Paul E. Slater

Effectiveness of a nationwide infant immunization program against Haemophilus influenzae b

An ongoing nationwide prospective surveillance program for invasive H. influenzae b (Hib) disease in Israel enabled us to study the effectiveness of a national infant Hib immunization program, which included all infants born since January 1994. The vaccine used was Hib polysaccharide conjugated to outer membrane protein complex of Neisseria meningitidis b (PRP-OMPC). For the cohort born during the 3 years since January 1994, the vaccine effectiveness was 94.9% for all invasive Hib diseases and 96.6% for meningitis. The efficacy in fully immunized subjects was 98.7 and 99.5%, respectively. A herd immunity effect could be observed, since a reduction in cases also occurred among infants too young to be immunized. No increase in invasive cases caused by S. pneumoniae and N. meningitidis was observed during the study period. This is the first report outside North America and Western Europe that demonstrates a nationwide extensive reduction of invasive Hib disease within a short time of the introduction of Hib conjugate vaccines to the infant immunization program.

Decay of maternally derived measles antibody in a highly vaccinated population in southern Israel

The introduction of live attenuated measles vaccine in Israel during 1967 dramatically decreased the incidence of measles. However, cases still occur in periodic outbreaks and epidemics, with an increasing proportion of infants and children younger than 2 years of age. We examined the decay of maternally derived measles antibody during the first year of life in the Jewish population of Israel which represents a highly vaccinated population with immunization rates exceeding 90%. We used sera of healthy full term infants born in 1988 and 1989. Fifty specimens for each of the following age groups were used: 0 (cord blood), 2, 4, 6, 7 and 12 months. Three assays for each specimen were used: enzyme-linked immunosorbent assay (ELISA); hem-agglutination-inhibition test (HI); and neutralization test (NT). Good correlation among all 3 tests was found. All cord blood specimens were positive by at least 2 assays. Seropositivity rates declined rapidly with age. Fifty percent of all 4-month-old infants and <30% of all 6-month-old infants were positive by 1 test or more; at 12

Measles in a highly vaccinated society: the 2007-08 outbreak in Israel.

BACKGROUND Despite success in controlling measles through a national immunization program, Israel recently experienced its largest measles outbreak since 1994. METHODS Using data reported by health district offices to the Ministry of Health, an epidemiological analysis of the 2007-08 measles outbreak was performed. RESULTS 1467 measles cases were reported in Israel, primarily among ultra-orthodox Jewish communities in the Jerusalem Health District and to a lesser extent in other areas. The highest age-specific incidence rate (122.5 per 100,000) occurred among infants. 38.6% of all measles patients were under the age of five, and 53.4% were under the age of ten. 186 patients (12.7%) were hospitalized; there were no fatalities. Only 4.6% of measles patients had been fully vaccinated for their age. CONCLUSION To minimize the risk of future outbreaks in Israel, successful marketing of the MMR vaccine to under-vaccinated sub-groups is essential.

Does grand multiparity affect fetal outcome

Low birthweight and stillbirth rates of 16,647 Jerusalem deliveries were examined by birth‐order comparing longitudinal to cross‐sectional data. Six hundred fifty‐seven complete sibships of 7 or more were assessed, including 95 sibships from the socio‐economically homogeneous ultraorthodox Jewish community of Mea Shearim. In both cross‐sectional and longitudinal studies grandmultiparas were not at increased risk for low birthweight, but did have a higher frequency of stillbirths.

West Nile fever in Israel: The reemergence of an endemic disease

BACKGROUND As a crossroads for bird migration between Africa and Eurasia and with its long history of human infection, Israel has been a major focus of attention during the continuing global spread of West Nile fever (WNF). This article reviews the background and reemergence of WNF in Israel; the recent epidemiology of WNF among Israelis; and the disease-control strategies being used to combat the disease. METHODS Employing the comprehensive base of case data that are reported to the Ministry of Health, an epidemiological record was constructed that details the incidence and distribution of WNF cases in Israel in recent years. RESULTS After decades of small, intermittent outbreaks, nearly 1400 cases of WNF were reported in Israel between 2000 and 2012. Incidence was consistently highest in the coastal cities, among elderly patients, and in the late summer months and early autumn. A broad range of control measures to prevent human infection has been implemented, and attention has been given to issues such as the protection of the national blood bank and the occurrence of long-term sequelae. CONCLUSIONS The reemergence of WNF in Israel is likely the result of a combination of factors including past immunity to the virus among the human population, a marked increase in awareness of WNF among physicians, and more frequent requests for the laboratory testing of suspected cases. In the absence of effective vaccine to protect humans from WNF, the best disease-control strategies include intensive vector-control measures, the continued development of techniques to forecast outbreaks, and effective public education programs that are targeted toward the high-risk elderly population.

A sero-epidemiological study of herpes virus type 1 and 2 infection in Israel

In order to obtain data on the prevalence and incidence of herpes virus type 2 (HSV(2)) infection in selected populations of women and to identify groups that might benefit from routine prenatal screening, an epidemiological study was conducted during the period 1984-1990, which showed HSV(2) seroprevalence to be 2.8%. Due to the worldwide increase of over 30% of HSV(2) infection in the past two decades, a second study was performed during the period 1 January 1998-31 December 1999. Four different population groups were studied: 172 children aged 6 months to 17 years (group 1), 716 adults, men and women aged 18-95 (group 2), 200 women aged 30-67 who participated in the first survey and were re-examined in 1999 in the second survey (group 3), and a prevalence group of 155 parturient women from six different delivery rooms (group 4). Among the healthy 716 males and females HSV(2) seroprevalence was 4.5%. When analyzed by subgroup, HSV(2) seroprevalence rose from 2.3% in the 18-30 years subgroup to 6.5% in the 30-50 years subgroup and to 7.3% in the 51-70 years subgroup, and then declined to 2.4% after age 70 years. In the 200 women re-examined, HSV(2) seroprevalence was 7.7% with a 0.55% HSV(2) sero incidence per annum. In the prevalence group HSV(2) seroprevalence was 4.5%. Sera from the 1223 participants of all four groups were also screened for HSV(1) infection. HSV(1) antibody was present in 22% of children aged 6 months-1 year, in 60% at 21 years and in 87% at age 70 years. The data support the conclusion that in Israel there is no justification for routine prenatal HSV(2) screening in the healthy female population.

Child-bearing after induced abortion: reassessment of risk.

We reviewed 1791 singleton pregnancies of women with a history of previous induced abortion and compared them with 14,857 pregnancies in mothers with no previous induced abortions. Therapeutic termination of pregnancy was associated with a statistically significant increase in the incidence of low birth weight infants and bleeding in the first trimester of pregnancy. When other variables were examined, no significant differences were found between the two groups, except for a significantly higher rate of stillbirths among women who had not had a prior induced abortion. There were no increases in major or minor congenital malformations.

Resurgence of Cutaneous Leishmaniasis in Israel, 2001–2012

Cutaneous leishmaniasis has long been endemic in Israel. After a 15-year period of moderate illness rates, reported incidence increased from 0.4 cases per 100,000 population in 2001 to 4.4 cases per 100,000 population in 2012, and the disease emerged in areas where its presence had previously been minimal. We analyzed all cases reported to the national surveillance system and found that outbreak patterns revealed an expansion of Leishmania major infections over large areas in the southern part of the country and the occurrence of spatially focused L. tropica outbreaks in the northern part of the country. Outbreaks often followed new construction in populated areas. Further study of factors affecting the transmission of cutaneous leishmaniasis is needed in Israel, as well as the development of effective methods to control the disease, an increase in awareness among health care professionals, and intensive public education regarding control measures in areas of known leishmaniasis foci.

Should the Mobile Intensive Care Unit Respond to Pediatric Emergencies

Between October 1982 and October 1985, the Mobile Intensive Care Unit (MICU) in Jerusalem responded to 625 pediatric emergencies, representing 5% of the total MICU case load. The most common medical problem was seizures, diagnosed in 205 cases (33%). The second most frequent group related to trauma (175 cases; 28%). There were 71 cases (11.4%) of cardiac arrest. Resuscitation was attempted in 37, but there were no long-term survivors. Almost all cardiac arrest patients were found in asystole, and most had antecedent serious medical problems. Compared with the adult population, children were less likely to require or benefit from an advanced level of prehospital care. When resources for advanced care are limited, priority should be given to adult emergencies.

The control of mumps in Israel

Background: Measles–mumps–rubella (MMR) vaccine replaced monovalent measles vaccine in the routine childhood vaccination schedule in Israel in December 1988, primarily to achieve the elimination of the congenital rubella syndrome. In this observational study, we report on changes in reported mumps incidence in Israel from the time of the introduction of MMR vaccine until the end of 1998. Methods: The report is based upon passive national surveillance of mumps incidence, which has been notifiable in Israel since 1977. Results: Reported mumps incidence in Israel is now less than 2% the pre-vaccine incidence. Conclusions: In the decade since the introduction of routine mumps vaccination in 1-year-olds in Israel, mumps control has been achieved. Although small outbreaks occur and may continue to occur in future years, because of undervaccination of children, primary vaccine failure and waning immunity, it can tentatively be said that mumps is no longer a public health problem in Israel.