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עמוד בית
Sat, 20.07.24

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August 2022
Ido Tzanani MD MPH, Daniel Bendayan MD, Anat Jaffe MD PHD, and Zohar Mor MD MPH MHA

Background: Diabetes mellitus (DM) is one of the risk factors for progression from latent to active tuberculosis. However, the effect of DM on subsequent tuberculosis treatment is still inconclusive.

Objectives: To compare tuberculosis treatment outcomes and the rate of drug resistance of tuberculosis patients with or without DM.

Methods: This case-control study was conducted between 2005 and 2015 at the only tuberculosis ward in Israel. All 80 tuberculosis patients who had DM and were hospitalized during the study period were included in this study, as were a randomized sample of 213 tuberculosis patients without DM. Demographic, clinical, and laboratory data were collected from patient files in the hospital and clinics after discharge.

Results: Tuberculosis patients with DM were more often older and more likely to be Israeli citizens with a lower socioeconomic status than patients without DM. No statistically significant differences were found in clinical presentation, radiological findings, and sputum smear tests between the two groups. Culture converting times were prolonged in patients with DM compared to normoglycemic patients. Multidrug drug resistance tuberculosis was more common among normoglycemic tuberculosis patients than tuberculosis patients with DM (9.2% vs. 1.6%, P = 0.12). Treatment success rates were 76.2% and 83.1% for tuberculosis patients with or without DM, respectively (P = 0.18). DM was not statistically significant in the multivariate analysis predicting treatment success, which controlled for age, citizenship, compliance, addictions, and chronic diseases.

Conclusions: The presence of DM does not necessarily affect tuberculosis treatment outcomes as long as treatment compliance is optimal.

April 2017
Valeria Zhdanov MPH, Natalya Bilenko MD MPH PhD and Zohar Mor MD MPH MHA

Background: Recurrent tuberculosis (TB) is one of the indices used to assess the effectiveness of the Israeli National TB Programs (NTP).

Objectives: To estimate the incidence of recurrent TB in Israel and to identify the associated risk factors.

Methods: We conducted a retrospective cohort study of all TB patients who were Israeli citizens and diagnosed between 1999 and 2011 with a treatment outcome recorded as “success." We compared those who had recurrent TB with those who did not. In addition, a nested case-control study included all those who had recurrent TB with a random sample from this cohort matched by age, gender, and year of TB diagnosis.

Results: Of 3515 TB patients diagnosed between 1999 and 2011, 37 (1.05%) had recurrent TB during the follow-up period, with an incidence rate of 1.55 cases per 1000 person-years (PY). Male gender [hazard ratio (HR) 3.2, 95% confidence interval (95%CI) 1.4–7.4], human immunodeficiency virus (HIV) infection (HR 3.9, 95%CI 1.5–10.4), positive sputum culture [odds ratios (OR) 2.7, 95%CI 1.1–6.9], and low adherence to anti-TB treatment (OR 3.2, 95%CI 1.0–10.3) were found to be risk factors for recurrent TB.

Conclusions: Male gender, HIV infection, positive sputum culture, and low adherence to anti-TB drugs during the initial TB episode were risk factors for developing recurrent TB.

January 2015
Zohar Mor MD MPH MPH, Orly Weinstein MD MHA, Dini Tischler-Aurkin MD MPA, Alex Leventhal MD MPH MPA, Alon Yaniv and Itamar Grotto MD PhD MPH

Background: Since 2006 more than 60,000 migrants arrived in Israel from the Horn of Africa (HoA: Sudan, Eritrea, Ethiopia). They were detained in prison and screened for tuberculosis (TB) by means of an interview and chest X-ray (CXR).

Objectives: To evaluate the yield of this screening process.

Methods: This cross-sectional study evaluated the validity of CXR in a random sample of 1087 of the 5335 HoA migrants (20.4%) who arrived in 2009, and assessed its related costs.

Results: Sixty-two migrants (5.7%) had CXRs with TB-suspicious findings, and 11 of them were finally diagnosed with TB (17.7% of all TB-suspicious CXRs). TB point-prevalence was 1000 cases per 100,000 migrants (1.0%). As no additional TB cases were diagnosed on arrival, CXR sensitivity, specificity and positive predictive value were 100%, 96.1% and 17.7%, respectively. The interview did not contribute to the detection of migrants with TB. Direct costs related to the detection of single TB cases in prison was 17,970 shekels (US$ 4585), lower than the treating cost of 28,745 shekels ($ 7335). During 2008–2010, 88 HoA migrants who had been screened at the prison after crossing the border were later diagnosed with TB in the community. The average annual TB incidence was 132 cases/100,000 migrants. We traced 56 (63.6%) of the CXRs that were performed during detention. Of those, 41 (73.2%) were unremarkable, 8 (14.2%) were TB suspicious and 7 (12.5%) had non-TB-related abnormalities.

Conclusions: CXR-based screening is a valid and cost-saving tool for screening  HoA migrants for TB; the interview has significant limitations. 

March 2012
Z. Mor, T. Shohat, Y. Goor and M. Dan
Background: The increase in human immunodeficiency virus (HIV) among men who have sex with men (MSM) in Israel during the last decade raises concerns regarding other sexually transmitted diseases (STD) in MSM, which are yet undetermined.

Objectives: To evaluate the STD burden in MSM and heterosexuals visiting the Tel Aviv walk-in STD clinic.

Methods: Records of all male patients who attended the clinic once were reviewed to identify demographic characteristics, behavioural attributes, and test results.

Results: Between 2002 and 2008, 1064 MSM (22%) and 3755 heterosexuals (78%) visited the clinic once. Positivity rates in MSM for HIV, urethral Neisseria gonorrhoea and infectious syphilis were higher than in heterosexuals (2.5%, 2.5%. 0.7% vs. 0.6%, 1.3%, 0.3%, respectively), while urethral Chlamydia trachomatis was higher in heterosexuals than in MSM (2.7% and 1.4%, respectively). MSM tested in our clinic were younger than heterosexuals (P < 0.001), more commonly circumcised (P = 0.03) and Israeli-born (P < 0.001), used substances during sex (P = 0.04), and had prior STD (P < 0.001), a greater number of sexual partners (P < 0.001), and earlier sexual debut (P = 0.02). The final multivariate results for MSM to be diagnosed with HIV/STD were greater number of sexual contacts, previous diagnosis with STD, and infrequent use of condom during anal intercourse.

Conclusions: MSM visiting the Levinsky Clinic had higher rates of HIV/STD than heterosexual males, which correlated with their higher-risk behaviors. The unique characteristics of MSM found in our study, such as sex work, substance use, previous diagnosis of STD, multiple partners and inconsistent use of condom during anal sex should be addressed with innovative interventions to prevent STD/HIV in the gay community in Israel.
T. Brosh-Nissimov, Z. Mor, E. Avramovich, E. Katchman, B. Avidor, O. Mor and D. Turner
Background: Outbreaks of syphilis have been described among men who have sex with men (MSM) in many western urban communities in the last few years.

Objectives: To describe the first reported outbreak of syphilis among MSM in Israel within a decade of a constant increase in human immunodeficiency virus (HIV) prevalence.

Methods: All patients diagnosed with syphilis were contacted and asked about their sexual behavior, substance use and previous infections. All were tested for HIV and a phylogenetic analysis was performed. 

Results: A total of 23 (59%) of all 39 male patients diagnosed with primary or secondary syphilis between August 2008 and August 2009 were interviewed. All were MSM and performed anal intercourse, while 13 (55%) reported unprotected anal intercourse. Most participants (21, 91%) practiced unprotected oral intercourse. Nine participants (39%) reported unprotected oral intercourse while using condoms during anal intercourse. Ten participants (43%) reported sexual contacts while traveling abroad in the previous few months. Most participants (96%) were co-infected with HIV, and 15 (68%) were already aware of their HIV infection. Fifteen (66%) reported the use of recreational drugs, alcohol, or both before or during sex. No common source or core transmitters were identified.

Conclusions: This syphilis outbreak included MSM who were co-infected with HIV and were characterized by risky sexual behavior including multiple partners, unprotected anal intercourse and substance use. Future targeted interventions should focus on HIV-infected MSM for secondary prevention.
March 2008
Z. Mor, A. Adler, A. Leventhal, I. Volovic, E. Rosenfeld, M.N. Lobato and D. Chemtob

Background: The crowded environment of correctional facilities may enhance infectious diseases transmission, such as tuberculosis.

Objectives: To define the tuberculosis burden in prisons in Israel, a country of low TB[1] incidence (7.9 cases:100,000 population in 2004), in which about 13,000 inmates are being incarcerated annually, and to recommend policy adaptations for TB control.

Methods: All prison clinic lung records from 1998 through 2004 in Israel were reviewed to identify pulmonary TB patients. Additionally, we reviewed TB epidemiological investigation files from one northern prison (years 2002 through 2005) to evaluate possible transmission of the disease.

Results: During the study period 23 Israeli inmates had pulmonary TB (25 cases/100,000 prisoners), which was 3.5 times higher than for the general population. Of those, 18 (78%) were born in the Former Soviet Union and immigrated to Israel after 1990. Four pulmonary TB cases in the evaluated prison were reported, and 22% (149/670) of all inmates and staff were referred for treatment of latent TB infection.

Conclusions: To prevent future TB cases, we recommend new prevention measures, including a symptom questionnaire for all new inmates and selective tuberculin skin testing for inmates infected with human immunodeficiency virus/AIDS, those who inject drugs, and those who emigrated from the former Soviet Union after 1990. New staff should be screened by the two-step tuberculin skin test and annual symptoms questionnaire thereafter. Incarceration may be used as a point of detection for TB and a window of opportunity for treatment in this hard-to-reach population. 






[1] TB =tuberculosis


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