Publications by authors named "Emmanouil A Fotakis"

Background: Development of insecticide resistance (IR) in sand fly populations is an issue of public health concern, threatening leishmaniasis mitigation efforts by insecticide-based vector control. There is a major knowledge gap in the IR status of wild populations worldwide, possibly attributed to the unavailability of specialized tools, such as bioassay protocols, species baseline susceptibility to insecticides and molecular markers, to monitor such phenomena in sand flies.

Methodology/principal Findings: Sand fly populations from (semi-)rural regions of Greece, Turkey and Iran were sampled and identified to species, showing populations' structure in accordance with previously reported data.

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Introduction: West Nile Virus (WNV) is a significant public health concern in southern Europe, with meteorological, climatic, and environmental factors playing a critical role in its transmission dynamics. This study aims to assess the short-term effects of meteorological variables on the incidence of WNV in five Italian regions in Northern Italy from 2012 to 2021.

Methods: Linking epidemiological data from the national surveillance system and local meteorological data, we conducted a Case-Time Series analysis to examine the association between WNV incident cases and temperature, humidity, and precipitation recorded up to ten weeks before case occurrence at the local administrative unit level.

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Article Synopsis
  • Leishmaniasis is a neglected disease in Greece with increasing incidence, particularly zoonotic visceral leishmaniasis and canine leishmaniasis, but it currently lacks adequate surveillance infrastructure.
  • The study conducts a review of existing surveillance methods and gathers expert opinions via questionnaires to assess the potential transition to a One Health (OH) surveillance system that includes humans, animals, and the environment.
  • Key findings highlight both the strengths and weaknesses of the current system, with financial constraints and insufficient entomological surveillance being major challenges, but there are opportunities for improvement based on past experiences with other disease surveillances in the region.
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Background: As of 2024, vaccination remains the main mitigation measure against COVID-19, but there are contradictory results on whether people living with HIV (PLWH) are less protected by vaccines than people living without HIV (PLWoH). In this study we compared the risk of SARS-CoV-2 infection and COVID-19 hospitalisation following full vaccination in PLWH and PLWoH.

Methods: We linked data from the vaccination registry, the COVID-19 surveillance system and from healthcare/pharmacological registries in four Italian regions.

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Evaluating how a COVID-19 seasonal vaccination program performed might help to plan future campaigns. This study aims to estimate the relative effectiveness (rVE) against severe COVID-19 of a seasonal booster dose over calendar time and by time since administration. We conducted a retrospective cohort analysis among 13,083,855 persons aged ≥60 years who were eligible to receive a seasonal booster at the start of the 2022-2023 vaccination campaign in Italy.

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Food insecurity comprises a major global public health threat, as its effects are detrimental to the mental, physical, and social aspects of the health and well-being of those experiencing it. We performed a narrative literature review on the magnitude of global food insecurity with a special emphasis on Greece and analyzed the major factors driving food insecurity, taking into consideration also the effect of the COVID-19 pandemic. An electronic search of international literature was conducted in three databases.

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This study analysed the evolution of the association of socioeconomic deprivation (SED) with SARS-CoV-2 infection and COVID-19 outcomes in urban Italy during the vaccine rollout in 2021. We conducted a retrospective cohort analysis between January and November 2021, comprising of 16,044,530 individuals aged ≥ 20 years, by linking national COVID-19 surveillance system data to the Italian SED index calculated at census block level. We estimated incidence rate ratios (IRRs) of infection and severe COVID-19 outcomes by SED tercile relative to the least deprived tercile, over three periods defined as low (0-10%); intermediate (> 10-60%) and high (> 60-74%) vaccination coverage.

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Conspiracy theories have been widespread in public discourses about COVID-19. Belief in conspiracy theories has negative effects on COVID-19 protective and preventive behaviour. However, evidence on the prevalence of belief in COVID-19 conspiracy theories, remains fragmented.

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Background: Limited evidence is available on the additional protection conferred by second mRNA vaccine boosters against severe COVID-19 caused by omicron BA.5 infection, and whether the adapted bivalent boosters provide additional protection compared with the monovalent ones. In this study, we aimed to estimate the relative effectiveness of a second booster with monovalent or bivalent mRNA vaccines against severe COVID-19 in Italy.

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Article Synopsis
  • - An outbreak of bloodstream infections affected 20 haemodialysis patients in four hospitals in north-eastern Italy, linked to a contaminated batch of urokinase vials imported from India.
  • - Whole genome sequencing showed a strong relationship between the strains found in patients and the contaminated urokinase, with an attack rate of 34% among treated patients.
  • - The outbreak was successfully terminated by discontinuing the use of the contaminated urokinase product.
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Effectiveness against severe COVID-19 of a second booster dose of the bivalent (original/BA.4-5) mRNA vaccine 7-90 days post-administration, relative to a first booster dose of an mRNA vaccine received ≥ 120 days earlier, was ca 60% both in persons ≥ 60 years never infected and in those infected > 6 months before. Relative effectiveness in those infected 4-6 months earlier indicated no significant additional protection (10%; 95% CI: -44 to 44).

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Over the past decade, Greece and other Mediterranean countries have witnessed the emergence and resurgence of several vector-borne diseases (VBDs), posing important public health challenges and threatening the tourist industry. An essential prerequisite for the design and execution of efficient and sustainable context-specific VBD control programmes is the establishment of integrative entomological and epidemiological surveillance systems. However, the monitoring and management of surveillance datasets (often chronologically fragmented, scattered in regional health district offices and partially accessible upon requisition), as well as their transformation into actionable information, is a complex undertaking.

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Article Synopsis
  • - Greece faces significant public health risks from vector-borne diseases (VBD), especially the West Nile virus (WNV), particularly affecting tourist-heavy regions like Crete, where over 5 million tourists visit annually.
  • - A comprehensive surveillance network was set up in Crete from 2018 to 2020 to study mosquito populations, pathogen presence, and insecticide resistance, utilizing both traditional and molecular diagnostic methods.
  • - Key findings revealed the presence of major disease-carrying mosquito species, with Culex pipiens being the most prevalent, and while no flavivirus pathogens were detected in mosquitoes, a small percentage of sentinel chickens had WNV antibodies, indicating early signs of virus activity that could precede human infections.
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  • Phlebotomine sand flies are major vectors for Leishmania parasites, causing significant fatalities second only to malaria worldwide, leading to a focus on insecticide-based control methods in the absence of human vaccines.
  • Current interventions include indoor residual spraying and treated bed nets, but there is growing insecticide resistance identified in some regions, particularly in India.
  • To effectively manage leishmaniasis, standardized diagnostic methods and integrated vector management programs are essential, alongside the exploration of novel biotechnology-based control strategies.
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  • Culex quinquefasciatus mosquitoes are key vectors for diseases but lack sufficient data on their biology and resistance to insecticides.
  • A study in Yaoundé, Cameroon, found that most populations of Cx. quinquefasciatus showed significant resistance to multiple insecticides, with mortality rates between 0-89%.
  • The resistance is linked to genetic mutations and overexpression of certain genes, indicating a complicated biological response that could reduce the effectiveness of existing pest control methods and highlights the need for new integrated strategies.
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Background: Aedes albopictus has a well-established presence in southern European countries, associated with recent disease outbreaks (e.g. chikungunya).

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Background: Diflubenzuron (DFB) is one of the most used insecticides in mosquito larval control including that of Culex pipiens, the proven vector of the recent West Nile Virus epidemics in Europe. Two mutations (I1043L and I1043M) in the chitin synthase (CHS) putative binding site of DFB have been previously reported in Cx. pipiens from Italy and associated with high levels of resistance against this larvicide.

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  • - The study assesses the risk of vector-borne diseases (VBD) in temporary refugee camps in Greece, focusing on mosquito and sand fly populations and their implications for disease control programs
  • - A surveillance network was established to collect samples from these insects, using traps over several months, analyzing species composition and pathogen infection rates
  • - Key disease vectors were found, including various species of mosquitoes and sand flies, with high Leishmania infection rates observed, but no evidence of certain mosquito-borne pathogens; additionally, resistance mutations against insecticides were noted in some populations
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Chemical insecticides are the main tool for vector control worldwide with pyrethroids and the larvicide diflubenzuron (DFB) used extensively against the primary West Nile virus vector Culex pipiens. In this study we monitored the presence, frequency and geographical distribution of the Chitin synthase 1 gene mutations I1043L, I1043M associated with striking diflubenzuron resistance and the knock down resistance mutation L1014F associated with pyrehtroid resistance, in Cx. pipiens populations from Turkey.

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High infection rates of Leishmania donovani and L. tropica were detected in Phlebotomus spp. sand flies collected from refugee camps in Greece, indicating increased risk of infection among local populations.

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Phlebotomine sand flies (Diptera: Psychodidae) are primary vectors of leishmaniasis. Greece and Turkey are both endemic for visceral and cutaneous leishmaniasis and are widely affected by the disease. Measures commonly applied for controlling sand flies rely on the use of insecticides, predominantly pyrethroids.

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During July-October 2017 a WNV outbreak took place in the Peloponnese, Southern Greece with five confirmed deaths. During routine monitoring survey in the Peloponnese, supported by the local Prefecture, we have confirmed the presence of all three Culex pipiens biotypes in the region, with a high percentage of Culex pipiens/molestus hybrids (37.0%) which are considered a highly competent vector of WNV.

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Greece has been recently affected by several mosquito borne diseases with the West Nile Virus (WNV) outbreak in 2010 being one of the largest reported in Europe. Currently at the epicenter of an economic and refugee crisis and visited by over 16 million tourists a year the integrated management of diseases transmitted by mosquitoes is a public health and economic priority. Vector control programs rely mainly on insecticides, however data on insecticide resistance and the mosquito fauna is essential for successful applications.

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We assessed window screens and eave baffles (WSEBs), which enable mosquitoes to enter but not exit houses, as an alternative to indoor residual spraying (IRS) for malaria vector control. WSEBs treated with water, the pyrethroid lambda-cyhalothrin, or the organophosphate pirimiphos-methyl, with and without a binding agent for increasing insecticide persistence on netting, were compared with IRS in experimental huts. Compared with IRS containing the same insecticide, WSEBs killed similar proportions of Anopheles funestus mosquitoes that were resistant to pyrethroids, carbamates and organochlorines and greater proportions of pyrethroid-resistant, early exiting An.

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