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 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 imp...

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Main Authors:	Tseroni, Maria, Baka, Agoritsa, Kapizioni, Christina, Snounou, Georges, Tsiodras, Sotirios, Charvalakou, Maria, Georgitsou, Maria, Panoutsakou, Maria, Psinaki, Ioanna, Tsoromokou, Maria, Karakitsos, George, Pervanidou, Danai, Vakali, Annita, Mouchtouri, Varvara, Georgakopoulou, Theano, Mamuris, Zissis, Papadopoulos, Nikos, Koliopoulos, George, Badieritakis, Evangelos, Diamantopoulos, Vasilis, Tsakris, Athanasios, Kremastinou, Jenny, Hadjichristodoulou, Christos
Format:	Online
Language:	English
Published:	Public Library of Science 2015
Online Access:	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4652894/

id	pubmed-4652894
recordtype	oai_dc
spelling	pubmed-46528942015-11-25 Prevention of Malaria Resurgence in Greece through the Association of Mass Drug Administration (MDA) to Immigrants from Malaria-Endemic Regions and Standard Control Measures Tseroni, Maria Baka, Agoritsa Kapizioni, Christina Snounou, Georges Tsiodras, Sotirios Charvalakou, Maria Georgitsou, Maria Panoutsakou, Maria Psinaki, Ioanna Tsoromokou, Maria Karakitsos, George Pervanidou, Danai Vakali, Annita Mouchtouri, Varvara Georgakopoulou, Theano Mamuris, Zissis Papadopoulos, Nikos Koliopoulos, George Badieritakis, Evangelos Diamantopoulos, Vasilis Tsakris, Athanasios Kremastinou, Jenny Hadjichristodoulou, Christos Research Article 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. Public Library of Science 2015-11-19 /pmc/articles/PMC4652894/ /pubmed/26583650 http://dx.doi.org/10.1371/journal.pntd.0004215 Text en © 2015 Tseroni et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
repository_type	Open Access Journal
institution_category	Foreign Institution
institution	US National Center for Biotechnology Information
building	NCBI PubMed
collection	Online Access
language	English
format	Online
author	Tseroni, Maria Baka, Agoritsa Kapizioni, Christina Snounou, Georges Tsiodras, Sotirios Charvalakou, Maria Georgitsou, Maria Panoutsakou, Maria Psinaki, Ioanna Tsoromokou, Maria Karakitsos, George Pervanidou, Danai Vakali, Annita Mouchtouri, Varvara Georgakopoulou, Theano Mamuris, Zissis Papadopoulos, Nikos Koliopoulos, George Badieritakis, Evangelos Diamantopoulos, Vasilis Tsakris, Athanasios Kremastinou, Jenny Hadjichristodoulou, Christos
spellingShingle	Tseroni, Maria Baka, Agoritsa Kapizioni, Christina Snounou, Georges Tsiodras, Sotirios Charvalakou, Maria Georgitsou, Maria Panoutsakou, Maria Psinaki, Ioanna Tsoromokou, Maria Karakitsos, George Pervanidou, Danai Vakali, Annita Mouchtouri, Varvara Georgakopoulou, Theano Mamuris, Zissis Papadopoulos, Nikos Koliopoulos, George Badieritakis, Evangelos Diamantopoulos, Vasilis Tsakris, Athanasios Kremastinou, Jenny Hadjichristodoulou, Christos Prevention of Malaria Resurgence in Greece through the Association of Mass Drug Administration (MDA) to Immigrants from Malaria-Endemic Regions and Standard Control Measures
author_facet	Tseroni, Maria Baka, Agoritsa Kapizioni, Christina Snounou, Georges Tsiodras, Sotirios Charvalakou, Maria Georgitsou, Maria Panoutsakou, Maria Psinaki, Ioanna Tsoromokou, Maria Karakitsos, George Pervanidou, Danai Vakali, Annita Mouchtouri, Varvara Georgakopoulou, Theano Mamuris, Zissis Papadopoulos, Nikos Koliopoulos, George Badieritakis, Evangelos Diamantopoulos, Vasilis Tsakris, Athanasios Kremastinou, Jenny Hadjichristodoulou, Christos
author_sort	Tseroni, Maria
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
title_short	Prevention of Malaria Resurgence in Greece through the Association of Mass Drug Administration (MDA) to Immigrants from Malaria-Endemic Regions and Standard Control Measures
title_full	Prevention of Malaria Resurgence in Greece through the Association of Mass Drug Administration (MDA) to Immigrants from Malaria-Endemic Regions and Standard Control Measures
title_fullStr	Prevention of Malaria Resurgence in Greece through the Association of Mass Drug Administration (MDA) to Immigrants from Malaria-Endemic Regions and Standard Control Measures
title_full_unstemmed	Prevention of Malaria Resurgence in Greece through the Association of Mass Drug Administration (MDA) to Immigrants from Malaria-Endemic Regions and Standard Control Measures
title_sort	prevention of malaria resurgence in greece through the association of mass drug administration (mda) to immigrants from malaria-endemic regions and standard control measures
description	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.
publisher	Public Library of Science
publishDate	2015
url	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4652894/
_version_	1613503910310313984

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

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