@article{3159707,
    title = "Genotyping Plasmodium vivax isolates from the 2011 outbreak in Greece",
    author = "Spanakos, Gregory and Alifrangis, Michael and Schousboe, Mette L. and and Patsoula, Eleni and Tegos, Nicholas and Hansson, Helle H. and Bygbjerg, and Ib C. and Vakalis, Nicholas C. and Tseroni, Maria and Kremastinou, Jenny and and Hadjichristodoulou, Christos",
    journal = "Malaria Journal",
    year = "2013",
    volume = "12",
    publisher = "BMC",
    issn = "1475-2875",
    doi = "10.1186/1475-2875-12-463",
    keywords = "Outbreak; Greece; Plasmodium vivax; Genotyping; Merozoite surface
protein-3a; Microsatellites",
    abstract = "Background: Plasmodium vivax malaria was common in Greece until the
1950s with epidemics involving thousands of cases every year. Greece was
declared free of malaria by the World Health Organization in 1974. From
1974 to 2010, an average of 39 cases per year were reported, which were
mainly imported. However, in 2009 and 2010 six and one autochthonous
cases were reported culminating with a total of 40 autochthonous cases
reported in 2011, of which 34 originated from a single region: Laconia
of Southern Peloponnese. In this study the genotypic complexity of the
P. vivax infections from the outbreak in Greece during 2011 is
described, to elucidate the possible origin and spread of the disease.
Methods: Three polymorphic markers of P. vivax were used; Pvmsp-3a and
the microsatellites m1501 and m3502 on P. vivax isolates sampled from
individuals diagnosed in Greece. Thirty-nine isolates were available for
this study (20 autochthonous and 19 imported), mostly from Evrotas
municipality in Laconia region, in southern Greece, (n = 29), with the
remaining representing sporadic cases originating from other areas of
Greece.
Results: Genotyping the Evrotas samples revealed seven different
haplotypes where the majority of the P. vivax infections expressed two
particular Pvmsp-3a-m1501-m3502 haplotypes, A10-128-151 (n = 14) and
A10-121-142 (n = 7). These haplotypes appeared throughout the period in
autochthonous and imported cases, indicating continuous transmission. In
contrast, the P. vivax autochthonous cases from other parts of Greece
were largely comprised of unique haplotypes, indicating limited
transmission in these other areas.
Conclusions: The results indicate that several P. vivax strains were
imported into various areas of Greece in 2011, thereby increasing the
risk of re-introduction of malaria. In the region of Evrotas ongoing
transmission occurred exemplifying that further control measures are
urgently needed in this region of southern Europe. In circumstances
where medical or travel history is scarce, methods of molecular
epidemiology may prove highly useful for the correct classification of
the cases."
}