Nadav Davidovitch

Influenza Outbreak Control in Confined Settings

Early reporting, on-site laboratory testing, and rapid mass vaccination may limit influenza outbreaks in confined settings.

A Cluster of Ecthyma Outbreaks Caused by a Single Clone of Invasive and Highly Infective Streptococcus pyogenes

BACKGROUND Ecthyma is an invasive, ulcerated skin infection. Four ecthyma outbreaks occurred in different infantry units in the Israeli Defense Force from October 2004 through February 2005. Morbidity attack rates in the first 3 outbreaks were 89% (49 of 55 soldiers), 73% (32 of 44), and 82% (37 of 45). In the fourth outbreak, in which early intervention (antimicrobial treatment and improvement of hygiene) was applied, the attack rate was 25% (10 of 40 soldiers). In the first outbreak cluster, 4 soldiers experienced poststreptococcal glomerulonephritis, and 5 cases of systemic sequelae were recorded (1 case of severe septic shock, 3 cases of pneumonia, and 1 case of septic olecranon bursitis). METHODS Streptococcus pyogenes and Staphylococcus aureus were isolated from ecthyma sores, oropharynx, and anterior nares of affected and unaffected soldiers involved in all 4 outbreaks. RESULTS Although the S. aureus isolates had different genomic profiles, >90% of S. pyogenes isolates were identified as belonging to a single clone, emm type 81, T type 8. Epidemiological investigation revealed that the hygiene levels of the soldiers and their living conditions were probably the most important cause for the difference in attack rates, wound severity, and systemic sequelae found between and within the units. CONCLUSIONS Our study demonstrates the possible ramifications of the combination of a virulent and highly infective S. pyogenes strain and poor living conditions, and it emphasizes the importance of early intervention in such conditions.

Seasonality trends of scabies in a young adult population: a 20-year follow-up

Summary Background Scabies is not a notifiable disease in most countries. Therefore, its seasonality trends are usually estimated and may be inaccurate.

Iodine and hypothyroidism in neonates with congenital heart disease

AIM To evaluate the influence of the intravenous injection of iodine during cardiac catheterisation, and of topical iodine antiseptics during surgical procedures, on thyroid function in full term neonates. METHODS Twenty one full term infants with major cardiac anomalies who survived for more than a month were studied. Thyroxine and thyrotropin concentrations were measured (by radioimmunoassay) before each procedure, 24 hours after the procedure, and every week thereafter until the age of 1 month or until normal. Thyroxine values less than 64.4 nmol/l were considered low, while thyrotropin values greater than 30 mU/l were considered high. RESULTS Thyroid function tests before iodine exposure were within normal limits in all infants. Following catheterisation or surgery six infants had raised thyrotropin concentrations; three had low thyroxine concentrations. Two of those infants were treated with L-thyroxine. CONCLUSION Iodine exposure during cardiac catheterisation or surgery may induce transient hypothyroidism in term infants.

Seasonality trends of Pediculosis capitis and Phthirus pubis in a young adult population: follow-up of 20 years

Background It is not mandatory to report Pediculosis capitis and Phthirus pubis in most countries; therefore, little is known about the seasonality of these infestations.

Longitudinal measurements of 17alpha-hydroxyprogesterone in premature infants during the first three months of life.

AIMS To determine normal concentrations of 17α-hydroxyprogesterone (17OHP) for premature infants. METHODS 17OHP was measured in 66 consecutive premature infants once a week during the first month, and once every two weeks thereafter, until the age of 3 months. The 17OHP values in 100 full term healthy neonates on the third day of life served as controls. Blood was sampled on filter paper using a neonatal radioimmunoassay kit. Findings were correlated with gestational age, birthweight, mode of delivery, Apgar scores, presence of respiratory distress syndrome and intake of maternal steroids. RESULTS Mean 17OHP was raised at 7 days of age (138.9, 46.3, 53.3, 29.9 nmol/l, respectively, for infants whose gestational age was under 29 weeks, 29 to 30 weeks, 31 to 32 weeks, and 33 weeks and above). It fell sharply in the first two weeks after which it gradually decreased further, reaching 32.7, 23.6, 16.9, and 13.0 nmol/l, respectively, by the age of 90 days. The mean (SEM) 17OHP concentration in full term infants on day 3 of life was 17.8 (8.9) nmol/l. These values were independent of the presence and severity of respiratory distress syndrome and of prenatal maternal steroids. CONCLUSIONS The increased 17OHP concentrations found at birth fell to those found in term infants during the first three months of life in infants over 31 weeks of gestation. Postconceptional age is the most important factor determining 17OHP concentration.

Tickborne relapsing fever in Israel.

We evaluated the epidemiology of relapsing fever from 1971 to 2003 in Israel. In civilians, incidence declined from 0.35 to 0.11 cases per 100,000 persons annually; in military personnel it averaged 6.4 cases per 100,000 persons annually. These data imply that the pathogen and vector continue to exist in Israel.

Seroepidemiology of Epstein-Barr virus and cytomegalovirus among Israeli male young adults.

PURPOSE To assess the seroprevalence and seroconversion of Epstein-Barr virus (EBV) and cytomegalovirus (CMV) Immunoglobulin G (IgG) antibodies and identify associated socioeconomic and smoking variables among male young adults in Israel, to explore health disparities and aid prevention efforts. METHODS A population-based seroprevalence study of EBV and CMV IgG antibodies in a systematic sample of Israeli males upon recruitment to mandatory military service during 1994-2004. Associations between socioeconomic and smoking variables and the seroprevalence of EBV/CMV were evaluated, controlling for possible confounders. A subset of seronegative subjects was assessed for seroconversion upon discharge from military service. RESULTS Overall seroprevalence rates were 87% for EBV and 59% for CMV. An association between the seroprevalence of EBV and CMV was observed. Seroconversion was 56% for EBV as compared with 31% for CMV. Lower paternal education was found to be associated with both EBV and CMV seroprevalence. Lower socioeconomic status, North African origin, and urban residence were found to be associated with CMV seropositivity, as was smoking for EBV seropositivity. CONCLUSIONS Socioeconomic disparities exist in the seroprevalence rates of CMV and EBV among Israeli male young adults. The results of the study could aid public health efforts and determine target populations when a vaccine becomes available.

Preventing mumps outbreaks in confined settings: comprehensive ring vaccination as a containment strategy.

Even among vaccinated cohorts, prevention and control of mumps outbreaks remain a challenge, owing to sub-optimal population immunity. This is especially true in confined settings, where a single case could be the index for an imminent outbreak. Efficacy of post-exposure prophylaxis has not been demonstrated, while early identification of mumps and comprehensive vaccination of populations in confined settings during outbreaks may enable containment of mumps and disrupt further spread. However, we are not aware of official international guidelines concerning vaccination of exposed individuals during an outbreak, especially in a confined setting. In this article we present our experience with mumps containment during outbreaks through vaccination campaigns in the Israeli civilian and military populations and discuss lessons for containment efforts in other settings. Our analysis shows that a comprehensive ring vaccination should be considered in any case of mumps in confined settings.

Integration of health and environment through health impact assessment: Cases from three continents

Despite the strong linkage between environment and health, institutions responsible for these fields operate in largely fragmented ways with limited interaction. As illustrated in the recent engagement between health and urban planning institutions, inter-institutional cooperation could support more effective and politically acceptable solutions for both local and global problems. Analysis of three case-studies, from three different continents, shows that HIA might serve to promote synergies among health and environmental disciplines in different local contexts, and could lead to institutional and procedural changes that promote health. Case examples provided supportive evidence for these effects, despite differences in approaches to HIA and governance levels. Obstacles to the use of HIA for inter-institutional integration also differed between countries. Lessons learned could support cooperation in other common interests of health and environment disciplines such as research, training and preparedness, and mitigation of public health emergencies related to the environment.