Infective hepatitis among civilians in Palestine
Authors: Olitzki L. , Bachi R. , Kallner G. 
Published: May 2009

A study has been made of the epidemic and endemic aspects of infective hepatitis as it affects the civilian population of Palestine. Since the data analysed pertain primarily to Jews who have migrated to the country during the last 25 years, the results must be interpreted in terms of this group, although available data for other segments of the population are presented. The analysis was based on (a) records of persons who were members of the Sick Fund of the General Federation of Jewish Labour (W.S.F.) and the Rural Sick Benefit Fund (R.S.B.F.), (b) records of infants and children under the supervision of the Hadassah Medical Organization (H.M.O.) and the Tel-Aviv municipality, (c) records of persons admitted to H.M.O. hospitals over a 20-year period, and (d) records of the Government Department of Statistics for 1944.

Sick-fund records and those of supervised children afford reasonably reliable incidence rates for these groups in various parts of the country. Hospital records, however, which have been the only source of information regarding other aspects of the disease are affected to an unknown extent by various factors which determine the selection of persons who apply for hospital care. The analysis has brought out the following points:

1. Incidence of infective hepatitis has been estimated at 100 per 10,000 of the people of Palestine. About 2 per 10,000 Jews in the population were hospitalized with the disease. Incidence was significantly greater in rural districts.

2. Incidence rose to epidemic proportions during the years 1941–4 in the various administrative subdistricts inhabited largely by Jews. On the coastal plain the epidemic reached its peak in 1942, but in the interior incidence was highest in 1943. Rates declined in 1944.

3. Fatality was generally low, but the disease may pursue a severe and even fatal course among children and pregnant women.

4. The monthly distribution of hepatitis cases varied somewhat with age and district. In general monthly indices reached their peak in December and January and dropped to a minimum in May, but among young children a subsidiary peak appeared in July and August.

5. Among native Palestinians 50% of the hospitalized patients were under 5 years of age, whereas among those born elsewhere, whether in Europe, the Mediterranean basin or the Near East, some 60% were between 15 and 29 years of age.

6. Males and females born in Palestine were equally affected, but there were more immigrant males than females in the hospitalized group of cases. Unmarried persons evidently acquired the disease sooner after their arrival than did those that were married.

In conclusion it may be said that the information derived from the hospital records suggests that the disease is endemic in Palestine and is usually acquired in childhood. Immigrants from non-endemic regions are likely to become infected soon after their arrival. The monthly distribution of infective hepatitis cases resembles that of the respiratory diseases, but the secondary rise among children in July and August suggests that flies and food contamination may play a part in transmission.