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Invasive meningococcal disease (IMD) is one of the leading causes of bacterial meningitis and septicemia in Israel. The purpose of the study was to describe the IMD in the Tel Aviv District and to identify specific populations who could benefit from vaccine introduction. In the Tel Aviv District, the incidence rates ranged from 0.4 to 1.4 cases per 100,000 population per year during 2007–2017. During the study period, seventy-nine patients (65%) occurred among children younger than four years of age. Eight deaths occurred (7%), most of them among children under the age of 1 year (5 deaths; 15%). A serogroup was identified in 82 isolates. Most of the isolates (69 cases − 84%) belonged to serogroup B (NmB). IMD clustered geographically in the city of Bnei Brak, with a predominantly Ultra-Orthodox Jewish population. It is the youngest and most densely populated city in the district. The overall incidence rates of IMD among children in Bnei Brak were more than seven times higher in children up to nine years, compared to the rest of the district. Specifically for NmB, disease rates were 9.08 times higher in children up to the age of four, and 7.74 times higher in children from five to nine years old in Bnei Brak, compared to the rest of the district. Our findings describe the burden of a vaccine-preventable disease and reinforce the need for routine 4CmenB introduction, especially in groups where the disease clusters.

Background and aims: Neisseria meningitidis (N. meningitidis) is a Gram-negative bacterium that can cause life-threatening invasive infections referred to as invasive meningococcal disease (IMD). In the last decade the incidence of IMD in Israel is about 1/100,000 population annually. We aimed to describe the epidemiology of IMD in Israel combining epidemiological data and characterization of N. meningitidis isolates. Methods: Invasive infection caused by N. meningitidis is a notifiable disease in Israel. Data were collected by epidemiological investigations and control measures were employed. Laboratory work-up included serogrouping, N. meningitides molecular characterization and whole-genome sequencing. Results: During 1998–2017, 1349 cases of IMD were notified in Israel (mean annual incidence rate 0.94/100,000). The peak incidence rates were observed in infants under 1 year of age (10.9/100,000). Case fatality rate was 9.7%. The majority of the N. meningitidis isolates were of serogroup B (67.9%). During 2007–2017, three clonal complexes (CC) 32, 41/44 and 23 (hyper-invasive clonal complexes) were the leading CC (61%). CC32 was the leading CC causing meningococcemia and mortality. In 2017, 35 isolates were tested for 4CMenB antigens variants; of the serogroup B isolates tested 46.7% showed a match to one or more antigens (fHbp or PorA:VR1), most were ST32 (CC32). Conclusions: Preliminary analysis based on limited number of samples suggests that the 4CMenB coverage would be about half the strains; further research is necessary. Integration of clinical, epidemiological and laboratory data is essential to support decision-making on the introduction of the novel MENB vaccines in Israel.

This study analyses the epidemiologic, clinical and molecular findings of all culture-confirmed cases of listeriosis notified from 2010 to 2015 in the Tel Aviv District, which is known to have high rates of listeriosis. All clinical isolates of Listeria monocytogenes were subtyped using two-enzyme pulsed-field gel electrophoresis. During the studied period, 102 cases of listeriosis were notified, including 23 pregnancy-associated cases (23%). Among 79 non-pregnancy-associated cases, 18 had neuro-invasive disease (21%). There were 26 deaths associated with the disease. Using molecular identification, we found a number of clusters of identical bacterial clones, which pointed to possible sources of infection. The high rates of morbidity and mortality resulting from listeriosis, as well as the diverse ways of infection demonstrated in this study, accentuate the need to boost public health actions, in order to raise awareness and better control high-risk contamination routes.

Associations of 6-week maternal depressive symptoms (Center for Epidemiological Studies Depression Scale (CES-D)) with 4-month mother-infant self- and interactive contingency patterns during face-to-face play were investigated in 132 dyads. Self- and interactive contingency (auto- and lagged cross-correlation, respectively) were assessed by multilevel time-series analysis. Infant and mother gaze, facial and vocal affect, touch, and spatial orientation behaviors were coded second-by-second from split- screen videotape, and a multimodal measure of facial-visual "engagement" was constructed, generating nine modality pairings. With higher CES-D, the self-contingency of both partners was lowered in most modalities. With higher CES-D, interactive contingency values were both heightened (in some modalities) and lowered (in others), varying by partner. These results are consistent with an optimal midrange model. With higher CES-D, interactive contingency showed the following patterns: (a) Mothers and their infants had a reciprocal orientational sensitivity; (b) mothers and infants manifested a reciprocal intermodal discordance in attention versus affect coordination, lowering gaze coordination, but heightening affective coordination; (c) infants heightened, but mothers lowered, touch coordination with partner touch—an "infant approach-mother withdraw" touch pattern. Nonlinear analyses indicated that altered self- and interactive contingency were similar at both the low ("denial") as well as the high ("endorsement") poles of depressive symptoms, in half the findings. These complex, multimodal findings define different aspects of communication disturbance, with relevance for therapeutic intervention.

Group G beta-hemolytic streptococcus (GGS) strains cause severe invasive infections, mostly in patients with comorbidities. GGS is known to possess virulence factors similar to those of its more virulent counterpart group A streptococcus (GAS). A streptococcal invasion locus, sil , was identified in GAS. sil encodes a competence-stimulating peptide named SilCR that activates bacterial quorum sensing and has the ability to attenuate virulence in GAS infections. We found that sil is present in most GGS strains (82%) but in only 25% of GAS strains, with a similar gene arrangement. GGS strains that contained sil expressed the SilCR peptide and secreted it into the growth medium. In a modified murine model of GGS soft tissue infection, GGS grown in the presence of SilCR caused a milder disease than GGS grown in the absence of SilCR. To further study the role of the peptide in bacterial virulence attenuation, we vaccinated mice with SilCR to produce specific anti-SilCR antibodies. Vaccinated mice developed a significantly more severe illness than nonvaccinated mice. Our results indicate that the sil locus is much more prevalent among the less virulent GGS strains than among GAS strains. GGS strains express and secrete SilCR, which has a role in attenuation of virulence in a murine model. We show that the SilCR peptide can protect mice from infection caused by GGS. Furthermore, vaccinated mice that produce specific anti-SilCR antibodies develop a significantly more severe infection. To our knowledge, this is a novel report demonstrating that specific antibodies against a bacterial component cause more severe infection by those bacteria.

Beatrice Beebe, PhD, New York State Psychiatric Institute; Frank Lachmann, PhD, Institute for the Psychoanalytic Study of Subjectivity; Joseph Jaffe, MD, Sara Markese, PhD, Karen A. Buck, MA, Patricia Cohen, PhD, Stanley Feldstein, PhD, and Howard Andrews, PhD, New York State Psychiatric Institute; Henian Chen, MD, PhD, College of Public Health, University of South Florida. This research was supported by The National Institute of Mental Health (Grant MH56130), The Psychoanalytic Fund, the Kohler Foundation, the Edward Aldwell Mother-Infant Research Fund, and the Los Angeles Infant Research and Psychoanalysis Fund. We thank our filming/coding team: Caroline Flaster, Donna Demetri-Friedman, Helen Demetriades, Nancy Freeman, Patricia Goodman, Michaela Hager-Budny, Elizabeth Helbraun, Allyson Hentel, Tammy Kaminer, Sandra Triggs Kano, Limor Kaufman-Balamuth, Greg Kushnick, Lisa Marquette, Jill Putterman, Jane Roth, Shanee Stepakoff, and Lauren Ellman. We also thank our lab assistants: Claire Jaffe, Daniella Polyak, Julia Reuben, Priscilla Caldwell, Jessica Lateck, Carol Scheik-Gamble, Danny Sims, Jake Freeman, Brianna Hailey, Alla Chavarga, Nidhi Parashar, Josianne Moise, Sarah Temech, Hope Igleheart, Yana Kuchirko, Elizabeth White, Greer Raggio, Kate Lieberman, Alina Pavlakos, Adrianne Lange, Kari Gray, Jennifer Lyne, Annee Ackerman, Fernanda Lucchese, Sarah Miller, Max Malitzky, Sam Marcus, Michael Klein, Kara Levin, Matthew Kirkpatrick, Lauren Cooper, Helen Weng, Iskra Smiljanic, and Christy Meyer. Finally, we thank our students and colleagues who contributed: Sara Hahn-Burke, Nancy Freeman, Michael Ritter, Glenn Bromley, Robert Gallaghan, Naomi Cohen, Paulette Landesman, Tina Lupi, Jillian Miller, Alan Phelan, Danielle Phelan, Katherine Weinberg, Edward Tronick, Doris Silverman, Anni Bergman, Lin Reicher, George Downing, Estelle Shane, and the Monday afternoon seminar, who consulted on our findings. Correspondence concerning this article should be addressed to Beatrice Beebe, PhD, New York State Psychiatric Institute #108, 1051 Riverside Drive, New York, NY 10032. E-mail: beebebe@pi.cpmc.columbia.edu Psychoanalytic Psychology © 2012 American Psychological Association 2012, Vol. 29, No. 4, 383–407 0736-9735/12/$12.00 DOI: 10.1037/a0029387

A microanalysis of 4-month mother-infant face-to-face communication predicted 12-month infant disorganized (vs. secure) attachment outcomes in an urban community sample. We documented a dyadic systems view of the roles of both partners, the roles of both self- and interactive contingency, and the importance of attention, orientation and touch, and as well as facial and vocal affect, in the co-construction of attachment disorganization. The analysis of different communication modalities identified striking intrapersonal and interpersonal intermodal discordance or conflict, in the context of intensely distressed infants, as the central feature of future disorganized dyads at 4 months. Lowered maternal contingent coordination, and failures of maternal affective correspondence, constituted maternal emotional withdrawal from distressed infants. This maternal withdrawal compromises infant interactive agency and emotional coherence. We characterize of the nature of emerging internal working models of future disorganized infants as follows: Future disorganized infants represent states of not being sensed and known by their mothers, particularly in moments of distress; they represent confusion about both their own and their mothers’ basic emotional organization, and about their mothers’ response to their distress. This internal working model sets a trajectory in development which may disturb the fundamental integration of the person. The remarkable specificity of our findings has the potential to lead to more finely-focused clinical interventions.

Since spring 2002, the Project for Mothers, Infants, and Young Children of September 11, 2001, has been providing diverse pro bono therapeutic services for women who were pregnant when widowed by the World Trade Center attacks of September 11, 2001. This primary prevention Project attempted to facilitate grieving in the families and to promote optimal relationships between the mothers and their infants and their older children. This article describes the components of the Project.

To determine whether rapid emergence of Salmonella enterica serovar Infantis in Israel resulted from an increase in different biotypes or spread of 1 clone, we characterized 87 serovar Infantis isolates on the genotypic and phenotypic levels. The emerging strain comprised 1 genetic clone with a distinct pulsed-field gel electrophoresis profile and a common antimicrobial drug resistance pattern.

This study examined the association of 6-week maternal self-report depressive symptoms measured by the Center for Epidemiological Studies-Depression Scale (CES-D) with 4-month infant vocal affect qualities. This was part a larger study which examined many additional domains of both infant and maternal behavior. Infant vocal affect qualities were examined in 122 4-month old infants during face-to-face play in relation to 6-week maternal depressive symptoms. Mothers were categorized depressed (26.2%) based on a 16+ cutoff on the CES-D. Videotaped interactions were coded on a 1-s time basis for infant vocal affect qualities (high positive, neutral/positive, fuss/whimper, cry, angry protest and silent.) Infants of depressed mothers were more vocally activated in both positive and negative qualities. In addition, infants of depressed mothers were more vocally variable, specifically in and out of fuss/whimper, as well as more likely to change, rather than maintain vocal states.

Associations of 6-week postpartum maternal self-criticism and dependency with 4-month mother-infant self- and interactive contingencies during face-to-face play were investigated in 126 dyads. Infant and mother face, gaze, touch, and vocal quality were coded second by second from split-screen videotape. Self- and interactive contingencies were defined as auto- and lagged cross-correlation, respectively, using multilevel time-series models. Statistical significance was defined as p

SUMMARYThe incidence of invasive infections due toNeisseria meningitidisin Israel is about 1/100 000 population annually. Three cases of meningococcal meningitis were reported in employees at a single plant; the first case appeared in March 2013 and the second and third cases appeared in December, almost 9 months later.N. meningitidisserogroup B was isolated from cerebrospinal fluid samples. Multilocus sequence typing assigned the three meningococcal isolates to ST10418, a new sequence type and a member of the ST32 clonal complex. The clonality was confirmed by performance of pulsed-field gel electrophoresis. Post-exposure antibiotic prophylaxis was administered to close contacts of the first case. Upon the diagnosis of the additional two cases, post-exposure prophylaxis was administered to all the plant employees. This report demonstrates the importance of combining public health measures and advanced laboratory studies to confirm clonality and to prevent further disease spread in a closed setting.

Recurrent group G Steptococcus bacteremia, associated with lymphatic disorders and possibly emm stG840.0, is described., Group G Streptococcus (GGS) can cause severe infections, including bacteremia. These organisms often express a surface protein homologous to the Streptococcus pyogenes M protein. We retrospectively studied the characteristics of patients from the Hadassah Medical Center with GGS bacteremia from 1989 to 2000. Ninety-four cases of GGS bacteremia were identified in 84 patients. The median age was 62 years, 54% were males, and 92% had underlying diseases (35% had a malignancy, and 35% had diabetes mellitus). The most frequent source for bacteremia was cellulitis (61%). emm typing of 56 available isolates disclosed 13 different types, including 2 novel types. Six patients had recurrent bacteremia with two to four bacteremic episodes, five had chronic lymphatic disorders, and two had emm type stG840.0 in every episode. Recurrent bacteremia has not been described for invasive group A Streptococcus. We describe an entity of recurrent GGS bacteremia, which is associated with lymphatic disorders and possibly with emm stG840.0.

We propose stochastic models for the interactive regulation of gaze on/off each partner's face in mother/infant gaze as well as ''turn-taking''. We infer that a Poisson timing mechanism indeed underlies the negative exponential distributions of gaze, providing a simplifying organizational principle for mother-infant communication, enabling both partners to predict the other's behavior. The Poisson rate constants quantify how likely infant or mother is to gaze on or off in comparison to each other. Mothers are far more likely to initiate gaze than infants, and infants are far more likely to terminate gaze than mothers. Initiation of a gaze ''turn'' (the individual unilaterally initiates gaze) follows a simple Poisson rule for infants, but mothers initiate a gaze turn with the second occurrence of infants' gaze termination. These turn findings suggest that mothers are using more history than infants in gaze turn regulation. For the infant, all three processes (gaze on, gaze off; gaze turn) are regulated by a Poisson process.

We performed emm typing of M nontypeable invasive group A streptococcal (GAS) isolates collected in a prospective population-based study in Israel. One hundred twenty of 131 isolates (92%) had emm sequences compatible with GAS, consisting of 51 different emm types. Eleven isolates were found to be group G streptococcus. Of the 120 isolates, 55 (46%) belonged to 32 types for which there were no typing sera available in the Streptococcal Reference Laboratory in Israel. The other 65 (64%) isolates, consisting of 19 types, had sera available and therefore could have been serotyped. Forty-three isolates had T and emm types which were not correlated according to standard M-typing protocols and were therefore missed. The principal effect of emm typing was the addition of 32 types not previously identified in Israel and the discovery of new associations between emm and T types. emm typing did not significantly change the proportion of M types; the five most common types were 3, 28, 2, 62, and 41. Twenty different types comprised 80% of all isolates. No new emm sequences were discovered. emm typing emphasized the unusually low incidence of M1 strains causing severe disease in Israel. As serological typing of GAS becomes more problematic due to lack of sera and the appearance of new emm types, reference laboratories should replace M typing with emm sequence typing. Development of a GAS vaccine relies on the emm type distributions in different geographical locations. In our study, 7% of isolates (types 41 and 62) are not included in a 26-valent vaccine that is being studied.

Group A streptococcus (GAS) causes diseases ranging from benign to severe infections such as necrotizing fasciitis (NF). The reasons for the differences in severity of streptococcal infections are unexplained. We developed the polymorphic-tag-lengths-transposon-mutagenesis (PTTM) method to identify virulence genes in vivo. We applied PTTM on an emm14 strain isolated from a patient with NF and screened for mutants of decreased virulence, using a mouse model of human soft-tissue infection. A mutant that survived in the skin but was attenuated in its ability to reach the spleen and to cause a lethal infection was identified. The transposon was inserted into a small open reading frame (ORF) in a locus termed sil, streptococcal invasion locus. sil contains at least five genes (silA-E) and is highly homologous to the quorum-sensing competence regulons of Streptococcus pneumoniae. silA and silB encode a putative two-component system whereas silD and silE encode two putative ABC transporters. silC is a small ORF of unknown function preceded by a combox promoter. Insertion and deletion mutants of sil had a diminished lethality in the animal model. Virulence of a deletion mutant of silC was restored when injected together with the avirulent emm14-deletion mutant, but not when these mutants were injected into opposite flanks of a mouse. DNA transfer between these mutants occurred in vivo but could not account for the complementation of virulence. DNA exchange between the emm14-deletion mutant and mutants of sil occurred also in vitro, at a frequency of approximately 10-8 for a single antibiotic marker. Whereas silC and silD mutants exchanged markers with the emm14 mutant, silB mutant did not. Thus, we identified a novel locus, which controls GAS spreading into deeper tissues and could be involved in DNA transfer.

The purpose of this study was to examine the hypothesis that 6-week-old infants are capable of coordinated interpersonal timing within social interactions. Coordinated interpersonal timing refers to changes in the timing of one individual's behavior as a function of the timing of another individual's behavior. Each of 45, first-born 6-week-old infants interacted with his or her mother and a stranger for a total of 14 minutes. The interactions were videotaped and coded for the gaze behavior of the infants and the vocal behavior of the mothers and strangers. Time-series regression analyses were used to assess the extent to which the timing of each of the infants' gazes was coordinated with the timing of the adults' vocal behavior. The results revealed that (a) coordinated timing occurs between infants and their mothers and between infants and strangers as early as when infants are 6 weeks old, and (b) strangers coordinated the timing of their pauses with the infants to a greater extent than did mothers. The findings are discussed in terms of the role of temporal sensitivity in social interaction.

JRS4(HE), a highly encapsulated, mouse-passaged variant of group A streptococcal strain JRS4, was characterized. The mucoid phenotype of JRS4(HE) was preserved after extensive passage in vitro. The level and size of csrRS transcript in JRS4(HE) was similar to that of JRS4, yet JRS4(HE) expressed high levels of has and sagA and exhibited an increased activity of streptolysin S. These findings indicate that the CsrRS repressor system was inactive in JRS4(HE). JRS4(HE) adhered to HEp-2 cells at the stationary phase but did not internalize these cells. At midlogarithmic phase, JRS4(HE) neither adhered to nor internalized cells, because of an increased amount of hyaluronic acid. Mice injected subcutaneously with JRS4(HE) developed large, deep necrotic lesions. In contrast, mice challenged with JRS4 developed small, superficial lesions. Despite the use of a high inoculum, mice challenged with JRS4(HE) did not develop a lethal bacteremic infection. It is concluded that inactivation of CsrRS in vivo is insufficient to cause a spreading necrotic disease.

Using research on the purely social face‐to‐face exchange, we examine patterns of mother—infant interaction and their relevance for the presymbolic origins of self and object representations, focusing on the representation of inter‐relatedness between self and object. Based on a dyadic systems view in which the system is defined by both self‐ and interactive‐regulation processes, we argue that characteristic patterns of self and interactive regulation form early interaction structures, which provide an important basis for emerging self and object representations. What will be represented, presymbolically, is the dynamic interactive process itself, the interplay, as each partner influences the other from moment to moment. This is a dynamic, process view of “interactive”; or “dyadic”; representations. The argument that early interaction structures organize experience is based on a transformational model in which there are continuous transformations and restructurings, where development is in a constant stat...

Two mathematical models of social contingency are examined in terms of their development over the first year of life. The interactions of 53 mothers and their infants were recorded at 6 weeks, 4 months, and 12 months. The infants' gazes at 6 weeks, the mothers' vocal behavior at 6 weeks, and the vocal behavior of the mother and infant at 4 and 12 months were automatically coded in terms of four states. The conditional dependence model and the response effects model were computed for each interaction at each age, and the coefficients of the models were examined as a function of age. The relative success of the models as estimates of moment-to-moment contingency as well as their variations with age are discussed.

Binding of the group A streptococcus (GAS) to respiratory epithelium is mediated by the fibronectin (Fn)-binding adhesin, protein F1. Previous studies have suggested that certain GAS strains express Fn-binding proteins that are different from protein F1. In this study, we have cloned, sequenced, and characterized a gene (prtF2) from GAS strain 100076 encoding a novel Fn-binding protein, termed protein F2. Insertional inactivation of prtF2 in strain 100076 abolishes its high-affinity Fn binding. prtF2-related genes exist in most GAS strains that lack prtF1 (encoding protein F1) but bind Fn with high affinity. These observations suggest that protein F2 is a major Fn-binding protein in GAS. Protein F2 is highly homologous to Fn-binding proteins from Streptococcus dysgalactiae and Strep-tococcus equisimilis, particularly in its carboxy-terminal portion. Two domains are responsible for Fn binding by protein F2. One domain (FBRD) consists of three consecutive repeats, whereas the other domain (UFBD) resides on a non-repeated stretch of approximately 100 amino acids and is located 100 amino acids amino-terminal of FBRD. Each of these domains is capable of binding Fn when expressed as a separate protein. In strain 100076, protein F2 activity is regulated in response to alterations in the concentration of atmospheric oxygen.