Preservation status and microbial communities of vacuum-packed hot smoked rainbow trout fillets.

Vacuum-packed hot smoked rainbow trout fillets from two different smokehouses of Greece were stored at 2 and 7.9 °C. Microbiological, sensory, and physicochemical changes were monitored. Microbial communities grown on MRS of three different pHs (5.4, 6.4 and 7.4) were also classified and identified using Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Shelf-life was found to differ between products from the two smokehouses (A: 104 and 45 days, B: 100 and 45 days, at 2 and 7.9 °C, respectively). At the time point that sensory rejection was recorded, counts on MRS were found at higher population levels than the other microorganisms tested, almost in all cases. Out of the 567 colonies isolated from MRS of three different pHs, 71 classified as Enterococcus spp., 383 as Candida spp. and 113 as Lactobacillus spp.. Candida zeylanoides dominated exclusively in fillets from the smokehouse A during storage at 2 °C, while Lactobacillus sakei dominated clearly against C. zeylanoides at 7.9 °C, in all pH values. For the smokehouse B, C. zeylanoides or Enterococcus faecalis found to dominate initially in MRS of three pHs, C. zeylanoides, and/or Candida famata in the middle and/or the time point that sensory rejection was recorded at 2 °C, while Lactobacillus curvatus or E. faecalis at 7.9 °C. This study reveals the predominant cultivable spoilage microbiota of vacuum-packed hot smoked rainbow trout, and provides valuable information to the researcher and producers towards the production of more stable products with improved shelf-life.

Prevalence and characteristics of Listeria monocytogenes in meat, meat products, food handlers and the environment of the meat processing and the retail facilities of a company in Northern Greece.

In this study, we investigated the incidence of Listeria monocytogenes in the receiving meat, the meat products, the personnel and the environment of a vertically integrated company in Northern Greece owing a processing plant and three trading facilities. A total of 303 samples were examined from the receiving raw meat, raw meat preparations, ready-to-eat meat products, processing surfaces and the environment of these facilities as well as the food handlers' hands and nasal cavities. MALDI-TOF MS was used for Listeria identification; from the 22 (7·26%) positive to Listeria spp. isolates, 12 (3·96%) identified as L. monocytogenes, eight (2·64%) as Listeria innocua and two (0·66%) as Listeria welshimeri. Molecular serotyping of L. monocytogenes isolates by multiplex PCR revealed 11 strains belonging to serogroup IIa (1/2a and 3a) and one to IIc (1/2c and 3c). The assay for the detection of the virulence-associated genes revealed eight isolates carrying all the examined genes (inlA, inlB, inlC, plcA, prfA, actA, hlyA and iap) and four carrying all except the actA gene. Eleven (91·7%) of the isolates showed a strong ability to form biofilm. All isolates were multidrug resistant. The MALDI-TOF Main Spectrum Profile (MSPs), revealed three clusters: one with five isolates (four from environmental samples and one from a food handler), one with five isolates (all from environmental samples) and one with two isolates (both from raw meat products). MALDI-TOF MS seems to be a reliable tool for the identification of niches and contamination routes in processing plants, contributing also to the evaluation and improvement of the applied preventive measures to control L. monocytogenes.

'Evidence for waterborne origin of an extended mixed gastroenteritis outbreak in a town in Northern Greece, 2019'.

We investigated a large gastroenteritis outbreak that occurred in Northern Greece in 2019. A case was defined as anyone presenting with diarrhoea and/or vomiting from 24 January 2019 to 04 February 2019. We conducted a case-control study (CCS) using random selection of participants >16 years of age, residents of town X, who visited the health care centre between 25 and 28 January 2019. Moreover, we conducted a retrospective cohort study (CS) at the four elementary schools of the town. We collected clinical and water samples and the water supply system was inspected. In total, we recorded 638 cases (53% female; median age was 44 years (range 0-93)). Forty-eight cases and 52 controls participated in the CCS and 236 students in the CS. Both CCS and CS indicated tap water as the most likely source (OR 10, 95% CI 2.09-93.4, explaining 95.7% of cases; RR = 2.22, 95% CI 1.42-3.46, respectively). More than one pathogen was detected from stool samples of 6 of the 11 cases tested (norovirus, Campylobacter jejuni, Enterohemorrhagic E. coli (EHEC) and Enteropathogenic E. coli (EPEC)). Water samples, collected after ad-hoc chlorination, tested negative. Technical failures of the water tanks' status were identified. Our results suggested a waterborne outbreak. We recommended regular monitoring of the water supply system and immediate repair of technical failures.

Epidemiology of hepatitis A in Greece in the last decade: management of reported cases and outbreaks and lessons learned.

Hepatitis A is a mandatory notifiable disease in Greece. Here, we present the epidemiological data for 2009-2018 and the results of outbreak investigations performed, and discuss future public health priorities.Overall, 1193 cases were reported; 320 migrants/refugees, 240 Roma, 112 travellers and 521 from the general population. The median age of the affected general population (37 years) had an increasing trend (from 30.8 years in 2009 to 40.5 in 2018, P < 0.001) and was significantly higher than that among Roma and migrants (7 and 8 years, respectively, P < 0.001). Twenty-two cases (2.2%) were unvaccinated patients with a chronic liver disease. Fifty clusters with 2-12 cases each were recorded; 44 were attributed to person-to-person transmission and six to food consumption. Three outbreaks accounting for 32.3% of the total number of recorded cases were identified; in 2013 among Roma (112 cases), in 2016 among refugees (188 cases) and in 2017 among men having sex with men (96 cases; 33 of them (34.4%) HIV-positive). The epidemiological data depict that improving living conditions and vaccination coverage of deprived populations, and informing adults on the disease focusing at faecal-oral transmission during sexual intercourse and travel should be the future public health priorities.

Norovirus waterborne outbreak in Chalkidiki, Greece, 2015: detection of GI.P2_GI.2 and GII.P16_GII.13 unusual strains.

Noroviruses, along with rotaviruses, are among the leading causes of gastroenteritis worldwide and novel strains are periodically emerging. In August 2015, an unusual increase of gastroenteritis cases occurred in a touristic district in Kassandra peninsula, Chalkidiki, Northern Greece. Seven stool specimens from cases were tested positive for norovirus. Molecular investigation and phylogenetic analysis identified that there was co-circulation of norovirus GI.P2_GI.2 and the recombinant strain GII.P16_GII.13. A 1:1 case-control study conducted and showed that tap water consumption significantly associated with developing symptoms of gastroenteritis (odds ratio = 36.9, P = 0.018). The results of the epidemiological investigation, the co-circulation of two different norovirus strains, the information of a pipeline breakage at the water supply system before the onset of cases, and reports on flooded wells and sewage overflow, indicated the possibility of water contamination by sewage during the pipeline breakage leading to a large outbreak with a peak at 10 August and a possible secondary person-to-person transmission after the 16th of August. Norovirus GI.P2_GI.2 strains are rarely reported in Europe, while it is the first time that infection from the recombinant strain GII.P16_GII.13 is recorded in Greece.

A large waterborne gastroenteritis outbreak in central Greece, March 2012: challenges for the investigation and management.

In March 2012, there was an unusual increase of gastroenteritis cases in a district with 37,264 inhabitants in central Greece. It was estimated that more than 3600 people developed symptoms. A 1:1 case-control study showed that consumption of tap water was a risk factor for acquiring infection [odds ratio (OR) 2.18, 95% confidence interval (CI) 1.11-4.28]. Descriptive data, low gastroenteritis incidence in adjacent areas with different water supply systems, and water-quality data further supported the hypothesis of a waterborne outbreak. Thirty-eight stool samples were positive for rotavirus. Bacterial indicators of recent faecal contamination were detected in samples from the water source and ice cubes from a local production enterprise. Molecular epidemiology of rotavirus strains, apart from the common strain, G3[P8], identified the unusual G/P combination G2P[8]. Water sanitation measures contributed to the control of the outbreak. This outbreak demonstrated the need for the cooperation of laboratories with different expertise and the importance of early notification of waterborne gastroenteritis outbreaks.

Duration of the thoracic epidural catheter in a fast-track recovery protocol may decrease the length of stay after a major hepatectomy: a case control study.

BACKGROUND: Fast-track recovery protocols are applied to major surgeries, including hepatectomies. The optimal duration of thoracic epidural catheter has not yet been defined. OBJECTIVE: To determine the ideal time to remove the epidural catheter after major hepatectomy. PATIENTS-METHODS: Forty-eight consecutive patients who underwent major hepatectomy over 4 years were studied. The data from laparoscopic hepatectomy were not included. Patients who underwent hepaticojejunostomy were included. A modified protocol of rapid postoperative recovery was implemented. In the first 24 patients, an epidural catheter was maintained for 4 days (group A), while in the next 24, the catheter was maintained for 2 days (group B). The length of hospital stay, time of functional recovery, and use of opioids and laxatives were recorded. RESULTS: There was no postoperative mortality. The average length of hospital stay was 6.92 ± 1.79 and 6.09 ± 2.08 days for groups A and B, respectively. The mean functional recovery was 5.46 ± 0.3 and 5.26 ± 0.91 days for groups A and B, respectively. However, in group B, more opioid analgesics by 50% and more laxatives by 17% were used. CONCLUSIONS: After major hepatectomy, a reduction from 4 to 2 days' duration of the epidural catheter may lead to a reduction in the length of hospital stay.

Parental attitudes and perceptions affecting children's dental behaviour in Greek population. A clinical study.

AIM: This was to investigate the relationship of children's behaviour during dental treatment to parental dental attitudes and perceptions in a definitive population of Greek children in Athens. METHODS: 88 children aged 3-11 years and their parents, attending the Community Dental Centre for Children in Athens, participated. A questionnaire including demographic information, questions regarding parents' dental experience and anxiety (M-DAS test), as well as questions regarding expectant behaviour of each child and his/her dental anxiety level (parental version of the CFSS -Dental Subscale), was completed by the parents during the first examination appointment. During the two following operative sessions each child's behaviour was recorded and evaluated using the Frankl Scale. Collected data were statistically analyzed using a SPSS statistical program. RESULTS: No significant difference was found between a child's actual behaviour and gender, nationality, frequency of parent's dental visits, parental dental fear (M-DAS) and previous medical experience of the child (p>0.001). In contrast, age (p=0.005), previous child's dental fear (p=0.081), previous child's dental behaviour (p<0.0001), predicted by the parent behaviour (p<0.0001) and parental version of CFSS-DS (p<0.001), revealed statistically significant associations to child's behaviour during treatment. CONCLUSION: According to the present study in Greek children, children's behaviour during dental treatment is related to age, previous dental fear and experience and behaviour prediction by the parents. Parents' estimations regarding their children's fear and behaviour could be a useful predictor of child's level of cooperation during dental treatment.