Mass antibiotic treatment to stop an outbreak of meningococcal disease: a molecular analysis.

The occurrence of three cases of meningococcal disease among children in a small community, two of whom attended the same day-care centre, prompted a programme of mass antibiotic prophylaxis. Nasopharyngeal and throat swabs were obtained on three occasions from all children registered at the day-care centre. Serogroup B Neisseria meningitidis was isolated from 13 of 61 children before prophylaxis, from three children after 2 weeks, and from 19 children after 3 months. Repetitive extragenic palindromic PCR analysis identified several meningococcal strains before treatment, one of which became predominant after 3 months. Mass antibiotic prophylaxis initially suppressed meningococcal carriage, but the carriage rate subsequently rebounded.

[Has the health profile and pregnant Ethiopian immigrants changed in the Ashkelon region in the past years?].

There are about 6500 births yearly in the Ashkelon District. 6% of the mothers are Ethiopians, most of whom immigrated to Israel since the early 90's. Our data are from 3 sources: birth certificates, infant death certificates, and the national population register. Birth rates in single mothers and rates of low-birth-weight births have declined over the years. Infant mortality and still-birth rates have also shown remarkable and consistent declines between 1990-1995. We conclude that improvement in life conditions of Ethiopian immigrants and better use of health services have had a great impact on birth outcomes and pregnancy patterns. The gap between Ethiopian immigrants and other Jewish communities in Israel is closing fast.

Serological markers for hepatitis B and treponemal infection among HIV carriers from Ethiopia.

A group of 52 HIV carriers among immigrants who arrived in Israel from Ethiopia in Operation Solomon, 1991, is described. A control group was randomly chosen from the same population. HBV serology and treponemal antibodies were obtained from both groups. The frequency of HBV markers was similar in both groups (70% among the HIV carriers and 78.8% in the controls). HBsAg was more frequently found among HIV carriers (20%) than in the control group (8.6%). Treponemal antibodies were common among HIV carriers (31%), and infrequent in the controls (3%). These data indicate that HIV infection in this community is linked to treponemal infection and that these carriers handle HBV less efficiently then HIV-negative subjects.

PIP: In Jerusalem and the Negev, physicians examined and took blood samples from recent Jewish immigrants older than 10 years who came to Israel from Ethiopia during Operation Solomon in 1991. The physicians and other colleagues compared data on the 52 people who were HIV positive with 139 who were HIV negative to examine HIV's relationships with treponemal infection and hepatitis B infection. The 2 groups were essentially the same age (37 years for cases and 35.5 years for controls). No significant difference in the prevalence of hepatitis B virus (HBV) markers existed between the 2 groups (70% for HIV-positive migrants and 78.8% for HIV-negative migrants). This confirmed other research that HBV is transmitted vertically in developing countries. Yet, HIV-positive migrants were more likely to have markers for hepatitis B surface antigen than HIV-negative migrants (20% vs. 8.6%; p = .018). The HIV-positive migrants had a higher prevalence of treponemal markers than did HIV-negative migrants (31% vs. 3%), indicating that treponemal disease increased their risk of HIV infection. The earlier group of Jewish immigrants from Ethiopia during 1984-1985 (Operation Moses) also had a high prevalence of treponemal antibodies but no one had HIV infection. These immigrants walked through a rural area to a refugee camp in Sudan from which they were taken to Israel by air. The newer immigrants rode buses to Addis Ababa and waited 1 year before they immigrated to Israel. The results of this study suggests that the new immigrants (an ethnic homogenous group just like their earlier counterparts) became infected with HIV during the short period in Addis Ababa. Israeli physicians have designed a study to follow the HIV-positive immigrants to determine whether the environment in Africa is responsible for the different clinical picture of AIDS.

Measles during the Gulf War: a public health threat in Israel, the West Bank, and Gaza.

A measles outbreak began in Ramallah District in the West Bank in the period just before the outbreak of the Gulf War in 1991. After a local control program, the outbreak was contained to a total of 236 reported cases, including one death, but sporadic cases appeared over the ensuing months. An epidemic of measles followed 2-3 weeks later in Beer Sheva district in Israel, initially among the Bedouin population just prior to the outbreak of the war, then spreading to the Jewish population. The epidemic reached its peak during the war in February, continuing into March. There were a total of over 433 reported cases, with 203 hospitalizations and 7 deaths. The epidemic was slowed by curtailment of school and other civilian activities, and a mass vaccination campaign reaching 60,000 children, but was spread by crowded conditions in hospital, and was spread to other parts of the country by internal population migration. An epidemic of a preventable disease occurring during a national emergency adds to the burdens of the health system. The public health system must be prepared to contain epidemics and other public health threats in wartime, employing standard control methods developed and practiced during peacetime. Routine immunization policies should take into account the possibility of a civilian epidemic during national emergencies, and the need to assure protection of both the civilian and military population in preparation for such contingencies.

Preventability of neonatal cold injury and its contribution to neonatal mortality.

When the body temperature of a small neonate falls below 35 degrees C, lassitude can be noted; severe derangements of cardiovascular, renal, hepatic, immunological, and hematological systems may also occur depending in part on the duration and severity of hypothermia. Diagnosis requires a low-reading thermometer, lacking which the diagnosis can be suspected, but most often is missed. Fatal cases of diagnosed cold injury commonly have terminal pneumonia or sepsis. Prevention involves identification and home visits to high-risk infants; intensive care of those with the diagnosis at Soroka Hospital Medical Center has reduced the case-fatality rate from 30% in 1971 to 3% in 1988-1989. During the same period in our region, the proportion of neonatal deaths occurring in winter months of December, January, and February has dropped from 55 to 27%. The expected proportion is 25%. We hypothesize that excess neonatal mortality during winter months, especially due to pneumonia and sepsis or sudden infant death syndrome (SIDS) is an indicator of missed cold injury syndrome. A preliminary evaluation was made form U.S. data by state, provided by the National Center for Health Statistics, which records no fatalities from cold injury during 1986. Contrasted with this are 26 cold injury deaths in Israel for 1977-1980. In the U.S., though, excess winter neonatal deaths in 1986 from SIDS, pneumonia, and sepsis are reported.(ABSTRACT TRUNCATED AT 250 WORDS)

Spotted fever and murine typhus in the Negev desert region of Israel, 1981.

During 1981, 52 cases of rickettsiosis caused by the spotted fever group of rickettsiae were reported in a population of 250 000 living in the Negev desert region of Israel. Retrospectively, at least 5 of these cases were serologically shown to have been caused by Rickettsia typhi, the agent of murine typhus. Most cases of rickettsial disease occurred in the summer months and one half of all cases occurred in children aged 9 years or less. While the specificity of a physician's diagnosis of the rickettsial diseases appears to be high (i.e., few cases of other diseases are misdiagnosed as either spotted fever or murine typhus), the sensitivity of the physician's diagnosis may be lower (i.e., many cases of these diseases presenting as fevers of unknown origin are not diagnosed as rickettsial disease). These findings may also be important for other countries of the region.