In January 1994 mass antibiotic prophylaxis was undertaken in the contiguous villages of Deir el-Asad and B'ine in northern Israel (combined population of 11600) in response to a prolonged outbreak of serogroup B meningococcal infection with an overall annual rate of 37.4 cases of infection per 100000 residents. The average case fatality rate in the villages was 23% compared with 11% in Israel during the same period. Neisseria meningitidis group B was identified in 9 of 13 (69%) cases. Seven of these were subtype P1.7,16. The persistence of the outbreak with its accompanying public reaction prompted the establishment of an intervention programme that included antibiotic prophylaxis for the whole community with monitoring for pharyngeal carriage of meningococci in a stratified sample of the population. The objectives were to achieve a reduction of carriage of the outbreak strain and to reduce morbidity and mortality. A total of 1036 pharyngeal swabs were taken 1 day before and 6 weeks after treatment. Antibiotic prophylaxis was administered in one dose: children under 5-years-old received ceftriaxone i.m.; all others received oral ciprofloxacin. Overall, 96% of the population received treatment. The carriage rate was 8.3% prior to treatment (three serogroup B:14:P1.7,16), and 1.3% afterwards (one serogroup B:14:P1.7,16). The intervention failed to eradicate carriage of the putative outbreak strain, or to reduce the incidence and fatality rates in the villages. The outbreak finally terminated in late 1996. Public health professionals should bear this experience in mind when faced with prolonged, localized, nonexplosive outbreaks of meningococcal disease associated with low carriage rates of the outbreak strain.

79 patients with meningococcal disease were evaluated retrospectively between 1972-1986. All the neisseria isolated were sensitive to penicillin but resistant to sulphonamides. Most of the infections (54%) were caused by serogroup B strains. Clinical features included fever (98%), vomiting (65%), and headache (60%). Purpura appeared in 95% and severe neurological features in 25%. Most patients (83%) were children less than 10 years old. The incidence was 1.4/100,000 in the non-Jewish population and 2.3/100,000 in the Jewish population. The overall mortality was 23%, but about 50% in the Jewish population (10 deaths in 18 cases). In kibbutzim the incidence (7.5/100,000) and mortality were especially high. The need for awareness of the disease and the importance of early diagnosis and aggressive treatment are emphasized.

Following the occurrence of a case of meningococcal disease in a kibbutz, extensive preventive measures were instituted, consisting of alternate courses of rifampicin (10 mg/kg for 2 consecutive days) and ceftriaxone (single IM injection of 125 mg). Throughout the observation period Neisseria meningitidis was absent from oropharyngeal secretions of all those treated, but was found in those of an untreated control group. The alternate use of rifampicin and ceftriaxone should be considered for the long-term prevention of the occurrence of oropharyngeal carriers of Neisseria meningitidis.

An outbreak of typhoid fever followed a large outbreak of dysentery in northern Israel. Both outbreaks resulted from contamination of a drilled well that supplied water to the municipal water system. The well was contaminated with sewage from a broken main-pipe coming from Shefaram (an Arab town). The outbreak of typhoid involved 77 persons, of whom 75 were hospitalized. In 67, phage-type C1 (the phage type dominant in Shefaram since the 1950s) was isolated. The incubation period was relatively long, between 12 and 40 days (median 22) following exposure. Over 50% of the cases were children aged 0 to 14, and only two patients were older than 35 years; the sex ratio among the patients was 1:1. The incidence rate in Shefaram was 2.3 times higher than in the Krayot (outlying suburbs of Haifa). This difference was due mainly to the high incidence in young females in Shefaram. The opposite was observed during the outbreak of dysentery, when the attack rates of the disease were higher in the Krayot. Relapses occurred in 12% (9 cases). This outbreak demonstrates the potential that still exists for serious outbreaks due to contamination of the municipal water supply.

A five-year serologic follow-up and a four-year monitoring of the polio and pertussis morbidity in an area immunized with a 2 + 1 dose schedule of a combined DTP-Po vaccine have shown that: the individual protection against polio measured by the presence of neutralizing antibody persists at a very adequate level five years after the first booster; after three years of a steady high proportion of children with pertussis antibody, a considerable drop is observed and in about 28% of individuals agglutinin levels of less than 1:20 were found five years after booster; the community protection against paralytic poliomyelitis and pertussis is satisfactory up to four years after the introduction of the program. Continuation of immunization with a 2 + 1 dose schedule at a maximal coverage and close seroepidemiologic surveillance are necessary in order to draw definite conclusions, because of the potentially strong impact of very dynamic ecological factors present in our geopolitical area upon the agent-host interrelationship.

As part of a study with a quadruple inactivated vaccine (diphtheria-pertussis-tetanus-polio), the serologic response to the pertussis antigen was investigated in infants at the age of routine immunization, inoculated with one of the following two regimens: either 0.5 ml vaccine at 2 and 3 1/2 months and a booster six months later, or an identical dose of vaccine given at 2, 4 and 6 months and a booster at the age of 12 months. A pertussis agglutination titer of greater than or equal to 1:10 was considered an immune response to the administration of the antigen. Two basic doses of pertussis antigen induced an immune response in about 92% of children, which was very close to that following three basic doses. A 100% seroconversion was observed in both groups one month after the booster dose, and geometric mean values were high in both regimens. At one and two years after the booster, the pertussis agglutinins were present in 100% of children of both groups, with higher geometric mean values in the group given the three basic doses regimen.

Comparison of Inactivated Poliovirus Vaccine and Oral Poliovirus Vaccine Programs in Israel Get access T. A. Swartz, T. A. Swartz Please address requests for reprints to Dr. T. A. Swartz, Department of Epidemiology, Ministry of Health, P.O. Box 1176, Jerusalem 91000, Israel. Search for other works by this author on: Oxford Academic PubMed Google Scholar E. Ben-Porath, E. Ben-Porath Search for other works by this author on: Oxford Academic PubMed Google Scholar H. Kanaaneh, H. Kanaaneh Search for other works by this author on: Oxford Academic PubMed Google Scholar L. Leitner, L. Leitner Search for other works by this author on: Oxford Academic PubMed Google Scholar N. Goldblum N. Goldblum Search for other works by this author on: Oxford Academic PubMed Google Scholar Reviews of Infectious Diseases, Volume 6, Issue Supplement_2, May-June 1984, Pages S556–S561, https://doi.org/10.1093/clinids/6.Supplement_2.S556 Published: 01 May 1984

A trail with inactivated polio vaccine (IPV) was carried out, aiming at the earliest possible vaccination of young infants from rural settlements, before their exposure to type 1 wild poliovirus, highly prevalent in the environment. One hundred and fifteen infants were primed at the age of 2 and 3 1/2 months with the quadruple antigen DPT-polio. When 10 months old, 61 were boosted with the same antigen, and 54 with TOPV associated with DTP. Another 53 babies fed with TOPV at 2, 4, 6 and 12 months were used as a control. One dose of IPV produced antibody to polio type 1 in 83% of babies. With two doses of IPV a 100% response was obtained. Six months after the second dose, a small decrease in the percentage of infants wih detectable antibody to type 1 was observed, but at one month after the booster a highly significant anamnestic response was achieved. The results with IPV compared favorably with the immune response of infants given TOPV. Details on the results of the field trial will be presented, and field implementations of IPV will be discussed.