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Influenza is associated with an increased risk for serious illness, hospitalization and/or death in pregnant women and young infants. We prospectively studied the effectiveness of a quadrivalent inactivated influenza vaccine (QIV) in pregnant women and their infants during the 2018-2019 influenza season. A QIV was offered to pregnant women cared in a maternity hospital in Athens. Women were contacted weekly by telephone during the influenza season and PCR test was offered to women or infants who developed influenza-like illness (ILI). We studied 423 pregnant women and 446 infants. Unvaccinated pregnant women had a 7.5% probability to develop laboratory-confirmed influenza compared to 2.1% among vaccinated women (Odds ratio: 3.6; confidence intervals: 1.14-11.34, p-value = 0.029). Infants whose mothers were not vaccinated had a 7.9% probability to develop laboratory-confirmed influenza compared to 2.8% among infants of vaccinated mothers (Odds ratio = 2.849, confidence intervals: 0.892-9.102, p-value = 0.053). Cox regression analyses showed that QIV vaccination was significantly associated with a decreased probability for laboratory-confirmed influenza, ILI, healthcare seeking and hospitalization among pregnant women and a decreased probability for laboratory-confirmed influenza, healthcare seeking and prescription of antibiotics among infants. The effectiveness of QIV against laboratory-confirmed influenza was 72% among pregnant women and 64.5% among infants during the 2018-2019 influenza season. Vaccination of pregnant women with the QIV was associated with a lower risk for laboratory-confirmed influenza for them and their infants during the influenza season. Our findings strongly support the World Health Organization recommendations for vaccinating pregnant women against influenza.

Aim Data about susceptibility rates in young adults are scarce. We estimated the complete vaccination rates, timeliness of vaccinations and susceptibility rates among male military recruits in Greece. Methods A standardized form was used to collect data. Immunity against measles, rubella, varicella, hepatitis A and hepatitis B was serologically estimated. Results We studied 385 recruits with a mean age of 23.5 years (range: 18.3–29.9 years). Complete vaccination rates were 94.3% for measles, 100% for rubella, 15% for varicella, 73.9% for hepatitis A and 96.5% for hepatitis B. Only 10.8% of participants were fully vaccinated against all five diseases. Timely vaccination was 47.2% for measles, 89.3% for rubella and 48.1% for hepatitis B. Recruits >23 years had a 1.5-fold increased probability for incomplete vaccinations compared to younger recruits. Laboratory-confirmed immunity rates were 80% against measles, 85.7% against rubella, 85.2% against varicella, 69.4% against hepatitis A and 77.1% against hepatitis B. It is estimated that approximately 388,696 persons aged 18–30 years are susceptible to measles, 277,640 persons to rubella, 287,736 persons to varicella, 595,664 persons to hepatitis A and 444,224 persons to hepatitis B in Greece. Conclusion Our study showed that young adults have significant immunity gaps against measles, rubella, varicella, hepatitis A and hepatitis B. Complete vaccination rates were suboptimal against hepatitis A and varicella. Strategies to access young adults and increase immunity rates through catch-up vaccination services should be investigated. A third dose of MMR vaccine should be considered for young adolescents in Greece.

Background: The fixed combination of extrafine beclometasone dipropionate 100 μg/formoterol 6 μg (extrafine BDP/F) delivered by NEXThaler has proved to be effective in patients with moderate-to-severe asthma in terms of lung function, symptoms and asthma control. The aim of this study was to investigate the usability/satisfaction of NEXThaler and adherence to treatment in asthma patients not well controlled by low-dose inhaled corticosteroids (ICS). Methods: This was a 6-month prospective, multicenter, open-label, observational study in 661 patients with asthma not well controlled by low-dose ICS according to the physician’s clinical assessment, which have received regular treatment with extrafine BDP/F NEXThaler. Feeling of Satisfaction with Inhaler (FSI), treatment adherence with self-reported Morisky scale, asthma control, lung function and QoL were recorded at baseline, 3 and 6 months after treatment with extrafine BDP/F. Results: The percentage of patients at least “fairly” satisfied with NEXThaler usability (FSI-10 score 40 to 50) was 96.3%. The mean FSI-10 total score was 46.8 ± 4.4 on Visit 2 and increased to 48.1 ± 3.3 on Visit 3 (p < 0.001). Approximately 67% of the patients reported “high adherence” on Visit 2, and 70% of them reported “high adherence” on Visit 3. The percentage of patients with ACQ-6-uncontrolled asthma decreased from 79.1% on Visit 1 to 22.3% on Visit 2 and further decreased to 6.7% on Visit 3. Significant improvements were also observed in the total AQLQ score, predicted FEV1% and reduction in rescue medication use. Conclusions: The NEXThaler device, delivering a combination of BDP/F, achieves satisfaction and high adherence in patients with asthma not well controlled with low-dose ICS. Asthma control, QoL, lung function and rescue medication use were improved in a Greek real-world setting.

Influenza vaccination rates of healthcare personnel (HCP) have been largely unsatisfactory in Greece. In September 2016, the Ministry of Health established a Steering Committee in order to raise influenza vaccine uptake by HCP. Hereby, we present the results of the actions undertaken by the Steering Committee during the first 2 years of operation. From the 2015–2016 through the 2017–2018 influenza season, influenza vaccination rates among HCP rose from 10.9 to 24.9% in hospitals, and from 24.3 to 40.2% in primary healthcare centers (increases of 128 and 65%, respectively). Rewards were consistently associated with higher vaccine uptake rates among HCP. The following strategies were also significantly associated with increased vaccination rates: vaccination on-site, vaccination of the heads of the departments and promotion of a culture of safety and ethical duty in the workplace.

Summary Objectives Unemployment in Greece has been increasing as a result of the financial crisis. The aim of this study was to assess the changing trends of business travelers and their pretravel preparation. Study design Prospective, questionnaire-based study. Methods The study was conducted between 2008 and 2016 at all Regional Public Health Departments. All travelers seeking pretravel advice during the study period were invited to participate. Results A total of 12,379 travelers completed the questionnaire, 58% of whom were business travelers. Between 2008 and 2016, the proportion of business travelers increased from 33% to 80.7% and those travelling for recreational purposes decreased from 47.9% to 15.5%. Business travelers sought pretravel advice at a mean of 18.5 days before departure; 89.1% were men with a mean age of 34.4 years. The Middle East was the most common destination (47.8%) followed by Sub-Saharan Africa (28.3%). Most business travelers stayed in urban areas (77.6%) and for ≥ 1 month (68.6%). Yellow fever vaccine was administered to 75% of business travelers. A total of 76.2%, 26.9%, 15.5%, and 13.9% of those visiting Sub-Saharan Africa received yellow fever, typhoid fever, hepatitis A, and meningococcal vaccines, respectively. Malaria prophylaxis vaccine was administered to 26.8% of business travelers; including 46.5% of those traveling to Sub-Saharan Africa and 53.5% to those traveling to the Indian subcontinent. Conclusions There is an increasing trend for business travel from Greece, especially to developing countries. Improving the knowledge of travel health consultants about the risks of business travel and the pretravel preparation of business travelers is crucial.

Background There are few publications focusing on vaccination and malaria chemoprophylaxis in adolescent travelers. We assessed pretravel vaccinations and malaria chemoprophylaxis of adolescents 12-18 years old traveling from Greece to international destinations. Methods We prospectively studied 239 adolescents 12-18 years old during 2008-2016. A standard questionnaire was used to collect data. Results Adolescents sought pretravel services at a mean of 24.1 days before departure. Their main destinations were sub-Saharan Africa (79 adolescents; 33.1%), Latin America (56; 23.5%) and North America (26; 10.9%). Almost half (46.1%) of them planned to stay abroad for at least 3 months. Sixteen (7.4%) adolescents planned to visit friends and relatives. The yellow fever vaccine and the typhoid vaccine were the most frequently administered vaccines (74.1% and 20.5%, respectively), while the hepatitis A vaccine and the tetanus-diphtheria vaccine accounted for most routine vaccinations (18% and 14.2%, respectively). The rabies and the typhoid fever vaccines were administered inadequately to adolescents traveling to endemic areas. Malaria chemoprophylaxis should have been prescribed in many cases traveling to sub-Saharan Africa and the Indian subcontinent. Conclusions Only a small number of adolescents from Greece traveling abroad seek pretravel counseling. We found significant gaps in typhoid fever and rabies vaccinations of adolescents traveling to endemic areas. We also found gaps in prescription of malaria chemoprophylaxis for those traveling to high-risk areas. There is a need to develop communication strategies to access adolescent travelers and improve appropriate vaccination and use of malaria chemoprophylaxis.

Introduction: The number of travellers from Greece who travel to sub-Saharan Africa has increased during the last decade. Our aim in this research was to study vaccination patterns for travellers travelling to sub-Saharan Africa.Methods: A cross-sectional study was conducted from January 2011 until December 2014 in all (57) public health departments in Greece. Travellers over 18 years travelling to sub-Saharan Africa participated in this study. A standard form was used in order to collect data about travellers’ demographics, immunization history and travel information.Results: During the study period, 1768 travellers (median age: 39.2 years) travelling to sub-Saharan Africa participated. Among them, 69.2% of them were male and 95.4% of them had a Greek nationality. Nigeria was their most common destination (15.7%). Among all the travellers, 56.7% stayed in urban areas, 57.9% travelled for less than one month, 58.5% for work, 29% for vacation, and 5.8% for visiting friends and relatives. Furthermore, 79.7%, 30.9%, 19.7%, 16.8%, and 14.1% received the yellow fever, typhoid fever, tetanus-diphtheria, hepatitis A, and meningococcal vaccines, respectively. The purpose of travelling was statistically significantly associated with gender, nationality, and the duration of travel. Tetanus, hepatitis A & B, poliomyelitis, rabies and meningococcal vaccines were more commonly recommended for recreational travel, whereas tetanus, hepatitis A, and poliomyelitis vaccines for short-term travellers and typhoid vaccine for long-term travellers.Conclusion: It can be concluded that vaccination rrecommendations should be improved for the travellers to sub-Saharan Africa. Individualized and more selective pre-travel recommendations are needed taking in consideration the purpose and duration of travel, the area and place of stay.

Pregnant women and young infants are at increased risk for influenza-associated severe disease, complications and hospitalizations. In Greece influenza vaccination during pregnancy remains extremely low. We studied the knowledge about influenza and the adherence to the recommendations for influenza vaccination of pregnant women following an educational intervention in a large maternity hospital. A standardized questionnaire was used. A knowledge score was calculated for each woman. A total of 304 pregnant women were studied [mean age: 31.5 years (standard deviation (SD): 5.4 years), mean gestational age: 27.8 weeks (SD: 9.6 weeks)]. Their mean knowledge score was 87%. Sixty pregnant women (19.5%) were vaccinated against influenza at a mean gestational age of 24.6 weeks (SD: 7.5 weeks). Multiple regression analysis revealed that previous influenza vaccination and information about the need to get vaccinated were the only significant factors associated with an increased probability for influenza vaccination during pregnancy (47% versus 17% in women with and without a history of influenza vaccination in the past, respectively; odds ratio = 3.6; p-value = 0.016, and 32% versus 4% in women informed compared to those uninformed about the need for vaccination during pregnancy, respectively; odds ratio = 17.8; p-value

We studied the rates and characteristics of antibiotics consumption for community-acquired infections in 309 adult patients. Of them, 293 (94.8%) had received at least 1 course of antibiotics during the past year. In total, 419 courses of antibiotics were consumed during the past year, including 285 (68%) following medical examination, 72 (17.2%) following telephone consultation, 30 (7.2%) following suggestion by a pharmacist, and in 16 (3.8%) the antibiotic was available at home. Older age and asthma were significantly associated with a higher risk for antibiotics consumption.

This article presents the results of actions undertaken to increase influenza vaccine uptake by healthcare workers (HCWs) in Greece during the 2016-2017 influenza season. Influenza vaccination among HCWs increased from 10.9% in acute care hospitals and 24.3% in primary healthcare centres in 2015-2016 to 18% in acute care hospitals and 34.6% in primary healthcare centers in 2016-2017. Vaccination on site at the healthcare facility and use of reward systems were significantly associated with increased vaccination rates. Offering vaccinated HCWs one day off work was associated with the greatest increase in influenza vaccine uptake.

Background: Greece is among the European countries with the highest consumption of antibiotics. Objectives: To study the rates and characteristics of consumption of antibiotics in the community by children in Greece. Methods: Questionnaire-based study of parents of hospitalized children. Results: A total of 549 children were studied; 247 (45%) received at least one course of antibiotics the previous year (mean number of antibiotic courses the past year: 1.9), including 427 (91.8%) following examination by a pediatrician, 6 (1.3%) following phone consultation, 2 (0.4%) following suggestion by a pharmacist and 2 (0.4%) as self-medication. Prevalent reasons for antibiotic consumption were acute otitis media (AOM) (27.3%), pharyngotonsillitiss (25.4%), and bronchitis (17.8%). Amoxicillin-clavulanate was the prevalent antibiotic for pharyngotonsillitis, urinary tract infection (UTI) and skin infection (30.5%, 35.7% and 36.4% of cases, respectively), amoxicillin for AOM and pneumonia (32.3% and 36.4% of cases, respectively), and clarithromycin for bronchitis (27.7%). We found 84.3%, 81.9%, 64.3%, 63.7%, and 50% of parents reporting treatment consisted with the national guidelines for AOM, pneumonia, UTI, skin infection, and pharyngotonsillitis, respectively. In the multivariate analysis, an age of 1â5 years and asthma were significantly associated with a higher probability for antibiotic consumption. Conclusions: Antibiotic consumption of children in Greece is mainly driven by pediatricians. Continuing medical education is expected to further improve antibiotic prescription practices by pediatricians. Keywords: Antibiotics, Consumption, Children, Community, Pediatrics

The objective of this study is to investigate antibiotic prescription practices among hospital-based physicians in Greece, using the 2007 national guidelines as the golden standard. A total of 168 physicians participated. Compliance rate with the first-line antibiotic treatment recommended by the national guidelines was 65·5% for acute bacterial sinusitis; 24% for acute uncomplicated cystitis; 36·4% for an acute febrile diarrheic syndrome; 38% for an afebrile adult with chronic obstructive pulmonary disease and non-productive cough of 7 days duration; 23·2% for streptococcal pharyngotonsillitis; 55·1% for a surgically sutured, dirty wound; and 48·2% for community-acquired pneumonia. The total mean rate of compliance with the first recommended antibiotic was 41·2%.

We describe the outbreak of a pan-susceptible Klebsiella pneumoniae strain in a neonatal intensive care unit. A total of 7 neonates developed bacteraemia (37% attack rate), of whom 3 died (43% case fatality rate). A birth weight < 1500 g was the only statistically significant risk factor. Despite an extensive environmental investigation, the source was not identified.

Carbapenem-resistant Gram-negative pathogens (CRPs) are emerging as major causes of nosocomial infections that increase morbidity, mortality and healthcare costs. Little is known about CRP infections in children.All newly detected infections caused by carbapenem-resistant Klebsiella spp, Pseudomonas spp or Acinetabocater spp in hospitalized patients are prospectively reported to the Hellenic Center for Disease Control and Prevention. All children15 years old with a CRP infection reported from November 1, 2010, through March 30, 2012, were included in this study.Between November 2010 and March 2012, 71 CRP infections in 65 children (median age: 1 year) were reported. Underlying conditions existed in 50 (76.9%) children. Cases included pneumonia (25 [35.2%], including 20 ventilator-associated pneumonias), bacteremia (32.4%), urinary tract infection (19.7%) and surgical site infection (12.7%). Isolates were Pseudomonas spp (41.1%), Acinetobacter spp (39.7%) and Klebsiella spp (19.2%). The first positive culture occurred a median of 20 days (range: 0-313 days) after admission. Twenty-four (33.8%) infections occurred in patients with a history of hospitalization the previous 6 months; 42 (59.2%) and 36 (50.7%) infections occurred among patients who had received broad-spectrum antibiotics including carbapenems the previous 6 months, respectively. The crude mortality at 28 days after the first positive CRP culture was 21.1%.Infections caused by CRPs among children are associated with significant morbidity and mortality.

Aim Data about immunisation rates in cystic fibrosis (CF) patients are scarce. We estimated the rates and timeliness of immunisations in CF patients aged 0.55–22 years. Methods We studied 122 subjects at a hospital in Greece in 2014. A standard questionnaire was used to collect data and parents' opinions about immunisations. Results The complete immunisation rates were 92.6% for diphtheria–tetanus–acellular pertussis-inactivated poliomyelitis-Haemophilus influenzae (DTaP-IPV-Hib), 96.7% for hepatitis A, 97.4% for hepatitis B, 97.4% for measles–mumps–rubella, 85.1% for the varicella zoster virus, 85.1% for the meningococcus C conjugate, 84.3% for the pneumococcus conjugate and 58.9% for the bacillus Calmette-Guerin vaccine. Immunisation rates in youths were 64.4% for DTaP-IPV, 26.8% for the tetravalent meningococcus conjugate vaccine and 54.1% for the human papilloma virus vaccine. In addition, 30.1% received the 23-valent pneumococcal polysaccharide vaccine and 45.6% received annual influenza vaccines. Complete, up-to-date immunisation rates fell from 61.4% at 12 months of age to 14.5% at six and 12 years. All vaccines experienced delays. Most parents believed vaccines were necessary to protect their child's health. Conclusion Our study of children with CF found immunisation gaps with no catch-up immunisations and these need to be administered at follow-up visits.

The aim of this study was to describe the children who seek pre-travel advice in Greece. During 2008-2010, 4065 persons sought pre-travel services in the 57 Prefectures, including 128 (3.15%) children15 years. Main travel destinations were sub-Saharan Africa (54 children; 42.2%), South America (18; 14.1%), the Middle East (16; 12.5%), the Indian subcontinent (12; 9.4%), and South East Asia (7; 5.5%). Seventy-six children (59.4%) stayed for1 month, 34 (26.6%) for 1-6 months, and 10 (7.8%) for6 months. Recreation was the main purpose of travel (81 children; 63.3%), followed by work (24; 18.8%), and to visit friends and relatives (VFRs) (14; 10.9%). Paediatric travellers VFRs stayed more frequently in local residences compared to non-VFR paediatric travellers (85.7% and 20.2%). Children stayed more frequently in local residences and travelled more frequently for recreational purposes or to VFRs (27.3%, 63.3%, and 10.9%, respectively), compared to older travellers (11.9%, 58.8%, and 4%, respectively). Malaria chemoprophylaxis was prescribed for 64.8% of children travelling to sub-Saharan Africa. This study demonstrated clearly that only a very small number of international paediatric travellers seek pre-travel services in Greece. Communication strategies to access paediatric travellers should be developed in order to improve travel medicine services for children in Greece.

Please cite this paper as: Maltezou et al. (2012). Extremely low risk for acquisition of a respiratory viral infection in the emergency room of a large pediatric hospital during the winter season. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750-2659.2012.00355.x. The aim of this study was to investigate the rate of transmission of respiratory viral infections to children visiting the emergency room of a large pediatric hospital during winter. A total of 615 children were prospectively studied. Twenty-two (3·6%) children developed at least one symptom compatible with a respiratory viral infection within 1–7 days after the visit, including cough (12 children), fever (8), rhinorrhea (7), and/or respiratory distress (1). Three children (0·49%) developed an influenza-like illness. These findings indicate that transmission of respiratory viral infections to children visiting an emergency room during the winter season is extremely low.

Summary Background We investigated an outbreak of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections that occurred among healthcare workers (HCWs) but not among residents of a long-term care facility (LTCF). Methods Cases of S. aureus infection were sought by reviewing the medical records of residents and HCWs. In order to identify risk factors for the development of an S. aureus infection, an unmatched case–control study was conducted. Cases were all HCWs with a clinically compatible S. aureus infection; controls were HCWs with no history of a clinically compatible S. aureus infection. Cases and controls were interviewed and anterior nasal swabs were collected. Results Over a period of 14 months, a total of eight cases were identified among practice nurses, giving an attack rate of 10% for this category of profession. All isolates were identified as MRSA Panton–Valentine leukocidin (PVL)-producing SCC mec type IV. By multivariate analysis, working in a specific zone and being a practice nurse were found to be statistically significant risk factors for infection. Conclusions The current outbreak indicates that HCWs may serve as vehicles for the entry of PVL-positive MRSA strains from the community into LTCFs, and that deficient hygiene practices and unrecognized carriage may facilitate spread. Given the increasing prevalence of PVL-positive MRSA infections worldwide, guidelines for the eradication of PVL-positive MRSA carriage within closed communities should be established and efforts to obtain cultures from compatible infections should be made.

Background Vaccination of healthcare students is important to protect them from acquiring and transmitting vaccine-preventable diseases (VPDs) to high-risk patients and other healthcare workers (HCWs). The aim of the current study was to estimate the vaccination coverage, the susceptibility against VPDs, the knowledge and attitudes toward vaccinations of healthcare students studying at the Athens Technological Educational Institute. Methods The study was conducted during the academic year 2012–2013 using a standardized questionnaire. Results The mean knowledge score (correct answers) of healthcare students about the vaccines that are recommended by the Greek Ministry of Health for HCWs was 41%. Completed vaccination rates range from 19.6% for varicella to 80.2% for tetanus-diphtheria. A history of measles, mumps, rubella, varicella, hepatitis A, hepatitis B, or pertussis was reported by 8.2%, 4%, 5.4%, 70.4%, 1.5%, 0%, and 3% of students, respectively. Susceptibility rates were 20.5% against measles, 26.4% against mumps, 13.9% against rubella, 15.7% against varicella, 47.8% against hepatitis A, 17.3% against hepatitis B, and 19.8% against tetanus–diphtheria. Mandatory vaccination of HCWs was supported by 145 (96.7%) students. Conclusions There are significant immunity gaps against all VPDs among healthcare students in Athens. A system to easily identify non-immune students should be established in association with efficient reminder systems. Education of healthcare students about VPDs and vaccines will improve their attitudes toward vaccinations and their vaccination coverage. Mandatory vaccinations should be considered for HCWs in order to promote safety within healthcare facilities.

Our aim was to study the antibiotic prescription practices and the knowledge about antibiotic costs, brand and generic drugs of paediatricians working in two hospitals in Greece. The 2007 national guidelines were used as the gold standard for antibiotic prescription. A total of 126 paediatricians participated in the study (50·4% response rate). The mean compliance rate with the guidelines was 50·1% (range per infection: 10·6–84·7%). The mean scores of knowledge about antibiotic costs and about brand name and generic drugs were 35·6 and 60·3%, respectively. Linear regression analysis found a significant association between the mean compliance rate with the national guidelines and the paediatricians’ age (mean compliance rates were 49·1, 53·0, and 43·0% in the ≤ 30, 31–40, and > 40 years age-groups, respectively; P = 0·003). In conclusion, five years after the first national guidelines were issued in Greece only half of the paediatricians working in hospitals comply fully with them.

We conducted a nationwide survey to investigate reasons for influenza vaccine uptake or refusal among health-care workers (HCWs) in Greece. Vaccination rates increased with increasing age, and among HCWs working in Northern Greece, in direct contact with patients, and with influenza vaccination in the past. Self-protection was the main reason for vaccination (89.1%), whereas 55.2% of HCWs reported vaccination to protect patients. Main reasons for refusing vaccination were perception of not being at risk for influenza (43.2%) and fear of vaccine adverse effects (33.4%).

Background. Influenza is associated with an increased risk for serious illness, hospitalization, and mortality in infants aged

Infections due to carbapenem-resistant Klebsiella pneumoniae (CR-KP) have emerged as a public health problem worldwide given their spread dynamics and the limited therapeutic options. Our aim was to study the clinical outcome of patients with CR-KP infections in relation to antimicrobial treatment. CR-KP infections that occurred in a 10-month period (September 2009 to June 2010) in patients admitted to 19 intensive care units all over Greece were studied. A total of 127 CR-KP infections were reported. Central venous catheter bacteraemia was the most frequent infection, followed by ventilator-associated pneumonia (39 (30.7%) and 35 (27.6%) cases, respectively). Resistance to colistin, tigecycline, gentamicin and amikacin was detected in 20%, 33%, 21% and 64% of isolates, respectively. Regarding treatment, 107 cases received active treatment, including 1 or ≥2 active antibiotics in 65 (60.7%) and 42 (39.3%) cases, respectively. The most frequent combination was colistin plus aminoglycoside and tigecycline plus aminoglycoside (17 and 11 cases, respectively). Forty-eight (45.2%) of the cases that received active treatment were considered clinical failures, with 23.5% mortality at 14 days. Logistic regression analysis revealed that age ≤55 years, non-immunocompromised patients and patients who received colistin had higher successful response rates, while patients ≤55 years old had lower mortality rates at 14 days after the introduction of active treatment. CR-KP infections are associated with a significant clinical failure rate. Colistin remains a valuable antimicrobial agent for treating these infections, while the rise of resistance to the last available antibiotics further limits treatment options.

The aim of this questionnaire-based study is to investigate antibiotic prescription practices among primary health care physicians in Greece using the 2007 Hellenic Center for Diseases Control and Prevention guidelines as the gold standard. Seven case scenarios were used. A total of 527 physicians participated. The mean compliance rate with the first recommended antibiotic by the guidelines was 51%, ranging from 22.9% to 71.5% by scenario. Younger physicians and female physicians had higher scores of compliance.

Young infants are at increased risk for influenza-associated serious illness, onset of complications, utilization of health-care services, and hospitalization. We investigated the feasibility and acceptance of an influenza vaccination (cocooning) strategy by household contacts implemented in a maternity hospital and the neonatal unit of a pediatric hospital in Athens. A total of 224 mothers (mean age: 30.2 years) who gave birth to 242 neonates were studied. Of them, 165 (73.7%) mothers were vaccinated. Multiple logistic regression revealed that statistically significant factors associated with increased vaccination rates among mothers were: being of Roma origin (p-value = 0.002), being an immigrant (p-value = 0.025), giving birth to a neonate with birth weight

Please cite this paper as: Maltezou et al. (2012). Extremely low risk for acquisition of a respiratory viral infection in the emergency room of a large pediatric hospital during the winter season. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750‐2659.2012.00355.x. The aim of this study was to investigate the rate of transmission of respiratory viral infections to children visiting the emergency room of a large pediatric hospital during winter. A total of 615 children were prospectively studied. Twenty‐two (3·6%) children developed at least one symptom compatible with a respiratory viral infection within 1–7 days after the visit, including cough (12 children), fever (8), rhinorrhea (7), and/or respiratory distress (1). Three children (0·49%) developed an influenza‐like illness. These findings indicate that transmission of respiratory viral infections to children visiting an emergency room during the winter season is extremely low.

We studied the attitudes with regard to occupational vaccines and vaccination coverage among healthcare workers in pediatric departments. Completed vaccination rates were 33%, 33%, 41.7%, 3%, 5.8%, 69.2% and 36.3% against measles, mumps, rubella, varicella, hepatitis A, hepatitis B and tetanus-diphtheria, respectively. Susceptibility rates were 14.2%, 15.7%, 14.6%, 7.6%, 87.4%, 22.6% and 61.8% for measles, mumps, rubella, varicella, hepatitis A, hepatitis B and tetanus-diphtheria, respectively. Mandatory vaccinations were supported by 70.6% of healthcare workers, with considerable differences by target disease.

Background The aim of this study was to assess the attitudes regarding mandatory occupational vaccinations and the vaccination coverage against vaccine-preventable diseases among health care workers (HCWs) working in primary health care centers in Greece. Methods A standardized questionnaire was distributed to HCWs working in all primary health care centers in Greece (n = 185). Results A total of 2,055 of 5,639 HCWs (36.4% response rate) from 152 primary health care centers participated. The self-reported completed vaccination rates were 23.3% against measles, 23.3% against mumps, 29.8% against rubella, 3% against varicella, 5.8% against hepatitis A, 55.7% against hepatitis B, and 47.3% against tetanus-diphtheria; corresponding susceptibility rates were 17%, 25%, 18.6%, 16.7%, 87.5%, 35%, and 52.6%. Mandatory vaccinations were supported by 65.1% of 1,807 respondents, with wide differences by disease. Multiple logistic regression analysis revealed higher rates of acceptance of mandatory vaccination in physicians compared with other HCW categories. Conclusions Despite the fact that two-thirds of HCWs working in primary health care centers in Greece support mandatory vaccination for HCWs, completed vaccination rates against vaccine-preventable diseases are suboptimal.

To assess the attitudes about mandatory vaccination and vaccination coverage against vaccine-preventable diseases among health-care workers (HCWs) working in tertiary-care hospitals in Greece.A questionnaire was distributed to HCWs working in four tertiary-care hospitals.In total, 505 HCWs participated in the survey. Self-reported completed vaccination rates were 18.8% against measles, 18.8% against mumps, 22.2% against rubella, 1.9% against varicella, 3.6% against hepatitis A, 56.5% against hepatitis B, and 35.7% against tetanus-diphtheria. Younger age groups had higher completed vaccination rates against measles, mumps, rubella, varicella, and hepatitis B compared with older HCWs (p-value 0.001). Self-reported susceptibility rates were 12.7% for measles, 18.9% for mumps, 15.8% for rubella, 15.2% for varicella, 89.9% for hepatitis A, 34.2% for hepatitis B, and 64.3% for tetanus-diphtheria. Sixty three percent of 451 HCWs who answered this question supported mandatory vaccinations for HCWs, with significant differences per target disease. Physicians more frequently supported a mandatory vaccination policy compared to nurses and other professions (72.1% versus 61.9% and 54.2%, respectively; p-value = 0.028).Approximately two thirds of HCWs working in tertiary-care hospitals in Greece support mandatory vaccinations for HCWs, however suboptimal vaccination rates against vaccine-preventable diseases were recorded.

Background This report describes 3 consecutive outbreaks caused by genetically unrelated Serratia marcescens clones that occurred in a neonatal intensive care unit (NICU) over a 35-month period. Methods Carriage testing in neonates and health care workers and environmental investigation were performed. An unmatched case-control study was conducted to identify risk factors for S marcescens isolation. Results During the 35-month period, there were 57 neonates with S marcescens isolation in the NICU, including 37 carriers and 20 infected neonates. The prevalence rate of S marcescens isolation was 12.3% in outbreak 1, 47.4% in outbreak 2, and 42% in outbreak 3. Nine of the 20 infected neonates died (45% case fatality rate). A total of 10 pulsed field gel electrophoresis types were introduced in the NICU in various times; 4 of these types accounted for the 9 fatal cases. During outbreak 3, a type VIII S marcescens strain, the prevalent clinical clone during this period, was detected in the milk kitchen sink drain. Multiple logistic regression revealed that the only statistically significant factor for S marcencens isolation was the administration of total parenteral nutrition. Conclusions Total parenteral nutrition solution might constitute a possible route for the introduction of microorganisms in the NICU. Gaps in infection control should be identified and strict measures implemented to ensure patient safety.