Jerusalem District Health Officer Dr. Chen Stein-Zamir has called for a change in regulations that would allow the health authorities to regularly examine food handlers at wedding halls, restaurants and other eating places to prevent them from spreading gastroenterological and other infections. Currently, they only examine them as part of an epidemiological investigation after a disease outbreak. Stein-Zamir and Health Ministry colleagues advocate this change in an article in the latest issue of IMAJ (The Israel Medical Association Journal) and describe a case in which one wedding hall employee who, despite having no symptoms himself, infected more than 500 people with Salmonella enterica bacteria on three consecutive days in August 2004. This type of bacteria is a global health problem, the authors note. In Britain alone, it caused 15,000 hospitalizations and 400 deaths in one year; in Israel, Salmonella enterica infection has a prevalence of 14.7 per 100,000 residents - higher than in the US, despite improved disease prevention practices. It spreads today mostly due to the lack of handwashing with soap and water after food handlers visit the toilet and before and after food preparation. The district health office team conducted an intensive epidemiological investigation of the 2004 incidents, taking stool samples from hundreds of guests and wedding hall staffers. Seventy-three percent of the guests developed gastrointestinal symptoms soon after the events, and two of the staffers were found positive for the bacteria - one who was sick on the second day and did not work on the third day of the outbreak, and the other an asymptomatic worker who was responsible for arranging food items on the plates serviced to the guests. After the unusual series of gastointestinal disease, the hall was closed down until the staff were educated about hygiene and food preparation procedures were changed. Stein-Zamir wrote that unlike those in other developed countries, food handlers in Israel are not required by regulations to be routinely tested for health problems and infections before they begin work or periodically while they are working. The only time they can be required to undergo testing and prevented from coming to work is if they are suspected of being contagious. While planning and execution of periodic testing of food handlers would pose "complex problems," they concluded, "concerted action is required to cut the chain of transmission by ensuring that basic rules of hygiene are scrupulously observed" to minimize illness, hospitalization and deaths. Health Ministry associate director-general Dr. Boaz Lev told The Jerusalem Post on Sunday he had not yet read the new IMAJ issue but that better supervision of services to improve public health was discussed from time to time in the ministry. He said he was in favor of giving the supervisory authorities more power, although finding funds for this could be a problem.