{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T20:24:09Z","timestamp":1792441449371,"version":"4.5.0"},"reference-count":36,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,2,6]]},"abstract":"<jats:p>Greece experienced the largest European West Nile virus (WNV) outbreak in 2010 since the 1996 Romania epidemic. West Nile virus reemerged in southern Greece during 2017, after a 2-year hiatus of recorded human cases, and herein laboratory findings, clinical features, and geographic distribution of WNV cases are presented. Clinical specimens from patients with clinically suspected WNV infection were sent from local hospitals to the Microbiology Department of Medical School, National and Kapodistrian University of Athens, and were tested for the presence of specific anti-WNV antibodies and WNV RNA. From July to September 2017, 45 confirmed or probable WNV infection cases were identified; 43 of them with an acute\/recent infection, of which 24 (55.8%) experienced WNV neuroinvasive disease (WNND). Risk factors for developing WNND included advanced age, hypertension, and diabetes mellitus. A total of four deaths (16.7%) occurred, all in elderly patients aged &gt; 70 years. Thirty-nine cases were identified in regional units that had not been affected before (36 in Argolis and two in Corinth, northeastern Peloponnese, and one in Rethymno, Crete). The remaining four cases were reported from previously affected regional units of northwestern Peloponnese. The reemergence of WNV after a 2-year hiatus of recorded human cases and the spread of the virus in newly affected regions of the country suggests that WNV has been established in Greece and disease transmission will continue in the future. Epidemiological surveillance, intensive mosquito management programs, and public awareness campaigns about personal protective measures are crucial to the prevention of WNV transmission.<\/jats:p>","DOI":"10.4269\/ajtmh.18-0339","type":"journal-article","created":{"date-parts":[[2018,12,11]],"date-time":"2018-12-11T07:00:59Z","timestamp":1544511659000},"page":"420-426","source":"Crossref","is-referenced-by-count":15,"title":["Reemergence of West Nile Virus Infections in Southern Greece, 2017"],"prefix":"10.4269","volume":"100","author":[{"given":"Maria","family":"Mavrouli","sequence":"first","affiliation":[{"name":"Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgia","family":"Vrioni","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Violetta","family":"Kapsimali","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constantinos","family":"Tsiamis","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Spyridon","family":"Mavroulis","sequence":"additional","affiliation":[{"name":"Department of Dynamic Tectonic Applied Geology, Faculty of Geology and Geoenvironment, National and Kapodistrian University of Athens, Athens, Greece;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danai","family":"Pervanidou","sequence":"additional","affiliation":[{"name":"Hellenic Center for Disease Control and Prevention, Department of Epidemiological Surveillance and Intervention, Vector-borne Diseases Office, Athens, Greece;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charalambos","family":"Billinis","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology and Parasitology, Faculty of Veterinary Medicine, University of Thessaly, Karditsa, Greece;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Hadjichristodoulou","sequence":"additional","affiliation":[{"name":"Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athanassios","family":"Tsakris","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Acta Microbiol Hellenica","first-page":"7","article-title":"West Nile virus: biology, transmission, clinical manifestations, diagnosis, therapeutic approaches, climatic correlates and prevention","volume":"60","author":"Mavrouli","year":"2015"},{"key":"b2","series-title":"Emerg Infect Dis","first-page":"311","article-title":"Experimental infection of North American birds with the New York 1999 strain of West Nile virus","volume":"9","author":"Komar","year":"2003"},{"key":"b3","series-title":"Emerg Infect Dis","first-page":"468","article-title":"Host feeding patterns of Culex mosquitoes and West Nile virus transmission, northeastern United States","volume":"12","author":"Molaei","year":"2006"},{"key":"b4","series-title":"Int J Environ Res Public Health","first-page":"6534","article-title":"West Nile virus state of the art report of MALWEST project","volume":"10","author":"Marka","year":"2013"},{"key":"b5","series-title":"Clin Microbiol Rev","first-page":"635","article-title":"West Nile virus: biology, transmission, and human infection","volume":"25","author":"Colpitts","year":"2012"},{"key":"b6","series-title":"Ann Intern Med","first-page":"173","article-title":"West Nile virus: a primer for the clinician","volume":"137","author":"Petersen","year":"2002"},{"key":"b7","series-title":"Am J Trop Med Hyg","first-page":"471","article-title":"A neurotropic virus isolated from the blood of a native of Uganda","volume":"20","author":"Smithburn","year":"1940"},{"key":"b8","series-title":"Clin Infect Dis","first-page":"1039","article-title":"The continuing spread of West Nile virus in the western hemisphere","volume":"45","author":"Gubler","year":"2007"},{"key":"b9","series-title":"Lancet","first-page":"767","article-title":"West Nile encephalitis epidemic in southeastern Romania","volume":"352","author":"Tsai","year":"1998"},{"key":"b10","series-title":"Emerg Infect Dis","first-page":"128","article-title":"Outbreak of West Nile virus infection, Volgograd region, Russia, 1999","volume":"7","author":"Platonov","year":"2001"},{"key":"b11","series-title":"N Engl J Med","first-page":"1807","article-title":"The outbreak of West Nile virus infection in the New York City area in 1999","volume":"344","author":"Nash","year":"2001"},{"key":"b12","series-title":"Open Virol J","first-page":"29","article-title":"Epidemiology of West Nile in Europe and in the Mediterranean basin","volume":"4","author":"Calistri","year":"2010"},{"key":"b13","series-title":"Euro Surveill","first-page":"1","article-title":"Ongoing outbreak of West Nile virus infections in humans in Greece, July\u2013August 2010","volume":"15","author":"Papa","year":"2010"},{"key":"b14","series-title":"Emerg Infect Dis","first-page":"1868","article-title":"Outbreak of West Nile virus infection in Greece, 2010","volume":"17","author":"Danis","year":"2011"},{"key":"b15","series-title":"Vector Borne Zoonotic Dis","first-page":"52","article-title":"Laboratory and clinical characteristics of human West Nile virus infections during 2011 outbreak in southern Greece","volume":"14","author":"Vrioni","year":"2014"},{"key":"b16","series-title":"J Clin Microbiol","first-page":"4641","article-title":"Performance of immunoglobulin G (IgG) and IgM enzyme-linked immunosorbent assays using a West Nile virus recombinant antigen (preM\/E) for detection of West Nile virus- and other flavivirus-specific antibodies","volume":"42","author":"Hogrefe","year":"2004"},{"key":"b17","series-title":"J Clin Microbiol","first-page":"12","article-title":"Utility of the focus technologies West Nile virus immunoglobulin M capture enzyme-linked immunosorbent assay for testing cerebrospinal fluid","volume":"42","author":"Prince","year":"2004"},{"key":"b18","series-title":"PLoS One","first-page":"e0143803","article-title":"West Nile Virus seroprevalence in the Greek population in 2013: a nationwide cross-sectional survey","volume":"10","author":"Hadjichristodoulou","year":"2015"},{"key":"b19","series-title":"Int J Environ Res Public Health","first-page":"3543","article-title":"Environmental drivers of West Nile fever epidemiology in Europe and western Asia\u2014a review","volume":"10","author":"Paz","year":"2013"},{"key":"b20","series-title":"Science","first-page":"2333","article-title":"Origin of West Nile virus responsible for an outbreak of encephalitis in the northeastern United States","volume":"286","author":"Lanciotti","year":"1999"},{"key":"b21","series-title":"Emerg Infect Dis","first-page":"920","article-title":"Genetic characterization of West Nile virus lineage 2, Greece 2010","volume":"17","author":"Papa","year":"2011"},{"key":"b22","series-title":"Viruses","first-page":"2311","article-title":"Genome sequencing of West Nile virus from human cases in Greece, 2012","volume":"5","author":"Barzon","year":"2013"},{"key":"b23","series-title":"Euro Surveill","first-page":"1","article-title":"Ongoing outbreak of West Nile virus infection in humans, Greece, July to August 2011","volume":"16","author":"Danis","year":"2011"},{"key":"b24","series-title":"Acta Trop","first-page":"26","article-title":"Serological monitoring of backyard chickens in central Macedonia-Greece can detect low transmission of West Nile virus in the absence of human neuroinvasive disease cases","volume":"163","author":"Chaintoutis","year":"2016"},{"key":"b25","author":"ECDC","year":"2017"},{"key":"b26","series-title":"Am J Trop Med Hyg","first-page":"885","article-title":"An outbreak of West Nile fever among migrants in Kisangani, Democratic Republic of Congo","volume":"61","author":"Nur","year":"1999"},{"key":"b27","author":"ECDC","year":"2018"},{"key":"b28","series-title":"J Infect","first-page":"170","article-title":"West Nile fever in Israel: the reemergence of an endemic disease","volume":"68","author":"Anis","year":"2014"},{"key":"b29","series-title":"Enferm Infecc Microbiol Clin","first-page":"561","article-title":"West Nile virus past infections in the general population of southern Spain","volume":"25","author":"Bernabeu-Wittel","year":"2007"},{"key":"b30","series-title":"Euro Surveill","first-page":"1","article-title":"West Nile virus outbreak in humans, Greece, 2012: third consecutive year of local transmission","volume":"19","author":"Pervanidou","year":"2014"},{"key":"b31","series-title":"Lancet Infect Dis","first-page":"519","article-title":"West Nile virus","volume":"2","author":"Campbell","year":"2002"},{"key":"b32","series-title":"Epidemiol Infect","first-page":"1325","article-title":"Risk factors for encephalitis and death from West Nile virus infection","volume":"134","author":"Murray","year":"2006"},{"key":"b33","series-title":"Euro Surveill","first-page":"1","article-title":"Prevalence of IgM and IgG antibodies to West Nile 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