Omer E. Ankol

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.

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.

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.

Smoking and Other Correlates of Health Care Services Utilization Among Mandatory Military Recruits in Israel

INTRODUCTION Data on utilization of ambulatory care and the impact of lifestyle on health among young adults are scarce. Israeli mandatory military service provides a unique opportunity to investigate these topics. Study objective was to analyze the utilization of health care services (HCS) during the first year of military service, and its associations with health behavior at recruitment, in order to plan health services, health classification, and health promotion activities. METHODS We conducted a retrospective cohort study among a representative sample of 5,751 mandatory new recruits between January 1, 2004, and December 31, 2008. Data were collected from the Israeli Defense Force computerized medical and administrative records and from an ongoing health survey among military recruits. RESULTS During their first year of service, recruits had, on average, more than 7 visits to the primary care clinic, more than 10 dispensed nonchronic medications, and more than 5 days of sick leave. Female sex (OR = 1.27; 1.06-1.51) and current cigarette smoking (OR = 1.57; 1.34-1.84) were significantly associated with increased use of HCS, after controlling for possible confounders. CONCLUSIONS Our findings indicate high utilization of HCS during the first year of military service and highlight the potential effect of cigarette smoking as a risk factor for increased morbidity among apparently healthy young adults. These findings support adding smoking status to fitness assessments and could aid health promotion efforts to reduce smoking rates among adolescents.

Rubella seroprevalence in the first birth cohort reaching fertility age after 20 years of two dose universal vaccination policy in Israel

BACKGROUND A national program of a 2-dose universal childhood MMR vaccination policy has been in effect in Israel since 1988. As the 1988 birth cohort reached fertility age, questions regarding immunity against rubella were raised. OBJECTIVE To assess the seroprevalence of rubella IgG antibodies among young Israeli adults born after 1987 in comparison to previous birth cohorts, in order to determine evidence based policy for prevention of rubella and congenital rubella syndrome. METHODS We conducted a seroprevalence study of rubella IgG antibodies among 416 Israeli adults (42.5% females) born in 1988-1989, based on a representative sample of sera collected at age 18-19 upon recruitment to mandatory military service in 2007. RESULTS In total, 87.7% were seropositive (>15 IU/ml) as compared with 84.8% in the 1999 recruitment (P=0.26) and 93.4% in 1987 (P=0.004). Yet there was a difference by gender. The proportion of seropositives among female young adults (92.7%) was significantly lower as compared to those measured in the 1999 (99.2%, P=0.001) and 1987 (99.0%, P=0.006) recruitments. The proportion of seropositives among males (84.1%) was significantly higher as compared to those measured in 1999 (73.0%, P<0.001) but similar to those of 1987 (88.8%, P=0.13). Females born in the FSU were found to be high risk groups as 11.5% were seronegative. CONCLUSIONS Our findings indicate that despite a successful program of congenital rubella syndrome prevention in Israel, there is a decline in seroprevalence among female young adults, especially immigrants from the FSU. A proactive catch-up program for females, especially for those of higher risk for susceptibility should be considered in Israel and in other countries.

Sub-optimal prevalence of mumps antibodies in a population based study of young adults in Israel after 20 years of two dose universal vaccination policy

BACKGROUND A recent mumps outbreak in Israel despite an ongoing national program of a 2-dose universal childhood vaccination policy since 1988, raised questions regarding population immunity among young adults. OBJECTIVE To assess the seroprevalence of mumps antibodies among young Israeli adults born after 1987 in order to determine evidence based vaccination policy. METHODS We conducted a seroprevalence study of mumps IgG antibodies among 441 Israeli adults born in 1988-9, based on a representative sample of sera collected upon recruitment to mandatory military service in 2007. RESULTS The overall seroprevalence of IgG antibody to mumps virus among 1988-9 born was 83.7%, 82.1% among males and 85.7% among females. Seroprevalence among 2007 recruits was similar to 1999 recruits (83.3%, P=0.89) and significantly lower than 1987 recruits (94.1%, P<0.0001). The absolute decrease between 2007 and 1987 for males was 13.1% (P<0.0001) and for females 7.0% (P=0.02). Seroprevalence was not significantly higher among native Israelis (84.9%) than among young adults born in the Commonwealth of Independent States (81.1%, P=0.46) and significantly higher compared to young adults born in Western Europe or North America (68.2%, P=0.045). CONCLUSIONS Our findings indicate sub-optimal population seroprevalence despite a 2-dose universal childhood vaccination policy. This study allows better understanding of current mumps outbreaks in Israel and elsewhere following periods of low circulation of wild virus. These findings support mumps vaccination, even for populations and individuals that received two doses during childhood, as means for outbreak containment among young adults, especially in crowded settings, and serve as a reminder to the need for dynamic vaccination policy, supported by health promotion activities.

Preventive effect of meningococcal vaccination in Israeli military recruits

BACKGROUND Meningococcal disease remains a major concern in populations living under crowded conditions. Following the 1995 report of several cases of meningococcal disease in Israeli soldiers, the Department of Epidemiology of the Army Health Branch, Israel Defense Forces (IDF) adopted an immunization policy for all recruits. The aim of the study was to summarize the IDF experience to date. METHODS The study population included all compulsory and permanent personnel of both sexes serving in the IDF from 1983 to 2007. Ages ranged from 18 to 55 years, although the majority of subjects was younger than 22 years. Meningococcal disease was defined as the isolation of Neisseria meningitidis from blood or cerebrospinal fluid. RESULTS The person-time incidence rate of vaccine-preventable meningococcal disease dropped from 1.31 cases per 100,000 person-years in 1983-1994, the period preceding the start of immunization, to 0 in 1995-2007 (P < .001). CONCLUSION The meningococcal immunization policy of the IDF led to a dramatic drop in the incidence of vaccine-preventable meningococcal disease.

Seroprevalence of measles, mumps and rubella among young adults, after 20 years of universal 2-dose MMR vaccination in Israel

Evidence-based vaccination policy is important for the global and local efforts of achieving control over measles. In 2007, the first Israeli birth cohort to be twice vaccinated during childhood with Measles-Mumps-Rubella vaccine reached adulthood. In parallel, Israel experienced its largest measles outbreak since 1994. We aimed to assess the seroprevalence of measles IgG antibodies and concordance with rubella and mumps seroprevalence among young Israeli adults born 1988–9 in comparison to previous birth cohorts, in order to inform evidence based prevention policy. We conducted a seroprevalence study of IgG antibodies among 439 Israeli adults born in 1988–9, based on a representative sample of sera collected at age 18–19 upon recruitment to mandatory military service in 2007. In total, 85.7% were seropositive for measles as compared with 95.6% in the 1996 recruitment (P < 0.001). The absolute decline was significant both for males (8.8%, P = 0.001) and females (12.1%, P < 0.001). There were no significant differences in seropositivity by gender, years of education, country of birth or smoking status. Rubella seropositivity among measles seropositives was 90.4%, significantly (P < 0.001) higher than 72.1% among measles seronegatives. Mumps seropositivity among measles seropositives was 87.0%, significantly (P < 0.001) higher than 62.3% among measles seronegatives. Results were similar for Israeli-born only. Our findings indicate that measles seroprevalence decreased after the last change in vaccination policy and reach sub-optimal level. Until global eradication is reached, a proactive vaccination program to supplement routine childhood vaccination program should be considered in Israel and in other countries.

Diminishing gender differences in condom use among a national sample of young israeli men and women between 1993 and 2005.

BACKGROUND Studies related to condom use among young adults consistently point to substantial gender disparities, although the use has generally increased. This study examined trends in condom use between 1993 and 2005 among 13,988 Israelis aged 18-25 years and the associated sociodemographic factors. METHODS An HIV/AIDS Knowledge, Attitudes, and Practice survey was self-administered to dischargees from Israels compulsory military service. Multivariate logistic regression models were used to assess trends in condom use and the association over time of sociodemographic factors and sexual behaviors with consistent condom use. RESULTS During the 13-year period, consistent condom use increased among men (from 35% to 58%) and women (from 17% to 54%), almost eliminating the gender difference. Among both genders, consistent condom use was associated with being single, being older at the time of sexual debut, and being religious, and was inversely associated with age and education; however, gender differences were found in the strength of the associations over time. CONCLUSIONS The excess risk of exposure of young women to lack of condom use has minimized, an unusual situation on international comparison, although population risk for HIV and sexually transmitted infections exists in Israel. Further understanding of factors influencing the decreasing gender differences is required to reorient and tailor HIV/AIDS interventions to most effectively reach young adults of both sexes.

Secular trends of gonorrhea in young adults in Israel: three decades of follow-up

Recent reports of increased rates of gonorrhea initiated an analysis of secular trends of gonorrhea in a young adult population. Gonorrhea is a notifiable disease in the Israel Defense Forces. The diagnosis is based on the typical clinical presentation, relevant epidemiologic data, and positive bacteriological culture. For the present study, the archives of the Epidemiology Department were reviewed for all documented cases of gonorrhea from January 1, 1978 to December 31, 2008, and the annual and seasonal incidence rates were calculated. Annual gonorrhea rates decreased from 2.3 cases per 1,000 soldiers in 1978 to an all-time low of 0.07 cases per 1,000 soldiers in 2008, representing a 97% decline. Multi-year average monthly rates varied from a low of 5.83 cases per 100,000 population in February to a high of 8.97 cases per 100,000 in August. The difference in the person-time incidence (PTI) rates for winter (5.9 cases per 100,000 person-years) and summer (6.8 cases per 100,000 person-years) was statistically significant (p < 0.01). Analyzing the long-term epidemiology of gonorrhea has shown that the infection rate is continuously decreasing and that it appears to be more prevalent in the warmer months.