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D Mimouni

Publications and source records attributed to D Mimouni.

At least 19 recordsLinked to original sources
PubMed2001

Decline in immunity to polio among young adults.

A serologic survey was conducted on a population-based representative sample of 521 18-year-old soldiers recruited to the Israel Defence Forces in 1997. The prevalence of neutralizing antibodies and geometric mean titers (GMTs) against the three types of poliovirus (Mahoney, MEF and Saukett strains) were found to be 98.7% (GMT--169.95), 99.6% (GMT--297.14) and 96.4% (GMT - 59.48), respectively. These GMTs are markedly lower than those recorded 4 years after booster vaccination carried out during a 1988 polio outbreak, and suggest a decline in immunity against polio among young adults. These findings support the policy of routine revaccination of children and adolescents in countries at risk of imported polioviruses and of revaccination of adults traveling to areas to which polio is endemic.

Adolescent↗
PubMed2001

Breast-feeding and the onset of atopic dermatitis in childhood: a systematic review and meta-analysis of prospective studies.

BACKGROUND: Despite the numerous studies on the possible protective effect of breast-feeding against the onset of atopic dermatitis during childhood, this issue remains controversial. OBJECTIVE: We conducted a systematic review with meta-analysis of prospective studies that evaluated the association between exclusive breast-feeding during the first 3 months after birth and atopic dermatitis. METHODS: A comprehensive search of the 1966-2000 MEDLINE database and review of the reference lists of relevant articles identified 18 prospective studies that met the predefined inclusion criteria. By means of a standardized approach, 2 of the investigators independently assessed the methodologic quality of the studies, duration and exclusivity of breast-feeding, outcome measures, and control for potential confounding factors. The same approach was applied during data abstraction and evaluation of the estimates of association. Summary measures of association were then calculated. RESULTS: The summary odds ratio (OR) for the protective effect of breast-feeding in the studies analyzed was 0.68 (95% confidence interval [CI], 0.52-0.88). This effect estimate was higher in the group of studies wherein children with a family history of atopy were investigated separately (OR = 0.58; CI, 0.41-0.92) than in those of combined populations (OR = 0.84; CI, 0.59-1.19). A small subset of studies of children without a history of atopy in first-degree relatives showed no association between breast-feeding and the onset of atopic dermatitis (OR = 1.43; CI, 0.72-2.86). CONCLUSION: Exclusive breast-feeding during the first 3 months of life is associated with lower incidence rates of atopic dermatitis during childhood in children with a family history of atopy. This effect is lessened in the general population and negligible in children without first-order atopic relatives. Breast-feeding should be strongly recommended to mothers of infants with a family history of atopy, as a possible means of preventing atopic eczema.

Breast Feeding↗
PubMed2001

Breast-feeding and the risk of bronchial asthma in childhood: a systematic review with meta-analysis of prospective studies.

BACKGROUND: The protective effect of breast-feeding on the development of childhood asthma remains a matter of controversy. We conducted a systematic review of prospective studies that evaluated the association between exclusive breast-feeding during the first 3 months after birth and asthma. STUDY DESIGN: We searched the 1966-1999 MEDLINE database and reviewed reference lists of relevant articles to identify 12 prospective studies that met pre-stated inclusion criteria. Methodological aspects of the studies, duration and exclusivity of breast-feeding, and outcomes were assessed. Effect estimates were abstracted by the investigators, using a standardized approach. RESULTS: The summary odds ratio (OR) for the protective effect of breast-feeding was 0.70 (95% CI 0.60 to 0.81). The effect estimate was greater in studies of children with a family history of atopy (OR = 0.52) than in studies of a combined population (OR = 0.73). CONCLUSIONS: Exclusive breast-feeding during the first months after birth is associated with lower asthma rates during childhood. The effect, caused by immunomodulatory qualities of breast milk, avoidance of allergens, or a combination of these and other factors, strengthens the advantage of breast-feeding, especially if a family history of atopy is present.

Asthma↗
PubMed2000

Active versus passive immunization against hepatitis A in the Israel defence forces: a cost-benefit analysis.

We compared cost-benefit and cost-effectiveness analyses of hepatitis A prevention with immune serum globulin (ISG) vs inactivated hepatitis A vaccine (iHAV) in the Israel Defence Forces. Personnel were grouped according to conditions and duration of service and analyses were performed based on maximum and minimum hepatitis A projected incidences for each group. For standing army soldiers in field units, iHAV is economically superior compared with ISG. For the five other groups studied, the reverse is true. Expected increases in production costs of ISG and expected decreases in costs of iHAV are likely to make iHAV more economical in the future.

Cost-Benefit Analysis↗
PubMed2000

[Trends in epidemiology of hepatitis in the Israel Defense Forces-- direction over several years].

During the 50's and 60's there were large scale epidemics of hepatitis A every 3-4 years in the Israel Defense Forces. During these epidemics the annual incidence exceeded 10/1000 soldiers at risk. There has been a highly significant decrease in rates during the past 30 years. The average annual incidence of clinically identified viral hepatitis A decreased from an average of 6/1000 during the 60's to 2.5/1000 during the 70's. The decrease coincided with the introduction in the 1970's of wide-scale post-exposure prophylaxis with immune serum globulin (ISG). The incidence was further significantly reduced to 0.5-1.0/1000 with the introduction of pre-exposure prophylaxis with ISG, starting in 1978 (p < 0.001). Other factors probably played a role in accelerating the decline in morbidity, such as improvement in personal hygiene and sanitation facilities, and in waste disposal and other aspects of military environmental health. These improvements were probably more pronounced in the civilian sector, leading to decreased exposure of children to the virus and consequently a higher proportion of seronegatives at induction. Increase in the proportion of recruits without natural immunity to the virus poses greater risk, both in terms of personal morbidity as well as military operational ability. This risk, combined with problems of ISG use and availability, has propelled hepatitis A prevention policy towards the use of the new inactivated vaccines.

Female↗
PubMed2000

Measles epidemic in Israel-successful containment in the military.

BACKGROUND: Measles vaccination at ages 12-15 months is a routine part of standard health care in developed countries. Nonetheless, the prevention and control of measles outbreaks remain a challenge, owing to incomplete or variable compliance with immunization programs and primary vaccine failure (approximately 5%). In Israel, vaccination coverage against measles is high, yet sero-epidemiological studies conducted in the early 1990s showed that 15% of 18-year-olds were unprotected. METHODS: 1994 there was a countrywide epidemic of measles, which spread to the military. The Israel Defense Forces Medical Corps immediately launched a wide-scale vaccination campaign, targeting primarily field units and training bases, where crowded living conditions are the rule. RESULTS: The immunization campaign led to an abrupt cessation of morbidity in the military. In the civilian sector, where no intervention was undertaken, the epidemic continued for another 4 months. CONCLUSIONS: Institutional measles outbreaks, especially in the presence of crowded conditions or high contact rates, may be effectively controlled by mass vaccination.

Incidence↗
PubMed2000

A waterborne outbreak of gastroenteritis in the Golan Heights due to enterotoxigenic Escherichia coli.

BACKGROUND: Over a period of 4 days between May 18-21, 1998, a multifocal outbreak of diarrhea, involving 175 Israel Defence Force soldiers and at least 54 civilians, occurred in the Golan Heights. PATIENTS AND METHODS: Stool samples from 40 affected soldiers were collected for microbiological testing. In addition, a rapid PCR technique was employed for the direct detection of the heat-labile (LT) and heat-stable toxin (ST) genes of enterotoxigenic Escherichia coli (ETEC) in stool samples. RESULTS: All 40 stool specimens taken from patients with diarrhea was negative by culture. However, ETEC was detected in 16 stool specimens using the rapid PCR method. The epidemiological investigation found no association between the food items consumed prior to the onset of the outbreak and the attack rate of diarrhea. A review of the water distribution system revealed that all affected military posts and civilian communities were supplied by a common water pipeline. Water sampled from various points along the distribution system showed inadequate chlorination and high concentrations of E. coli. CONCLUSION: This report suggests that the involvement of ETEC in the etiology of waterborne diarrheal outbreaks may be underestimated, probably due to the difficulties involved in the laboratory identification of this enteropathogen. Adoption of our rapid method for the identification of ETEC, which is applicable to routine diagnostic laboratories, facilitates pathogen detection within hours, and allows early intervention in cases of widespread diarrheal epidemics.

Bacterial Toxins↗
PubMed2000

Rabies in Israel: decades of prevention and a human case.

Animal rabies is endemic in Israel, with 50-80 laboratory-confirmed cases being diagnosed annually. Despite the high incidence among animals, human rabies has not occurred in Israel for almost four decades. This is likely due to the highly effective prevention policy implemented by the Ministry of Health, based on pre-exposure vaccination of populations at risk, post-exposure treatment, and updated rules. Notwithstanding the previous success, a human case occurred in 1996 when a soldier was bitten, while asleep, by an unidentified small animal, which according to his description was a rat or a mouse. Since injuries by these rodents do not require antirabies treatment, no antirabies post-exposure prophylaxis was administered. Five weeks later the soldier complained of fever and nausea with interchanging periods of rage and calm, confusion, and water aversion. His condition deteriorated gradually, leading to deep coma and death. Immunofluorescence examination of a skin biopsy was positive for rabies, and PCR of saliva revealed Lyssavirus genotype 1. We review the changes in the epizootiology of rabies in Israel, the trends of human exposure to animals, and the pre- and post-exposure prophylaxis guidelines, and discuss possible measures that could have been undertaken to prevent the eventuality of this case. This case of rabies, the first after a long period without human disease, accentuates the importance of strict adherence to prevention guidelines. Considerations of geography, epidemiology, and the circumstances of exposure are crucial in the treatment decision-making process.

Adult↗
PubMed2000

Does immune serum globulin confer protection against skin diseases?

BACKGROUND: Following a case of serologically proven hepatitis A in a food-handling worker serving several military bases in the same vicinity, the entire military population was vaccinated with immune serum globulin (ISG). OBJECTIVE: To evaluate the effectiveness of ISG in preventing skin disease. METHODS: The data for this study were drawn from the military archives of the Medical Corps. The population of the bases was followed for a period of 3 months after immunization. Rates of selected skin diseases were compared with those of a nearby base during the same period, and with those in the population of the same bases a year earlier. RESULTS: The rates of several skin diseases (bacterial skin infections, dermatitis and eczema, fungal infections, acne, warts, nail disorders, and nonspecific skin diseases) among the vaccinated population were significantly lower when compared to the historical control group and to the contemporary control group of the nearby base. CONCLUSIONS: ISG provides a protecting effect for skin diseases, especially those of infectious origin.

Adolescent↗
PubMed2000

Pediatric journals on the Internet.

UNLABELLED: The objective of this study was to evaluate the structure and contents of the websites of the major journals in general pediatrics. A comprehensive search of the Internet was carried out to identify all pediatric journals in English that are listed in the Scientific Citation Index. Websites of 11 journals in general pediatrics were found, and their Web pages were systematically compared. Two of the appraised websites provided free on-line access to the full journal text, seven had on-line abstracts, and all provided the table of contents. The contents and abstracts covered varying periods, mostly just a few years back. Most of the journals offered easy search and other navigational options, but only a few allowed electronic submission of manuscripts. CONCLUSION: We conclude that in the era of immense growth and dissemination of information, aimed either at medical professionals or their patients, general pediatrics journals are lagging behind. The pediatrician today remains dependent on hospital libraries and their limited and sometimes cumbersome capabilities. Only a few of the pediatric journal websites can serve as an efficient on-line source for updating the knowledge. Further developments in the future should allow for improved services.

Internet↗
PubMed2000

Adverse reactions to smallpox vaccine: the Israel Defense Force experience, 1991 to 1996. A comparison with previous surveys.

The aim of the present study was to assess the post-smallpox vaccination complication rate in a cohort of Israel Defense Force recruits enlisted in the calendar years 1991 to 1996 and to compare it with rates reported, in similar age groups, in large surveys during the 1960s. The overall complication rate was 0.4 per 10,000 vaccinees, and the rate of severe complications was very low, similar to previously published data. We conclude that among young healthy adults, vaccination with smallpox vaccine is relatively safe and is associated with a low rate of complications. Severe complications were very rare in this age group in our study. However, the complication rate is increasing with the increased percentage of primary vaccinees.

Adult↗
PubMed2000

Helicobacter pylori infection and subsequent peptic duodenal disease among young adults.

BACKGROUND: Evidence for a causal relationship between presence of Helicobacter pylori (H. pylori) in gastric mucosa and development of peptic disease is based largely on intervention studies in which eradication of H. pylori led to healing of the lesion. The aim of this study was to assess the importance of H. pylori seropositivity for subsequent development of peptic disease in a prospective study design in young Israelis. METHODS: A nested case-control serum bank study based on a systematic sample of male and female inductees to the Israel Defense Force. Twenty-nine cases of duodenal ulcer or duodenitis of moderate or higher severity, diagnosed between 1986 and 1995, were individually matched for age, sex, ethnicity, education and year of induction, with five healthy controls each. Presence of anti-H. pylori antibodies in the frozen stored sera was determined by ELISA. RESULTS: The geometric mean titre of anti-H. pylori antibodies at baseline was significantly higher in cases (18. 3 U/ml) than controls (6.9 U/ml; P = 0.009). The matched odds ratio for peptic ulcer disease by seropositivity was 3.8 (95% CI : 1.4-10. 2). A stronger association was evident for subjects diagnosed > or =2 years after induction than those diagnosed earlier. The population attributable fraction was 56.6% (95% CI : 15.7-81.1). CONCLUSIONS: Pre-existing infection with H. pylori, as determined by seropositivity, is an important determinant of development of duodenal ulcer or duodenitis in young Israelis, supporting the generalizability of an apparent causal association to diverse populations.

Adolescent↗
PubMed1999

Successful postexposure rabies prophylaxis after erroneous starting treatment.

BACKGROUND: Postexposure prophylaxis, adequately applied after exposure to a rabid animal, is highly effective in prevention of human disease. Deviations from the recommended vaccination postexposure treatment protocol have been associated with vaccination failure and human mortality. We investigated an incident in which seven Israel Defense Forces soldiers were bitten by a rabid fox and initially treated not in accordance with the recommended vaccination protocol. METHODS: The soldiers received modified anti-rabies postexposure prophylaxis, including a higher dosage of both the active and the passive vaccines. The humoral antibody response was monitored subsequently. RESULTS: All soldiers showed a satisfactory increase (above 0.5 UE/ml by ELISA) in serum anti-rabies antibody titers. None developed the disease more than a year after follow-up. CONCLUSIONS: Strict adherence to the treatment guidelines following an injury by a rabid animal is of utmost importance. We suggest possible compensatory management after a potentially lethal deviation from protocol.

Administration, Topical↗
PubMed1999

Efficacy of topical application of eosin compared with zinc oxide paste and corticosteroid cream for diaper dermatitis.

BACKGROUND: Corticosteroids, zinc paste and eosin 2% are well-known topical agents for the treatment of moderate to severe diaper dermatitis. Among these treatments, the aqueous solution of eosin 2% is extensively used in several European countries, but not in the USA or Israel. OBJECTIVE: To assess the therapeutic efficacy of eosin 2% solution compared to the other treatment modalities for diaper dermatitis. METHODS: Fifty-four infants with diaper dermatitis, recruited from hospital wards and community clinics, were randomly assigned to three treatment groups: zinc oxide paste (containing allantoin 0.5%, cod liver oil 17% and zinc oxide 47epercnt;); clobetasone butyrate 0.05%, and aqueous solution of eosin 2%. The severity of the disorder was graded on a 6-point scale by observation and quantitative measurement of the lesions. The groups were compared for rates and time to heal. Due to the red color of eosin, a double-blind controlled study was impossible. RESULTS: Following 5 days of treatment, the rate of complete healing in the group treated with eosin (61%) was significantly higher (p = 0.0479) than that in the zinc oxide paste and corticosteroid groups (22 and 33%, respectively). Furthermore, in cases of partial healing, the degree of improvement was higher in the eosin group than the other two (p = 0.0205). The fastest improvement was observed in the group treated with corticosteroid cream. CONCLUSION: Considering the potential hazards of topical corticosteroids and the greater overall efficacy of eosin 2% solution, we suggest that eosin is the preferred treatment for diaper dermatitis.

Administration, Cutaneous↗
PubMed1999

Secular trends in the epidemiology of major infectious diseases among Israeli soldiers.

BACKGROUND: Army personnel, albeit in general young and healthy, are at greater risk for infectious morbidity owing to higher crowding, compromised hygienic conditions, and exposure to new geographic and climatic factors. We describe the changing trends in the incidence of major infectious diseases of public health importance in the Israeli military: hepatitis A, measles, meningococcal disease, and diarrheal diseases. METHODS: Departments of Epidemiology and Medical Statistics of the Israel Defense Forces Medical Corps monitor the incidence of infectious diseases within the military. Notifiable diseases are predefined and their reporting is mandatory. RESULTS: The incidence of hepatitis has declined significantly since the introduction of prophylaxis with immune serum globulin in the 1970s, and complete control of outbreaks has been achieved. Outbreaks of diarrheal diseases have decreased, probably as a result of intensive control measures begun in the last decade. However, sporadic diarrheal morbidity continues to rise. The vaccination of recruits against Neisseria meningitidis was begun in 1994, following an increase in cases caused by serogroup C bacteria. So far, the program has proved efficacious in reducing morbidity. Measles morbidity in the military was much higher than in the civilian sector over the years. It has become negligible since 1995, when the first cohorts with 2 vaccination doses began their service. CONCLUSION: Despite improvements in personal and environmental health measures, immunization remains the most efficient means for preventing infectious diseases in the military.

Adult↗