Five more Greek municipalities recorded West Nile virus exposure in the past week, bringing the national total to 45 affected areas, including 29 in Attica, according to a report from Greece’s national public health organization, EODY.

The newly affected municipalities are Dionysos, Petroupoli and Kallithea in Attica, Alexandria in Imathia, and Thiva in Sterea Ellada. Nine additional municipalities, though free of human cases, were classified high-risk due to proximity to affected areas, geography, and mosquito and animal surveillance data.

Officials noted high-risk areas have quickly become affected areas before. Most infected people show no symptoms; studies suggest roughly 140 asymptomatic or mildly symptomatic infections occur for every case involving the central nervous system. Common symptoms include fever, headache, muscle and joint pain, fatigue, rash, nausea, vomiting or diarrhea.

People over 50, the immunocompromised and those with underlying conditions face the highest risk of severe illness.