Influenza A [H1N1] Pandemic in Iran: report of First Confirmed Cases from June to November 2009

Since the declaration of a swine flu pandemic by the World Health Organization [WHO], the Islamic Republic of Iran has launched a surveillance system to test all suspected cases, both in community and hospital settings. From June 1[st] to November 11[th], 2009, there were 2662 [1307 females and 1355 males] RT-PCR confirmed cases of pandemic influenza A [H1N1] detected in Iran. Of these cases, 75% were 5-40 years-old. During this period, 58 patients [2.18%] died. Of the total number of cases, 33 were pregnant women with no reported mortalities amongst them. The prevalence of death had no significance correlation with sex and age [P=0.720 and 0.194, respectively]. Geographic distribution of the reported cases showed the highest rates in central and eastern provinces of Iran. There were two disease phases until November 2009, including an initial exogenous wave which blended into a second wave of indigenous disease, with a peak of cases after the start of the educational year. A review of the epidemiology of these initial phases of disease in Iran can help for better planning and more efficient action in future phases of the disease. It is of utmost importance to strengthen the surveillance system for this disease and appropriately transfer the resultant knowledge to the medical professionals, stakeholders and the general population, accordingly

[Relationship between occurrence of guillan-barre syndrome and mass campaign of measles and rubella immunization in Iranian 5-14 years old children]

Several case reports and epidemiologic studies have reported a relation between different vaccines including measles, rubella, and mumps and Guillain-Barre syndrome [GBS]. In this study we investigated relation between receiving measles and/or rubella vaccines and occurrence of Guillain-Barre syndrome after national immunization campaign in 2003 in Iran. In this study we used National Surveillance system for acute flaccid paralysis data from the beginning of 2002 to the end of 2004. We studied 5-14 year-old children. Three-year time span of the study was divided into fifteen 10 weeks periods, and number of reported and approved cases of Guillain-Barre syndrome in each time period has been analyzed supposing their distribution was according to Poisson distribution. One of time periods has been chosen in a manner that its first 4 weeks included embedded National Immunization and following 6 weeks were designated for covering incubation period of Guillin-Barre syndrome. Of total 553 reported flaccid paralysis cases in 5-15 year-old children 370 were approved to be Guillain-Barre [67%]. Estimated average incidence of Guillain-Barre syndrome in<15 year-olds is 1/100,000/year [95% CI: 0.88-13], and in 5-15 year-old children is 0.6/100,000/year [95% CI: 0.58-083]. Thus, number of expected cases in 25 cases each 10 weeks time period was 23.8 of GBS that were reported in the time period which coincided with immunization campaign. Probability of occurring>/=25 cases of GBS in that time period according to Poison distribution with expected case numbers of 23.8 is equal to 0.43 [P=0.43]. Yearly incidence rate of GBS in this study was similar to other studies. According to our results, there was no increase in GBS incidence in the 4 weeks national Immunization Campaign and 6 weeks after it in comparison to other 10 weeks periods before or after this time period