Child Health Care in Israel.

Israel is a relatively rapidly growing country with a high fertility rate and a young population. These data emphasize the importance of an efficient and appropriate pediatric service for its population. Although the pediatric service in Israel has attained several achievements, such as a relatively low infant mortality, high vaccination rates, and a primary care service that is mainly based on licensed pediatricians, several challenges, such as overcoming inequalities in health care and health indices between different regions and different populations within the country and the provision of a more organized mental and dental health care service to children, need to be addressed.

[Influenza A/H1N1 in Israel--clinical and epidemiological characteristics].

BACKGROUND: 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. METHODS: 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. RESULTS: 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. DISCUSSION: 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.

Tailoring the GVHD prophylaxis regimen according to transplantation associated toxicities-Substituting the 3rd dose of methotrexate to mycophenolate mofetil.

We hypothesized that in patients with early post allogeneic transplantation toxicities, the omission of the 3rd dose of methotrexate with concomitant starting of MMF would favorably affect complications. We found a higher incidence of grade 2-4 acute GVHD in patients given two doses methotrexate and MMF (n=31) compared to those given three courses of methotrexate (n=70) (p=.004), while grade 3-4 was similar. Other transplantation outcomes, including overall regimen-related-toxicity, were comparable. We conclude that tailoring the GVHD prophylaxis regimen may decrease the early post transplantation complications, however this come at the extent of a higher incidence of non-severe acute GVHD.