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Ash N, Triki N, Waitzberg R. The COVID-19 pandemic posed many dilemmas for policymakers, which sometimes resulted in unprecedented decision-making. Isr J Health Policy Res 2023; 12:13. [PMID: 37072814 PMCID: PMC10112313 DOI: 10.1186/s13584-023-00564-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/10/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic evolved through five phases, beginning with 'the great threat', then moving through 'the emergence of variants', 'vaccines euphoria', and 'the disillusionment', and culminating in 'a disease we can live with'. Each phase required a different governance response. With the progress of the pandemic, data were collected, evidence was created, and health technology was developed and disseminated. Policymaking shifted from protecting the population by limiting infections with non-pharmaceutical interventions to controlling the pandemic by prevention of severe disease with vaccines and drugs for those infected. Once the vaccine became available, the state started devolving the responsibility for the individual's health and behavior. MAIN BODY Each phase of the pandemic posed new and unique dilemmas for policymakers, which resulted in unprecedented decision-making. Restrictions to individual's rights such as a lockdown or the 'Green Pass policy' were unimaginable before the pandemic. One of the most striking decisions that the Ministry of Health made was approving the third (booster) vaccine dose in Israel, before it was approved by the FDA or any other country. It was possible to make an informed, evidence-based decision due to the availability of reliable and timely data. Transparent communication with the public probably promoted adherence to the booster dose recommendation. The boosters made an important contribution to public health, even though their uptake was less than the uptake for the initial doses. The decision to approve the booster illustrates seven key lessons from the pandemic: health technology is key; leadership is crucial (both political and professional); a single body should coordinate the actions of all stakeholders involved in the response, and these should collaborate closely; policymakers need to engage the public and win their trust and compliance; data are essential to build a suitable response; and nations and international organizations should collaborate in preparing for and responding to pandemics, because viruses travel without borders. CONCLUSION The COVID-19 pandemic posed many dilemmas for policymakers. The lessons learned from the actions taken to deal with them should be incorporated into preparedness for future challenges.
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Affiliation(s)
- Nachman Ash
- Department of Health Systems Management, Ariel University, Ariel, Israel.
- Ministry of Health, Jerusalem, Israel.
| | - Noa Triki
- Ministry of Health, Jerusalem, Israel
| | - Ruth Waitzberg
- Department of Health Care Management, Faculty of Economics and Management, Technische Universität Berlin, Berlin, Germany
- The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Jerusalem, Israel
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Amir O, Goldberg Y, Mandel M, Bar-On YM, Bodenheimer O, Freedman L, Alroy-Preis S, Ash N, Huppert A, Milo R. Protection against Omicron BA.1/BA.2 severe disease 0-7 months after BNT162b2 booster. Commun Biol 2023; 6:315. [PMID: 36959496 PMCID: PMC10035472 DOI: 10.1038/s42003-023-04669-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/07/2023] [Indexed: 03/25/2023] Open
Abstract
Following evidence of waning immunity against both infection and severe disease after 2 doses of the BNT162b2 vaccine, Israel began administering a 3rd BNT162b2 dose (booster) in July 2021. Recent studies showed that the 3rd dose provides a much lower protection against infection with the Omicron variant compared to the Delta variant and that this protection wanes quickly. However, there is little evidence regarding the protection of the 3rd dose against Omicron (BA.1/BA.2) severe disease. In this study, we estimate the preservation of immunity from severe disease up to 7 months after receiving the booster dose. We calculate rates of severe SARS-CoV-2 disease between groups of individuals aged 60 and above, comparing those who received two doses at least 4 months previously to those who received the 3rd dose (stratified by the time from vaccination), and to those who received a 4th dose. The analysis shows that protection conferred by the 3rd dose against Omicron severe disease did not wane over a 7-month period. Moreover, a 4th dose further improved protection, with a severe disease rate approximately 3-fold lower than in the 3-dose cohorts.
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Affiliation(s)
- Ofra Amir
- Technion - Israel Institute of Technology, Haifa, Israel
| | - Yair Goldberg
- Technion - Israel Institute of Technology, Haifa, Israel.
| | - Micha Mandel
- The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yinon M Bar-On
- Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot, Israel
| | | | - Laurence Freedman
- The Bio-statistical and Bio-mathematical Unit, The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | | | - Nachman Ash
- Israel Ministry of Health, Jerusalem, Israel
| | - Amit Huppert
- The Bio-statistical and Bio-mathematical Unit, The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
- The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Milo
- Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot, Israel
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Mevorach D, Anis E, Cedar N, Hasin T, Bromberg M, Goldberg L, Levi N, Perzon O, Magadle N, Barhoum B, Parnassa E, Dichtiar R, Hershkovitz Y, Green MS, Ash N, Keinan-Boker L, Alroy-Preis S. Myocarditis After BNT162b2 COVID-19 Third Booster Vaccine in Israel. Circulation 2022; 146:802-804. [PMID: 36067275 PMCID: PMC9439627 DOI: 10.1161/circulationaha.122.060961] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Dror Mevorach
- Pnimit B & Division of Rheumatology-Immunology-Allergology and the Wohl Institute for Translational Medicine, Department of Medicine, Hadassah Medical Center, Jerusalem, Israel (D.M., O.P., N.M., B.B., E.P.).,Faculty of Medicine, Hebrew University, Jerusalem, Israel (D.M., E.A., T.H.)
| | - Emilia Anis
- Faculty of Medicine, Hebrew University, Jerusalem, Israel (D.M., E.A., T.H.).,Division of Epidemiology, Israeli Ministry of Health, Jerusalem (E.A., N.C., L.G.).,Braun School of Public Health, Jerusalem, Israel (E.A., N.C., L.G.)
| | - Noa Cedar
- Division of Epidemiology, Israeli Ministry of Health, Jerusalem (E.A., N.C., L.G.).,Braun School of Public Health, Jerusalem, Israel (E.A., N.C., L.G.)
| | - Tal Hasin
- Faculty of Medicine, Hebrew University, Jerusalem, Israel (D.M., E.A., T.H.).,Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel (T.H., N.L.)
| | - Michal Bromberg
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel (M.B., R.D., Y.H., L.K.-B.).,Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel (M.B.)
| | - Lital Goldberg
- Division of Epidemiology, Israeli Ministry of Health, Jerusalem (E.A., N.C., L.G.).,Braun School of Public Health, Jerusalem, Israel (E.A., N.C., L.G.).,Clalit Health Services, Tel Aviv, Israel (L.G.)
| | - Nir Levi
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel (T.H., N.L.)
| | - Ofer Perzon
- Pnimit B & Division of Rheumatology-Immunology-Allergology and the Wohl Institute for Translational Medicine, Department of Medicine, Hadassah Medical Center, Jerusalem, Israel (D.M., O.P., N.M., B.B., E.P.)
| | - Nur Magadle
- Pnimit B & Division of Rheumatology-Immunology-Allergology and the Wohl Institute for Translational Medicine, Department of Medicine, Hadassah Medical Center, Jerusalem, Israel (D.M., O.P., N.M., B.B., E.P.)
| | - Barhoum Barhoum
- Pnimit B & Division of Rheumatology-Immunology-Allergology and the Wohl Institute for Translational Medicine, Department of Medicine, Hadassah Medical Center, Jerusalem, Israel (D.M., O.P., N.M., B.B., E.P.)
| | - Elchanan Parnassa
- Pnimit B & Division of Rheumatology-Immunology-Allergology and the Wohl Institute for Translational Medicine, Department of Medicine, Hadassah Medical Center, Jerusalem, Israel (D.M., O.P., N.M., B.B., E.P.)
| | - Rita Dichtiar
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel (M.B., R.D., Y.H., L.K.-B.)
| | - Yael Hershkovitz
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel (M.B., R.D., Y.H., L.K.-B.)
| | - Manfred S. Green
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel (M.S.G., L.K.-B.)
| | - Nachman Ash
- Department of Health Management, Ariel University, Jerusalem, Israel (N.A.).,Israeli Ministry of Health, Jerusalem (N.A., S.A.-P.)
| | - Lital Keinan-Boker
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel (M.B., R.D., Y.H., L.K.-B.).,School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel (M.S.G., L.K.-B.)
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Abstract
BACKGROUND Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) provides natural immunity against reinfection. Recent studies have shown waning of the immunity provided by the BNT162b2 vaccine. The time course of natural and hybrid immunity is unknown. METHODS Using the Israeli Ministry of Health database, we extracted data for August and September 2021, when the B.1.617.2 (delta) variant was predominant, on all persons who had been previously infected with SARS-CoV-2 or who had received coronavirus 2019 vaccine. We used Poisson regression with adjustment for confounding factors to compare the rates of infection as a function of time since the last immunity-conferring event. RESULTS The number of cases of SARS-CoV-2 infection per 100,000 person-days at risk (adjusted rate) increased with the time that had elapsed since vaccination with BNT162b2 or since previous infection. Among unvaccinated persons who had recovered from infection, this rate increased from 10.5 among those who had been infected 4 to less than 6 months previously to 30.2 among those who had been infected 1 year or more previously. Among persons who had received a single dose of vaccine after previous infection, the adjusted rate was low (3.7) among those who had been vaccinated less than 2 months previously but increased to 11.6 among those who had been vaccinated at least 6 months previously. Among previously uninfected persons who had received two doses of vaccine, the adjusted rate increased from 21.1 among those who had been vaccinated less than 2 months previously to 88.9 among those who had been vaccinated at least 6 months previously. CONCLUSIONS Among persons who had been previously infected with SARS-CoV-2 (regardless of whether they had received any dose of vaccine or whether they had received one dose before or after infection), protection against reinfection decreased as the time increased since the last immunity-conferring event; however, this protection was higher than that conferred after the same time had elapsed since receipt of a second dose of vaccine among previously uninfected persons. A single dose of vaccine after infection reinforced protection against reinfection.
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Affiliation(s)
- Yair Goldberg
- From the Faculty of Industrial Engineering and Management, Technion-Israel Institute of Technology, Haifa (Y.G.), the Department of Statistics and Data Science, Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., N.A., S.A.-P.), Jerusalem, the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Biostatistics and Biomathematics Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.S.F., A.H.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Micha Mandel
- From the Faculty of Industrial Engineering and Management, Technion-Israel Institute of Technology, Haifa (Y.G.), the Department of Statistics and Data Science, Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., N.A., S.A.-P.), Jerusalem, the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Biostatistics and Biomathematics Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.S.F., A.H.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Yinon M Bar-On
- From the Faculty of Industrial Engineering and Management, Technion-Israel Institute of Technology, Haifa (Y.G.), the Department of Statistics and Data Science, Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., N.A., S.A.-P.), Jerusalem, the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Biostatistics and Biomathematics Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.S.F., A.H.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Omri Bodenheimer
- From the Faculty of Industrial Engineering and Management, Technion-Israel Institute of Technology, Haifa (Y.G.), the Department of Statistics and Data Science, Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., N.A., S.A.-P.), Jerusalem, the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Biostatistics and Biomathematics Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.S.F., A.H.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Laurence S Freedman
- From the Faculty of Industrial Engineering and Management, Technion-Israel Institute of Technology, Haifa (Y.G.), the Department of Statistics and Data Science, Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., N.A., S.A.-P.), Jerusalem, the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Biostatistics and Biomathematics Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.S.F., A.H.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Nachman Ash
- From the Faculty of Industrial Engineering and Management, Technion-Israel Institute of Technology, Haifa (Y.G.), the Department of Statistics and Data Science, Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., N.A., S.A.-P.), Jerusalem, the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Biostatistics and Biomathematics Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.S.F., A.H.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Sharon Alroy-Preis
- From the Faculty of Industrial Engineering and Management, Technion-Israel Institute of Technology, Haifa (Y.G.), the Department of Statistics and Data Science, Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., N.A., S.A.-P.), Jerusalem, the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Biostatistics and Biomathematics Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.S.F., A.H.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Amit Huppert
- From the Faculty of Industrial Engineering and Management, Technion-Israel Institute of Technology, Haifa (Y.G.), the Department of Statistics and Data Science, Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., N.A., S.A.-P.), Jerusalem, the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Biostatistics and Biomathematics Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.S.F., A.H.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Ron Milo
- From the Faculty of Industrial Engineering and Management, Technion-Israel Institute of Technology, Haifa (Y.G.), the Department of Statistics and Data Science, Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., N.A., S.A.-P.), Jerusalem, the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Biostatistics and Biomathematics Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.S.F., A.H.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
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Bar-On YM, Goldberg Y, Mandel M, Bodenheimer O, Amir O, Freedman L, Alroy-Preis S, Ash N, Huppert A, Milo R. Protection by a Fourth Dose of BNT162b2 against Omicron in Israel. N Engl J Med 2022; 386:1712-1720. [PMID: 35381126 PMCID: PMC9006780 DOI: 10.1056/nejmoa2201570] [Citation(s) in RCA: 220] [Impact Index Per Article: 110.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND On January 2, 2022, Israel began administering a fourth dose of BNT162b2 vaccine to persons 60 years of age or older. Data are needed regarding the effect of the fourth dose on rates of confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and of severe coronavirus disease 2019 (Covid-19). METHODS Using the Israeli Ministry of Health database, we extracted data on 1,252,331 persons who were 60 years of age or older and eligible for the fourth dose during a period in which the B.1.1.529 (omicron) variant of SARS-CoV-2 was predominant (January 10 through March 2, 2022). We estimated the rate of confirmed infection and severe Covid-19 as a function of time starting at 8 days after receipt of a fourth dose (four-dose groups) as compared with that among persons who had received only three doses (three-dose group) and among persons who had received a fourth dose 3 to 7 days earlier (internal control group). For the estimation of rates, we used quasi-Poisson regression with adjustment for age, sex, demographic group, and calendar day. RESULTS The number of cases of severe Covid-19 per 100,000 person-days (unadjusted rate) was 1.5 in the aggregated four-dose groups, 3.9 in the three-dose group, and 4.2 in the internal control group. In the quasi-Poisson analysis, the adjusted rate of severe Covid-19 in the fourth week after receipt of the fourth dose was lower than that in the three-dose group by a factor of 3.5 (95% confidence interval [CI], 2.7 to 4.6) and was lower than that in the internal control group by a factor of 2.3 (95% CI, 1.7 to 3.3). Protection against severe illness did not wane during the 6 weeks after receipt of the fourth dose. The number of cases of confirmed infection per 100,000 person-days (unadjusted rate) was 177 in the aggregated four-dose groups, 361 in the three-dose group, and 388 in the internal control group. In the quasi-Poisson analysis, the adjusted rate of confirmed infection in the fourth week after receipt of the fourth dose was lower than that in the three-dose group by a factor of 2.0 (95% CI, 1.9 to 2.1) and was lower than that in the internal control group by a factor of 1.8 (95% CI, 1.7 to 1.9). However, this protection waned in later weeks. CONCLUSIONS Rates of confirmed SARS-CoV-2 infection and severe Covid-19 were lower after a fourth dose of BNT162b2 vaccine than after only three doses. Protection against confirmed infection appeared short-lived, whereas protection against severe illness did not wane during the study period.
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Affiliation(s)
- Yinon M Bar-On
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G., O.A.), the Hebrew University of Jerusalem, (M.M.) and the Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Bio-statistical and Bio-mathematical Unit, the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), and the Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Yair Goldberg
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G., O.A.), the Hebrew University of Jerusalem, (M.M.) and the Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Bio-statistical and Bio-mathematical Unit, the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), and the Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Micha Mandel
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G., O.A.), the Hebrew University of Jerusalem, (M.M.) and the Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Bio-statistical and Bio-mathematical Unit, the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), and the Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Omri Bodenheimer
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G., O.A.), the Hebrew University of Jerusalem, (M.M.) and the Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Bio-statistical and Bio-mathematical Unit, the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), and the Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Ofra Amir
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G., O.A.), the Hebrew University of Jerusalem, (M.M.) and the Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Bio-statistical and Bio-mathematical Unit, the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), and the Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Laurence Freedman
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G., O.A.), the Hebrew University of Jerusalem, (M.M.) and the Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Bio-statistical and Bio-mathematical Unit, the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), and the Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Sharon Alroy-Preis
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G., O.A.), the Hebrew University of Jerusalem, (M.M.) and the Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Bio-statistical and Bio-mathematical Unit, the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), and the Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Nachman Ash
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G., O.A.), the Hebrew University of Jerusalem, (M.M.) and the Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Bio-statistical and Bio-mathematical Unit, the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), and the Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Amit Huppert
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G., O.A.), the Hebrew University of Jerusalem, (M.M.) and the Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Bio-statistical and Bio-mathematical Unit, the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), and the Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Ron Milo
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G., O.A.), the Hebrew University of Jerusalem, (M.M.) and the Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Bio-statistical and Bio-mathematical Unit, the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), and the Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
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Amir O, Goldberg Y, Mandel M, Bar-On YM, Bodenheimer O, Ash N, Alroy-Preis S, Huppert A, Milo R. Protection following BNT162b2 booster in adolescents substantially exceeds that of a fresh 2-dose vaccine. Nat Commun 2022; 13:1971. [PMID: 35418201 PMCID: PMC9008037 DOI: 10.1038/s41467-022-29578-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/24/2022] [Indexed: 11/15/2022] Open
Abstract
Israel began administering a BNT162b2 booster dose to restore protection following the waning of the 2-dose vaccine. Biological studies have shown that a "fresh" booster dose leads to increased antibody levels compared to a fresh 2-dose vaccine, which may suggest increased effectiveness. To compare the real-world effectiveness of a fresh (up to 60 days) booster dose with that of a fresh 2-dose vaccine, we took advantage of a quasi-experimental study that compares populations that were eligible to receive the vaccine at different times due to age-dependent policies. Specifically, we compared the confirmed infection rates in adolescents aged 12-14 (215,653 individuals) who received the 2-dose vaccine and in adolescents aged 16-18 (103,454 individuals) who received the booster dose. Our analysis shows that the confirmed infection rate was lower by a factor of 3.7 (95% CI: 2.7 to 5.2) in the booster group.
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Affiliation(s)
- Ofra Amir
- Technion-Israel Institute of Technology, Haifa, Israel
| | - Yair Goldberg
- Technion-Israel Institute of Technology, Haifa, Israel.
| | - Micha Mandel
- The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yinon M Bar-On
- Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot, Israel
| | | | - Nachman Ash
- Israel Ministry of Health, Jerusalem, Israel
| | | | - Amit Huppert
- The Bio-statistical and Bio-mathematical Unit, The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Milo
- Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot, Israel
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Mevorach D, Anis E, Cedar N, Hasin T, Bromberg M, Goldberg L, Parnasa E, Dichtiar R, Hershkovitz Y, Ash N, Green MS, Keinan-Boker L, Alroy-Preis S. Myocarditis after BNT162b2 Vaccination in Israeli Adolescents. N Engl J Med 2022; 386:998-999. [PMID: 35081295 PMCID: PMC8823652 DOI: 10.1056/nejmc2116999] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | - Emilia Anis
- Israeli Ministry of Health, Jerusalem, Israel
| | - Noa Cedar
- Israeli Ministry of Health, Jerusalem, Israel
| | - Tal Hasin
- Shaare Zedek Medical Center, Jerusalem, Israel
| | | | | | | | - Rita Dichtiar
- Israel Center for Disease Control, Ramat Gan, Israel
| | | | - Nachman Ash
- Israeli Ministry of Health, Jerusalem, Israel
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8
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Abstract
BACKGROUND After promising initial results from the administration of a third (booster) dose of the BNT162b2 messenger RNA vaccine (Pfizer-BioNTech) to persons 60 years of age or older, the booster campaign in Israel was gradually expanded to persons in younger age groups who had received a second dose at least 5 months earlier. METHODS We extracted data for the period from July 30 to October 10, 2021, from the Israel Ministry of Health database regarding 4,696,865 persons 16 years of age or older who had received two doses of BNT162b2 at least 5 months earlier. In the primary analysis, we compared the rates of confirmed coronavirus disease 2019 (Covid-19), severe illness, and death among those who had received a booster dose at least 12 days earlier (booster group) with the rates among those who had not received a booster (nonbooster group). In a secondary analysis, we compared the rates in the booster group with the rates among those who had received a booster 3 to 7 days earlier (early postbooster group). We used Poisson regression models to estimate rate ratios after adjusting for possible confounding factors. RESULTS The rate of confirmed infection was lower in the booster group than in the nonbooster group by a factor of approximately 10 (range across five age groups, 9.0 to 17.2) and was lower in the booster group than in the early postbooster group by a factor of 4.9 to 10.8. The adjusted rate difference ranged from 57.0 to 89.5 infections per 100,000 person-days in the primary analysis and from 34.4 to 38.3 in the secondary analysis. The rates of severe illness in the primary and secondary analyses were lower in the booster group by a factor of 17.9 (95% confidence interval [CI], 15.1 to 21.2) and 6.5 (95% CI, 5.1 to 8.2), respectively, among those 60 years of age or older and by a factor of 21.7 (95% CI, 10.6 to 44.2) and 3.7 (95% CI, 1.3 to 10.2) among those 40 to 59 years of age. The adjusted rate difference in the primary and secondary analyses was 5.4 and 1.9 cases of severe illness per 100,000 person-days among those 60 years of age or older and 0.6 and 0.1 among those 40 to 59 years of age. Among those 60 years of age or older, mortality was lower by a factor of 14.7 (95% CI, 10.0 to 21.4) in the primary analysis and 4.9 (95% CI, 3.1 to 7.9) in the secondary analysis. The adjusted rate difference in the primary and secondary analyses was 2.1 and 0.8 deaths per 100,000 person-days. CONCLUSIONS Across the age groups studied, rates of confirmed Covid-19 and severe illness were substantially lower among participants who received a booster dose of the BNT162b2 vaccine than among those who did not.
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Affiliation(s)
- Yinon M Bar-On
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), the Department of Statistics and Data Science, Hebrew University of Jerusalem (M.M.), and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (L.F., A.H.) - all in Israel
| | - Yair Goldberg
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), the Department of Statistics and Data Science, Hebrew University of Jerusalem (M.M.), and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (L.F., A.H.) - all in Israel
| | - Micha Mandel
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), the Department of Statistics and Data Science, Hebrew University of Jerusalem (M.M.), and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (L.F., A.H.) - all in Israel
| | - Omri Bodenheimer
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), the Department of Statistics and Data Science, Hebrew University of Jerusalem (M.M.), and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (L.F., A.H.) - all in Israel
| | - Laurence Freedman
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), the Department of Statistics and Data Science, Hebrew University of Jerusalem (M.M.), and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (L.F., A.H.) - all in Israel
| | - Sharon Alroy-Preis
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), the Department of Statistics and Data Science, Hebrew University of Jerusalem (M.M.), and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (L.F., A.H.) - all in Israel
| | - Nachman Ash
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), the Department of Statistics and Data Science, Hebrew University of Jerusalem (M.M.), and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (L.F., A.H.) - all in Israel
| | - Amit Huppert
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), the Department of Statistics and Data Science, Hebrew University of Jerusalem (M.M.), and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (L.F., A.H.) - all in Israel
| | - Ron Milo
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), the Department of Statistics and Data Science, Hebrew University of Jerusalem (M.M.), and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (L.F., A.H.) - all in Israel
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9
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Abstract
BACKGROUND In December 2020, Israel began a mass vaccination campaign against coronavirus disease 2019 (Covid-19) by administering the BNT162b2 vaccine, which led to a sharp curtailing of the outbreak. After a period with almost no cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, a resurgent Covid-19 outbreak began in mid-June 2021. Possible reasons for the resurgence were reduced vaccine effectiveness against the delta (B.1.617.2) variant and waning immunity. The extent of waning immunity of the vaccine against the delta variant in Israel is unclear. METHODS We used data on confirmed infection and severe disease collected from an Israeli national database for the period of July 11 to 31, 2021, for all Israeli residents who had been fully vaccinated before June 2021. We used a Poisson regression model to compare rates of confirmed SARS-CoV-2 infection and severe Covid-19 among persons vaccinated during different time periods, with stratification according to age group and with adjustment for possible confounding factors. RESULTS Among persons 60 years of age or older, the rate of infection in the July 11-31 period was higher among persons who became fully vaccinated in January 2021 (when they were first eligible) than among those fully vaccinated 2 months later, in March (rate ratio, 1.6; 95% confidence interval [CI], 1.3 to 2.0). Among persons 40 to 59 years of age, the rate ratio for infection among those fully vaccinated in February (when they were first eligible), as compared with 2 months later, in April, was 1.7 (95% CI, 1.4 to 2.1). Among persons 16 to 39 years of age, the rate ratio for infection among those fully vaccinated in March (when they were first eligible), as compared with 2 months later, in May, was 1.6 (95% CI, 1.3 to 2.0). The rate ratio for severe disease among persons fully vaccinated in the month when they were first eligible, as compared with those fully vaccinated in March, was 1.8 (95% CI, 1.1 to 2.9) among persons 60 years of age or older and 2.2 (95% CI, 0.6 to 7.7) among those 40 to 59 years of age; owing to small numbers, the rate ratio could not be calculated among persons 16 to 39 years of age. CONCLUSIONS These findings indicate that immunity against the delta variant of SARS-CoV-2 waned in all age groups a few months after receipt of the second dose of vaccine.
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Affiliation(s)
- Yair Goldberg
- From Technion-Israel Institute of Technology, Haifa (Y.G.), the Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., E.J.H., S.A.-P., N.A.), Jerusalem, the Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center Tel Hashomer, Ramat Gan (L.F., A.H.), Tel Aviv University, Tel Aviv (A.H.), and Ben Gurion University, Beersheva (E.J.H.) - all in Israel
| | - Micha Mandel
- From Technion-Israel Institute of Technology, Haifa (Y.G.), the Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., E.J.H., S.A.-P., N.A.), Jerusalem, the Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center Tel Hashomer, Ramat Gan (L.F., A.H.), Tel Aviv University, Tel Aviv (A.H.), and Ben Gurion University, Beersheva (E.J.H.) - all in Israel
| | - Yinon M Bar-On
- From Technion-Israel Institute of Technology, Haifa (Y.G.), the Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., E.J.H., S.A.-P., N.A.), Jerusalem, the Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center Tel Hashomer, Ramat Gan (L.F., A.H.), Tel Aviv University, Tel Aviv (A.H.), and Ben Gurion University, Beersheva (E.J.H.) - all in Israel
| | - Omri Bodenheimer
- From Technion-Israel Institute of Technology, Haifa (Y.G.), the Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., E.J.H., S.A.-P., N.A.), Jerusalem, the Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center Tel Hashomer, Ramat Gan (L.F., A.H.), Tel Aviv University, Tel Aviv (A.H.), and Ben Gurion University, Beersheva (E.J.H.) - all in Israel
| | - Laurence Freedman
- From Technion-Israel Institute of Technology, Haifa (Y.G.), the Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., E.J.H., S.A.-P., N.A.), Jerusalem, the Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center Tel Hashomer, Ramat Gan (L.F., A.H.), Tel Aviv University, Tel Aviv (A.H.), and Ben Gurion University, Beersheva (E.J.H.) - all in Israel
| | - Eric J Haas
- From Technion-Israel Institute of Technology, Haifa (Y.G.), the Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., E.J.H., S.A.-P., N.A.), Jerusalem, the Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center Tel Hashomer, Ramat Gan (L.F., A.H.), Tel Aviv University, Tel Aviv (A.H.), and Ben Gurion University, Beersheva (E.J.H.) - all in Israel
| | - Ron Milo
- From Technion-Israel Institute of Technology, Haifa (Y.G.), the Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., E.J.H., S.A.-P., N.A.), Jerusalem, the Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center Tel Hashomer, Ramat Gan (L.F., A.H.), Tel Aviv University, Tel Aviv (A.H.), and Ben Gurion University, Beersheva (E.J.H.) - all in Israel
| | - Sharon Alroy-Preis
- From Technion-Israel Institute of Technology, Haifa (Y.G.), the Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., E.J.H., S.A.-P., N.A.), Jerusalem, the Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center Tel Hashomer, Ramat Gan (L.F., A.H.), Tel Aviv University, Tel Aviv (A.H.), and Ben Gurion University, Beersheva (E.J.H.) - all in Israel
| | - Nachman Ash
- From Technion-Israel Institute of Technology, Haifa (Y.G.), the Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., E.J.H., S.A.-P., N.A.), Jerusalem, the Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center Tel Hashomer, Ramat Gan (L.F., A.H.), Tel Aviv University, Tel Aviv (A.H.), and Ben Gurion University, Beersheva (E.J.H.) - all in Israel
| | - Amit Huppert
- From Technion-Israel Institute of Technology, Haifa (Y.G.), the Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., E.J.H., S.A.-P., N.A.), Jerusalem, the Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center Tel Hashomer, Ramat Gan (L.F., A.H.), Tel Aviv University, Tel Aviv (A.H.), and Ben Gurion University, Beersheva (E.J.H.) - all in Israel
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10
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Abstract
BACKGROUND In December 2020, Israel began a mass vaccination campaign against coronavirus disease 2019 (Covid-19) by administering the BNT162b2 vaccine, which led to a sharp curtailing of the outbreak. After a period with almost no cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, a resurgent Covid-19 outbreak began in mid-June 2021. Possible reasons for the resurgence were reduced vaccine effectiveness against the delta (B.1.617.2) variant and waning immunity. The extent of waning immunity of the vaccine against the delta variant in Israel is unclear. METHODS We used data on confirmed infection and severe disease collected from an Israeli national database for the period of July 11 to 31, 2021, for all Israeli residents who had been fully vaccinated before June 2021. We used a Poisson regression model to compare rates of confirmed SARS-CoV-2 infection and severe Covid-19 among persons vaccinated during different time periods, with stratification according to age group and with adjustment for possible confounding factors. RESULTS Among persons 60 years of age or older, the rate of infection in the July 11-31 period was higher among persons who became fully vaccinated in January 2021 (when they were first eligible) than among those fully vaccinated 2 months later, in March (rate ratio, 1.6; 95% confidence interval [CI], 1.3 to 2.0). Among persons 40 to 59 years of age, the rate ratio for infection among those fully vaccinated in February (when they were first eligible), as compared with 2 months later, in April, was 1.7 (95% CI, 1.4 to 2.1). Among persons 16 to 39 years of age, the rate ratio for infection among those fully vaccinated in March (when they were first eligible), as compared with 2 months later, in May, was 1.6 (95% CI, 1.3 to 2.0). The rate ratio for severe disease among persons fully vaccinated in the month when they were first eligible, as compared with those fully vaccinated in March, was 1.8 (95% CI, 1.1 to 2.9) among persons 60 years of age or older and 2.2 (95% CI, 0.6 to 7.7) among those 40 to 59 years of age; owing to small numbers, the rate ratio could not be calculated among persons 16 to 39 years of age. CONCLUSIONS These findings indicate that immunity against the delta variant of SARS-CoV-2 waned in all age groups a few months after receipt of the second dose of vaccine.
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Affiliation(s)
- Yair Goldberg
- From Technion-Israel Institute of Technology, Haifa (Y.G.), the Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., E.J.H., S.A.-P., N.A.), Jerusalem, the Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center Tel Hashomer, Ramat Gan (L.F., A.H.), Tel Aviv University, Tel Aviv (A.H.), and Ben Gurion University, Beersheva (E.J.H.) - all in Israel
| | - Micha Mandel
- From Technion-Israel Institute of Technology, Haifa (Y.G.), the Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., E.J.H., S.A.-P., N.A.), Jerusalem, the Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center Tel Hashomer, Ramat Gan (L.F., A.H.), Tel Aviv University, Tel Aviv (A.H.), and Ben Gurion University, Beersheva (E.J.H.) - all in Israel
| | - Yinon M Bar-On
- From Technion-Israel Institute of Technology, Haifa (Y.G.), the Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., E.J.H., S.A.-P., N.A.), Jerusalem, the Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center Tel Hashomer, Ramat Gan (L.F., A.H.), Tel Aviv University, Tel Aviv (A.H.), and Ben Gurion University, Beersheva (E.J.H.) - all in Israel
| | - Omri Bodenheimer
- From Technion-Israel Institute of Technology, Haifa (Y.G.), the Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., E.J.H., S.A.-P., N.A.), Jerusalem, the Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center Tel Hashomer, Ramat Gan (L.F., A.H.), Tel Aviv University, Tel Aviv (A.H.), and Ben Gurion University, Beersheva (E.J.H.) - all in Israel
| | - Laurence Freedman
- From Technion-Israel Institute of Technology, Haifa (Y.G.), the Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., E.J.H., S.A.-P., N.A.), Jerusalem, the Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center Tel Hashomer, Ramat Gan (L.F., A.H.), Tel Aviv University, Tel Aviv (A.H.), and Ben Gurion University, Beersheva (E.J.H.) - all in Israel
| | - Eric J Haas
- From Technion-Israel Institute of Technology, Haifa (Y.G.), the Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., E.J.H., S.A.-P., N.A.), Jerusalem, the Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center Tel Hashomer, Ramat Gan (L.F., A.H.), Tel Aviv University, Tel Aviv (A.H.), and Ben Gurion University, Beersheva (E.J.H.) - all in Israel
| | - Ron Milo
- From Technion-Israel Institute of Technology, Haifa (Y.G.), the Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., E.J.H., S.A.-P., N.A.), Jerusalem, the Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center Tel Hashomer, Ramat Gan (L.F., A.H.), Tel Aviv University, Tel Aviv (A.H.), and Ben Gurion University, Beersheva (E.J.H.) - all in Israel
| | - Sharon Alroy-Preis
- From Technion-Israel Institute of Technology, Haifa (Y.G.), the Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., E.J.H., S.A.-P., N.A.), Jerusalem, the Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center Tel Hashomer, Ramat Gan (L.F., A.H.), Tel Aviv University, Tel Aviv (A.H.), and Ben Gurion University, Beersheva (E.J.H.) - all in Israel
| | - Nachman Ash
- From Technion-Israel Institute of Technology, Haifa (Y.G.), the Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., E.J.H., S.A.-P., N.A.), Jerusalem, the Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center Tel Hashomer, Ramat Gan (L.F., A.H.), Tel Aviv University, Tel Aviv (A.H.), and Ben Gurion University, Beersheva (E.J.H.) - all in Israel
| | - Amit Huppert
- From Technion-Israel Institute of Technology, Haifa (Y.G.), the Hebrew University of Jerusalem (M.M.), and the Israeli Ministry of Health (O.B., E.J.H., S.A.-P., N.A.), Jerusalem, the Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center Tel Hashomer, Ramat Gan (L.F., A.H.), Tel Aviv University, Tel Aviv (A.H.), and Ben Gurion University, Beersheva (E.J.H.) - all in Israel
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Mor O, Zuckerman NS, Hazan I, Fluss R, Ash N, Ginish N, Mendelson E, Alroy-Preis S, Freedman L, Huppert A. BNT162b2 vaccine effectiveness was marginally affected by the SARS-CoV-2 beta variant in fully vaccinated individuals. J Clin Epidemiol 2021; 142:38-44. [PMID: 34715314 PMCID: PMC8553421 DOI: 10.1016/j.jclinepi.2021.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/14/2021] [Accepted: 10/20/2021] [Indexed: 11/04/2022]
Abstract
Objective To evaluate the effectiveness of the Pfizer BNT162b2 vaccine against the SARS-Cov-2 Beta variant. Study Design and Setting Israel's mass vaccination program, using two doses of the Pfizer BNT162b2 vaccine, successfully curtailed the Alpha variant outbreak during winter 2020–2021, However, the virus may mutate and partially evade the immune system. To monitor this, sequencing of selected positive swab samples of interest was initiated. Comparing vaccinated with unvaccinated PCR positive persons, we estimated the odds ratio for a vaccinated case to have the Beta vs. the Alpha variant, using logistic regression, controlling for important confounders. Results There were 19 cases of Beta variant (3.2%) among those vaccinated more than 14 days before the positive sample and 79 (3.4%) among the unvaccinated. The estimated odds ratio was 1.26 (95% CI: 0.65–2.46). Assuming the effectiveness against the Alpha variant to be 95%, the estimated effectiveness against the Beta variant was 94% (95% CI: 88%–98%). Conclusion Despite concerns over the Beta variant, the BNT162b2 vaccine seemed to provide substantial immunity against both the Beta and the Alpha variants. From 14 days following the second vaccine dose, the effectiveness of BNT162b2 vaccine was at most marginally affected by the Beta variant.
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Affiliation(s)
- Orna Mor
- Central Virology Laboratory, Israel Ministry of Health, Sheba Medical Center, Tel-Hashomer 5262100, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Neta S Zuckerman
- Central Virology Laboratory, Israel Ministry of Health, Sheba Medical Center, Tel-Hashomer 5262100, Israel
| | - Itay Hazan
- Israel Ministry of Health, 39 Yirmiyahu Street, P.O.Box 1176, Jerusalem 9101002, Israel
| | - Ronen Fluss
- The Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Ramat Gan 5265601, Israel
| | - Nachman Ash
- Israel Ministry of Health, 39 Yirmiyahu Street, P.O.Box 1176, Jerusalem 9101002, Israel
| | - Netanel Ginish
- Israel Ministry of Health, 39 Yirmiyahu Street, P.O.Box 1176, Jerusalem 9101002, Israel
| | - Ella Mendelson
- Central Virology Laboratory, Israel Ministry of Health, Sheba Medical Center, Tel-Hashomer 5262100, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Sharon Alroy-Preis
- Public Health Services, Israel Ministry of Health, 39 Yirmiyahu Street, P.O.Box 1176, Jerusalem 9101002, Israel
| | - Laurence Freedman
- The Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Ramat Gan 5265601, Israel
| | - Amit Huppert
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel; The Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Ramat Gan 5265601, Israel.
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Waitzberg R, Triki N, Alroy-Preis S, Lotan T, Shiran L, Ash N. The Israeli Experience with the "Green Pass" Policy Highlights Issues to Be Considered by Policymakers in Other Countries. Int J Environ Res Public Health 2021; 18:11212. [PMID: 34769731 PMCID: PMC8582817 DOI: 10.3390/ijerph182111212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 02/07/2023]
Abstract
In the first half of 2021, Israel had been ahead of other countries concerning the speed of its rollout and coverage of COVID-19 vaccinations. During that time, Israel had implemented a vaccine certificate policy, the "Green Pass Policy" (GPP), to reduce virus spread and to allow the safe relaxation of COVID-19 restrictions in a time of great uncertainty. Based on an analysis of GPP regulations and public statements compiled from the Israeli Ministry of Health website, we describe the design and implementation of the GPP. We also look back and discuss lessons learned for countries that are considering a GPP policy, given the current upsurge of the Delta variant as of summer 2021. To reduce equity concerns when introducing a GPP, all population groups should be eligible for the vaccine (contingent on approval from the manufacturer) and have access to it. Alternatively, health authorities can grant temporary certificates based on a negative test. We also highlight the fact that in practice, there will be gaps between the GPP regulations and implementation. While some places might require a GPP without legal need, others will not implement it despite a legal obligation. The GPP regulations should have standardised epidemiological criteria, be implemented gradually, remain flexible, and change according to the epidemiological risks.
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Affiliation(s)
- Ruth Waitzberg
- Department of Health Care Management, Faculty of Economics & Management, Technische Universität, 10623 Berlin, Germany
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
- The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Jerusalem 91037, Israel
| | - Noa Triki
- Ministry of Health, Jerusalem 9101002, Israel; (N.T.); (N.A.)
| | - Sharon Alroy-Preis
- Public Health Services, Ministry of Health, Jerusalem 9101002, Israel; (S.A.-P.); (L.S.)
| | - Tomer Lotan
- Ministry of Public Security, Jerusalem 9103401, Israel;
| | - Liat Shiran
- Public Health Services, Ministry of Health, Jerusalem 9101002, Israel; (S.A.-P.); (L.S.)
| | - Nachman Ash
- Ministry of Health, Jerusalem 9101002, Israel; (N.T.); (N.A.)
- Department of Health Systems Management, School of Health Sciences, Ariel University, Ariel 40700, Israel
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Bar-On YM, Goldberg Y, Mandel M, Bodenheimer O, Freedman L, Kalkstein N, Mizrahi B, Alroy-Preis S, Ash N, Milo R, Huppert A. Protection of BNT162b2 Vaccine Booster against Covid-19 in Israel. N Engl J Med 2021. [PMID: 34525275 DOI: 10.1056/nejmoa2114255/suppl_file/nejmoa2114255_disclosures.pdf] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
BACKGROUND On July 30, 2021, the administration of a third (booster) dose of the BNT162b2 messenger RNA vaccine (Pfizer-BioNTech) was approved in Israel for persons who were 60 years of age or older and who had received a second dose of vaccine at least 5 months earlier. Data are needed regarding the effect of the booster dose on the rate of confirmed coronavirus 2019 disease (Covid-19) and the rate of severe illness. METHODS We extracted data for the period from July 30 through August 31, 2021, from the Israeli Ministry of Health database regarding 1,137,804 persons who were 60 years of age or older and had been fully vaccinated (i.e., had received two doses of BNT162b2) at least 5 months earlier. In the primary analysis, we compared the rate of confirmed Covid-19 and the rate of severe illness between those who had received a booster injection at least 12 days earlier (booster group) and those who had not received a booster injection (nonbooster group). In a secondary analysis, we evaluated the rate of infection 4 to 6 days after the booster dose as compared with the rate at least 12 days after the booster. In all the analyses, we used Poisson regression after adjusting for possible confounding factors. RESULTS At least 12 days after the booster dose, the rate of confirmed infection was lower in the booster group than in the nonbooster group by a factor of 11.3 (95% confidence interval [CI], 10.4 to 12.3); the rate of severe illness was lower by a factor of 19.5 (95% CI, 12.9 to 29.5). In a secondary analysis, the rate of confirmed infection at least 12 days after vaccination was lower than the rate after 4 to 6 days by a factor of 5.4 (95% CI, 4.8 to 6.1). CONCLUSIONS In this study involving participants who were 60 years of age or older and had received two doses of the BNT162b2 vaccine at least 5 months earlier, we found that the rates of confirmed Covid-19 and severe illness were substantially lower among those who received a booster (third) dose of the BNT162b2 vaccine.
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Affiliation(s)
- Yinon M Bar-On
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), Hebrew University of Jerusalem (M.M.) and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), KI Research Institute, Kfar Malal (N.K., B.M.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Yair Goldberg
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), Hebrew University of Jerusalem (M.M.) and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), KI Research Institute, Kfar Malal (N.K., B.M.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Micha Mandel
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), Hebrew University of Jerusalem (M.M.) and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), KI Research Institute, Kfar Malal (N.K., B.M.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Omri Bodenheimer
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), Hebrew University of Jerusalem (M.M.) and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), KI Research Institute, Kfar Malal (N.K., B.M.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Laurence Freedman
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), Hebrew University of Jerusalem (M.M.) and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), KI Research Institute, Kfar Malal (N.K., B.M.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Nir Kalkstein
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), Hebrew University of Jerusalem (M.M.) and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), KI Research Institute, Kfar Malal (N.K., B.M.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Barak Mizrahi
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), Hebrew University of Jerusalem (M.M.) and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), KI Research Institute, Kfar Malal (N.K., B.M.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Sharon Alroy-Preis
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), Hebrew University of Jerusalem (M.M.) and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), KI Research Institute, Kfar Malal (N.K., B.M.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Nachman Ash
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), Hebrew University of Jerusalem (M.M.) and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), KI Research Institute, Kfar Malal (N.K., B.M.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Ron Milo
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), Hebrew University of Jerusalem (M.M.) and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), KI Research Institute, Kfar Malal (N.K., B.M.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Amit Huppert
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), Hebrew University of Jerusalem (M.M.) and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), KI Research Institute, Kfar Malal (N.K., B.M.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
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14
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Bar-On YM, Goldberg Y, Mandel M, Bodenheimer O, Freedman L, Kalkstein N, Mizrahi B, Alroy-Preis S, Ash N, Milo R, Huppert A. Protection of BNT162b2 Vaccine Booster against Covid-19 in Israel. N Engl J Med 2021; 385:1393-1400. [PMID: 34525275 PMCID: PMC8461568 DOI: 10.1056/nejmoa2114255] [Citation(s) in RCA: 767] [Impact Index Per Article: 255.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND On July 30, 2021, the administration of a third (booster) dose of the BNT162b2 messenger RNA vaccine (Pfizer-BioNTech) was approved in Israel for persons who were 60 years of age or older and who had received a second dose of vaccine at least 5 months earlier. Data are needed regarding the effect of the booster dose on the rate of confirmed coronavirus 2019 disease (Covid-19) and the rate of severe illness. METHODS We extracted data for the period from July 30 through August 31, 2021, from the Israeli Ministry of Health database regarding 1,137,804 persons who were 60 years of age or older and had been fully vaccinated (i.e., had received two doses of BNT162b2) at least 5 months earlier. In the primary analysis, we compared the rate of confirmed Covid-19 and the rate of severe illness between those who had received a booster injection at least 12 days earlier (booster group) and those who had not received a booster injection (nonbooster group). In a secondary analysis, we evaluated the rate of infection 4 to 6 days after the booster dose as compared with the rate at least 12 days after the booster. In all the analyses, we used Poisson regression after adjusting for possible confounding factors. RESULTS At least 12 days after the booster dose, the rate of confirmed infection was lower in the booster group than in the nonbooster group by a factor of 11.3 (95% confidence interval [CI], 10.4 to 12.3); the rate of severe illness was lower by a factor of 19.5 (95% CI, 12.9 to 29.5). In a secondary analysis, the rate of confirmed infection at least 12 days after vaccination was lower than the rate after 4 to 6 days by a factor of 5.4 (95% CI, 4.8 to 6.1). CONCLUSIONS In this study involving participants who were 60 years of age or older and had received two doses of the BNT162b2 vaccine at least 5 months earlier, we found that the rates of confirmed Covid-19 and severe illness were substantially lower among those who received a booster (third) dose of the BNT162b2 vaccine.
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Affiliation(s)
- Yinon M Bar-On
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), Hebrew University of Jerusalem (M.M.) and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), KI Research Institute, Kfar Malal (N.K., B.M.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Yair Goldberg
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), Hebrew University of Jerusalem (M.M.) and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), KI Research Institute, Kfar Malal (N.K., B.M.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Micha Mandel
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), Hebrew University of Jerusalem (M.M.) and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), KI Research Institute, Kfar Malal (N.K., B.M.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Omri Bodenheimer
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), Hebrew University of Jerusalem (M.M.) and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), KI Research Institute, Kfar Malal (N.K., B.M.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Laurence Freedman
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), Hebrew University of Jerusalem (M.M.) and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), KI Research Institute, Kfar Malal (N.K., B.M.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Nir Kalkstein
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), Hebrew University of Jerusalem (M.M.) and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), KI Research Institute, Kfar Malal (N.K., B.M.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Barak Mizrahi
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), Hebrew University of Jerusalem (M.M.) and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), KI Research Institute, Kfar Malal (N.K., B.M.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Sharon Alroy-Preis
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), Hebrew University of Jerusalem (M.M.) and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), KI Research Institute, Kfar Malal (N.K., B.M.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Nachman Ash
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), Hebrew University of Jerusalem (M.M.) and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), KI Research Institute, Kfar Malal (N.K., B.M.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Ron Milo
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), Hebrew University of Jerusalem (M.M.) and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), KI Research Institute, Kfar Malal (N.K., B.M.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
| | - Amit Huppert
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), Hebrew University of Jerusalem (M.M.) and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), KI Research Institute, Kfar Malal (N.K., B.M.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel
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15
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Shapiro Ben David S, Rahamim‐Cohen D, Tasher D, Geva A, Azuri J, Ash N. COVID-19 in children and the effect of schools reopening on potential transmission to household members. Acta Paediatr 2021; 110:2567-2573. [PMID: 34053108 PMCID: PMC8222890 DOI: 10.1111/apa.15962] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/24/2021] [Accepted: 05/27/2021] [Indexed: 12/29/2022]
Abstract
AIM The effect of reopening schools on children's contribution to SARS-CoV-2 transmission, especially within households, remains controversial. This study describes the clinical presentation of a large ambulatory COVID-19 paediatric cohort and evaluates the role of children in household transmission prior to and following school reopening. METHODS A retrospective database cohort study was conducted in a large Health Maintenance Organization in Israel. Data of all paediatric, laboratory-confirmed Coronavirus cases between 28/2/2020 and 20/6/2020 were extracted. All cases were analysed for household contacts and primary cases within each family cluster. RESULTS A total of 1,032 cases under 18 years old (median age 12 years) were included. Of these cases, 432 (41.9%) were asymptomatic; 122 (11.8%) cases acquired the infection at school, and 45 of them were part of two school clusters; 846 children had at least one positive household contact, in 498 family clusters, and among them, 293 primary cases were identified. Only 27 (9.2%) primary cases were under 18 years of age and six (2%) were below 10. The proportion of primary cases did not change after the re-opening of educational facilities. CONCLUSION Children, particularly under 10 years of age, are less likely to be the vector for SARS-CoV-2 infection within household settings. Opening educational facilities did not change transmission dynamics.
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Affiliation(s)
- Shirley Shapiro Ben David
- Health Division Maccabi Healthcare Services Tel Aviv Israel
- Infectious disease unit E. Wolfson Medical Center Holon Israel
| | | | - Diana Tasher
- Pediatric Infectious disease unit E. Wolfson Medical center Holon Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Adi Geva
- Health Division Maccabi Healthcare Services Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Joseph Azuri
- Health Division Maccabi Healthcare Services Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Nachman Ash
- Health Division Maccabi Healthcare Services Tel Aviv Israel
- Health Systems Management Department Ariel University Ariel Israel
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16
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Shapiro Ben David S, Cohen D, Karplus R, Irony A, Ofer-Bialer G, Potasman I, Greenfeld O, Azuri J, Ash N. COVID-19 community care in Israel-a nationwide cohort study from a large health maintenance organization. J Public Health (Oxf) 2021; 43:723-730. [PMID: 33690854 PMCID: PMC7989272 DOI: 10.1093/pubmed/fdab055] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 02/11/2021] [Accepted: 02/14/2021] [Indexed: 11/16/2022] Open
Abstract
Background Among the many medical challenges presented by the COVID-19 pandemic, management of the majority of patients in community outpatient settings is crucial. The aim of this study was to describe the characteristics and outcomes among confirmed COVID-19 cases who were managed at three settings: two outpatient settings and one inpatient. Methods A retrospective database cohort study was conducted in a large Israeli Health Maintenance Organization. All COVID-19 cases diagnosed between 28 February 2020 and 20 July 2020 were included. Cases in the community settings were managed through a nationwide remote monitoring center, using preliminary telehealth triage and 24/7 virtual care. Outcome parameters included hospital admission, disease severity, need for respiratory support and mortality. Results About 5448 cases, aged range 0–97 years, were enrolled; 88.7% were initially managed as outpatient either at home or in designated hotels, 3.1 and 2.1% of them, respectively, later required hospitalization. The main reason for hospitalization was dyspnea; 12 were diagnosed with severe disease; 56 patients (1.3%) died, five (0.1%) of whom were initially allocated to the outpatient settings. Conclusions Care for appropriately selected COVID-19 patients in the community provides a safe and effective option. This can contribute to reducing the hospitalization burden, with no evidence of increased morbidity or mortality.
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Affiliation(s)
| | - Daniella Cohen
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
| | - Rebekah Karplus
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
| | - Angela Irony
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
| | - Gili Ofer-Bialer
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Israel Potasman
- Internal Medicine and Infectious Diseases, Maccabi Healthcare Services, Haifa 3474407, Israel
| | - Orly Greenfeld
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
| | - Joseph Azuri
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Nachman Ash
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel.,Health Systems Management Department, Ariel University, Ariel 4077625, Israel
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17
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Triki N, Ash N, Porath A, Birnbaum Y, Greenberg D, Hammerman A. Risk sharing or risk shifting? On the development of patient access schemes in the process of updating the national list of health services in Israel. Expert Rev Pharmacoecon Outcomes Res 2019; 19:749-753. [PMID: 31825682 DOI: 10.1080/14737167.2019.1702525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Agreements between payers and pharmaceutical/medical device companies are widely implemented to address financial and clinical uncertainties. We analyzed the main characteristics of these agreements in Israel from 2011-2018.Research design and methods: We reviewed all agreements implemented during the study period. Information regarding the type of agreement, therapeutic indications, its time frame and the total budget involved are presented.Results: A total of 56 agreements were signed since 2011, of which 53 (95%) were financial-based and 50 (89%) referred to pharmaceuticals. The annual number of agreements increased from one in 2011 to 21 in 2018. The main therapeutic areas covered were: oncology (41%), hepatitis C (16%), neurology (11%), respiratory (9%), and cardiovascular (7%). The proportion of the annual budget allocated subject to these agreements increased accordingly from 3% in 2011 to 73% in 2018. The majority (63%) of the agreements were signed for 5 years, 9% were shorter-term and 20% have no time-limit. In 14 (44%) of the financial-based agreements implemented through 2017, the actual utilization exceeded the pre-specified threshold and the companies reimbursed the health-plans accordingly.Conclusions: The number of agreements and the allocated budget subject to these agreements increased substantially in recent years. Most agreements are financial-based that, in many cases, shifted the short-term financial risk from health-plans to the industry.
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Affiliation(s)
- Noa Triki
- Department of Health Technology Policy, Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Nachman Ash
- Medical Division, Maccabi Healthcare Services, Tel-Aviv, Israel.,The Department of Health Systems Management, Ariel University, Ariel, Israel
| | - Avi Porath
- Department of Public Health, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Yair Birnbaum
- Clalit Health Services Headquarters, Tel-Aviv, Israel
| | - Dan Greenberg
- Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Ariel Hammerman
- Department of Pharmaceutical Technology Assessment, Clalit Health Services Headquarters, Tel-Aviv, Israel
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Goshen R, Choman E, Ran A, Muller E, Kariv R, Chodick G, Ash N, Narod S, Shalev V. Computer-Assisted Flagging of Individuals at High Risk of Colorectal Cancer in a Large Health Maintenance Organization Using the ColonFlag Test. JCO Clin Cancer Inform 2019; 2:1-8. [PMID: 30652563 DOI: 10.1200/cci.17.00130] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To evaluate in a sample of adults who had been noncompliant with colorectal cancer (CRC) screening whether screening could be enhanced by an automated patient recall system based on identifying high-risk individuals using the ColonFlag test and an electronic medical record database. METHODS A total of 79,671 individuals who were determined to be noncompliant with current screening recommendations were identified in the Maccabi Health Services program in Israel. Their cancer risk was determined by ColonFlag using information on age, sex, and CBC results. Doctors of individuals who were flagged as high risk were notified and asked to follow up with their patients. RESULTS The ColonFlag identified 688 men and women who scored in the highest 0.87 percentile. Of these individuals, 254 had colonoscopies performed by Maccabi physicians, and 19 CRCs (7.5%) were found. An additional 15 cancers primarily identified outside of Maccabi were found through code matching. CONCLUSION The ColonFlag test is a rapid, efficient, and inexpensive test that can be applied to scan electronic medical records to identify individuals at high risk of CRC who would otherwise avoid screening.
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Affiliation(s)
- Ran Goshen
- Ran Goshen, Eran Choman, Ayelet Ran, and Efrat Muller, Medial EarlySign, Kfar Malal; Revital Kariv, Gabriel Chodick, and Varda Shalev; Maccabi Institute for Research and Innovation, Maccabi Healthcare Services; Nachman Ash, Maccabi Healthcare Services, Tel-Aviv; Revital Kariv, Gabriel Chodick, and Varda Shalev, Tel Aviv University; Revital Kariv, Sourasky Medical Center; Nachman Ash, Ariel University, Ariel, Israel; and Steven Narod, Women's College Research Institute, Women's College Hospital, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Eran Choman
- Ran Goshen, Eran Choman, Ayelet Ran, and Efrat Muller, Medial EarlySign, Kfar Malal; Revital Kariv, Gabriel Chodick, and Varda Shalev; Maccabi Institute for Research and Innovation, Maccabi Healthcare Services; Nachman Ash, Maccabi Healthcare Services, Tel-Aviv; Revital Kariv, Gabriel Chodick, and Varda Shalev, Tel Aviv University; Revital Kariv, Sourasky Medical Center; Nachman Ash, Ariel University, Ariel, Israel; and Steven Narod, Women's College Research Institute, Women's College Hospital, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ayelet Ran
- Ran Goshen, Eran Choman, Ayelet Ran, and Efrat Muller, Medial EarlySign, Kfar Malal; Revital Kariv, Gabriel Chodick, and Varda Shalev; Maccabi Institute for Research and Innovation, Maccabi Healthcare Services; Nachman Ash, Maccabi Healthcare Services, Tel-Aviv; Revital Kariv, Gabriel Chodick, and Varda Shalev, Tel Aviv University; Revital Kariv, Sourasky Medical Center; Nachman Ash, Ariel University, Ariel, Israel; and Steven Narod, Women's College Research Institute, Women's College Hospital, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Efrat Muller
- Ran Goshen, Eran Choman, Ayelet Ran, and Efrat Muller, Medial EarlySign, Kfar Malal; Revital Kariv, Gabriel Chodick, and Varda Shalev; Maccabi Institute for Research and Innovation, Maccabi Healthcare Services; Nachman Ash, Maccabi Healthcare Services, Tel-Aviv; Revital Kariv, Gabriel Chodick, and Varda Shalev, Tel Aviv University; Revital Kariv, Sourasky Medical Center; Nachman Ash, Ariel University, Ariel, Israel; and Steven Narod, Women's College Research Institute, Women's College Hospital, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Revital Kariv
- Ran Goshen, Eran Choman, Ayelet Ran, and Efrat Muller, Medial EarlySign, Kfar Malal; Revital Kariv, Gabriel Chodick, and Varda Shalev; Maccabi Institute for Research and Innovation, Maccabi Healthcare Services; Nachman Ash, Maccabi Healthcare Services, Tel-Aviv; Revital Kariv, Gabriel Chodick, and Varda Shalev, Tel Aviv University; Revital Kariv, Sourasky Medical Center; Nachman Ash, Ariel University, Ariel, Israel; and Steven Narod, Women's College Research Institute, Women's College Hospital, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Gabriel Chodick
- Ran Goshen, Eran Choman, Ayelet Ran, and Efrat Muller, Medial EarlySign, Kfar Malal; Revital Kariv, Gabriel Chodick, and Varda Shalev; Maccabi Institute for Research and Innovation, Maccabi Healthcare Services; Nachman Ash, Maccabi Healthcare Services, Tel-Aviv; Revital Kariv, Gabriel Chodick, and Varda Shalev, Tel Aviv University; Revital Kariv, Sourasky Medical Center; Nachman Ash, Ariel University, Ariel, Israel; and Steven Narod, Women's College Research Institute, Women's College Hospital, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nachman Ash
- Ran Goshen, Eran Choman, Ayelet Ran, and Efrat Muller, Medial EarlySign, Kfar Malal; Revital Kariv, Gabriel Chodick, and Varda Shalev; Maccabi Institute for Research and Innovation, Maccabi Healthcare Services; Nachman Ash, Maccabi Healthcare Services, Tel-Aviv; Revital Kariv, Gabriel Chodick, and Varda Shalev, Tel Aviv University; Revital Kariv, Sourasky Medical Center; Nachman Ash, Ariel University, Ariel, Israel; and Steven Narod, Women's College Research Institute, Women's College Hospital, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Steven Narod
- Ran Goshen, Eran Choman, Ayelet Ran, and Efrat Muller, Medial EarlySign, Kfar Malal; Revital Kariv, Gabriel Chodick, and Varda Shalev; Maccabi Institute for Research and Innovation, Maccabi Healthcare Services; Nachman Ash, Maccabi Healthcare Services, Tel-Aviv; Revital Kariv, Gabriel Chodick, and Varda Shalev, Tel Aviv University; Revital Kariv, Sourasky Medical Center; Nachman Ash, Ariel University, Ariel, Israel; and Steven Narod, Women's College Research Institute, Women's College Hospital, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Varda Shalev
- Ran Goshen, Eran Choman, Ayelet Ran, and Efrat Muller, Medial EarlySign, Kfar Malal; Revital Kariv, Gabriel Chodick, and Varda Shalev; Maccabi Institute for Research and Innovation, Maccabi Healthcare Services; Nachman Ash, Maccabi Healthcare Services, Tel-Aviv; Revital Kariv, Gabriel Chodick, and Varda Shalev, Tel Aviv University; Revital Kariv, Sourasky Medical Center; Nachman Ash, Ariel University, Ariel, Israel; and Steven Narod, Women's College Research Institute, Women's College Hospital, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Abstract
IMPORTANCE Previous studies have suggested that Holocaust survivors may experience different chronic comorbidities more often than the general population. However, the mortality hazard among these individuals has not been addressed. OBJECTIVE To assess the overall mortality rate and comorbidities of a cohort of Holocaust survivors compared with an age-matched control group. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included all Holocaust survivors insured by Maccabi Healthcare Services in Israel who were born between 1911 and 1945 in Europe and control individuals born in Israel during the same years and insured by the same service. Data were collected from January 1, 1998, through December 31, 2017. OUTCOMES AND MEASURES Rates of morbidities and mortality rates adjusted for sex, socioeconomic status, and body mass index using logistic regression, Cox regression, and Kaplan-Meier analysis. RESULTS The 38 597 Holocaust survivors included 22 627 women (58.6%) and had a mean (SD) age of 81.7 (5.4) years, and the 34 931 individuals in the control group included 18 615 women (53.3%) and had a mean (SD) age of 77.7 (5.3) years. The Holocaust survivors had higher rates than control individuals of reported hypertension (32 038 [83.0%] vs 23 285 [66.7]), obesity (12 838 [33.3%] vs 9254 [26.5]), chronic kidney disease (11 929 [30.9%] vs 6927 [19.8]), cancer (11 369 [29.5%] vs 9721 [27.8]), dementia (6389 [16.6%] vs 3355 [9.6]), ischemic heart disease, nonmyocardial infarction (5729 [14.8%] vs 4135 [11.8]), myocardial infarction (3641 [9.4%] vs 2723 [7.8]), and osteoporotic fractures among women (6429 [28.4%] vs 4120 [22.1]). In contrast, the overall mortality rate was lower among Holocaust survivors (25.3%) compared with the control group (41.1%). After adjustment for confounders, mean age at death was significantly higher in the survivor group compared with the control group. CONCLUSIONS AND RELEVANCE The findings showed higher rates of comorbidities and lower mortality among Holocaust survivors, which may be associated with a combination of improved health literacy and unique resilience characteristics among Holocaust survivors. More research is needed to explore the biologic and psychosocial basis for these results.
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Affiliation(s)
- Naama Fund
- Maccabi Kahn Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Nachman Ash
- Maccabi Kahn Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Faculty of Medicine, Ariel University, Ariel, Israel
| | - Avi Porath
- Maccabi Kahn Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Epidemiology, Ben Gurion University of the Negev, Beersheba, Israel
| | - Varda Shalev
- Maccabi Kahn Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Pediatrics, Tel Aviv University, Tel Aviv, Israel
| | - Gideon Koren
- Maccabi Kahn Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Faculty of Medicine, Ariel University, Ariel, Israel
- Department of Epidemiology, Ben Gurion University of the Negev, Beersheba, Israel
- Department of Pediatrics, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatrics, Western University, London, Ontario, Canada
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Ash N. [OUTSOURCING OF MEDICAL SERVICES FOR SOLDIERS TO CIVILIAN HEALTH FUNDS]. Harefuah 2018; 157:660-663. [PMID: 30343546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The Israeli Medical Corps provides a great deal of medical services by its own medical personnel and purchases some services from various civilian suppliers, including public hospitals. Although the IDF has bought hospital services since it's early days, few attempts have been made to purchase primary and secondary medical services for soldiers in rear units. This article presents an analysis of the outsourcing project ("Aviv" project) of medical services for rear units which was operating between the years 2010 - 2014. In this project soldiers chose to receive services from one of the four healthcare funds in Israel. The project is analyzed from two perspectives, military and civilian, based on the personal experience of the author who led the implementation of the project while he was the Surgeon General of the Medical Corps and gained additional experience at a later stage during his positions in Maccabi Healthcare Services. Despite the different policies of the medical corps and the healthcare funds that are described in the article, it is advisable to utilize the civilian infrastructure in Israel to provide soldiers with better medical services. Future projects should consider the lessons learned from the Aviv project and adjust the demands of the Medical Corps from the healthcare funds, so that soldiers will receive similar services to their civilian counterparts. Among other recommendations, the author advises that soldiers will pay copayment and will receive broad services, including the basic basket and complimentary health services.
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Ben-Pazi H, Simcha N, Ash N. [TELENEUROLOGY CLINIC - HIGH COMPLIANCE AND ADHERENCE]. Harefuah 2018; 157:503-506. [PMID: 30175565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Telemedicine carries the potential of providing healthcare for individuals with limited access to clinics. While in some subspecialties telemedicine has been proved to be effective, its efficacy for replacing standard visits in complex subspecialties, such as pediatric neurology, has not been studied. OBJECTIVES To determine compliance and adherence to follow-up and medication prescription for online pediatric neurology clinics. METHODS We reviewed clinical records for follow-up and prescription requests of medication prescribed for children visiting the Maccabi Online Neuropediatric clinic in Ariel. RESULTS A total of 78 children (aged 10.9±3.2 years; 40 girls, 38 boys) visited the online neuropediatric clinic between October 2015 and November 2017; 78 first visits, 44 follow-up visits. The first visit lasted 50 minutes including technical time. The main diagnoses were ADD/ADHD (41/78, 53%), followed by behavioral/emotional issues (11/78, 14%), headaches/migraines (9/78, 12%), learning disabilities (8/78, 10%) epilepsy (4/78, 5%) and others (5/78, 6%). Follow-up was recommended in most cases (48/78, 62%) mainly for ADD/ADHD and headaches/migraines. Most patients complied with follow-up (55%) with better rates among ADD/ADHD (19/29, 66%). Only a few patients (3/78,4%) continued follow-up in a regular clinic. Medication was recommended for 29/41 (71%) children with ADD/ADHD; all of whom requested medication prescription from the pediatrician (as it could not be prescribed digitally). Adherence was high as most patients (24/29, 83%) continued to request medication prescription. CONCLUSIONS While adherence and compliance rates are high in tele-neurology clinics, especially for ADHD, further controlled studies are needed to compare services to regular visits and to assess the additional benefits of specialists healthcare delivery to underserved populations.
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Abstract
Summary
Objectives: As millions of consumers perform health information retrieval online, the mismatch between their terminology and the terminologies of the information sources could become a major barrier to successful retrievals. To address this problem, we studied the characteristics of consumer terminology for health information retrieval.
Methods: Our study focused on consumer queries that were used on a consumer health service Web site and a consumer health information Web site. We analyzed data from the site-usage logs and conducted interviews with patients.
Results: Our findings show that consumers’ information retrieval performance is very poor. There are significant mismatches at all levels (lexical, semantic and mental models) between the consumer terminology and both the information source terminology and standard medical vocabularies.
Conclusions: Comprehensive terminology support on all levels is needed for consumer health information retrieval.
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Avisar N, Heller Y, Weil C, Ben-Baruch A, Potesman-Yona S, Oren R, Chodick G, Shalev V, Ash N. Multi-disciplinary patient-centered model for the expedited provision of costly therapies in community settings: the case of new medication for hepatitis C. Isr J Health Policy Res 2017; 6:46. [PMID: 28954630 PMCID: PMC5618729 DOI: 10.1186/s13584-017-0172-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 08/18/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In January 2015, the first interferon-free direct-acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV) infection was approved for inclusion in Israel's national basket of health services. During 2015, HCV genotype 1 patients with advanced liver fibrosis (stage F3-F4) were eligible for treatment with ombitasvir/paritaprevir/ritonavir and dasabuvir (OMB/PTV/r + DSV) provided through the four national health plans. As all health plans committed to identifying eligible patients nationwide, risk-sharing agreements created an additional incentive to develop an innovative model for rapid treatment delivery. AIM This article aims to describe the development and implementation of a multi-disciplinary patient-centered model for the expedited provision of costly therapies in a community setting, based on experience delivering new HCV therapy in 2015. METHODS We present the case of the Central District in Maccabi Healthcare Services (MHS), one of five districts in a 2-million-member healthcare provider. We describe the dimensions of the model and its implementation, including the composition and responsibilities of the multi-disciplinary team, screening for patient eligibility, provision of care, and barriers and facilitators identified at each stage. RESULTS The experience of the MHS Central District indicates that good communication between all stakeholders was the key driver of successful implementation of the model. Overall, monthly treatment uptake increased following the intervention and by the end of 2015 a total of 99 patients were treated with OMB/PTV/r + DSV in this district. Early data indicate high effectiveness in this population and evaluation in ongoing. CONCLUSIONS This multi-disciplinary patient-centered model enabled rapid integration of screening and disease staging to identify and treat eligible HCV patients in the MHS central district. The model forms the basis of the 2017 project to deliver DAAs according to broader health basket criteria and may be adapted for the provision of other innovative health technologies in different healthcare settings.
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Affiliation(s)
- Nitzan Avisar
- Central District, Maccabi Healthcare Services, Yoni Netanyahu 5/31, Petach Tikva, Israel
| | - Yael Heller
- Central District, Maccabi Healthcare Services, Yoni Netanyahu 5/31, Petach Tikva, Israel
| | - Clara Weil
- Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Aviva Ben-Baruch
- Central District, Maccabi Healthcare Services, Yoni Netanyahu 5/31, Petach Tikva, Israel
| | - Shani Potesman-Yona
- Central District, Maccabi Healthcare Services, Yoni Netanyahu 5/31, Petach Tikva, Israel
| | - Ran Oren
- Institute of Gastroenterology and Liver Diseases, Hadassah Ein Karem Hospital, Jerusalem, Israel
| | - Gabriel Chodick
- Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Varda Shalev
- Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nachman Ash
- Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel
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Ash N. "Code Blue" for coding discharge diagnoses in the emergency department. Isr Med Assoc J 2014; 16:52-53. [PMID: 24575507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Topaz M, Ash N. [Overview of the US policies for health information technology and lessons learned for Israel]. Harefuah 2013; 152:262-309. [PMID: 23885448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The heaLthcare system in the United States (U.S.) faces a number of significant changes aimed at improving the quality and availability of medical services and reducing costs. Implementation of health information technologies, especiaLly ELectronic Health Records (EHR), is central to achieving these goals. Several recent Legislative efforts in the U.S. aim at defining standards and promoting wide scale "Meaningful Use" of the novel technologies. In Israel, the majority of heaLthcare providers adopted EHR throughout the Last decade. Unlike the U.S., the process of EHR adoption occurred spontaneously, without governmental control or the definition of standards. In this article, we review the U.S. health information technology policies and standards and suggest potential lessons Learned for Israel. First, we present the three-staged Meaningful Use regulations that require eligible healthcare practitioners to use EHR in their practice. We also describe the standards for EHR certification and national efforts to create interoperable health information technology networks. Finally, we provide a brief overview of the IsraeLi regulation in the field of EHR. Although the adoption of health information technology is wider in Israel, the Lack of technology standards and governmental control has Led to Large technology gaps between providers. The example of the U.S. Legislation urges the adoption of several critical steps to further enhance the quality and efficiency of the Israeli healthcare system, in particular: strengthening health information technology regulation; developing Licensure criteria for health information technology; bridging the digital gap between healthcare organizations; defining quality measures; and improving the accessibility of health information for patients.
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Affiliation(s)
- Maxim Topaz
- Pennsylvania University of Nursing School of Philadelphia Pa, USA.
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Zelingher J, Ash N. [Data coding in the Israeli healthcare system - do choices provide the answers to our system's needs?]. Harefuah 2013; 152:267-309. [PMID: 23885449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The IsraeLi healthcare system has undergone major processes for the adoption of health information technologies (HIT), and enjoys high Levels of utilization in hospital and ambulatory care. Coding is an essential infrastructure component of HIT, and ts purpose is to represent data in a simplified and common format, enhancing its manipulation by digital systems. Proper coding of data enables efficient identification, storage, retrieval and communication of data. UtiLization of uniform coding systems by different organizations enables data interoperability between them, facilitating communication and integrating data elements originating in different information systems from various organizations. Current needs in Israel for heaLth data coding include recording and reporting of diagnoses for hospitalized patients, outpatients and visitors of the Emergency Department, coding of procedures and operations, coding of pathology findings, reporting of discharge diagnoses and causes of death, billing codes, organizational data warehouses and national registries. New national projects for cLinicaL data integration, obligatory reporting of quality indicators and new Ministry of Health (MOH) requirements for HIT necessitate a high Level of interoperability that can be achieved only through the adoption of uniform coding. Additional pressures were introduced by the USA decision to stop the maintenance of the ICD-9-CM codes that are also used by Israeli healthcare, and the adoption of ICD-10-C and ICD-10-PCS as the main coding system for billing purpose. The USA has also mandated utilization of SNOMED-CT as the coding terminology for the ELectronic Health Record problem list, and for reporting quality indicators to the CMS. Hence, the Israeli MOH has recently decided that discharge diagnoses will be reported using ICD-10-CM codes, and SNOMED-CT will be used to code the cLinical information in the EHR. We reviewed the characteristics, strengths and weaknesses of these two coding systems. In summary, the adoption of ICD-10-CM is in line with the USA decision to abandon ICD-9-CM, and the Israeli heaLthcare system could benefit from USA heaLthcare efforts in this direction. The Large content of SNOMED-CT and its sophisticated hierarchical data structure will enable advanced cLinicaL decision support and quality improvement applications.
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Affiliation(s)
- Julian Zelingher
- Clalit Health Services Corporate Headquarters, Ministry of Health.
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Ash N. [The American Medical Informatics Association annual symposium-transforming health and healthcare Chicago, IL, USA 3-7 Nov 2012]. Harefuah 2013; 152:290-291. [PMID: 23885453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Ash N, Levy I. [Health Information Technology -where are we heading?]. Harefuah 2013; 152:254-310. [PMID: 23885446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The current issue of "Harefuah" dedicates a special corner to Health Information Technology (HIT), with a collection of five review papers discussing different areas of the field, focusing on its benefits to the quality of healthcare. In the first paper Topaz and Ash describe the United States MeaningfuL Use project, and list the lessons that the Israeli health system should learn from it. Zelingher and Ash analyze the decision of the Israeli Ministry of Health to move from the old coding system of ICD-9-CM to a combination of SNOMED-CT as a clinical terminology system and ICD-10-CM as the classification coding system. The authors conclude that achieving a standardized, homogenous and thorough coding of problems, diagnoses and procedures will enable interoperability in the Israeli health system. Shalom et al present us to the world of computerized clinical guidelines. They review the different projects that aim to bring tools and methods to transform the paper based guidelines to computer programs that support the everyday decisions that physicians take regarding their patients. The authors focus on their experience in developing methodology, tools and a library of computerized guidelines, and describe their evaluation in several projects. Shahar et al dive deeper to describe the challenge of representing time in cLinicaL guidelines and creating tools to discover new knowledge based on represented known knowledge. These two papers demonstrate the meaningful use of medicaL data. In the last article, Siegal addresses some legal concerns evolving from the HIT revolution, pointing to the emerging concepts in Israeli jurisprudence, which regards medical IT as an important contribution to patient empowerment, aspects of medical risk management and management of national health system resources. In the judgment of the Israeli court, a medical organization will possibly have to take the responsibiLity of not implementing a proven HIT system. This paper concludes with descriptions of two studies evaluating health information systems in Israel. These studies will be presented at the forthcoming conference of the IsraeLi Association of Medical Informatics (ILAMI).
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Glassberg E, Lipsky AM, Lending G, Sergeev I, Elbaz A, Morose A, Katzenell U, Ash N. Blood glucose levels as an adjunct for prehospital field triage. Am J Emerg Med 2013; 31:556-61. [PMID: 23380089 DOI: 10.1016/j.ajem.2012.10.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 10/09/2012] [Accepted: 10/29/2012] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Elevated blood glucose levels (BGL) are known to be part of the physiologic response to stress following physical trauma. We aimed to study whether a measured BGL might help improve accuracy of field triage. METHODS We conducted a retrospective study using the Israel Defense Forces Trauma Registry. BGLs were determined upon hospital arrival and were not available to medical providers in the field. RESULTS There were 706 casualties in the registry who had a recorded BGL upon hospital arrival. Sixty percent (18/30) of casualties who had a BGL ≥200 mg/dL had been triaged in the field as severely wounded, whereas 11% (71/651) of casualties who had a BGL <200 mg/dL had been triaged as severely wounded. For predicting an Injury Severity Score >15, the positive likelihood ratio using field triage of severe was 11, using BGL ≥200 mg/dL was 8, and using a combination of the two tests was 26. For predicting the need for intensive care unit (ICU) admission, the ratios were 8, 13, and 23, respectively. CONCLUSIONS Elevated BGL improved prediction of high Injury Severity Score and ICU use among casualties triaged as severe. If future research using BGL measured in the field yields similar results, combining BGL with standard field triage may allow for more accurate identification of casualties who need acute field intervention, have major injury, or require ICU admission.
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Affiliation(s)
- Elon Glassberg
- Medical Corps, Surgeon General Headquarters, Military POB 02149, Israel Defense Force, 02149, Israel.
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Abstract
OBJECTIVE We assessed the causes of death of military casualties in order to determine the characteristics of injury and to determine how survivability can be improved. METHODS A retrospective review of the trauma registry of the Israel Defense Forces was conducted. The causes of death were determined. Casualties that were found alive but died later at any level of care were included. RESULTS Information about casualties that was recorded during the years 2002-2009 was reviewed. Eighty-one fatalities were included in the analysis. Fifty-one (63%) fatalities were caused by gunshot wounds. Analysis of the data regarding the cause of death revealed that 66 (81.5%) of the casualties died because of hemorrhage and 25 (30.9%) because of head trauma. Of the casualties that died of hemorrhage, 12 (18.2%) had neck or limbs potentially compressible hemorrhage. All fatalities from hemorrhage died before arriving at a medical facility. CONCLUSION Torso noncompressible hemorrhage was found to be the main cause of death among the casualties investigated. Potentially compressible hemorrhage and head injury are significant too. Research and development of means to treat hemorrhage and emphasis on distribution of means to stop hemorrhage and on training may improve outcome of potentially compressible hemorrhage.
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Affiliation(s)
- Udi Katzenell
- Trauma Branch, Medical Corps, Israel Defense Forces, Tel Hashomer, Israel
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Machluf Y, Pirogovsky A, Palma E, Yona A, Navon A, Shohat T, Yitzak A, Tal O, Ash N, Nachman M, Chaiter Y. Coordinated computerized systems aimed at management, control, and quality assurance of medical processes and informatics. Int J Health Care Qual Assur 2012; 25:663-81. [DOI: 10.1108/09526861211270622] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sergeev I, Lipsky AM, Ganor O, Lending G, Abebe-Campino G, Morose A, Katzenell U, Ash N, Glassberg E. Training Modalities and Self-Confidence Building in Performance of Life-Saving Procedures. Mil Med 2012; 177:901-6. [DOI: 10.7205/milmed-d-12-00018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Ash N, Gamzu R. [Benchmarking adoption and use of information and communication technologies in the health sector Paris, France, 30th-31th January 2012]. Harefuah 2012; 151:313-314. [PMID: 22844739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Ran Y, Hadad E, Daher S, Ganor O, Yegorov Y, Katzenell U, Ash N, Hirschhorn G. Triage and air evacuation strategy for mass casualty events: a model based on combat experience. Mil Med 2011; 176:647-51. [PMID: 21702381 DOI: 10.7205/milmed-d-10-00390] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Management of combat casualties should optimize outcomes by appropriate patient triage, prehospital care, and rapid transport to the most capable medical facility, while avoiding overwhelming individual facilities. METHODS Planning the medical support for the campaign was done by the medical department of the IDF Southern command in cohort with the medical department of the Homefront command. Data collection and analysis were done by the Trauma Branch of the Medical corp. RESULTS 339 soldiers were injured, among them were 10 fatalities. Five hospitals received casualties, although the 2 regional hospitals received 84% of the primary evacuation load. The majority of urgently injured soldiers (90%) were evacuated by air, as opposed to 59% of non-urgently injured soldiers. CONCLUSIONS In a cross border setting, airlifting the urgent casualties to farther away level I trauma centers provides appropriate care for them, while not crossing the "surge capacity" line for the near-by medical centers.
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Affiliation(s)
- Yuval Ran
- Trauma Branch, Israel Defence Force, 02149
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Levy G, Blumberg N, Kreiss Y, Ash N, Merin O. Application of information technology within a field hospital deployment following the January 2010 Haiti earthquake disaster. J Am Med Inform Assoc 2011; 17:626-30. [PMID: 20962123 DOI: 10.1136/jamia.2010.004937] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Following the January 2010 earthquake in Haiti, the Israel Defense Force Medical Corps dispatched a field hospital unit. A specially tailored information technology solution was deployed within the hospital. The solution included a hospital administration system as well as a complete electronic medical record. A light-weight picture archiving and communication system was also deployed. During 10 days of operation, the system registered 1111 patients. The network and system up times were more than 99.9%. Patient movements within the hospital were noted, and an online command dashboard screen was generated. Patient care was delivered using the electronic medical record. Digital radiographs were acquired and transmitted to stations throughout the hospital. The system helped to introduce order in an otherwise chaotic situation and enabled adequate utilization of scarce medical resources by continually gathering information, analyzing it, and presenting it to the decision-making command level. The establishment of electronic medical records promoted the adequacy of medical treatment and facilitated continuity of care. This experience in Haiti supports the feasibility of deploying information technologies within a field hospital operation. Disaster response teams and agencies are encouraged to consider the use of information technology as part of their contingency plans.
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Affiliation(s)
- Gad Levy
- Israel Defense Forces Medical Corps, Tel-Hashomer, Israel.
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Chaiter Y, Palma E, Machluf Y, Yona A, Cohen A, Pirogovsky A, Shohat T, Ytzhak A, Ash N. Quality‐assuring intervention for technical medical staff at medical committees. Int J Health Care Qual Assur 2011; 24:19-30. [DOI: 10.1108/09526861111098210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Oberman AS, Brosh-Nissimov T, Ash N. Medicine and the Holocaust: a visit to the Nazi death camps as a means of teaching medical ethics in the Israel Defense Forces Medical Corps. J Med Ethics 2010; 36:821-826. [PMID: 21030474 DOI: 10.1136/jme.2010.037101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A novel method of teaching military medical ethics, medical ethics and military ethics in the Israel Defense Force (IDF) Medical Corps, essential topics for all military medical personnel, is discussed. Very little time is devoted to medical ethics in medical curricula, and even less to military medical ethics. Ninety-five per cent of American students in eight medical schools had less than 1 h of military medical ethics teaching and few knew the basic tenets of the Geneva Convention. Medical ethics differs from military medical ethics: the former deals with the relationship between medical professional and patient, while in the latter military physicians have to balance between military necessity and their traditional priorities to their patients. The underlying principles, however, are the same in both: the right to life, autonomy, dignity and utility. The IDF maintains high moral and ethical standards. This stems from the preciousness of human life in Jewish history, tradition and religious law. Emphasis is placed on these qualities within the Israeli education system; the IDF teaches and enforces moral and ethical standards in all of its training programmes and units. One such programme is 'Witnesses in Uniform' in which the IDF takes groups of officers to visit Holocaust memorial sites and Nazi death camps. During these visits daily discussions touch on intricate medical and military ethical issues, and contemporary ethical dilemmas relevant to IDF officers during active missions.
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Chaiter Y, Machluf Y, Pirogovsky A, Palma E, Yona A, Shohat T, Yitzak A, Tal O, Ash N. Quality control and quality assurance of medical committee performance in the Israel Defense Forces. Int J Health Care Qual Assur 2010; 23:507-15. [PMID: 20845680 DOI: 10.1108/09526861011050538] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE The paper aims to focus on a unique quality control system that was set up ten years ago to evaluate Medical Classification Committee decision-making processes at the Israel Defense Forces (IDF) conscription center. DESIGN/METHODOLOGY/APPROACH Two main approaches were deployed by the control system to assess medical classification committees' performance. The first was direct assessment of the medical committees' clinical work and decision-making processes. The second applied data mining procedures to the computerized medical databases. The functional classification codes (FCCs)--codes for the most common medical disorders assigned to male recruits from the central computerized central IDF database, the sub-districts comprising the recruitment centers, and the chairmen assigning the FCCs to recruits--were all analyzed. FINDINGS A total of 26 FCCs, each indicating a common medical problem and its severity, constituted approximately 90 percent of all FCCs assigned at recruitment centers between 2001 and 2006. Major contributors to medical profiling outcomes were underweight, asthma, chronic headache, mental illness, symptomatic scoliosis, hypnosis, chronic back pain, knee joint disorders, allergic rhinitis and sinusitis. Evaluating the computerized medical database revealed significant differences in: medical profile prevalence; recruitment center FCCs; different sub-districts in a given recruitment center; and profiling by medical committee chairmen. PRACTICAL IMPLICATIONS Findings indicate disparities between recruitment centers and their chairmen in the medical profiling process owing to variations in recruitment center working methods and medical history taking, physical examinations, interpreting medical information and individual differences in the chairmen's decision-making process. Other reasons include technician and laboratory staff inaccuracies. These significant discrepancies highlighted the need for an intervention program. To minimize variations and create a uniform work platform, an orderly instruction system and training programs for the committee chairmen, technicians and laboratory staff were established. These actions resulted in improved performance in 2007 as confirmed by a decreased variability in the assignment of medical FCCs. ORIGINALITY/VALUE The paper highlights methods that can be used to assess disability screening, sports medicine committees and primary care setting procedures.
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Affiliation(s)
- Yoram Chaiter
- Israel Defense Forces, Medical Corps, Quality Control Committee, Haifa.
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Balicer RD, Zarka S, Levine H, Klement E, Sela T, Porat N, Ash N, Dagan R. Control of Streptococcus pneumoniae serotype 5 epidemic of severe pneumonia among young army recruits by mass antibiotic treatment and vaccination. Vaccine 2010; 28:5591-6. [PMID: 20599301 PMCID: PMC7126119 DOI: 10.1016/j.vaccine.2010.06.031] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 06/08/2010] [Accepted: 06/08/2010] [Indexed: 11/19/2022]
Abstract
During an outbreak of severe pneumonia among new army recruits, an epidemiological investigation combined with repeated nasopharyngeal/oropharyngeal cultures from sick and healthy contacts subjects was conducted. Fifteen pneumonia cases and 19 influenza-like illness cases occurred among 596 recruits over a 4-week period in December 2005. Pneumonia attack rates reached up to 5.5%. A single pneumococcus serotype 5 clone was isolated from blood or sputum cultures in 4 patients and 30/124 (24.1%) contacts. Immunization with 23-valent polysaccharide vaccine supplemented with a 2-dose azithromycin mass treatment rapidly terminated the outbreak. Carriage rates dropped to <1%, 24 and 45 days after intervention.
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Kreiss Y, Merin O, Peleg K, Levy G, Vinker S, Sagi R, Abargel A, Bartal C, Lin G, Bar A, Bar-On E, Schwaber MJ, Ash N. Early disaster response in Haiti: the Israeli field hospital experience. Ann Intern Med 2010; 153:45-8. [PMID: 20442270 DOI: 10.7326/0003-4819-153-1-201007060-00253] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The earthquake that struck Haiti in January 2010 caused an estimated 230,000 deaths and injured approximately 250,000 people. The Israel Defense Forces Medical Corps Field Hospital was fully operational on site only 89 hours after the earthquake struck and was capable of providing sophisticated medical care. During the 10 days the hospital was operational, its staff treated 1111 patients, hospitalized 737 patients, and performed 244 operations on 203 patients. The field hospital also served as a referral center for medical teams from other countries that were deployed in the surrounding areas. The key factor that enabled rapid response during the early phase of the disaster from a distance of 6000 miles was a well-prepared and trained medical unit maintained on continuous alert. The prompt deployment of advanced-capability field hospitals is essential in disaster relief, especially in countries with minimal medical infrastructure. The changing medical requirements of people in an earthquake zone dictate that field hospitals be designed to operate with maximum flexibility and versatility regarding triage, staff positioning, treatment priorities, and hospitalization policies. Early coordination with local administrative bodies is indispensable.
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Affiliation(s)
- Yitshak Kreiss
- Israel Defense Forces Medical Corps Field Hospital, Home Front Command, and Israel Defense Forces Medical Corps Surgeon General, Jerusalem,
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Affiliation(s)
- Ofer Merin
- Trauma Unit and Department of Cardiothoracic Surgery, Shaare Zedek Medical Center, and Hebrew University Faculty of Medicine, Jerusalem, Israel
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Kreiss Y, Vinker S, Ash N. [The Israel Defense Forces medical corps field hospital in Haiti]. Harefuah 2010; 149:129-130. [PMID: 20684160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Shapira SC, Vinker S, Razin E, Ash N. [Military tract of medicine--the need and the vision]. Harefuah 2010; 149:89-124. [PMID: 20549925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Establishing the Military Tract in the Hebrew University School of Medicine is an opportunity to enrich the medical curriculum with contents relevant to better training of military physicians. Subjects such as hyperbaric medicine, hypobaric physiology, terror medicine, mass casualty event (MCE) and management of non-conventional injuries will be added to the regular M.D. curriculum. Medical education based on the elements of excellence: Judaism, Zionism, humanism and leadership, will be the foundations for the future generation of medical leaders in Israel for both the military and civilian systems. This leadership will be articulated in the clinical, research and administrative fields.
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Molina Hazan V, Balicer RD, Groto I, Zarka S, Ankol OE, Bar-Zeev Y, Levine H, Ash N. [The military role in a flu pandemic]. Harefuah 2010; 149:9-64. [PMID: 20422833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Pandemic influenza is a major challenge to emergency preparedness agencies and health systems throughout the world. It requires preparation for a situation of widespread morbidity due to flu and its complications which will lead to a huge burden on the health system in the community and in hospitals, and work absenteeism, also among health care personnel. This may require major involvement of the army in both preparedness and measures to be taken to tackle such an event. This article reviews the different roles armies could take in such a crisis, and presents the Israeli test case. Defense systems are characterized by a number of attributes that may be major advantages during pandemic influenza: crisis management capacities, ability to deal with varied tasks in sub-optimal conditions, logistic resources (fuel, food and water), widespread deployment in the country and sometimes in the world, and the ability to activate people in risky situations, even against their will. The army roles during pandemic outbreaks could include: taking national and regional command of the event, assigning workforce for essential civilian missions, use of logistic and military resources, maintaining public order and implementing public health measures such as isolation and quarantine. In addition, the army must continue its primary role of maintaining the security and guarding the borders of the state, especially in times of global geopolitical changes due to pandemic. Since March 2009, the influenza A/H1N1 2009 virus spread throughout the world, leading the WHO to declare a state of pandemic influenza. According to Israeli preparedness plans, the management of the event was supposed to pass to the defense system. However, due to the moderate severity of the illness, it was decided to leave the management of the event to the health system. In view of the necessity of maintaining military combat capabilities, and the possibility of outbreaks in combat units, which actually occurred, the Israel Defense Forces (IDF) policy for the pandemic was stricter than the policy of the Ministry of Health. Defense systems in Israel and the world should prepare, the sooner the better, for the possibility of a worse pandemic, in which the army may take a major role, especially since regular life in the country, in such a case, would be disturbed.
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Abstract
With the escalation of terrorism worldwide in recent years, situations arise in which the perpetration of violence and the defense of human rights come into conflict, creating serious ethical problems. The Geneva Convention provides guidelines for the medical treatment of enemy wounded and sick, as well as prisoners of war. However, there are no comparable provisions for the treatment of terrorists, who can be termed unlawful combatants or unprivileged belligerents. Two cases of severely injured terrorists are presented here to illustrate the dilemmas facing the medical staff that treated them. It is suggested that international legal and bioethical guidelines are required to define the role of the physician and auxiliary medical staff vis a vis injured terrorists. There are extreme situations where the perpetration of violence and the defense of human rights come into conflict, leading to serious ethical and psychological discord. Terrorists, using violence to create fear in order to further their political objectives, might require life-saving medical care if injured during the course of their terror activities.
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Sachs JD, Baillie JEM, Sutherland WJ, Armsworth PR, Ash N, Beddington J, Blackburn TM, Collen B, Gardiner B, Gaston KJ, Godfray HCJ, Green RE, Harvey PH, House B, Knapp S, Kumpel NF, Macdonald DW, Mace GM, Mallet J, Matthews A, May RM, Petchey O, Purvis A, Roe D, Safi K, Turner K, Walpole M, Watson R, Jones KE. Biodiversity Conservation and the Millennium Development Goals. Science 2009; 325:1502-3. [DOI: 10.1126/science.1175035] [Citation(s) in RCA: 188] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Abstract
Magnetic resonance imaging of the knee is greater than 90% accurate in detecting intraarticular disease when performed and interpreted by musculoskeletal magnetic resonance imaging specialists in specialized medical centers. However, independent imaging institutions often offer less expensive services to health insurers. We wondered if the magnetic resonance imaging performed in our community is of equivalent quality and accuracy. We studied a homogenous group of healthy, young, and fit military recruits to represent a cross section of our country's population. We analyzed all knee magnetic resonance images of soldiers who subsequently had primary arthroscopic knee surgery within a 3-month period from 1997-1998. The results were compared with surgical findings of four structures: medial meniscus, lateral meniscus, anterior cruciate ligament, and articular cartilage. Of the 1185 arthroscopies and 633 magnetic resonance images of the knee performed in 14 institutions, 139 paired magnetic resonance imaging arthroscopic reports met our inclusion criteria. The results showed a false positive rate of 65% for the medial meniscus, 43% for the lateral meniscus, 47.2% for the anterior cruciate ligament, and 41.7% for articular cartilage disease when compared with surgical findings. Accuracy rates were 52%, 82%, 80%, and 77%, respectively. Thirty-seven percent of the operations supported by a significant disorder on magnetic resonance imaging were unjustified. Our findings highlight the consequences that may occur when basing medical care on cost rather than quality of care.
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Affiliation(s)
- Peleg Ben-Galim
- Department of Orthopedic Surgery B, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
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Solomon I, Maharshak N, Chechik G, Leibovici L, Lubetsky A, Halkin H, Ezra D, Ash N. Applying an artificial neural network to warfarin maintenance dose prediction. Isr Med Assoc J 2004; 6:732-5. [PMID: 15609884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
BACKGROUND Oral anticoagulation with warfarin can lead to life-threatening events as a result of either over-anticoagulation or undertreatment. One of the main contributors to an undesirable warfarin effect is the need to adjust its daily dose for a specific patient. The dose is adjusted empirically based on the experience of the clinician, a method that is often imprecise. There is currently no other well-accepted method for predicting the maintenance dose of warfarin. OBJECTIVE To describe the application of an artificial neural network to the problem of warfarin maintenance dose prediction. METHODS We designed a neural network that predicts the maintenance dose of warfarin. Data on 148 patients attending a large anticoagulant clinic were collected by file review. Using correlational analysis of the patients' data we selected the best input variables. The network was trained by using the back-propagation algorithm on a subset of our data and the results were validated against the rest of the data. We used a multivariate linear regression to create a comparable model. RESULTS The neural network generated reasonable predictions of the maintenance dose (r = 0.823). The results of the linear regression model were similar (r = 0.800). CONCLUSION Neural networks can be applied successfully for warfarin maintenance dose prediction. The results are promising, but further investigation is needed.
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Affiliation(s)
- Idit Solomon
- Department of Ophthalmology, Rabin Medical Center, Petah Tiqva, Israel
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Mandel D, Zimlichman E, Ash N, Mimouni FB, Ezra Y, Kreiss Y. Quality assessment of primary health care in a military setting. Mil Med 2003; 168:890-2. [PMID: 14680043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
PURPOSE The aim of this study was to analyze the quality of primary care in Israeli Defense Forces primary care clinics and physicians (PCPs) and to test the hypotheses that: (1) the quality of primary care provided in battalions is higher than that provided by other primary care providers and (2) the evaluation of a specific PCP within the framework of the quality assessment program results in an improved score during a second evaluation. METHODS Teams of two physicians carried out the control process. Each primary care clinic is evaluated in a standardized manner by filling a prospectively established form. Five parameters are examined: (1) direct inspection of the PCP, (2) medical record audit, (3) high-risk patients' management evaluation, (4) evaluation of secondary health care characteristics, and (5) medical staff guidance evaluation. The various clinics and physicians evaluated were classified as: battalion clinics, division and brigade clinics, training center clinics, and home-front clinics. RESULTS Between the years 1999 and 2001, 149 primary care clinics and 250 PCPs were evaluated. Seventy-four PCPs (29.6%) were evaluated twice. Battalion clinics scored higher than the other clinics. PCPs evaluated twice had significantly better quality assessment results at the second encounter. CONCLUSIONS Quality of primary health care is the highest in battalion troops clinics. We interpret the increase in quality assessment scores from one examination to the other as an index of improvement resulting from the feedback given to the providers.
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Affiliation(s)
- Dror Mandel
- Medicine Branch, Medical Corps, IDF, Israel.
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