Brucellosis Outbreak in Children and Adults in Two Areas in Israel.
Two parallel outbreaks of Brucella melitensis infection occurred in 2014 in two geographical areas in Israel. In two medical centers in northern Israel and one medical center in Jerusalem, 102 patients (58 children, 47 adults) were diagnosed with brucellosis. Most patients (N = 76, 72%) were Muslim Arabs, 28 (27%) were Druze, and one was Jewish. The source of infection was often traced to cheese from the Palestinian Authority. Biovar-1 was evident in 98% in northern Israel but only in 42% in Jerusalem. Most common manifestations were fever (82%) and osteoarticular symptoms (49%). The major differences between the geographic areas were ethnicity and duration until diagnosis. Compared with adults, children had higher rates of hospitalization (93% versus 64%, P = 0.001), osteoarticular symptoms (60% versus 36%, P = 0.05), elevated alanine aminotransferase (12% versus 0%, P = 0.01), and lower C-reactive protein (2.28 ± 2.08 versus 5.57 ± 6.3l mg/dL, P = 0.001). Two unrelated brucellosis outbreaks occurred in 2014 in two different geographic areas of Israel and were limited to sections of the Arab and Druze populations. Most of the demographic and clinical aspects of patients were not affected by geographic variability. Clinical and laboratory differences were found between children and adults emphasizing the nonuniformity of the disease in different age groups. Effective control of unpasteurized dairy foods, health education programs, and improved regional cooperation are required to control brucellosis in Israel.
Pediatric Infectious Diseases Unit, Pediatric Department, Shaare Zedek Medical Center, Jerusalem, Israel. orlimegged@szmc.org.il.
Orli
O
Megged
Infectious Diseases Unit, Emek Medical Center, Afula, Israel.
Bibiana
B
Chazan
Clinical Microbiology Laboratory, Galilee Medical Center, Nahariya, Israel.
Atef
A
Ganem
Pediatric Department, Galilee Medical Center, Nahariya, Israel.
Abeer
A
Ayoub
Infectious Diseases Unit, Emek Medical Center, Afula, Israel.
Anna
A
Yanovskay
Pediatric Department B', Emek Medical Center, Afula, Israel. The Pediatric Infectious Diseases Service, Emek Medical Center, Afula, Israel.
Waheeb
W
Sakran
The Pediatric Infectious Diseases Service, Emek Medical Center, Afula, Israel. Pediatric Department A', Emek Medical Center, Afula, Israel.
Dan
D
Miron
Immunology and Serology Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel.
Ahuva
A
Dror-Cohen
Microbiology Laboratory, Emek Medical Center, Afula, Israel.
Yoram
Y
Kennes
Brucellosis Lab, OIE, FAO Reference Laboratory, Kimron Veterinary Institute, Bet Dagan, Israel.
Svetlana
S
Berdenstein
The Pediatric Infectious Diseases Service, Galilee Medical Center, Nahariya, Israel. The Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.
Daniel
D
Glikman
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D018912:Arabs; D002006:Brucellosis / Q000175:diagnosis / Q000453:epidemiology*; D002097:C-Reactive Protein / Q000378:metabolism; D002611:Cheese / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D005506:Food Contamination; D005516:Food Microbiology; D006760:Hospitalization; D006801:Humans; D007557:Israel / Q000453:epidemiology; D007585:Jews; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
D002097:C-Reactive Protein; D007770:L-Lactate Dehydrogenase; D000410:Alanine Transaminase