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Mellou K, Tryfinopoulou K, Pappa S, Gkolfinopoulou K, Papanikou S, Papadopoulou G, Vassou E, Kostaki EG, Papadima K, Mouratidou E, Tsintziloni M, Siafakas N, Florou Z, Katsoulidou A, Sapounas S, Sourvinos G, Pournaras S, Petinaki E, Goula M, Paparizos V, Papa A, Zaoutis T, Paraskevis D. Overview of Mpox Outbreak in Greece in 2022-2023: Is It Over? Viruses 2023; 15:1384. [PMID: 37376683 PMCID: PMC10303940 DOI: 10.3390/v15061384] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/11/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
In May 2022, for the first time, multiple cases of mpox were reported in several non-endemic countries. The first ever case of the disease in Greece was confirmed on 8 June 2022, and a total of 88 cases were reported in the country until the end of April 2023. A multidisciplinary response team was established by the Greek National Public Health Organization (EODY) to monitor and manage the situation. EODY's emergency response focused on enhanced surveillance, laboratory testing, contact tracing, medical countermeasures, and the education of health care providers and the public. Even though management of cases was considered successful and the risk from the disease was downgraded, sporadic cases continue to occur. Here, we provide epidemiological and laboratory features of the reported cases to depict the course of the disease notification rate. Our results suggest that measures for raising awareness as well as vaccination of high-risk groups of the population should be continued.
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Affiliation(s)
| | - Kyriaki Tryfinopoulou
- National Public Health Organization, 15123 Athens, Greece
- Central Public Health Laboratory, 16672 Athens, Greece
| | - Styliani Pappa
- Department of Microbiology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | | | | | | | - Evangelia Vassou
- National Public Health Organization, 15123 Athens, Greece
- Central Public Health Laboratory, 16672 Athens, Greece
| | - Evangelia-Georgia Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, Kapodistrian University of Athens, 11527 Athens, Greece
| | | | | | | | - Nikolaos Siafakas
- Clinical Microbiology Laboratory, Attikon General University Hospital of Athens, 12462 Athens, Greece
| | - Zoi Florou
- Department of Medical Biopathology, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
| | - Antigoni Katsoulidou
- National Public Health Organization, 15123 Athens, Greece
- Central Public Health Laboratory, 16672 Athens, Greece
| | | | - George Sourvinos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Spyridon Pournaras
- Clinical Microbiology Laboratory, Attikon General University Hospital of Athens, 12462 Athens, Greece
| | - Efthymia Petinaki
- Department of Medical Biopathology, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
| | - Maria Goula
- State Dermatology Department, Hospital of Skin and Venereal Diseases, 54643 Thessaloniki, Greece
| | - Vassilios Paparizos
- 1st Department of Dermatology and Venereology, National and Kapodistrian University of Athens Medical School, "Andreas Syggros" Hospital for Skin and Venereal Diseases, 16121 Athens, Greece
| | - Anna Papa
- Department of Microbiology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
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2
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Maltezou HC, Pavli A, Tsonou P, Balaska A, Raftopoulos V, Papadima K, Andreopoulou A, Tentolouris A, Gamaletsou MN, Sipsas NV, Tentolouris N. Role of diabetes mellitus in the clinical course and outcome of SARS-CoV-2 infected patients. Hormones (Athens) 2022; 21:221-227. [PMID: 35138606 DOI: 10.1007/s42000-021-00342-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 12/07/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Our aim was to study patients with diabetes mellitus and SARS-CoV-2-infection diagnosed during the first pandemic wave in Greece. METHODS Cases were retrieved from the national database of SARS-CoV-2 infections. RESULTS We studied 2624 SARS-CoV-2 infected cases, including 157 with diabetes. Patients with diabetes more often had other comorbidities (68.8 vs. 24.1%; p-value < 0.001). Among patients with diabetes, 149 (94.9%) developed symptomatic disease (COVID-19) compared to 1817 patients (73.7%) without diabetes (p-value < 0.001). A total of 126 patients with diabetes and COVID-19 were hospitalized and 41 died (27.5% case-fatality rate compared to 7.5% among patients without diabetes; p-value < 0.001). Patients with diabetes more often were hospitalized, developed complications, were admitted to the intensive care unit (ICU), received invasive mechanical ventilation, and died compared to patients without diabetes (p-values < 0.001 to 0.002 for all comparisons). Multivariate logistic regression analyses revealed that diabetes, having other comorbidities, and older age were significantly associated with higher risk for hospitalization, ICU admission, invasive mechanical ventilation, and death, and that obesity was significantly associated with higher risk for hospitalization, ICU admission, and mechanical intubation, while female gender protected against these outcomes. CONCLUSION COVID-19 is associated with increased rates of serious morbidity and adverse outcome in patients with diabetes and represents a severe illness for them.
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Affiliation(s)
- Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece.
| | - Androula Pavli
- Department of Travel Medicine, National Public Health Organization, Athens, Greece
| | - Paraskevi Tsonou
- Department of Travel Medicine, National Public Health Organization, Athens, Greece
| | - Asimina Balaska
- Directorate of Non-Communicable Diseases, National Public Health Organization, Athens, Greece
| | | | - Kalliopi Papadima
- Department of Respiratory Infections, Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Anastasia Andreopoulou
- Department of Respiratory Infections, Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Anastasios Tentolouris
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria N Gamaletsou
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos V Sipsas
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Tentolouris
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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3
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Mellou K, Gkolfinopoulou K, Andreopoulou A, Tsekou A, Papadima K, Stamoulis K, Kossyvakis A, Mentis A, Maltezou HC. A COVID-19 outbreak among migrants in a hosting facility in Greece, April 2020. J Infect Prev 2022; 23:235-238. [PMID: 36003137 PMCID: PMC9389273 DOI: 10.1177/17571774221092568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/22/2022] [Indexed: 12/04/2022] Open
Abstract
In April 2020, a coronavirus disease 2019 outbreak was identified among migrants/refugees
in Greece. Overall, 155 of 450 hosted migrants and two of 46 employees were infected
(attack rates: 34.4% and 4.3%, respectively). The mean age of infected migrants was
24.9 years (3 days-68 years). In addition, 177 community contacts were tested negative.
Cases were cohorted in separate rooms from people tested negative. Surfaces were cleaned
and disinfected daily. The implementation of measures for the containment of the outbreak
was challenging due to language barriers and lack of space for cohorting. At that time,
there was no official recommendation to the general population regarding the use of masks
or other personal protective equipment. Extensive testing of vulnerable populations and
building trust in order to report symptoms and comply with the recommendations are
essential.
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Affiliation(s)
- Kassiani Mellou
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Kassiani Gkolfinopoulou
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Anastasia Andreopoulou
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Aikaterini Tsekou
- Directorate of Preparedness and Response, National Public Health Organization, Athens, Greece
| | - Kalliopi Papadima
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | | | - Athanasios Kossyvakis
- National Reference Laboratory for Influenza and Other Respiratory Viruses, Hellenic Pasteur Institute, Athens, Greece
| | - Andreas Mentis
- National Reference Laboratory for Influenza and Other Respiratory Viruses, Hellenic Pasteur Institute, Athens, Greece
| | - Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece
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4
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Ktena D, Kourkouni E, Kontopidou F, Gkolfinopoulou K, Papadima K, Georgakopoulou T, Magaziotou I, Andreopoulou A, Tzanakaki G, Zaoutis T, Papaevangelou V. Population-based study of influenza and invasive meningococcal disease among Greek children during the COVID-19 pandemic. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2021-001391. [PMID: 36053653 PMCID: PMC8905915 DOI: 10.1136/bmjpo-2021-001391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/21/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Aiming to the containment of the coronavirus disease 2019 (COVID-19) pandemic, governments worldwide have implemented a series of non-pharmaceutical interventions. Many of them and especially school closures have impacted the circulation of multiple airborne pathogens among children and adolescents. This study investigates the incidence of influenza and invasive meningococcal disease among children aged 0-14 years in Greece during the COVID-19 pandemic. METHODS Data regarding the number of influenza-like illness cases, influenza-related paediatric intensive care unit (PICU) admissions and invasive meningococcal disease cases among children 0-14 years old were obtained from the National Public Health Organization. The incidence of the two diseases during the COVID-19 pandemic period (2020/2021) was compared with that of the six preceding seasons (2014-2019). RESULTS A notable decrease was observed in both influenza and invasive meningococcal disease cases during the period 2020/2021 compared with the years 2014-2019. The mean annual rate of influenza-like illness cases and influenza-related PICU admissions in children 0-14 years old has reduced by 66.9% and 100%, respectively, while the mean annual invasive meningococcal disease rate has declined by 70%. Both weekly influenza-like illness and monthly invasive meningococcal disease rates were significantly decreased. CONCLUSIONS The activity of influenza and invasive meningococcal disease in the children and adolescents of Greece has decreased during the COVID-19 pandemic period. Reduced transmission is likely related to the public health measures that were implemented to control the pandemic. The value of these measures may have relevance to the future management of influenza or invasive meningococcal disease epidemics.
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Affiliation(s)
- Danai Ktena
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Attica, Greece
| | - Eleni Kourkouni
- Centre for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
| | - Flora Kontopidou
- Department of Healthcare-Associated Infections and Antimicrobial Resistance, Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Kassiani Gkolfinopoulou
- Department of Surveillance Systems, Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Kalliopi Papadima
- Department of Respiratory Diseases, Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Theano Georgakopoulou
- Department for Vaccine Preventable Diseases and Congenital Diseases, Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Ioanna Magaziotou
- Department for Vaccine Preventable Diseases and Congenital Diseases, Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Anastasia Andreopoulou
- Department of Respiratory Diseases, Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Georgina Tzanakaki
- National Meningitis Reference Laboratory, Department of Public Health Policy, University of West Attica, Athens, Greece
| | - Theoklis Zaoutis
- Second Department of Pediatrics, P&A Kyriakou Children's Hospital, National and Kapodistrian University of Athens, Athens, Attica, Greece.,National Public Health Organization, Athens, Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Attica, Greece
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5
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Maltezou HC, Giannouchos TV, Pavli A, Tsonou P, Dedoukou X, Tseroni M, Papadima K, Hatzigeorgiou D, Sipsas NV, Souliotis K. Costs associated with COVID-19 in healthcare personnel in Greece: a cost-of-illness analysis. J Hosp Infect 2021; 114:126-133. [PMID: 33894306 PMCID: PMC8061082 DOI: 10.1016/j.jhin.2021.04.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/17/2021] [Accepted: 04/17/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Healthcare personnel (HCP) are at increased risk of infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the aetiological agent of coronavirus disease 2019 (COVID-19). AIM To estimate the costs related to SARS-CoV-2 exposure and infection among HCP in Greece. METHODS Data were retrieved from the national database of SARS-CoV-2 infections and from the database of HCP exposed to patients with COVID-19. A cost-of-illness analysis was performed to estimate total, direct and indirect costs. RESULTS In total, 254 HCP with COVID-19 and 3332 HCP exposed to patients with COVID-19 during the first epidemic wave were studied. Of the 254 HCP with COVID-19, 49 (19.3%) were hospitalized (mean length of hospitalization 11.6 days) and four were admitted to intensive care units (mean duration 10.8 days). Overall, 1332 (40%) exposed HCP had a mean duration of absenteeism of 7.5 days, and 252 (99.2%) HCP with COVID-19 had a mean duration of absenteeism of 25.8 days. The total costs for the management of the two groups were estimated at €1,735,830 (€772,890 Euros for HCP with COVID-19 and €962,940 for exposed HCP). Absenteeism accounted for a large proportion of the total costs (80.4% of all expenditures), followed by costs for reverse transcriptase polymerase chain reaction and hospitalization (10.2% and 6.5% of all expenditures, respectively). CONCLUSION COVID-19 is associated with increased rates and duration of absenteeism among HCP. Indirect costs, particularly absenteeism, are the major driver of total costs among exposed HCP and HCP with COVID-19. The estimated total costs are conservative. Studies are needed to explore the impact of COVID-19 vaccination of HCP on absenteeism and COVID-19-associated costs.
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Affiliation(s)
- H C Maltezou
- Directorate for Research, Studies and Documentation, National Public Health Organization, Athens, Greece.
| | - T V Giannouchos
- Pharmacotherapy Outcomes Research Center, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - A Pavli
- Department of Travel Medicine, National Public Health Organization, Athens, Greece
| | - P Tsonou
- Department of Travel Medicine, National Public Health Organization, Athens, Greece
| | - X Dedoukou
- National Public Health Organization, Athens, Greece
| | - M Tseroni
- Directorate for Epidemiologic Surveillance of Infectious Diseases, National Public Health Organization, Athens, Greece
| | - K Papadima
- Directorate for Epidemiologic Surveillance of Infectious Diseases, National Public Health Organization, Athens, Greece
| | - D Hatzigeorgiou
- Medical Directorate, Hellenic Air Force General Staff, Athens, Greece
| | - N V Sipsas
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - K Souliotis
- Faculty of Social and Political Sciences, University of Peloponnese, Corinth, Greece; Health Policy Institute, Athens, Greece
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6
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Maltezou HC, Raftopoulos V, Vorou R, Papadima K, Mellou K, Spanakis N, Kossyvakis A, Gioula G, Exindari M, Froukala E, Martinez-Gonzalez B, Panayiotakopoulos G, Papa A, Mentis A, Tsakris A. Association Between Upper Respiratory Tract Viral Load, Comorbidities, Disease Severity, and Outcome of Patients With SARS-CoV-2 Infection. J Infect Dis 2021; 223:1132-1138. [PMID: 33388780 PMCID: PMC7798974 DOI: 10.1093/infdis/jiaa804] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/29/2020] [Indexed: 01/01/2023] Open
Abstract
Background There is limited information on the association between upper respiratory tract (URT) viral loads, host factors, and disease severity in SARS-CoV-2 infected patients. Methods We studied 1,122 patients (mean age: 46 years) diagnosed by PCR. URT viral load, measured by PCR cycle threshold, was categorized as high, moderate or low. Results There were 336 (29.9%) patients with comorbidities; 309 patients (27.5%) had high, 316 (28.2%) moderate, and 497 (44.3%) low viral load. In univariate analyses, compared to patients with moderate or low viral load, patients with high viral load were older, had more often comorbidities, developed symptomatic disease, were intubated and died; in addition, patients with high viral load had longer stay in intensive care unit and longer intubation compared to patients with low viral load (p-values <0.05 for all). Patients with chronic cardiovascular disease, hypertension, chronic pulmonary disease, immunosuppression, obesity and chronic neurological disease had more often high viral load (p-value<0.05 for all). Multivariate analysis found that a high viral load was associated with COVID-19. The level of viral load was not associated with any other outcome. Conclusions URT viral load could be used to identify patients at higher risk for morbidity or severe outcome.
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Affiliation(s)
- Helena C Maltezou
- Directorate of Research, Studies, and Documentation, National Public Health Organization, Athens, Greece
| | - Vasilios Raftopoulos
- Epidemiological Surveillance of HIV/AIDS Division, National Public Health Organization, Athens, Greece
| | - Rengina Vorou
- Directorate for Epidemiological Surveillance and Interventions, National Public Health Organization, Athens, Greece
| | - Kalliopi Papadima
- Directorate for Epidemiological Surveillance and Interventions, National Public Health Organization, Athens, Greece
| | - Kassiani Mellou
- Directorate for Epidemiological Surveillance and Interventions, National Public Health Organization, Athens, Greece
| | - Nikolaos Spanakis
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Kossyvakis
- National Reference Laboratory for Influenza and Other Respiratory Viruses, Hellenic Pasteur Institute, Athens, Greece
| | - Georgia Gioula
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Exindari
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elisavet Froukala
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Beatriz Martinez-Gonzalez
- National Reference Laboratory for Influenza and Other Respiratory Viruses, Hellenic Pasteur Institute, Athens, Greece
| | | | - Anna Papa
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Mentis
- National Reference Laboratory for Influenza and Other Respiratory Viruses, Hellenic Pasteur Institute, Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Maltezou HC, Papadima K, Gkolfinopoulou K, Ferentinos G, Mouratidou E, Andreopoulou A, Pavli A, Magaziotou I, Georgakopoulou T, Mellou K, Vorou R, Antoniadou A, Stathakarou A, Chrysochoou A, Gogos C, Karaiskou A, Kotanidou A, Koutsoukou A, Marangos M, Mentis A, Metallidis S, Papa A, Pefanis A, Tsakris A, Sipsas NV. Coronavirus disease 2019 pandemic in Greece, February 26 - May 3, 2020: The first wave. Travel Med Infect Dis 2021; 41:102051. [PMID: 33819570 PMCID: PMC8016712 DOI: 10.1016/j.tmaid.2021.102051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 03/22/2021] [Accepted: 03/29/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece.
| | - Kalliopi Papadima
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Kassiani Gkolfinopoulou
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - George Ferentinos
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece
| | - Elisavet Mouratidou
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Anastasia Andreopoulou
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Androula Pavli
- Department of Travel Medicine, National Public Health Organization, Athens, Greece
| | - Ioanna Magaziotou
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Theano Georgakopoulou
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Kassiani Mellou
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Rengina Vorou
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Anastasia Antoniadou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Stathakarou
- Infection Control Committee, Pammakaristos Hospital of Divine Providence, Athens, Greece
| | | | - Charalambos Gogos
- Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Angeliki Karaiskou
- Infection Control Department, Thriassio General Hospital of Elefsina, Athens, Greece
| | - Anastasia Kotanidou
- Department of Intensive Care Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonia Koutsoukou
- Intensive Care Unit, Department of Respiratory Medicine, University of Athens, Greece
| | - Markos Marangos
- Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Andreas Mentis
- National Reference Laboratory for Influenza and Other Respiratory Viruses, Hellenic Pasteur Institute, Athens, Greece
| | - Symeon Metallidis
- First Internal Medicine Department, Infectious Diseases Division, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna Papa
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Angelos Pefanis
- First Internal Medicine and Infectious Diseases Department, "Sotiria" General and Chest Diseases Hospital of Athens, Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos V Sipsas
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, Greece
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8
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Maltezou HC, Dedoukou X, Tseroni M, Tsonou P, Raftopoulos V, Papadima K, Mouratidou E, Poufta S, Panagiotakopoulos G, Hatzigeorgiou D, Sipsas N. SARS-CoV-2 Infection in Healthcare Personnel With High-risk Occupational Exposure: Evaluation of 7-Day Exclusion From Work Policy. Clin Infect Dis 2021; 71:3182-3187. [PMID: 32594160 PMCID: PMC7337654 DOI: 10.1093/cid/ciaa888] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/23/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As of late February 2020, Greece has been experiencing the coronavirus disease 2019 (COVID-19) epidemic. Healthcare personnel (HCP) were disproportionately affected, accounting for ~10% of notified cases. Exclusion from work for 7 days was recommended for HCP with high-risk occupational exposure. Our aim was to evaluate the 7-day exclusion from work policy for HCP with high-risk exposure. METHODS HCP with a history of occupational exposure to COVID-19 were notified to the Hellenic National Public Health Organization, regardless of their exposure risk category. Exposed HCP were followed for 14 days after last exposure. RESULTS We prospectively studied 3398 occupationally exposed HCP; nursing personnel accounted for most exposures (n = 1705; 50.2%). Of the 3398 exposed HCP, 1599 (47.1%) were classified as low-risk, 765 (22.5%) as moderate-risk, and 1031 (30.4%) as high-risk exposures. Sixty-six (1.9%) HCP developed COVID-19 at a mean of 3.65 (range: 0-17) days postexposure. Of the 66 HCP with COVID-19, 46, 7, and 13 had a history of high-, moderate- or low-risk exposure (4.5%, 0.9%, and 0.8% of all high-, moderate-, and low-risk exposures, respectively). Hospitalization and absenteeism were more prevalent among HCP with high-risk exposure. A logistic regression analysis showed that the following variables were significantly associated with an increased risk for the onset of COVID-19: male, administrative personnel, underlying disease, and high-risk exposure. CONCLUSIONS HCP with high-risk occupational exposure to COVID-19 had increased probability of serious morbidity, healthcare seeking, hospitalization, and absenteeism. Our findings justify the 7-day exclusion from work policy for HCP with high-risk exposure.
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Affiliation(s)
- Helena C Maltezou
- Department of Respiratory Infections, Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | | | - Maria Tseroni
- Department of Respiratory Infections, Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Paraskevi Tsonou
- Department of Cardiovascular Diseases, Directorate of Noncommunicable Diseases, National Public Health Organization, Athens, Greece
| | - Vasilios Raftopoulos
- Department of HIV Surveillance, National Public Health Organization, Athens, Greece
| | - Kalliopi Papadima
- Department of Respiratory Infections, Directorate for Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Elisavet Mouratidou
- Department of Respiratory Infections, Directorate for Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Sophia Poufta
- Department of Respiratory Infections, Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | | | | | - Nikolaos Sipsas
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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9
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Maltezou HC, Dedoukou X, Tsonou P, Tseroni M, Raftopoulos V, Pavli A, Papadima K, Chrysochoou A, Randou E, Adamis G, Kostis E, Pefanis A, Gogos C, Sipsas NV. Hospital factors associated with SARS-CoV-2 infection among healthcare personnel in Greece. J Hosp Infect 2020; 109:40-43. [PMID: 33169676 PMCID: PMC7581318 DOI: 10.1016/j.jhin.2020.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/17/2020] [Accepted: 10/18/2020] [Indexed: 11/24/2022]
Abstract
Healthcare workers (HCWs) have been recognized as a high-risk group for infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This study estimated their risk of infection based on hospital characteristics. Factors significantly associated with increased risk for SARS-CoV-2 infection were: working in a non-referral hospital compared with a coronavirus disease 2019 (COVID-19) referral hospital, working in a hospital with a high number of employees, and working in a hospital with an increased number of patients with COVID-19. This study revealed gaps in infection control in the non-referral hospitals. There is an urgent need for continuous training in infection control practices. Compliance of HCWs with the use of personal protective equipment should also be addressed.
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Affiliation(s)
- H C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece.
| | - X Dedoukou
- National Public Health Organization, Athens, Greece
| | - P Tsonou
- Department of Cardiovascular Diseases, Directorate of Non-Communicable Diseases, National Public Health Organization, Athens, Greece
| | - M Tseroni
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - V Raftopoulos
- Department of HIV Surveillance, National Public Health Organization, Athens, Greece
| | - A Pavli
- Department of Travel Medicine, National Public Health Organization, Athens, Greece
| | - K Papadima
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - A Chrysochoou
- Emergency Department, General Hospital of Kastoria, Kastoria, Greece
| | - E Randou
- Department of Internal Medicine, General Hospital of Kozani, Kozani, Greece
| | - G Adamis
- First Department of Internal Medicine - Infectious Diseases Unit, Gennimatas General Hospital, Athens, Greece
| | - E Kostis
- Therapeutic Clinic, Alexandra General Hospital, Athens, Greece
| | - A Pefanis
- First Internal Medicine and Infectious Diseases Department, 'Sotiria' General and Chest Diseases Hospital of Athens, Athens, Greece
| | - C Gogos
- Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - N V Sipsas
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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10
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Maltezou HC, Vorou R, Papadima K, Kossyvakis A, Spanakis N, Gioula G, Exindari M, Metallidis S, Lourida AN, Raftopoulos V, Froukala E, Martinez-Gonzalez B, Mitsianis A, Roilides E, Mentis A, Tsakris A, Papa A. Transmission dynamics of SARS-CoV-2 within families with children in Greece: A study of 23 clusters. J Med Virol 2020; 93:1414-1420. [PMID: 32767703 PMCID: PMC7441283 DOI: 10.1002/jmv.26394] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/27/2020] [Accepted: 08/02/2020] [Indexed: 11/22/2022]
Abstract
There is limited information on severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection clustering within families with children. We aimed to study the transmission dynamics of SARS‐CoV‐2 within families with children in Greece. We studied 23 family clusters of coronavirus disease 2019 (COVID‐19). Infection was diagnosed by reverse‐transcriptase polymerase chain reaction in respiratory specimens. The level of viral load was categorized as high, moderate, or low based on the cycle threshold values. There were 109 household members (66 adults and 43 children). The median attack rate per cluster was 60% (range: 33.4%‐100%). An adult member with COVID‐19 was the first case in 21 (91.3%) clusters. Transmission of infection occurred from an adult to a child in 19 clusters and/or from an adult to another adult in 12 clusters. There was no evidence of child‐to‐adult or child‐to‐child transmission. In total 68 household members (62.4%) tested positive. Children were more likely to have an asymptomatic SARS‐CoV‐2 infection compared to adults (40% vs 10.5%; P = .021). In contrast, adults were more likely to develop a severe clinical course compared with children (8.8% vs 0%; P = .021). In addition, infected children were significantly more likely to have a low viral load while adults were more likely to have a moderate viral load (40.7% and 18.6% vs 13.8% and 51.7%, respectively; P = .016). In conclusion, while children become infected by SARS‐CoV‐2, they do not appear to transmit infection to others. Furthermore, children more frequently have an asymptomatic or mild course compared to adults. Further studies are needed to elucidate the role of viral load on these findings. We studied 23 family clusters; an adult was the first case in 21 (91.3%) of them. The median attach rate per family cluster was 60% (range: 33.4%‐100%). There was no evidence of child‐to‐adult or child‐to‐child transmission. Children more often were asymptomatic or had a mild illness compared to adults.
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Affiliation(s)
- Helena C Maltezou
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Rengina Vorou
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Kalliopi Papadima
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Athanasios Kossyvakis
- National Reference Laboratory for Influenza and other Respiratory Viruses, Hellenic Pasteur Institute, Athens, Greece
| | - Nikolaos Spanakis
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Gioula
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Exindari
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Symeon Metallidis
- Infectious Diseases Division, First Internal Medicine Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasia N Lourida
- Infection Prevention and Control Committee, Aghia Sofia Children's Hospital, Athens, Greece
| | - Vasilios Raftopoulos
- Epidemiological Surveillance of HIV/AIDS Department, National Public Health Organization, Athens, Greece
| | - Elisavet Froukala
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Beatriz Martinez-Gonzalez
- National Reference Laboratory for Influenza and other Respiratory Viruses, Hellenic Pasteur Institute, Athens, Greece
| | - Athanasios Mitsianis
- Internal Medicine Department, Mpodosakeio General Prefecture Hospital of Ptolemaida, Ptolemaida, Greece
| | - Emmanuel Roilides
- Third Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Mentis
- National Reference Laboratory for Influenza and other Respiratory Viruses, Hellenic Pasteur Institute, Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Papa
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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11
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Pavli A, Smeti P, Papadima K, Andreopoulou A, Hadjianastasiou S, Triantafillou E, Vakali A, Kefaloudi C, Pervanidou D, Gogos C, Maltezou HC. A cluster of COVID-19 in pilgrims to Israel. J Travel Med 2020; 27:5862547. [PMID: 32584403 PMCID: PMC7337872 DOI: 10.1093/jtm/taaa102] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 01/02/2023]
Affiliation(s)
- Androula Pavli
- Department of Travel Medicine, National Public Health Organization, Athens, Greece
| | - Paraskevi Smeti
- Department of Travel Medicine, National Public Health Organization, Athens, Greece
| | - Kalliopi Papadima
- Department of Respiratory Diseases, Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Anastasia Andreopoulou
- Department of Respiratory Diseases, Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | | | - Eleni Triantafillou
- Department of Respiratory Diseases, Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Annita Vakali
- Department of Vectorborne Diseases, Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Chrysovalantou Kefaloudi
- Department of Vectorborne Diseases, Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Danai Pervanidou
- Department of Vectorborne Diseases, Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Charalambos Gogos
- Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Helena C Maltezou
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
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12
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Koutsoukou A, Koulouris N, Bekos B, Sotiropoulou C, Kosmas E, Papadima K, Roussos C. Expiratory flow limitation in morbidly obese postoperative mechanically ventilated patients. Acta Anaesthesiol Scand 2004; 48:1080-8. [PMID: 15352952 DOI: 10.1111/j.1399-6576.2004.00479.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Although obesity promotes tidal expiratory flow limitation (EFL), with concurrent dynamic hyperinflation (DH), intrinsic PEEP (PEEPi) and risk of low lung volume injury, the prevalence and magnitude of EFL, DH and PEEPi have not yet been studied in mechanically ventilated morbidly obese subjects. In 15 postoperative mechanically ventilated morbidly obese subjects, we assessed the prevalence of EFL [using the negative expiratory pressure (NEP) technique], PEEPi, DH, respiratory mechanics, arterial oxygenation and PEEPi inequality index as well as the levels of PEEP required to abolish EFL. In supine position at zero PEEP, 10 patients exhibited EFL with a significantly higher PEEPi and DH and a significantly lower PEEPi inequality index than found in the five non-EFL (NEFL) subjects. Impaired gas exchange was found in all cases without significant differences between the EFL and NEFL subjects. Application of 7.5 +/- 2.5 cm H2O of PEEP (range: 4-16) abolished EFL with a reduction of PEEPi and DH and an increase in FRC and the PEEPi inequality index but no significant effect on gas exchange. The present study indicates that: (a) on zero PEEP, EFL is present in most postoperative mechanically ventilated morbidly obese subjects; (b) EFL (and concurrent risk of low lung volume injury) is abolished with appropriate levels of PEEP; and (c) impaired gas exchange is common in these patients, probably mainly due to atelectasis.
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Affiliation(s)
- A Koutsoukou
- Critical Care Department and Pulmonary Services, Evangelismos General Hospital, University of Athens Medical School, Athens, Greece.
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13
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Alchanatis M, Tourkohoriti G, Kosmas EN, Panoutsopoulos G, Kakouros S, Papadima K, Gaga M, Jordanoglou JB. Evidence for left ventricular dysfunction in patients with obstructive sleep apnoea syndrome. Eur Respir J 2002; 20:1239-45. [PMID: 12449180 DOI: 10.1183/09031936.02.00278002] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
There is limited information on the development of left ventricular (LV) dysfunction in patients with obstructive sleep apnoea (OSA) in the absence of lung and cardiac comorbidity. This study aimed to investigate whether OSA patients without heart morbidity develop LV dysfunction, and to assess the effect of continuous positive airway pressure (CPAP) on LV function. Twenty-nine OSA patients and 12 control subjects were studied using technetium-99m ventriculography to estimate LV ejection fraction (LVEF), LV peak emptying rate (LVPER), time to peak emptying rate (TPER), peak filling rate (LVPFR) and time to peak filling rate (TPFR) before and after 6 months of treatment with CPAP. A significantly lower LVEF was found in OSA patients, compared to control subjects, (53+/-7 versus 61+/-6%) along with a reduced LVPER (2.82+/-0.58 versus 3.82+/-0.77 end-diastolic volumes x s(-1)). Furthermore, OSA patients had significantly lower LVPFR (2.67+/-0.71 versus 3.93+/-0.58 end-diastolic volumes x s(-1)) and delayed TPFR (0.19+/-0.04 versus 0.15+/-0.03 s) in comparison with the control group. Six-months of CPAP treatment was effective in significantly improving LVEF, LVPER, LVPFR and TPFR. In conclusion, obstructive sleep apnoea patients without any cardiovascular disease seem to develop left ventricular systolic and diastolic dysfunction, which may be reversed, either partially or completely, after 6 months of continuous positive airway pressure treatment.
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Affiliation(s)
- M Alchanatis
- Pulmonary Dept. Athens University Medical School, Greece.
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