Modeling the spread of polio in an IPV-vaccinated population: lessons learned from the 2013 silent outbreak in southern Israel.

BACKGROUND: Polio eradication is an extraordinary globally coordinated health program in terms of its magnitude and reach, leading to the elimination of wild poliovirus (WPV) in most parts of the world. In 2013, a silent outbreak of WPV was detected in Israel, a country using an inactivated polio vaccine (IPV) exclusively since 2005. The outbreak was detected using environmental surveillance (ES) of sewage reservoirs. Stool surveys indicated the outbreak to be restricted mainly to children under the age of 10 in the Bedouin population of southern Israel. In order to curtail the outbreak, a nationwide vaccination campaign using oral polio vaccine (OPV) was conducted, targeting all children under 10. METHODS: A transmission model, fitted to the results of the stool surveys, with additional conditions set by the ES measurements, was used to evaluate the prevalence of WPV in Bedouin children and the effectiveness of the vaccination campaign. Employing the parameter estimates of the model fitting, the model was used to investigate the effect of alternative timings, coverages and dosages of the OPV campaign on the outcome of the outbreak. RESULTS: The mean estimate for the mean reproductive number was 1.77 (95 % credible interval, 1.46-2.30). With seasonal variation, the reproductive number maximum range was between zero and six. The mean estimate for the mean infectious periods was 16.8 (8.6-24.9) days. The modeling indicates the OPV campaign was effective in curtailing the outbreak. The mean estimate for the attack rate in Bedouin children under 10 at the end of 2014 was 42 % (22-65 %), whereas without the campaign the mean projected attack rate was 57 % (35-74 %). The campaign also likely shortened the duration of the outbreak by a mean estimate of 309 (2-846) days. A faster initiation of the OPV campaign could have reduced the incidence of WPV even if a lower coverage was reached, at the risk of prolonging the outbreak. CONCLUSIONS: OPV campaigns are essential for interrupting WPV transmission, even in a developed country setting with a high coverage of IPV. In this setting, establishing ES of WPV circulation is particularly crucial for early detection and containment of an outbreak.

Silent reintroduction of wild-type poliovirus to Israel, 2013 - risk communication challenges in an argumentative atmosphere.

Israel has been certified as polio-free by the World Health Organization and its routine immunisation schedule consists of inactivated poliovirus vaccine (IPV) only. At the end of May 2013, the Israeli Ministry of Health (MOH) has confirmed the reintroduction of wild-type poliovirus 1 into the country. Documented ongoing human-to-human transmission necessitated a thorough risk assessment followed by a supplemental immunisation campaign using oral polio vaccine (OPV). The unusual situation in which ongoing poliovirus transmission was picked up through an early warning system of sewage monitoring without active polio cases, brought about significant challenges in risk communication. This paper reviews the challenges faced by the MOH and the communication strategy devised, in order to facilitate and optimise the various components of the public health response, particularly vaccination. Lessons learned from our recent experience may inform risk communication approaches in other countries that may face a similar situation as global polio eradication moves towards the 'End game'.

Insidious reintroduction of wild poliovirus into Israel, 2013.

Israel was certified as polio-free country in June 2002, along with the rest of the World Health Organization European Region. Some 11 years later, wild-type polio virus 1 (WPV1) was isolated initially from routine sewage samples collected between 7 and 13 April 2013 in two cities in the Southern district. WPV1-specific analysis of samples indicated WPV1 introduction into that area in early February 2013. National supplementary immunisation with oral polio vaccine has been ongoing since August 2013.

Ongoing African measles virus genotype outbreak in Tel Aviv district since April, Israel, 2012.

A measles outbreak is affecting the Tel Aviv district, Israel, since April 2012. As of 10 September, 99 cases were confirmed, including 63 (64%) migrants of Eritrean and Sudanese origin. All genotyped cases had the African B3 genotype*. The mean age of migrant and non-migrant cases was 6.0±9.6 and 30.2±24.2 years, respectively (p<0.001). The majority of both migrant and non-migrant cases was unvaccinated. This is the second African measles B3 genotype outbreak within the World Health Organization European region in 2012.

Surveillance of West Nile virus disease, Tel Aviv district, Israel, 2005 to 2010.

We present the findings of a six-year surveillance period (2005­2010) of human West Nile virus (WNV) infection in Tel Aviv district, Israel. Initial notifications of positively identified patients received from the Central Virology Laboratory were followed by epidemiological investigations of the local district health office. During 2005­2010, 104 patients, 79 with WNV neuroinvasive and 25 with WNV non-neuroinvasive disease were reported. The median age of the patients with a neuroinvasive disease was 74 years (range: 15 to 95 years) and 53 of such patients had encephalitis, 14 had acute flaccid paralysis, and 12 had meningitis. The case-fatality rate in these patients was 8%. The average annual incidence of neuroinvasive disease during 2005­2010 was 1.08 per 100,000 population. The incidence declined by 86% steadily between 2005 and 2009 (p for trend=0.005), but increased by more than six-fold in 2010. Elderly (≥65 years) men, comprising 25 patients of whom 24 were chronically-ill, had the highest incidence of WNV encephalitis <0.001). These findings are concordant with previous data, at the national level, published in Israel and the United States. Notably, the percentage of previously healthy patients, who developed a neuroinvasive disease was the highest (37%, p=0.001) in the surveillance period in 2010.

Relapsing vivax malaria cluster in Eritrean refugees, Israel, June 2010.

We report on a cluster of relapsing vivax malaria among Eritrean refugees residing in Israel. Since the beginning of 2010, 15 cases have been identified. Five of the six patients who had complete medical and epidemiological histories, reported Sudan as the place of primary infection during their journey to Israel, and having had the first relapse in Israel, six months later (median). Suggested place of exposure is the region of the Eritrean refugee camps in Sudan.

Comparing early embryo mortality in dairy cows during hot and cool seasons of the year.

The objectives of this study were to identify the level and stage of embryonic mortality that occur in dairy cows during hot and cool seasons of the year. Experimental dairy cows, of varying ages, were artificially inseminated with frozen-thawed semen from proven Holstein sires. Females on each dairy unit were then randomly allocated to one of three experimental groups after partitioning by day of artificial insemination, days post partum, parity, and current milk production level. In Group I and Group II, nonsurgical embryo collection was performed on each cow using Dulbecco's phosphate-buffered saline as the flushing medium. Embryos from cows in Group I were collected on Days 6 or 7 post insemination during the hot (n=93) and cool (n=64) seasons. Embryos from cows in Group II were collected on Days 13 or 14 post insemination during the hot (n=97) and cool (n=63) seasons. In Group III, contemporary control cows were also inseminated during the hot (n=106) and cool (n=106) seasons, and fetal heart beat was evaluated via ultrasound between Days 25 and 35 following insemination. Embryo viability decreased (P<0.05) from 59% at Day 7 to 27% at Day 14 in the hot season, but was not decreased during the cool season (52 vs. 60%). Pregnancy rate at Days 25 to 35 was 21% in the hot season, which was less (P<0.05) than the 36% in the cool season. The percentage of unfertilized ova collected in both the hot and cool seasons suggests that fertilization failure was not affected by season of breeding. In summary, embryonic loss after Day 7 of pregnancy appears to be a problem in this hot, dry climate.

Evaluating two different evaporative cooling management systems for dairy cows in a hot, dry climate.

Milk production, rectal temperature, live weight gain, reproductive performance, and weather data were obtained on 150 Holstein cows managed under two cooling systems on a large dairy farm in Saudi Arabia during the summer months. Cows were paired at the onset of the trial according to days postpartum, lactation number, and current milk production. Females were then allocated either to a system that forced air, precooled by evaporative cooling, over the cows or to a system that alternately showered a fine mist onto the surface of the cows and then forced air at ambient temperature over them. The cows receiving evaporative cooling and those with spray and fan cooling were on sand and on slatted concrete floor, respectively, during the periods of cooling. The onset of estrus was observed during the night when the cows preferred the unshaded corral. For the 120-d trial period, 84% (62 of 75) of the cows receiving evaporative cooling and 60% (44 of 75) of the cows receiving spray and fan cooling became pregnant. In the evaporative cooling system, the pregnancy rate per insemination was 35.2% (179 inseminations) versus 23.2% (194 inseminations) for spray and fan cooling. The mean postpartum interval to pregnancy was 117.6 d for the evaporative cooling cows and 146.7 d for spray and fan cooling cows. The evaporative cooling system, with its open shades and sand bedding, enhanced reproductive performance and milk production compared with that of cows cooled with a spray and fan system with slatted flooring in this hot climate.

Pregnancy rates in dairy cows following the administration of a GnRH analogue at the time of artificial insemination or at mid-cycle post insemination.

Lactating Holstein dairy cows (n=1,533) were allocated to one of three treatment groups, with Group I (n=514) receiving 10 microg of a GnRH analogue (buserelin) at artificial insemination (AI) and Group II (n=503) receiving 10 microg of the same analogue at both the time of AI and at 12 days post AI. Herdmates in Group III (n=516) were inseminated on the same day and served as contemporary AI controls. The trial was conducted on five large dairy farms during the spring and summer months in Saudi Arabia. Pregnancy rates were determined by palpation per rectum between 33 and 50 days following AI. The first service pregnancy rate for the control cows (42.4%) was lower (P<0.05) than that for cows treated with the GnRH analogue at AI (48.8%) or for the combined treatment at AI and at Day 12 post AI (51.5%). No additive effect on the pregnancy rate was noted from the combined analog treatment. The overall increase in pregnancy rate from the analogue treatment at AI resulted from an 11% increase in pregnancy rate in first parity cows over that of contemporary controls (P<0.05) and a 14.7% increase in pregnancy for cows mated at 40 to 59 days post partum and treated with the analogue at AI over that of the corresponding controls (P<0.05). The pregnancy rates from repeat AI (interval

[Does chronic therapy of hypertension with acebutolol or hydrochlorothiazide effect coronary risk factors?]. / Czy leczenie nadcisnienia tetniczego acebutololem lub hydrochlorotiazydem nasila biochemiczne czynniki zagrozenia choroba wiencowa?

In 78 patients with mild or moderate hypertension, effect of acebutolol and hydrochlorothiazide on plasma lipids, lipoproteins, fibrinogen and plasma fibrinolysis time were investigated. 42 patients were treated with acebutolol for 18 months and 36 with hydrochlorothiazide for 24 months. It was shown that neither acebutolol nor hydrochlorothiazide induced significant alterations in investigated biochemical risk factors. The possible causes of controversy encountered in literature and analysis of factors which may influence the character and severity of metabolic disorders resulting from antihypertensive therapy were discussed.