Israeli Adult Population Research Articles

Mental Health Outcomes of Arab and Jewish Populations in Israel a Month after the Mass Trauma Events of October 7, 2023: A Cross-Sectional Survey of a Representative Sample

On October 7, 2023, a war erupted in Israel following a mass terror attack including mass shootings, violent events, civilian abductions, and numerous fatalities, ranking as the third most deadliest terror attack. This cross-sectional, population-based study evaluated the impact on the mental health and utilization of mental health services in the Arab and Jewish populations. Conducted through a virtual platform, the study compared demographic factors, exposure to war-related events, anxiety, and post-traumatic stress symptoms among 517 participants in a representative sample of the adult population in Israel (79.1% Jewish, 20.9% Arab). Jews reported higher exposure to war-related events, but a majority expressed a lack of interest in mental help. In contrast, more Arabs desired mental help but faced barriers like stigma and scarce resources. Arabs showed a greater preference for group therapy and medical treatment. Trust in official bodies was consistently higher among Jews. Both populations exhibited similar levels (12-15.4%) of probable post-traumatic stress disorder (PTSD). This study equips clinicians, researchers and policymakers with real-time insights into improving mental health support for the culturally diverse needs of Jewish and Arab communities following exposure to mass trauma.

Aging With Grace: The Quest for Integrated, Compassionate Care for Older Adults.

This Practice Update discusses the potential for implementation of the 4M model for care of older adults in Israel, to complement the medical-centric model that exists today. The older adult population in Israel is increasing. However, efficient and sufficient care that takes patient's wishes into consideration is lacking. Care of older adults, particularly palliative patients, is complex and requires multidisciplinary efforts. There are numerous challenges to caring for older adults. These include fragmentation of care, unclear boundaries between palliative and geriatric care, and the preservation of patient autonomy, indicating a need to adopt new care frameworks. The authors suggest implementing the 4M model as a new care framework in addition to the current medical-centric model. This framework considers important care aspects during discussions of care: what matters to the patient, medication, mentation, and mobility. Implementation of this model can promote better-integrated care, thus improving the quality of life for older adults.

A retrospective cohort study, analyzing trends in management of upper urinary tract stones in the adult Israeli population.

To assess trends of surgical intervention in adults with upper urinary tract stones in Israel. A retrospective cohort study utilizing administrative databases held at Clalit Health Services, to identify all adults (⩾18 years) who underwent their first surgical treatment for upper tract urolithiasis. Descriptive statistics were employed to summarize baseline patient demographics and surgical trends were analyzed using the Cochrane-Armitage test for trend. Between 2003 and 2020, 36,624 adult patients were treated surgically for upper tract urinary stones. Mean age was 53.6 years (SD16.1). During the period investigated, the number of insured by Clalit Health Services increased by 25% and the total number of surgically treated stones increased by 98.7%. By type of procedure: Ureteroscopy (URS) increased by 351%, percutaneous nephrolithotripsy (PCNL) increased by 67%, shockwave lithotripsy (SWL) declined by 79%. The number of procedures per 100,000 population grew from to 37.5 in 2003 to 58.05 in 2022. The percentage increase in total number of surgical procedures was 103% and 90% in males and females, respectively. Our findings reveal significant increases in the total number of surgically treated stones over the investigated period. Notably, this increase far outpaced the growth in the number of individuals insured by Clalit Health Services. Further research and interventions are warranted to explore the underlying factors driving these trends and to develop targeted approaches for prevention, early detection, and minimally invasive treatment of upper urinary tract stones in Israel.

Public Conformism with Health Regulation is Crumbling as COVID-19 Becomes a Chronic Threat – A Cohort Study

Introduction:Three years into the COVID-19 pandemic, experience and studies have shown that public behavior significantly contributes to the disease spread increase or reduction. As the pandemic becomes a chronic threat, maintaining public trust to comply with health regulations proves challenging as people develop pandemic fatigue. This study aims to analyze the long-term trends in public attitudes toward the COVID-19 pandemic and compliance with health regulations.Method:A longitudinal cohort study was performed from February 2020 until January 2022, collecting data from nationally representative samples (N=2,568) of the adult population in Israel. Data Collection was timed with the first five morbidity waves of the COVID-19 pandemic. We examined public trust in Israeli health regulations, public panic, worry, and compliance with health regulations, particularly self-quarantine.Results:The data shows that public trust in health regulations in January 2022 is at an all-time low (25%) compared to the maximum value measured in March 2020 (~75%). The perceived worry from COVID-19 is steadily declining, whereas the perception of public panic is increasing as the pandemic progresses into a chronic threat. While public compliance with self-quarantine was reported to be close to 100% in the early stages of the pandemic, it has dropped to 38% in early 2022, mainly when compensation for lost wages is not offered. Regression analysis suggests that trust is a significant predictor of compliance with health regulations.Conclusion:The findings, spanning more than two years of the pandemic, highlight the importance of maintaining public trust as a significant driver of public compliance with health regulations. The "fifth wave" of the pandemic resulted in an all-time low in public trust. The Israeli public, usually highly compliant, shows signs of crumbling conformity. Decision-makers ought to consider means to foster public trust.

Outcomes of vaccinated versus unvaccinated COVID-19 patients in Israel during the Omicron and Delta waves—A retrospective cohort study

IntroductionInitiation of global vaccination significantly reduced the morbidity and mortality of COVID-19. During the Omicron wave, approximately 70% of the Israeli adult population was fully vaccinated, but the efficacy of the vaccine was questioned. MethodsWe conducted a retrospective cohort study of all adult patients admitted to the COVID-19 departments in Rabin Medical Center, during the Delta wave and the Omicron wave. Patients were matched in the 2 waves using the inverse probability of treatment weighting (IPTW) method and risk for mechanical ventilation and 30-day all-cause mortality was assessed. ResultsVaccination had a significant effect on 30-day mortality in the Delta and Omicron waves with adjusted OR of 0.35 (0.17–0.70) and 0.5 (0.27–0.95) respectively. Nonetheless, the rate of mechanical ventilation was similar between the groups with OR of 0.75 (0.52–1.09) and 0.64 (0.40–1.01). Vaccination status did not change the length of admission in both waves. ConclusionWe observed a decreased risk for 30-day mortality among vaccinated patients during the Delta and Omicron waves in Israel. This association, even though consistent, was of a lesser magnitude during the Omicron wave.

Characterization of Pterygomaxillary Suture Morphology: A CBCT Study

One of the most challenging procedures during maxillary osteotomy is pterygomaxillary suture (PMS) separation, due to the difficulty of directly inspecting this suture and the anatomical complexity of the adjacent structures. Knowing the precise anatomical dimensions and the position of the PMS, namely, the angle at which to approach this structure, may help in determining the proper osteotome. It will also help the oral and maxillofacial surgeon to perform this sensitive procedure more precisely and to minimize surgical complications (e.g., internal maxillary artery injury and unfavorable fracture during separation). The current study aimed to evaluate the morphology of PMS in an adult Israeli population using CBCT scans of the maxilla. Fifty CBCTs of healthy males (n = 27) and females (n = 23) were collected and analyzed. The vertical height, maximal thickness, and angulation of the PMS relative to the midsagittal plane of the skull were evaluated on both the right and left sides of the patient. An independent samples t-test was carried out to determine PMS morphological differences between males and females. A related samples t-test was conducted to determine the PMS morphological differences between the right and left sides. No significant differences in PMS parameters were found between sides in males and females (p > 0.225). Both males and females exhibited similar height and angulation of the PMS (p > 0.486). Interestingly, the PMS thickness was statistically greater in males (p = 0.029); however, this difference was clinically insignificant. The mean dimensions of the PMS in a healthy Israeli adult population are presented and discussed, as well as the clinical and methodological implications.

Public conformism with health regulation is crumbling as COVID-19 becomes a chronic threat: Repeated Cross-sectional Studies

BackgroundThe purpose of this study is to analyze the long terms trends in public attitudes toward the COVID-19 pandemic and compliance with self-quarantine regulations.MethodsRepeated cross-sectional studies looking into data collected from nationally representative samples (N = 2568) of the adult population in Israel at five points in time representing the five morbidity waves of the COVID-19 pandemic. This study examined public trust in Israeli health regulations, levels of public panic, feelings of personal worry, and compliance with health regulations, specifically self-quarantine.ResultsPublic trust in health regulations in January 2022 is at an all-time low (25%) compared to the maximum value of nearly 75% measured in March 2020. While reported worry is steadily reducing, the perception of public panic is increasing. In earlier rounds, public compliance with self-quarantine was reported close to 100%; however, it has dropped to 38% by January 2022 when compensation is not assumed. Regression analysis suggests that trust is a major predictor of compliance with health regulations.ConclusionsThe “fifth wave” of the COVID-19 pandemic brought about an all-time low in public trust in health regulations. The Israeli public, normally a highly compliant one, is showing signs of crumbling conformity.

739. The High Burden of Bloodstream Infection in Adults: A Nation-Wide Population- Based Study

Abstract Background Limited data exist on the long-term consequences of bloodstream infections (BSI). We examined incidence, 1-year mortality, and years of potential life lost (YPLL) following BSI by eight sentinel bacteria in adults. We also estimated the relative contribution of hospital-onset BSI (HO-BSI) and of antibiotic-resistant BSI to the burden of BSI. Methods We used data from Israel's national BSI surveillance system (covering E. coli, K. pneumoniae, P. aeruginosa, A. baumannii, S. pneumoniae, S. aureus, E. faecalis and E. faecium, comprising 70% of all BSI) and the national death registry. Adults with BSI between 1/1/2018 and 31/12/2019 were included. The outcomes were all-cause 30-day and 1-year mortality. We constructed Kaplan-Meier curves and used the log-rank test to compare survival between age groups. We calculated the age-standardized mortality rate and YPLL using the Global Burden of Disease reference population and life expectancy tables. Results A total of 25,376 BSI occurred over 2 years in the adult Israeli population (mean adult population: 6,068,580). Drug-resistant BSI comprised 32% of all events (41.1% of HO-BSI). The annual BSI incidence was 209 per 100,000 population. The case fatality rate (CFR) was 25.6% at 30 days and 46.4% at 1 year. The 1-year CFR was higher among males than females (RR=1.17, 95% CI 1.14–1.20) and it increased with age (OR=1.37 per decade, 95% CI 1.36–1.39). In all age groups survival continued to decline up to 1 year (Figure). For the outcome of 1-year mortality, the annual age-standardized mortality rate and YPLL per 100,000 population following BSI were 48.6 and 1002.2, respectively. For comparison, the global mortality rate and YPLL from ischemic stroke are 36.6 and 521.8 per 100,000, respectively. HO-BSI represented 27.4% of BSI but contributed to 33.9% of deaths and 39.9% of YPLL. HO-BSI by drug-resistant bacteria represented 11.3% of BSI, 14.8% of deaths, and 17.4% of YPLL. Conclusion BSI have grave long-term consequences: nearly 50% of affected adult patients died within 1 year. The burden of BSI is higher than that of ischemic stroke. HO-BSI and drug-resistant BSI contribute disproportionately to BSI mortality and YPLL. Attention and resources should be directed to prevention of BSI, as well as to advances in early diagnosis and better treatment. Disclosures Yehuda Carmeli, MD, Allecra Therapeutics: Advisor/Consultant|MSD: Advisor/Consultant|Nabriva: Advisor/Consultant|Pfizer: Advisor/Consultant|Qpex Pharmaceuticals: Advisor/Consultant|Roche: Advisor/Consultant|Shinogi: Advisor/Consultant|Spero Therapeutics: Advisor/Consultant.

Allergenic food protein consumption is associated with systemic IgG antibody responses in non-allergic individuals

Although food-directed immunoglobulin E (IgE) has been studied in the context of allergies, the prevalence and magnitude of IgG responses against dietary antigens are incompletely characterized in the general population. Here, we measured IgG binding against food and environmental antigens obtained from allergen databases and the immune epitope database (IEDB), represented in a phage displayed library of 58,233 peptides. By profiling blood samples of a large cohort representing the average adult Israeli population (n= 1,003), we showed that many food antigens elicited systemic IgG in up to 50% of individuals. Dietary intake of specific food protein correlated with antibody binding, suggesting that diet can shape the IgG epitope repertoire. Our work documents abundant systemic IgG responses against food antigens and provides a reference map of the exact immunogenic epitopes on a population scale, laying the foundation to unravel the role of food- and environmental antigen-directed antibody binding in disease contexts.

Relationship between adjustment disorder symptoms and probable diagnosis before and after second lockdown in Israel: longitudinal symptom network analysis.

There is cumulative evidence of the importance of exploring the change of dynamics between symptoms over time as reflective of consolidation of psychopathology. To explore the interactions between symptoms of ICD-11 adjustment disorder before and after the second lockdown of the COVID-19 pandemic in Israel and identify the most central symptoms and their concurrent and prospective associations with probable adjustment disorder. This is a population-based study drawn from a probability-based internet panel. A representative sample of the adult Israeli population was assessed at two time points (T1, pre-second lockdown, n = 1029, response rate 76.17%; T2, post-second lockdown, n = 764, response rate 74.24%). Symptoms of adjustment disorder were assessed by the International Adjustment Disorder Questionnaire (IADQ). Although the overall strength of associations at the two measurement points was similar and two same communities were found, there was a significant change in their structure, with a more consolidated network at T2. The most central item was 'difficult to relax' in both networks. Cross-sectionally, all symptoms of failure to adapt significantly predicted adjustment disorder. 'Worry a lot more' (preoccupation) and 'difficult to adapt to life' (failure to adapt) at T1 significantly predicted this diagnosis at T2. Adjustment disorder symptoms consolidated during the second lockdown of the pandemic. In line with the ICD-11 conceptualisation of adjustment disorder, both preoccupation and failure-to-adapt symptoms have prognostic validity. This highlights the importance of identifying and targeting adjustment disorder symptoms during a period of stress such as the COVID-19 pandemic.

The Prevalence of Chronic Pain in the Adult Population in Israel: An Internet-Based Survey.

Background Chronic pain (CP) prevalence in different studies has been inconsistent, ranging from 12% in Spain to 42% in the UK. Purpose We conducted an internet-based survey in a representative cohort of Israeli adults assembled by a large professional survey company in order to probe the prevalence of CP in Israel. Methods 8,300 Israeli adults comprising a representative cohort of the Israeli population were asked whether they were suffering from pain lasting over 3 months. 1647 participants responded (19.8% response rate). Of these, 515 (31.3%) had CP. Participants with CP were then asked a series of follow-up questions regarding their chronic pain. Statistical weights were used to correct for the distribution of the Israeli population based on sociodemographic characteristics. Results CP patients were significantly older than respondents without pain. The average daily pain was 5.8/10 on a numerical rating scale. Common pain locations were axial skeleton and headaches. However, over half of patients reported pain in multiple body areas, and around a fifth had an undiagnosed chronic pain syndrome. Around 40% of pain patients reported to have visited a specialized pain clinic, and the same proportion has consulted several specialists. Despite this, a sizable proportion of high pain intensity patients were still left with no or inefficient treatment to alleviate their pain. Conclusions This is the first internet survey conducted in Israel to estimate the incidence of CP, and the high CP prevalence documented is in agreement with previous reports from Europe and the USA. It also reaffirms the widespread existence of multifocal or widespread pain in clinical chronic pain and the correlation between pain intensity, impact on patients' quality of life and disability, and pain intractability. These data reaffirm the similarly major health burden CP presents across different countries and cultures.

Lockdown Efficacy in Controlling the Spread of COVID-19 May Be Waning Due to Decline in Public Compliance, Especially among Unvaccinated Individuals: A Cross-Sectional Study in Israel.

Public compliance is paramount for the success of public health measures and decision making, such as lockdowns, in controlling the spread of diseases. The aim of this population-based cross-sectional study was to investigate the level of reported compliance with home isolation among the adult Israeli population (n = 940) during the first three national lockdowns, compliance with a potential fourth national lockdown if enacted, risk perception of COVID-19, vaccination uptake status, perceived effectiveness of the vaccine, and compliance with additional protective health behaviors (e.g., mask wearing and social distancing). Following widespread compliance with initial lockdowns (90.7% reported “high” or “very high” compliance), as few as 60.1% of participants indicated that they would comply with a fourth lockdown if the government decides to enact it. Non-vaccinated individuals reported the lowest levels of compliance with previous lockdowns, compared to participants who received one or two vaccines and participants vaccinated with three doses. Adjusted for gender and age, the results suggest that fearing being infected with COVID-19, perceiving the vaccine to be effective, and reporting being compliant with other health behaviors—such as mask wearing and maintaining social distance from others—are predictors of lockdown compliance. Considering the effect of pandemic lockdown fatigue, there is little support for additional lockdowns among the Israeli public, unless dramatic changes occur in the characteristics of the COVID-19 pandemic. Compliance with lockdowns is reduced among individuals who are at higher risk of contracting COVID-19, therefore rendering this non-pharmaceutical intervention even less effective in reducing the spread of the disease.

Measurement of mathematics anxiety in an Israeli adult population

Maths anxiety is common and refers to feelings of anxiety, fear and other negative emotions and thoughts in individuals when confronted with mathematical tasks or numerical information. Self-report measures of maths anxiety have been created, but the majority are in English and are not culturally relevant to all countries. This study aimed to translate and validate existing measures for future use in Hebrew-speaking adult populations. The Mathematics Anxiety Scale – UK (MAS-UK) was translated to Hebrew and adult participants completed it alongside the Mathematics Anxiety Rating Scale – Revised (MARS-R) and a general anxiety measure. Factor structures were explored for both the translated MAS-UK and a Hebrew version of the MARS-R, as well as being checked for reliability and convergent and discriminant validity. Results from a final sample of 213 participants, indicated the shortened, Hebrew version of the MAS-UK and the MARS-R are internally consistent and suitable for use in future maths anxiety research in adult Israeli populations. Findings regarding sex differences in maths anxiety are also discussed.

The Effects of COVID-19 on Wellbeing: Evidence from Israel

Many aspects of wellbeing have been studied in the context of the COVID-19 pandemic. However, studies that measure a comprehensive, multi-faceted conceptualization of wellbeing are rare. Using a broad conceptualization of wellbeing, based on the Organisation for Economic Co-operation and Development (OECD) wellbeing indicators and a theoretical model of wellbeing developed previously, this study empirically assesses the wellbeing effects of COVID-19 in Israel. A representative sample of the adult population in Israel was surveyed and structural equation modeling (SEM) was used to analyze the impacts of the pandemic on a number of wellbeing indicators. Relationships among indicators were also analyzed. The study’s findings highlight the importance of social interactions, economics, mental health, and leisure on wellbeing. The study can be used by policymakers to fully understand the impact of various COVID-19 response policies on the wellbeing of the population.

Physicians' Perspective on Vaccine-Hesitancy at the Beginning of Israel's COVID-19 Vaccination Campaign and Public's Perceptions of Physicians' Knowledge When Recommending the Vaccine to Their Patients: A Cross-Sectional Study.

Because public healthcare workers (HCWs) are at the forefront of the battle against COVID-19, they must be able to provide vaccination information to their patients and respond to their anxieties and concerns. This research objectives were to (1) examine physicians' perceptions of how they received information about the Pfizer COVID-19 vaccine, their attitudes toward hesitant colleagues, and their own knowledge and self-efficacy in communicating information to their patients, and (2) to examine the public's perceptions of physicians' knowledge when recommending the COVID-19 vaccine to their patients. At the beginning of the vaccination campaign, a survey examined the attitudes of physicians in the Israeli public healthcare system (n = 295) regarding the Pfizer vaccine. In addition, the attitudes of a representative sample (n = 500) of the Israeli adult population (age 18+) were examined through interviews. Most of the participating physicians (81%) reported they had already been vaccinated or intended to be vaccinated. When asked about their reasons for vaccine hesitancy, 27% cited concerns about long-term side effects and doubts about the vaccine's effectiveness in preventing contagion. They cited system pressure and departmental norms as explanations for their eventual compliance. Moreover, they saw the system as less tolerant of hesitant physicians, while they themselves tend to be more tolerant. The results of the survey of the public showed that mostly young people (under 44) who tend to be critical believe that physicians do not have sufficient knowledge to make recommendations about the COVID-19 vaccine. The findings indicate that the health system should employ complete transparency in conveying the advantages and disadvantages of the COVID-19 vaccine to physicians. The system should be more tolerant of physicians' worries and concerns and grant legitimacy to their reservations and misgivings. Moreover, medical studies should reinforce physicians' immunological knowledge regarding vaccinations so they can help their patients make informed decisions.

Psychometric Properties of the Hebrew Modified Dental Anxiety Scale in Adult Israeli Population.

Dental anxiety results in the neglect of oral hygiene and poor oral health, requiring an accurate screening tool for dental practitioners to evaluate dental anxiety. The Modified Dental Anxiety Scale (MDAS) is frequently used cross-culturally. The present study aimed to assess the reliability and validity of the Hebrew version of the MDSA. A total of 553 (mean age 35.87 years, SD = 13.14) Israeli participants were recruited through means of social media, mailing lists, and forums. The sample was randomly divided into two population sets. Dental anxiety was evaluated using the Hebrew version of the MDAS. The psychometric evaluation consisted of exploratory factor analysis (study 1, n = 274) and confirmatory factor analysis (study 2, n = 279). Cronbach’s alpha coefficient was used to assess internal consistency. Results showed high internal consistency (0.93) for the Hebrew version of the MDAS. Confirmatory factor analysis showed a single factor solution. Findings demonstrated 13.4% of Israeli participants with dental anxiety. Younger participants, females, participants with lower education, lower income, and more religious participants reported higher dental anxiety. In conclusion, the Hebrew version of the MDAS demonstrated high reliability and validity. It is recommended to use the Hebrew version of the MDAS to evaluate dental anxiety in Israeli dental settings.

Investigating the Influence of Vaccine Literacy, Vaccine Perception and Vaccine Hesitancy on Israeli Parents' Acceptance of the COVID-19 Vaccine for Their Children: A Cross-Sectional Study.

Vaccination is currently the most effective strategy for combating COVID-19. COVID-19 vaccines were introduced to the adult population in Israel in early December 2020 and have been available for children aged 12–15 since June 2021. Our study aimed at assessing the influence of vaccine literacy, perception, hesitancy, and behavior on Israeli parents’ intentions to have their children vaccinated. Using an anonymous online questionnaire, we recruited 520 parents; 70.4% of the parents indicated that they would get their children vaccinated. The participants’ COVID-19 vaccination status was the only socio-demographic factor significantly associated with COVID-19 vaccination acceptability (OR = 32.89; 95%CI = [13.11, 82.54]). The most common sources of information regarding the COVID-19 vaccine were health-care providers and the Internet. Parents who intend to vaccinate their children had higher mean levels of vaccine literacy (2.99 ± 0.47 vs. 3.07 ± 0.44 respectively, p = 0.06), more positive perception of the vaccine (mean scores of 2.26 ± 0.75 vs. 3.44 ± 0.68 respectively, p < 0.001), and lower perceived vaccine hesitancy (7.53 ± 2.37 vs. 4.68 ± 2.71 respectively, p < 0.001) than parents who do not intend to do so. Vaccine behavior was measured using the 5C model of psychological antecedents. All 5C components were significantly correlated with parents’ willingness to vaccinate their children. Understanding of parents’ willingness to have their children receive the COVID-19 vaccine and the barriers to and facilitators of the vaccination is crucial, as vaccination of children aged 5–11 has recently been approved by the FDA. Providing the population with reliable information regarding the COVID-19 vaccine is an important measure in the attempt to increase COVID-19 vaccine acceptance.

Perceived social support in the social distancing era: the association between circles of potential support and COVID-19 reactive psychopathology

ABSTRACT Background and Objectives Stressors related to the COVID-19 pandemic are risk factors for psychopathology, but psychosocial protective factors might play a crucial role in buffering the pathogenic effects of the outbreak. Design In the current study, we examined the association of inner resources and potential external sources of support for coping with the pandemic and related lockdowns to mental health during the pandemic, while controlling for sociodemographic variables as covariates. Methods We tested the model in a probability-based internet survey of a representative sample of the Israeli adult population (N = 812) conducted during the COVID-19 pandemic. Results Perceived support in close relationships was negatively associated with the intensity of depression, anxiety, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). Larger rings of potential support such as perceived belongingness to a community and trust in government were also negatively related to anxiety and depression but were positively associated with the intensity of OCD and PTSD. Conclusions Findings support the “tend and befriend” theory in the social distancing era and highlight the importance of keeping personal relationships alive when facing a mass trauma.

A Serological Snapshot of COVID-19 Initial Stages in Israel by a 6-Plex Antigen Array.

ABSTRACTThe first case of SARS-CoV-2 was discovered in Israel in late February 2020. Three major outbreaks followed, resulting in over 800,000 cases and over 6,000 deaths by April 2021. Our aim was characterization of a serological snapshot of Israeli patients and healthy adults in the early months of the COVID-19 pandemic. Sera from 55 symptomatic COVID-19 patients and 146 healthy subjects (early-pandemic, reverse transcription-quantitative PCR [qRT-PCR]-negative), collected in Israel between March and April 2020, were screened for SARS-CoV-2-specific IgG, IgM, and IgA antibodies, using a 6-plex antigen microarray presenting the whole inactivated virus and five viral antigens: a stabilized version of the spike ectodomain (S2P), spike subunit 1 (S1), receptor-binding-domain (RBD), N-terminal-domain (NTD), and nucleocapsid (NC). COVID-19 patients, 4 to 40 days post symptom onset, presented specific IgG to all of the viral antigens (6/6) in 54 of the 55 samples (98% sensitivity). Specific IgM and IgA antibodies for all six antigens were detected in only 10% (5/55) and 4% (2/55) of the patients, respectively, suggesting that specific IgG is a superior serological marker for COVID-19. None of the qRT-PCR-negative sera reacted with all six viral antigens (100% specificity), and 48% (70/146) were negative throughout the panel. Our findings confirm a low seroprevalence of anti-SARS-CoV-2 antibodies in the Israeli adult population prior to the COVID-19 outbreak. We further suggest that the presence of low-level cross-reacting antibodies in naive individuals calls for a combined, multiantigen analysis for accurate discrimination between naive and exposed individuals.IMPORTANCE A 6-plex protein array presenting the whole inactivated virus and five nucleocapsid and spike-derived SARS-CoV-2 antigens was used to generate a serological snapshot of SARS-CoV-2 seroprevalence and seroconversion in Israel in the early months of the pandemic. Our findings confirm a very low seroprevalence of anti-SARS-CoV-2 antibodies in the Israeli adult population. We further propose that the presence of low-level nonspecific antibodies in naive individuals calls for a combined, multiantigen analysis for accurate discrimination between naive and exposed individuals enabling accurate determination of seroconversion. The developed assay is currently applied to evaluate immune responses to the Israeli vaccine during human phase I/II trials.

Association between mental health trajectories and somatic symptoms following a second lockdown in Israel: a longitudinal study

ObjectivesTo identify mental health prospective trajectories before and after a second lockdown during the COVID-19 pandemic and their associations with somatic symptoms.DesignProspective Study.SettingPopulation-based study drawn from a probability-based internet panel...