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DENGUE/DHF UPDATE 2009 (15)
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Saudi Arabia
Date: Mon 13 Apr 2009
Source: Saudi Gazette [edited]
<http://www.saudigazette.com.sa/index.cf ... 9041334934>


[There have been] 2 dengue fever deaths at the King Faisal Hospital
in Makkah. Authorities have become increasingly concerned at an
apparent rise in the cases of dengue fever, with the National Society
for Human Rights noting last week some 139 cases receiving treatment
at a Makkah hospital in the last 3 months alone. The Minister of
Agriculture made a tour of sites in Jeddah last week to oversee
efforts to combat the virus.

[Byline: Hatim Al-Masoudi]

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[A HealthMap/ProMED-mail interactive map of Saudi Arabia showing the
cities mentioned can be accessed at
<http://healthmap.org/r/008R>.
- Mod.TY]

DENGUE/DHF UPDATE 2009 (16)
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Saudi Arabia
Date: Sun 19 Apr 2009
Source Saudi Gazette [edited]
<http://www.saudigazette.com.sa/index.cf ... 9041435020>


More than 100 dengue fever cases were reported in Makkah last week
[week of 12 Apr 2009]. During the same period, 33 cases were
registered in Jeddah, a report from the Saudi Press Agency said
Monday [13 Apr 2009].

The report stated that government bodies had begun putting into
action a program to control the spread of the mosquito-borne virus,
with municipalities engaged in spraying districts and homes, and the
Ministry of Agriculture overseeing the aerial spraying of sites where
mosquitoes conglomerate.

The Ministry of Health is carrying out schemes to raise medical
awareness, facilitate laboratory diagnosis and provide patient care.
The report said that the directorates of Health Affairs in Makkah and
Jeddah were conducting intensive awareness campaigns targeting
infested homes and their vicinities.

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[A HealthMap/ProMED-mail interactive map of Saudi Arabia showing the
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<http://healthmap.org/r/008R>.
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DENGUE/DHF UPDATE 2009 (17)
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Saudi Arabia (Makkah): NOT
Date: Sun 26 Apr 2009
Source: Arab News [edited]
<http://www.arabnews.com/?page=1&section ... ry=Kingdom>


Health Minister Dr Abdullah Al-Rabeeah dismissed, in a statement
yesterday [25 Apr 2009], reports of deaths caused by dengue fever in
the Makkah province as contrary to facts. "No death attributed to
dengue fever has been reported in the region till date. After the
passing of 17 weeks since the breakout of the disease only 44 cases
of the fever have been reported," Al-Rabeeah told Arab News after a
meeting with Makkah Mayor Osama Al-Bar at his office yesterday [25
Apr 2009].

"The combating of dengue fever is a top priority for not only the
mayoralty, but the Ministry of Health and the Ministry of
Agriculture," Al-Rabeeah said while assuring the public that the
disease was under control. The mayor's office and other governmental
departments are also to implement a scheme to beef up the combating
of the disease, he added.

"The Ministry of Health does not deny the presence of the fever in
the province but it is at a very low rate compared to other parts of
the world. Serious efforts are under way to contain its spread in the
region. We hope that media campaigns would educate people on
precautions to be taken to keep them safe," the minister said. The
minister stressed the significance of developing a civic culture on
water consumption so that water is not allowed to pool in open areas
thus providing a breeding ground for mosquitoes. The minister also
referred to the current campaign of insecticide spraying in
residential areas.

"It is comforting to learn that integrated action teams have been set
up in different areas of the city to fight the disease-carrying
insects," he added. Saleh Ezzat, director of cleaning in the Makkah
municipality, said aerial spraying to kill dengue mosquitoes would be
undertaken in collaboration with the Ministry of Agriculture.
"Necessary supplies of insecticides have been procured for aerial
spraying over regions to the north and south of Makkah," the official
said. He added that the municipal teams sprayed insecticide at more
than 160 schools in the area. He said no spraying was undertaken in
schools during class hours to avoid exposing pupils to insecticides.

[Byline: Zainy Abbas]

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[Aerial spraying will, at best, provide very temporary reduction of
_Aedes_ vector mosquito populations. Efforts to reduce breeding sites
will be more effective.

The province of Makkah can be located on the map of Saudi Arabia at
<http://www.lib.utexas.edu/maps/middle_e ... l_2003.pdf>.
A HealthMap/ProMED-mail interactive map of Saudi Arabia can be accessed at
<http://healthmap.org/r/00aE>. - Mod.TY]

DENGUE/DHF UPDATE 2009 (18 )
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Saudi Arabia
Date: Sun 3 May 2009
Source: The National [edited]
<http://www.thenational.ae/article/20090 ... /1011/NEWS>


Municipal authorities in Mecca, Jeddah, and Taif are struggling to
control an outbreak of dengue fever in the cities, to the extent that
the World Health Organisation last month [April 2009] sent a
delegation to assess the situation.

While authorities have declined to comment on the outcome of the WHO
visit, various officials have given different figures for the number
of people who have contracted the disease, as well as different
accounts of the seriousness of the outbreak.

The mayor of Jeddah, Adil Faqeeh, told reporters in March [2009] the
number of people afflicted by dengue fever in his city had risen to
104 that month from 84 in February.

In the city of Mecca, the non-governmental National Society for Human
Rights (NSHR) reported last month [April 2009] that nearly 150 people
had been hospitalised with dengue fever in the past 3 months. Press
reports said the number of cases is rising and the disease has spread
to the city of Taif which, along with Jeddah and Mecca, is located in
Mecca [Makkah] province.

Moreover, the daily Okaz reported 2 weeks ago that Mr Faqeeh had
secretly reopened the municipality's crisis management unit, which
had been closed 2 years ago, last month.

However, the Saudi health minister, Dr Abdullah al Rabeeah, told a
press conference on 25 Apr [2009] that only 44 cases of dengue fever
have been reported in total since the outbreak of the disease in
December [2008]. "The ministry of health does not deny the presence
of the fever in [Mecca] province but it is at a very low rate
compared to other parts of the world. Serious efforts are under way
to contain its spread in the region" [he said].

Dr al Rabeeah also denied press reports there had been deaths as a
result of the disease in Mecca province. Okaz reported 2 weeks ago
that a man and a woman, both in their 20s, had died in hospital and
quoted the father of the man as saying dengue fever had been the
cause of his son's death.

According to Mr Faqeeh, the outbreak in Jeddah is concentrated in the
city's slums, where poor sanitation facilities, unclean water, and
the city's still incomplete sewage system all facilitate the spread
of the disease. Sewage in Jeddah is collected in a lake called the
"musk lake," which is a breeding ground for the mosquitoes that
transmit the disease [virus] and is located close to slum areas.

Mr Faqeeh launched an awareness campaign in March [2009] against
dengue fever. The government has spent an estimated 1.4 billion
riyals (United Arab Emirates dirham 1.37 billion) [about USD 373.3
million] on combating the disease, though it is unclear what the
funds have been spent on.

[Byline: Wael Mahdi]

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[There is a discrepancy between the numbers of dengue cases over the
past 3 months reported by the National Society for Human Rights (150
hospitalized cases) and those reported by the Ministry of Health (44
total cases). It would be of interest to know how many of these
reported cases are laboratory confirmed. Household water catchments,
rather than the sewage lagoon, are breeding sites of the _Aedes
aegypti_ mosquito vector of dengue virus, so that is where vector
control efforts should be focused.

The province of Makkah (Mecca) can be located on the map of Saudi Arabia at
<http://www.lib.utexas.edu/maps/middle_e ... l_2003.pdf>.
A HealthMap/ProMED-mail interactive map of Saudi Arabia can be accessed at
<http://healthmap.org/r/00aE>. - Mod.TY]

DENGUE/DHF UPDATE 2009 (20)
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Saudi Arabia
Date: Tue 12 May 2009
Source: Maktoob.com [edited]
<http://business.maktoob.com/20090000002 ... rticle.htm>


Swine flu might have taken the world by storm,
but Saudi health officials say they have treated
72 people for the potentially lethal
mosquito-borne tropical dengue fever in the past
week [week of 3 May 2009]. The patients were
treated in Jeddah, Saudi daily Arab News reported
on Tuesday [12 May 2009]. The newspaper did not
say what condition the patients were in.

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[An interactive map of Saudi Arabia showing the
locations mentioned can be accessed at the above URL. - Mod.TY]

DENGUE/DHF UPDATE 2009 (23)
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Saudi Arabia
Date: Thu 28 May 2009
Source: Saudi Wave [edited]
<http://www.saudiwave.com/index.php?opti ... Itemid=182>


Several newspapers and websites have rung alarm bells and warned
against a new epidemic of dengue fever, [caused by] a virus mainly
transmitted by mosquitoes that decimates mainly the animal but also
the human population. [Animals in Saudi Arabia would not be affected
by dengue virus infection. - Mod.TY]

"A horror gripped the people of Saudi Arabia after the appearance of
the dengue fever cases in Jeddah and Mecca," Mohamed Sayed Ali had
reported on 13 Apr 2009 on "Islamonline."

Quoting government medical sources, the official Saudi press agency
SPA had at the time announced "33 cases of dengue fever illness in
Jeddah and 103 in Mecca since the beginning of the month" [April 2009].

The daily "Okaz" had, on 12 Apr 2009, reported that a Saudi man and
woman, aged respectively 20 and 22 years old and afflicted by the
virus, had finally succumbed the previous day at King Faisal hospital in Mecca.

The following day, other newspapers had reported the hospitalization
in Mecca of more than 100 people affected by the disease. Most of
them were discharged from the hospitals after receiving emergency treatment.

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[A map of Saudi Arabia can be accessed at
<http://www.lib.utexas.edu/maps/cia08/sa ... m_2008.gif>.

Saudi-Arabien - Dengue
22.06.2009

Die Zahl der gemeldeten Dengue-Erkrankungen stieg bis Mitte Juni weiter an. Betroffen sind die Städte Mekka und Jeddah im Westen Saudi-Arabiens. Schutz vor tagaktiven Stechmücken beachten. / Quelle: crm

DENGUE/DHF UPDATE 2009 (25)
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Saudi Arabia
Date: Wed 17 Jun 2009
Source: Arab News (edited)
<http://www.arabnews.com/?page=1&section ... ry=Kingdom>


691 dengue fever cases have been reported so far this year [2009] in
Jeddah alone, despite concerted efforts by the government to contain
the disease, Al-Madinah newspaper said in a report published yesterday
[16 Jun 2009]. Dr Hussein Al-Bar, head of the Environment and Health
Committee at the Municipal Council, said from January until May
[2009], 691 dengue fever cases were reported in different parts of the
city. "At this rate we expect the cases to reach 950 this year,"
Al-Bar said, emphasizing the need to take intensive measures by
municipal and health authorities to contain the disease. He added
that 30 new cases were reported in Thuwal.

Al-Bar warned the public against laxity in taking precautions. He
said sewage lakes in streets breed mosquitoes that spread the
disease. Overflowing septic tanks are common in many residential
districts of south Jeddah. Residents of the area have complained
about the worsening situation and called for quick intervention by
the authorities. "The field teams of the Jeddah municipality are not
doing what is required to correct the situation," one citizen said,
while calling for immediate action. A resident of Ghulail said the
district has been suffering from overflowing septic tanks for long.
"Many people have contacted the municipality's operation room to
remove sewage from streets but they have failed to take any action,"
he said. [Another man] said many people in his neighborhood have been
affected and are receiving treatment in hospitals.

Muhammad Al-Yami, public relations manager at the municipality, said
his organization has launched a systematic campaign against dengue
fever. "We are focusing on exterminating mosquitoes from residential
areas by spraying insecticides," he said. Al-Yami said the
municipality has published pamphlets in 5 languages to enlighten the
public, including expatriates.

The largest number of 1308 dengue fever cases was reported in 2006,
the paper said. The number of cases then fell to 243 in 2007 but went
up again to 811 in 2008. An average of 200 cases are now reported a
month in Jeddah. During the last 2 months 80 new cases were reported
in the holy city of Makka.

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[Although overflowing septic tanks and sewage in the streets may
provide breeding areas for mosquitoes, these are not the breeding
sites for _Aedes aegypti_, the dengue virus vector, which breeds in
water catchments and storage containers in and immediately around
houses. Spraying will provide only temporary reduction of _Ae.
aegypti_ adult populations. Elimination or treatment of breeding
sites is required for effective control of this vector.

Maps of Saudi Arabia can be accessed at
<http://www.lib.utexas.edu/maps/cia08/sa ... m_2008.gif>
and the HealthMap/ProMED mail interactive map at
<http://healthmap.org/r/008R>. - Mod.TY]

RABIES, ANIMAL - ISRAEL: (CENTRAL) HUMAN EXPOSURE
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[1]
Date: Thu 15 Oct 2009
Source: YNET (Yediot Aharonot daily, Israel) [in Hebrew, trans. Mod.AS,
edited]
<http://www.ynet.co.il/articles/0,7340,L-3790717,00.html>


Rabies continues striking; a cow suspected to be hit in Western Galilee
-----------------------------------------------------------------------
The Ministry of Agriculture is concerned about the sharp rise in the number
of rabies cases among animals -- 36 cases since the beginning of the
current year [2009]. The last case was discovered in a cattle barn, in
Bustan Hagalil, Western Galilee; the cow's owners had to be vaccinated
[post exposure] and additional precautionary measures taken. The cow, which
died of an unknown illness, was transferred to the central animal-cadaver
destruction facility and was incinerated there without being sampled.
Later, the veterinary practitioner got the details of her clinical signs
and the suspicion for possible rabies was raised and reported to the
veterinary district office. "Because of the seriousness of rabies, the
Ministry of Agriculture's District Veterinary Officer decided to treat the
incident as a case of rabies. A message was forwarded to the Ministry of
Health, which decided, that due to the serious life-threatening risk posed
by the disease, the exposed people would be treated although the case
remained suspected, obviously not confirmed. The local authority decided on
other measures, to vaccinate animals in the region," said the Ministry of
Agriculture.

According to Ministry of Agriculture's information, a steep rise in the
number of rabies cases in animals has been recorded in recent months,
becoming an "almost daily" event. Since the beginning of this year [2009],
36 rabies cases have been detected in animals, 22 of them in dogs, mostly
in the Galilee and Golan Heights. This compares with only 12 cases during
2008, 15 cases in 2005 and 9 in 2006 [total annual numbers).

The last published case involved an infected donkey in the village
Sedot-Micha, near Bet-Shemesh (Jerusalem district; see item 2 below -
Mod.AS]. Last month [September 2009], 9 people were bitten during one night
by infected jackals in the Afula-Nazareth area [northern Israel].

[byline: Ahiam Rabd, Meital Yasur-Beit Or]

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[2]
Date: Sat 10 Oct 2009
Source: YNET (Yediot Aharonot daily, Israel) [in Hebrew, trans. Mod.AS,
edited]
<http://www.ynet.co.il/articles/0,7340,L-3787869,00.html>


Fear of rabies in the mountains of Jerusalem; infected donkey discovered
------------------------------------------------------------------------
A rabies outbreak is feared in the village Sedot-Micha, near Jerusalem. The
Hadassah Hospital, Ein-Karem [Jerusalem] said tonight (Fri 9 Oct 2009] that
during the last 3 days, 7 people from the vicinity of the village have been
vaccinated, after one of them was bitten by a donkey, which later tested
positive for rabies. The hospital warned that the animal that had infected
the donkey, probably a dog or a fox, was not found.

The suspicion about rabies occurred after a group of boys found 3 female
donkeys [jennets] roaming the hills of Jerusalem and brought them to the a
school-farm nearby the village Sedot Micha. One of the boys was bitten by a
donkey and was taken to the hospital. The donkey was transferred to the
Veterinary Service and found positive [for rabies].

"From that moment, we had to vaccinate everyone who came into contact with
the sick animal, since rabies is transferred through the saliva. This is a
significant problem since we do not know how the donkey got infected," YNET
was told by the head of the Department of Emergency Medicine at Hadassah
Ein Kerem, Professor Kobi Assaf.

"The donkey was found in a central location, among many settlements such as
Beit Shemesh, Netiv HaLamed he, Zoreah, Zechariah village, Aviezer, Tirosh
Geffen, Srigim, Zafririm, and Givat-Yeshayahu. We call upon the public not
to tie dogs in the yard but to keep them indoors. Those responsible for
health and security in each community should invite the veterinary service
to come and look for stray animals. Certainly, anyone bitten or exposed to
a stray dog, must come to be examined at the hospital or health office.
This is great public concern."

According to Professor Assaf, every year 700 to 900 bitten persons attend
the hospital, of which at least 300 get [post exposure] vaccinations
against rabies.

[byline: Ronen Medzini]

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[An updated, 2009 map and table of rabies cases in Israel is available at
<http://agri3.huji.ac.il/~yakobson/rabheb/mapa2009.html>. Since our
previous report on rabies in Israel, dated 27 Aug 2009, 10 additional cases
in animals have been laboratory confirmed; 2009 has become, rabies-wise,
the worst since 2003. The implementation of the fox-targeted oral
vaccination programme (ORV), initially (1998) on a limited scale and later
(2003) on a larger one, led eventually to a dramatic fall in the number of
cases, the disease practically disappearing from most parts of the country,
with a few cases sporadically appearing in the north east (Syrian border
areas).

Between 1979 and 2000, foxes constituted the main reservoir of rabies in
Israel. During 2004-2007, the biological and molecular characterization of
the rabies isolates showed that stray dogs emerged as the main animal
reservoir in Northern Israel while lower numbers of cases were reported in
domestic animals. The virus isolates from foxes and dogs differed, in their
molecular characterization, suggesting 2 distinct separate lineages. The
transition from fox-mediated rabies to dog-mediated rabies is of great
concern to public health because of the close contact between dogs and the
human population (see reference below).

The case in a donkey in the Judean hills (central Israel) described above,
may be indicative of returning cases in wildlife, in spite of continuing
oral vaccination; this is in need of explanation. Until 2005, 2 annual
aerial bait dispersion campaigns were carried out, in the spring and in the
fall. During the last 4 years, 2006-2009, the project included only one
annual aerial dispersion campaign, in the fall; 350 000 baits are dispersed
annually, covering an area of 20 000 sq/km (approx 7700 sq/mi). A map,
showing the distribution of oral vaccine baits for foxes and jackals since
2004, is available at
<http://agri3.huji.ac.il/~yakobson/rabhe ... -2011.html>.

Reference
---------
D David, N Devers, BA Yakobson, I Davidson. Emergence of dog rabies in the
Northern region of Israel. Epidemiol Infect 2009; 137(4): 544-8;
DOI:10.1017/S0950268808001180. - Mod.AS]

Israel - Tollwut
27.10.2009

Aus Israel wird ein Anstieg der Tollwut-Fallzahlen, insbesondere unter streunenden Hunden gemeldet. Betroffen ist vor allem die Region Galiläa und die Golan Höhen. Zuletzt wurden gehäuft Tierbisse von tollwütigen Tieren registriert. Nach verdächtigen Tierkontakten sollte umgehend ein Arzt aufgesucht werden. / Quelle: crm

DENGUE/DHF UPDATE 2009 (45)
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Yemen (Taiz)
Date: Fri 16 Oct 2009
Source: UN Office for the Coordination of Humanitarian Affairs (OCHA),
Integrated Regional Information Networks (IRIN) News [edited]
<http://www.irinnews.org/Report.aspx?ReportId=86616>


Hundreds of people in Taiz city, 250 km [155 mi] south of the Yemeni
capital, Sanaa, have dengue fever and local hospitals are taking in new
cases on a daily basis, according to health officials. "Since the new
outbreak in September [2009], at least 350 cases have been confirmed and a
further 1000 are suspected," Mohammed Mahmoud, manager of the government's
National Malaria Control Programme (NMCP) in Taiz, told IRIN.

He said the number of infections had increased due to the widespread use of
uncovered water tanks, particularly in the city's slums. "Swamps and open
sewers contribute much to the reproduction of the vector, known as _Aedes_
(mosquito) that transmits the fever [virus]," Mahmoud said. [Water tanks
certainly can serve as _Aedes aegypti_ breeding sites. Swamps and open
sewers do not. - Mod.TY]

Many cases go undiagnosed and are not properly treated as most of those
infected do not go to hospital for screening, said Huwaida al-Shathili, a
professor at Taiz university's faculty of medicine. Al-Shathili said the
number of dengue-infected cases may be many times more than those
registered by NMCP, as symptoms can be difficult to detect.

Doctors say Taiz (population 500 000) has a fertile environment for
mosquito breeding. "In Taiz, dengue isn't an epidemic it is a recurring
disease in the governorate where stagnant water and pollution are
commonplace. The disease appears every 2 or 3 years," al-Shathili noted.
"Last year [2008], more than 300 cases were detected."

Spraying campaigns were undertaken in some parts of the city in September
[2009] but results have been poor due to a lack of funding, according to
Mahmoud.

"We proposed 2 massive spraying campaigns to cover all 94 000 houses in the
city at a cost of YR 38 million [USD 190 000]," he said, adding that the
Health Ministry had provided insufficient funding.

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[Results may have been poor because space spraying provides only temporary
reduction in vector populations of _Aedes aegypti_.

A map of Yemen showing the provinces can be accessed at
<http://www.lib.utexas.edu/maps/middle_e ... n_2002.jpg>.
A HealthMap/ProMED-mail interactive map of Yemen can be accessed at
<http://healthmap.org/r/00YN>. - Mod.TY]

Jemen - Dengue
10.11.2009

Aus der Stadt Taiz (250 km südlich der Hauptstadt Sanaa) wird ein Dengue-Ausbruch gemeldet. Seit September wurden 350 Infektionen labortechnisch bestätigt, bei mehr als 1.000 weiteren Patienten besteht die Verdachtsdiagnose. Schutz vor tagaktiven Stechmücken beachten. / crm

MUMPS, YESHIVA STUDENTS - ISRAEL, REQUEST FOR INFORMATION
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Date: Wed 18 Nov 2009
Source: Yeshiva World News (YWN) [edited]


It appears that mumps is continuing to spread in chareidi yeshivas in
Eretz Yisrael [the Land of Israel], with signs of infection beginning
to appear in Chevron Yeshiva. YWN-Israel reported that the illness
has already infected many bochrim in Ohr Shmuel (Yerushalayim) and a
Bnei Brak yeshiva, in which 100 of 160 talmidim were diagnosed.

Cases of mumps have also been detected in Yeshiva Maynei Shel Torah.
In the case of the latter, as well as Yeshivas Chevron, roshei
yeshiva have informed talmidim that if they detect the earliest signs
of the illness, or suspect they may have it, they are to immediately
leave the beis medrash and seek medical attention and/or prophylactic
treatment.

--
Communicated by:
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[The students at these educational institutions are presumed to be
males, teen-agers and young adults. The incidence of mumps among
students at these institutions seems extraordinarily high (100 out of
160 in one instance) and suggests that few have been vaccinated or
perhaps received only a single dose of vaccine. Further information
would be welcomed verifying the extent of this outbreak, the
relationship between these institutions, and the vaccination status
of the pupils.

The HealthMap/ProMED-mail interactive map of Israel can be accessed
at: <http://healthmap.org/r/00aH>. - ModsAS/CP]

MUMPS - ISRAEL (02)
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Date: Wed 18 Nov 2009
Source: Haaretz - Israel News [edited]
<http://www.haaretz.com/hasen/spages/1128723.html>


Ministry: Israel in midst of mumps outbreak
-------------------------------------------
Israel is in the midst of a mumps outbreak, the Health Ministry
announced this week [week of 16 Nov 2009]. Since the beginning of
September [2009], 105 people have been diagnosed with mumps, most
between the ages of 10 and 24. During the same period in 2008, only 4
people were diagnosed with the disease, a contagious virus
characterized by swollen salivary glands. Only 13 cases were reported
for the entire year. In 2007, only 6 mumps cases were reported.

Of the current cases, 82 are people from Jerusalem, but the disease
has also been found in the central region (11 cases), Tel Aviv (5),
the south (4), and Haifa (2). One of the patients developed
testicular infection, a complication of mumps, and is hospitalized in
a Jerusalem hospital.

Itamar Grotto, director of Public Health Services in the Health
Ministry, believes the increase in the number of cases stems from the
fact that the mumps inoculation was added to the national vaccination
program only in 1988, along with measles and rubella. The mumps
vaccine is given to children in 2 doses -- at the age of 1 year and
in 1st grade.

"The outbreak is believed to have occurred among Israelis who didn't
get both doses," Grotto said. Most of the patients are believed to be
from communities that refuse to be inoculated, particularly the
ultra-Orthodox. "People who are not inoculated are not exposed to
children's diseases, because the population around them has been
inoculated. However, they tend to contract these diseases as adults,
and at this stage the diseases are more dangerous due to possible
complications," said Professor David Greenberg, of the Pediatric
Infectious Disease Unit in the Soroka University Medical Center at
Ben-Gurion University.

In most cases, mumps runs it course without treatment, but one-tenth
of patients develop mild forms of meningitis. In other cases, it
could lead to testicular infection or ovarian inflammation. In men it
could also lead to deafness or sterility. The Israel Pediatrics
Association called on parents to make sure their children receive
both doses of the mumps vaccine, in keeping with the national program.

An increase in mumps cases has also been reported in the United
States and Canada. At the end of last week [week of 9 Nov 2009], 15
students at Jerusalem's Or Shmuel Yeshiva came down with mumps,
apparently after being in close proximity to a student who contracted
the disease in Brooklyn [currently the site of an ongoing outbreak of
mumps in the USA, see: ProMED-mail archive references below}.

[Byline: Dan Even]

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[The late introduction of universal mumps vaccination in Israel may
in part explain the extent of the current outbreak of mumps in young
adults. Additionally the fact that most of the patients are believed
to be from ultra-orthodox communities, that decline vaccination, may
explain the high incidence of mumps among Yeshiva students as
reported in the preceding ProMED-mail report archive no.
20091119.3990). It is clear that the population of Israel contains an
appreciable proportion of individuals unvaccinated or partially
vaccinated, and that the country as a whole is vulnerable to
introduction of infection from elsewhere (in this case probably the
USA or Canada).

The HealthMap/ProMED-mail interactive map of Israel can be accessed at
<http://healthmap.org/r/00aH>. - Mod.CP]

MUMPS - ISRAEL: YESHIVA STUDENTS, 2009
**************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 17 Dec 2009
Source: Eurosurveillance edition 2009; 14(50) [edited]
<http://www.eurosurveillance.org/ViewArt ... leId=19440>


Mumps outbreak in Jerusalem affecting mainly male adolescents
-------------------------------------------------------------
[Rapid communication: C Stein-Zamir, H Shoob, N Abramson, et al.
Jerusalem District Health Office, Ministry of Health, Israel]

Mumps is a notifiable disease in Israel by law. From mid-September
2009 to 7 Dec 2009, 173 cases of mumps have been reported to the
Jerusalem District Health Office [up from 105 on 16 Nov 2009. -
Mod.CP]. The patients were mainly (147/173; 85 percent) students in
yeshivas (religious academies operated as boarding schools) in
several Jerusalem neighbourhoods and 2 neighbouring cities, and 142
of 173 (82 percent) were males. The epidemic curve is presented shows
a pattern compatible with person-to-person transmission. The median
age of the patients was 14.5 years and the mean was 14.8 plus/minus
7.3 years. Altogether, 60 schools have been affected [listed in a
table in the original text]. The outbreak spread to other regions of
the country, and up to 7 Dec 2009 over 250 cases have been reported
with similar demographic and epidemiologic characteristics.

The clinical picture included unilateral and bilateral parotitis. One
patient (a 19 year-old) was hospitalised in a urology department with
orchitis and another 3 were admitted to ear, nose, and throat
departments. A further 6 patients were observed for varying periods
in hospital emergency departments and discharged.

Case ascertainment included: positive mumps IgM antibody (in 20
patients) and positive real-time RT-PCR in urine (in 4 patients). The
virus was classified by the central virology laboratory of the Israel
ministry of health as genotype G5. The remaining 149 cases were
diagnosed on the basis of clinical features together with an
epidemiologic association.

Of the 173 patients, 116 (67 percent) had received 2 doses of
measles-mumps-rubella (MMR) vaccine (Priorix GlaxoSmithKline
Biologicals-Jeryl Lynn strain), 29 (16.8 percent) had received one
dose (age-appropriate in 12 of them), 20 (11.6 percent) were not
immunised, and in another eight patients (4.6 percent) the
immunisation status was unknown

A number of patients reported contact with yeshiva students from the
United States (New York) who visited Israel during the High Holidays
in mid-September 2009 and some of whom were reported to have recently
had mumps.

Outbreak control measures included investigations in the relevant
schools to determine the students' vaccination status and referral
for completion of MMR vaccination where necessary. Information on the
outbreak was circulated to all health maintenance organisations in
the District and to the public via the mass media.

Discussion
----------
Mumps is an acute viral infection; a third of infections are
subclinical, another 30-40 percent are expressed clinically as
unilateral or bilateral parotitis. Complications occur more
frequently in adults than in children; 10-15 percent of mumps
patients develop meningo-encephalitis. Orchitis occurs in 20-50
percent of post-pubertal men, but sterility is rare. Other
complications include pancreatitis, oophoritis, deafness, arthritis,
thyroiditis, and myocarditis. Transmission is through droplet
infection. Confirmation of mumps infection includes serological
testing (for IgM antibodies by various methods), identification of
mumps RNA by RT-PCR and viral isolation in cell culture (1).

Mumps vaccination was included in the routine childhood immunisation
schedule in Israel in 1984, and since 1994 has been administered in a
two-dose schedule at ages 12 months and 6 years (1st grade in school)
in the form of the MMR vaccine, and since 2008 as
measles-mumps-rubella-varicella (MMRV) vaccine. The average overall
immunisation coverage for the 1st dose of mumps vaccine (MMR/MMRV) in
the Jerusalem District has been maintained between 93 and 96.7
percent over the past decade [Jerusalem District Health Office,
unpublished data]. It is to be noted that in 1992, the coverage for
the 1st dose of MMR among the Jewish population of Jerusalem was a
mere 82.3 percent.

Mumps control in Israel improved significantly during the 1990's (2),
although periodic outbreaks still occurred due to under-vaccination,
primary vaccine failure, and waning immunity. In 1998 and 2005, 2
outbreaks (each of the order of 100 cases) occurred in Israel. In
2006, 12 cases were reported; 6 were reported in 2007 and 13 in 2008.
Serological studies performed in the late 1990s revealed relatively
low mumps antibody levels among adolescents and army recruits in
Israel, ranging from 59 to 83.3 percent positivity; such levels do
not guarantee adequate herd immunity (3, 4).

Mumps outbreaks, mainly involving adolescents and young adults, have
emerged recently in several countries. A nationwide mumps outbreak
occurred in the United Kingdom in 2004-2005, with 56 390 reported
cases. The majority (79 percent) were aged 15-24 years; two thirds
were unvaccinated. Non-availability of MMR vaccine probably
contributed to susceptibility of the birth cohorts 1983-1986 [5]. In
the United States, the largest outbreak in 20 years occurred in
2006-2007, encompassing more than 6 000 cases centred in college
campuses. Of the students aged 18-24 years, 84 percent had been
vaccinated with 2 doses of mumps vaccine (6). The epidemic occurred
despite high vaccination rates and low mumps activity in the community (7).

England and Wales are currently in the throes of an outbreak of mumps
centred in college campuses, with 998 cases reported in
January-February 2009, and further cases still being reported, mainly
among college students. The circulating genotype is G5 (8).

Other European outbreaks have been reported in recent years. In an
Austrian outbreak involving over 200 cases (9), 49 percent of the
patients were unvaccinated -- a very different situation from the
outbreak we report. In the Republic of Moldova, an extremely large
outbreak of nearly 20 000 cases was reported in 2007-2008 (10). Most
of the patients (96 percent) had received only one dose of MMR. A
2-dose schedule was introduced in that country in 2002, for birth
cohorts from 1995 onwards.

In an ongoing mumps outbreak in the United States (New York, New
Jersey), and Canada (Quebec), 179 and 15 cases, respectively, were
reported in August-October 2009. The affected individuals are mainly
members of a Jewish religious community (83 percent males; median age
14 years). Of those for whom vaccination status is known 72 percent
were vaccinated with 2 doses. The virus was of genotype G [?] (11).

Conclusions
-----------
The 2 main characteristics of the current outbreak in Jerusalem are
the predominance of male adolescents in religious boarding schools
and the fact that most cases (74 percent) are appropriately
vaccinated for their age. The male predominance is striking, and
requires further study.

It had been observed that the mumps component of the MMR vaccine
provides inferior protection compared to the measles and rubella
components. Unlike the levels of 95 percent and 98 percent provided
by the latter 2, the mumps protection levels are approximately 62 85
percent and 85 88 percent for the 1st and 2nd doses, respectively.

Recently, the effectiveness in the United Kingdom was determined as
88 percent and 95 percent, respectively. However, the effectiveness
of one dose waned from 96 percent in two year-olds to 66 percent in
11-12 year-olds, and the effectiveness of two doses from 99 percent
in 5-6 year-olds to 86 percent in 11-12 year-olds [12].

The reasons for the particular characteristics of these mumps
outbreaks are unclear. Possible explanations include a combination of
primary and secondary vaccine failure, waning immunity, inadequate
vaccine effectiveness, and previous low immunisation coverage.
Contributory factors include living conditions in specific population
groups such as college freshmen, army recruits, and adolescent
students in boarding schools.

References
----------
1. Atkinson W, Wolfe S, Hamborsky J, McIntyre L, editors:
Epidemiology and Prevention of Vaccine-Preventable Diseases. 11th ed.
Centers for Disease Control and Prevention (CDC). Chapter 13: Mumps.
Washington, D.C.: Public Health Foundation; 2009. p.189-91. Available from
<http://www.cdc.gov/vaccines/pubs/pinkbook/default.htm>.
2. Slater PE, Anis E, Leventhal A: The control of mumps in Israel.
Eur J Epidemiol. 1999 Sep;15 (8): 765-7 [abstract available from
<http://www.ncbi.nlm.nih.gov/pubmed/10555621>].
3. Muhsen K, Aboudy Y, Mendelson E, et al: Prevalence of mumps
antibodies in the Israeli population in relation to mumps vaccination
policy and incidence of disease. Epidemiol Infect. 2008 May; 136(5):
688-93 [abstract available from
<http://www.ncbi.nlm.nih.gov/pubmed/17608960>].
4. Huerta M, Davidovitch N, Aboudy Y, et al: Declining population
immunity to mumps among Israeli military recruits. Vaccine. 2006 Sep
11; 24(37-39): 6300-3 [abstract available from
<http://www.ncbi.nlm.nih.gov/pubmed/16844272>].
5. Centers for Disease Control and Prevention (CDC): Mumps epidemic -
United Kingdom, 2004-2005. MMWR Morb Mortal Wkly Rep. 2006 Feb 24;
55(7): 173-5 [available from
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5507a1.htm>].
6. Dayan GH, Quinlisk MP, Parker AA, et al: Recent resurgence of
mumps in the United States. N Engl J Med. 2008 Apr 10; 358(15):
1580-9 [available from
<http://content.nejm.org/cgi/content/full/358/15/1580>].
7. Barskey AE, Glasser JW, LeBaron CW: Mumps resurgences in the
United States: A historical perspective on unexpected elements.
Vaccine. 2009 Oct 19; 27(44): 6186-95 [abstract available from
<http://www.ncbi.nlm.nih.gov/pubmed/19815120>.
8. Health Protection Agency: Continued increase in mumps in
universities 2008-2009. Health Protection Report. 2009; 3(14), 9 Apr
2009, United Kingdom. Available from
<http://www.hpa.org.uk/hpr/archives/2009/news1409.htm>.
9. Schmid D, Holzmann H, Alfery C, et al: Mumps outbreak in young
adults following a festival in Austria, 2006. Euro Surveill. 2008;
13(7): pii=8042. Available from
<http://www.eurosurveillance.org/ViewArt ... cleId=8042>.
10. Mossong J, Bonert C, Weicherding P, et al: Mumps outbreak among
the military in Luxembourg in 2008: epidemiology and evaluation of
control measures. Euro Surveill. 2009; 14(7): pii=19121. Available from
<http://www.eurosurveillance.org/ViewArt ... leId=19121>.
11. Centers for Disease Control and Prevention (CDC): Mumps outbreak
- New York, New Jersey, Quebec, 2009. MMWR Morb Mortal Wkly Rep. 2009
Nov 20; 58(45): 1270-4 [available from
<http://www.cdc.gov/mmwr/preview/mmwrhtm ... 1112a1.htm>].
12. Cohen C, White JM, Savage EJ, et al: Vaccine effectiveness
estimates, 2004-2005 mumps outbreak, England. Emerg Infect Dis. 2007
Jan; 13(1):12-7 [available from
<http://www.cdc.gov/ncidod/EID/13/1/12.htm>].

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[The continued prevalence of mumps in several different countries in
the face of high levels of vaccination may be due to poor initial
response to vaccination in a proportion of individuals and/or early
waning of the immune response in others. One predisposing factor has
been the congregation of young adults in colleges and similar
educational establishments. The yeshiva system of boarding schools in
Israel and in orthodox Jewish communities elsewhere seems to provide
similar conditions allowing the transmission of mumps in younger
age-groups despite higher levels of vaccination. Further information
regarding the containment of the Jerusalem outbreak would be welcomed.

The HealthMap/ProMED-mail interactive map of Israel can be accessed
at
<http://healthmap.org/r/00aH>. - Mod.CP]