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We investigated a large gastroenteritis outbreak that occurred in Northern Greece in 2019. A case was defined as anyone presenting with diarrhoea and/or vomiting from 24 January 2019 to 04 February 2019. We conducted a case-control study (CCS) using random selection of participants >16 years of age, residents of town X, who visited the health care centre between 25 and 28 January 2019. Moreover, we conducted a retrospective cohort study (CS) at the four elementary schools of the town. We collected clinical and water samples and the water supply system was inspected. In total, we recorded 638 cases (53% female; median age was 44 years (range 0-93)). Forty-eight cases and 52 controls participated in the CCS and 236 students in the CS. Both CCS and CS indicated tap water as the most likely source (OR 10, 95% CI 2.09-93.4, explaining 95.7% of cases; RR = 2.22, 95% CI 1.42-3.46, respectively). More than one pathogen was detected from stool samples of 6 of the 11 cases tested (norovirus, Campylobacter jejuni, Enterohemorrhagic E. coli (EHEC) and Enteropathogenic E. coli (EPEC)). Water samples, collected after ad-hoc chlorination, tested negative. Technical failures of the water tanks' status were identified. Our results suggested a waterborne outbreak. We recommended regular monitoring of the water supply system and immediate repair of technical failures. [ABSTRACT FROM AUTHOR]

Hepatitis A is a mandatory notifiable disease in Greece. Here, we present the epidemiological data for 2009–2018 and the results of outbreak investigations performed, and discuss future public health priorities. Overall, 1193 cases were reported; 320 migrants/refugees, 240 Roma, 112 travellers and 521 from the general population. The median age of the affected general population (37 years) had an increasing trend (from 30.8 years in 2009 to 40.5 in 2018, P < 0.001) and was significantly higher than that among Roma and migrants (7 and 8 years, respectively, P < 0.001). Twentytwo cases (2.2%) were unvaccinated patients with a chronic liver disease. Fifty clusters with 2–12 cases each were recorded; 44 were attributed to person-to-person transmission and six to food consumption. Three outbreaks accounting for 32.3% of the total number of recorded cases were identified; in 2013 among Roma (112 cases), in 2016 among refugees (188 cases) and in 2017 among men having sex with men (96 cases; 33 of them (34.4%) HIV-positive). The epidemiological data depict that improving living conditions and vaccination coverage of deprived populations, and informing adults on the disease focusing at faecal–oral transmission during sexual intercourse and travel should be the future public health priorities. [ABSTRACT FROM AUTHOR]

Campylobacter infection usually causes enteritis, the nosological spectrum of which varies from watery, non-bloody diarrhea to severe inflammatory diarrhea with abdominal pain and fever. Bacteremia, Reiter syndrome, Guillain-Barré syndrome and hemolytic uremic syndrome are possible complications of this infection, which can also cause localised infections, such as meningitis and encephalitis, especially in children. Campylobacter infection is transmitted through the consumption of contaminated food or water. The incubation period of the disease is usually two to five days and the transmission period lasts throughout the duration of infection, usually from a few days to a few weeks. According to the most recently published data of the European Centre for Diseases Control and Prevention, the overall incidence of the disease among the 25 countries of the European Union was 44.1 cases per 100,000 population in 2008, and Campylobacter spp was the most frequently reported bacterial cause of acute gastroenteritis and also the most frequently isolated pathogen in stool cultures, surpassing Salmonella spp. In Greece, the surveillance of the disease is voluntary and the available epidemiological data are limited. Risk factors for Campylobacter infection are consumption of poultry, red meat, unpasteurized milk or untreated water, swimming, travelling abroad, contact with animals, consumption of omeprazole or H2 inhibitors, the presence of an underlying condition, etc. The contribution of each of these factors to disease morbidity varies according to the particular characteristics of the population. Only a limited number of analytical epidemiological studies have been conducted in Southern Europe, one of which refers to the urban population of children in Greece. In summer 2009 an outbreak of campylobacteriosis with 54 recorded cases was reported to the Greek public health authorities for the first time. Consequently, it is important for clinicians to be well-informed about the recent epidemiological data of the disease, in order to increase the frequency of laboratory investigation of gastroenteritis cases for Campylobacter spp. In this way, the public health authorities will be able to investigate cases of Campylobacter infection more actively. [ABSTRACT FROM AUTHOR]

During 2010, an outbreak of West Nile virus infection occurred in Greece. A total of 197 patients with neuroinvasive disease were reported, of whom 33 (17%) died. Advanced age and a history of heart disease were independently associated with death, emphasizing the need for prevention of this infection in persons with these risk factors. [ABSTRACT FROM AUTHOR]

OBJECTIVE On 4 March 2010, the Department of Epidemiological Surveillance and Intervention of the Hellenic Centre for Disease Control and Prevention was notified about an outbreak of gastroenteritis among high school pupils who had stayed at a hotel of the Prefecture of Central Macedonia from 11 to 15 February 2010, in the context of a school excursion. The aim of this study was to detect the possible source of the outbreak and to define the mode and the vehicle of disease transmission. METHOD A retrospective cohort study was conducted. Individuals who had participated in the school excursion were interviewed via a structured questionnaire, which covered demographic data and information about the disease and possible exposures. Epidata v3.1 was used for data entry and STATA v11.0 for data analysis. Relative risks (RR) and 95% corresponding confidence intervals (CI) were computed for all the risk factors tested. An association was considered statistically significant when the p value was <0.05. The presence of statistically significant independent associations was examined via multiple logistic regression using backward elimination techniques. Risk factors for which the univariate analysis showed a p value <0.05 and RR >3 were included in the multivariate analysis model. A culture was ordered for one stool sample taken from a student. The Health Directorate conducted an environmental inspection of the hotel's kitchen premises and the procedures followed during food preparation. RESULTS Of the 61 persons who participated in the excursion, 54 were included in the study (88.5%). The attack rate was 27.8%. Univariate analysis showed statistically significant association of the disease with several food items that had been consumed during the pupils' stay at the hotel, but the only statistically significant risk factor derived from the multivariate analysis was the consumption of pasta with carbonara sauce at the dinner of the fourth day (RR=17.5, 95% CI: 2.47-123.8). Results of the stool culture were negative. The environmental investigation detected several deficiencies regarding hygiene measures and some food items that were found inappropriate for consumption were confiscated. CONCLUSIONS Even in cases where the laboratory verification of an outbreak is not possible, the epidemiological investigation of an outbreak of gastroenteritis can be of great use, as it provides information regarding the possible source and the mode of the disease transmission. [ABSTRACT FROM AUTHOR]

Background: A nosocomial outbreak in a 740-bed hospital in Athens, Greece, was investigated in January-February 2012. Methods: Recommendations on infection control measures were given and two case-control studies were conducted among patients (study A) and health care workers (HCWs) (study B). Compliance to control measures was evaluated. Results: The absence of a routine recording system of nosocomial-acquired gastroenteritis cases led to a 10 days delay in outbreak identification. In total, 63 gastroenteritis cases were identified; 30 HCWs and 33 patients. In the multivariable analysis of study A the disease incidence among patients was statistical significantly associated with a prior incident of vomitus in their room (OR=7.96, 95% CI=1.29-49.2). In study B, the incidence was associated with the history of direct contact with a symptomatic patient (OR=3.03, 95%CI 1.01-9.12). Twenty one (75%) of the symptomatic HCWs reported absence from work for a median of 2 days (range: 1-4). Seven (25.0%) continued to work despite being symptomatic. Only, 11.1% of patients were isolated or cohorted after developing symptoms. In-hospital virological testing was not feasible and one specimen sent to a university laboratory was positive for norovirus. Conclusions: An appropriately designed protocol regarding the detection, the management and the laboratory investigation of nosocomial gastroenteritis outbreaks should be followed in order effective containment to be reassured. [ABSTRACT FROM AUTHOR]