HCDCP

Malaria

General Information

Malaria is an infectious disease, caused by the parasite “plasmodium” of malaria and is transmitted through the bite of infected mosquitoes of the “Anopheles” genus. Mosquitoes are infected from infectious patients (i.e., patients with parasitemia).

Ongoing transmission of malaria is currently recorded in >80 countries/ areas around the world (WHO, World Malaria Report, 2019), mainly in sub-Saharan Africa, Asia and Latin America. Until the mid-twentieth century, several countries in Europe and North America were also malaria endemic, but -after intense malaria control programs- it was eliminated.

Malaria was eliminated from Greece in 1974, following an intense control program (1946- 1960). Since then, several (20-110 cases) imported cases are recorded annually, referring to patients infected abroad. Increased numbers of imported malaria cases are expected due to the increase of travels and population movements worldwide, and are observed in all developed countries.

Additionally, since 2009 a number of locally acquired/introduced P. vivax malaria cases have been recorded in some -mainly rural- areas of the country (i.e., among patients without travel history to a malaria endemic country), mainly as sporadic introduced cases (1st generation transmission) but also in clusters (in 2011 – 2012).

The following Table presents the number of malaria cases reported to the Hellenic National Public Health Organization (NPHO) by year of symptom onset (for imported cases) or infection (for locally acquired cases) and by epidemiological case classification (imported/ locally acquired), in 2009-2020.

Table 1: Reported malaria cases by year of symptom onset1 (for imported cases) or infection (for locally acquired/ introduced cases) and by epidemiological case classification (imported/ locally acquired), Greece, 2009 – 20202.

Year Case classification
Imported cases Locally acquired/ introduced cases3
2009 44 7
2010 40 4
2011 54 42
2012 73 20
2013 22 3
2014 38 0
2015 79 8
2016 111 6
2017 100 7
2018 44 11
2019 38 1
2020 21 2
  1. Cases with no information regarding symptom onset were classified according to the year of hospitalization or notification to the NPHO.
  2. Known reported relapses, two locally acquired malariae cases (2012), that were attributed to former transmission periods, and three malaria cases “of undetermined classification” (two in 2016 and one in 2018) are not included.
  3. All were vivax cases, except two P.falciparum cases (one in 2017 and one in 2020).

 

As indicated by the malaria surveillance data, in the malaria-free Greece, the risk of re-introduction of the disease in specific vulnerable and receptive areas of the country exists, especially where the presence of adequate numbers of Anopheles mosquitoes (the competent vector of the disease) is combined with the presence of malaria patients coming from endemic countries.

Following a peak of locally acquired malaria cases in 2011-2012, their number declined steadily in the following years, with recording of only a limited number of sporadic introduced cases (1st generation of transmission). This decrease is the result of a number of intense public health interventions uninterruptedly implemented, with the collaboration of various stakeholders at the national, regional and local level, which have contributed to the successful prevention of the re-appearance of malaria in Greece.

Early detection and eradication treatment of malaria cases, personal protection against mosquito bites and the timely implementation of effective integrated vector control measures represent the main components of the public health strategy to prevent P.vivax reintroduction and re-appearance in high risk areas of the country.

The Hellenic National Public Health Organization has developed (since 2011) and continuously implements an operational action plan for the management of malaria. In addition, in 2015, the Ministry of Health published the “National Action Plan for the Management of Malaria”. According to these plans, a series of activities are implemented nationwide for the prevention and management of malaria, with the collaboration of national, regional and local authorities, which include: risk assessment, enhancement of malaria surveillance and laboratory malaria diagnosis, proper case management, communication activities for the public, health professionals and local authorities, mosquito vector surveillance and control activities, and blood safety measures.

More detailed information regarding malaria surveillance data and activities for the prevention of malaria in Greece can be found in the published ad hoc and annual malaria surveillance reports.

 

Epidemiological Surveillance

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