The state of Israel was certified by the World Health Organization (WHO) as a polio free country in 2002. During April 2013, a wild poliovirus type 1 was isolated from routine sewage sample in Rahat and Be’er-Sheva, two cities in the Southern Region of Israel [1]. At the end of May 2013, the central virology laboratory identified the pathogen as a non-Sabin poliovirus type 1, which was isolated previously in Pakistan and Egypt [2]. Most of the isolations came from children below 10 years living in Bedouin Arab communities characterized with high IPV immunization rate (90–۹۵%), but also with low socio-economic status and poor sanitation and overcrowded living conditions [3,4]. Not a single case of clinical polio infection was documented in Israel during the transmission period. The Israel Ministry of Health (MoH) responded to the polio transmission with several actions, including the initiation of supplemental immunization with bOPV (bivalent oral polio vaccine) and the launching of a nationwide bOPV campaign throughout mass media channels [5–۱۱]. By the end of the supplemental immunization activity, a coverage of 80–۹۰% was reached in the Southern District where the outbreak begun among the high risk pediatric population. The notion that media coverage can impact the public response during crisis was first described in the late 1950s [12]. This phenomenon can be attributed to the lack of information, atmosphere of risk and media tendency to focus on sensational stories which can alter health behaviour [13–۱۵]. For instance, statins use was recently shown to be associated with negative media coverage of drug’s potential adverse effects. [16,17]. The aim of this study was to investigate the association of media exposure and vaccines uptake during the 2013 polio silent outbreak in Southern Israel.

۲٫ Methods

۲٫۱٫ Clinical data sources

The study was approved by the Institutional Ethics Committee. The study population included all children under 10 years old (during 2013) in the Southern District of Israel who received at least one polio vaccine (any type) during the study period. We chose this group as they were the target population for the bOPV vaccination during the MoH supplemental immunization activity. We obtained data on immunization rates from the MoH. This included the number of daily bOPV vaccines given during the supplemental immunization activities (August to October 2013). Additionally, we collected data on routine immunizations to investigate a possible ‘‘spillover effect” of the polio exposure on the media to other routine scheduled vaccines, such as the diphtheria-tetanuspertussis-hemophilus influenza B-inactive polio (DTaP-Hib-IPV) vaccine, measles-mumps-rubella-varicella (MMRV), vaccine against pneumococcus bacteria (PCV) and against rotavirus (RVV) (June to October 2013). The latter period was chosen since after the supplemental immunization activities were initiated (August 2013), most of MoH resources were aimed at delivering bOPV even at the expense of the routine immunization plan. We retrieved demographic data from the Israeli MoH database including ethnicity of Jewish/non-Jewish communities and socio-economic status [18].