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ECDC - West Nile Virus in Europe and neighbouring countries - Map - 2018 - Updated dec 14

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  • ECDC - West Nile Virus in Europe and neighbouring countries - Map - 2018 - Updated dec 14

    West Nile fever monitoring: First cases reported in EU for 2018 season



    In the past week, the first human cases of West Nile fever have been reported in the EU for the current transmission season.

    Greece reported four cases (three confirmed and one probable case) in Dytiki Attiki in the Attiki Region. Human West Nile fever cases have been previously reported in the Attiki Region between 2012 and 2014.

    In Italy, one confirmed case was reported in Rovigo, an area where human West Nile Fever cases have also been reported in previous years.

    ECDC monitors the occurrence of West Nile fever cases in Europe throughout the transmission season (June ? November). A weekly update with interactive data on the human and equine cases in the EU/EEA and neighbouring countries is made available every Friday through the ECDC Surveillance Atlas.

    The specific aim of these weekly updates is to provide timely information on affected areas to the blood safety authorities in Europe, and thus support them in the application of related EU regulations. According to the EU regulations, EU Member states should defer or test prospective blood donors who have travelled to or reside in areas with West Nile transmission.






    The European Union agency?aimed at strengthening Europe's defences against infectious diseases.
    Last edited by tetano; August 25, 2018, 10:52 AM.
    ?Addressing chronic disease is an issue of human rights ? that must be our call to arms"
    Richard Horton, Editor-in-Chief The Lancet

    ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

  • #2
    Situation update

    Between 29 June and 5 July 2018, four cases of human West Nile fever were reported in the EU.

    Greece reported two confirmed cases in Dytiki Attiki in the Attiki Region and one probable case in Voiotia. No cases have previously been reported in Voiotia.

    Austria reported one confirmed case in Wiener Umland/ Nordteil, a region affected in previous transmission seasons.

    Serbia reported two confirmed human cases in regions that were affected in previous transmission seasons.


    This week Hungary reported the first outbreak among equids in this transmission season in the EU.

    Since the beginning of the 2018 transmission season and as of 5 July 2018, nine human cases have been reported in EU/ EEA Member States by Greece (7), Italy (1) and Austria (1) and two human cases have been reported in neighbouring countries, both by Serbia.

    The European Union agency?aimed at strengthening Europe's defences against infectious diseases.
    Last edited by Gert van der Hoek; July 6, 2018, 12:44 PM.
    ?Addressing chronic disease is an issue of human rights ? that must be our call to arms"
    Richard Horton, Editor-in-Chief The Lancet

    ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

    Comment


    • #3
      Situation update

      Between 6 and 12 July 2018, five cases of human West Nile fever were reported in the EU.

      Greece reported one confirmed case in Thessaloniki and one probable case in Voiotia. Italy reported three confirmed cases, two in Modena and one in Rovigo.


      The human case reported in Austria in the previous week is currently not confirmed and under investigation for further confirmation.

      Serbia reported nine confirmed human cases. All human cases were reported from regions that were affected in previous transmission seasons.

      This week, no outbreaks among equids were reported.

      Since the beginning of the 2018 transmission season and as of 12 July 2018, 13 human cases have been reported in EU/ EEA Member States by Greece (9) and Italy (4). Eleven human cases were reported in neighbouring countries, all by Serbia.

      Hungary reported one outbreak among equids in this transmission season.

      Click image for larger version

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      The European Union agency?aimed at strengthening Europe's defences against infectious diseases.
      ?Addressing chronic disease is an issue of human rights ? that must be our call to arms"
      Richard Horton, Editor-in-Chief The Lancet

      ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

      Comment


      • #4
        Situation update

        Between 13 and 19 July 2018, six cases of human West Nile fever were reported in the EU by Greece (3), Romania (2) and Hungary (1). In neighbouring EU countries, 18 cases were reported by Serbia.

        All human cases were reported from regions that have been affected during previous transmission seasons.

        This week, two outbreaks among equids were reported: one in Greece and another in Italy.

        Since the beginning of the 2018 transmission season, as of 19 July 2018, 19 human cases have been reported in EU/EEA Member States by Greece (12), Italy (4), Romania (2) and Hungary (1). Twenty-nine human cases have been reported in neighbouring EU countries, all by Serbia.

        During the current transmission season, outbreaks among equids have been reported by Greece (1), Hungary (1) and Italy (1).


        Click image for larger version

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        The European Union agency?aimed at strengthening Europe's defences against infectious diseases.
        ?Addressing chronic disease is an issue of human rights ? that must be our call to arms"
        Richard Horton, Editor-in-Chief The Lancet

        ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

        Comment


        • #5
          Situation update

          Between 20 and 26 July 2018, 37 cases of human West Nile fever were reported in the EU/EEA by Italy (20), Greece (10), Hungary (4) and Romania (3). In EU neighbouring countries, 12 cases were reported by Serbia, including three deaths.

          All human cases were reported from regions that have been affected during previous transmission seasons.


          This week, one outbreak among equids was reported in Hungary.

          Since the beginning of the 2018 transmission season, as of 26 July 2018, 56 human cases have been reported in EU/EEA Member States by Greece (22), Italy (24), Romania (5) and Hungary (5). Forty-one human cases have been reported in EU neighbouring countries, all by Serbia, including three deaths.

          During the current transmission season, outbreaks among equids have been reported by Hungary (2), Greece (1) and Italy (1).

          Click image for larger version

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          The European Union agency?aimed at strengthening Europe's defences against infectious diseases.
          ?Addressing chronic disease is an issue of human rights ? that must be our call to arms"
          Richard Horton, Editor-in-Chief The Lancet

          ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

          Comment


          • #6
            Situation update

            Between 27 July and 2 August 2018, 55 human cases of West Nile fever were reported in the EU. Italy reported 27 cases including two deaths, Greece 21 cases, Hungary five cases and Romania two cases. In the EU neighbouring countries, 29 cases (including one death) were reported, all by Serbia. All human cases were reported from regions that have been affected during previous transmission seasons.

            One outbreak among equids was reported in Hungary in the same week.

            Since the beginning of the 2018 transmission season, as of 2 August 2018, 111 human cases have been reported in the EU/EEA Member States. Italy reported 51 cases, including two deaths, Greece 43 cases, Hungary ten cases and Romania seven cases. Seventy human cases, including four deaths, have been reported in the EU neighbouring countries, all by Serbia.

            During the current transmission season, outbreaks among equids have been reported by Hungary (3), Greece (1) and Italy (1).


            The European Union agency?aimed at strengthening Europe's defences against infectious diseases.
            ?Addressing chronic disease is an issue of human rights ? that must be our call to arms"
            Richard Horton, Editor-in-Chief The Lancet

            ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

            Comment


            • #7
              Weekly updates: 2018 West Nile fever transmission season

              Situation update

              Between 17 and 23 August 2018, EU Member States reported 136 human cases of West Nile fever: Italy (59), Greece (31), Romania (25), Hungary (19) and France (2). EU neighbouring countries reported 82 cases: Israel (49) and Serbia (33).
              Human cases were reported for the first time from two areas in Romania and one area in Greece. All other human cases were reported from areas that have been affected during previous transmission seasons.
              This week, 19 deaths were reported by Greece (7), Romania (5), Serbia (4) and Italy (3).
              In the same week, ten outbreaks among equids were reported by Hungary (6), Greece (2) and Italy (2).
              In 2018, as of 23 August 2018, EU Member States reported 410 human cases: Italy (183), Greece (106), Hungary (58), Romania (56), France (5) and Croatia (2). EU neighbouring countries reported 210 human cases: Serbia (159), Israel (49) and Kosovo* (2). To date, a total of 39 deaths due to West Nile fever have been reported by Serbia (15), Greece (11), Italy (6), Romania (6) and Kosovo*(1).
              During the current transmission season, 64 outbreaks among equids have been reported by Italy (41), Hungary (18) and Greece (5).

              https://ecdc.europa.eu/en/west-nile-...ease-data-ecdc

              Comment


              • #8
                Situation update

                Between 24 and 30 August 2018, EU Member States reported 300 human cases of West Nile fever: Italy (144), Romania (61), Greece (41), Hungary (38), Austria (8), France (6), Croatia (1) and Slovenia (1). EU neighbouring countries reported 55 cases: Serbia (54) and Kosovo* (1).

                In six areas, human cases were reported for the first time: Italy (3), Austria (1) and Slovenia (1). All other human cases were reported from areas that have been affected during previous transmission seasons.

                This week, 25 deaths were reported by Romania (6), Serbia (6), Italy (7), Greece (5) and France (1).
                In the same week, 13 outbreaks among equids were reported, all by Hungary.
                According to the Friedrich-Loeffler-Institut (FLI), West Nile virus infection was detected in birds in Germany for the first time. The infection was detected in two dead owls in a bird park in Halle (Saale River), Saxony-Anhalt, Germany.
                In 2018, as of 30 August 2018, EU Member States reported 710 human cases: Italy (327), Greece (147), Romania (117), Hungary (96), France (11), Austria (8), Croatia (3) and Slovenia (1). EU neighbouring countries reported 265 human cases: Serbia (213), Israel (49) and Kosovo* (3). To date, a total of 64 deaths due to West Nile fever have been reported by Serbia (21), Greece (16), Italy (13), Romania (12), France (1) and Kosovo* (1).
                During the current transmission season, 77 outbreaks among equids have been reported by Italy (41), Hungary (31) and Greece (5).
                Click image for larger version

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                The European Union agency?aimed at strengthening Europe's defences against infectious diseases.
                Last edited by Gert van der Hoek; August 31, 2018, 09:21 AM.
                ?Addressing chronic disease is an issue of human rights ? that must be our call to arms"
                Richard Horton, Editor-in-Chief The Lancet

                ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

                Comment


                • #9
                  Situation update

                  Between 31 August and 6 September 2018, EU Member States reported 86 human cases of West Nile fever: Hungary (38), Croatia (22), Greece (19), France (5) and Austria (2). EU neighbouring countries reported 49 cases, all by Serbia.

                  In five areas, human cases were reported for the first time: Croatia (4) and France (1). All other human cases were reported from areas that have been affected during previous transmission seasons.

                  This week, 8 deaths were reported by Serbia (5), Greece (2) and Hungary (1).


                  In the same week, 40 outbreaks among equids were reported by Italy (25), Hungary (11), Greece (3) and Romania (1).


                  In 2018, as of 6 September 2018, EU Member States reported 798 human cases: Italy (327), Greece (168), Romania (117), Hungary (134), Croatia (25), France (16), Austria (10) and Slovenia (1).
                  EU neighbouring countries reported 314 human cases
                  : Serbia (262), Israel (49) and Kosovo* (3). To date, a total of 71 deaths due to West Nile fever have been reported by Serbia (26), Greece (18), Italy (13), Romania (12), Hungary (1) and Kosovo* (1).


                  During the current transmission season, 117 outbreaks among equids have been reported by Italy (66), Hungary (42), Greece (8) and Romania (1).

                  Click image for larger version

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                  The European Union agency?aimed at strengthening Europe's defences against infectious diseases.
                  ?Addressing chronic disease is an issue of human rights ? that must be our call to arms"
                  Richard Horton, Editor-in-Chief The Lancet

                  ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

                  Comment


                  • #10
                    Situation update

                    Between 7 and 13 September 2018, EU Member States reported 150 human West Nile virus infections: Romania (66), Italy (34), Greece (24), Hungary (21), Austria (3) and Bulgaria (2). EU neighbouring countries reported 56 cases: Serbia (24) and Israel (32).

                    In four areas, human cases were reported for the first time: Romania (2), Hungary (1) and Serbia (1). All other human cases were reported from areas that have been affected during previous transmission seasons.


                    This week, 19 deaths were reported by Romania (7), Greece (6), Italy (3) and Serbia (3).

                    In the same week, 46 outbreaks among equids were reported by Italy (26), Hungary (16), France (2), Greece (1) and Romania (1).

                    In 2018, as of 13 September 2018, EU Member States have reported 948 human cases: Italy (361), Greece (192), Romania (183), Hungary (155), Croatia (25), France (16), Austria (13), Bulgaria (2) and Slovenia (1).

                    EU neighbouring countries reported 370 human cases: Serbia (286), Israel (81) and Kosovo* (3). To date, 90 deaths due to West Nile virus infection have been reported by Serbia (29), Italy (21), Greece (19), Romania (19), Hungary (1) and Kosovo* (1).



                    During the current transmission season, 163 outbreaks among equids have been reported by Italy (92), Hungary (58), Greece (9), France (2) and Romania (2).
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                    The European Union agency?aimed at strengthening Europe's defences against infectious diseases.
                    ?Addressing chronic disease is an issue of human rights ? that must be our call to arms"
                    Richard Horton, Editor-in-Chief The Lancet

                    ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

                    Comment


                    • #11
                      Situation update

                      Between 14 and 20 September 2018, EU Member States reported 186 human West Nile virus infections: Italy (92), Greece (32), Romania (33), Hungary (12), Croatia (11), Austria (2), Slovenia (2) and Bulgaria (2). This week, no human cases were reported by EU neighbouring countries.

                      In six areas, human cases were reported for the first time: Croatia (2), Slovenia (2), Italy (1) and Greece (1). All other human cases were reported from areas that have been affected during previous transmission seasons.

                      This week, 25 deaths were reported by Italy (14), Romania (6) and Greece (5).

                      In the same week, 12 outbreaks among equids were reported by Italy (6), Hungary (5) and Austria (1).

                      In 2018, as of 20 September 2018, EU Member States have reported 1 134 human cases: Italy (453), Greece (224), Romania (216), Hungary (167), Croatia (36), France (16), Austria (15), Bulgaria (4) and Slovenia (3). EU neighbouring countries reported 370 human cases: Serbia (286), Israel (81) and Kosovo* (3). To date, 115 deaths due to West Nile virus infection have been reported by Italy (35), Serbia (29), Romania (25), Greece (24), Hungary (1) and Kosovo* (1).

                      During the current transmission season, 175 outbreaks among equids have been reported by Italy (98), Hungary (63), Greece (9), France (2), Romania (2) and Austria (1).

                      In accordance with European Commission Directive 2014/110/EU, prospective blood donors should defer for 28 days after leaving an area with evidence of West Nile virus circulation among humans unless the results of an individual nucleic acid test are negative.
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                      The European Union agency?aimed at strengthening Europe's defences against infectious diseases.
                      ?Addressing chronic disease is an issue of human rights ? that must be our call to arms"
                      Richard Horton, Editor-in-Chief The Lancet

                      ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

                      Comment


                      • #12
                        West Nile fever in Europe in 2018 - human cases; updated 28 September

                        28 Sep 2018
                        Period: 21 Sep 2018 - 27 Sep 2018



                        Between 21 and 27 September 2018, EU Member States reported 132 human West Nile virus infections: Greece (37), Italy (42), Hungary (23), Romania (21), Croatia (8) and Bulgaria (1). The EU neighbouring countries reported 34 cases, all by Serbia.

                        In four areas, human cases were reported for the first time: Croatia (2), Bulgaria (1) and Serbia (1). All other human cases were reported from areas that have been affected during previous transmission seasons.

                        This week, 9 deaths were reported by Romania (5), Greece (2), Bulgaria (1) and Italy (1).

                        In 2018, as of 27 September 2018, EU Member States have reported 1 266 human cases: Italy (495), Greece (261), Romania (237), Hungary (190), Croatia (44), France (16), Austria (15), Bulgaria (5) and Slovenia (3). EU neighbouring countries reported 404 human cases: Serbia (320), Israel (81) and Kosovo* (3). To date, 124 deaths due to West Nile virus infection have been reported by Italy (36), Romania (30), Serbia (29), Greece (26), Bulgaria (1), Hungary (1) and Kosovo* (1).

                        In accordance with European Commission Directive 2014/110/EU, prospective blood donors should defer for 28 days after leaving an area with evidence of West Nile virus circulation among humans unless the results of an individual nucleic acid test are negative.


                        During the current transmission season, 201 outbreaks among equids have been reported by Italy (107), Hungary (78), Greece (10), France (2), Romania (2), Austria (1) and Germany (1).
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                        The European Union agency?aimed at strengthening Europe's defences against infectious diseases.
                        Last edited by Gert van der Hoek; September 28, 2018, 08:45 AM.
                        ?Addressing chronic disease is an issue of human rights ? that must be our call to arms"
                        Richard Horton, Editor-in-Chief The Lancet

                        ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

                        Comment


                        • #13
                          Situation update

                          Between 28 September and 4 October 2018, EU Member States reported 50 human West Nile virus infections in Greece (22), Romania (19), Hungary (7), Bulgaria (1) and the Czech Republic (1). EU neighbouring countries reported 30 cases, all in Serbia.

                          In three areas, human cases were reported for the first time: Bulgaria (1), the Czech Republic (1) and Serbia (1). All other human cases were reported from areas that have been affected during previous transmission seasons.

                          This week, 18 deaths were reported by Greece (8), Romania (6), Serbia (3) and the Czech Republic (1).


                          In the same week, 21 outbreaks among equids were reported by Italy (13), Greece (3), France (3), Hungary (1) and Slovenia (1).

                          In 2018 and as of 4 October 2018, EU Member States have reported 1 317 human cases in Italy (495), Greece (283), Romania (256), Hungary (197), Croatia (45), France (16), Austria (15), Bulgaria (6), Slovenia (3) and the Czech Republic (1).
                          EU neighbouring countries reported 434 human cases in Serbia (350), Israel (81) and Kosovo* (3). To date, 142 deaths due to West Nile virus infection have been reported by Italy (36), Romania (36), Greece (34), Serbia (32), Bulgaria (1), the Czech Republic (1), Hungary (1) and Kosovo* (1).


                          During the current transmission season, 222 outbreaks among equids have been reported by Italy (120), Hungary (79), Greece (13), France (5), Romania (2), Austria (1), Germany (1) and Slovenia (1).

                          In accordance with European Commission Directive 2014/110/EU, prospective blood donors should defer for 28 days after leaving an area with evidence of West Nile virus circulation among humans unless the results of an individual nucleic acid test are negative.

                          Click image for larger version

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                          The European Union agency?aimed at strengthening Europe's defences against infectious diseases.
                          ?Addressing chronic disease is an issue of human rights ? that must be our call to arms"
                          Richard Horton, Editor-in-Chief The Lancet

                          ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

                          Comment


                          • #14
                            Situation update

                            Between 5 and 11 October 2018, EU Member States reported 85 human West Nile virus infections in Italy (41), Romania (12), Greece (11), France (6), Hungary (6), Bulgaria (5), Austria (3) and the Czech Republic (1). EU neighbouring countries reported 48 cases in Israel (29) and Serbia (19).

                            In two areas (NUTS 3 level), human cases were reported for the first time, one new area in France and one in Bulgaria. All other human cases were reported from areas that have been affected during previous transmission seasons.

                            This week, 12 deaths were reported by Italy (7), Romania (2), Serbia (2) and Greece (1).


                            In the same week, 13 outbreaks among equids were reported by Hungary (5), France (3), Italy (2), Germany (1), Greece (1) and Spain (1).

                            In September, a 31-year-old veterinarian was diagnosed with suspected West Nile Virus (WNV) infection after having performed necropsy of a just-deceased owl (great grey owl, Strix nebulosa) found in a wildlife park near Poing, Ebersberg, Bavaria. WNV was detected in the owl by PCR in tissue samples recovered during the necropsy. In the veterinarian, positive serological tests, with IgM antibodies (IF titre 1:80), strongly indicated WNV infection. Further tests of follow-up samples from the patient to confirm the diagnosis are pending.
                            Assessment: WNV infections acquired after occupational exposure by necropsy on birds (blue jay, the USA, 2002), mice (in the USA, 2002) and horses (South Africa, 2008) have been reported in literature, and are not unexpected. It is important to note that in this case, transmission by mosquitoes can be excluded.

                            In 2018 and as of 11 October 2018, EU Member States have reported 1 402 human cases in Italy (536), Greece (294), Romania (268), Hungary (203), Croatia (45), France (22), Austria (18), Bulgaria (11), Slovenia (3) and the Czech Republic (2). EU neighbouring countries reported 482 human cases in Serbia (369), Israel (110) and Kosovo* (3). To date, 154 deaths due to West Nile virus infection have been reported by Italy (43), Romania (38), Greece (35), Serbia (34), Bulgaria (1), the Czech Republic (1), Hungary (1) and Kosovo* (1).

                            During the current transmission season, 235 outbreaks among equids have been reported by Italy (122), Hungary (84), Greece (14), France (8), Romania (2), Germany (2), Austria (1), Spain (1) and Slovenia (1).

                            In accordance with European Commission Directive 2014/110/EU, prospective blood donors should defer for 28 days after leaving an area with evidence of West Nile virus circulation among humans unless the results of an individual nucleic acid test are negative.

                            Click image for larger version

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                            The European Union agency?aimed at strengthening Europe's defences against infectious diseases.
                            ?Addressing chronic disease is an issue of human rights ? that must be our call to arms"
                            Richard Horton, Editor-in-Chief The Lancet

                            ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

                            Comment


                            • #15
                              Situation update

                              Between 5 and 11 October 2018, EU Member States reported 85 human West Nile virus infections in Italy (41), Romania (12), Greece (11), France (6), Hungary (6), Bulgaria (5), Austria (3) and the Czech Republic (1). EU neighbouring countries reported 48 cases in Israel (29) and Serbia (19).

                              In two areas (NUTS 3 level), human cases were reported for the first time, one new area in France and one in Bulgaria. All other human cases were reported from areas that have been affected during previous transmission seasons.

                              This week, 12 deaths were reported by Italy (7), Romania (2), Serbia (2) and Greece (1).

                              In the same week, 13 outbreaks among equids were reported by Hungary (5), France (3), Italy (2), Germany (1), Greece (1) and Spain (1).
                              In September, a 31-year-old veterinarian was diagnosed with suspected West Nile Virus (WNV) infection after having performed necropsy of a just-deceased owl (great grey owl, Strix nebulosa) found in a wildlife park near Poing, Ebersberg, Bavaria. WNV was detected in the owl by PCR in tissue samples recovered during the necropsy. In the veterinarian, positive serological tests, with IgM antibodies (IF titre 1:80), strongly indicated WNV infection. Further tests of follow-up samples from the patient to confirm the diagnosis are pending.
                              Assessment: WNV infections acquired after occupational exposure by necropsy on birds (blue jay, the USA, 2002), mice (in the USA, 2002) and horses (South Africa, 2008) have been reported in literature, and are not unexpected.
                              In 2018 and as of 11 October 2018, EU Member States have reported 1 402 human cases in Italy (536), Greece (294), Romania (268), Hungary (203), Croatia (45), France (22), Austria (18), Bulgaria (11), Slovenia (3) and the Czech Republic (2). EU neighbouring countries reported 482 human cases in Serbia (369), Israel (110) and Kosovo* (3). To date, 154 deaths due to West Nile virus infection have been reported by Italy (43), Romania (38), Greece (35), Serbia (34), Bulgaria (1), the Czech Republic (1), Hungary (1) and Kosovo* (1).
                              During the current transmission season, 235 outbreaks among equids have been reported by Italy (122), Hungary (84), Greece (14), France (8), Romania (2), Germany (2), Austria (1), Spain (1) and Slovenia (1).

                              In accordance with European Commission Directive 2014/110/EU, prospective blood donors should defer for 28 days after leaving an area with evidence of West Nile virus circulation among humans unless the results of an individual nucleic acid test are negative.

                              Click image for larger version

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                              The European Union agency?aimed at strengthening Europe's defences against infectious diseases.
                              ?Addressing chronic disease is an issue of human rights ? that must be our call to arms"
                              Richard Horton, Editor-in-Chief The Lancet

                              ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

                              Comment

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