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During a national measles outbreak in 2018–2019, the Tel Aviv District suffered a major upsurge of cases, with 413 patients reported. Among them, 100 (24%) were <1 year, 92 (22%) patients were aged 12 months to 4 years, 47 (11%) were 5–18 years, 169 (41%) were 19–60 years, and 5 (1%) patients were older than 61 years (born before 1957). Among all cases, 230 (56%) were part of the Ultra-Orthodox Jewish community, 55 (13%) were among undocumented African immigrants. Despite high vaccination coverage, sustained measles transmission occurred, due in part to importations and numerous exposures in medical settings by a susceptible birth cohort. The Ultra-Orthodox Jewish community was particularly afflicted due to its condense population, high birth rates, and multiple exposures in crowded religious settings. This outbreak demonstrates the necessity of addressing immunity gaps as well optimal healthcare planning in order to prevent future outbreaks. [ABSTRACT FROM AUTHOR]

To the Editor: We report 2 cases of possible recurrent laboratoryconfi rmed infection with pandemic (H1N1) 2009 virus in Israel. Patient 1, a 24-year-old man, had Noonan syndrome (1,2). He [...]

To the Editor: We report results of an active surveillance system established by the Tel Aviv District Health Office in Israel. This surveillance system monitors the daily status of patients [...]

On August 6, 2017, the Israeli Defense Force Public Heath Branch (IDFPHB) was notified of two suspected measles cases. IDFPHB conducted an epidemiologic investigation, which identified nine measles cases in a population with high measles vaccination coverage. All measles patients had signs and symptoms consistent with modified measles (i.e., less severe disease with milder rash, fever, or both, with or without other mild typical measles symptoms). A total of 1,392 contacts were identified, and 162 received postexposure prophylaxis (PEP) with measles-mumps-rubella (MMR) vaccine; the remaining contacts were followed for 21 days (one incubation period). No tertiary cases were identified., Competing Interests: All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Background: A survey of winter morbidity revealed a high incidence of childhood influenza. A clinical, virologic and economic survey of childhood influenza morbidity was conducted to characterize this morbidity., Methods: Incidence of respiratory disease and influenza-like symptoms was determined among 9,300 children in the Tel Aviv area in the 1997-8 influenza season, and viral cultures performed from nasal swabs. A telephone survey was conducted among the patients' families to determine the family dynamics of the illness and the number of working days lost., Results: Among the study population, 38% had influenza-like symptoms. The highest incidence was among kindergarten and school-age children. Upper respiratory tract infections (URTI) were common in the 0-2 years age group (27.4%). In contrast, 83% of children with influenza-like illness (ILI) were aged 3-15 years (p < 0.01). Of 180 valid viral culture samples, 93 (51%) were positive for influenza, which represents 22% of all children surveyed. Extrapolation to a national level reveals that of approximately two million children in the country, 440,000 would have positive laboratory evidence of influenza infection. In 49 of 52 (90%) families surveyed, the child was the initial patient in the household, and, on average, 66% of family members became ill. The average income lost was NIS 300 per family; at a national level that extrapolates to a loss of NIS 132 million., Conclusions: Influenza-like illness is common among children, particularly in the peak period of influenza activity. As opposed to upper respiratory infections, influenza-like disease is particularly common in the 3-15 year age group (kindergarten and school age). The incidence of children diagnosed with influenza (22%) is much higher than in the general population. Children are the first in the family to become ill and infect other family members. Cost-effectiveness analysis justifies mass childhood influenza immunization.

Background: Food-borne pharyngitis outbreaks causing substantial morbidity have been documented., Objectives: To investigate an outbreak of food-borne Streptococcus beta hemolyticus group A pharyngitis among employees of a hitech company., Methods: We received a report on an unusually high rate of morbidity among employees of a company in September 2003. The Tel Aviv District Health Office conducted an epidemiological investigation of the outbreak., Results: Among the 278 people who attended a company party, 83 became ill. The overall attack rate was 29.8%. Information was available on 174 of 193 employees and family members who attended the party and worked in the Tel Aviv district. Forty-six of them became ill (attack rate 26.4%). The secondary attack rate was 3.8%. Most cases developed symptoms 24-48 hours following the event. Seven cases had throat cultures positive for Streptococcus beta hemolyticus group A. Three items were significantly associated with becoming sick: spring chicken (odds ratio 2.26, 95% confidence interval 1.11-4.63, P = 0.02), vegetable salad (OR 2.88 95% CI 1.40-5.94, P = 0.003) and corn (OR 7.73, 95% CI 3.18-18.80, P < 0.001). Eating corn remained significantly associated with pharyngitis after controlling for other food items consumed., Conclusions: We describe the epidemiological investigation of a large food-borne outbreak of Streptococcus beta hemolyticus group A pharyngitis most probably transmitted by corn. No previous publication has implicated corn. Food handlers and the public should be aware that they can transmit diseases to others. Physicians should be aware that streptococcal pharyngitis could be a foodborne disease and that outbreaks in a non-confined setting may be easily missed.