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David Greenberg

Publications and source records attributed to David Greenberg.

At least 37 records · Page 2Linked to original sources
PubMed2005

Pertussis immunization in the global pertussis initiative North American region: recommended strategies and implementation considerations.

In North America, children currently receive 5 doses of a combined diphtheria-tetanus-acellular pertussis vaccine between the ages of 2 months and 6 years. Although this schedule has reduced the incidence of childhood pertussis, it has not led to the development of herd immunity in the total population, largely because pertussis immunity wanes with time. The time course over which immunity wanes is uncertain; however, high pertussis antibody titers in adolescents and adults indicate unrecognized infection in these groups. There is evidence that this group serves as a source of infection for young infants who are not fully immunized. Therefore, of the potential strategies reviewed by the North American Global Pertussis Initiative group, universal adolescent immunization would in theory reduce the risk of pertussis in this age group and may reduce transmission to young infants. However, because immunity probably wanes at the same rate in adolescents and children, the burden of disease will likely shift to older age groups, including young adults (parents of vulnerable infants). Therefore the ideal would be immunization of adolescents and adults, particularly those who are in contact with young infants. Adolescent immunization is already recommended in Austria, France, Germany and Canada, and participants in the Global Pertussis Initiative recommend that this strategy be implemented across North America with a view to eventually extending immunization to include adults. The final decision to implement such a strategy will depend on pertussis surveillance studies and analysis of the effectiveness and tolerability of adolescent and adult pertussis immunization as well as program considerations related to feasibility and economics.

Adolescent↗
PubMed2005

Clinical and bacterial characteristics of acute bacterial conjunctivitis in children in the antibiotic resistance era.

BACKGROUND: Acute conjunctivitis is the most common eye disorder in young children. Bacteria are responsible for 54-73% of all cases. The goals of the study were to identify the rates of Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis in cases of bacterial conjunctivitis in children and to define antibiotic resistance rates. METHODS: During a 2-year study period, conjunctival swabs of children 2-36 months old were collected prospectively. Nontypable H. influenzae, S. pneumoniae and M. catarrhalis were defined as the study pathogens. Analyzed variables included demography, clinical presentation, bacteriologic results and susceptibility patterns. RESULTS: There were 428 patients enrolled. Of all cultures, 55% (237 of 428) yielded at least 1 of the study pathogens. H. influenzae and S. pneumoniae were isolated from 29 and 20% of cultures, respectively. beta-Lactamase production was found in 29% of H. influenzae isolates, and penicillin nonsusceptibility was observed in 60% of S. pneumoniae isolates. The most common S. pneumoniae serotypes were: 19F (14%); 6A and 14 (11% each). Nontypable S. pneumoniae was found in 12%. The 7-valent pneumococcal conjugate vaccine (PCV-7) could potentially cover 44% of all isolates. Conjunctivitis-otitis syndrome was found in 32% of patients, of whom 82% of cultures yielded H. influenzae. CONCLUSIONS: Antibiotic resistance rates are alarmingly high. Conjunctivitis-otitis syndrome, predominantly caused by H. influenzae, is quite common. The potential coverage of the PCV-7 in conjunctivitis is relatively lower than that reported in other pneumococcal infections. Our findings should alert physicians on the choice of appropriate antibiotic treatment, on the frequent copresence of acute otitis media and on the potential role of conjunctivitis in the spread of antibiotic-resistant pathogens.

Acute Disease↗
PubMed2005

Superficial skin infection caused by Streptococcus pneumoniae in children.

Pneumococcal superficial skin infections are rarely described. We present 3 cases of Streptococcus pneumoniae superficial skin infections in previously healthy children. In 2 cases, lesions occurred on facial skin; in the third case they occurred on the scrotal raphe. One isolate was fully penicillin-resistant.

Cheek↗
PubMed2005

Accuracy of acute otitis media diagnosis in community and hospital settings.

AIM: To evaluate the accuracy rates of acute otitis media (AOM) diagnosis in the community by analyzing the initial AOM diagnosis (according to information from the referral letters to the Pediatric Emergency Department [PED]) among children with AOM diagnosis confirmed by tympanocentesis at PED. METHODS: A descriptive, retrospective study conducted during the year 2000, including 590 children aged 0-48 mo diagnosed with AOM at PED. AOM was confirmed by tympanocentesis. We defined: (1) simple AOM as < 3 or < 4 episodes during the last 6 or 12 mo, respectively; (2) complicated AOM as > or = 3 or > or = 4 episodes during the last 6 or 12 mo, respectively, and/or not improving with antibiotics. RESULTS: 571 (96.8%) were < 24 mo of age; 355 (60%) were Arab Bedouins and 235 (40%) Jews. Seventy-three pediatricians, 57 general practitioners and 27 family practitioners provided referral letters. Information on disease severity was available in 471/590 (79.8%) patients, of whom 320 (68%) had simple and 151 (32%) complicated AOM. Three hundred and sixty-five (62%) of 590 patients were accurately diagnosed by referring physicians, more frequently in patients with complicated than simple AOM (p < 0.001). Diagnostic accuracy was similar among physician specialties (p = 0.33) and ethnic groups (p = 0.11). Multivariable logistic regression analysis showed that complicated AOM, adjusted for age, sex, ethnic origin, and physician specialty, was the only predictive factor for accurate AOM diagnosis (odds ratio 4.0, p < 0.001). CONCLUSIONS: Inaccurate diagnosis of AOM in community settings is common, occurring more frequently in simple than in complicated AOM, and is unrelated to physician specialty and children's ethnicity.

Acute Disease↗
PubMed2005

Community-acquired pneumonia in children: quantifying the burden on patients and their families including decrease in quality of life.

OBJECTIVES: Childhood respiratory infections have an important impact on society and are a frequent cause of physician visits, consumption of antibiotics and over-the-counter drugs, work loss, and reduction of quality of life. The aim of this study was to assess the burden of community-acquired pneumonia (CAP) on children and their families, including quantification of expenses and decrease in quality of life. METHODS: Patients <3 years old with pneumonia were enrolled in 3 sites in southern Israel: pediatric wards, the pediatric emergency department, and a primary health clinic. In the primary health clinic, the diagnosis was based on clinical judgment, and in the hospital the diagnosis was based on the World Health Organization Standardization of Interpretation of Chest Radiographs for the diagnosis of CAP in children. Data regarding the children's medical history and various aspects of direct and indirect burden were gathered every 2 to 3 days during the 29 days of follow-up. The patients' parents were asked to give the names of 2 healthy children who could serve as controls from among the child's friends, neighbors, or day care center attendees. RESULTS: Two-hundred thirteen children with pneumonia were enrolled: 34 (16.0%) in the pediatric wards, 73 (34.2%) in the pediatric emergency department, and 106 (49.8%) in the primary pediatric clinic. The control group consisted of 99 children. During the 29 follow-up days, hospitalized children had the most severe and prolonged symptoms, followed in decreasing order by children seen at the emergency department, primary health clinic, and controls: The mean +/- standard deviation (SD) of febrile days was 4.9 +/- 2.8, 4.8 +/- 3.1, 3.3 +/- 2.5, and 1.4 +/- 3.3, respectively (statistically significant between any patient group and the control group). The mean duration of respiratory distress +/- SD was 3.8 +/- 5.6, 2.8 +/- 4.4, 2.2 +/- 4.4, and 0.4 +/- 1.8 days, respectively (statistically significant between any patient group and the control group). The median duration of nonroutine days as judged by the parents was 13, 8, 7, and 0, respectively. The mean number of workdays lost by working mothers +/- SD was 4.2 +/- 4.8, 2.0 +/- 2.6, 1.7 +/- 1.9, and 0.2 +/- 0.9, respectively (between any patient group and the control group). The quality-of-life-questionnaire analysis reveals statistically significant differences with regard to all 11 questions asked between any of the patient groups and the control group. There was a clear trend toward decreasing quality of life from the control group to the primary health clinic, pediatric emergency department, and pediatric wards groups. CONCLUSIONS: CAP in children causes a significant burden on both patients and their families, including substantial expenses, loss of routine, and decrease in quality of life.

Caregivers↗
PubMed2005

Community prescribing and resistant Streptococcus pneumoniae.

We investigated the association between prescribing antimicrobial agents and antimicrobial resistance of Streptococcus pneumoniae among children with acute otitis media in southern Israel. During a 6-year period, all prescriptions of a sample of approximately 20% of Jewish and Bedouin children <5 years of age were recorded and all pneumococcal isolates from middle ear fluid were collected. Although antimicrobial drug use was significantly higher in Bedouin children, the proportion of S. pneumoniae isolates with penicillin MIC = or > 1.0 microg/mL was significantly higher in Jewish children. In both populations, antimicrobial prescriptions were markedly reduced over time, especially for penicillins and erythromycin. In contrast, azithromycin prescriptions increased from 1998 to 2001 with a parallel increase in macrolide and multidrug resistance. Penicillin resistance was associated with macrolide resistance. These findings strongly suggest that azithromycin affects increased antimicrobial resistance, including multidrug resistance, in S. pneumoniae.

Acute Disease↗
PubMed2005

Involuntary outpatient commitment: a naturalistic study of its use and a consumer survey at one community mental health center in Israel.

The following study assessed the efficacy of involuntary outpatient commitment in promoting treatment adherence and preventing hospitalization during and after a period of compulsory treatment in one community mental health center in Israel and evaluated the attitudes of patients and psychiatrists. All patients referred for involuntary outpatient commitment over a two year period (N = 26) were followed up for 3-5 years. After the termination of the commitment, the patient and psychiatrist were interviewed. Although only three patients had been in regular outpatient treatment before the commitment, fourteen remained in regular care during the commitment's duration and ten remained for a further two years. Comparing the follow-up period with the identical duration before the commitment, the number of hospitalizations and number of days hospitalized were significantly reduced. Fifteen were rehospitalized during follow-up. Thirteen patients were interviewed at the termination of the commitment, and nearly all perceived the commitment in negative terms, although eight did not think it had a negative effect on their relationship with the psychiatrist and six thought their opinions were respected. Six of the psychiatrists considered they were not giving optimum treatment. Despite the presence of the commitment, psychiatrists were often sensitive to patients' wishes and the involuntary aspect of the care was often not pursued. While half of the sample were lost to community care, half remained for several years. The study reflects the delicate nature of involuntary care in the community, so that in practice it is often not involuntary, not for outpatients and not a commitment.

Adult↗
PubMed2005

[Infectious complications with herpes virus after ritual Jewish circumcision: a historical and cultural analysis].

Ritual circumcision performed on eight-day-old male infants is rooted in the Bible and is discussed in the earliest Jewish sources. The practice has been observed across the generations in every Jewish community in Israel and the Diaspora. According to Jewish ritual, the mohel--the ritual circumcisor--amputates the foreskin and then folds back the membrane that lies beneath it. This is followed by metzitza--"suction"--a practice performed throughout the ages by mouth. Halakhic literature sets down strict rules regarding this surgical intervention in order to prevent medical complications for the newborn. Metzitza by mouth has been recognized as a risk factor in the transfer of infection from the mohel to the newborn. A recent study relates to eight infants who became infected with herpes virus as a result of the procedure. We shall review the halakhic literature in order to clarify the custom of metzitza by mouth and understand the principles underlying the controversy that surrounds it. The custom of metzitza by mouth has been the subject of extensive rabbinic discussion since the middle of the nineteenth century. A better understanding of the historical, social and cultural background of the issue might allow us to formulate alternatives to the practice. The metzitza controversy gave rise to a stimulating discussion in the rabbinic literature with diverse and conflicting opinions. We shall undertake a precise analysis of the rabbinic discussion and its historical and social background, and attempt to identify the ideological underpinnings of the various positions. Rabbinic literature is replete with cautionary measures to be observed when circumcising a newborn child. The halakhic disputes beginning in the middle of the nineteenth century reflect ideological considerations and objectives. Metzitza was performed throughout the generations by mouth because that was the recognized method of disinfection at the time. Beginning in the nineteenth century, medical and esthetic considerations have led to the abolishment of metzitza by mouth or to its performance by way of a swab or through a glass tube in order to prevent infection. Ideological tendentiousness is evident in both approaches: Should the medical risks of metzitza by mouth be overlooked and denied out of loyalty to ancient tradition, thus allowing the practice to be continued? Or should the recognition of such risks along with esthetic considerations lead to changes in halakhic thinking to perform the metzitza in a hygienic technique? Historically, the issue of metzitza by mouth has been a bone of contention between traditional outlook and modern halakhic thinking, which takes into consideration advances in medical knowledge. In light of the reports in the medical literature about complications in the wake of metzitza by mouth, some of the halakhic rulings regarding circumcision should be reconsidered. Clinically, it is important to raise the medical community's awareness of the phenomenon and treat infected infants accordingly.

Circumcision, Male↗
PubMed2005

Community-acquired pneumonia in children: from diagnosis to treatment.

Community-acquired pneumonia (CAP) in children is a leading cause of childhood morbidity and mortality mainly in the developing world. Its etiology can be viral, bacterial, or mixed infection. The etiological agents are different in different age groups and during the various seasons of the year. Chest X-rays and inflammatory laboratory tests have low diagnostic sensitivity and specificity. CAP in children has an important impact on society and is a frequent cause of physician visits, work loss, and reduction of quality of life of the children and his/her family. The use of treatment algorithms in the developing countries has led to lower mortality rates, but the future of this approach, given the rate of development of antimicrobial resistance, is uncertain. The wider use of pneumococcal vaccines may represent an important advance in the prevention of pneumonia caused by Streptococcus pneumoniae.

Child↗
PubMed2004

New pertussis vaccination strategies beyond infancy: recommendations by the global pertussis initiative.

BACKGROUND: The Global Pertussis Initiative, an expert scientific forum, was established to address the ongoing problems associated with pertussis disease worldwide. METHODS: The group analyzed pertussis disease trends, developed recommendations to improve disease control through expanded vaccination strategies, and proposed solutions to barriers to implementation and support of research activities. RESULTS: Bordetella pertussis infection is endemic and continues to be a serious problem among unvaccinated or incompletely vaccinated infants. In addition, the reported incidence of pertussis disease is increasing in adolescents and adults, who not only experience a considerable health burden themselves but also infect vulnerable infants. CONCLUSIONS: Current vaccination strategies need to be reinforced. Expanded vaccination should include adding booster doses to existing childhood schedules (preschool or adolescent) and booster doses for those specific adult subgroups that have the highest risk of transmitting B. pertussis infection to infants (i.e., new parents, other contacts of newborns, and health care workers). More epidemiological studies and studies of disease transmission and the cost-effectiveness of vaccination would be valuable, and surveillance, diagnostic improvements, and educational campaigns are needed for implementation. However, as a prelude to universal adult vaccination, immediate universal adolescent vaccination should be instituted in countries in which it is economically feasible.

Adolescent↗
PubMed2004

Immune responses and antibody decay after immunization of adolescents and adults with an acellular pertussis vaccine: the APERT Study.

As part of a prospective acellular pertussis (ACP) vaccine efficacy trial, 5 serum samples were obtained, over an 18-month period, from 101 ACP-vaccine recipients and 99 control subjects, to assess ACP antibody response and decay. Immunoglobulin (Ig) G and IgA antibodies to pertussis toxin (PT), filamentous hemagglutinin (FHA), pertactin (PRN), and fimbriae 2/3 (FIM) were measured by enzyme-linked immunosorbant assay, and titers of agglutinin were determined. Of the subjects, 16%-19% had preimmunization values of antibodies to PT that were above the assay's limit of quantitation (LOQ); in contrast, 36%-63% of the subjects had preimmunization values of antibodies to FHA, PRN, or FIM that were above the LOQ. Substantial increases in titers of IgG and IgA antibodies to the 3 ACP antigens (PT, FHA, and PRN) were observed. Over the 18-months, the percent decay in IgG and IgA antibodies ranged from 56% to 73% and from 57% to 70%, respectively; the IgG antibody response and decay suggests that geometric mean titers likely remain above the LOQ for 2-9 years and above the threshold of detection for 4-13 years. These findings support the use of ACP booster immunizations for adolescents and adults, to provide sustained levels of antibody.

Adolescent↗
PubMed2004

The thyroglobulin gene as the first thyroid-specific susceptibility gene for autoimmune thyroid disease.

Recent linkage and association studies provide evidence for thyroglobulin (Tg) being an autoimmune thyroid disease (AITD) susceptibility gene. The Tg locus has been reported to be linked with AITD in two independent studies, and further analysis demonstrated that markers within the Tg gene were associated with AITD. Furthermore, missense single-nucleotide polymorphisms (SNPs) in the Tg gene were shown to be associated with autoimmune thyroiditis in both mice and humans. If Tg is confirmed as a susceptibility gene for AITD, it could provide a novel therapeutic target.

Animals↗
PubMed2004

Vitamin K status of older individuals in northern China is superior to that of older individuals in the UK.

To explore whether differences in vitamin K nutrition might, at least in part, underlie differences in fracture incidence between Asian and European populations, the vitamin K status of older individuals in Shenyang, China (eighty-six men, ninety-two women) and in Cambridge, UK (sixty-seven men, sixty-seven women) was compared. Dietary information was collected by food questionnaire in Shenyang and food diary in Cambridge and used to estimate the intake and sources of phylloquinone. Fasting blood was analysed for phylloquinone, triacylglycerol, total osteocalcin (tOC) and undercarboxylated osteocalcin (expressed as percentage of tOC; %ucOC). The mean intakes of green leafy vegetables were 127 (SD 90) g/d in Shenyang and 39 (SD 48) g/d in Cambridge. The estimated phylloquinone intakes (geometric means) were 247 (95% CI 226, 270) microg/d in Shenyang and 103 (95% CI 94, 112) microg/d in Cambridge. Plasma phylloquinone concentrations (geometric means) were significantly higher in the Shenyang subjects (2.17 (95% CI 1.95, 2.42) nmol/l) than in the Cambridge subjects (0.69 (95% CI 0.63, 0.76) nmol/l; P<0.001). Plasma phylloquinone concentration was positively related to phylloquinone intake in both the Shenyang (coefficient 0.17 (SE 0.08); P=0.03) and Cambridge subjects (coefficient 0.29 (SE 0.10); P=0.005). tOC concentration and %ucOC (after adjusting for tOC) were significantly lower in the Shenyang than in the Cambridge subjects (tOC 25.2 (SE 4.2)% and %ucOC 68.5 (SE 10.0)% lower respectively; P<0.001). After adjusting for tOC and triacylglycerol, %ucOC was negatively related to plasma phylloquinone concentration in both the Shenyang (coefficient -0.41 (se 0.11); P=0.0003) and Cambridge subjects (coefficient -0.17 (SE 0.07); P=0.02). The present study demonstrates that older individuals in northern China have a better vitamin K status compared with their British counterparts in Cambridge, UK.

Aged↗
PubMed2004

Relationship among peripheral leukocyte counts, etiologic agents and clinical manifestations in acute otitis media.

OBJECTIVES: To analyze the peripheral leukocyte counts of children with acute otitis media (AOM) in relation to etiology, age, clinical symptoms and signs, prior antibiotic treatment, previous AOM history and pathogen eradication during antibiotic therapy. PATIENTS AND METHODS: Leukocyte counts were determined at diagnosis and on days 4 to 6 of therapy in patients age 3 to 36 months with AOM enrolled in double tympanocentesis studies. Clinical status was determined by a clinical score evaluating severity of fever, irritability and tympanic membrane redness and bulging. RESULTS: Of 771 enrolled patients, culture-positive middle ear fluid was reported in 590 (77%): 294 (50%) Haemophilus influenzae; 150 (25%) Streptococcus pneumoniae; 127 (21%) H. influenzae and S. pneumoniae together; 9 (2%) Moraxella catarrhalis; and 10 (2%) others. Mean leukocyte count +/- sd in patients with AOM caused by S. pneumoniae (15.7 +/- 6.7 cells x 10/mm) was significantly higher than those of patients with AOM caused by H. influenzae (13.7 +/- 5.8 cells x 10/mm) and patients with culture-negative AOM (13.8 +/- 5.6 cells x 10/mm), P < 0.01 for each comparison. Mean absolute neutrophil count (ANC) +/- sd was higher in patients with AOM caused by S. pneumoniae (8.6 +/- 5.1 cells x 10/mm) than in patients with AOM caused by H. influenzae (6.5 +/- 4.0 cells x 10/mm) or culture-negative patients (6.5 +/- 4.4 cells x 10/mm), P < 0.05 for each comparison. When multivariant regression analysis was used, S. pneumoniae etiology and fever (body temperature > or = 38 degrees Celsius) were independent factors, each significantly associated with leukocyte and ANCs. A significant correlation was found between leukocyte and ANCs and higher clinical scores in patients with pneumococcal AOM (P = 0.01, r = 0.21 and P < 0.01, r = 0.27, respectively). The mean leukocyte count on Days 4 to 6 was lower than on Day 1 (11.5 +/- 4.1 compared with 14.2 +/- 6.0 cells x 10/mm, P < 0.01). When paired (Day 1 and Days 4 to 6) examinations were analyzed, the leukocyte counts were lower on Days 4 to 6 irrespective of bacterial eradication or persistence. CONCLUSIONS: Significantly higher leukocyte counts and ANCs were found in pneumococcal AOM than in AOM caused by H. influenzae or in culture-negative AOM. A significant decrease in leukocyte counts was found during antibiotic therapy for AOM, regardless of etiology and bacteriologic outcome. Isolation of S. pneumoniae and fever were each significantly associated with increased peripheral leukocyte and ANCs.

Acute Disease↗
PubMed2004

Relative importance of nasopharyngeal versus oropharyngeal sampling for isolation of Streptococcus pneumoniae and Haemophilus influenzae from healthy and sick individuals varies with age.

Streptococcus pneumoniae and Haemophilus influenzae carriage is a useful index for measuring the emergence of resistance and outcome in vaccination trials. We performed a study to determine which sampling site, nasopharynx (NP) or oropharynx (OP), yields the highest rate of S. pneumoniae and H. influenzae isolation at different ages. Both NP and OP cultures were obtained from 216 children aged <60 months and their mothers. The total S. pneumoniae carriage rate was 68% among children and 15% among mothers (P < 0.001). Using NP alone for the isolation of S. pneumoniae would have missed 2, 2, and 42% and using OP alone would have missed 77, 66, and 45% of S. pneumoniae in children aged 0 to 23 months, 24 to 59 months, and mothers, respectively. Using NP cultures alone for H. influenzae would have missed 23, 24, and 81% of the isolates, respectively. The respective figures for H. influenzae isolation from OP alone are 38, 29, and 9%. In children, S. pneumoniae was carried mainly in the NP while H. influenzae was equally carried in the NP and OP. In mothers, S. pneumoniae was carried equally in the NP and OP while H. influenzae was carried significantly more often in the OP. In children, H. influenzae colonization increased during illness, mainly in the NP. Culturing only one site significantly reduced the recovery of H. influenzae at all ages. NP cultures for S. pneumoniae detected close to 100% of isolates in children but only 58% of isolates in mothers.

Adult↗
PubMed2004

Neonatal genital herpes simplex virus type 1 infection after Jewish ritual circumcision: modern medicine and religious tradition.

OBJECTIVE: Genital neonatal herpes simplex virus type 1 (HSV-1) infection was observed in a series of neonates after traditional Jewish ritual circumcision. The objective of this study was to describe neonate genital HSV-1 infection after ritual circumcision and investigate the association between genital HSV-1 after circumcision and the practice of the traditional circumcision. METHODS: Eight neonates with genital HSV-1 infection after ritual circumcision were identified. RESULTS: The average interval from circumcision to clinical manifestations was 7.25 +/- 2.5 days. In all cases, the traditional circumciser (the mohel) had performed the ancient custom of orally suctioning the blood after cutting the foreskin (oral metzitzah), which is currently practiced by only a minority of mohels. Six infants received intravenous acyclovir therapy. Four infants had recurrent episodes of genital HSV infection, and 1 developed HSV encephalitis with neurologic sequelae. All four mohels tested for HSV antibodies were seropositive. CONCLUSION: Ritual Jewish circumcision that includes metzitzah with direct oral-genital contact carries a serious risk for transmission of HSV from mohels to neonates, which can be complicated by protracted or severe infection. Oral metzitzah after ritual circumcision may be hazardous to the neonate.

Circumcision, Male↗