Israel Ministry of Health

Respiratory syncytial virus (RSV) is a major cause of morbidity and mortality among older adults. Limited information is available in Israel regarding RSV outcomes, particularly compared to influenza, to guide strategies for RSV vaccination. This study aimed to characterize RSV infection and predictors of clinical outcomes among hospitalized adults aged ≥ 60years in Israel between 2016 and 2023, and to compare disease severity and outcomes with those of seasonal influenza hospitalizations. A retrospective analysis was conducted of hospitalized adults aged ≥ 60years with positive RSV or influenza confirmed via standard-of-care RT-PCR between 2016 and 2023. The primary outcome was a composite of intensive care unit (ICU) admission, mechanical ventilation, vasopressor support, or 30-day mortality. Cardiovascular complications were recorded. An inverse probability treatment weighting (IPTW) was used to adjust for potential confounding. Weighted and unweighted relative risks (RRs) were estimated to compare clinical outcomes between RSV and influenza. Overall, 817 RSV-positive and 2113 influenza-positive patients were included. Among patients with RSV, 30-day and 90-day mortality rates were 11.9% and 18.8% respectively; ICU admission was required for 10.6%, mechanical ventilation for 6.4%, and vasopressor support for 6.5%. Tachyarrhythmia was documented in 17.7% and ischemia in 9.9%. Predictors of the composite primary outcome included chronic pulmonary disease, lower respiratory tract infection, hypothermia, elevated pulse, lower blood pressure and increased creatinine. In IPTW-adjusted analyses, RSV infection had a trend for increased risk for the composite primary outcome (RR 1.03, 95% confidence interval [CI] 1.00, 1.06) and 90-day mortality (RR 1.02, 95%CI 0.99, 1.05) compared with influenza. Among hospitalized older adults, RSV infection carries considerable morbidity and mortality and may have a higher risk for poor clinical outcomes compared with influenza. These findings support the prioritization of RSV vaccination programs among older adults.

How does collective performance-related pay influence street-level bureaucrats’ job performance in public service settings? What is the magnitude of this effect? How do such incentive systems ultimately impact clients’ outcomes? To address these questions in a natural work environment, we analyze a dataset of 35,635 elective surgical procedures conducted in 23 public hospitals in Israel during the 2018–2019 fiscal years, where performance-related pay is implemented at the collective, hospital-level rather than the individual level. Overall, the findings support our hypothesis that collective performance-related pay improves SLBs’ performance. For client outcomes (LOS), the evidence is heterogeneous: the pooled nonparametric comparison shows no robust difference, while the causal model detects a small average signal, and hospital-level patterns vary—suggesting context-dependent effects. By drawing on large-scale administrative data from an actual policy implementation, this study extends prior research that has largely focused on individual-based incentives in experimental or highly stylized settings and contributes to the street-level bureaucracy and performance management literature by empirically distinguishing between effects on frontline performance and effects on client outcomes.

Exposure to air pollution is considered the most significant environmental risk factor to human health. Updates in epidemiological studies in recent years provided the scientific evidence for the World Health Organization (WHO)’s air quality guidelines in 2021, allowing an update to the quantitative calculation of premature death (PD) from air pollution. This study examines the impact of air pollution on public health in Israel, focusing on PD and years of life lost (YLL) associated with exposure to PM2.5, nitrogen dioxide (NO2), and ozone (O3) and compares them to findings from 41 European countries. Applying the latest WHO air quality guidelines and incorporating census tract level demographic with age and gender separation, the study reveals the significant burden of air pollution in Israel. Between 2015 and 2023, a total of 4,461–6,166 PD per year are calculated from ambient exposure to the three pollutants, and the number of YLL ranges between 46,216 − 65,289 per year. PD and YLL are higher for males compared to females for most age groups except for 85 and over and infants under 1 year. An increase in PD and YLL is seen with age, except for infants under 1 year having the highest YLL. Israel experiences lower rates of PD and YLL compared to European nations with similar pollutant concentrations. This difference is largely attributed to Israel’s younger population. The findings underscore the importance of continued air quality improvements to protect public health in Israel.

The aim of this study was to investigate the association of gestational weight gain with carotid artery intima-media thickness (IMT) during late pregnancy, and the association with metabolic parameters, pregnancy outcome and placental histological assessment. Pregnant patients admitted with signs of labor were prospectively recruited and categorized into two groups: Group 1 included women with excessive weight gain during pregnancy; Group 2 included women with gestational weight gain within recommended range. IMT of the carotid arteries was measured sonographically. Placental histopathology was assessed by an experienced pathologist. The study group included 59 women, 32 in group 1 and 27 in group 2. Mean carotid artery IMT was thicker in group 1 compared with group 2 (0.7 vs. 0.6 mm, P=0.028). Metabolic parameters including blood glucose and insulin resistance, using the homeostasis model assessment-insulin resistance (HOMA-IR) were also significantly higher in women with excessive weight gain during pregnancy as compared with group 2 (P=0.026 and P=0.045, respectively). Gestational age at delivery was similar in the two groups, while birthweight and the rate of macrosomia were significantly higher in group 1 than in group 2 (P=0.033 and P=0.014, respectively). Placental lesions consistent with fetal thrombo-occlusive disease were more prevalent in group 1 than in group 2. Excessive weight gain during pregnancy is associated with increased IMT of the carotid arteries that correlate with abnormal metabolic parameters, adverse pregnancy outcome and abnormal placental findings.

Abstract SARS-CoV-2 mutations play a key role in viral evolution, in immune escape, and potentially in disease severity. However, the clinical impact of most mutations remains poorly understood, particularly across different variants. A historical observational study was conducted using SARS-CoV-2 whole-genome sequencing data linked to clinical metadata from 175,503 COVID-19 cases in Israel. The dataset was stratified into four variant-specific periods: B.1.1.7, B.1.617.2, BA.1, and BA.2. Logistic regression models were applied separately within each period to assess the association between individual mutations and the need for hospitalization, adjusting for age, gender, and time since vaccination. False discovery rate correction was used to account for multiple testing. A total of 18 SARS-CoV-2 mutations were significantly associated with COVID-19 severity, of which eight remained statistically significant after false discovery rate correction. Among these, two were associated with increased risk and six with reduced risk. Most were non-synonymous mutations located in functionally relevant regions such as the spike protein and non-structural proteins. This study provides a variant-stratified assessment of SARS-CoV-2 mutations associated with clinical severity, revealing both known and novel associations. The findings highlight the importance of integrating genomic and clinical data in public health surveillance and may inform future outbreak preparedness by identifying mutations with potential clinical impact.

Background/Objectives: Vaccination programs are highly effective public health interventions, yet parental hesitancy toward combination vaccines has led to growing demand for alternative vaccination schedules, defined in this study as parental requests to split or replace recommended combination vaccines with single-antigen vaccines for non-clinical reasons. While parental attitudes have been widely studied, little empirical evidence exists on the real-world use of single-antigen vaccines and their public health implications in countries with otherwise high coverage. This study examined the prevalence patterns and parental motivations for requesting such alternative vaccination schedules in Israel, where national guidelines recommend specific combination vaccines, including measles-mumps-rubella-varicella (MMRV) and the pentavalent diphtheria-tetanus-pertussis–inactivated polio–Haemophilus influenzae type b (DTaP+IPV+Hib) vaccines, but informal accommodations exist. Methods: A mixed-methods design was employed: a retrospective cohort analysis of vaccination data from 2018 to 2021 (before and during the COVID-19 pandemic) focused on measles (first dose at 12 months) and pertussis (four-dose primary series), followed by semi-structured interviews with Maternal and Child Health clinic providers, policymakers, and parents. Results: Alternative vaccination schedules involving single-antigen measles or pertussis vaccines are occasionally used despite official policy, accounting for less than 1% of vaccinations overall. Outcomes include delayed administration, lower uptake of combination vaccines, and incomplete protection in certain groups. Parents cited safety concerns, fear of immune overload, and mistrust of authorities. These concerns were often amplified by misinformation, while providers described balancing parental preferences with the need for adequate coverage. Conclusions: This study provides new evidence on how vaccine hesitancy translates into service utilization, highlights the tension between individualized parental decision-making and contribution to collective health, and underscores the need for communication, policy strategies and service designs that sustain high coverage while addressing community-specific concerns.