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1.
Clin Infect Dis ; 78(1): 210-216, 2024 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-37596934

RESUMO

BACKGROUND: A low-level risk of intussusception following rotavirus vaccination has been observed in some settings and may vary by vaccine type. We examined the association between RotaTeq vaccination and intussusception in low-income settings in a pooled analysis from 5 African countries that introduced RotaTeq into their national immunization program. METHODS: Active surveillance was conducted at 20 hospitals to identify intussusception cases. A standard case report form was completed for each enrolled child, and vaccination status was determined by review of the child's vaccination card. The pseudo-likelihood adaptation of self-controlled case-series method was used to assess the association between RotaTeq administration and intussusception in the 1-7, 8-21, and 1-21 day periods after each vaccine dose in infants aged 28-245 days. RESULTS: Data from 318 infants with confirmed rotavirus vaccination status were analyzed. No clustering of cases occurred in any of the risk windows after any of the vaccine doses. Compared with the background risk of naturally occurring intussusception, no increased risk was observed after dose 1 in the 1-7 day (relative incidence = 2.71; 95% confidence interval [CI] = 0.47-8.03) or the 8-21 day window (relative incidence = 0.77; 95%CI = 0.0-2.69). Similarly, no increased risk of intussusception was observed in any risk window after dose 2 or 3. CONCLUSIONS: RotaTeq vaccination was not associated with increased risk of intussusception in this analysis from 5 African countries. This finding mirrors results from similar analyses with other rotavirus vaccines in low-income settings and highlights the need for vaccine-specific and setting-specific risk monitoring.


Assuntos
Intussuscepção , Infecções por Rotavirus , Vacinas contra Rotavirus , Rotavirus , Humanos , Lactente , Intussuscepção/induzido quimicamente , Intussuscepção/epidemiologia , Infecções por Rotavirus/epidemiologia , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/efeitos adversos , Vacinas Atenuadas/efeitos adversos , Vacinas Combinadas
2.
Eur J Clin Microbiol Infect Dis ; 41(3): 501-504, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34997389

RESUMO

In 2018, Mycobacterium canariasense bloodstream infection was diagnosed in Israel. Further investigation had identified additional five cases in three medical centers, including isolates from blood (1), cornea (1), and sputum (3). Isolates were susceptible to all the antimicrobial tested. All but one isolate was related by whole-genome phylogeny.


Assuntos
Mycobacteriaceae , Infecções por Mycobacterium , Humanos , Israel/epidemiologia , Filogenia , Escarro
4.
Emerg Infect Dis ; 27(8): 2117-2126, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34286684

RESUMO

In a multicenter, nationwide, retrospective study of patients hospitalized with spotted fever group rickettsiosis in Israel during 2010-2019, we identified 42 cases, of which 36 were autochthonous. The most prevalent species was the Rickettsia conorii Israeli tick typhus strain (n = 33, 79%); infection with this species necessitated intensive care for 52% of patients and was associated with a 30% fatality rate. A history of tick bite was rare, found for only 5% of patients; eschar was found in 12%; and leukocytosis was more common than leukopenia. Most (72%) patients resided along the Mediterranean shoreline. For 3 patients, a new Rickettsia variant was identified and had been acquired in eastern, mountainous parts of Israel. One patient had prolonged fever before admission and clinical signs resembling tickborne lymphadenopathy. Our findings suggest that a broad range of Rickettsia species cause spotted fever group rickettsiosis in Israel.


Assuntos
Rickettsia conorii , Rickettsia , Rickettsiose do Grupo da Febre Maculosa , Humanos , Israel/epidemiologia , Estudos Retrospectivos , Rickettsia/genética , Rickettsiose do Grupo da Febre Maculosa/diagnóstico , Rickettsiose do Grupo da Febre Maculosa/epidemiologia
5.
Emerg Infect Dis ; 26(9)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32620179

RESUMO

Israel's response during the containment phase of the COVID-19 outbreak in early 2020 led to a delay in sustained community transmission and effective mitigation. During February-April 2020, a total of 15,981 confirmed cases resulted in 223 deaths. A total of 179,003 persons reported electronically to self-quarantine and were entitled to paid sick leave.


Assuntos
Infecções por Coronavirus/epidemiologia , Surtos de Doenças/legislação & jurisprudência , Política de Saúde , Pandemias/legislação & jurisprudência , Pneumonia Viral/epidemiologia , Quarentena/legislação & jurisprudência , Betacoronavirus , COVID-19 , Infecções por Coronavirus/prevenção & controle , Humanos , Israel/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Quarentena/métodos , SARS-CoV-2 , Fatores de Tempo
6.
Euro Surveill ; 24(10)2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30862335

RESUMO

We report nine travellers with confirmed chikungunya virus infection, returning from tourist areas of Thailand to Sweden, Switzerland, the United Kingdom, Romania, Israel and France, diagnosed in January and February 2019. These sentinel tourists support the intensification of chikungunya virus circulation in Thailand and highlight the potential for importation to areas at risk of local transmission.


Assuntos
Aedes/virologia , Febre de Chikungunya/diagnóstico , Vírus Chikungunya/isolamento & purificação , Surtos de Doenças , Vigilância de Evento Sentinela , Viagem , Adolescente , Corticosteroides/uso terapêutico , Adulto , Idoso , Animais , Anti-Inflamatórios não Esteroides/uso terapêutico , Artralgia/tratamento farmacológico , Artralgia/etiologia , Febre de Chikungunya/tratamento farmacológico , Febre de Chikungunya/epidemiologia , Dengue/epidemiologia , Europa (Continente) , Febre/tratamento farmacológico , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Oriente Médio , Mosquitos Vetores , Reação em Cadeia da Polimerase em Tempo Real , Tailândia/epidemiologia , Adulto Jovem
7.
Isr Med Assoc J ; 21(8): 538-541, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31474016

RESUMO

BACKGROUND: Travelers' diarrhea (TD) is frequently encountered in people traveling from high-income to low-income countries; however, its epidemiology in those traveling between high-income countries is not known. OBJECTIVES: To evaluate the incidence of diarrhea in North American students relocating to Israel. METHODS: A retrospective cohort study involving medical students from the United States and Canada relocating to Israel was conducted. Students who relocated to Israel during 2010-2016 were contacted by email to participate in an anonymous survey. Data included demographic information as well as occurrence, timing, duration, and outcome of diarrhea after relocation. RESULTS: Ninety-seven students participated in the survey. Most (93.7%) students relocated from the United States or Canada. The period-prevalence of diarrhea was 69.1%. The incidence of diarrhea declined from 34.8 cases per 100 student-months during the first month after relocation to 1.3 cases per 100 student-months after 1 year. The duration of diarrhea was up to 1 week in 72.7%. Students who reported diarrhea were younger than students who did not (mean age 24.0 ± 2.2 and 28.4 ± 1.8 years, respectively, P < 0.001). No other demographic parameter was significantly associated with a higher likelihood of diarrhea. CONCLUSIONS: A high proportion of North American medical students relocating to Israel reported diarrhea with clinical and epidemiological features similar to classic TD. Further studies are needed to elucidate the causative agents of TD in Israel.


Assuntos
Diarreia/epidemiologia , Inquéritos Epidemiológicos/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Doença Relacionada a Viagens , Doença Aguda , Adulto , Canadá/etnologia , Estudos de Coortes , Diarreia/etnologia , Feminino , Humanos , Incidência , Israel/epidemiologia , Masculino , Projetos Piloto , Estudos Retrospectivos , Viagem , Estados Unidos/etnologia , Adulto Jovem
8.
Emerg Infect Dis ; 24(4): 790-793, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29553319

RESUMO

We characterized posttravel hospitalizations of citizens returning to Israel by summarizing the returning traveler hospitalization dataset of the national referral Center for Travel Medicine and Tropical Diseases at Sheba Medical Center in Israel. Of 722 hospitalizations, 181 (25%) infections were life-threatening; most would have been preventable by chemoprophylaxis and pretravel vaccination.


Assuntos
Vigilância da População , Medicina de Viagem , Doença Relacionada a Viagens , Viagem , Adulto , Feminino , História do Século XXI , Hospitalização/estatística & dados numéricos , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Medicina de Viagem/história , Medicina de Viagem/estatística & dados numéricos
9.
Thorac Cardiovasc Surg ; 66(6): 491-497, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-28315286

RESUMO

BACKGROUND: Coronary endarterectomy and patch angioplasty for the left anterior descending (LAD) artery have been shown to be effective adjunct techniques to surgical revascularization for severe coronary lesions. The objective of this study is to review the short- and long-term results of these two methods in our institution. METHODS: We retrospectively reviewed 166 consecutive patients who underwent internal thoracic artery grafting to the LAD, with either adjunct endarterectomy (95 patients) or patch angioplasty (71 patients) between 2002 and 2014. We compared the early and late outcomes between groups. RESULTS: The endarterectomy patients were older than the patch angioplasty patients (71 vs. 67 years, p = 0.007) and had lower rates of recent myocardial infarction (25% vs. 45%, respectively, p = 0.008). Median pulmonary bypass times and aortic cross clamp times were significantly longer in the endarterectomy group compared with the patch angioplasty group by 47 minutes (p < 0.001) and 42 minutes (p < 0.001), respectively. Median follow-up time was 6.9 years. No significant differences in operative mortality, perioperative myocardial infarction, and long-term survival were found. Freedom from percutaneous coronary intervention at 1 and 5 years was significantly higher in the endarterectomy group compared with the patch angioplasty group (p = 0.002). CONCLUSIONS: Endarterectomy and patch angioplasty are comparable methods to reach complete revascularization for highly selected patients with diffuse atherosclerotic disease in the LAD. Compared with patch angioplasty, complete extraction of the atherosclerotic plaque with an endarterectomy leads to similar short-term outcomes and long-term survival while significantly reducing the need for further interventions in the future.


Assuntos
Angioplastia/métodos , Doença da Artéria Coronariana/cirurgia , Endarterectomia das Carótidas , Veia Safena/transplante , Idoso , Angioplastia/efeitos adversos , Angioplastia/mortalidade , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Intervalo Livre de Doença , Endarterectomia das Carótidas/efeitos adversos , Endarterectomia das Carótidas/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
10.
Clin Infect Dis ; 65(9): 1516-1522, 2017 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-29020345

RESUMO

BACKGROUND: Little is known about Plasmodium malariae, a relatively rare cause of malaria in returned travelers. Recently, polymerase chain reaction (PCR) use for malaria diagnosis has enhanced specificity of P. malariae detection. The study objective was to describe the unique aspects of P. malariae diagnosis and clinical course in travelers. METHODS: Malaria is a reportable disease in Israel. All PCR-proven P. malariae monoinfections in Israeli travelers between January 2008 and January 2017 were retrieved from the Ministry of Health Reference Parasitology Laboratory. Data regarding method and timing of diagnosis, clinical characteristics, and laboratory testing were collected from patient charts. RESULTS: Eighteen patients with P. malariae were included. All cases were acquired in Africa. During the study period, the relative proportion of P. malariae increased (2%-10% of all malaria cases). Malaria was identified by blood smear in 10 of 18 patients (56%) on admission, and by rapid antigen test in 5 of 18 (29%) patients only, while P. malariae speciation was correctly identified by smear in 2 of 18 (11%) patients. Though all patients reported fever, only 4 of 18 (22%) described a quartan fever course. In 7 of 18 (39%) patients, malaria was contracted despite prophylactic treatment. Five patients had prolonged prepatent periods (median, 55 days), all of whom received prior prophylaxis. CONCLUSIONS: The relative proportion of P. malariae is on the rise. Diagnosis in routine clinical settings is inadequate due to the low sensitivity and specificity of blood smears. PCR should be considered when clinical suspicion is high. Prophylaxis failure, which caused delayed clinical presentation, was documented.


Assuntos
Malária , Plasmodium malariae , Viagem , Adulto , África , Idoso , Antimaláricos/uso terapêutico , Feminino , Humanos , Israel , Malária/diagnóstico , Malária/tratamento farmacológico , Malária/epidemiologia , Masculino , Pessoa de Meia-Idade , Primaquina/uso terapêutico , Estudos Retrospectivos , Adulto Jovem
12.
Lancet ; 397(10286): 1685-1687, 2021 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-33901422
15.
Clin Infect Dis ; 62 Suppl 2: S155-60, 2016 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-27059350

RESUMO

BACKGROUND: Pentavalent rotavirus vaccine (RV5) was introduced into the Israeli National Immunization Program in January 2011. We determined RV5 vaccine effectiveness (VE) in southern Israel, a region characterized by 2 distinct populations: Bedouins living in a low- to middle-income, semirural setting, and Jews living in a high-income, urban setting. METHODS: We enrolled vaccine-eligible children who visited the emergency department (ED) or were hospitalized due to acute gastroenteritis (AGE) during the first 3 rotavirus seasons after RV5 vaccine introduction (2011-2013). Fecal specimens were tested for rotavirus by enzyme immunoassay and genotyped. Vaccination among laboratory-confirmed rotavirus cases was compared with rotavirus-negative AGE controls. Regression models were used to calculate VE estimates by age, clinical setting, and ethnicity. RESULTS: Of 515 enrolled patients, 359 (70%) were Bedouin. Overall, 185 (36%) patients were rotavirus positive; 79 of 119 (66%) were G1P[8] genotype. The adjusted VE for a full 3-dose course of RV5 against ED visit or hospitalization was 63% (95% confidence interval [CI], 38%-78%). RV5 provided G1P[8] genotype-specific effectiveness of 78% (95% CI, 58%-88%). By age, RV5 VE was 64% (95% CI, 21%-84%) and 71% (95% CI, 39%-86%) among children aged 6-11 months and 12-23 months, respectively. By clinical setting, RV5 VE was 59% (95% CI, 23%-78%) against hospitalization, and 67% (95% CI, 11%-88%) against ED visit. The adjusted VE of a full RV5 course among Bedouin children was 62% (95% CI, 29%-79%). CONCLUSIONS: RV5 significantly protected against rotavirus-associated ED visits and hospitalizations in a diverse population of vaccine-eligible children living in southern Israel.


Assuntos
Árabes , Gastroenterite/prevenção & controle , Programas de Imunização , Judeus , Infecções por Rotavirus/etnologia , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/imunologia , Pré-Escolar , Serviço Hospitalar de Emergência , Fezes/virologia , Feminino , Gastroenterite/epidemiologia , Gastroenterite/etnologia , Gastroenterite/virologia , Genótipo , Hospitalização , Humanos , Imunogenicidade da Vacina , Lactente , Israel/epidemiologia , Masculino , Rotavirus/imunologia , Infecções por Rotavirus/epidemiologia , Infecções por Rotavirus/virologia , Vacinas contra Rotavirus/administração & dosagem , Vacinação/estatística & dados numéricos , Potência de Vacina , Vacinas Atenuadas/administração & dosagem , Vacinas Atenuadas/imunologia
16.
Clin Infect Dis ; 62 Suppl 2: S196-9, 2016 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-27059356

RESUMO

Togo introduced monovalent rotavirus vaccine starting 19 June 2014. We compared all-cause acute gastroenteritis (AGE) hospitalizations and rotavirus-associated hospitalizations during the prevaccine period (July 2008-June 2014) to 1 year after vaccine introduction (July 2014-June 2015). The proportion of children with AGE who tested positive for rotavirus declined from 53% (645/1223) in prevaccine years to 36% (68/187) in the postvaccine year (P< .01). The decline only occurred in children <1 year of age who were eligible for vaccination and was greatest during the rotavirus season months, supporting that it was associated with vaccine implementation.


Assuntos
Gastroenterite/epidemiologia , Gastroenterite/prevenção & controle , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/imunologia , Vacinação/estatística & dados numéricos , Doença Aguda , Pré-Escolar , Feminino , Gastroenterite/virologia , Hospitalização , Humanos , Lactente , Masculino , Rotavirus/imunologia , Infecções por Rotavirus/virologia , Vacinas contra Rotavirus/administração & dosagem , Estações do Ano , Togo/epidemiologia , Vacinas Atenuadas/administração & dosagem , Vacinas Atenuadas/imunologia
17.
Clin Infect Dis ; 62 Suppl 2: S127-32, 2016 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-27059346

RESUMO

BACKGROUND: Because >60 rotavirus strains have been reported worldwide, concerns exist about strain replacement after the introduction of rotavirus vaccines, particularly in developing countries with diverse strains and lower efficacy. METHODS: We used the case-control design in 4 hospitals in Nicaragua to assess strain-specific vaccine effectiveness (VE) of a pentavalent rotavirus vaccine (RotaTeq) against rotavirus diarrhea. Cases were identified through prospective strain surveillance with reverse transcription-polymerase chain reaction for 3 years among children hospitalized for diarrhea, and controls were children negative for rotavirus. RESULTS: We enrolled 1178 case-patients, 1082 (92%) with G and P typing, and 4927 controls. A different strain predominated each year with increasing age of the vaccine-eligible cohort during the study period: G2P[4] in 2008 (97%; mean age, 11.9 months), G1P[8] in 2009 (55%; mean age, 17.0 months), and G3P[8] in 2010 (78%; mean age, 17.3 months). Overall VE was 45% (95% confidence interval, 25%-59%). Regardless of the strain, VE estimates were 12%-79% lower among children aged ≥12 months relative to those 6-11 months of age. The lower VE for G3P[8] was related to the higher mean age of cases (17.3 months) compared with the G2P[4] strains (11.9 months), with a significant trend (R(2)= 0.819;P< .001) of declining effectiveness with increasing mean age of the cases. CONCLUSIONS: Introduction of RotaTeq did not result in sustained emergence of any particular strain in Nicaragua. Variation in strain-specific effectiveness was due to an age-related decline in effectiveness rather than differences in protection against the observed strains.


Assuntos
Diarreia/prevenção & controle , Gastroenterite/prevenção & controle , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/imunologia , Estudos de Casos e Controles , Criança Hospitalizada/estatística & dados numéricos , Pré-Escolar , Países em Desenvolvimento , Diarreia/epidemiologia , Diarreia/virologia , Fezes/virologia , Feminino , Gastroenterite/virologia , Genótipo , Humanos , Imunogenicidade da Vacina , Lactente , Masculino , Nicarágua/epidemiologia , Estudos Prospectivos , Reação em Cadeia da Polimerase em Tempo Real , Rotavirus/classificação , Rotavirus/genética , Rotavirus/imunologia , Infecções por Rotavirus/imunologia , Infecções por Rotavirus/virologia , Análise de Sequência de DNA , Sorogrupo , Potência de Vacina , Vacinas Atenuadas/imunologia
18.
Clin Infect Dis ; 63(6): 737-745, 2016 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-27318332

RESUMO

BACKGROUND: During late summer/fall 2014, pediatric cases of acute flaccid myelitis (AFM) occurred in the United States, coincident with a national outbreak of enterovirus D68 (EV-D68)-associated severe respiratory illness. METHODS: Clinicians and health departments reported standardized clinical, epidemiologic, and radiologic information on AFM cases to the Centers for Disease Control and Prevention (CDC), and submitted biological samples for testing. Cases were ≤21 years old, with acute onset of limb weakness 1 August-31 December 2014 and spinal magnetic resonance imaging (MRI) showing lesions predominantly restricted to gray matter. RESULTS: From August through December 2014, 120 AFM cases were reported from 34 states. Median age was 7.1 years (interquartile range, 4.8-12.1 years); 59% were male. Most experienced respiratory (81%) or febrile (64%) illness before limb weakness onset. MRI abnormalities were predominantly in the cervical spinal cord (103/118). All but 1 case was hospitalized; none died. Cerebrospinal fluid (CSF) pleocytosis (>5 white blood cells/µL) was common (81%). At CDC, 1 CSF specimen was positive for EV-D68 and Epstein-Barr virus by real-time polymerase chain reaction, although the specimen had >3000 red blood cells/µL. The most common virus detected in upper respiratory tract specimens was EV-D68 (from 20%, and 47% with specimen collected ≤7 days from respiratory illness/fever onset). Continued surveillance in 2015 identified 16 AFM cases reported from 13 states. CONCLUSIONS: Epidemiologic data suggest this AFM cluster was likely associated with the large outbreak of EV-D68-associated respiratory illness, although direct laboratory evidence linking AFM with EV-D68 remains inconclusive. Continued surveillance will help define the incidence, epidemiology, and etiology of AFM.


Assuntos
Enterovirus Humano D , Infecções por Enterovirus/epidemiologia , Hipotonia Muscular/epidemiologia , Mielite/epidemiologia , Doença Aguda , Adolescente , Criança , Pré-Escolar , Infecções por Enterovirus/líquido cefalorraquidiano , Infecções por Enterovirus/diagnóstico por imagem , Feminino , Humanos , Lactente , Masculino , Hipotonia Muscular/líquido cefalorraquidiano , Hipotonia Muscular/diagnóstico por imagem , Mielite/líquido cefalorraquidiano , Mielite/diagnóstico por imagem , Vigilância em Saúde Pública , Estados Unidos
19.
Emerg Infect Dis ; 22(8): 1387-94, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27434186

RESUMO

During August 8, 2014-October 14, 2014, a total of 11 children with acute flaccid myelitis and distinctive neuroimaging changes were identified near Denver, Colorado, USA. A respiratory prodrome was experienced by 10, and nasopharyngeal specimens were positive for enterovirus D68 (EV-D68) for 4. To determine whether an association exists between EV-D68 infection and acute flaccid myelitis, we conducted a retrospective case-control study comparing these patients with 2 groups of outpatient control children (1 group tested for acute respiratory illness and 1 for Bordetella pertussis infection). Adjusted analyses indicated that, for children with acute flaccid myelitis, the odds of having EV-D68 infection were 10.3 times greater than for those tested for acute respiratory infection and 4.5 times greater than for those tested for B. pertussis infection. No statistical association was seen between acute flaccid myelitis and non-EV-D68 enterovirus or rhinovirus infection. These findings support an association between EV-D68 infection and acute flaccid myelitis.


Assuntos
Enterovirus Humano D/isolamento & purificação , Infecções por Enterovirus/epidemiologia , Infecções por Enterovirus/virologia , Mielite/epidemiologia , Mielite/virologia , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Colorado/epidemiologia , Surtos de Doenças , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Fatores de Tempo
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