"Trends in infectious diseases hold particular interest. Whereas tuberculosis incidence continued its declining trend (according to the Hellenic Centre for Disease Control and Prevention, reported new cases of tuberculosis decreased by 26.8% between 2007 and 2010),55 Greece surprisingly faced 3 infectious disease outbreaks in a period of less than 18 months, between July 2010 and December 2011: an outbreak of West Nile virus infection in northern Greece between July and October 2010, including 197 patients with neuroinvasive disease and 35 deaths56; an outbreak of malaria in southern Greece between May and October 2011, including 63 cases, of which 40 reported no travel history to endemic countries57; and worsening trends in HIV infection between 2010 and 2011, such as a 57.2% increase in newly diagnosed cases of HIV-1 infection (from 607 new cases in 2010 to 954 cases in 2011) and a 1506.7% increase of newly diagnosed cases of HIV-1 infection among injection drug users (from 15 cases in 2010 to 241 cases in 2011).58
"In all 3 examples, outbreaks were initially attributed to environmental risk factors59,60 or to migrant populations.60,61 Nevertheless, the public health measures that have been retrospectively implemented for the control of the epidemics (intensified distribution of needles and condoms among injection drug users, intensification of vector- and mosquito-control activities) imply that the risks of transmission had not been addressed through prevention, most likely because of the dismantling of services previously provided by national and regional public health agencies. For example, the number of needles and condoms that were freely distributed to injection drug users by public preventive programs decreased sharply in 2010 (by approximately 31% compared with 2009) just before the marked increase in newly diagnosed cases of HIV-1 infection.62 Mosquito-control activities implemented by public local authorities also were delayed in 2011 because of financial problems.63"


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