title: West Nile fever in Israel: the reemergence of an endemic disease.
abstract: BACKGROUND
  As a crossroads for bird migration between Africa and Eurasia and with its long history of human infection, Israel has been a major focus of attention during the continuing global spread of West Nile fever (WNF). This article reviews the background and reemergence of WNF in Israel; the recent epidemiology of WNF among Israelis; and the disease-control strategies being used to combat the disease.
  
  
  METHODS
  Employing the comprehensive base of case data that are reported to the Ministry of Health, an epidemiological record was constructed that details the incidence and distribution of WNF cases in Israel in recent years.
  
  
  RESULTS
  After decades of small, intermittent outbreaks, nearly 1400 cases of WNF were reported in Israel between 2000 and 2012. Incidence was consistently highest in the coastal cities, among elderly patients, and in the late summer months and early autumn. A broad range of control measures to prevent human infection has been implemented, and attention has been given to issues such as the protection of the national blood bank and the occurrence of long-term sequelae.
  
  
  CONCLUSIONS
  The reemergence of WNF in Israel is likely the result of a combination of factors including past immunity to the virus among the human population, a marked increase in awareness of WNF among physicians, and more frequent requests for the laboratory testing of suspected cases. In the absence of effective vaccine to protect humans from WNF, the best disease-control strategies include intensive vector-control measures, the continued development of techniques to forecast outbreaks, and effective public education programs that are targeted toward the high-risk elderly population.
authors.affiliation: Ministry of Health, Jerusalem, Israel; Hebrew University and Hadassah, Jerusalem, Israel. Electronic address: Emilia.anis@moh.health.gov.il.
authors.forename: Emilia
authors.initials: E
authors.lastname: Anis
authors.affiliation: Ministry of Health, Jerusalem, Israel; Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Itamar
authors.initials: I
authors.lastname: Grotto
authors.affiliation: Ministry of Health, Jerusalem, Israel; Central Virology Laboratory, Tel Hashomer, Israel.
authors.forename: Ella
authors.initials: E
authors.lastname: Mendelson
authors.affiliation: Ministry of Health, Jerusalem, Israel; Central Virology Laboratory, Tel Hashomer, Israel.
authors.forename: Hanna
authors.initials: H
authors.lastname: Bin
authors.affiliation: Ministry of Health, Jerusalem, Israel; Laboratory of Entomology, Jerusalem, Israel.
authors.forename: Laor
authors.initials: L
authors.lastname: Orshan
authors.affiliation: Ministry of Health, Jerusalem, Israel.
authors.forename: Dan
authors.initials: D
authors.lastname: Gandacu
authors.affiliation: Ministry of Health, Jerusalem, Israel.
authors.forename: Bruce
authors.initials: B
authors.lastname: Warshavsky
authors.affiliation: Magen David Adom Blood Services, Israel.
authors.forename: Eilat
authors.initials: E
authors.lastname: Shinar
authors.affiliation: Ministry of Health, Jerusalem, Israel; Hebrew University and Hadassah, Jerusalem, Israel.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Slater
authors.affiliation: Ministry of Health, Jerusalem, Israel.
authors.forename: Boaz
authors.initials: B
authors.lastname: Lev
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D021821:Communicable Diseases, Emerging / Q000453:epidemiology* / Q000517:prevention & control; D019353:Endemic Diseases; D006801:Humans; D015994:Incidence; D007303:Insect Vectors; D007557:Israel / Q000453:epidemiology; D008875:Middle Aged; D014901:West Nile Fever / Q000453:epidemiology* / Q000517:prevention & control
keywords: Control measures; Reemergence; Vector; West Nile fever