What do we need to learn for policy decision-making on sexually transmitted infections prevention and treatment in Israel?

The rising trend of sexually transmitted infections (STIs) reported in several western countries has also affected Israel. To review epidemiological trends and to address additional issues needed for a wider overview on STIs in Israel, we analysed notified data on infectious syphilis, gonorrhoea, Chlamydia trachomatis and HIV/AIDS during 1998-2007, by age groups, and each available publication on STIs in Israel. The trend of each disease had a unique pattern, probably influenced by different screening procedures, case definition, mix of populations and better access to care for high-risk populations. Higher rates were found among patients aged 25-34 years. Rates found in different peak years for gonorrhoea, HIV, chlamydia and infectious syphilis reached 43.6, 18.9, 10.8 and 8.1 cases per 100,000 population, respectively. We compare trends to those of countries from World Health Organization (WHO) European Region and discuss interventions for subpopulations on which additional data are needed for evidence-based policy-making. Incidence rates of syphilis, gonorrhoea, chlamydia and HIV/AIDS are still low in Israel. We propose additional components needed for a more comprehensive evidence-based policy on STIs.

The fall and rise of gonorrhoea incidence in Israel: an international phenomenon?

BACKGROUND: There is evidence of a recent resurgence of the incidence of gonorrhoea in some countries. AIM: To examine trends in gonorrhoea incidence in Israel and compare them with the United States and countries in Europe METHOD: The 1967-2001 annual incidence of gonorrhoea in Israel was obtained from the Israel Ministry of Health's department of epidemiology and for the United States from summary reports of the Centers for Disease Control. The incidence of gonorrhoea in European countries was extracted from the World Health Organization, Health for All database. RESULTS: In Israel, following a long period of decline from 40 per 100 000 in 1970 to 0.74 per 100 000 in 1997, incidence rates began to increase in 1998 to 13.8 per 100 000 in 2001. This pattern parallels those observed in a number of European countries and to some extent, in the United States. Most reported morbidity in Israel occurs among males aged 20-44 years. CONCLUSIONS: The resurgence of gonorrhoea does not appear to be explained solely by behavioural changes. Transmission of the disease should be further studied among different subpopulations in order to develop new prevention strategies.

[Transitory changes in public and physician behavior following the reappearance of human rabies in Israel].

Three Israelis died of rabies in a single year following a hiatus of almost 40 years since the last case of human rabies in Israel. These tragic deaths from a uniformly lethal disease, preventable by correct post-exposure treatment, were highly publicized in the mass media and led to substantial public anxiety and professional concern. In this investigation we examine public response, as well as changes in the behavior of public health physicians responsible for human rabies control, in the face of the reappearance of human rabies in Israel. In the weeks following each new case of human rabies, animal-contact visits to public health offices increased five-fold, and public health physicians initiated post-exposure prophylaxis in 25% of all applicants, compared to 10% in the no-rabies era. Together, these changes in public and professional behavior led to marked increases in rabies vaccine and rabies immune globulin consumption, and resulted in severe shortages necessitating strict rationing. Within four months of the last case, population and physician behavior had returned to baseline levels. Rabies prevention is a multi-level activity involving eliminating stray animals, immunization of pets, oral immunization of selected wild animal populations, pre-exposure immunization of persons at very high exposure risk and rapid evaluation and appropriate treatment of humans following exposure. Moreover, the public must be educated to avoid potentially dangerous animal contacts and to seek immediate professional guidance after an accidental exposure has occurred.

West Nile fever outbreak, Israel, 2000: epidemiologic aspects.

From August 1 to October 31, 2000, 417 cases of West Nile (WN) fever were serologically confirmed throughout Israel; 326 (78%) were hospitalized patients. Cases were distributed throughout the country; the highest incidence was in central Israel, the most populated part. Men and women were equally affected, and their mean age was 54+/-23.8 years (range 6 months to 95 years). Incidence per 1,000 population increased from 0.01 in the 1st decade of life to 0.87 in the 9th decade. There were 35 deaths (case-fatality rate 8.4%), all in patients >50 years of age. Age-specific case-fatality rate increased with age. Central nervous system involvement occurred in 170 (73%) of 233 hospitalized patients. The countrywide spread, number of hospitalizations, severity of the disease, and high death rate contrast with previously reported outbreaks in Israel.

The efficacy of naltrexone in preventing reabuse of heroin after detoxification.

The efficacy of Naltrexone in preventing reabuse of heroin among heroin addicts in Israel was studied in a double-blind, controlled design. Naltrexone (or placebo) treatment was given as part of a general treatment plan that continued for 12 weeks. Thirty-two addicts who successfully completed a detoxification program and met research criteria, were included in the study. Fifty milligrams of Naltrexone were taken orally three times a week (25 mg twice a week for the first 2 weeks). The follow-up procedure included an interview, urine tests, and screening for possible adverse effects. In addition, social and psychological parameters were evaluated. Fewer heroin-positive urine tests were found the Naltrexone group than in the placebo group. Throughout the entire study, the number of drug-free patients in the Naltrexone group was higher than in the placebo group. The Naltrexone group showed a significant improvement in most psychological parameters as compared with the placebo group. No differences were found in compliance or ratio of adverse effects between the Naltrexone and placebo groups. The concept "heroin abuse load" based on daily heroin consumption and duration of addiction enabled us to predict which addicts would complete the treatment program. The results suggest that heroin addicts in Israel may benefit from treatment with Naltrexone.