Reemergence of Human Brucellosis in Israel

Background: The epidemiology of human brucellosis (HB) continues to evolve. Objectives: To describe the current epidemiology of HB in Israel in general and in the population at risk. Methods: We calculated the incidence of HB in Israel for the period 2009-2015, overall and for the Arab population. Data are based on mandatory reporting of HB in Israel, defined clinically with either laboratory confirmation or epidemiological linkage to a laboratory -confirmed case. We mapped the geographic distribution of HB throughout the study period according to localities. We specified localities with high incidence (>= 10 per 100,000 population) and mapped the distribution of dense localities with time. Results: The incidence of HB in the general population in Israel increased sharply from 1.9 per 100,000 in 2009 to a peak of 7.3 per 100,000 in 2014. Each year, 95-100% of cases occurred among Arabs, thus the incidence in the Arab population increased from 10 per 100,000 in 2009 to 33.5 per 100,000 in 2014. Throughout this period 133 different localities reported at least one case of HB, and of these 20 were high-incidence localities during one year at least. During the period 2009-2013 the number of affected localities ranged from 35 to 44 per year and the disease was local, while in 2014 there were 82 localities distributed across the country. Conclusions: We demonstrate the importance of analyzing incidence in the population at risk for a disease. HB is an urgent public health issue in the Arab population in Israel, mandating an immediate and long-term eradication and control program.