Emilia Anis

Response to and monitoring of viral outbreaks can be efficiently focused when rapid, quantitative, kinetic information provides the location and the number of infected individuals. Environmental surveillance traditionally provides information on location of populations with contagious, infected individuals since infectious poliovirus is excreted whether infections are asymptomatic or symptomatic. Here, we describe development of rapid (1 week turnaround time, TAT), quantitative RT-PCR of poliovirus RNA extracted directly from concentrated environmental surveillance samples to infer the number of infected individuals excreting poliovirus. The quantitation method was validated using data from vaccination with bivalent oral polio vaccine (bOPV). The method was then applied to infer the weekly number of excreters in a large, sustained, asymptomatic outbreak of wild type 1 poliovirus in Israel (2013) in a population where >90% of the individuals received three doses of inactivated polio vaccine (IPV). Evidence-based intervention strategies were based on the short TAT for direct quantitative detection. Furthermore, a TAT shorter than the duration of poliovirus excretion allowed resampling of infected individuals. Finally, the method documented absence of infections after successful intervention of the asymptomatic outbreak. The methodologies described here can be applied to outbreaks of other excreted viruses such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), where there are (1) significant numbers of asymptomatic infections; (2) long incubation times during which infectious virus is excreted; and (3) limited resources, facilities, and manpower that restrict the number of individuals who can be tested and re-tested.

Pertussis is the only vaccine-preventable disease that has re-emerged in Israel. In the last two decades, despite high primary immunization coverage, crude incidence increased over tenfold, with...

There is on ongoing debate in the literature regarding the real burden of STIs (sexually transmitted infections) in Western countries and the proper strategies needed to estimate and to prevent them. Our purpose is to present an evidence-based national strategic plan for STI prevention in Israel through assessing the current burden of illness, leading international preventive strategies, and practical policymaking experience. Epidemiologic and health policy data on STIs were analyzed from various sources: a) systematic national surveillance data for the years 2002–2014; b) the international scientific literature (published between 2002–16; keywords: Sexually Transmitted Diseases (STD) (or STI) AND prevention AND intervention AND gonorrhea OR chlamydia OR syphilis; c) internal Ministry of Health (MOH) analyses and reports, and d) expert opinion. Incidence rates in Israel of Chlamydia trachomatis (chlamydia), Neisseria gonorrhea (gonorrhea) and Treponema pallidum (syphilis) are lower than in most Western countries. However, rates vary among population subgroups: chlamydia, gonorrhea and syphilis are higher in Jews than in non-Jews, and this gap has increased for chlamydia over the past decade. Primary and secondary syphilis rates have increased among men having sex with men (MSM). It is likely that STIs are under-reported and that incidence is even rising due to migration. A key recommendation is the establishment of an active surveillance system of STIs, utilizing active case finding in high risk populations, along with regular contact with STI clinics run by the four national health management organizations and by the MoH. As with most European countries, the low prevalence of chlamydia and gonorrhea does not justify population-wide screening. Conversely, the increasing incidence of syphilis among MSM should lead to regular screening among this group. A national STIs prevention strategy for the year 2025 was presented. Although the current burden of illness is low relatively to other Western countries, this is thought to reflect a certain degree of underreporting. These and other gaps suggest a need for focused epidemiologic and health services research to better characterize health risk behaviors as well as provider practice patterns. Innovative implementation strategies have been described, together with the capacity building components needed for developing specific and implementable policy recommendations for the year 2025.

JPHP provides a medium for publication of scholarly articles on the epidemiologic and social foundations of public health policy; presents the results of research bearing on such policy; evaluates administrative experience in the implementation of specific public health policies and programs; and helps make more effective the services provided by health departments, other health agencies, and public health workers in protecting and improving the health of the public.

The majority of human brucellosis cases in Israel are caused by the ingestion of unpasteurized dairy foods produced from unlicensed family-owned flocks whose products are sold door-to-door at low prices. Exposure to infected farm animals is another major cause of infection. To determine, by examining recent incidence data and brucellosis control programs, whether a reduction in the incidence of human brucellosis in Israel can be sustained. Case information is reported to the Health Ministry and national data are compiled and analyzed by the Division of Epidemiology. The current study focuses on data from 1998 through 2009 and discusses several of the major prevention and health education programs that have been implemented. An incidence decline of almost 70% during the period 1998-2002 was followed by a return to previously existing levels, although the incidence has remained consistently lower than in past decades. The disease is mostly limited to certain sectors of the rural Arab population. In 2009 the incidence rate per 100,000 population was 7.0 among Arabs compared with 0.2 among Jews. Between 1998 and 2009, 63% of cases were from the Beer Sheva and Acre health districts, which together comprise 15.5% of the Israeli population. Control programs--including efforts to combat brucellosis in animals and to discourage the sale of unpasteurized homemade dairy products--have met with partial success. Without routine vaccination of all family-owned flocks, more effective restraints on the market for unpasteurized dairy foods and improved regional cooperation, human brucellosis will continue to be a contained, but persistent, health problem in Israel due to cultural behavior, socioeconomic factors, and the regional political environment.

SUMMARY: Mumps outbreaks in recent years have given rise to questions about the effectiveness of the mumps vaccine. This study examined the epidemiological data from a recent mumps outbreak in Israel and from outbreaks in other countries with high vaccination coverage, and considered whether long-established vaccination policies designed to protect against mumps are in need of revision. Of over 5000 case patients in the Israeli outbreak, half of whom were in the Jerusalem health district, nearly 40% were aged ⩾15 years and, of those whose vaccination status was known, 78% had been fully vaccinated for their age – features similar to those in recent mumps outbreaks in Europe and North America. The epidemiological and laboratory evidence suggests that many previously vaccinated adolescents and young adults are now susceptible to mumps because their vaccine-based immunity has waned. Booster vaccination programmes for those at high risk of infection during mumps outbreaks – particularly those in congregate living environments – merit priority consideration.

When four deaths occurred in one week among influenza vaccine recipients, the Israeli Health Ministry suspended its 2006 influenza vaccination campaign pending investigation of the causes of death....

In March 2009, a novel A/H1N1 influenza virus began its inexorable spread around the world. Information regarding disease characteristics, groups at risk and prognosis remain partial. The Epidemiology Division of the Israeli Ministry of Health performs ongoing influenza surveillance and tracking of patients in Israel. The authors set out to characterize the disease and its spread in Israel. Surveillance and investigation procedures were modified in accordance with changing Ministry of Health policy. From the outset of the outbreak and until June 30, 2009, all suspected cases of influenza A/H1N1 were investigated and laboratory verified. Starting July 1, 2009, lab confirmation was reserved for severely ill patients or those at high risk of complications. All hospitalized cases were monitored and tracked daily. By June 30, 2009, 596 patients had laboratory confirmed Influenza A/H1N1: 58% of these were aged 10-30 years, and only 5% were above 50 years of age; 58% were male. In addition to fever (83%), patients reported cough (74%), rhinorrhea (59%), and headache and sore throat (53% each). Thirty three patients were considered at high risk for complications, four of which required hospitalization in an intensive care unit; 64% of infections were acquired in Israel and 22% in the United States. By July 29, 2009, 952 additional cases had been verified. Overall, 13 of the cases had been hospitalized in intensive care, 3 of whom died. Early data indicate spread particularly to younger populations, expressing non-specific respiratory symptoms. Ongoing investment in real-time data collection and analysis will enable epidemiologists to supply the information necessary to deal with the influenza epidemic.