Vectorborne Diseases in the Refugee/Migrant Crisis GREECE Agoritsa Baka, MD Hellenic Centre for Disease Control and Prevention (KEELPNO)
Hellenic Police reported data, 2014-2015 Comparison Jan-Sep 2014 vs. 2015 Until Oct 2015: already >500,000 crossing through the East Mediterranean route to the islands www.astynomia.gr
Frontex, Fran Q2 2015
Profile Until 2014 fitting the healthy migrant : Young adult single males Looking for employment Increased incidence of diseases in the first 2-5 years after relocation ΤΒ Malaria Source: Hellenic Police www.astynomia.gr
Current profile The current profile, during 2015, has changed dramatically: families Pregnant women Elderly Chronic diseases (hypertension, diabetes, even renal failure) Persons with special needs of all ages Different behaviors after arrival until winter 2015 Afghan families: mean stay in Greece <5 days in three camps in Athens Pakistan migrants: connect with local migrant communities in rural areas, where they can find temporary employment Source: Hellenic Police www.astynomia.gr
www.ecdc.europa.eu
ECDC- Risk of importation and spread of malaria and other vector-borne diseases associated with the arrival of migrants to the EU 21 October 2015, Stockholm, 2015.
Newly arriving migrants, Greece 2006-2015 1000000 900000 800000 700000 600000 500000 400000 300000 200000 100000 0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 total malaria endemic countries Afghanistan and Indian Subcontinent Source: www.astynomia.gr, Hellenic Police, 2016: refers to Jan-Feb 2016
Malaria, Greece 2015 Malaria Epi-Report, 25/10/2015 Until 9/11/2015-18 imported P.vivax from the Dodecanese - 1 imported P.vivax from Samos - 1 imported P.vivax from Leros - 4 imported P.vivax from Lesvos : imported cases : introduced P. vivax cases
Newly arriving migrants and malaria cases, Greece 2006-2015 Imported malaria cases Orange line: migrants from Afghanistan and Indian Subcontinent Source: www.astynomia.gr, Hellenic Police, 2015: refers to Jan-Sep 2015
Imported malaria cases, Greece, 2015 (n=79) 82% of imported cases: immigrants Malaria cases among immigrants (n=65): 85% P.vivax, 3% P.non-falciparum, 12% P.falciparum 85% PK, 3% AF, 12% Africa Median time from arrival to onset symptoms= 4 (-66 to 298) days 42% (n=27): newly arrived in points of entry (Aegean islands) - South Aegean: 21 - North Aegean: 6-93% (23/27): diagnosed by RDT (MSF-KEELPNO)
Reported VBD cases among immigrants, Greece, 2016 Malaria: 1 case (north Aegean) Cutaneous leishmaniasis: 1 confirmed case, 3 suspected cases (from Syria) Scabies: clusters in 3 hotspots (4-150 cases/camp) Shistosomiasis: 1 suspected case (from Mali)
Arthropod transmitted Borrelia recurrentis: transmitted through body lice (Pediculus humanus) NL: 2 Borrelia cases in refugees from Eritrea IT: 3 Borrelia cases in adolescent refugees from Somalia D: 11 Borrelia cases in refugees from Eritrea, Somalia and Ethiopia NO: 1 Borrelia case in a refugee from Eritrea Όλοι μέσω στρατοπέδων στη Λιβύη Bartonella Quintana (trench fever): 1 case in a refugee from Eritrea
ECDC: recommendations VBDs I Recommendation 1 The risk for onward transmission with secondary cases and localised outbreaks in the transit and/or destination country depends on the presence of competent vectors, the season in the year, the health promotion and vector control measures at all borders, transit and settlement areas, and the access to health services. Related PH tasks Vector control Entomological surveillance & Communication to local authorities Study the compatibility of vectors and hosts Reminders early Quarantine ships from endemic country and spray Awareness raising to the public and doctors for differential dx Environmental rehabilitation/management Enhance lab capacity Treatment availability and access ECDC- Risk of importation and spread of malaria and other vector-borne diseases associated with the arrival of migrants to the EU 21 October 2015, Stockholm, 2015.
ECDC: recommendations VBDs II Recommendation 2 Competent vectors for malaria, leishmaniasis and schistosomiasis are present in some European countries, but vector activity is low during the winter months. However, transmission could occur in the spring and summer of 2016, when environmental conditions may become permissive and if similar migration patterns prevail. Related PH tasks Entomological surveillance More than mosquitoes Updated ECDC- Risk of importation and spread of malaria and other vector-borne diseases associated with the arrival of migrants to the EU 21 October 2015, Stockholm, 2015.
ECDC: recommendations VBDs III Recommendation 3 The risk of transmission of louse-borne diseases is a function of crowding and might be of more concern during winter months. Related PH tasks Strategy for the management of the migration flows Health promotion Guidance for simple hygiene measures and rules Disinsection measures and pharmaceuticals Posters and brochures/ mediators Attention to language, pictures Official guidance for the structure of migrant centres ECDC- Risk of importation and spread of malaria and other vector-borne diseases associated with the arrival of migrants to the EU 21 October 2015, Stockholm, 2015.
ECDC: recommendations VBDs IV Recommendation 4 Ensuring the right to health for mobile populations and universal access to public health services with rapid detection and treatment of vector-borne diseases is particularly important for the prevention of secondary cases and disease outbreaks. Vector abatement strategies are called for during the season of high vector activity. Related PH tasks Policy making and lobbying Creating programmes to provide access (?) ECDC- Risk of importation and spread of malaria and other vector-borne diseases associated with the arrival of migrants to the EU 21 October 2015, Stockholm, 2015.
ECDC: recommendations VBDs V Recommendation 5 Preparedness regarding these vector-borne diseases in the EU requires the capacity to detect possible cases in areas with presence of the competent vectors and strengthened surveillance systems. Related PH tasks Enhance surveillance systems And laboratory diagnosis Surge capacity ECDC- Risk of importation and spread of malaria and other vector-borne diseases associated with the arrival of migrants to the EU 21 October 2015, Stockholm, 2015.
Malaria response activities, 2012-2016 Working Groups on vector-borne diseases Risk assessment - Risk levels 0-3 1.Enhanced malaria surveillance - Case investigation Risk assessment - Active case detection in high-risk areas / Focus investigation 2. Mass drug administration in immigrants (Evrotas, 2013 2015) 3. Enhanced laboratory diagnosis (RDTs for malaria) 4. Case management 5. Communication 6. Blood safety measures 7. Vector surveillance and control activities collaboration with local authorities and guidance
Malaria response activities in areas hosting immigrants camps/hotspots, 2016 Risk assessment Raise awareness of local authorities in vulnerable areas to intensify: - vector surveillance - vector control - communication activities to local population and immigrants Enhance laboratory diagnosis (RDTs for malaria) in local health units and immigrants health care providers Support hospitals in case management (diagnosis, treatment) Focus investigation (re-active case detection) of malaria cases in vulnerable areas
Foto: L. Partsalis for Rizopoulos Post Thank you www.keelpno.hr @keelpno_gr