Estimating the disease burden of 2009 pandemic influenza A(H1N1) from surveillance and household surveys in Greece.

BACKGROUND: The aim of this study was to assess the disease burden of the 2009 pandemic influenza A(H1N1) in Greece. METHODOLOGY/PRINCIPAL FINDINGS: Data on influenza-like illness (ILI), collected through cross-sectional nationwide telephone surveys of 1,000 households in Greece repeated for 25 consecutive weeks, were combined with data from H1N1 virologic surveillance to estimate the incidence and the clinical attack rate (CAR) of influenza A(H1N1). Alternative definitions of ILI (cough or sore throat and fever>38°C [ILI-38] or fever 37.1-38°C [ILI-37]) were used to estimate the number of symptomatic infections. The infection attack rate (IAR) was approximated using estimates from published studies on the frequency of fever in infected individuals. Data on H1N1 morbidity and mortality were used to estimate ICU admission and case fatality (CFR) rates. The epidemic peaked on week 48/2009 with approximately 750-1,500 new cases/100,000 population per week, depending on ILI-38 or ILI-37 case definition, respectively. By week 6/2010, 7.1%-15.6% of the population in Greece was estimated to be symptomatically infected with H1N1. Children 5-19 years represented the most affected population group (CAR:27%-54%), whereas individuals older than 64 years were the least affected (CAR:0.6%-2.2%). The IAR (95% CI) of influenza A(H1N1) was estimated to be 19.7% (13.3%, 26.1%). Per 1,000 symptomatic cases, based on ILI-38 case definition, 416 attended health services, 108 visited hospital emergency departments and 15 were admitted to hospitals. ICU admission rate and CFR were 37 and 17.5 per 100,000 symptomatic cases or 13.4 and 6.3 per 100,000 infections, respectively. CONCLUSIONS/SIGNIFICANCE: Influenza A(H1N1) infected one fifth and caused symptomatic infection in up to 15% of the Greek population. Although individuals older than 65 years were the least affected age group in terms of attack rate, they had 55 and 185 times higher risk of ICU admission and CFR, respectively.

Heat waves observed in 2007 in Athens, Greece: synoptic conditions, bioclimatological assessment, air quality levels and health effects.

Heat waves are considered to be increasing in frequency and intensity whereas they comprise a significant weather-related cause of deaths in several countries. Two heat waves occurred in Greece in summer 2007. These severe heat waves are assessed by analyzing the prevailing synoptic conditions, evaluating human thermal discomfort, through the Heat Load Index (HL), as well as investigating its interrelation of air pollutant concentrations, and the daily air quality stress index (AQSI), in the greater region of Athens (Attica), Greece. Furthermore, the relation of HL values and the number of heatstroke and heat exhaustion events recorded in public hospitals operating within the Greek National Health System is examined. Data included radiosonde measurements from the Athens airport station (LGAT), NCEP/NCAR reanalysis data in order to obtain the position of the Subtropical Jet Stream (STJ), GDAS meteorological data for back-trajectory calculation, 10-min meteorological data from 10 Hydro-Meteorological stations and mean hourly values of nitric dioxide (NO(2)), sulphur dioxide (SO(2)) and ozone (O(3)) concentrations, measured at 7 different sites, for the last 10-day period of June and July 2007. Spearman's rank correlation test was used to observe any possible correlation between HL values and air pollutant concentrations, and AQSI values. The results demonstrated different synoptic characteristics for the heat waves of June and July. In the heat wave of June, higher ambient temperatures were recorded and greater HL values were calculated. Extreme discomfort conditions were identified in both heat waves during both day-time and night-time hours. The air pollution analysis showed poor air quality conditions for the heat wave of July, while a significant correlation was found between HL values and average hourly concentrations of O(3), NO(2) and SO(2). The number of heat-affected patients reported during the June heat wave was larger.

Mass gatherings and public health: the experience of the Athens 2004 Olympic games

The Olympic Games are a very popular but also vulnerable global event and thus intrinsically raise the expectations of the international community on all aspects of preparedness, including public health. This is the first time that the whole public health and health care experience from Olympic Games has been incorporated into one comprehensive publication. The book contains strategic, technical and scientific information about epidemiological surveillance, environmental management, emergency and hospital care, preparedness for the potential deliberate use of explosives, biological and chemical agents or radionuclear material, disease prevention as well as coordination and unified command. It also highlights that mass sports gatherings such as the Olympics can be powerful platforms for promoting health messages, especially physical activity and active living, healthy nutrition and avoidance of smoking. Finally, it synthesizes the conclusions and lessons learned, and offers insights and strategic points for future organizers of mass gatherings.

Thoracic spinal injuries: operative treatments and neurologic outcomes.

Between January 1983 and December 1997, 29 patients with either a fracture (11 patients) or a fracture-dislocation (18 patients) of the thoracic spine were treated operatively. All patients underwent posterior decompression and stabilization within a mean time of 4 days after injury (range, 0-45 days). Patients with complete paraplegia had no postoperative improvement in neurologic status, whereas all patients with incomplete spinal cord lesions improved in neurologic status after surgery. There was no significant association between time from injury to operation and final neurologic outcome. For thoracic fractures, the procedure of surgical decompression and stabilization is safe, and neurologic recovery may be anticipated in patients with incomplete spinal cord lesions.