Measles outbreak associated with a preschool setting among partially vaccinated children in the Tel Aviv District, Israel, October 2023

In October 2023, the Tel Aviv District was notified of ten cases of measles. The outbreak initiated in a preschool with high vaccination coverage with one dose of MMR vaccine. Serological testing was available for eight patients (six children and two adults). Among the six children vaccinated with one dose of MMR vaccine, primary vaccine failure was demonstrated. Among the adults, secondary vaccine failure was confirmed. The outbreak was successfully contained due to a combination of factors, notably its occurrence within a population characterized by high vaccination coverage in Tel Aviv, during a period of restricted public interactions due to the prevailing state of war in the country. Despite challenging wartime conditions, effective prophylactic measures were promptly executed, encompassing a 2-dose MMR vaccination schedule for close contacts and the broader community of children in the TA district, successfully curbing the outbreak and preventing widespread infections.

Monkeypox outbreak in the Tel Aviv District, Israel, 2022

OBJECTIVES

From May-September 2022, 203 cases of monkeypox (MPX) were reported in the Tel Aviv (TA) District, Israel. We aim to report the first ongoing local transmission of MPX in Israel.

METHODS

We analyzed the epidemiologic and clinical features of all cases of MPX notified to the TA District. Each case was contacted to verify the source of infection and locate potential contacts.

RESULTS

All cases were men; 195 (96%) were among men having sex with men, and 171 (84%) resided in the city of TA. Median age was 35 years. One case occurred in a healthcare worker. All cases had a self-limiting disease.

CONCLUSION

A combined public health campaign with vaccination against MPX of high-risk individuals leads to a decrease in disease rates. Enhanced surveillance and prevention among susceptible populations are warranted.

A Measles Outbreak in the Tel Aviv District, Israel, 2018-2019

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.

Pediatric measles cases by residence status in Tel Aviv, Israel

BACKGROUND

Measles is a vaccine-preventable infectious disease whose outbreaks generally originate from exposure to populations with low vaccination coverage.

METHODS

This study compared the rates and morbidity of measles cases in the district of Tel-Aviv during two outbreaks (2012 and 2018-2019) by citizenship and geographic location.

RESULTS

There were 67 pediatric cases reported in 2012 and 222 in 2018-2019. Cases were more likely to have pneumonia in 2012 as compared to in 2018-2019 (58.2% versus 6.3%) and less likely to report a single vaccination dose (9.5% versus 22.8%, respectively). In 2012, the majority of cases were among children without legal residence (CWLR), while in 2018-2019, they were the minority of cases (N = 54, 80.6% versus N = 51, 23.0%, respectively). In both outbreaks, CWLR were more likely to be less than one year old (the recommended age for the first dose of measles vaccination), unvaccinated or with unknown vaccine status, to be treated in a tertiary care center, and to have pneumonia than children with Israeli citizenship (CC). In both outbreaks, CWLR lived in a concentrated neighborhood in Southern Tel Aviv.

CONCLUSION

While the two measles outbreaks differed in overall morbidity, in both outbreaks CWLR presented with a more severe clinical presentation and were less likely to be vaccinated (in part due to their younger age) than CC. The geographically concentration of CWLR was distinct from that of the CC in both outbreaks. Healthcare professionals should promote vaccination uptake and increase parents' awareness to early signs of the disease.

Tuberculosis outbreak in a nursing home involving undocumented migrants and Israeli citizens

ABSTRACK

OBJECTIVES: Israel has absorbed > 60,000 migrant from the horn of Africa (MHOA) since 2006. No cross-transmission of Mycobacterium tuberculosis from MOHA to Israeli citizens has yet been reported. This study describes the results of contact investigation and laboratory work-out of a unique mixed cluster which included both MOHA and Israeli citizens.

METHODS

Description of the results of epidemiological investigation including laboratory confirmation.

RESULTS

This unique Mycobacterium tuberculosis strain included 29 patients: 26 were MOHA and three citizens who immigrated to Israel from the former Soviet Union. This is the first mixed cluster described in Israel, which has not been represented in the SITVIT international database of genotyping markers. The transmission from non-citizens to citizens occurred in a nursing institution, when MOHA infected three other contacts- two of whom were retarded residents, one of them died. The index case was screened before employment, and was permitted to return to wok although his chest X-ray demonstrated radiological findings compatible with tuberculosis. Epidemiological links were found in other 12 MOHA members of the cluster.

CONCLUSION

This report describes cross-transmission of Mycobacterium tuberculosis from non-citizens MOHA to Israeli citizens who were residents of a nursing home, which may be the first sign for an epidemiological shift. Although cross-ethnical transmission is still rare in Israel, medical settings should employ efficient infection control measures to protect both patients and staff from Mycobacterium tuberculosis.