Preventative Health Guidelines: Adults

Knowing the national preventive health guidelines is important for all physicians and all immigrants. It's something which affects everyone, personally and professionally.

This is a clear, up-to-date reference for the recommended adult vaccinations and cancer screening tests in Israel. While many recommendations may resemble those you were familiar with elsewhere, national guidelines may differ based on budgets, available evidence, and the country’s specific epidemiology. One example is BRCA screening, which in Israel is recommended and subsidized for all women aged 25 and over of Ashkenazi or Ethiopian ancestry.

In Israel, there is an added layer of complexity which is good to understand: Ministry of Health recommendations are not always identical to what is included in the Health Basket (the subsidized basic level of care guaranteed to all residents). For example, the herpes zoster vaccine is recommended from age 60, but is included in the Health Basket only from age 65.

The most recent document published by the Israeli Medical Association (IMA) on preventive health is the leaflet

The document “Health Promotion and Preventive Medicine” (קידום בריאות ורפואה מונעת) is published by the Israeli Medical Association, and makes recommendations for the Ministry of Health to implement when setting the national healthcare programs. The latest version was released in October 2022 and is already out of date, as several vaccines, such as Prevenar and Shingrix, have since been approved and become widely available in Israel.

IMA Preventative Health Doc

The information presented below is based on the current Ministry of Health screening programs, the Health Basket, health fund (kupot) policies, and the IMA preventive health leaflet.

We hope this serves as a helpful and practical reference.

Vaccinations

Tetanus Diphtheria

→ Td/Tdap

→ Every 10 years

HPV

→ Gardasil 9

→ In Health Basket for unvaccinated women and men ages 18- 26 (3 doses required)

→ Vaccine is approved for ages 27- 45, but needs payment or supplemental health packages

Influenza

→ Annually

→ Recommended for all ages (from 6 months +)

Herpes Zoster (Shingles)

→ Shingrix

→ 2 doses, 2-6 months apart

→ Recommended for all adults 60 years +

→ Approved from age 50 +

→ In the Health Basket for Adults 65 + and 18+ with HIV, cancer, solid organ transplant recipients, or bone marrow transplant recipients

→ The vaccine can be given after prior shingles or ≥8 weeks after Zostavax.

Pneumococcal

→ Prevenar 20 (PCV20)

→ Recommended for all adults 65 years + and adults 18–64 at high risk for pneumococcal disease

→ 1 dose

→ Adults ≥65 should be vaccinated regardless of prior pneumococcal vaccination: give one dose of PCV20 at least 1 year after the last pneumococcal vaccine

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Cancer Screening

Cervical Cancer

→ Primary screening: HPV DNA test every 5 years

→ If HPV abnormal: Pap smear test every 3 years

→ Ages 25–65: Every five years

→ Ages 66+ who have not been tested (HPV or Pap) in the past 10 years are entitled to a single test

Breast Cancer

→ Mammography screening test

→ Women aged 50–74: every 2 years

→ Women aged 40–49 with a first-degree relative with breast cancer: annual mammography together with physician examination.

→ BRCA1/2 genetic testing: All women ages 25+ of Ashkenazi or Ethiopian descent regardless of medical history.

→ For BRCA1/2 mutation carriers, annual breast MRI is recommended.

Colorectal Cancer

→ Annual fecal occult blood test (FOBT) from age 50 to 74.

→ Colonoscopy for those with a positive FOBT.

→ Family history of colorectal cancer:

• Perform colonoscopy every 5 years from age 40 for individuals with a first-degree relative (parent or sibling) with colorectal cancer.

• Alternatively, begin colonoscopy 10 years earlier than the age at which the relative was diagnosed.

Lung Cancer

→ Low Dose CT

→ Men and women aged 65–74 who meet all of the following:

≥20 pack-years smoking history

Current smokers or quit within the past 15 years

→ Screen every 2 years as long as criteria are met

Prostate Cancer

→ There is no clear recommendation for routine, systematic early screening for prostate cancer in the general male population from age 50.

→ Men aged 55–69 who request screening may be referred for testing (PSA) as a screening measure. It is recommended to explain the benefits and limitations of the test and to document the discussion.

→ Based on expert opinion alone, annual PSA testing and TRUS (transrectal ultrasound) from age 50 is recommended for high-risk men with a first-degree relative diagnosed with prostate cancer before age 70.

Ovarian Cancer

→ There is no justification for routine screening for early detection of ovarian cancer in women without increased risk.

→ Genetic counseling is recommended if the woman belongs to one of the following groups:

1) Personal or family history of breast cancer diagnosed before age 50

2)Family history of ovarian cancer

3)Personal or family history of colorectal cancer or endometrial cancer diagnosed before age 50

→ If defined as being at increased risk for ovarian cancer after genetic counseling, periodic screening from age 25 is recommended, including gynecologic examination, transvaginal ultrasound, and CA-125 testing.

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Other diseases

Abdominal Aortic Aneurysm

→ One-time abdominal ultrasound for men aged 65–74 who smoke/have ever smoked

Osteoporosis

→ Recommended to screen in all women aged 65+

→ Included in the health basket for women and men ≥60: every 5 years

→ Women and Men ≥50: every 2 years if any of the following apply: Prior fracture, First-degree relative with an osteoporotic fracture, BMI <19, Treatment with alendronate(and raloxifene, or risedronate for women only)

→ Women or men of any age with conditions associated with increased osteoporosis risk, or ≥3 months of glucocorticoid therapy