Abstract
An influx of immigrants is contributing to the reemergence of Plasmodium vivax malaria in Greece; 1 persistent focus of transmission is in Laconia, Pelopónnese. We genotyped archived blood samples from a substantial proportion of malaria cases recorded in Greece in 2009–2013 using 8 microsatellite markers and a PvMSP-3α gene fragment and plotted their spatiotemporal distribution. High parasite genetic diversity with low multiplicity of infection was observed. A subset of genetically identical/related parasites was restricted to 3 areas in migrants and Greek residents, with some persisting over 2 consecutive transmission periods. We identified 2 hitherto unsuspected additional foci of local transmission: Kardhítsa and Attica. Furthermore, this analysis indicates that several cases in migrants initially classified as imported malaria were actually locally acquired. This study shows the potential for P. vivax to reestablish transmission and counsels public health authorities about the need for vigilance to achieve or maintain sustainable malaria elimination.
Highlights
An influx of immigrants is contributing to the reemergence of Plasmodium vivax malaria in Greece; 1 persistent focus of transmission is in Laconia, Pelopónnese
Episodes of rapid resurgence of P. vivax malaria have occurred as a consequence of substantial disruption of public health services and large-scale population displacement triggered by war, civil unrest, or socioeconomic crises [3,4]
Greece was hyperendemic for malaria before an intense malaria eradication program, which led to the country becoming malaria-free in 1974, with a small number of imported malaria cases recorded annually thereafter [8]
Summary
An influx of immigrants is contributing to the reemergence of Plasmodium vivax malaria in Greece; 1 persistent focus of transmission is in Laconia, Pelopónnese. We identified 2 hitherto unsuspected additional foci of local transmission: Kardhítsa and Attica This analysis indicates that several cases in migrants initially classified as imported malaria were locally acquired. In South Korea (declared malaria-free in 1979), reintroduction of P. vivax malaria followed by sustained transmission was observed. The Hellenic Center for Disease Control and Prevention (HCDCP; Athens, Greece) declared these 113 cases as imported malaria (defined as occurring in persons arriving from endemic areas). HCDCP defined P. vivax cases occurring in migrants
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