Brucellosis Outbreak in Children and Adults in Two Areas in Israel

Orli Megged Pediatric Infectious Diseases Unit, Pediatric Department, Shaare Zedek Medical Center, Jerusalem, Israel.

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Bibiana Chazan Infectious Diseases Unit, Emek Medical Center, Afula, Israel.

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Atef Ganem Clinical Microbiology Laboratory, Galilee Medical Center, Nahariya, Israel.

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Abeer Ayoub Pediatric Department, Galilee Medical Center, Nahariya, Israel.

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Anna Yanovskay Infectious Diseases Unit, Emek Medical Center, Afula, Israel.

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Waheeb Sakran Pediatric Department B', Emek Medical Center, Afula, Israel.
The Pediatric Infectious Diseases Service, Emek Medical Center, Afula, Israel.

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Dan Miron The Pediatric Infectious Diseases Service, Emek Medical Center, Afula, Israel.
Pediatric Department A', Emek Medical Center, Afula, Israel.

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Ahuva Dror-Cohen Immunology and Serology Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel.

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Yoram Kennes Microbiology Laboratory, Emek Medical Center, Afula, Israel.

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Svetlana Berdenstein Brucellosis Lab, OIE, FAO Reference Laboratory, Kimron Veterinary Institute, Bet Dagan, Israel.

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Daniel Glikman The Pediatric Infectious Diseases Service, Galilee Medical Center, Nahariya, Israel.
The Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.

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DOI:
https://doi.org/10.4269/ajtmh.16-0116
Volume/Issue:
Volume 95: Issue 1
Page(s):
31–34
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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.

Author Notes

* Address correspondence to Orli Megged, Infectious Diseases Unit, Shaare Zedek Medical Center, P.O. Box 3235, Jerusalem 91031, Israel. E-mail: orlimegged@szmc.org.il

Authors' addresses: Orli Megged, Pediatric Department, Shaare Zedek Medical Center, Jerusalem, Israel, E-mail: orlimegged@yahoo.com. Bibiana Chazan, Infectious Diseases Unit, Emek Medical Center, Afula, Israel, E-mail: chazan_b@clalit.org.il. Atef Ganem, Clinical Microbiology Laboratory, Western Galilee Medical Center, Nahariya, Israel, E-mail: atefG@gmc.gov.il. Abeer Ayoub and Daniel Glikman, Pediatric Department, Western Galilee Medical Center, Nahariya, Israel, E-mails: abeersa@hotmail.com and dannyg@gmc.gov.il. Anna Yanovskay, Waheeb Sakran, and Dan Miron, Pediatric Department, Emek Medical Center, Afula, Israel, E-mails: anna_fe@clalit.org.il, sakran_w@clalit.org.il, and miron_da@clalit.org.il. Ahuva Dror-Cohen, Immunology and Serology Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel, E-mail: ahuvadc@walla.com. Yoram Keness, Microbiology Laboratory, Emek Medical Center, Afula, Israel, E-mail: keness@clalit.org.il. Svetlana Berdenstein, Brucellosis Lab, OIE, FAO Reference Laboratory, Kimron Veterinary Institute, Bet Dagan, Israel, E-mail: svetab@moag.gov.il.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2016
Received:
16 Feb 2016
|
Accepted:
02 Mar 2016
|
Published Online:
06 Jul 2016
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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