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Introduction: Helminth infection has a profound effect on the immune system. However, the precise nature of the immune changes that are elicited by helminth infection have not been sufficiently characterized. Furthermore, the reversibility of these changes after treatment has not been documented sufficiently. We studied the immune profiles of Ethiopian immigrants to Israel at baseline, that is on arrival and at one-year follow-up and compared individuals who received antihelminthic treatment during the study period with those who missed the treatment. Methods: A longitudinal follow up study involving different groups of subjects was conducted. Baseline data was recorded from the newly arrived Ethiopian immigrants for a series of peripheral blood tests, including: IgE and Eosinophil levels, T-cell populations, T-cell receptor phenotypes, and cytokine measurement. These tests were all repeated after a 1-year interval. Results were compared between the newly arrived Ethiopian immigrants (NEW-Eth-Il), long term Ethiopian immigrants (LT-Eth-Il), and non Ethiopian Israeli controls (NON-Imm-Il). Results: Of the 184 individuals, 111 were NEW-Eth-Il, who had a high prevalence of helminth infection, the immunological changes were elevated IgE levels and eosinophil counts, decreased CD4/CD8 ratio, increased proportion of HLA-DR+CD3+, HLA-DR+CD4+ and HLA-DR+CD8+ cells, decreased proportion of CD45RA+CD4+ (naive) and CD28+CD8+ cells, increased proportion of CD45RO+CD4+ (memory) cells, and increased secretion of IL-4 and IL-5 (Th2 type cytokines). In the 42 LT-Eth-Il participants, who all had negative tests for helminth infection, we did not observe these immune changes and their immune profile did not differ markedly from that of the NON-Imm-Il controls. The follow-up immune profiles of 33 NEW-Eth-Il who received succesful antihelminth treatment, showed a significant normalization in the above-mentioned variables that was not observed in the 19 NEW-Eth-Il who missed and did not receive the antihelminth treatment. Conclusions: These findings demonstrate that helminth infection is associated with profound immune changes that are normalized within a short time after helminth eradication. They also strengthen the hypothesis that effective antihelminth interventions, in areas endemic for intestinal helminths, may have an impact on AIDS and tuberculosis epidemics.

Helminth infection may be protective against allergy and account for the low prevalence of allergy in developing countries. We studied prospectively the prevalence of allergy in Ethiopian immigrants with heavy helminth infection on arrival in Israel, and again after a year of adjustment to an urban industrialized setting, to explore the roles of helminth infection, changed environment and background immunity on the manifestations of allergy. 126 newly arrived Ethiopian immigrants were studied at baseline and 115 after a year of follow up in Israel. Allergic symptoms, Skin prick tests (SPT), Tuberculin (PPD) skin tests, stool and blood samples were obtained for determining parasites, blood IgE and eosinophil levels, respectively. Anti-helminthic therapy was offered to the entire infected individuals, but only 50/108 (46.3%) took the medication. At baseline, there was a significant negative association between helminth infection and allergy, 4/18 (22.2%) of uninfected participants were allergic compared to 7/108 (6.5%) of helminth-infected participants (p = 0.028), as well as between helminth infection and SPT reactivity, 12/18 (66.6%) of uninfected participants compared to 43/108 (39.8%) of helminth-infected participants (p = 0.033). After one year, a significant general increase in allergy and SPT was observed. While only 11/126 (8.7%) were allergic at baseline, 30/115 (26.1%) became allergic at follow-up (p, Author Summary The role of intestinal parasitic infections in allergy is of great interest since it has been suggested that they suppress the development of allergy. Urbanization has also been claimed to cause allergy because of air pollution and higher exposure to allergens. The present study took advantage of the special opportunity presented by the recent Ethiopian immigration to Israel in order to study this question. A cohort of newly arrived Ethiopian immigrants to Israel, highly infected with parasites, was studied prospectively for the presence of allergy and response to allergens on arrival and after a year of follow up in Israel. The results showed clearly a significant inverse association between the presence of parasitic infections and allergy on arrival, while after a year of living in Israel, accompanied by a lowered parasitic infection load, a general increase of allergy was observed in all immigrant groups, and not only in those that had parasitic infections on arrival. These results lend support to the suppressive effect of intestinal parasites on allergy, but suggest that additional factors, most probably environmental, also play a role in the generation of allergy.

Stage A 27-year-old man was hospitalized in late September 1998 with a three-day history of low-grade fever and malaise accompanied by a nonproductive cough, without dyspnea, chills, dysuria, or diarrhea. He also had a pruritic rash covering the gluteal region. The rash and itching had started about two weeks earlier, during the last week of a month-long vacation on the coast of Thailand, and had increased in intensity despite topical treatment with fusidic acid (Fucicort) cream and calamine lotion. Two days before the patient was admitted, a dermatologist in Israel had diagnosed folliculitis and prescribed 2 g of cephalexin daily. . . .

On 21st November 1916, the Royal Navy Hospital ship 'Britannic' (the sister ship of the 'Titanic') was torpedoed near the island of Kea in the Aegean Sea. Captain Dr. John Cropper, aged 52, was one of 30 people who drowned of the 1100 on board. Dr. Cropper was born in 1864, at Guisborough, England. He obtained his medical degree from Cambridge University in 1891. After his marriage to Anne Ellen Walker in 1895, the Church Missionary Society sent him on a medical mission to Palestine. Dr. Cropper stayed in Palestine for about 10 years working in Acre, Nablus, Ramallah and Jerusalem. He published his experiences in 35 articles and letters in English medical periodicals, more than anyone else did in Palestine at that time. In those publications, he described various operations that he carried out and observations on infectious diseases, most of which were the first descriptions from that remote and unhealthy country. His prominent research was in the field of malaria - the most common and important disease in Palestine during that period. It was less than two years after Grassi's discovery of the role of Anopheles mosquitoes as the vector of human malaria that Dr. Cropper carried out surveys of larval and adult mosquitoes in correlation with malarial distribution in Palestine. Dr. Cropper was the first who routinely examined slides microscopically in Palestine and correctly diagnosed the type of malaria. Dr. Cropper was also the first in Palestine to suggest antimalarial measures aimed directly at the mosquito vector and paid attention to ecological aspects such as breeding places and the daily behavior of adult mosquitoes. Dr. Cropper noted the common antimalarial measurements of that time, such as covering of wells, planting of Eucalyptus trees to drain swamps and the routine use of quinine as a preventive medicine, but he wrote that those measures were not effective under the local conditions. He suggested that the only effective measures must be aimed against the larval mosquitoes and he recommended the use of a sulphur compound in order to destroy the larvae. Only many years later were those observations recognized as being correct. In our local public scientific memory, we remember early researchers such as Dr. Hillel Jaffe, Prof. Peter Muehlens, Prof. Israel Kligler, Prof. Gideon Mer, Dr. Zvi Saliternik and many others. Dr. Cropper preceded all of them. The comprehensive contributions of this English doctor to the medical research in Palestine should not be forgotten.

Since 1984, several waves of Ethiopian immigrants have settled in Israel. On arrival they were found to be highly infected with intestinal parasites and to have increased serum immunoglobulin E and eosinophilia.To study serum IgE levels in Ethiopian children growing up in the environment of Israel.We assessed four groups of children of Ethiopian origin: a) adolescents examined on their arrival to Israel (group 1, n=11); b) adolescents born in Ethiopia and living in Israel for more than 7 years (group 2, n=10); c) children of Ethiopian origin born in Israel, without a history of allergy or asthma (group 3, n=15); and d) asthmatic children of Ethiopian origin born in Israel (group 4, n=8). A thorough clinical interview and examination as well as laboratory work up (including serum IgE levels, stool parasites and absolute eosinophil count) were performed.Group 1 (11 newly arrived Ethiopian adolescents) had a mean eosinophil count of 688 cells/ml (0-1739) and a mean serum IgE of 1043 IU/ml (253-2932), P0.0009 as compared to group 2. Helminthic parasites were observed in 8/11 individuals; after 1 year of follow-up and anti-parasitic treatment, serum IgE levels did not change significantly. Group 2 (10 Ethiopian born adolescents living in Israel for on average 10 years, 7-15 years) had a normal leukocyte count, MEC 192 cells/ml (range 54-289), serum IgE 142 IU/ml (range 14-399 IU/ml) and no parasites in stool. Group 3 (15 Ethiopian children born in Israel) had a normal leukocyte count, MEC 128 cells/ml (0-324), serum IgE 55 IU/ml (7-189 IU/ml), similar to age-matched Israeli controls. In group 4 (8 Israeli born children of Ethiopian descent diagnosed with asthma), serum IgE showed significant elevation compared to Israeli age-matched asthmatic children (P0.005).High levels of IgE found in Ethiopian children on arrival to Israel declined to Israeli control levels after several years of living in the new environment. Ethiopian children born in Israel had normal levels of IgE, suggesting that environment is the main factor affecting IgE levels in this population. Israeli born Ethiopian children with asthma had significantly increased serum IgE levels compared to asthmatics of Israeli origin. These findings suggest that both environmental and genetic factors determine the level of serum IgE in these children.

Onchocerciasis results from infestation by the nematode Onchocerca volvulus, and is characterized clinically by troublesome itching, skin lesions and eye manifestations. Since 1992, approximately 9,000 immigrants have arrived in Israel from the Kuwara province of northwest Ethiopia where the prevalence of onchocerciasis is particularly high.To determine whether onchocerciasis is the cause of cutaneous and ocular symptoms among recent immigrants from the Kuwara province in Ethiopia.We examined 1,200 recent immigrants from the Kuwara province residing at the Mevasseret Zion immigration center outside Jerusalem. Among them, patients with cutaneous signs suggestive of onchocerciasis underwent a skin-snip biopsy and a thorough eye examination.In the detailed skin examination performed in 83 patients, the most common skin finding was chronic papular onchodermatitis, found in more than 46 patients (55%); depigmentation and atrophy was found in 13 (15%) and 12 (14%), respectively. In 40 patients (48%), living microfilaria were detected in their skin snips. Of the 65 patients who underwent a through eye examination, 45 patients (66%) had ocular complaints. Corneal abnormalities were found in 55 of the 130 eyes (42%), active anterior segment intraocular inflammation and live microfilariae were found in 4 eyes (3%) and lens changes in 16 eyes (1%). Eleven eyes (9%) showed retinal or choroidal changes.Skin and eye manifestations associated with onchocerciasis are prevalent among symptomatic Ethiopians who immigrated to Israel from the Kuwara province.

Although a significant resurgence of malaria in Israel is unlikely at present, the risk for a localized outbreak of malaria cases due to infection of local anopheline mosquitoes by imported cases does exist. A national computerized surveillance system of breeding sites of Anopheles mosquitoes and imported malaria cases was established in 1992 using a geographic information system (GIS). Distances between population centers and breeding sites were calculated, and maps associating epidemiologic and entomologic data were generated. Risk of malaria transmission was assessed with consideration of vectorial capacity and flight range of each Anopheles species. The GIS-based surveillance system ensures that if a localized outbreak does occur, it will be associated rapidly with a likely breeding site, a specific Anopheles vector, and a probable human source, so that prompt control measures can be most efficiently targeted. This cost-effective GIS-based surveillance system can be expanded and adapted for countries with indigenous malaria transmission.

To the Editor.— The article entitled "Turtle-Associated Salmonellosis in Puerto Rico" 1 led us to investigate the status of Salmonella in small green pet turtles, Pseudemys scripta-elgans in Israel. All of these turtles were legally imported into Israel and originated in Louisiana. Water (50 to 80 mL) from 32 aquariums containing these turtles was collected from pet shops and private households and examined for Salmonella at the Ministry of Health laboratories either in Beersheva or Jerusalem. All aquariums were sampled once. Of the 32, seven (22%) yielded Salmonella . One sample yielded two serotypes. All others yielded one serotype. There were six serotypes isolated, including Salmonella poona (three samples), Salmonella arizona, Salmonella blockley, Salmonella java, Salmo- nella schwarzengrund, and Salmonella thompson (one sample each). As a result of the article, which renewed our interest in this hazard to public health, the importation of these turtles into Israel has been temporarily banned.