Increased upper respiratory infection (URI) among children at the beginning of school year is well known to parents and pediatricians. However, this phenomenon is not well documented or ...characterized.
Computerized datasets from a large health maintenance organization in Israel were used to calculate the weekly rates of URI among children 3-14 years old for the years 2007-2012. In addition, nasopharyngeal swabs were collected in 2010-2012 from children with URI symptoms and controls during school opening time. Swabs were tested by real-time polymerase chain reaction for the presence of respiratory viruses.
Time-series analysis demonstrated a peak of URI in September each year. The peaks reached their height 2 weeks after school opening and returned to baseline within 4-7 weeks. The main 3 viruses detected both in URI patients and in healthy controls during the first weeks of school opening were rhinovirus, adenovirus and enterovirus. The detection rate of any respiratory virus, and of rhinovirus in particular, was significantly higher among cases than among controls (54% vs. 16%, P < 0.001 for any virus, and 35% vs. 6.0%, P < 0.01 for rhinovirus). When adjusting for age and sex cases had 5.8 times more viral detection when compared with controls. Upper respiratory symptoms were significantly more prevalent among the virus-positive cases when compared with negative ones.
Back-to-school illness consisting of URI has a distinct epidemiological pattern demonstrating a rapid rise peaking within 2 weeks of school opening and is associated predominantly with rhinovirus.
Background. On 28 June 2005, numerous cases of febrile illness were reported among 322 students and employees of a boarding high school located in an urban area in central Israel. Subsequent ...investigation identified a large outbreak of Q fever which started 2 weeks earlier. We describe the investigation of this outbreak and its possible implications. Methods. We conducted a case-control study to identify risk factors for Q fever disease. Environmental sampling was conducted to identify the source and the mode of transmission of Coxiella burnetii the infectious agent. Results. Of 303 individuals, 187 (62%) reported being ill between 15 June and 13 July 2005. Serological evidence for C. burnetii infection was evident in 144 (88%) of the 164 tested individuals. Being a student, dining regularly at the school dining room, and boarding at school during a June religious holiday and the preceding weekend were all significant risk factors for contracting Q fever. C. burnetii DNA was detected using polymerase chain reaction on samples from the school dining room's air conditioning system, supporting contribution of the air conditioning system to the aerosol transmission of the infectious agent. Conclusions. We report a large outbreak of Q fever in an urban school, possibly transmitted through an air conditioning system. A high level of suspicion for C. burnetii infection should be maintained when investigating point source outbreaks of influenza-like disease, especially outside the influenza season.
Little is known about the development of cross-reactive antibodies following natural exposure to pathogens. Such knowledge is critical in the development of new universal influenza vaccines.
To study ...the possibility of the presence of cross-reactive antibodies to influenza viruses which underwent a major antigenic drift between the years 1999 and 2007 sera from samples of 80 children and 400 adults were selected at random from the Israeli national serum bank. The sera was obtained in 2002 and in 2007, two time points that followed a major drift in the infectious H3N2 influenza virus strain (A/Panama/2007/99 to A/Wisconsin/67/2005).
In the summer of 2002, 13% of the children had Hemagglutination Inhibition (HI) antibody titers of at least 40 and these antibodies recognized both A/Panama/2007/99 and A/Wisconsin/67/2005, where the latter strain only began to circulate in Israel in 2006. In 2007, 29% of the children had HI antibody titers of at least 40 directed against both A/Wisconsin/67/2005 and A/Panama/2007/99, even though they had never been exposed to the latter virus. Anti-A/Panama/2007/99 antibodies were detected in 58% and 68% of the 2002 and 2007 adult samples, respectively, while 8% and 39% had antibodies against A/Wisconsin/67/2005, respectively.
The presence of naturally occurring cross-reactive influenza virus antibodies in a significant percentage of children has important implications for the development of a universal influenza vaccine.
Background
Influenza virus A(H1N1)pdm09 first appeared in Israel in late April 2009, disappeared in mid‐March 2010, and reappeared in late October 2010. Symptoms were mostly mild without need for ...medical care.
Objectives
To provide targets for future pandemic preparedness and response by evaluating the dynamics and cumulative incidence of A(H1N1)pdm09 infection, the virus‐specific seroprevalence (HI antibody titer >1:40) at the height of the pandemic, during its decline and thereafter.
Methods
A cross‐sectional seroepidemiological study was conducted on 6911 serum samples collected before, during, and after the pandemic.
Results
Cumulative incidence of infection derived from the differences between post‐ and pre‐pandemic seroprevalence was 54·1%, 32·9%, 22·9%, 14·8%, and 6·3% in age‐groups 0–9, 10–19, 20–49, 50–79, and ≥80 years, respectively, and 28·5% for all age‐groups combined. Vaccination could have contributed at the most 4·6% to the post‐pandemic population seroprevalence. High pre‐pandemic immune response (47·4%) found in a cohort aged 15–18 year was strongly associated with birth years 1990–1993. Morbidity began to decline in mid‐November 2009 at 32·8% population seroprevalence (45% in ages 0–19 year) and stopped in March 2010 at 43·4% population seroprevalence in February 2010 (70% in ages 0–19 year). Between February and September 2010, seroprevalence declined by 12·2% allowing virus recirculation from October 2010.
Conclusions
Our study provides targets for controlling future influenza pandemics in Israel. Vaccination should focus on the younger age‐groups (0–19 year) which played a key role in transmission of the A(H1N1)pdm09 due to lack of background immunity (ages 0–9 year) and high exposure rates (ages 10–19 year).
Abstract Objective To explore the possibility that mild inflammatory changes exist in asymptomatic adults during bouts of acute respiratory tract infections in the general population, and may mediate ...atherothrombotic events. Methods An epidemiological study that enrolled 5315 males and 2795 females attending a routine screening health program between the years 2003 and 2007. We correlated the concentrations of high sensitivity C-reactive protein (hs-CRP) and quantitative fibrinogen in completely asymptomatic and non-inflamed adults to the weekly epidemiological data for the incidence of acute respiratory tract infections in the community. Results Significant seasonal variations in the inflammatory variables were found for both genders. The population's weekly rates of acute respiratory tract infection had a significant epidemiological influence on the inflammatory biomarkers in the asymptomatic cohort. The magnitude of this influence could reach as much as 12% (3–22%) in hs-CRP concentrations in women and 0.30 μmol/L (0.20–0.41) in fibrinogen concentrations in men, for the change between the mean August and the mean January population's respiratory illness burden. Conclusion Increase in the concentrations of two inflammation-sensitive biomarkers can occur in completely asymptomatic adults at times of increased burden of acute respiratory tract infection in the general population. The possibility exists that these inflammatory changes represent occult and asymptomatic infections that could by themselves trigger acute atherothrombotic events.
Background
Influenza virus
A
(
H
1
N
1)pdm09 first appeared in
I
srael in late
A
pril 2009, disappeared in mid‐
M
arch 2010, and reappeared in late
O
ctober 2010. Symptoms were mostly mild without ...need for medical care.
Objectives
To provide targets for future pandemic preparedness and response by evaluating the dynamics and cumulative incidence of
A
(
H
1
N
1)pdm09 infection, the virus‐specific seroprevalence (
HI
antibody titer >1:40) at the height of the pandemic, during its decline and thereafter.
Methods
A cross‐sectional seroepidemiological study was conducted on 6911 serum samples collected before, during, and after the pandemic.
Results
Cumulative incidence of infection derived from the differences between post‐ and pre‐pandemic seroprevalence was 54·1%, 32·9%, 22·9%, 14·8%, and 6·3% in age‐groups 0–9, 10–19, 20–49, 50–79, and ≥80 years, respectively, and 28·5% for all age‐groups combined. Vaccination could have contributed at the most 4·6% to the post‐pandemic population seroprevalence. High pre‐pandemic immune response (47·4%) found in a cohort aged 15–18 year was strongly associated with birth years 1990–1993. Morbidity began to decline in mid‐November 2009 at 32·8% population seroprevalence (45% in ages 0–19 year) and stopped in March 2010 at 43·4% population seroprevalence in February 2010 (70% in ages 0–19 year). Between
F
ebruary and
S
eptember 2010, seroprevalence declined by 12·2% allowing virus recirculation from
O
ctober 2010.
Conclusions
Our study provides targets for controlling future influenza pandemics in Israel. Vaccination should focus on the younger age‐groups (0–19 year) which played a key role in transmission of the
A
(
H
1
N
1)pdm09 due to lack of background immunity (ages 0–9 year) and high exposure rates (ages 10–19 year).
In this paper we report the use of the open source Spatiotemporal Epidemiological Modeler (STEM, www.eclipse.org/stem) to compare three basic models for seasonal influenza transmission. The models ...are designed to test for possible differences between the seasonal transmission of influenza A and B. Model 1 assumes that the seasonality and magnitude of transmission do not vary between influenza A and B. Model 2 assumes that the magnitude of seasonal forcing (i.e., the maximum transmissibility), but not the background transmission or flu season length, differs between influenza A and B. Model 3 assumes that the magnitude of seasonal forcing, the background transmission, and flu season length all differ between strains. The models are all optimized using 10 years of surveillance data from 49 of 50 administrative divisions in Israel. Using a cross-validation technique, we compare the relative accuracy of the models and discuss the potential for prediction. We find that accounting for variation in transmission amplitude increases the predictive ability compared to the base. However, little improvement is obtained by allowing for further variation in the shape of the seasonal forcing function.
Background Studies in the literature have indicated that the timing of seasonal influenza epidemic varies across latitude, suggesting the involvement of meteorological and environmental conditions in ...the transmission of influenza. In this study, we investigated the link between meteorological parameters and influenza activity in 9 sub-national areas with temperate and subtropical climates: Berlin (Germany), Ljubljana (Slovenia), Castile and Leon (Spain) and all 6 districts in Israel. Methods We estimated weekly influenza-associated influenza-like-illness (ILI) or Acute Respiratory Infection (ARI) incidence to represent influenza activity using data from each country's sentinel surveillance during 2000-2011 (Spain) and 2006-2011 (all others). Meteorological data was obtained from ground stations, satellite and assimilated data. Two generalized additive models (GAM) were developed, with one using specific humidity as a covariate and another using minimum temperature. Precipitation and solar radiation were included as additional covariates in both models. The models were adjusted for previous weeks' influenza activity, and were trained separately for each study location. Results Influenza activity was inversely associated (p<0.05) with specific humidity in all locations. Minimum temperature was inversely associated with influenza in all 3 temperate locations, but not in all subtropical locations. Inverse associations between influenza and solar radiation were found in most locations. Associations with precipitation were location-dependent and inconclusive. We used the models to estimate influenza activity a week ahead for the 2010/2011 period which was not used in training the models. With exception of Ljubljana and Israel's Haifa District, the models could closely follow the observed data especially during the start and the end of epidemic period. In these locations, correlation coefficients between the observed and estimated ranged between 0.55 to 0.91and the model-estimated influenza peaks were within 3 weeks from the observations. Conclusion Our study demonstrated the significant link between specific humidity and influenza activity across temperate and subtropical climates, and that inclusion of meteorological parameters in the surveillance system may further our understanding of influenza transmission patterns.
Ageless Arete Reid, Heather; Serrati, John
2022
eBook
Open access
Arete is a crucial concept in ancient Greek culture that defies simple translation. In general, it indicates excellence—especially of human beings, but also of animals, institutions, even objects. It ...is linked to important concepts such as glory, justice, truth and harmony. It influences important activities such as religion, athletics, politics, and education. This collection demonstrates the length and breadth of arete’s importance in ancient Greek and Roman culture, from its prehistorical etymological roots to its mystification in pre-Christian theology and even its manifestation in the career of a modern archaeologist. Leaving aside Plato and Aristotle, to whom a companion volume has been dedicated, these essays explore arete in Presocratic philosophy, classical oratory, epinician poetry, tragic drama, ancient Sicilian history, Stoicism, Epicureanism, and Neoplatonic thought. To many, arete was inherited by blood from the Homeric heroes, a birthright of social elites used to reinforce traditional hierarchies in the classical polis. To others, arete was an achievement distinct from social advantage but expected to advantage society. To understand arete philosophically, we must explore its wider cultural function—and vice versa. Arete is an enduring—even ageless—concept that, properly understood, may benefit humanity even today.
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