A case of #CCHF imported in #Greece: #Contact #tracing and #management of exposed #HCWs (J Infect Prev., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Infect Prev. 2019 Jul;20(4):171-178. doi: 10.1177/1757177419852666. Epub 2019 Jun 6.

A case of Crimean-Congo haemorrhagic fever imported in Greece: Contact tracing and management of exposed healthcare workers.

Maltezou HC1, Papa A2, Ventouri S3, Tseki C4, Pervanidou D5, Pavli A1, Panagopoulos P3,6, Markatou P7, Gavana E2, Maltezos E3,6.

Author information: 1 Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece. 2 Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece. 3 Department of Infection Control, University Hospital of Alexandroupolis, Alexandroupolis, Greece. 4 Department of Infection Control, General Hospital of Xanthi, Xanthi, Greece. 5 Department for Epidemiological Surveillance and Intervention, Hellenic Center for Disease Control and Prevention, Athens, Greece. 6 Second Department of Internal Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece. 7 Department of Internal Medicine, University Hospital of Alexandroupolis, Alexandroupolis, Greece.




Nosocomial transmission is a major mode of infection of Crimean-Congo haemorrhagic fever (CCHF). In May 2018, a patient with CCHF was hospitalised in Greece.


Our aim was to present the management of healthcare workers (HCWs) to the CCHF case.


Contact tracing, risk assessment and follow-up of exposed HCWs were performed. Testing (RT-PCR and/or serology) was offered to contacts. Post-exposure prophylaxis (PEP) with ribavirin was considered for high-risk exposures.


Ninety-one HCWs were exposed to the case. Sixty-six HCWs were grouped as high-risk exposures. Ribavirin PEP was offered to 29 HCWs; seven agreed to receive prophylaxis. Forty-one HCWs were tested for CCHF infection; none was found positive. Gaps in infection control occurred.


CCHF should be considered in patients with compatible travel history and clinical and laboratory findings. Early clinical suspicion and laboratory confirmation are imperative for the implementation of appropriate infection control measures. Ribavirin should be considered for high-risk exposures. Infection control capacity for highly pathogenic agents should increase.

KEYWORDS: Crimean-Congo haemorrhagic fever; contact tracing; healthcare workers; infection control; ribavirin

PMID: 31428197 PMCID: PMC6683607 [Available on 2020-07-01] DOI: 10.1177/1757177419852666

Keywords: CCHF; HCWs; Greece.



A #paediatric #influenza #update 100 years after the #Skyros island #Spanishflu #outbreak (Exp Ther Med., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Exp Ther Med. 2019 Jun;17(6):4327-4336. doi: 10.3892/etm.2019.7515. Epub 2019 Apr 22.

A paediatric influenza update 100 years after the Skyros island Spanish flu outbreak.

Mammas IN1, Theodoridou M2, Thiagarajan P3, Melidou A4, Papaioannou G5, Korovessi P6, Koutsaftiki C7, Papatheodoropoulou A8, Calachanis M9, Dalianis T10, Spandidos DA1.

Author information: 1 Department of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece. 2 First Department of Paediatrics, ‘Aghia Sophia’ Children’s Hospital, University of Athens School of Medicine, 115 27 Athens, Greece. 3 Neonatal Unit, Division for Women’s & Children Health, Noble’s Hospital, IM4 4RJ Douglas, Isle of Man, British Isles. 4 Second Laboratory of Microbiology, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece. 5 Department of Paediatric Radiology, ‘Mitera’ Children’s Hospital, 151 23 Athens, Greece. 6 Department of Paediatrics, ‘Penteli’ Children’s Hospital, 152 36 Penteli, Greece. 7 Paediatric Intensive Care Unit (PICU), ‘Penteli’ Children’s Hospital, 152 36 Penteli, Greece. 8 Paediatric Intensive Care Unit (PICU), ‘P. and A. Kyriakou’ Children’s Hospital, 115 27 Athens, Greece. 9 Department of Paediatric Cardiology, ‘Penteli’ Children’s Hospital, 152 36 Penteli, Greece. 10 Karolinska Institutet, Karolinska University Hospital, SE-117 77 Stockholm, Sweden.



This year marks the 100th anniversary of the 1918 Spanish flu outbreak on the Greek Aegean Sea island of Skyros, which devastated its population in less than 30 days. According to Constantinos Faltaits’s annals published in 1919, the influenza attack on the island of Skyros commenced acutely ‘like a thunderbolt’ on the 27th of October, 1918 and was exceptionally severe and fatal. At that time, the viral cause of the influenza had not been detected, while the total number of victims of the Spanish flu outbreak has been estimated to have surpassed 50 million, worldwide. Almost one century after this Aegean Sea island’s tragedy, the ‘4th Workshop on Paediatric Virology’, organised on the 22nd of September, 2018 in Athens, Greece, was dedicated to the 100 years of the ‘Spanish’ flu pandemic. This review article highlights the plenary and key lectures presented at the workshop on the recent advances on the epidemiology, clinical management and prevention of influenza in childhood.

KEYWORDS: H1N1; Paediatric Intensive Care Unit; antiviral drugs; influenza; myocarditis; neurological complications; paediatric virology; probiotics; radiology; vaccination

PMID: 31186675 PMCID: PMC6507498 DOI: 10.3892/etm.2019.7515

Keywords: Pandemic Influenza; Spanish Flu; Pediatrics; History; Greece.


On #lifestyle trends, #health and #mosquitoes: Formulating welfare levels for control of the Asian tiger mosquito in #Greece (PLoS Negl Trop Dis., abstract)

[Source: PLoS Neglected Tropical Diseases, full page: (LINK). Abstract, edited.]


On lifestyle trends, health and mosquitoes: Formulating welfare levels for control of the Asian tiger mosquito in Greece

Antonios Kolimenakis , Kostas Bithas, Dionysis Latinopoulos, Clive Richardson

Published: June 4, 2019 / DOI: https://doi.org/10.1371/journal.pntd.0007467 / This is an uncorrected proof.



The expansion of urban ecosystems and climate change, both outcomes of massive lifestyle changes, contribute to a series of side effects such as environmental deterioration, spread of diseases, increased greenhouse gas emissions and introduction of invasive species. In the case of the Athens metropolitan area, an invasive mosquito species—the Asian tiger mosquito (Aedes albopictus)–has spread widely in the last decade. This spread is favoured within urban environments and is also affected by changing climatic trends. The Asian tiger mosquito is accompanied by risks of mosquito-borne diseases, greater nuisance levels, and increased expenses incurring for its confrontation. The main aims of this paper are (i) to estimate the various costs associated with their control of this invasive species, as well as its health and nuisance impacts, (ii) to evaluate the level of citizens’ well-being from averting these impacts and (iii) to record citizens’ and experts’ perceptions regarding alternative control measures. Evidence shows that experts tend to place a high value on mosquito control when associated with serious health risks, while citizens are more sensitive and concerned about the environmental impacts of control methods. The synthesis of results produced by the current study could act as a preliminary guide for the estimation of societal welfare from the confrontation of similar problems in the context of a complex ecosystem.


Author summary

This paper is based on several years’ collaboration among researchers from various disciplines, key health policy makers and stakeholders in an attempt to evaluate the economic dimensions related to the presence of the Asian Tiger Mosquito (Aedes albopictus) and the challenges of tackling mosquito-borne disease outbreaks in Greece and Southern Europe. Similar studies have been conducted and continue to be published in Europe and the USA examining the socioeconomic benefit from the implementation of relevant control and prevention strategies. These studies conclude that there are significant benefits related both to the reduction of nuisance levels and the reduction of the health risks posed by various mosquito species. In our case, the application of an updated economic analysis on the effectiveness of relevant public control and prevention programs provides essential information for public health decision-making, bearing in mind the significant restructuring of the public sector and the fiscal crisis apparent in the European South.


Citation: Kolimenakis A, Bithas K, Latinopoulos D, Richardson C (2019) On lifestyle trends, health and mosquitoes: Formulating welfare levels for control of the Asian tiger mosquito in Greece. PLoS Negl Trop Dis 13(6): e0007467. https://doi.org/10.1371/journal.pntd.0007467

Editor: Olaf Horstick, University of Heidelberg, GERMANY

Received: October 2, 2018; Accepted: May 14, 2019; Published: June 4, 2019

Copyright: © 2019 Kolimenakis et al. 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 credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: Part of this research has been co-financed by the European Union (EU Environmental Funding Programme LIFE+ Environment Policy and Governance) and Greek national funds through the LIFE CONOPS project “Development & demonstration of management plans against—the climate change enhanced—invasive mosquitoes in S. Europe” (LIFE12ENV/GR/000466). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Climate change; Mosquitoes; Aedes albopictus; Society; Poverty; Greece.


Emergence of #ceftazidime – #avibactam- #resistant #Klebsiella pneumoniae during #treatment, #Finland, December 2018 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Emergence of ceftazidime-avibactam-resistant Klebsiella pneumoniae during treatment, Finland, December 2018

Kati Räisänen 1, Irma Koivula 2, Heikki Ilmavirta 3, Santeri Puranen 4, Teemu Kallonen 1,5, Outi Lyytikäinen 1, Jari Jalava 1

Affiliations: 1 Department of Health Security, National Institute for Health and Welfare, Helsinki, Finland; 2 Kuopio University Hospital, Unit of Infections and Hospital hygiene, Kuopio University Hospital, Kuopio, Finland; 3 Eastern Finland laboratory Centre, Kuopio, Finland; 4 Aalto University, Department of Computer Science, Espoo, Finland; 5 Department of Biostatistics, University of Oslo, Oslo, Norway

Correspondence:  Kati Räisänen

Citation style for this article: Räisänen Kati, Koivula Irma, Ilmavirta Heikki, Puranen Santeri, Kallonen Teemu, Lyytikäinen Outi, Jalava Jari. Emergence of ceftazidime-avibactam-resistant Klebsiella pneumoniae during treatment, Finland, December 2018. Euro Surveill. 2019;24(19):pii=1900256. https://doi.org/10.2807/1560-7917.ES.2019.24.19.1900256

Received: 24 Apr 2019;   Accepted: 07 May 2019



In December 2018, a ceftazidime-avibactam (CAZ-AVI)-resistant KPC-2-producing Klebsiella pneumoniae strain was isolated in Finland. CAZ-AVI resistance was observed 34 days after CAZ-AVI treatment in a trauma patient transferred from a hospital in Greece who had been colonised with blaKPC-2-producing K. pneumoniae ST39, and later developed a bloodstream infection. The CAZ-AVI-resistant strain contained a novel 15 amino acid insertion in the KPC-2 protein causing structural changes proximal to the KPC-2 active site.

©   This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: Antibiotics; Drugs Resistance; Ceftazidime; Avibactam; Klebsiella pneumoniae; Greece; Finland.


Emergence of #NDM1-producing #Klebsiella pneumoniae in #Greece: evidence of a #widespread clonal #outbreak (J Antimicrob Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

Emergence of NDM-1-producing Klebsiella pneumoniae in Greece: evidence of a widespread clonal outbreak

Lida Politi, Konstantina Gartzonika, Nicholas Spanakis, Olympia Zarkotou, Aggeliki Poulou, Lemonia Skoura, Georgia Vrioni, Athanasios Tsakris

Journal of Antimicrobial Chemotherapy, dkz176, https://doi.org/10.1093/jac/dkz176

Published: 07 May 2019




NDM-producing Enterobacteriaceae clinical isolates remain uncommon in the European region. We describe the emergence and broad dissemination of one successful NDM-1-producing Klebsiella pneumoniae clone in Greek hospitals.


During a 4 year survey (January 2013–December 2016), 480 single-patient carbapenem non-susceptible K. pneumoniae isolates, phenotypically MBL positive, were consecutively recovered in eight Greek hospitals from different locations and subjected to further investigation. Antimicrobial susceptibility testing, combined-disc test, identification of resistance genes by PCR and sequencing, molecular fingerprinting by PFGE, plasmid profiling, replicon typing, conjugation experiments and MLST were performed.


Molecular analysis confirmed the presence of the blaNDM-1 gene in 341 (71%) K. pneumoniae isolates. A substantially increasing trend of NDM-1-producing K. pneumoniae was noticed during the survey (R2 = 0.9724). Most blaNDM-1-carrying isolates contained blaCTX-M-15, blaOXA-1, blaOXA-2 and blaTEM-1genes. PFGE analysis clustered NDM-1 producers into five distinct clonal types, with five distinct STs related to each PFGE clone. The predominant ST11 PFGE clonal type was detected in all eight participating hospitals, despite adherence to the national infection control programme; it was identical to that observed in the original NDM-1 outbreak in Greece in 2011, as well as in a less-extensive NDM-1 outbreak in Bulgaria in 2015. The remaining four ST clonal types (ST15, ST70, ST258 and ST1883) were sporadically detected. blaNDM-1 was located in IncFII-type plasmids in all five clonal types.


This study gives evidence of possibly the largest NDM-1-producing K. pneumoniae outbreak in Europe; it may also reinforce the hypothesis of an NDM-1 clone circulating in the Balkans.

Topic: polymerase chain reaction – plasmids – carbapenem – bulgaria – clone cells – disease outbreaks – electrophoresis, gel, pulsed-field – enterobacteriaceae – genes – greece – ichthyosis, x-linked – infectious disease prevention / control – klebsiella pneumoniae  – replicon – sequence tagged sites – sodium thiosulfate – antimicrobial susceptibility test – beta-lactamase ndm-1 – resistance genes – molecular profiling


© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Antibiotics; Drugs Resistance; Carbapene; NDM1; Klebsiella pneumoniae; Greece; Nosocomial outbreaks.


#Detection in #Greece of a #clinical #Enterococcus faecium isolate carrying the novel #oxazolidinone #resistance gene poxtA (J Antimicrob Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

Detection in Greece of a clinical Enterococcus faeciumisolate carrying the novel oxazolidinone resistance gene poxtA

Costas C Papagiannitsis, Katerina Tsilipounidaki, Ergina Malli, Efi Petinaki

Journal of Antimicrobial Chemotherapy, dkz155, https://doi.org/10.1093/jac/dkz155

Published: 22 April 2019



Oxazolidinones possess potent activity against Gram-positive pathogens such as VRE. Soon after their introduction into clinical practice, linezolid-resistant enterococcal isolates were reported.1 Resistance of enterococci to oxazolidines is mainly associated with mutations in 23S rRNA genes and L3 and L4 ribosomal proteins.2 Additionally, transferable resistance determinants including the cfr, optrAand poxtA genes have also emerged.3–5 Here we report, to the best of our knowledge, the first detection of a poxtA-positive Enterococcus faecium strain isolated in Greece.

…E. faecium isolate (Efa-955) was recovered, in 2018, from a urine sample of a patient treated in the University Hospital…



© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Antibiotics; Drugs Resistance; Linezolid; Enterococcus faecium; Greece.


#Reversal of #carbapenemase-producing #Klebsiella pneumoniae #epidemiology from blaKPC- to blaVIM-harbouring isolates in a #Greek #ICU after introduction of #ceftazidime/avibactam (J Antimicrob Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

Reversal of carbapenemase-producing Klebsiella pneumoniae epidemiology from blaKPC- to blaVIM-harbouring isolates in a Greek ICU after introduction of ceftazidime/avibactam

Matthaios Papadimitriou-Olivgeris, Christina Bartzavali, Anastasia Lambropoulou, Anastasia Solomou, Ekaterini Tsiata, Evangelos D Anastassiou, Fotini Fligou, Markos Marangos, Iris Spiliopoulou, Myrto Christofidou

Journal of Antimicrobial Chemotherapy, dkz125, https://doi.org/10.1093/jac/dkz125

Published: 19 April 2019




Our aim was to determine the epidemiology of bloodstream infections (BSIs) by carbapenemase-producing Klebsiella pneumoniae (CP-Kp) after the introduction of ceftazidime/avibactam in January 2018 among ICU patients.

Patients and methods

All patients hospitalized at the ICU of the University General Hospital of Patras, Greece with CP-Kp BSI during 2015–18 were included. MICs of meropenem, fosfomycin, tigecycline and ceftazidime/avibactam (only for isolates from 2018) were determined by Etest, whereas for colistin, the broth microdilution method was applied. All isolates were tested by PCR for the presence of blaKPC, blaVIM, blaNDM and blaOXA-48 genes.


Among 170 BSIs due to CP-Kp (2015–18), 132 (78%) were caused by isolates carrying blaKPC (4 ceftazidime/avibactam-resistant), 17 blaVIM (10%), 16 blaNDM (9%) and 5 carrying both blaKPC and blaVIM (3%). From 2015 to 2017 (125 BSIs), KPC-producing strains (110; 88%) predominated, followed by NDM-producing strains (15; 12%), whereas no VIM-producing strain was isolated. Among the 45 BSIs in 2018, 22 (49%) were due to isolates carrying blaKPC (4 ceftazidime/avibactam resistant), followed by 17 (38%) carrying blaVIM, 5 (11%) carrying both blaKPC and blaVIM, and 1 isolate carrying blaNDM (2%). MBLs were more frequent in 2018 compared with 2015–17 (51% versus 12%; P < 0.001). Multivariate analysis found that prior administration of ceftazidime/avibactam (P = 0.014; OR 16.7, 95% CI 1.8–158.6) was independently associated with the development of BSI due to ceftazidime/avibactam-resistant isolates.


Widespread ceftazidime/avibactam use may lead to a change in the palette of carbapenemases by replacing KPC with MBL-producing isolates.


© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Antibiotics; Drugs Resistance; Ceftazidime; Avibactam; NDM; ICU; Greece; Klebsiella pneumoniae.