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Helicobacter species affect humans and animals, mainly causing gastrointestinal but also extra-gastrointestinal pathologies. Besides Helicobacter pylori, which is the main human pathogen, Non-Helicobacter pylori Helicobacters (NHPH) are also associated with human diseases, thus raising concern about their zoonotic potential. Veterinarians are considered a risk group for NHPH infections and act as first-line communicators to animal owners about their prophylaxis. Therefore, we aimed to assess the knowledge and perception of veterinarians working in Greece about Helicobacter pylori and NHPH by asking them to participate anonymously in an online 34-question survey. The questionnaire consisted of three sections regarding environmental exposure to Helicobacter spp.; know-how about clinical signs in various species, including personal human experience; and willingness to get updated information about NHPH. Of the 111 respondents, 41.4% had not heard of H. suis (NHPH), and 35.0% were unaware of the species that could be affected. Almost 60.0% of companion animal veterinarians rarely suspect and 20.0% never suspect Helicobacter spp. infections in the case of gastritis. Nevertheless, 41.0% of respondents considered Helicobacter as zoonotic, and 87.0% wanted to receive information via professional channels and brochures. Despite the limited number of respondents and the exploratory nature of our study, as with similar data from Portugal, we emphasize the need to train veterinarians to have a more targeted focus on the zoonotic potential of Helicobacter within a One Health approach.

In this study, the vaccination coverage, serological sampling and infection rate of sheep and goats were evaluated as predictors for the modeling of human brucellosis in Greece. The human brucellosis disease frequency per local regional unit (RU) varied significantly (RR90) among consecutive years. The notification rate was higher (p < 0.001) in the RUs with implementation of vaccination in sheep and goats (vaccination zone—VZ) with a median of 1.4 (IQR 0.0–3.1) compared with the RUs of the eradication zone (EZ) with a median of 0.0 (IQR 0.0–0.0). In VZ, the increased frequency of human cases was associated with delayed vaccine administration (estimate: 0.14 (0.04; 0.29), p = 0.03) and higher vaccination coverage of the animals (estimate: −0.349 (−0.72; −0.07), p < 0.01). However, the flock sampling rate was highly heterogenous among RUs (IQR 10.56–52.93), and inconsistent within RUs throughout the period of the study 2013–2017 (p = 0.001), limiting the reliable estimation of the infection rate in livestock and the design of an integrated One Health model for human disease.

There are few studies about the presence of murine typhus in Greece. Our objective was to conduct a large scale retrospective investigation to determine the clinical and epidemiological features of patients diagnosed with murine typhus in Greece. From 2012 to 2019 serum samples from hospitalized patients and outpatients throughout Greece suspected for murine typhus infection were tested by immunofluorescence assay for Rickettsia typhi. Immunofluorescence positive samples obtained since 2016 were also tested by qPCR targeting R. typhi. Clinical and epidemiological data were retrospectively collected for the patients with confirmed murine typhus. Overall, we tested 5,365 different patients and, in total, 174 patients from all geographic regions of Greece were diagnosed with murine typhus. The most frequently reported sign or symptom was fever (89%), followed by headache (84%) and rash (81%). The classical triad of fever, headache, and rash was present in 72% of patients during their illness. Severe infections with complications including acute renal failure or septic shock were not recorded. The majority of cases (81%) occurred during May-October and peaked in June and September. Most of patients (81%) infected in Athens, recalled that their only activity the last weeks before symptoms onset was swimming on the beach and 59% of them also reported an insect bite while sunbathing. Our results may reflect the reemergence of murine typhus in Greece and we highlight the importance of awareness of this difficult-to-recognize undifferentiated febrile illness.

The internal microbiome of common cat and dog fleas was studied for DNA evidence of pathogenic bacteria. Fleas were grouped in pools by parasitized animal. DNA was extracted and investigated with 16S metagenomics for medically relevant (MR) bacteria, based on the definitions of the International Statistical Classification of Diseases and Related Health Problems (WHO). The MR bacterial species totaled 40, were found in 60% of flea-pools (N = 100), and included Acinetobacterbaumannii, Bacteroidesfragilis, Clostridiumperfringens, Enterococcusfaecalis, E. mundtii, Fusobacteriumnucleatum, Haemophilusaegyptius, Kingellakingae, Klebsiellapneumoniae, Leptotrichiabuccalis, L. hofstadii, Moraxellalacunata, Pasteurellamultocida, Propionibacteriumacnes, P. propionicum, Proteusmirabilis, Pseudomonasaeruginosa, Rickettsiaaustralis, R. hoogstraalii, Salmonellaenterica, and various Bartonella, Staphylococcus, and Streptococcus species. B. henselae (p = 0.004) and B. clarridgeiae (p = 0.006) occurred more frequently in fleas from cats, whereas Rickettsiahoogstraalii (p = 0.031) and Propionibacteriumacnes (p = 0.029) had a preference in fleas from stray animals. Most of the discovered MR species can form biofilm, and human exposure may theoretically occur through the flea-host interface. The fitness of these pathogenic bacteria to cause infection and the potential role of fleas in the transmission of a broad range of diseases should be further investigated.

Q fever is not considered as a public health problem in Greece where most regions are considered as Coxiella burnetii free possibly because of the low interest for this agent. Our objective was to conduct a large‐scale study to investigate the sero‐epidemiology of C. burnetii in domestic ruminants throughout the most of Greek regions. We tested serum samples obtained from goats, sheep and bovines from different regions of Greece. All sera were tested for C. burnetii IgG antibodies by a commercial ELISA according to the manufacturer's recommendations. We tested 1,173 goats and sheep obtained from 177 different herds and totally 194 (17%) animals from 78 (44%) herds were positive for C. burnetii. Positive animals were present in seven (88%) different regions and seropositivity varied widely among these regions. The highest percentage was observed in Peloponnese (44%), where all the tested herds presented animals with C. burnetii antibodies. Ιn all Aegean Islands except the island of Limnos we detected goats and sheep positive for C. burnetii with seroposivity varying between 2% in Kos to 37% in Rhodes. Finally, in 22 (85%) Greek prefectures we found C. burnetii IgG‐positive animals whereas in 14 (54%) prefectures more than 50% of tested herds had seropositive animals. We also tested 28 cows from five different herds in Macedonia and Aegean Islands and six (21%) of them, obtained from two (40%) herds were positive. Considering the importance of C. burnetii for public health, our data reflect the lack of awareness by veterinarians, physicians and competent authorities as we provide evidence of C. burnetii seropositivity in productive animals throughout the most of Greek territories. Due to the increased risk of inhalation of the bacterium by people who entered the affected farms we raise the question of Q fever emergence in Greece. Q fever is not considered as a public health problem in Greece and few human cases have been recorded possibly because of the low interest for this agent. We conducted a large‐scale study to investigate the sero‐epidemiology of C. burnetii in domestic ruminants and we provide evidence of C. burnetii presence in productive animals throughout the most of Greek regions.

The internal microbiome of common cat and dog fleas was studied for DNA evidence of pathogenic bacteria. Fleas were grouped in pools by parasitized animal. DNA was extracted and investigated with 16S metagenomics for medically relevant (MR) bacteria, based on the definitions of the International Statistical Classification of Diseases and Related Health Problems (WHO). The MR bacterial species totaled 40, were found in 60% of flea-pools (N = 100), and included Acinetobacter baumannii, Bacteroides fragilis, Clostridium perfringens, Enterococcus faecalis, E. mundtii, Fusobacterium nucleatum, Haemophilus aegyptius, Kingella kingae, Klebsiella pneumoniae, Leptotrichia buccalis, L. hofstadii, Moraxella lacunata, Pasteurella multocida, Propionibacterium acnes, P. propionicum, Proteus mirabilis, Pseudomonas aeruginosa, Rickettsia australis, R. hoogstraalii, Salmonella enterica, and various Bartonella, Staphylococcus, and Streptococcus species. B. henselae (p = 0.004) and B. clarridgeiae (p = 0.006) occurred more frequently in fleas from cats, whereas Rickettsia hoogstraalii (p = 0.031) and Propionibacterium acnes (p = 0.029) had a preference in fleas from stray animals. Most of the discovered MR species can form biofilm, and human exposure may theoretically occur through the flea-host interface. The fitness of these pathogenic bacteria to cause infection and the potential role of fleas in the transmission of a broad range of diseases should be further investigated.

Dental and oral health are considered among the main health issues for migrants and refugees, as access to dental health care services is often expensive and difficult. The study investigates dental and oral health determinants among migrants and refugees in 10 European countries (Austria, Bulgaria, Cyprus, France, Germany, Greece, Italy, Malta, Spain, and Sweden), examining how mental health, legal status, discrimination issues and dental services’ use frequency affect dental health. Methods: A cross sectional study using a purpose-made questionnaire was carried out to assess health status and access, with a dedicated section to measure self-perceived dental health, prevalence of caries, last visit to dentist and anticipated access to dental health services. Multivariable logistic regression models were performed to investigate the impact of quality of life, discrimination, immigration status, and other demographic factors on dental health. Results: About half of the sample suffered from poor dental condition and 22% had never visited a dentist. Migrants with higher educational levels had higher odds of having good dental health (OR = 1.08; 95%CI (1.03, 1.12)) and brushing their teeth daily (OR = 1.1; 95%CI (1.04, 1.17)). Higher general and mental health scores were indicative of better dental condition (general health: OR = 1.02; 95%CI (1.01, 1.03); mental health: OR = 1.01; 95%CI (1.004, 1.02)) and higher probability of daily teeth brushing (general health: OR = 1.02; 95%CI (1.01, 1.03); mental health: OR = 1.02; 95%CI (1.01, 1.03)). The possession of any kind of legal immigration permission and not having any children showed similar results. Age and discrimination were correlated with decreased likelihood for good dental conditions. Gender was correlated with daily teeth brushing, as female migrants had higher odds of brushing their teeth daily. Conclusions: Many migrants report poor dental health. Nonetheless, migrants with higher education levels, legal immigration status, better general and mental health, no children, lower sense of discrimination, younger age, and regular dental visits were positively correlated to good dental health (perceived as no dental caries).