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Biomedical subjects

Itamar Grotto

Publications and source records attributed to Itamar Grotto.

At least 19 recordsLinked to original sources
PubMed2006

Identification of risk factors for infection in an outbreak of Mycoplasma pneumoniae respiratory tract disease.

BACKGROUND: Mycoplasma pneumoniae is one of the most common pathogens that causes community-acquired respiratory tract infection. Outbreaks are well known, and all age groups are susceptible. An outbreak in an army training unit afforded an opportunity to identify possible risk factors for morbidity. METHODS: An outbreak of respiratory illness that occurred in a unit comprising 91 trainees was investigated and analyzed as a cohort study. M. pneumoniae infection was suspected on clinical grounds and was confirmed by polymerase chain reaction, culture, and serologic testing. Data regarding medical history, symptoms, signs, and laboratory tests were collected. RESULTS: During a period of 12 days, 41 soldiers (45.1%) had respiratory illnesses, of which 10 (11.0%) were pneumonia. Comparison of symptomatic and asymptomatic individuals revealed that smoking was associated with higher rates of disease (risk ratio, 2.1; 95% confidence interval [CI], 1.3-3.2; P<.005) and seroconversion (risk ratio, 2; 95% CI, 1.2-3.4; P=.03). In multivariate analysis, both lower acute immunoglobulin G values (adjusted odds ratio, 7.8; 95% CI, 1.4-42.5; P=.018) and smoking (adjusted odds ratio, 5.6; 95% CI, 1.5-20.4; P=.01) were associated with symptomatic infection; stratification according to smoking status revealed that immunoglobulin G levels among nonsmokers were protective. Patients who had pneumonia had lower lymphocyte counts (1400+/-258 vs. 2000+/-465 cells/microL; P=.001). CONCLUSIONS: Smoking and lower preexisting immunoglobulin G levels were strongly associated with M. pneumoniae respiratory infection. These findings emphasize the importance of immunity and cessation of smoking for the prevention of disease. The high attack rate emphasizes the extent of infection transmission among healthy persons living in close contact.

Cohort Studies↗
PubMed2006

Postexposure treatment with doxycycline for the prevention of tick-borne relapsing fever.

BACKGROUND: Tick-borne relapsing fever (TBRF) is an acute febrile illness. In Israel, TBRF is caused by Borrelia persica and is transmitted by Ornithodoros tholozani ticks. We examined the safety and efficacy of postexposure treatment to prevent TBRF. METHODS: In a double-blind, placebo-controlled trial, 93 healthy subjects with suspected tick exposure (52 with signs of tick bites and 41 close contacts--those without signs but with a similar risk of contact with ticks) were randomly assigned to receive either doxycycline (Dexxon, in a dose of 200 mg the first day and then 100 mg per day for four days) or placebo after presumed exposure to TBRF. Cases of TBRF were defined by fever and a positive blood smear. Serologic analysis for cross-reactivity to Borrelia burgdorferi and polymerase chain reaction (PCR) for the borrelia glpQ gene were also performed. RESULTS: After randomization, 47 subjects (26 with signs of tick bites and 21 close contacts) received doxycycline. Forty-six other subjects (26 with signs of tick bites and 20 close contacts) received placebo. All 10 cases of TBRF identified by a positive blood smear were in the placebo group of subjects with signs of a tick bite (P<0.001). These findings suggested a 100 percent efficacy of preemptive treatment (95 percent confidence interval, 46 to 100 percent). PCR for the borrelia glpQ gene was negative at baseline for all subjects and subsequently positive in all subjects with fever and a positive blood smear. Seroconversion was detected in eight of nine cases of TBRF. PCR and serum samples were negative for all of the other subjects tested. No major treatment-associated adverse effects were identified. CONCLUSIONS: Treatment with doxycycline is safe and efficacious in preventing TBRF after suspected exposure to ticks in a high-risk environment. (ClinicalTrials.gov number, NCT00237016 [ClinicalTrials.gov].).

Adult↗
PubMed2006

Declining population immunity to mumps among Israeli military recruits.

Population-based seroepidemologic data on mumps have not been available in Israel since 1987, and the effects of mass immigration from the Commonwealth of Independent States during the 1990s have not been investigated. We conducted a seroprevalence study of mumps antibodies among 353 Israeli military recruits aged 18-19, based on a representative sample of sera collected in 1999. The overall seroprevalence rate was 83.3%, which was significantly lower than that measured in 1987 (94.1%, P<0.001). Foreign-born subjects had substantially lower seroporevalence rates than their native Israeli counterparts (68.5% versus 86.1%, P<0.001). Recent seroprevalence levels are below those required for herd immunity, and most likely contributed to an outbreak of mumps observed among young adults in Israel in 2005. Immigration appears to be a contributing factor to the decrease in population seroprevalence over time.

Antibodies, Viral↗
PubMed2006

Prevalence of prehypertension and associated cardiovascular risk profiles among young Israeli adults.

Recently the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure introduced the term "prehypertension" for systolic blood pressure levels of 120 to 139 mm Hg and diastolic BP levels of 80 to 89 mm Hg. Little is known about the prevalence of this entity and the cardiovascular risk factors associated with it. We aimed to determine the prevalence of prehypertension and the cardiovascular risk factors associated with it in a large population-based sample of young Israeli adults. We studied 36,424 Israel Defense Forces employees during the years 1991 to 1999. Subjects completed a detailed questionnaire and underwent physical examination, and blood samples were drawn after a 14-hour fast. Prehypertension was defined as a systolic blood pressure of 120 to 139 mm Hg, and/or a diastolic blood pressure of 80 to 89 mm Hg. We calculated the age- and sex-specific prevalence of prehypertension and other cardiovascular risk factors associated with this condition. Prehypertension was observed among 50.6% of men and 35.9% of women. The prehypertensive group had higher levels of blood glucose, total cholesterol, low-density lipoprotein cholesterol, and triglycerides, higher body mass index, and lower levels of high-density lipoprotein cholesterol than did the normotensive group. Multivariate logistic regression analysis showed that body mass index was the strongest predictor of prehypertension among both males and females (odds ratio, 1.100; 95% CI, 1.078 to 1.122 and odds ratio, 1.152; 95% CI, 1.097 to 1.21, respectively, for every 1 kg/m2 increase). Our findings support the recommendation of lifestyle modification for prehypertensive patients. Further prospective studies are required to determine the role of pharmacotherapy in prehypertension.

Adult↗
PubMed2006

Long-term immunity in young adults after a single dose of inactivated Hepatitis A vaccines.

We evaluated in a prospective study the immune response of naïve subjects to a single dose of inactivated Hepatitis A vaccine. Ninety-seven percent of the vaccinees sero-converted 1 month after vaccination and 93% were still positive 2 years later. All of the vaccinees had a strong booster response 2 years after the single dose. Avaxim was more immunogenic than Vaqta for the primary dose (p = 0.01 for sero-positivity, p<0.001 for antibody level) but no differences were found after boosting with Avaxim. Performance of intense physical activity during the first month after a single vaccine dose was associated with lower antibody levels (p = 0.004). This study indicates that a single dose of inactivated HAV vaccine elicits protective immune memory for at least 2 years.

Adolescent↗
PubMed2006

Decline in the prevalence of antibodies to herpes simplex virus types 1 and 2 among Israeli young adults between 1984 and 2002.

OBJECTIVE: The objective of this study was to estimate the seroprevalence of herpes simplex virus (HSV) types 1 and 2 in male and female soldiers discharged from the Israel Defense Force (IDF) over a period of 18 years. GOAL: The goal of this study was to study the secular trends of HSV-1 and HSV-2 infection rates in Israeli young adults. STUDY DESIGN: Three consecutive cross-sectional studies were carried out on stored sera of systematic random samples of soldiers (median age = 20.8) discharged from the IDF in 1984-1985, 1992-1993, and 2001-2002. HSV-1 and -2 seroprevalence was analyzed using indirect IgG enzyme-linked immunosorbent assay for type-specific antibodies. RESULTS: There was a significant decrease in HSV-1 and HSV-2 seropositivity rates at discharge from the army and an estimated 10-fold decline in the incidence rates of HSV-2 infection during the military service over the last 2 decades. CONCLUSIONS: The decline in HSV-1 seroprevalence rate is similar to that reported from other industrialized countries. The decrease in HSV-2 seroprevalence and transmission rates among Israeli young adults is steeper than that reported from Western countries.

Adult↗
PubMed2005

Beveled needle technique is not associated with low "take" rates in Israeli smallpox revaccination campaign.

BACKGROUND: In its first large-scale smallpox vaccination campaign in the 20(th) century, Israel has experienced an exceptionally high rate of failure to achieve clinical take following vaccination. It was hypothesized that this failure rates might be attributed to the unique vaccination technique adopted in Israel, of using beveled needles rather than bifurcated needles. MATERIALS AND METHODS: We retrospectively identified two cohorts vaccinated in the defined dates during the Israeli revaccination campaign, in which beveled needles and bifurcated needles were used alternately, and studied the impact of different covariates on clinical vaccination outcome measures. RESULTS: Of 116 subjects that were vaccinated within the defined dates, 46 were vaccinated using bifurcated needles, and 70 by beveled needles. 'Take' rates in subjects vaccinated up to 20 years earlier was 77.5%, compared with 97.2% among those vaccinated in the more distant past (p = 0.001). In multivariate analyses, vaccination 'take' was independently associated with a shorter time from previous vaccination (p = 0.013), but not with gender, birth country, vaccinator or the vaccination technique used. CONCLUSIONS: The low take rates observed in the Israeli smallpox revaccination campaign could not be attributed to the unique local vaccination technique, and was most likely induced by a higher rate of residual immunity among vaccinees, compared with the US, as well as by the lower vaccine concentrations used in Israel. In countries and circumstances when bifurcated needles are not sufficiently available, the beveled needle technique may be considered an appropriate alternative.

Adult↗
PubMed2005

Secular trends in age at menarche, smoking, and oral contraceptive use among Israeli girls.

INTRODUCTION: The improved nutrition and socioeconomic status of the population in industrialized countries has resulted in a decrease in the mean age at menarche. This trend raises the question of whether cigarette smoking and the use of oral contraceptives, health behaviors often adopted during adolescence, may also be starting at a younger age. Cigarette smoking and use of oral contraceptives are a public health concern because they pose an increased risk for development of chronic diseases, particularly in combination. This study was designed to identify secular trends in age at menarche, at first cigarette, and at first use of oral contraceptives among a large population-based sample of young Israeli women and to assess whether these trends are associated with sociodemographic factors. METHODS: A systematic, population-based survey used data obtained from female recruits to the Israel Defense Force from 1986 to 2000. During the study period, 11,392 questionnaires were collected from Jewish women aged 18 to 19 years. Participants were interviewed concerning geographic origin and level of education, father's geographic origin and level of education, current smoking status, use of oral contraceptives, and recalled age at first menstruation, first cigarette, and first use of oral contraceptives. RESULTS: Reported mean age (-/+ D) at menarche showed a monotonic trend of decreasing over time, from 13.41 (-/+ .30) years for women born before 1970 to 13.03 (-/+ 1.28) years for those born after 1978 (P < .001). Women born after 1978 were twice as likely to experience menarche by the age of 11 as those born prior to 1970 (odds ratio 2.0; 95% confidence interval, 1.41-2.82). Significant trends toward younger age at first use were observed for cigarettes and oral contraceptives. CONCLUSION: The trends of earlier age at menarche, first cigarette, and first use of oral contraceptives suggest health behaviors among young women that may herald increased chronic disease morbidity in the future. These trends indicate the need for further investigation and preventive measures aimed at this population.

Adolescent↗
PubMed2005

Prevalence of iron deficiency and anemia among strenuously trained adolescents.

PURPOSE: There is a lack of awareness among physicians, dieticians, and public health planners as to the prevalence of iron deficiency and anemia among adolescents undergoing strenuous physical training. The aim of this study was to estimate the prevalence of iron deficiency and anemia among male adolescents undergoing such activity. METHODS: We studied 292 male adolescents on the day of entry into a volunteer military unit. Hemoglobin (Hb), mean corpuscular volume, ferritin, iron, iron-transferrin saturation, and soluble transferrin receptor (TfR) were measured, and TfR-F index was calculated. RESULTS: The mean Hb level (+/-SD) in the study population was 14.7 +/- .9 g/dL (range, 10.8-16.8 g/dL), mean ferritin level was 50.6 +/- 32.6 ng/mL (range, 5.4-162.5 ng/mL), and mean iron level was 97.1 +/- 39.9 microg/dL (range, 24-267 microg/dL). The prevalence of anemia (Hb <14 g/dL) was 18.5%, and 3.4% had Hb concentrations less than 13 g/dL. Iron deficiency (ferritin <22 ng/mL) was present in 18% of the subjects, and 11.3% had ferritin levels less than 17 ng/mL. The mean soluble transferrin receptor concentration was 1.9 +/- .8 mg/L, and the mean TfR-F index was 1.21 +/- .57. CONCLUSIONS: Nearly 19% of the study subjects had mild anemia at recruitment, and depletion of iron stores was observed among 18%. Overall, these changes were not accompanied by a significant increase in soluble TfR. This high prevalence is most likely the result of "sports anemia" due to the intense physical training regimen adopted prior to their recruitment.

Adolescent↗
PubMed2005

Reliability of self-reported smoking history and age at initial tobacco use.

BACKGROUND: Many studies use questionnaires to determine smoking status and age of smoking onset. This study aimed to determine the reliability of self-reported smoking history and age of smoking initiation. METHOD: The proportion of inconsistent answers and correlation coefficients of reported age of initial smoking were measured by an answer-reanswer analysis of questionnaires in an ongoing, two-step, population-based survey of health behavior. Interviews were conducted on the day of recruitment to and the day of discharge from mandatory military service in Israel among a sample of 25,437 young men and women recruited between 1986 and 2000. RESULTS: Of 7276 participants reporting current or past smoking upon recruitment, 559 (7.7%) reported never having smoked upon discharge, thus demonstrating prima facie inconsistency. Variables significantly associated with reliable reporting in a multivariate logistic regression model were female gender (P = 0.04) and more than 4 years of military service (P < 0.01). 6010 subjects who reported a positive smoking history at both recruitment and discharge were available for analysis of reliability of reported age at smoking onset. Intraclass correlation coefficients for recruitment/discharge consistency in reported age at first cigarette were 0.73 (95% CI: 0.71-0.74) and 0.76 (95% CI: 0.74-0.78) for men and women, respectively. Eastern origin, lower subject education level, and lower paternal education level were also associated with lower reliability. CONCLUSIONS: Our results showed a relatively high level of answer-reanswer reliability, with some variance attributable to personal characteristics. These results suggest that self-reported age at onset of tobacco use is practical and reliable in normative, young adult populations. However, time elapsed between questionnaires and demographic and lifestyle characteristics may affect reliability rates, and thus should be carefully regarded in future studies.

Adolescent↗
PubMed2005

Smoking habits and obesity in young adults.

AIMS: The aim of this work was to study the association between obesity and smoking habits in young adults. Specifically, we tested the hypothesis that obesity does not prevent young adults from smoking and conversely smoking does not protect against obesity. DESIGN AND SETTING: Trained nurses interviewed participants concerning demographic data and health behaviors such as smoking. At the time of the interview, weight and height were measured. Data were analyzed retrospectively. PARTICIPANTS: A representative sample of Israel Defense Force (IDF) personnel upon discharge from compulsory service, usually at the age of 20-21 years. FINDINGS: Overall, 29 745 participants were included during the 13-year study (16,363 males and 13,382 females). Smoking rates were higher among obese participants than among overweight and non-obese participants (34.9%, 37.1%, 43.6% for non-obese, overweight and obese, respectively; P < 0.001). Mean number of cigarettes smoked per day were also higher among smokers that were obese and overweight compared to the non-obese (15.2 +/- 9.2, 15.6 +/- 10.7, 18.0 +/- 9.8, respectively; P < 0.001). Overweight and obesity were associated with the father's lower academic educational level. In logistic regression analysis, obesity, year of study and parental academic education were correlated independently with smoking (P < 0.001). CONCLUSION: The positive association between obesity and smoking suggests that obesity is not a deterrent to smoking and also that smoking does not help to prevent obesity.

Adult↗
PubMed2005

The changing prevalence of myopia in young adults: a 13-year series of population-based prevalence surveys.

PURPOSE: To determine the changing prevalence of myopia during the years 1990 through 2002 among the 16- to 22-year age group and identify possible risk factors. METHODS: A retrospective study, based on 13 repeated prevalence surveys conducted over a 13-year period. The study subjects were all Israeli nationals belonging to the 16- to 22-year age group from the years 1990 to 2002. Refraction was determined by using subjective visual acuity followed by noncycloplegic autorefraction and subjective validation based on the autorefraction RESULTS: Mild myopia was defined as a refractive error of -0.50 to -3.00 D in at least one eye, moderate myopia as -3.25 to -6.00 D, and high myopia as more than -6.00 D. results. There were 919,929 subjects (382,139 [42%] females and 537,790 [58%] males) included in the study. The overall prevalence of myopia increased from 20.3% in 1990 to 28.3% in 2002. The prevalence of high, moderate, and mild myopia significantly increased in males from 1.7%, 5.7%, and 11.6% in 1990 to 2.05%, 7.2%, and 16.3% in 2002, respectively (P < 0.001). In females, the prevalence of myopia increased from 1.9%, 6.6%, and 13.5% in 1990 to 2.4%, 9.2%, and 20.7% in 2002, respectively (P < 0.001). A correlation between myopia and the number of years of education was observed. Non-Israeli origin was found to be a significant risk factor for myopia. CONCLUSIONS: During the 13 years from 1990 to 2002, the prevalence of myopia significantly increased among the Israeli population. Although there was an association with the level of education, gender, ethnicity, and origin, the prevalence of myopia increased on an annual basis, independent of these factors.

Adolescent↗
PubMed2005

Influenza outbreak control in confined settings.

Influenza may rapidly disseminate within populations living in confined settings, causing considerable morbidity and disrupting daily activities. We describe an influenza A outbreak on a military base where 3,000 young adults, most of whom were unvaccinated, lived in close daily contact. Visits to the base clinic by 48 persons with acute respiratory illness within 2 days allowed early identification of this outbreak and prompted immediate epidemiologic investigation. Overall, 85 personnel (2.83% of base population) met the case definition for influenzalike illness. On-site laboratory confirmation with field detection kits, rapid implementation of respiratory illness control protocols, and a mass vaccination campaign were applied to limit disease dissemination. The outbreak was halted 14 days after the mass vaccination campaign was completed. We review the control measures available for controlling influenza outbreaks in confined settings and discuss the role of rapid mass vaccination within this context.

Disease Outbreaks↗
PubMed2005

Cost-benefit of stockpiling drugs for influenza pandemic.

We analyzed strategies for the use of stockpiled antiviral drugs in the context of a future influenza pandemic and estimated cost-benefit ratios. Current stockpiling of oseltamivir appears to be cost-saving to the economy under several treatment strategies, including therapeutic treatment of patients and postexposure prophylactic treatment of patients' close contacts.

Acetamides↗
PubMed2005

Tickborne relapsing fever in Israel.

We evaluated the epidemiology of relapsing fever from 1971 to 2003 in Israel. In civilians, incidence declined from 0.35 to 0.11 cases per 100,000 persons annually; in military personnel it averaged 6.4 cases per 100,000 persons annually. These data imply that the pathogen and vector continue to exist in Israel.

Animals↗
PubMed2005

Infectious diarrheal outbreaks in the Israeli military, 1988-2002.

We analyzed 865 diarrheal outbreaks with an identified bacterial pathogen or unknown cause that occurred in the Israeli military between 1988 and 2002. The number of outbreaks per year declined over the study period, as did the proportion of outbreaks with an identified pathogen. Shigella, Salmonella, and Staphylococcus species were the bacteria most commonly isolated. Seventy percent of the outbreaks involved < 35 cases and only 5% involved > 100 cases. More than one-half of the outbreaks occurred in field units, but these outbreaks were smaller than those in other units. The most commonly identified cause of the outbreaks was a lapse in maintaining standards of food preparation. Improvements in infrastructure and enhanced attention to surveillance, education, and infection control have resulted in a marked decline in the number of outbreaks in recent years.

Disease Outbreaks↗