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Malaria, HIV on the rise in Greece due to economic problems
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I was struck by recent news articles about two infectious disease outbreaks in Greece — malaria and HIV. Malaria was officially eliminated in Greece in 1974, except for imported cases, but in 2011 there were 40 cases of autochthonous malaria, and this year there were 16 by mid-October. These autochthonous cases were attributed to a decrease in public health programs (surveillance and vector control programs) and to increased difficulty in access to health care (prompt diagnosis and treatment) for some populations. There are mosquitoes in Greece that are capable of transmitting malaria, and just as with most European countries, there are cases of imported malaria every year. Therefore, the potential for local transmission is always present; prevention depends on prompt diagnosis and therapy of imported cases and public health measures when cases occur.
From 2007 to 2010, there were only 10 to 15 new cases per year of HIV infection in injecting drug users (IDUs). However, during 2011, there were 256 cases in IDUs. Another 314 cases in IDUs were reported between January and August 2012. Here again the increase has been attributed to decreases in availability of health care services for IDUs. Waiting times for methadone programs have increased dramatically and the number of syringes given to IDUs has decreased.
The situation in Greece is related to its economic problems with cuts in health care and public health measures. Imported malaria is to be expected anywhere, but the occurrence of autochthonous cases is disturbing. Lest we forget, at one time malaria was widespread in the US and the vectors are still present. We rely on our systems for prompt diagnosis and therapy of imported cases, prompt reporting, and when necessary, vector control. Similarly, the increase in HIV in IDUs in Greece is probably not only related to the methadone and syringe programs cited but also to a decrease in the availability of testing and medical care in general for the population of IDUs. I suspect that other infectious diseases such as TB and vaccine preventable diseases may be on the rise also.
Donald Kaye, MD, is a professor of Medicine at Drexel University College of Medicine, Associate Editor of ProMED-mail, Section Editor of News for Clinical Infectious Diseases and is an Infectious Disease News Editorial Board member.