Use of vaccination in a large outbreak of primary varicella in a detention setting for African immigrants.

BACKGROUND: Primary varicella (PV) presents a public health risk for adults in closed residential settings, especially for immigrants from tropical areas where infection during childhood is less likely. METHODS: In this study, an outbreak of PV at a detention facility for illegal immigrants from Eritrea and Sudan in southern Israel is described. Basic demographic information and clinical course for all cases were obtained. RESULTS: One hundred and nine cases of PV, all in young adult men aged 18-40 years, were diagnosed over a 7-month period (June to December 2012). Diagnosed patients were placed in quarantine until the resolution of illness without other public health measures being implemented. The Israeli Ministry of Health was notified of the outbreak in early December and recommended two doses of varicella vaccine for all susceptible detainees and staff. Within 2 weeks of completion of the first dose of vaccine, there was only one additional case in a detainee immunized 13 days prior to diagnosis. The effectiveness of vaccination in halting the outbreak was immediate, despite the fact that 15.6% of detainees refused to be immunized. CONCLUSIONS: The possible roles of vaccination or natural infection in achieving herd immunity and thereby ending the outbreak in this population are discussed. We recommend considering early vaccination for all when an outbreak or a series of connected cases is detected in a closed-residential setting such as the detention facility described here.

Human brucellosis outbreak acquired through camel milk ingestion in southern Israel.

BACKGROUND: Human brucellosis is common in southern Israel among the semi-nomadic Bedouin, a population that consumes unpasteurized dairy products. Though camel milk ingestion is a known mechanism for brucellosis acquisition, only a few reports of sporadic cases have been published in the medical literature. OBJECTIVES: To describe a local brucellosis outbreak in 15 extended Bedouin family members, following ingestion of infected camel milk. METHODS: Data regarding patient's clinical manifestations, laboratory findings, treatment and outcome were collected from the hospital and the health fund clinics' computerized database. Camel's blood and milk were tested for Brucella serology and culture. Cases were defined by positive Rose Bengal test, symptoms correlating with brucellosis, and consumption of infected camel milk. RESULTS: Fifteen patients were diagnosed with acute brucellosis from March to June 2011. Sixty percent of cases had serum agglutination test titers of 1:160 or higher and 4/8 (50%) had positive blood culture for Brucella melitensis. Arthralgia and fever were the most consistent clinical manifestations. Blood and milk serology and milk culture taken from the female camel were positive for Brucella melitensis. CONCLUSIONS: The treating physicians must consider the possibility of infected camel milk ingestion as the mode of infection, both in sporadic cases and in outbreaks of brucellosis.

Adherence with oseltamivir chemoprophylaxis among workers exposed to poultry during avian influenza outbreaks in southern Israel.

OBJECTIVES: To determine adherence with recommended pre- and post-exposure oseltamivir prophylaxis (OP) among workers exposed to poultry during five simultaneous avian influenza (AI) H5N1 outbreaks in poultry farms in southern Israel in March 2006, as well as the efficiency of the distribution system of oseltamivir in the community. DESIGN: Epidemiological investigation identified 201 workers exposed to poultry during AI outbreaks. They were interviewed by a public health nurse regarding adherence with recommended OP, symptoms, and possible side effects. Data were collected on type of exposure, age, sex, rate of adherence with OP, and reasons for non-adherence. For eight workers, paired sera were drawn for the determination of antibodies to H5. Data were collected on the efficiency of the distribution of oseltamivir tablets to workers in the community. RESULTS: High adherence with OP (87.6%) was found among poultry workers during outbreaks of AI, with no difference by type of exposure, age, or sex. There was a low rate of side effects of OP (1.5%). No exposed workers developed AI and none of the eight who had paired sera drawn showed seroconversion. The distribution of OP in the community was inefficient, with 27.7% of the tablets 'lost' or returned unusable. CONCLUSIONS: These data emphasize the importance of developing efficient targeted distribution systems in the community for OP, in order to prevent human infection during AI outbreaks.

Two-dose measles immunization as a strategy to eliminate measles in the Middle East and Israel.

The data presented above show that most countries of the Middle East (Israel and countries of the Eastern Mediterranean Region of the WHO) are progressing towards achieving WHO goals for improving immunization coverage for measles immunization to over 90%, along with the introduction of a two-dose immunization strategy. There has been corresponding progress in the reduction of incidence of measles. However, the goal of the WHO to eliminate measles has not been achieved and is unlikely to be in the near future.

Elimination of hepatitis a infection outbreaks in day care and school settings in southern Israel after introduction of the national universal toddler hepatitis a immunization program.

BACKGROUND: In 1999, Israel became the first country to begin universal toddler immunization against hepatitis A infection with a 2-dose schedule at 18 and 24 months. The effect of the Israeli program on outbreaks of Hepatitis A in day care and school settings was studied. METHODS: The records of all hepatitis A illness outbreaks in day care and school settings reported to the Ministry of Health in Southern Israel during 1993 through 2005 were reviewed. The number of exposed contacts for whom postexposure prophylaxis was administered was retrieved from records of epidemiologic investigations. Rates of immunization coverage were extracted from records of Maternal and Child Health Clinics. RESULTS: Three hundred nineteen cases of hepatitis A illness during the years 1993 through 2005 were associated with 113 outbreaks in day care and school settings of which 92% occurred before the institution of universal toddler immunization. Since 2000, no hepatitis A infection outbreaks have been reported in any day care and school settings in the region. An average of 732 children received immunoglobulin prophylaxis yearly because of exposure to an outbreak in an educational setting during the preimmunization period, 106 in 2000 and zero in the 5 years since 2001. The data showed marked herd immunity since school-aged children born before 1999 were not immunized, but elimination of outbreaks occurred equally in that age group. Immunization coverage was 86.4% for one dose of hepatitis A vaccine by age 3 years and 77.3% for 2 doses among the birth cohort of 2000. CONCLUSIONS: Universal hepatitis A immunization of toddlers was associated with disappearance of outbreaks in educational settings. This included cohorts of nonimmunized children representing marked herd immunity.

Risk of transmission of leptospirosis from infected cattle to dairy workers in southern Israel.

BACKGROUND: Leptospirosis is a zoonotic disease that occurs worldwide, found predominantly in agricultural workers, port workers and dairy workers. OBJECTIVE: To investigate the risk of disease transmission to dairy workers following an outbreak in 1999 of Leptospirosis hardjo in the dairy herds of two kibbutzim in southern Israel. METHODS: A seroepidemiologic survey of all the dairy workers from these two kibbutzim was conducted, including individual interview and examination. Data were collected on the presence of clinical symptoms of leptospirosis during the previous month. One month later the medical personnel on the two kibbutzim were contacted in order to determine if any worker had subsequently developed clinical signs or symptoms of leptospirosis. All dairy workers had blood drawn for serology. Those workers whose initial serology had been borderline for leptospirosis had a repeated serology test between 2 and 4 weeks later. Doxycycline was given prophylactically to all dairy workers on one kibbutz only. RESULTS: Either with or without chemoprophylaxis, no dairy workers exposed to herds infected with Leptospira hardjo showed evidence of seroconversion or disease. This indicated a low risk of transmission of this serovar from cows to dairy workers. CONCLUSION: Since human illness with leptospirae can cause illness associated with significant morbidity, we recommend that physicians make an informed decision regarding doxycycline prophylaxsis for dairy workers exposed to cattle herds infected with Leptospira hardjo.