The epidemiology of dog bite injuries in Greece: preliminary results of a surveillance scheme.

Background: Dog bite injuries commonly fall under the radar of the public health surveillance systems. Nevertheless, these incidents may result in emotional distress, disfigurement, functional deficit, or exposure to zoonotic agents and therefore may have a considerable impact on public health. Methods: A pilot surveillance scheme was launched in Greece to assess the epidemiology of dog bite injuries. Physicians in hospital-based emergency room departments and primary health care centers were required to report bite cases via a reporting form. The collected data were analyzed cross-sectionally. Results: From January to June 2023, 1,656 dog bite victims attended the healthcare settings in Greece. The rate was estimated at 15.8 cases per 100,000 population. The frequency of healthcare visits varied significantly among the regions (p <0.0001), ranging from 0.9 to 45.2 per 100,000 inhabitants. The median number (interquartile range in brackets) of visits concerning dog bite victims for the examined period per reporting hospital was nine (2, 21) and per reporting health center three (1, 10), respectively. The ownerless-to-owned dogs ratio was almost equal (1.04). According to the Abbreviated Injury Scale, 67.3 % of the injuries were classified as minor, 27.7 % as moderate, 4.9 % as serious, and 0.1 % as critical. The lower limb was the most frequently affected anatomical site (50.6 %). Head/neck injuries were associated with younger patients (p <0.0001). Macroscopic tissue loss occurred in 11.9 % of the cases, with the majority presenting areas of damaged or missing skin (50.9 %); partially or completely amputated hand digits occurred in nine of these cases (8.5 %). Among dog bite victims, 2.8 % were hospitalized (inpatients), and 1 % were referred to other hospitals. Conclusions: Dog bite surveillance offers important epidemiological information on the respective traumatic impact. HIPPOKRATIA 2023, 27 (2):82-88.

Changing trends and pretravel preparation of business travelers from Greece during the financial crisis.

OBJECTIVES: Unemployment in Greece has been increasing as a result of the financial crisis. The aim of this study was to assess the changing trends of business travelers and their pretravel preparation. STUDY DESIGN: Prospective, questionnaire-based study. METHODS: The study was conducted between 2008 and 2016 at all Regional Public Health Departments. All travelers seeking pretravel advice during the study period were invited to participate. RESULTS: A total of 12,379 travelers completed the questionnaire, 58% of whom were business travelers. Between 2008 and 2016, the proportion of business travelers increased from 33% to 80.7% and those travelling for recreational purposes decreased from 47.9% to 15.5%. Business travelers sought pretravel advice at a mean of 18.5 days before departure; 89.1% were men with a mean age of 34.4 years. The Middle East was the most common destination (47.8%) followed by Sub-Saharan Africa (28.3%). Most business travelers stayed in urban areas (77.6%) and for ≥ 1 month (68.6%). Yellow fever vaccine was administered to 75% of business travelers. A total of 76.2%, 26.9%, 15.5%, and 13.9% of those visiting Sub-Saharan Africa received yellow fever, typhoid fever, hepatitis A, and meningococcal vaccines, respectively. Malaria prophylaxis vaccine was administered to 26.8% of business travelers; including 46.5% of those traveling to Sub-Saharan Africa and 53.5% to those traveling to the Indian subcontinent. CONCLUSIONS: There is an increasing trend for business travel from Greece, especially to developing countries. Improving the knowledge of travel health consultants about the risks of business travel and the pretravel preparation of business travelers is crucial.

Vaccination of healthcare workers against influenza: does a day off make a difference?

This article presents the results of actions undertaken to increase influenza vaccine uptake by healthcare workers (HCWs) in Greece during the 2016-2017 influenza season. Influenza vaccination among HCWs increased from 10.9% in acute care hospitals and 24.3% in primary healthcare centres in 2015-2016 to 18% in acute care hospitals and 34.6% in primary healthcare centers in 2016-2017. Vaccination on site at the healthcare facility and use of reward systems were significantly associated with increased vaccination rates. Offering vaccinated HCWs one day off work was associated with the greatest increase in influenza vaccine uptake.

Antibiotic prescription practices for common infections and knowledge about antibiotic costs by private-practice pediatricians in Greece.

AIM: Greece is among the European countries with the highest antibiotic consumption in the community. We investigated the antibiotic prescription practices by private-practice paediatricians, using the 2007 national guidelines for antibiotic use as the gold standard. METHODS: A standardized questionnaire was distributed to 520 private-practice pediatricians. There were 6 scenarios about common infections. RESULTS: A total of 124 pediatricians participated (23.8% response rate). Compliance with the first recommended antibiotic was 48% for streptococcal pharyngitis, 30.6% for community-acquired pneumonia, 12.4% for urinary tract infection, 67.8% for bacterial skin infection, 48.8% for acute otitis media, and 18.2% for bacterial pneumonia. The highest variation in antibiotic prescription concerned the community-acquired pneumonia scenario (11 antibiotics, including 6 beyond the guidelines). The overall mean compliance rate with the first recommended antibiotic was 37.4%. The mean compliance rates were 49.2%, 36.4%, 35.8%, and 27.5% in the <40, 41-50, 51-60, and >60 years age groups, respectively (P value<0.001). CONCLUSION: Five years after the first guidelines about antibiotic use were issued in Greece, a wide range of antibiotic prescription practices by private-practice pediatricians was discovered, with only one every three pediatricians complying fully with them.

Infections caused by carbapenem-resistant Klebsiella pneumoniae among patients in intensive care units in Greece: a multi-centre study on clinical outcome and therapeutic options.

Infections due to carbapenem-resistant Klebsiella pneumoniae (CR-KP) have emerged as a public health problem worldwide given their spread dynamics and the limited therapeutic options. Our aim was to study the clinical outcome of patients with CR-KP infections in relation to antimicrobial treatment. CR-KP infections that occurred in a 10-month period (September 2009 to June 2010) in patients admitted to 19 intensive care units all over Greece were studied. A total of 127 CR-KP infections were reported. Central venous catheter bacteraemia was the most frequent infection, followed by ventilator-associated pneumonia (39 (30.7%) and 35 (27.6%) cases, respectively). Resistance to colistin, tigecycline, gentamicin and amikacin was detected in 20%, 33%, 21% and 64% of isolates, respectively. Regarding treatment, 107 cases received active treatment, including 1 or ≥2 active antibiotics in 65 (60.7%) and 42 (39.3%) cases, respectively. The most frequent combination was colistin plus aminoglycoside and tigecycline plus aminoglycoside (17 and 11 cases, respectively). Forty-eight (45.2%) of the cases that received active treatment were considered clinical failures, with 23.5% mortality at 14 days. Logistic regression analysis revealed that age ≤55 years, non-immunocompromised patients and patients who received colistin had higher successful response rates, while patients ≤55 years old had lower mortality rates at 14 days after the introduction of active treatment. CR-KP infections are associated with a significant clinical failure rate. Colistin remains a valuable antimicrobial agent for treating these infections, while the rise of resistance to the last available antibiotics further limits treatment options.

Panton-Valentine leukocidin-positive methicillin-resistant Staphylococcus aureus outbreak among healthcare workers in a long-term care facility.

BACKGROUND: We investigated an outbreak of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections that occurred among healthcare workers (HCWs) but not among residents of a long-term care facility (LTCF). METHODS: Cases of S. aureus infection were sought by reviewing the medical records of residents and HCWs. In order to identify risk factors for the development of an S. aureus infection, an unmatched case-control study was conducted. Cases were all HCWs with a clinically compatible S. aureus infection; controls were HCWs with no history of a clinically compatible S. aureus infection. Cases and controls were interviewed and anterior nasal swabs were collected. RESULTS: Over a period of 14 months, a total of eight cases were identified among practice nurses, giving an attack rate of 10% for this category of profession. All isolates were identified as MRSA Panton-Valentine leukocidin (PVL)-producing SCCmec type IV. By multivariate analysis, working in a specific zone and being a practice nurse were found to be statistically significant risk factors for infection. CONCLUSIONS: The current outbreak indicates that HCWs may serve as vehicles for the entry of PVL-positive MRSA strains from the community into LTCFs, and that deficient hygiene practices and unrecognized carriage may facilitate spread. Given the increasing prevalence of PVL-positive MRSA infections worldwide, guidelines for the eradication of PVL-positive MRSA carriage within closed communities should be established and efforts to obtain cultures from compatible infections should be made.

Posttraumatic stress reactions among children following the Athens earthquake of September 1999.

The objective of the present study was to assess symptoms of posttraumatic stress disorder (PTSD), depression and anxiety among children 6 months after they had been exposed to an earthquake (EQ) affecting the northwestern suburbs of Athens in September 1999. A total of 115 children attending two elementary schools located at the epicentre of the EQ were assessed. A group of 48 children not affected by the EQ attending a school not affected by the EQ were used as controls. The children and their parents completed a number of questionnaires. Overall, there was a high rate (78%) of severe to mild PTSD symptoms in the EQ exposed group. Additionally, a substantial proportion of these children scored above criteria (32%) for depression compared to the control group (12.5%). Severe or moderate symptoms of PTSD were associated with high scores of depression (p = 0.002). The relationship between PTSD symptoms and anxiety was limited to the "avoidance" factor of the anxiety questionnaire (p = 0.029). Those who were most likely to be affected were children alone at the time of the EQ, and children who sustained injuries. In summary, countries where EQs are frequent should be prepared to offer psychological support to a substantial proportion of children presenting with PTSD and depressive symptoms and should educate and prepare children to cope with these events.