Shigellosis in Israel - Update 1995

Introduction: The incidence of shigellosis in Israel was fairly stable until around 1974, when it gradually began to increase to a peak in 1985. This was accompanied by a shift in the maximum incidence in the Jewish population from the age group < 1 to 1-4 years. Aim: To update the epidemiology of shigellosis in Israel 1986-1995. Methods: Only laboratory-confirmed cases of shigellosis in the civilian population were analyzed. Data were obtained from the weekly reports of the subdistricts. Antibiotic sensitivity data were obtained from several hospitals and the General Worker's Sick Fund laboratories in Jerusalem, Haifa, and Tel Aviv. Results: From 1986 to 1991, shigellosis incidence per 100,000 decreased by about 50%, and the decrease occurred mainly in the Jewish population. Several regional outbreaks in 1992 reversed this decline, but by 1995, the incidence was similar to that observed prior to 1974. The disease still occurs mainly in the summer, with an occasional winter outbreak. Higher incidence rates occurred in the northern subdistricts. The peak incidence in the non-Jewish population moved from the < 1-year-olds to the 1-4 year-old group, similar to the pattern in the Jewish population in 1970. In 1991, for the first time, the rate in the age group 5-9 years among non-Jews exceeded that of those < 1 year old. Marked decreases in sensitivity to several antibiotics were found in peripheral and hospital laboratories. An increase in the sensitivity to tetracycline was noted since 1991. Case fatality rates remain low, with a mean of 0.05% for the decade of the 1980s. Conclusions: Shigellosis remains a highly endemic disease in Israel, but changes in the age-related peak incidence indicate that the pattern of spread is becoming more similar to other developed countries.