Greece is the only European Union member state that in 2008 included hepatitis A (HAV) vaccine in the routine national childhood immunization program (NCIP). Given that the resources allocated to public health have dramatically decreased since 2008 and that Greece is a low endemicity country for the disease, the benefit from universal vaccination has been questioned. The aim of this paper is to summarize the available epidemiological data of the disease for 1982-2013, and discuss the effects of universal vaccination on disease morbidity. Descriptive analysis, ARIMA modeling and time series intervention analysis were conducted using surveillance data of acute HAV. A decreasing trend of HAV notification rate over the years was identified (p<0.001). However, universal vaccination (~ 80% vaccine coverage of children) had no significant effect on the annual number of reported cases (p = 0.261) and has resulted to a progressive increase of the average age of infection in the general population. The mean age of cases before the inclusion of the vaccine to NCIP (24.1 years, SD = 1.5) was significantly lower than the mean age of cases after 2008 (31.7 years, SD = 2.1) (p<0.001). In the last decade, one third of all reported cases were Roma (a population accounting for 1.5% of the country’s total population) and in 2013 three outbreaks with 16, 9 and 25 Roma cases respectively, were recorded, indicating the decreased effectiveness of the current immunization strategy in this group. Data suggest that universal vaccination may need to be re-considered. Probably a more cost effective approach would be to implement a program that will include: a) vaccination of high risk groups, b) universal vaccination of Roma children and improving conditions at Roma camps, c) education of the population and travel advice, and d) enhancement of the control measures to increase safety of shellfish and other foods.

When an increased number of acute gastroenteritis (AG) cases is detected among tourists staying at the same accommodation, outbreak management plans must be activated in a timely manner to prevent large outbreaks. Syndromic surveillance data collected between 1 January 2010 and 31 December 2013 by five seagoing cruise ships were analysed to identify attack rate thresholds for early outbreak detection. The overall incidence rate of AG was 2.81 cases per 10,000 traveller-days (95% confidence interval (CI): 0.00–17.60), while the attack rate was 19.37 cases per 10,000 travellers (95% CI: 0.00–127.69). The probability of an outbreak occurring was 11% if 4 per 1,000 passengers reported symptoms within the first 2 days of the voyage, and this increased to 23 % if 5 per 1,000 passengers reported such within the first 3 days. The risk ratio (RR) for outbreak occurrence was 2.35, 5.66 and 8.63 for 1, 2 and 3 days’ delay of symptoms reporting respectively, suggesting a dose–response relationship. Shipping companies’ policies and health authorities’ efforts may consider these thresholds for initiating outbreak response measures based on the number of cases according to day of cruise. Efforts should focus on ensuring travellers report symptoms immediately and comply with isolation measures.

Insects, similarly to other small terrestrial invertebrates, are particularly susceptible to climatic stress. Physiological adjustments to cope with the environment (i.e., acclimation) together with genetic makeup eventually determine the tolerance of a species to climatic extremes, and constrain its distribution. Temperature and desiccation resistance in insects are both conditioned by acclimation and may be interconnected, particularly for species inhabiting xeric environments. We determined the effect of temperature acclimation on desiccation resistance of the peach fruit fly (Bactrocera zonata, Tephritidae) – an invasive, polyphagous pest, currently spreading through both xeric and mesic environments in Africa and the Eurasian continent. Following acclimation at three constant temperatures (20, 25, and 30°C), the survival of adult flies deprived of food and water was monitored in extreme dry and humid conditions (&lt;10 and &gt;90% relative humidity, respectively). We found that flies acclimated at higher temperatures were significantly heavier, and contained more lipids and protein. Acclimation temperature significantly and similarly affected the survival of males and females at both high and low humidity conditions. In both cases, flies maintained at 30°C survived longer compared to 20 and 25°C – habituated counterparts. Regardless of the effect of acclimation temperature on survival, overall life expectancy was significantly shortened when flies were assayed under desiccating conditions. Additionally, our experiments indicate no significant difference in survival patterns between males and females, and that acclimation temperature had similar effects after both short (5–10 days) and long (11–20 days) acclimation periods. We conclude that acclimation at 30°C prolongs the survival of B. zonata, regardless of ambient humidity levels. Temperature probably affected survival through modulating feeding and metabolism, allowing for accumulation of larger energetic reserves, which in turn, promoted a greater ability to resist starvation, and possibly desiccation as well. Our study set the grounds for understanding the phenotypic plasticity of B. zonata from the hydric perspective, and for further evaluating the invasion potential of this pest.

The Mediterranean fruit fly, Ceratitis capitata (Diptera: Tephritidae), is an invasive pest, that is currently expanding its geographic distribution from the Mediterranean coasts to more temperate areas of Europe. Given that low temperature is a primary determinant of insect species’ range boundaries especially in the Northern Hemisphere with pronounced seasonality, we used chill coma recovery time for assessing latitudinal clines in basal chill tolerance of C. capitata adults. We selected six populations obtained from areas with broad climatic variability based on the main bioclimatic variables of temperature and precipitation, spanning a latitudinal range of about 19° from Middle East to Central Europe. Adults were exposed to 0 °C for 4 h, and time to regain the typical standing position of a fly at 25 °C were recorded. The post-stress survival after a period of 8 days was also recorded. Results revealed that adults from Israel and Austria were less chill tolerant than those from Greece, resulting in curvilinear trends with latitude. Analysis of macroclimatic conditions revealed combined effects of latitude (as a proxy of photoperiod) and macroclimatic conditions on chill coma recovery time. Nonetheless, there was not a deleterious effect on post-recovery survival, except for flies obtained from the northern most point (Vienna, Austria). Overall, it seems that evolutionary patterns of basal chill coma recovery time of C. capitata adults are driven mainly by local climatic variability.

Drosophila suzukii is a polyphagous pest of small and soft fruit, originating from Asia, which has spread and established in Europe and the USA. Adults exhibit seasonal phenotypes, i.e., summer morphs (SM) and winter morphs (WM) to cope with fluctuating environmental conditions. WM have a darker cuticle and larger wings compared to SM, while WM females experience reproductive dormancy. We studied the life history traits (lifespan, female reproductive status and number of produced offspring) of WM and SM that were exposed to winter field conditions of a coastal and a mainland agricultural area, with mild and cold winter climates, respectively. Mated adults of each phenotype were individually placed in vials bearing nutritional/oviposition substrate, and transferred to the field from November 2019 to May 2020, when the death of the last individual was recorded. Almost all SM females (90%) and no WM female carried mature ovarioles before being transferred to the field. WM exhibited a longer lifespan than SM adjusting for location and sex. Differences in survival between the two phenotypes were more pronounced for adults kept in the mainland area. The majority of SM females produced offspring during overwintering in the mild coastal area, but only a few SM were reproductively active in the cold mainland area. Some WM females produced progeny during overwintering in the mild conditions of the coastal area, but all WM females were in reproductive arrest in the mainland area. Overwintering females in the coastal area had a shorter lifespan and produced more progeny than those kept in the mainland area. High survival rates of WM provide indications of the successful performance of this phenotype in the adverse conditions of the cold climates. Additionally, the continuous reproductive activity of SM females and the onset of progeny production by WM females during overwintering in the coastal area indicate that the insect remains reproductively active throughout the year in areas with mild climatic conditions. Our findings support the successful adaptation of D. suzukii in both areas tested and can be used for the development of area-specific population models, based on the prevailing climatic conditions.

Despite the recent invasion and wide spread of Drosophila suzukii Matsumura (Diptera: Drosophilidae) in Europe, little is known regarding its population trends in coastal areas of the southern Mediterranean countries. Using adult trapping and fruit sampling, we studied the population dynamics of D. suzukii in coastal and mainland (semi-highland) cherry orchards of Greece, from 2018 to 2020. Adults were captured in traps baited with apple cider vinegar, placed in conventional and unmanaged sweet-cherry orchards, and in neighbouring wild growing hosts. Sampling of sweet-cherry fruit to assess infestation levels was conducted from early and late-ripening cherry cultivars in both areas. Adults were captured throughout the year in the coastal area with two peaks registered in spring and late-autumn. Captures were nearly zero during the hot summer months. Flight activity exhibited only one peak in autumn at the mainland area, and ceased during winter and spring. Captures in wild hosts were lower during the sweet-cherry ripening period than later in the season. Higher sweet-cherry infestation levels were recorded in the coastal than in the mainland area and in unmanaged than in commercial orchards. Both early and late-ripening cultivars were highly susceptible to D. suzukii infestation in the coastal area. Infestation rates were higher in late-ripening cultivars than in early-ripening ones in the mainland area. We conclude that D. suzukii has well adapted to the Mediterranean climate of Greece, and is able to progressively exploit several crops and wild hosts of mainland and coastal areas.

<b><i>Background:</i></b> Comparative studies among the various cardiovascular medications used for the treatment of neonatal hypotension are lacking. <b><i>Methods:</i></b> This systematic review and pairwise meta-analysis of the anti-hypotensive treatments in preterm and term infants was conducted to evaluate efficacy and impact on outcome. Electronic databases were searched up to February 2021 for relevant articles. As an extension of the current approach for study selection, a machine learning technique was used. Only randomized controlled trials (RCTs) of inotropes, pressors, volume therapy, and corticosteroids were included. Response to treatment was the primary outcome while secondary outcomes included mortality and common morbidities. <b><i>Results:</i></b> Nineteen RCTs involving 758 preterm and term neonates were found, and 8 treatments were evaluated. Most studies involved subjects with early hypotension associated with prematurity. Pairwise meta-analysis among treatments showed that dopamine was more effective than dobutamine regarding the response to treatment (restoration of normotension or normalization of blood pressure) (7 trials, 286 neonates, odds ratio, 3.06 [95% CI = 1.06–8.87]; <i>I</i>² = 49%, very low quality of the evidence per GRADE). Comparisons of other treatments were not significant. No differences were found among regimens regarding survival and other secondary outcomes. <b><i>Conclusion:</i></b> In this systematic review and pairwise meta-analysis, only the comparison of dopamine versus dobutamine provided evidence for efficacy of treatment and favored dopamine. No safe conclusions could be reached in regard to other treatments. Data regarding the management of arterial hypotension in conditions other than transition after birth in preterm newborns are sparse both in preterm and term infants.

The Mediterranean fruit fly, Ceratitis capitata (Diptera: Tephritidae), is an invasive pest, that is currently expanding its geographic distribution from the Mediterranean coasts to more temperate areas of Europe. Given that low temperature is a primary determinant of insect species’ range boundaries especially in the Northern Hemisphere with pronounced seasonality, we used chill coma recovery time for assessing latitudinal clines in basal chill tolerance of C. capitata adults. We selected six populations obtained from areas with broad climatic variability based on the main bioclimatic variables of temperature and precipitation, spanning a latitudinal range of about 19oN from Middle East to Central Europe. Adults were exposed to 0oC for 4h, and time to regain the typical standing position of a fly at 25oC were recorded. The post-stress survival after a period of 8 days was also recorded. Results revealed that adults from Israel and Austria were less chill tolerant than those from Greece, resulting in curvilinear trends with latitude. Analysis of macroclimatic conditions revealed combined effects of latitude (as a proxy of photoperiod) and macroclimatic conditions on chill coma recovery time. Nonetheless, there was not a deleterious effect on post-recovery survival, except for flies obtained from the northern most point (Vienna, Austria). Overall, it seems that evolutionary patterns of basal chill coma recovery time of C. capitata adults are driven mainly by local climatic variability.