Sophy Goren

The seroepidemiology of Bordetella pertussis in Israel--Estimate of incidence of infection.

This study was undertaken to estimate the magnitude of Bordetella pertussis infections in a highly vaccinated population in Israel in order to evaluate the relationship between clinical notification data and serology-based evidence of infection. A cross-sectional survey was conducted on a total of 1982 serum samples from the National Serum Bank, collected from January 2000 through December 2001, in order to monitor high levels of pertussis toxin (PT) IgG antibody indicative of recent B. pertussis infection, by standardized methods. The estimation yielded an infection incidence rate of 2448 per 100,000 population (> or =3 years of age) for the year 2000 compared to an annual incidence of reported pertussis of 5.6 per 100,000 for the same period. The peaks of estimated incidence of infection were found in the groups of 15-19-year olds (5245 per 100,000) and older than 60 years (6469 per 100,000), whereas the majority of clinical pertussis cases were reported for the 10-14-year olds (20.5 per 100,000). The findings clearly show that despite a high vaccination coverage rate (>93%), there is still a considerable circulation of B. pertussis, particularly in adolescents and elderly. Population-based serosurveillance for pertussis offers the potential to assist interpretation of trends independent of notification and diagnostic bias.

Effectiveness of rotavirus vaccines for prevention of rotavirus gastroenteritis-associated hospitalizations in Israel: a case-control study.

The association between rotavirus gastroenteritis (RVGE)-associated hospitalization and rotavirus vaccine receipt was examined, and vaccine effectiveness was estimated in a case-control study conducted between 11/2007 and 12/2009 among Israeli children age eligible for rotavirus vaccination. Cases (n=111) were hospitalized children with diarrhea testing positive for rotavirus by immunochromatography. Controls (n=216) were hospitalized children with diarrhea testing negative for rotavirus. Among controls 36 (16.7%) children were vaccinated against rotavirus compared with two children (1.8%) among cases (p

Incidence, Characteristics, and Economic Burden of Rotavirus Gastroenteritis Associated with Hospitalization of Israeli Children <5 Years of Age, 2007–2008

BACKGROUND Limited data exist on the epidemiology and burden of rotavirus gastroenteritis in Israel. Objectives. Our objective was to examine the incidence, characteristics, and economic burden of rotavirus gastroenteritis associated with hospitalization of children <5 years of age in Israel. METHODS A prospective study was initiated in pediatric wards at 3 hospitals in northern Israel. Presence of rotavirus in stool specimens was detected by immunochromatography, and G and P genotypes were determined by reverse-transcriptase polymerase chain reaction. Demographic data, clinical manifestations, and expenditures related to a childs illness were studied using parental interviews. RESULTS From November 2007 through October 2008, 472 children hospitalized with gastroenteritis were enrolled in the study. Rotavirus gastroenteritis was diagnosed in 39.1% of children, with a peak identification rate during November 2007-January 2008 (62.5%-71.0%). Most cases of rotavirus gastroenteritis (87.2%) occurred in children <2 years of age. In infections with 1 rotavirus genotype, G1P[8] was the most frequently detected (49.1%), followed by G1P[4] (11.1%) and G9P[8] (9.3%). Mixed rotavirus isolates were identified in 28.9% of the children. The estimated incidence of primary hospitalizations for rotavirus gastroenteritis among children aged 0-5 years was 5.7 hospitalizations per 1000 children per year (95% confidence interval, 5.1-6.3 hospitalizations per 1000 children per year), resulting in an estimate of 4099 annual national hospitalizations (95% confidence interval, 3668-4531 hospitalizations per year). This figure represents approximately 6.5% of the total annual hospitalizations among Israeli children <5 years of age. The annual calculated cost of hospitalizations for rotavirus gastroenteritis was US

The uptake of rotavirus vaccine and its effectiveness in preventing acute gastroenteritis in the community.

7,680,444, including US

Incidence, Age of Acquisition and Risk Factors of Helicobacter pylori Infection among Israeli Arab Infants

4,578,489 (59.6%) in direct costs to the health care system and US

Recent trends in the epidemiology of shigellosis in Israel

3,101,955 in overall household costs. CONCLUSIONS Our findings are important for decision making regarding implementation and evaluation of a routine immunization program against rotavirus gastroenteritis.

Interaction Among Ethnicity, Socioeconomic Status, and Helicobacter pylori Seroprevalence in Israeli Children and Adolescents

We examined the uptake of rotavirus vaccine and its effectiveness in preventing acute gastroenteritis (AGE) in the community. Data on rotavirus vaccines purchases and AGE were extracted from the computerized database of a large health maintenance organization in Israel. The incidence of AGE requiring a physician visit during 2008-09 rotavirus season among vaccinated and non-vaccinated children were compared, and vaccine effectiveness was calculated as: (1-Relative Risk)×100. During the study period, the uptake of rotavirus vaccine (mostly monovalent) reached 55.1% (N=19,108) of the studied cohort. The risk of AGE requiring a physician visit was 23.2% and 46.4% among vaccinated and unvaccinated children, respectively, yielding an effectiveness of 50.1% (95% CI: 47.5%, 52.6%). Rotavirus monovalent vaccine was highly effective in preventing AGE in the community.

Helicobacter pylori Infection in Early Childhood and Growth at School Age.

We examined the age of acquisition of Helicobacter pylori infection in a prospective study that was conducted among 231 Israeli Arab children. Helicobacter pylori was identified in stool specimens collected at ages 2, 4, 6, 8, 12 and 18 months, using a monoclonal stool antigen immunoassay. Information on household characteristics, breastfeeding, antibiotic use and hygiene practices was obtained. The incidence of H. pylori infection was 33.3%. The estimated mean age of H. pylori infection acquisition was 14 months. The determinants of H. pylori infection were living in a low socioeconomic status (SES) village: OR 9.60 (95% CI 2.91-31.68, p < 0.001); low paternal education: OR 3.35 (95% CI 1.21-9.29, p = 0.02); and boiling feeding bottles and nipples at low frequency: OR 7.12 (95% CI 1.82-27.86, p = 0.005). In conclusion, H. pylori infection is acquired at a higher rate in low SES settings. Parental education and hygiene play an important role in H. pylori acquisition in infancy.

INCIDENCE AND CHARACTERISTICS OF SPORADIC NOROVIRUS GASTROENTERITIS ASSOCIATED WITH HOSPITALIZATION OF CHILDREN LESS THAN 5 YEARS OF AGE IN ISRAEL

We provide an update on the epidemiology of shigellosis in Israel using data generated by a sentinel laboratory-based surveillance network for the period 1998-2012. The average annual incidence of culture-proven shigellosis was 97/100 000. We estimated that each case of shigellosis accounted for 25 cases in the community indicating the high burden of disease. Orthodox Jewish communities, living in highly crowded conditions and with a high number of children aged <5 years were the epicentre of country-wide biennial propagated epidemics of S. sonnei shigellosis. S. flexneri was the leading Shigella serogroup in Israeli Arabs. S. flexneri 2a and S. flexneri 6 alternated as the most common serotypes. Both S. sonnei and S. flexneri isolates showed high rates of resistance to ampicillin and trimethoprim/sulfamethoxazole and very low rates of resistance to quinolones and third-generation cephalosporins. Shigellosis due to S. sonnei conferred 81% (95% confidence interval 69-89) protection against the homologous Shigella serotype when epidemic exposure re-occurred 2 years later. These data are of value in the process of Shigella vaccine development.

A significant and consistent reduction in rotavirus gastroenteritis hospitalization of children under 5 years of age, following the introduction of universal rotavirus immunization in Israel.

Objectives: The aim of the study was to examine the prevalence of Helicobacter pylori infection among Israeli children from different backgrounds and to assess potential interactions between ethnicity, socioeconomic status (SES), and H pylori seroprevalence. Patients and Methods: The present sero-epidemiologic study was conducted among 0- to 20-year-old children seeking medical attention, not specifically gastrointestinal symptoms, using sera collected between 2000 and 2001 from 575 Israeli Arab children, 584 Jewish children from the general population, and sera that were obtained between 1997 and 2007 from 464 children of an ultraorthodox Jewish community. An enzyme-linked immunosorbent assay was used to measure H pylori serum immunoglobulin G antibodies and seropositivity to H pylori CagA strains. Results: H pylori seropositivity was 22.9% (95% confidence interval [CI] 19.7–26.5) among Jewish children from the general population, 25.2% (95% CI 21.5–29.4) among ultraorthodox Jewish children, and 45.6% (95% CI 41.5–49.7) among Arab children. H pylori seroprevalence increased significantly with age in the 3 study groups, but it was consistently higher in Arab children. Compared with Jewish participants from high SES and controlling for age and sex, the odds ratio for H pylori seropositivity was 2.03 (95% CI 1.31–3.12) in Jewish children from intermediate SES, 2.42 (95% CI 1.29–4.53) in Arab children from intermediate SES, 2.26 (95% CI 1.52–3.36) in Jewish children from low SES, and 5.72 (95% CI 3.89–8.42) in Arab children from low SES. CagA seropositivity was 40.8% and 45.0% among Jewish and Arab children, respectively (P = 0.59), and it was highest among subjects of lower SES. Conclusions: Socioeconomic factors may not totally explain the ethnic differences in H pylori prevalence.