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This paper examines the concept and scope of surveillance in relation to health and disease with special reference to infectious disease in Israel. The methodology of surveillance is reviewed with particular consideration of legal notification. The need for selectivity in relation to notification of infectious disease is outlined and the Canadian approach set out. A brief account is given of infectious disease patterns in Israel and of how this is reflected in notification obligations. A review is strongly suggested. The need to restate the importance of infectious disease control is emphasized, as is that of cooperation with those engaged in surveillance in other fields.

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Shifts in population and employment patterns in Israel since 1948 have been accompanied by profound changes in the distribution of echinococcal disease. Formerly, it was most commonly imported with the mass immigration of Jews after 1948 from the Arab countries of North Africa and Asia Minor, and appeared to be relatively uncommon in Israel-born Jews and Arabs. In 1980 the disease was made notifiable, and this paper presents a review of the years 1981-1989. The prevalence pattern that prevailed after the end of mass immigration has reversed so that cases are now twice as common in Arabs as in Jews. Among the Arabs the disease appears most commonly in the north of the country, especially among the Druze, less commonly among Christians and least in Muslims. We suggest that this prevalence pattern is related largely to home slaughter of sheep, to differing attitudes to dogs, and possibly also to the hunting of wild pig. Targetted education and better enforcement of existing regulations can lead to a reduction in disease.

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An outbreak of 15 cases of paralytic poliomyelitis caused by type 1 poliovirus between July and October, 1988, prompted mass vaccination of the whole Israeli population under the age of 40 years. The focus of the outbreak (12 cases) was the Hadera subdistrict, one of two subdistricts where enhanced inactivated poliovaccine (eIPV) had been the only poliovaccine used for infants since 1982. 9 of the 15 victims were 15 years or older, and 9 had previously been immunised with at least three doses of oral poliovaccine (OPV). The authors are divided in their interpretation of the findings. One group considered that the likely causative factors were the greater susceptibility of young adults previously vaccinated with OPV as well as transmission of wild poliovirus to susceptible people by children with low gut immunity against poliovirus after vaccination with eIPV; they concluded that a vaccination programme combining eIPV with OPV is the best option for Israel in future. The other group believed the causative factors were exposure to contaminated sewage or close social contact within the epidemic foci, the presence of an epidemic strain differing from the wild Mahoney and Sabin type 1 vaccine strains, and the lower seropositivity rates and geometric mean titres of neutralising antibodies to the epidemic than to vaccine strains; they believe that eIPV is the means to achieve effective control of poliomyelitis in Israel.

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BACKGROUND: Q fever was first described over fifty years ago. While in a proportion of cases there is a clear etiologic link to farm animals, their products, and fomites, in the majority of cases no such association is apparent, and the mode of infection is a mystery. METHODS: In this paper, we examine the reported incidence of Q fever in Israel since it was made notifiable in 1951, and in particular for the period 1981-1985, when special surveillance at national reference laboratories was carried out. RESULTS: Age and sex as well as urban-rural distributions suggest the influence of occupation, but in the large majority of cases mode of transmission was unknown. CONCLUSIONS: If our knowledge concerning the etiology of Q fever in Israel, and the means of preventing it, is to be advanced, each case should be investigated assiduously to uncover risk factors for exposure, and sero-epidemiologic studies carried out to identify geographic or occupational groups differentially infected.

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INTRODUCTION AND METHODS. In Israel, as in most economically developed countries, rheumatic fever has become uncommon, although cases continue to be reported each year, particularly in the Arab population. In this observational survey, based on cases notified to, and investigated by, the Ministry of Health, we review the epidemiology of acute rheumatic fever in Israel in the decade 1981-90. RESULTS AND RECOMMENDATIONS. Where it persists in Israel, acute rheumatic fever remains commoner in non-Jews than in Jews and in males rather than in females, in children aged 5-14, and in children from relatively overcrowded and deprived homes. Despite the steady decline in rheumatic fever incidence in the past decade, its continued occurrence in Israel, and reports of outbreaks of acute rheumatic fever and virulent streptococcal infection in North America and Europe, demand that clinicians continue to treat streptococcal sore throats with full curative antibiotic doses, that confirmed cases receive extended chemoprophylaxis, and that surveillance and notification of acute rheumatic fever be continued.

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In 1968 Illsley and Gill examined the rise in illegitimacy in the decade 1955-65 and showed that this rise, unlike rises in the first and second world wars, had not been accompanied by a fall in prenuptial conceptions but by a rise. Statistics from 1970 to 1975 have been examined and a third parameter, legal abortion, added. After a period characterised by an apparent rise in the total of extramarital conceptions there has since 1972 been a decline; and in the age group 20-24 this fall dates from 1971. Improved contraceptive practice is probably the reason.

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