Daily Newspaper View of Dengue Fever Epidemic, Athens, Greece, 1927–1931

Christos Louis

Author affiliation: Foundation for Research and Technology–Hellas, Heraklion, Greece; and University of Crete, Heraklion

Abstract

During the late summers of 1927 and 1928, a biphasic dengue epidemic affected the Athens, Greece, metropolitan area; >90% of the population became sick, and >1,000 persons (1,553 in the entire country) died. This epidemic was the most recent and most serious dengue fever epidemic in Europe. Review of all articles published by one of the most influential Greek daily newspapers (I Kathimerini) during the epidemic and the years that followed it did not shed light on the controversy about whether the high number of deaths resulted from dengue hemorrhagic fever after sequential infections with dengue virus types 1 and 2 or to a particularly virulent type 1 virus. Nevertheless, study of the old reports is crucial considering the relatively recent introduction of Aedes albopictus mosquitoes and the frequent warnings of a possible reemergence of dengue fever in Europe.

The dengue fever (DF) epidemic of 1927–1928 in Greece, which first affected the Athens area, was the most recent dengue epidemic in Europe. Transmitted by Aedes aegypti mosquitoes, the epidemic probably involved dengue virus type 1 (DENV-1) and type 2 (DENV-2) (1–4). The rapid economic and social development of the continent has since led to dramatically reduced habitats of the vector and, most likely, to its elimination and is the main reason the likelihood of a similar event is small. Yet, the recent invasion of Europe by Ae. albopictus mosquitoes (5) and the marked ecology of this mosquito make emergence of a new DF epidemic possible, even if the impact of such an event is not expected to be of the same dimension as the epidemic described here.

Greece in 1927 lagged behind other countries in development. For example, most roads in Athens were unpaved; electric service was intermittent; a citywide sewage system was nonexistent; and the potable water supply was rudimentary, often forcing residents to store water in containers. Moreover, the population of the metropolitan Athens area, like the remainder of the country, had increased markedly because of the exchange of populations between Turkey and Greece after the war between the 2 countries and the defeat of Greece in 1922 (6). The Hellenic National Statistical Agency reported the arrival to Greece of ≈1 million refugees, leading to a 23.68% increase of the population during 1920–1928. In the Athens metropolitan area, the increase was ≈68%, and most of the newcomers were destitute and lived in extremely poor housing conditions (7).

In addition to these problems, the country was deeply divided politically into royalists and liberals, a division initiated early in 1915 by the rift between King Konstantin I and Prime Minister E. Venizelos about whether Greece should enter World War I. This division, exacerbated by the defeat of Greece in the Asia Minor campaign of 1921–1922, contributed to the lack of political solutions for the country’s major problems (8).
During this period of hardship, the DF epidemic struck Greece. The epidemic was then often called the dengue pandemic because almost the entire population of Athens (population ≈600,000) was affected. On the basis of the current definition of pandemic, the term epidemic is used here to describe the events of the summers of 1927 and 1928.

By focusing exclusively on all 561 items published in 1 daily newspaper during the epidemic, this review compares reports from 83 years ago with today’s knowledge. I chose the fully digitized archives of the Athens newspaper Η Καθημερινή (I Kathimerini) (9). This newspaper was, and still is, one of the major newspapers in Greece (currently first in daily circulation). During the time of the DF epidemic, the newspaper held a steady antiliberal and proroyalist position at a time when the liberal party ruled Greece. This position is often indicated in commentaries about the government’s handling of the epidemic, which will only briefly be mentioned here. Unless specifically referenced, all sources of original statements listed below (translated into English and appearing in quotes) are based on the pieces published by I Kathimerini.