Waterborne outbreak in a rural area in Greece during the COVID-19 pandemic: contribution of community pharmacies
Introduction: On 15 June 2020, the National Public Health Organization was informed about the identification of two cases of Escherichia coli Ο157 infection in a small town in the Peloponnese Region in Greece and we suspected an outbreak. Methods: We asked the local pharmacist to...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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James Cook University
2021-07-01
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| Series: | Rural and Remote Health |
| Subjects: | |
| Online Access: | https://www.rrh.org.au/journal/article/6630/ |
| _version_ | 1818901670512295936 |
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| author | Kassiani Mellou Theologia Sideroglou Chrysovalanti Kefaloudi Kyriaki Tryfinopoulou Anthi Chrysostomou Georgia Mandilara Maria Pavlaki Helena Maltezou |
| author_facet | Kassiani Mellou Theologia Sideroglou Chrysovalanti Kefaloudi Kyriaki Tryfinopoulou Anthi Chrysostomou Georgia Mandilara Maria Pavlaki Helena Maltezou |
| author_sort | Kassiani Mellou |
| collection | DOAJ |
| description | Introduction: On 15 June 2020, the National Public Health Organization was informed about the identification of two cases of Escherichia coli Ο157 infection in a small town in the Peloponnese Region in Greece and we suspected an outbreak.
Methods: We asked the local pharmacist to assist us to verify the outbreak by providing the daily number of over-the-counter anti-diarrheal drugs sold from 20 May 2020 onwards. The pharmacist asked customers with gastroenteritis to submit stool samples at the local hospital. Samples were tested for 22 pathogens. We conducted a 1 : 1 case-control study. Cases and controls were retrieved from the pharmacy client list. Chlorination records of the water supply system were retrieved, and water samples were tested for microbiological indicators and viruses.
Results: The increased number of sales of anti-diarrheal drugs verified the outbreak. Overall, 58 cases and 57 controls were recruited for the study. Tap water consumption (odds ratio (OR)=10.9, 95% confidence interval (CI)=3.1-38.0, p<0.001) and consumption of ice cubes made from tap water (OR=39.3, 95%CI=10.3-150.9, p<0.001) were independently associated with gastroenteritis occurrence. Eleven stool samples were tested; one was positive for shigatoxin-producing E. coli, one for enteropathogenic E. coli, four for E. coli O157 and one for Salmonella spp. Four samples tested negative. Five water samples collected on 18 June tested negative. The residual chlorine on 5 and 14 June ranged from 0.12 mg/L to 0.14 mg/L.
Conclusion: This was the first investigation of a waterborne outbreak in Greece performed with the collaboration of a local pharmacy. The COVID-19 pandemic favored the use of alternative resources and channels of communication with the local population, which can also be used in the future, especially in remote areas of the country. |
| first_indexed | 2024-12-19T20:23:27Z |
| format | Article |
| id | doaj.art-2de8aaf0b96f43ff98dbaeffbd823a2f |
| institution | Directory Open Access Journal |
| issn | 1445-6354 |
| language | English |
| last_indexed | 2024-12-19T20:23:27Z |
| publishDate | 2021-07-01 |
| publisher | James Cook University |
| record_format | Article |
| series | Rural and Remote Health |
| spelling | doaj.art-2de8aaf0b96f43ff98dbaeffbd823a2f2022-12-21T20:06:54ZengJames Cook UniversityRural and Remote Health1445-63542021-07-012110.22605/RRH6630Waterborne outbreak in a rural area in Greece during the COVID-19 pandemic: contribution of community pharmaciesKassiani Mellou0Theologia Sideroglou1Chrysovalanti Kefaloudi2Kyriaki Tryfinopoulou3Anthi Chrysostomou4Georgia Mandilara5Maria Pavlaki6Helena Maltezou7Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization, 3-5 Agrafon Street, Athens 15123, GreeceDirectorate of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization, 3-5 Agrafon Street, Athens 15123, GreeceDirectorate of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization, 3-5 Agrafon Street, Athens 15123, Greece; and European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Gustav III Boulevard 40, Solna 16973, Stockholm, SwedenCentral Public Health Laboratory, 34 A. Fleming Street, Vari, GreeceDirectorate of Epidemiological Surveillance and Intervention for Infectious Diseases, National Public Health Organization, 3-5 Agrafon Street, Athens 15123, GreeceNational Reference Laboratory for Salmonella-Shigella, Department of Public Health Policy, School of Public Health, University of West Attica, 196 Alexandras Ave, Athens 111521, GreeceInfectious Diseases Unit, Health Care Unit of Argos, General Hospital of Argolida, 191 Korinthou Ave, 21200 Argos, Argolida, GreeceDirectorate of Research, Studies and Documentation, National Public Health Organization, 3-5 Agrafon St, Athens 15123, GreeceIntroduction: On 15 June 2020, the National Public Health Organization was informed about the identification of two cases of Escherichia coli &Omicron;157 infection in a small town in the Peloponnese Region in Greece and we suspected an outbreak. Methods: We asked the local pharmacist to assist us to verify the outbreak by providing the daily number of over-the-counter anti-diarrheal drugs sold from 20 May 2020 onwards. The pharmacist asked customers with gastroenteritis to submit stool samples at the local hospital. Samples were tested for 22 pathogens. We conducted a 1 : 1 case-control study. Cases and controls were retrieved from the pharmacy client list. Chlorination records of the water supply system were retrieved, and water samples were tested for microbiological indicators and viruses. Results: The increased number of sales of anti-diarrheal drugs verified the outbreak. Overall, 58 cases and 57 controls were recruited for the study. Tap water consumption (odds ratio (OR)=10.9, 95% confidence interval (CI)=3.1-38.0, p<0.001) and consumption of ice cubes made from tap water (OR=39.3, 95%CI=10.3-150.9, p<0.001) were independently associated with gastroenteritis occurrence. Eleven stool samples were tested; one was positive for shigatoxin-producing E. coli, one for enteropathogenic E. coli, four for E. coli O157 and one for Salmonella spp. Four samples tested negative. Five water samples collected on 18 June tested negative. The residual chlorine on 5 and 14 June ranged from 0.12 mg/L to 0.14 mg/L. Conclusion: This was the first investigation of a waterborne outbreak in Greece performed with the collaboration of a local pharmacy. The COVID-19 pandemic favored the use of alternative resources and channels of communication with the local population, which can also be used in the future, especially in remote areas of the country.https://www.rrh.org.au/journal/article/6630/case-control studycommunity pharmaciesCOVID-19Greeceover-the-counter anti-diarrheal drugswaterborne outbreak. |
| spellingShingle | Kassiani Mellou Theologia Sideroglou Chrysovalanti Kefaloudi Kyriaki Tryfinopoulou Anthi Chrysostomou Georgia Mandilara Maria Pavlaki Helena Maltezou Waterborne outbreak in a rural area in Greece during the COVID-19 pandemic: contribution of community pharmacies Rural and Remote Health case-control study community pharmacies COVID-19 Greece over-the-counter anti-diarrheal drugs waterborne outbreak. |
| title | Waterborne outbreak in a rural area in Greece during the COVID-19 pandemic: contribution of community pharmacies |
| title_full | Waterborne outbreak in a rural area in Greece during the COVID-19 pandemic: contribution of community pharmacies |
| title_fullStr | Waterborne outbreak in a rural area in Greece during the COVID-19 pandemic: contribution of community pharmacies |
| title_full_unstemmed | Waterborne outbreak in a rural area in Greece during the COVID-19 pandemic: contribution of community pharmacies |
| title_short | Waterborne outbreak in a rural area in Greece during the COVID-19 pandemic: contribution of community pharmacies |
| title_sort | waterborne outbreak in a rural area in greece during the covid 19 pandemic contribution of community pharmacies |
| topic | case-control study community pharmacies COVID-19 Greece over-the-counter anti-diarrheal drugs waterborne outbreak. |
| url | https://www.rrh.org.au/journal/article/6630/ |
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