Rita Dichtiar

Long-term Death Rates, West Nile Virus Epidemic, Israel, 2000

We studied the 2-year death rate of 246 adults discharged from hospital after experiencing acute West Nile Virus infection in Israel during 2000. The age- and sex-adjusted death rates were significantly higher than in the general population. This excess was greater for men. Significant adverse prognostic factors were age, male sex, diabetes mellitus, and dementia.

Trends in the incidence of type 1 diabetes among Jews and Arabs in Israel

To assess the trends in the incidence of type 1 diabetes between 1997 and 2010 among 0–17‐yr‐old Israeli Jews and Arabs compared with global trends.

Breast cancer trends in Israeli Jewish and Arab women, 1996-2007.

Breast cancer is the most common malignancy in Israeli Jewish and Arab women. The main objective of this study was to reexamine the trends in breast cancer incidence, mortality, and survival in Israel in 1996 through 2007, as well as the use of mammography. Data were obtained from the Israel National Cancer Registry, the Central Bureau of Statistics, and National Health Surveys. Incidence and mortality rates per 100 000 are age adjusted to the world standard population. Time trends are presented using the joinpoint regression analysis. The relative survival was calculated for the diagnosis years 1996–2003. Data on mammography performance were obtained from the Knowledge, Attitudes and Practices surveys carried out in 2002–2008. From 1996 through 2007, the incidence of in-situ breast cancer increased in both subpopulations whereas the incidence of invasive breast cancer decreased by 3% for Jewish women and increased by 98% for Arab women (P value for ‘between-populations’ differences <0.001). Reports on having had a mammogram in the last 2 years increased by 16% in Jewish women and by 17% in Arab women in 2002 through 2008 (P=0.880). Breast cancer mortality rates decreased significantly from 24.7 in 1996 to 19.0 in 2007 in Jewish women, but remained stable in Arab women (P=0.041). The 5-year relative survival increased in both subpopulations (P=0.420). The incidence of breast cancer has been stable in Jewish women, but had been increasing rapidly in Arab women throughout 1996–2007. The differences indicate an epidemiologic transition in the Arab minority in Israel. Efforts should focus not only on secondary but also on primary prevention strategies.

Significant cross reactive antibodies to influenza virus in adults and children during a period of marked antigenic drift.

BackgroundLittle is known about the development of cross-reactive antibodies following natural exposure to pathogens. Such knowledge is critical in the development of new universal influenza vaccines.MethodsTo study the possibility of the presence of cross-reactive antibodies to influenza viruses which underwent a major antigenic drift between the years 1999 and 2007 sera from samples of 80 children and 400 adults were selected at random from the Israeli national serum bank. The sera was obtained in 2002 and in 2007, two time points that followed a major drift in the infectious H3N2 influenza virus strain (A/Panama/2007/99 to A/Wisconsin/67/2005).ResultsIn the summer of 2002, 13% of the children had Hemagglutination Inhibition (HI) antibody titers of at least 40 and these antibodies recognized both A/Panama/2007/99 and A/Wisconsin/67/2005, where the latter strain only began to circulate in Israel in 2006. In 2007, 29% of the children had HI antibody titers of at least 40 directed against both A/Wisconsin/67/2005 and A/Panama/2007/99, even though they had never been exposed to the latter virus. Anti-A/Panama/2007/99 antibodies were detected in 58% and 68% of the 2002 and 2007 adult samples, respectively, while 8% and 39% had antibodies against A/Wisconsin/67/2005, respectively.ConclusionsThe presence of naturally occurring cross-reactive influenza virus antibodies in a significant percentage of children has important implications for the development of a universal influenza vaccine.

Lack of severe long-term outcomes of acute, subclinical B1 deficiency in 216 children in Israel exposed in early infancy

Background:A vitamin B1-deficient soy-based infant formula was marketed in Israel in 2003, exposing infants to clinical or subclinical B1 deficiency. We investigated whether subclinical B1 deficiency in early infancy had medical, neurodevelopmental, or cognitive effects at 3–5 y of age.Methods:A historical prospective cohort study was conducted consisting of four groups: “exposed,” consuming a B1-deficient soy-based formula exclusively for four consecutive weeks or longer; “control,” consuming no soy-based formula; “mixed,” consuming the formula nonexclusively or exclusively for less than four consecutive weeks; and “other,” consuming soy-based formulas other than Remedia. Participants were evaluated by medical examination, Stanford–Binet (SB) intelligence test, sensory profile evaluation, and Conners scales (attention deficit disorder/attention deficit and hyperactivity disorder (ADD/ADHD)).Results:Following adjustment for gender, age, and maternal education, there were no significant differences among the four groups on the mean SB scores, on the verbal and nonverbal scores, or in the proportion of children in each group with scores <90. A significantly higher proportion of exposed children as compared with control children had an impaired sensory profile and scores on the Conners scales (ADD/ADHD), but these proportions were also high in the “other” and “mixed” groups.Conclusion:The results do not support an association between subclinical B1 deficiency in infancy and long-term development.

The dynamics of infection and the persistence of immunity to A(H1N1)pdm09 virus in Israel

Influenza virus A(H1N1)pdm09 first appeared in Israel in late April 2009, disappeared in mid‐March 2010, and reappeared in late October 2010. Symptoms were mostly mild without need for medical care.

Renal cell cancer in Israel: Sex and ethnic differences in incidence and mortality, 1980–2004

BACKGROUND The causes of renal cell cancer (RCC) remain largely unexplained. While the incidence is generally higher in men than in women, little has been reported on ethnic differences. We examine trends in RCC incidence and mortality rates among Israeli Arab and Jewish populations and compared with the rates in other countries. METHODS Age-adjusted RCC incidence and mortality rates in Israel, during 1980-2004, were calculated by sex and population group, using the National Cancer Registry. They were compared with the United States based on the Surveillance Epidemiology and End Results [SEER] program and the IARC database for international comparisons. RESULTS While RCC incidence rates in Israel are similar to the United States and the European average, the rates are significantly higher among Israeli Jews than Arabs. Men are affected more than women. Incidence rates over the last 24 years have increased among all men and Jewish women, but not among Arab women. Among men, the incidence rate ratio for Jews to Arabs declined from 3.96 in 1980-1982 to 2.34 in 2001-2004, whereas for women there was no change. The mortality rates were higher among Jews than Arab and among men than women. There were no significant change in the mortality rates and rate ratios. CONCLUSIONS Our findings demonstrate marked ethnic differences in RCC in Israel. The lower incidence among Arabs stands in contrast to the higher prevalence of potential risk factors for RCC in this population group. Genetic factors, diet and other lifestyle factors could play protective roles.

Prehypertension among 2.19 million adolescents and future risk for end-stage renal disease

Objective: Persistent hypertension in adulthood is a leading cause of end-stage renal disease (ESRD). Whether lower blood pressure (BP) values, in the range of prehypertension, are also associated with future occurrence of ESRD is unclear. Even less clear is the potential risk of early prehypertension appearing in adolescence. To address this question, we examined whether BP measurements in the prehypertensive range at age 16–19 years predict adult ESRD. Methods: Medical data on 2194 635 16–19-year-old adolescents examined for medical fitness prior to military service from 1977 to 2013 were linked to the Israeli ESRD registry in this nationwide population-based cohort study. Incident cases of ESRD were recorded. Survival models were applied. Results: During 35 007 506 person-years of follow-up (median follow-up 16.8 years), there were 690 ESRD cases, with an overall incidence rate of 1.97 cases per 100 000 person-years. Examinees with elevated BP readings in the prehypertensive range (BP between the 90th and 95th percentiles or between 120 and 139/80–89 mmHg) had increased incidence of ESRD with a hazard ratio of 1.32 (95% confidence interval, 1.11–1.58) adjusted for year of birth, age at examination, sex, BMI, education, socioeconomic status, and country of origin. Hypertension (BP above the 95th percentile or above 140/90 mmHg) was associated with a hazard ratio of 1.44 (95% confidence interval, 1.17–1.79). A spline model demonstrated a nadir of risk at SBP values as low as 94 mmHg. Conclusion: Asymptomatic, healthy adolescents with prehypertension have a 32% increased risk for subsequent ESRD, compared with adolescents with optimal BP.

Return of pandemic H1N1 influenza virus

BackgroundInfluenza pandemics are usually caused by the re-assortment of several influenza viruses, results in the emergence of new influenza virus strains that can infect the entire population. These pandemic strains, as well as seasonal influenza viruses, are subjected to extensive antigenic change that has, so far, prevented the generation of a universal vaccine.MethodsSamples of patients hospitalized due to infection with the pandemic H1N1 influenza virus (A(H1N1)pdm09) from 2009, when the virus first appeared, until 2013 were analyzed.ResultsWhile many patients were hospitalized in 2009 due to infection with the pandemic H1N1 influenza virus, only small percentages of patients were hospitalized later in 2010–2012. Surprisingly, however in 2012–2013, we noticed that the percentages of patients hospitalized due to the pandemic H1N1 influenza infection increased significantly. Moreover, the ages of hospitalized patients differed throughout this entire period (2009–2013) and pregnant women were especially vulnerable to the infection.ConclusionsHigh percentages of patients (especially pregnant women) were hospitalized in 2013 due to the A(H1N1)pdm09 infection, which may have been enabled by an antigenic drift from those which circulated at the onset of the pandemic.

Mortality and cancer incidence among patients treated with recombinant growth hormone during childhood in Israel

The inconclusive evidence regarding long‐term safety of recombinant human growth hormone (rhGH) therapy underlines the need for long‐term large‐scale cohorts.