1. Greece - Background 2011 40 cases of P. vivax infection were reported from 5 districts (have no travel history to a malaria endemic area) – Laconia (34) – Attica (2) – Evvoia (2) – Viotia (1) – Larisa (1) A cluster involving 27 Greek resident cases and 7 immigrant cases from non-endemic countries was identified in the area of Evrotas, Laconia. In addition, 23 cases of P. vivax in Lakonia were reported in migrant farm workers from malaria-endemic countries. Source: http://ecdc.europa.eu/en/press/news/Lists/News/ECDC

2. 2012 Between January 1 and October 1, 2012 70 cases of malaria reported -54 were caused by P. vivax 12 are locally acquired 2 are relapses 40 occurred in immigrants October 1 - November 14 additional P. vivax malaria cases 4 locally-acquired cases in Greek residents with no previous travel 10 cases in immigrants (10 cases could have either been imported or acquired locally)

3. Programmatic issues and specific factors Weakening Economy resulted in budget cuts weakened/reduced surveillance (lack of early case detection; disease is no longer reported) Entry of migrant workers in agricultural areas No/Low immunity among local population increase their vulnerability High receptivity and vulnerability but no vigilance

4. Measures taken to reverse and Prevent it Enhancing surveillance system, epidemiological and entomological Intensified malaria vector in currently and previously affected areas Healthcare providers educated about early malaria diagnosis and treatment Public information about the symptoms of malaria and prevention of mosquito bites Travel advisory from the countries travelling to Greece