Jerusalem District Health Office

West Jerusalem, Israel

Jerusalem District Health Office

West Jerusalem, Israel

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Adler A.,National Center for Infection Control | Solter E.,National Center for Infection Control | Masarwa S.,National Center for Infection Control | Miller-Roll T.,National Center for Infection Control | And 10 more authors.
Journal of Clinical Microbiology | Year: 2013

This study describes the course of an OXA-48-producing Enterobacteriaceae (OPE) outbreak that started in March 2012 in a neonatal intensive care unit (NICU) in Jerusalem, Israel. During the peak of the outbreak (January to August 2012), there were 49 patients who had proven or suspected acquisition of OPE in the NICU, including 16 with invasive infections, out of a total of 156 patients who were hospitalized during that period. Three children hospitalized in the pediatric ICU were identified as carriers of OPE. Three patients with a previous stay in the affected NICU were identified as OPE carriers upon admission to another hospital. The Ministry of Health was notified and then intervened in July 2012. Intervention included cohorting colonized patients, conducting frequent rectal-culture surveillance, and improving the implementation of infection control practices. As a result, the incidence of OPE acquisition declined to 5 cases in the first 4 months, followed by no new cases in the next 3 months. Thirty-one patient-unique isolates were available for analysis: 29 Klebsiella pneumoniae isolates, all belonging to a single clone (sequence type 39 [ST39]), and 2 isolates from Enterobacter cloacae. All isolates possessed the blaOXA-48 and blaCTX-M-14 genes, which are located on the same plasmid. This plasmid, similar to the global blaOXA-48-harboring vector, has now acquired blaCTX-M-14, leading to resistance to all β-lactam agents. Copyright © 2013, American Society for Microbiology. All Rights Reserved.


Ginsberg G.M.,Public Health Service | Block C.,Hebrew University of Jerusalem | Stein-Zamir C.,Jerusalem District Health Office | Stein-Zamir C.,Hebrew University of Jerusalem
International Journal of Public Health | Year: 2016

Objectives: Using cost-utility analysis, to evaluate whether or not to adopt a Neisseria meningitidis serogroup B vaccination programme for Israeli children. Methods: Epidemiological, demographic, health service utilisation and economic data were integrated into a spreadsheet model to calculate the cost per averted disability-adjusted life year (DALY) of the intervention. Results: Assuming 78 % vaccine efficacy with no herd immunity, vaccination will prevent 223 cases and 22 deaths over a 100-year period. Based on vaccine price of $60 per dose, total intervention costs ($315,400,000) are partially offset by a $22,700,000 reduction in treatment and sequelae costs as a result of decreased morbidity. The intervention was not cost-effective since the net cost ($292,700,000) per averted DALY gained (1249 mostly due to decreased mortality) was $234,394. Additional two dose catch-up programmes vaccinating children in cohorts aged 1–2 to 1–13 were also not cost-effective. Conclusions: The vaccination will become cost-effective if vaccine costs fall below $19.44 per dose. However, in identified high risk areas, the vaccine would be cost-effective and could be recommended for use both with and without catch-up campaigns. © 2016 Swiss School of Public Health (SSPH+)


Stein Zamir C.,Jerusalem District Health Office | Stein Zamir C.,Hebrew University of Jerusalem | Schroeder H.,Jerusalem District Health Office | Schroeder H.,Hebrew University of Jerusalem | And 3 more authors.
Human Vaccines and Immunotherapeutics | Year: 2015

In recent years, large mumps outbreaks, involving mainly adolescents and young adults, have re-emerged in several countries. We investigated a large mumps outbreak, evaluated the association between mumps clinical severity (complications, hospitalization) and vaccination status (number of previous measles, mumps and rubella - MMR vaccine doses), and assessed vaccine effectiveness. The first mumps cases emerged in an ultra-orthodox boys' school in Jerusalem and were epidemiologically linked to the mumps outbreak in New York. Overall, 3130 mumps cases were notified in the Jerusalem district during September 2009-August 2011 (median age 13y, 64% males). Most cases were reported from community clinics. Patients with systemic symptoms and/or complications (419, 13.4%) were either hospitalized (n = 79) or treated in an emergency medical center (n = 340). The main complications included orchitis (3.8% males> age 12y) and meningoencephalitis (0.5%). The mumps virus genotype was G5. The distribution of previous MMR vaccine doses (n = 0,1,2) was: 24.8%, 28.3% and 46.9%, respectively. The number of previous vaccine doses was inversely associated with clinical severity. Adjusted values for MMR vaccine effectiveness against complications were estimated as 52.1% (95% CI −4 −78%) for one vaccine dose and 62.7% (95% CI 25.7–81.3%) for 2 doses. The outbreak was characterized by predominance of male students; the majority of whom had been previously vaccinated. The reported complication rate was relatively low. Vaccination status was associated with age and disease severity. The combination of limited mumps vaccine effectiveness and the specific school setting (dense learning and living conditions) probably contributed to the disease spread. © 2015, Taylor and Francis Group, LLC.


Sharf M.,Jerusalem District Health Office | Sela R.,Jerusalem District Health Office | Zentner G.,Jerusalem District Health Office | Shoob H.,Jerusalem District Health Office | And 3 more authors.
Appetite | Year: 2012

Nutritional labelling of packaged foods, mandated by law, includes details of the food content and composition - information that can affect individual and public lifestyle decisions and health status. We studied the comprehension of food labels among 120 young adults (mean age 24.1. years) attending an international travel immunization clinic. Each participant was presented with 10 food packages of common local products and was interviewed regarding the label's content. Most subjects (77.5%) reported that they took note of the food labels; women, the more educated and those engaging regularly in physical exercise were more inclined to do so. Out of a possible 10 points the overall median comprehension score was 6.0 (mean 5.7 ± 1.8). The nutritional table section of the food label was understood the best, and the nutritional declaration section the least. The subjects thought they understood the food labels better than they actually did; 43.9% stated that they understood them very well, whereas only 27.2% achieved high scores. This inadequate comprehension of food labels represents a missed opportunity to provide essential information necessary for healthy food choices at the individual level. A combination of strategies is necessary, including improving food labels (simplification and standardization) combined with targeted educational programs. © 2011 Elsevier Ltd.


Daudi N.,Hebrew University of Jerusalem | Shouval D.,Hebrew University of Jerusalem | Stein-Zamir C.,Jerusalem District Health Office | Ackerman Z.,Hebrew University of Jerusalem
Breastfeeding Medicine | Year: 2012

Breastmilk specimens from three women with acute hepatitis A virus (HAV) infection were studied. Anti-HAV immunoglobulin M and immunoglobulin G antibodies were detected in serum and breastmilk specimens of the three women. The three women also had serum HAV RNA. However, HAV RNA was detected only in two of the three breastmilk specimens. It is interesting that none of the three infants contracted clinical HAV infection. Furthermore, mothers with HAV infection should not be encouraged to discontinue breastfeeding. © 2012, Mary Ann Liebert, Inc.


PubMed | Hebrew University of Jerusalem, Public Health Service and Jerusalem District Health Office
Type: Journal Article | Journal: International journal of public health | Year: 2016

Using cost-utility analysis, to evaluate whether or not to adopt a Neisseria meningitidis serogroup B vaccination programme for Israeli children.Epidemiological, demographic, health service utilisation and economic data were integrated into a spreadsheet model to calculate the cost per averted disability-adjusted life year (DALY) of the intervention.Assuming 78% vaccine efficacy with no herd immunity, vaccination will prevent 223 cases and 22 deaths over a 100-year period. Based on vaccine price of $60 per dose, total intervention costs ($315,400,000) are partially offset by a $22,700,000 reduction in treatment and sequelae costs as a result of decreased morbidity. The intervention was not cost-effective since the net cost ($292,700,000) per averted DALY gained (1249 mostly due to decreased mortality) was $234,394. Additional two dose catch-up programmes vaccinating children in cohorts aged 1-2 to 1-13 were also not cost-effective.The vaccination will become cost-effective if vaccine costs fall below $19.44 per dose. However, in identified high risk areas, the vaccine would be cost-effective and could be recommended for use both with and without catch-up campaigns.


PubMed | Hebrew University of Jerusalem and Jerusalem District Health Office
Type: Journal Article | Journal: Vaccine | Year: 2015

Pertussis is a contagious bacterial disease causing substantial health burden. Pertussis-related morbidity and mortality are highest in young infants. We investigated risk markers for pertussis and vaccination status in infants.Reported pertussis cases under one year old during 1998-2011 in the Jerusalem district were matched to controls by birthdate and residence. Data sources included epidemiological investigations, health records and vaccination records (number and dates of DTP\DTaP doses scheduled at 2, 4, 6 months). Vaccine effectiveness was calculated by number of vaccine doses stratified by age group. Timeliness of vaccine doses was also evaluated.The study population included 1268 infants under 1 year: 317 pertussis cases and 951 age-matched controls (mean age 3.953, median 2.9 months). Low birthweight (<2500g, 12.3% in cases vs. 6.3% in controls) and high birth order (4th and above) were found to be independent risk markers. Male gender and low socio-economic status were more frequent among cases. Some 40% of the cases (127/317) were hospitalized, most of them (111/127, 87.4%) were under 4 months (mean age 2.422.05, median 1.8 months). The distribution of the number of pertussis vaccine doses 0, 1, 2 and 3 differed considerably being 42.2%, 32.7%, 15.6%, 9.5% vs. 13.7%, 41.9%, 22.9%, 21.5% among cases and controls (2m), respectively. The overall vaccine effectiveness found was 72.9%, 76.1% and 84.4%, for the 1st, 2nd and 3rd doses of a pertussis vaccine. The infants age at the first dose of pertussis vaccine was recorded with follow-up until age 18 months. Delay was more common among cases with a lower proportion vaccinated-78.9% at 18 months vs. 99% in controls.Specific risk markers for pertussis in young infants were identified. Reported pertussis cases over age 2 months were significantly more likely to be unvaccinated and have delayed vaccinations. The vaccine effectiveness increased with the number of vaccine doses.


Braustein H.E.,Tel Aviv University | Braustein I.E.,Jerusalem District Health Office
ECS Transactions | Year: 2013

There is a growing need for virus-detecting sensors with improved sensitivity and dynamic range, for applications including disease diagnosis, pharmaceutical research, agriculture and homeland security. We report a novel electrochemical biosensing method for improving the sensitivity for detection of the bacteriophage virus MS2, using nanoporous oxirane-derivatized beads. These beads are a commercial polymethyl-metacrylate (PMMA) polymer that has extremely high surface area to volume ratio, making it an ideal platform for surface based sensors. We have developed and evaluated a method for covalent bioconjugation of antibodies and biological support to polymeric beads. The resulting Solid State Kits (SSK) were used to selectively capture enzyme-labeled MS2 viruses from different solutions, enabling detection of a viral concentration of as low as 10 plaque-forming units per milliliter (pfu ml-1) by measuring the current (A) from the exposed SSK beads to the enzymatic reaction electrons movement not clear. The kit is connected to a "home made" designed micro-flow system, that exhibits sensitivity and dynamic range similar to the ELISA immuno-liquid array-based assay while outperforming protein micro-array methods. Immuno-Amperometric techniques, using nano-Bio-Polymers Solid Phase Disposable Kit, were used to measure and thus to validate the accuracy of novel technology for virus concentration determination. These work demonstrate the utility of immunoelectrochemical techniques for use in environmental-health quality assurance measurements of viruses. © 2014 The Electrochemical Society.


Stein-Zamir C.,Jerusalem District Health Office | Shoob H.,Jerusalem District Health Office | Abramson N.,Jerusalem District Health Office | Zentner G.,Jerusalem District Health Office
Epidemiology and Infection | Year: 2012

We investigated a measles outbreak in the Jerusalem district in 2007-2008 (992 cases). Most cases (72.6%) were aged <15 years, 42.9% aged <5 years, and 12.8% were infants aged <1 year. The peak incidence rate was in infants aged 6-12 months (916.2/100 000). This represents a significant shift from former outbreaks in 2003-2004, where the peak incidence was in the 1-4 years age group. Of children aged <5 years the proportion aged 6-12 months tripled (7.7% vs. 25.6%). In a case-control study (74 cases, 148 controls) children who developed measles were less likely to be registered in a well-baby clinic and had lower overall immunization coverage. The differences in proportions for registration, DTaP3 and MMR1 coverage were 35.1%, 48.6% and 80.8%, respectively (all P<0.001). Rising birth order of cases and their siblings was associated with non-registration and non-compliance with MMR immunization. The vulnerability of young infants and the risk markers noted above should be taken into account in planning intervention programmes. © 2011 Cambridge University Press.


Stein-Zamir C.,Jerusalem District Health Office | Shoob H.,Jerusalem District Health Office | Abramson N.,Jerusalem District Health Office | Zentner G.,Jerusalem District Health Office
Vaccine | Year: 2010

Background: Pertussis remains a cause of considerable morbidity in children worldwide. Due to the resurgence of the disease, two vaccine doses for schoolchildren were added to the routine Israeli schedule. In 2005 a 5th dose was introduced for second-graders (aged 7-8), and in 2008 an additional catch-up dose in the eighth grade (13-14 year-olds). Methods: Population-based epidemiologic study of pertussis in the Jerusalem district. Results: 1736 pertussis cases were reported from 1990 to 2009. The pertussis incidence rates increased sharply from 2.6/100,000 in 1990, to 10/100,000 in 2000, peaking at 28.8/100,000 in 2006, then declining to 22/100,000 in 2008 and to 15.7 in 2009 (2006 vs. 2009, p= 0.0001). Most cases (74.4%, 1134/1524 during 1998-2009) were under 20 years. Infants under one year had the highest average incidence rate (72.3/100,000; 12.5% of cases); specifically those under 6 months (84.3% of cases under one year). The case distribution among 1-4, 5-9, 10-14, and 15-19 year-olds was: 11%, 18%, 24.1%, and 8.9%. The vaccination status (age-appropriate) was: unvaccinated - 19.2%, partially vaccinated - 7.6%, and fully vaccinated - 73.2%. The overall hospitalization rate was 5.4%; infants - 33.5%. Household transmission occurred in 16.1% of cases.The two age groups showing significant decline were children aged 5-9 (61.5% reduction) and 10-14 years (73.9% reduction); there is as yet no significant decline in other age groups. Conclusions: The recent marked decline in pertussis incidence among the 5-14 year-olds is encouraging. Young infants still constitute a significant disease burden, and the incidence in this age group should be followed closely. © 2010 Elsevier Ltd.

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