Burden and risk factors of Shigella sonnei shigellosis among children aged 0-59 months in hyperendemic communities in Israel.

OBJECTIVES: Ultraorthodox Jewish populations living in towns with good sanitary infrastructure but with conditions of crowding have been the epicenter of Shigella sonnei shigellosis outbreaks. In this study, the incidence and risk factors of S. sonnei shigellosis in children living in an ultraorthodox community were determined. METHODS: Data for the years 2000-2013 for all reported culture-proven S. sonnei shigellosis cases in children aged 0-59 months in the city of Elad were compared with data for the rest of the sub-district. Environmental factors obtained through parental interviews were evaluated for 78 incident cases of S. sonnei shigellosis and 141 community controls, matched by age, sex, and neighborhood. Conditional logistic regression models were performed. RESULTS: Cyclic epidemics of S. sonnei shigellosis occurred every 2 years. The mean annual incidence was 10.0 per 1000 children in Elad (95% confidence interval 7.9-12.6) vs. 3.8 per 1000 children (95% confidence interval 3.3-4.4) in the sub-district (p<0.001). Concurrent diarrheal disease in family members, having the same person in the daycare center responsible for food handling and changing diapers, and more rooms and sinks in the center, were positively associated with S. sonnei shigellosis, while children's hand-washing before meals was inversely associated. CONCLUSIONS: The burden of S. sonnei shigellosis in ultraorthodox communities is high. Enhanced hygiene interventions are required for epidemic control.

Bacteremia caused by a highly-resistant Streptococcus pneumoniae serotype 19A circulating in a daycare center.

We describe the clinical course of a previously healthy 20-month-old toddler admitted with high fever and leukocytosis. Blood culture grew Streptococcus pneumoniae serotype 19A, belonging to the ST663 clone, highly resistant to penicillin, ceftriaxone, and erythromycin. The same clone with identical antibiogram was isolated from the nasopharynx of another three of the other five healthy children attending the same daycare center as the patient. This case exemplifies the potential problems posed by highly-resistant S. pneumoniae serotype 19A, an emerging pathogen worldwide.

A cluster of deaths following influenza vaccination, Israel, 2006.

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. Medical histories of the deceased vaccinees, quality control reports, and laboratory test results were examined. Prior vaccine use that season and a risk assessment of the vaccinated population were also considered. All four decedents had been treated for cardiac and other chronic diseases, and none had experienced post-injection symptoms suggesting adverse reaction to influenza vaccine. Quality control and laboratory reports confirmed vaccine batch safety, and no adverse effects had been reported among any other vaccine recipients. Investigators found no causal connection between the deaths and the vaccine, and the Health Ministry resumed the campaign. Israeli public health officials viewed the investigation as vital to maintaining broad confidence in the public health system, and in future vaccination campaigns.