CHANGING EPIDEMIOLOGY OF INVASIVE STREPTOCOCCUS-PYOGENES INFECTIONS IN SOUTHERN ISRAEL - DIFFERENCES BETWEEN 2 ETHNIC-POPULATION GROUPS

Background. Two ethnic populations (westernized Jews and Bedouins in t ransition from semi-nomadic to sedentary life conditions) living in So uthern Israel and receiving inpatient services in the only medical fac ility of the region. Objective. To determine whether the incidence and severity of Streptococcus pyogenes infections among Jewish and Bedoui n children have changed over the years. Study design. Retrospective (1 980 to 1994), population-based. Medical charts of children younger tha n 15 years of age hospitalized with S. pyogenes bacteremia and/or seve re invasive infection were reviewed, Incidence rates of bacteremia amo ng Jewish and Bedouin children were calculated separately. Results. Th e incidence of S. pyogenes bacteremia was 2.82/100 000 between 1980 an d 1984, was 2.58/100 000 between 1985 and 1989 and rose significantly during 1990 through 1994 to 4.82/100 000 (P < 0.01), The observed incr ement was the result of a significant increase among the Jews, whereas the incidence among the Bedouin population remained relatively stable . Streptococcal toxic shock syndrome was diagnosed in three Jewish pat ients between 1992 and 1994. No predominance of any particular strepto coccal M-type was observed. Conclusions. The incidence of pediatric S. pyogenes bacteremia has increased in Southern Israel in recent years. This increase has occurred among the Jewish population, among which t he first cases of streptococcal toxic shock syndrome have recently occ urred. The increased incidence observed is not the result of dissemina tion of a single virulent streptococcal clone.