Cutaneous leishmaniasis in Iran: Results from an epidemiological study in urban and rural provinces

Objective To examine the prevalence and clinical manifestations of cutaneous leishmaniasis (CL) in Iran. Methods This study was conducted in Iran between 2011 and 2013. Sampling, preparing, developing, and fixing of suspicious skin lesions were completed in healthcare centers in 31 Iranian provinces as well as in the Academic Reference Laboratory and the National Reference Laboratory. The information was then analyzed at the Ministry of Health's Information Management Center of Contagious Diseases. Results Over a three-year period, the number of people identified with CL was 56 546. The highest incidence was reported in 2011 (27.5 per 100 000). Wet CL accounted for 43.7% of cases while 43.3% resulted from sporotrichoid leishmaniasis. The results showed that there was a higher incidence of CL due to Leishmania major (50.2%) than to Leishmania tropica. The results of this study found that the highest incidence of CL had happened respectively in Ilam, Fars and, Khorasan Razavi Provinces between 2011 and 2013. Conclusions Although the incidence of the disease is declining, CL is still a public health concern and disease control protocols need to be established. Therefore, further studies are needed to identify the vectors, reservoirs, and disease species as well as to develop appropriate disease control strategies.

An epidemiological comparative study on diagnosis of rodent leptospirosis in Mazandaran Province, northern Iran / 한국역학회지

OBJECTIVES: Leptospirosis is a zoonosis caused by leptospires, in which transmission occurs through contact with contaminated biological fluids from infected animals. Rodents can act as a source of infection for humans and animals. The disease has a global distribution, mainly in humid, tropical and sub-tropical regions. The aim of this study was to compare culture assays, the microscopic agglutination test (MAT), polymerase chain reaction (PCR), and nested PCR (n-PCR), for the diagnosis of leptospirosis in rodents in Mazandaran Province, northern Iran. METHODS: One hundred fifty-one rodents were trapped alive at 10 locations, and their urine and kidney samples were collected and used for the isolation of live Leptospira. The infecting serovars were identified and the antibody titres were measured by MAT, using a panel of 20 strains of live Leptospira species as antigens. The presence of leptospiral DNA was evaluated in urine and kidney samples using PCR and n-PCR. RESULTS: No live leptospires were isolated from the kidney and urine samples of the rodents. Different detection rates of leptospirosis were observed with MAT (21.2%), PCR (11.3%), and n-PCR (3.3%). The dominant strain was Leptospira serjoehardjo (34.4%, p=0.28), although other serotypes were also found. The prevalence of positive leptospirosis tests in rodents was 15.9, 2.6, and 2.6% among Rattus norvegicus, R. rattus, and Apodemus sylvaticus, respectively. CONCLUSIONS: Leptospirosis was prevalent in rodents in Mazandaran Province, northern Iran. MAT was able to detect leptospires more frequently than culture or PCR. The kidney was a more suitable site for identifying leptospiral DNA by n-PCR than urine. Culture was not found to be an appropriate technique for clinical diagnosis.

[Problems of health care systems and disease reporting for communicable diseases and surveillance in hospitals and the potential solutions: a qualitative study]

Background and Aim: Report of communicable diseases is an essential component in control and early detection of epidemics. Hospitals which admit patients for treatment can be the start point of an epidemic. Considering different problems in the hospital reporting system in Iran, this study was conducted to determine these potential problems and develop potential solutions in the reporting systems of communicable diseases

Material and Methods: In this phenomenological qualitative study, 54 people were assessed using structured interviews and focused group discussions. The participants were managers, nurses, professional experts of hospitals and health networks in Kurdistan and East Azarbaijan, and country disease control center. The results were reported using content analysis

Results: The results showed that there were lack of feedback and incentives, lack of instructions and duty assignment programs and lack of a clear reporting system in the hospitals. In addition, we found differences in reporting methods, unfamiliarity of managers with reporting levels, inconsistencies between the health and treatment departments

Conclusion: The absence of a clear process for reporting infectious diseases in the Iranian hospitals require development of guidelines for reporting these communicable diseases. This process calls for collaboration of the health care department at all administrative levels

Health needs of people living with HIV/AIDS: from the perspective of policy makers, physicians and consultants, and people living with HIV/AIDS

HIV/AIDS has been concentrated among injecting drug users in the country. This study aimed to investigate and identify health and treatment needs of people living with HIV/AIDS in Iran. This qualitative study was conducted in 2012 in Iran. The study groups consisted of experts, practitioners, and consultants working with People Living with HIV/AIDS and their families. Data was collected through Focus Group Discussions and deep interviews. Data were analyzed using content analysis method. The findings of this study included the needs of people living with HIV/AIDS, which were classified in three main categories. The first category was prevention and counseling services with several sub-groups such as education and public and available consultation, distribution of condoms to vulnerable groups, increasing counseling centers in urban areas, providing appropriate psychological and supportive counseling, and family planning services. The second category included diagnostic and treatment services and had several sub-groups such as full retroviral treatment, Tuberculosis treatment and continuing care, providing care and treatment for patients with hepatitis, and providing dental services. The third category included rehabilitation services and had some sub-categories such as home care, social and psychological support, nutritional support, and empowering positive clubs. This study puts emphasis on making plans based on the priorities to meet the needs of people living with HIV/AIDS in Iran

Determination of malaria epidemiological status in Iran's malarious areas as baseline information for implementation of malaria elimination program in Iran

According to willingness of the Ministry of Health, Iran and presence of appropriate conditions for disease elimination, national malaria control program decided to conduct a research to clarify malaria status in 2007 and to provide required information to perform the elimination program. This review is comprised of the basis of national malaria elimination program in vision of 2025, which was started in 2010. In this descriptive study, data were analyzed by applications of different variables at district level. All districts in the three south eastern provinces, in which malaria has local transmission, were considered. Malaria cases has been determined and studied based on the national malaria surveillance system. Since vivax malaria is predominant in Sistan and Baluchestan Province, number of vivax cases is equal to malaria positive cases approximately. The important point is that Nikshahr contains the maximum number of local vivax cases in this province and the maximum number of falciparum cases is reported from Sarbaz district. Among all districts of Hormozgan Province, no case of autochthonous falciparum was detected except in Bandar Jask and one case in Minab. There was no case of autochthonous falciparum in Kerman Province, except in Kahnoj and Ghale Ganj that each of them had one case in 2007. It appears that the report of locally transmitted cases in Iran is increasing over the past few years, before starting malaria elimination plan. Since the Afghan refugees started to return to their own country so the main source of reporting of imported malaria cases reduced and local cases would be demonstrated more clearly

Serum cholesterol level nomograms for Iranian population; suggestion for national cut-offs

High cholesterol levels are associated with increased risk of coronary heart disease and stroke. Under-standing the distribution of serum cholesterol levels in each country is valuable index for use in public health planning. This study aimed to construct nomograms of total cholesterol [TC] levels and establish the cut-points specific to Iranian population. Data on serum TC levels of 19,630 non-institutionalized individuals aged 25-64 years from third national survey on non-communicable diseases [SuRFNCD] in 2007 were used to construct cholesterol nomograms. We pro-posed cutoff values for borderline and high TC levels based on rounded 75th and 90th percentiles in three age groups [25-34, 35-44 and 45-64] respectively. Average yearly increase of TC for males up to the age of 45 and females up to 64 were 1.15 and 1.03 mg/dl, respectively. TC levels were higher in females. In males, cutoff values for "borderline and high" TC levels were 195 and 220 mg/dl in 25-34, 210 and 240 mg/d in 35-44 and 215 and 245 mg/dl in 45-64 years old individuals. In women, these values were 200 and 225 mg/dl in 25-34,215 and 240 mg/dl in 35-44 and 235 and 265 mg/dl in 45-64 years old individuals respectively. Since TC levels are different in two sexes and change with age, we proposed different cutoffs for sex and age group. We think these cutoffs could be used in national public health planning

Epidemiology of typhoid fever in Iran during last five decades from 1962-2011

Typhoid fever is one of the most important infectious diseases transmitted by contaminated food and water. This study aimed at epidemiological features of disease during the last five decades, over the period from 1962-2011. A retrospective cross-sectional study was conducted using typhoid fever national surveillance data. The highest incidence of typhoid fever was registered in 1965 with 133.4 /100,000 cases/year and the lowest in 2011 with 0.52/100,000 cases/year. Typhoid fever incidence in Iran had three phases. Before the year 1969, with high incidence >100 [phase 1], the period between1969-1996 with medium [10-100], [Phase 2] and the phase 3 has inaugurated from 1996 until now with low incidence rate less than 10 /100,000. Kermanshah Province was the most infected area. Most cases were occurred in warm months in 2010. Of 196 [31%] cases were under 15 years old whom were more affected. 53.6% of total cases in 2010 were female and 56.6% stayed in rural area. In 2010, 27.8% cases were confirmed. Among positive cases, the sources of culture were 46.8% stool, 37.2% blood, 14.6% urine and 1.2% bone marrow. Following treatment, 97.8% of cases were recovered completely and in 1.6% of cases had experienced complications and only 0.6% of confirmed cases have been died. As a result of development in socio-economic condition in Iran, the typhoid fever incidence has been dramatically declined from high [133.4/100,000 cases/year] in 1965 to low [0.52/100,000 cases/year] in 2011

Modeling of human immunodeficiency virus modes of transmission in Iran

Main technique to control acquired immunodeficiency syndrome [HIV] infection is the effective preventive programs among high-risk groups. Modeling is one of the effective methods where there is inadequate data. We used the modes of transmission [MOT] model to predict the transmission of HIV infection in Iran. We systematically searched published and grey literature to find values for the input parameters of MOT in 2010. The data were discussed by experts before being fed into the model. Using the Monte Carlo simulation, we computed the 95% confidence interval [CI] for the outputs of the MOT. The MOT estimates that 9136 new HIV infections would have occurred in Iran in 2010 [95% CI: 6831, 11757]. About 56% [95% CI: 47.7%, 61.6%] of new infections were among intravenous drug users [IDUs] and 12% [95% CI: 9.5%, 15%] among their sexual partners. The major routes of direct and indirect HIV transmission in Iran are unsafe injection [68%] and unprotected sexual contact [34% unprotected heterosexual and 10% homosexual] respectively. If current coverage for safe injection among IDUs increases from 80% to 95%, new HIV infections in this group would decrease around 75%. IDUs remain at highest risk of HIV infection in Iran, so the preventive program coverage for IDUs and their spouses needs to be increased. As the sexual transmission of HIV contributes increasingly to the pool of new infections, serious measures such as harm reduction program are required to reduce sexual transmission of HIV among the relevant key populations.

Adverse reactions following immunization with MMR vaccine in children at selected provinces of Iran

Several adverse events following immunization [AEFI] have been attributed to immunization with live attenuated measles, mumps, and rubella [MMR] vaccines. The MMR vaccine was introduced into the routine infant immunization schedule in 2003, followed by a second dose of vaccine at school-entry for children 4 to 6 years of age. The objective of this study was to characterize adverse reactions following MMR vaccination in Iran. Children who received the MMR vaccine and resided in five selected provinces of Iran were examined weekly for four weeks to detect well-known AEFIs that included: parotitis, fever and convulsions, convulsions without fever, encephalopathy, and anaphylactic reactions. Incidence of AEFIs were calculated and compared among recipients in both age groups. During the follow-up period, trained providers reported 792 AEFIs. Parotitis was the most frequent event occurring in 1.8% of recipients. Of 14, 109 children vaccinated at 12 months of age the following AEFIs occurred: parotitis [147], fever and convulsions [8], convulsions [7], encephalopathy [1], and anaphylactic reactions [1]. Of 29,338 children vaccinated to 4 to 6 years of age, parotitis, fever and convulsions, encephalopathy, and anaphylaxis occurred in 626, 5, 1, and 1 child, respectively; no convulsions without fever were reported in this age groups. Parotitis is the most frequent AEFI among MMR vaccine recipients in Iran. Incidence rates of AEFIs following MMR vaccination in Iran are similar to rates of AEFIs reported in other studies

Association of body mass index and abdominal obesity with marital status in adults

Obesity continues to be an important public health problem worldwide. The objective of this study was to determine the association of body mass index and abdominal obesity with current marital status among the adult population of Iran. A nation-wide cross-sectional survey was conducted from December 2004 through February 2005.The subjects were selected by stratified probability cluster sampling through household family members in Iran. Weight, height, waist circumference, and marital status of 89,404 men and women aged 15 - 65 [mean: 39.2] years were recorded. Four classes of body mass index, i.e., <18.5, 18.5 - 24.9, 25 - 29.9, and ?30 kg/cm2, and three marital status, i.e., currently-, formerly-, and never-married were used. Abdominal obesity was defined as waist circumference ?102 cm in men and ?88 cm in women. The prevalence of overweight was twofold higher in married men [OR: 2.24; 95% CI: 2.08 - 2.41] and women [OR: 2.36; 95% CI: 2.20 - 2.53] than never-married men and women, even when age, educational level, leisure time physical activity, smoking habits, and place of residence were controlled. The multivariate OR of obesity was increased about threefold in married men [2.82; 95% CI: 2.51 - 3.18] and women [3.64; 95% CI: 3.31 - 3.99]. The prevalence of abdominal obesity was twofold higher among married men [2.02; 95% CI: 1.79 - 2.29] and about threefold higher among married women [2.87; 95% CI: 2.69 - 3.06]. The marital status appears to influence the likelihood of developing overweight, obesity, and abdominal obesity in both men and women in Iran