of IDDM in Greece. Cases diagnosed in 1992. Hellenic Epidemiology Study Group.

OBJECTIVE: To detect the incidence, geographic distribution, and seasonal variation of insulin-dependent diabetes mellitus (IDDM) in all of Greece. RESEARCH DESIGN AND METHODS: One hundred and thirty-seven children (75 boys and 62 girls) up to 14.9 years of age were diagnosed with IDDM in Greece in 1992. RESULTS: The age-adjusted incidence of IDDM in Greece in 1992 was 6.25/100,000 population (boys: 6.17/100,000;: girls: 6.28/100,000). There was a significant pubertal peak. The incidence of IDDM was significantly higher in metropolitan (10.0/100,000) than in rural (4.21/100,000), semirural (7.48/100,000), or urban areas (5.36/100,000) of Athens. There was a marginal difference between rural and semirural areas. No significant seasonal variation in the incidence of IDDM was observed. CONCLUSIONS: We conclude that the incidence of IDDM in Greece is among the five lowest in Europe. An impressive clustering of cases was observed in the Athens metropolitan area compared with the rural and semirural areas, an observation that possibly underlines the importance of environmental factors (stressful situations, infections, dietary habits, and others) in the expression of IDDM.

Adolescent↗

PubMed2002

Chronic venous insufficiency. A common health problem in general practice in Greece.

BACKGROUND: A study was carried out in Greece with the aim of assessing the prevalence of chronic venous insufficiency (CVI) in Greece and to discuss the role of general practice in the epidemiology, early diagnosis, and initial management of this disease. METHODS DESIGN: a prevalence study was carried out in rural Greece between January 17 and December 30, 1997. SETTING: 13 GPs, 11 of those working in 13 rural primary health centers, 1 in the University Hospital of Heraklion and 1 private sector from different Greek districts were invited to participate in the study. PARTICIPANTS AND METHODS: patients with the following criteria were entered into the study: weight, pain, cramps, burning, itching, formication and swelling. Complete information about patients' history was collected by the general practitioners (GPs) who used a semi-structured questionnaire. The diagnosis of CVI was established with Doppler ultrasound. RESULTS: Data were based on 6,119 questionnaires and GPs observed 4,502 randomly selected patients. The diagnosis of CVI was established in 993 patients and its prevalence was found to be 11.9% in males and 39.8% in females. Varicose veins were the most frequent clinical finding in patients with vein reflux and diabetes mellitus was the most common co-existing disease in males and hypertension in females. CONCLUSIONS: The prevalence of venous insufficiency (VI) appears to be a frequent health problem in general practice in Greece. It requires further investigation in order to explore the observed differences between various groups.

Aged↗

PubMed2003

Laypersons' expectation of the sequelae of whiplash injury: a cross-cultural comparative study between Canada and Greece.

BACKGROUND: The objective of the present study is to compare the frequency and nature of expected 'whiplash' symptoms in Greece [a country where the chronic whiplash syndrome is rare or unknown] with that in Canada. MATERIAL/METHODS: A symptom checklist was administered to 2 subject groups selected from local companies in Patras Greece, and Edmonton, Canada, respectively. Subjects were asked to imagine having suffered a neck sprain [whiplash injury] with no loss of consciousness in a motor vehicle collision, and to check which, of a variety of symptoms, they would expect might arise from the injury. For symptoms they anticipated, they were asked to select the period of time they expected those symptoms to persist. RESULTS: In both the Greek and Edmontonian groups, the pattern of symptoms anticipated closely resembled the acute symptoms commonly reported by accident victims with acute neck sprain, but while up to 50% of Edmontonians also anticipated symptoms to last months or years, very few Greek subjects selected any symptoms as likely to persist. CONCLUSIONS: In Greece, despite the documented occurrence of neck sprain symptoms in individuals following motor vehicle collisions, there is a very low rate of expectation of any sequelae from this injury. What current or previous aspects of society that underlie this remain uncertain. This lack of expectation of chronicity in Greece may, in part, determine the low prevalence of the chronic whiplash syndrome there. Further studies of symptom expectation as an etiologic factor in the chronic whiplash syndrome are needed.

Accidents, Traffic↗

PubMed2002

Countrywide estimation of the burden of injuries in Greece: a limited resources approach.

BACKGROUND: We have assessed the ability of the Emergency Department Injury Surveillance System (EDISS), a registration network operating with limited resources, to predict the burden and pattern of injuries in the whole Greece. METHODS: We have compared hospitalizations calculated on the basis of EDISS with those routinely recorded by the National Statistical Service countrywide. EDISS relies on data collected in the Emergency Departments of four hospitals, two located in the Greater Athens area, and two district hospitals in the remaining Greece. EDISS data concern hospitalized and non-hospitalized patients of all ages, with all types of injuries irrespectively of their etiology or intent. RESULTS: Over a three-year period 148 835 subjects with injuries were interviewed. Using sampling ratios of 2.2% for all injuries outside Greater Athens and for adults in Greater Athens but 28.9% for childhood injuries, the total annual number of injuries in Greece was estimated at 1.53 million (95% confidence interval: 1.48-1.57 million). Of those, about 18% concern children less than 15 years old. The difference between the EDISS estimated and the actually recorded hospitalized injuries was, in preliminary terms, acceptable. DISCUSSION: Of the ten major categories of injuries, seven among children and five among adults have shown deviations of less than 20%. For the remaining categories deviations were larger but in only one instance did the difference exceed 50%. It is concluded, that for a small and relatively homogeneous country, like Greece, injury data provided by four large hospitals can generate reasonably reliable estimates for large categories of injuries.

Adolescent↗

PubMed2003

Commodities consumed in Italy, Greece and other Mediterranean countries compared with Australia in 1960s and 1990s.

Consumption figures for 15 major commodities (cereals, wheat, rice, maize, potato, pulses, olive oil, other vegetable oils, vegetables, fruits, wine, meats, animal fats, milk + products, and fish + seafood) were collected from FAO Food Balance Sheets during the 1960s (1961-1969) and late 1990s (1995-1999). For some nutritionists the "model Mediterranean diet" is the Italian or Greek diet of the 1960s, for others the concept of Mediterranean countries is more general. Analysis shows: (1) In the 1960s, Australia consumed more meat, milk, animal fat than Italy or Greece and less cereals, wheat, pulses, olive oil, vegetables, fruits and wine. (2) In the 1960s, Australia's olive oil, vegetables, fruits and wine consumption were within the range for all 18 Mediterranean countries (i.e. Spain, France, Italy, Malta, Croatia, Bosnia, Albania, Greece, Cyprus, Turkey, Syria, Lebanon, Israel, Egypt, Libya, Tunisia, Algeria and Morocco). (3) In the 1990s, food consumptions have evolved; Australia's wine and milk consumption is now similar to Italy and Greece; consumption of wheat, olive oil, vegetables, fruits and fish are lower; consumption of potato, pulses, other vegetable oils and meat are higher than Italy or Greece. (4) Australia's consumption of the 15 commodities is within the range of all Mediterranean countries in the late 1990s, except wheat consumption was lower.

Australia↗

PubMed2004

Vascular surgery training in Greece.

The aim of the study was to describe current training in vascular surgery in Greece. The method used was the presentation of data obtained by direct contact with the units. Vascular surgery has been a mono-specialty in Greece since 1989. The duration of training is 7 years (3 years common trunk in general surgery, 3 years in vascular surgery and 1 year in cardiothoracic surgery). However, its duration often exceeds 11 years due to lost time in waiting to start training. The latter happens because there has been a tremendous increase of the number of medical graduates during the last decade and thus the number of trainees has increased disproportionately to the demand for vascular surgeons nationwide. Greece has the second higher ratio of vascular trainees per million population in EU (3.6 trainees/million population). There are 14 accredited centres for training in vascular surgery, the majority of them being in Athens (9/14). In these centres there are a total of 52 trainers and 38 trainees (ratio 1.4/1). An average of 380 operations are performed per centre/year and 140 operations/trainee/year. In conclusion, there is a need for re-defining the training programme in vascular surgery in Greece. The main concern is the tremendous increase in medical graduates leading to a discrepancy between accredited training posts and fellows waiting to fill them.

Greece↗

PubMed2004

Surveillance data on paediatric HIV infection and AIDS in Greece.

In Greece, HIV/AIDS surveillance is conducted by the Hellenic Centre for Infectious Diseases Control. The AIDS case reporting system was implemented in 1984, followed by notification of HIV infections in 1998. This article presents surveillance and trend analysis of paediatric HIV infection and AIDS, including cases identified prior to 1998. The number of HIV infected children in Greece is relatively low, raising to a cumulative total of 69 cases by June 2003, 44 (64%) of whom are thought to have been infected through mother-to-child transmission. Thirty three paediatric AIDS cases have been reported since the onset of epidemic, with Pneumonocystis carinii pneumonia being the most frequent opportunistic infection. A significant number of children in Greece were diagnosed after the age of 1 year. This could be attributed to the fact that many HIV-infected women are not identified during pregnancy, despite that fact that voluntary testing is available. It could also be attributed to the fact that data includes HIV infections collected retrospectively after 1998, and that foreign HIV-infected children may arrive in Greece at a later age. Furthermore, new paediatric HIV positive cases that were reported during the first half-year period of 2003 were foreign children born in eastern Europe and sub-Saharan Africa. Efforts should be made to identify women in these populations in time for proper intervention. HIV infection in children remains a huge problem worldwide, and it is very important to focus on reducing the risk of mother-to-child transmission.

AIDS-Related Opportunistic Infections↗

PubMed1992

[Epizootiology of foot and mouth disease during a quarter century (1962-1988) in Greece].

Greece has been considered as free from FMD since 1984. During the years 1962-1988 29 primary and 240 secondary (totally 269) outbreaks had appeared in Greece. From these 187 were of Type O, 60 of Type A, 14 of Type C, 6 of Type SAT 1 and 2 of Type ASIA 1. From the 269 cases 81 appeared in Attiki, 57 in Evros (near the Turkey) and 131 in the other provinces. With reference to animal species 197 were in cattle, 60 in pigs and 12 in sheep and goats. Most of the 29 primary outbreaks appeared in January and none in December. According to the epizootiological results FMD seems to be introduced in Greece either by imported meat and meat products (especially in Attiki) or from the neighbour Turkey (especially in Evros), where the disease is enzootic. Because of the geographical position of Greece it seems very important for all EEC countries that the FMD-Institute in Athens as well as the State Veterinary Service in Evros should be better organised so that any zoonoses from Asia could be controlled without delay.

Animals↗

PubMed2006

A pseudo-outbreak of human A/H5N1 infections in Greece and its public health implications.

The recent wide geographic spread of the highly pathogenic avian influenza A/H5N1 virus has important public health implications. Several wild migratory birds were confirmed to be infected with avian influenza A/H5N1 in Greece in February and March 2006. The aim of this paper is to report data from potential H5N1 human cases that presented to local hospitals during this period with a respiratory infection and expressing concern about exposure to avian influenza. A case-control investigation was conducted that included case identification with the use of a structured definition, review of epidemiological and clinical characteristics and molecular testing for avian influenza A/H5N1. The setting was the entire country of Greece during February and March 2006. The main outcomes were rates of possible cases (meeting both a clinical and an epidemiological criterion) and clinical or epidemiological characteristics differentiating them from potential cases that met either one of the criteria of a possible case, but not both. Twenty six potential patients (81% of whom met a clinical criterion, and 39% of whom met an epidemiological criterion) presented and most (85%) were admitted in local hospitals during the period of interest. The majority of cases (85%) were observed in northern Greece where most of the confirmed A/H5N1 avian cases were documented. Five of the 26 evaluated patients met the definition of a possible case. These clustered within the early period of confirmed A/H5N1 cases in wild migratory birds (P=0.05). Molecular testing was negative for all possible cases. Application of a revised case definition constructed according to newer European Union guidance resulted in the exclusion of two possible cases. Several potential A/H5N1 human cases were recently identified in Greece. Both the timing of identification and the geographical location of potential cases suggest an increased awareness on the part of the general public, as well as poor interpretation of the case definition by the clinicians.

Adolescent↗