Chen Stein-Zamir

Figuring out food labels. Young adults' understanding of nutritional information presented on food labels is inadequate.

Nutritional labelling of packaged foods, mandated by law, includes details of the food content and composition - information that can affect individual and public lifestyle decisions and health status. We studied the comprehension of food labels among 120 young adults (mean age 24.1 years) attending an international travel immunization clinic. Each participant was presented with 10 food packages of common local products and was interviewed regarding the labels content. Most subjects (77.5%) reported that they took note of the food labels; women, the more educated and those engaging regularly in physical exercise were more inclined to do so. Out of a possible 10 points the overall median comprehension score was 6.0 (mean 5.7±1.8). The nutritional table section of the food label was understood the best, and the nutritional declaration section the least. The subjects thought they understood the food labels better than they actually did; 43.9% stated that they understood them very well, whereas only 27.2% achieved high scores. This inadequate comprehension of food labels represents a missed opportunity to provide essential information necessary for healthy food choices at the individual level. A combination of strategies is necessary, including improving food labels (simplification and standardization) combined with targeted educational programs.

The clinical features and long-term sequelae of invasive meningococcal disease in children.

We evaluated the outcome of invasive meningococcal disease in children <15 years of age (n = 181). Neisseria meningitidis serogroup B comprised 78% of bacterial isolates. Case fatality rate was 11.6%. In follow-up interviews (115/160 survivors, 72%), at least 1 long-term sequela was reported in 38/115 children (33%), including learning-academic difficulties (22.6%), hearing impairment (7%), neurologic (12.2%), behavioral (14.8%) and motor (10.4%) deficits.

Ecoepidemiology of cutaneous leishmaniasis outbreak, Israel.

A total of 161 cases of cutaneous leishmaniasis caused by Leishmania tropica occurred in the Jerusalem district during 2004–2005; 127 (79%) cases were in a town just outside Jerusalem. Environmental models suggest that in the context of global warming, this outbreak has the potential to extend into Jerusalem.

Epidemiological and Microbiological Characteristics of an Outbreak Caused by OXA-48-Producing Enterobacteriaceae in a Neonatal Intensive Care Unit in Jerusalem, Israel

ABSTRACT This study describes the course of an OXA-48-producing Enterobacteriaceae (OPE) outbreak that started in March 2012 in a neonatal intensive care unit (NICU) in Jerusalem, Israel. During the peak of the outbreak (January to August 2012), there were 49 patients who had proven or suspected acquisition of OPE in the NICU, including 16 with invasive infections, out of a total of 156 patients who were hospitalized during that period. Three children hospitalized in the pediatric ICU were identified as carriers of OPE. Three patients with a previous stay in the affected NICU were identified as OPE carriers upon admission to another hospital. The Ministry of Health was notified and then intervened in July 2012. Intervention included cohorting colonized patients, conducting frequent rectal-culture surveillance, and improving the implementation of infection control practices. As a result, the incidence of OPE acquisition declined to 5 cases in the first 4 months, followed by no new cases in the next 3 months. Thirty-one patient-unique isolates were available for analysis: 29 Klebsiella pneumoniae isolates, all belonging to a single clone (sequence type 39 [ST39]), and 2 isolates from Enterobacter cloacae. All isolates possessed the bla OXA-48 and bla CTX-M-14 genes, which are located on the same plasmid. This plasmid, similar to the global bla OXA-48-harboring vector, has now acquired bla CTX-M-14, leading to resistance to all β-lactam agents.

Comparison of two hearing screening programs in the same population: Oto-acoustic emissions (OAE) screening in newborns and behavioral screening when infants

OBJECTIVE Hearing screening programs in infancy should identify hearing impairment as early as possible. The two common programs utilize either objective neonatal tests (oto-acoustic emissions (OAE) or automatic auditory brainstem responses (aABR)) or behavioral screening at 7-9 months of age. Most countries employ only one of these options. The uniqueness of this study is the comparison of both hearing screening programs on the same group of children. METHODS The study was conducted on 1545 children born between the years 1999 and 2003 who were followed up in public well baby clinics in the Jerusalem district. The children were tested with transient oto-acoustic emissions (TEOAE) before discharge from the neonatal ward, and later, at the age of 7-9 months, underwent a behavioral hearing screening test in a public well baby clinic. The results of both hearing screening programs were compared. RESULTS The compliance rates were 99.7% for the neonatal testing and 83% for the 7-9 months behavioral testing (p=0.0001). The failure rate was 4-6% in both screening programs; failure of OAE testing was unilateral in 65% of newborns; at 7-9 months bilateral failure was more common (56%). There was an 11.2% disagreement (kappa coefficient 0.03) between the outcomes of both tests. In another group of 49 known hearing-impaired children, 27 who had undergone newborn screening were diagnosed before the age of behavioral testing. Twelve children had failed either both tests or the only test they underwent. In nine cases, the children had passed one of the hearing screening tests and had failed the other, and one child had passed both tests. CONCLUSIONS Newborn hearing screening has the advantages of objectivity, early identification, and higher compliance. The major advantage of the later behavioral test is identification of later onset or progressive hearing impairment as well as auditory neuropathy spectrum disorder. Each screening test is testing different entities; hence they are complementary and not interchangeable or superfluous. We recommend a comprehensive two-step hearing screening plan (newborn and later behavioral) with close cooperation between the health care providers involved.

The impact of additional pertussis vaccine doses on disease incidence in children and infants.

BACKGROUND Pertussis remains a cause of considerable morbidity in children worldwide. Due to the resurgence of the disease, two vaccine doses for schoolchildren were added to the routine Israeli schedule. In 2005 a 5th dose was introduced for second-graders (aged 7-8), and in 2008 an additional catch-up dose in the eighth grade (13-14 year-olds). METHODS Population-based epidemiologic study of pertussis in the Jerusalem district. RESULTS 1736 pertussis cases were reported from 1990 to 2009. The pertussis incidence rates increased sharply from 2.6/100,000 in 1990, to 10/100,000 in 2000, peaking at 28.8/100,000 in 2006, then declining to 22/100,000 in 2008 and to 15.7 in 2009 (2006 vs. 2009, p=0.0001). Most cases (74.4%, 1134/1524 during 1998-2009) were under 20 years. Infants under one year had the highest average incidence rate (72.3/100,000; 12.5% of cases); specifically those under 6 months (84.3% of cases under one year). The case distribution among 1-4, 5-9, 10-14, and 15-19 year-olds was: 11%, 18%, 24.1%, and 8.9%. The vaccination status (age-appropriate) was: unvaccinated--19.2%, partially vaccinated--7.6%, and fully vaccinated--73.2%. The overall hospitalization rate was 5.4%; infants--33.5%. Household transmission occurred in 16.1% of cases. The two age groups showing significant decline were children aged 5-9 (61.5% reduction) and 10-14 years (73.9% reduction); there is as yet no significant decline in other age groups. CONCLUSIONS The recent marked decline in pertussis incidence among the 5-14 year-olds is encouraging. Young infants still constitute a significant disease burden, and the incidence in this age group should be followed closely.

Public Health Nurses Promoting Healthy Lifestyles (PHeeL-PHiNe): methodology and feasibility.

Mother and Child Health Clinics have provided preventive health services in Israel for nearly a century. The Public Health Nurses Promote Healthy Lifestyles Program was developed to assist families in adopting healthy behaviors. The program ran in the Jerusalem District from 2009 to 2011. After piloting, 175 public health nurses received training and interventions took place in 45 clinics serving parents of 167 213 infant and toddlers per year. When evaluation is completed, our hope is to incorporate the program into Mother and Child Health Clinic services regularly provided nationwide, thereby becoming an integral part of the initiative, Healthy Israel 2020.

Ongoing mumps outbreak in Israel, January to August 2017

In Israel, 262 mumps cases were registered between 1 January and 28 August 2017 despite a vaccine coverage of ≥ 96%. The majority (56.5%) of cases were adolescents and young adults between 10 and 24 years of age. Nearly twice as many cases were reported in males than in females. Sequence information identified genotype G and suggested specific transmission chains in different religious communities, with the Muslim population in Jerusalem being most severely affected.

Age-appropriate versus up-to-date coverage of routine childhood vaccinations among young children in Israel

ABSTRACT Background and aims: Routine childhood vaccinations schedules recommend that children receive the vaccine doses at specific ages. Vaccination coverage data are conventionally reported by the up-to-date method. We aimed to assess vaccination timeliness by the age-appropriate method and compare with the up-to-date vaccination coverage. Methods: Assessment of age-appropriate and up-to-date vaccination coverage among children born in Israel in 2009 and followed to age 48 months (national representative sample, n = 3892). The vaccinations included: Hepatitis B vaccine (HBV), Diphtheria-Tetanus-acellular Pertussis-Polio-Haemophilus-influenzae-b (DTaP-IPV-Hib), Pneumococcal conjugate vaccine (PCV), Measles-mumps-rubella-varicella vaccine (MMR/MMRV) and Hepatitis A vaccine (HAV). The categories defined: age-appropriate (at the recommended age and up to 1 month), delayed less than 6 months, delayed 6 months and above and unvaccinated (48 months). Results: The age-specific vaccinations assessment showed considerable delay in receipt of routine vaccination. While most (96%, 95%, 91%, 96%, 94% and 86%) children were vaccinated up-to-date for HBV3, DTaP-IPV-Hib4, PCV3, MMR/MMRV1, HAV1and HAV2 vaccine doses; only 26%, 29%, 47%, 64%, 55% and 12% were vaccinated age-appropriate. Vaccination delay was more common in vaccines with multiple doses. Vaccination delay was associated with high childs birth order, low socio-economic rank, ethnicity (delay more common in Jews vs. Arabs), season of birth (winter) and delayed receipt of DTaP-IPV-Hib vaccine 1st dose. Conclusions: This study assessed age-appropriate childhood vaccination coverage in a national cohort of children. While the overall vaccination coverage stands in line with the WHO goals, vaccination timeliness and equity are inadequate and targeted public health intervention programs aimed at vaccination timeliness are necessary.

Invasive meningococcal disease epidemiology and characterization of Neisseria meningitidis serogroups, sequence types, and clones; implication for use of meningococcal vaccines

ABSTRACT Background and aims: Neisseria meningitidis (N. meningitidis) is a Gram-negative bacterium that can cause life-threatening invasive infections referred to as invasive meningococcal disease (IMD). In the last decade the incidence of IMD in Israel is about 1/100,000 population annually. We aimed to describe the epidemiology of IMD in Israel combining epidemiological data and characterization of N. meningitidis isolates. Methods: Invasive infection caused by N. meningitidis is a notifiable disease in Israel. Data were collected by epidemiological investigations and control measures were employed. Laboratory work-up included serogrouping, N. meningitides molecular characterization and whole-genome sequencing. Results: During 1998–2017, 1349 cases of IMD were notified in Israel (mean annual incidence rate 0.94/100,000). The peak incidence rates were observed in infants under 1 year of age (10.9/100,000). Case fatality rate was 9.7%. The majority of the N. meningitidis isolates were of serogroup B (67.9%). During 2007–2017, three clonal complexes (CC) 32, 41/44 and 23 (hyper-invasive clonal complexes) were the leading CC (61%). CC32 was the leading CC causing meningococcemia and mortality. In 2017, 35 isolates were tested for 4CMenB antigens variants; of the serogroup B isolates tested 46.7% showed a match to one or more antigens (fHbp or PorA:VR1), most were ST32 (CC32). Conclusions: Preliminary analysis based on limited number of samples suggests that the 4CMenB coverage would be about half the strains; further research is necessary. Integration of clinical, epidemiological and laboratory data is essential to support decision-making on the introduction of the novel MENB vaccines in Israel.