Epidemiological status of leishmaniasis in the Islamic Republic of Iran, 1983-2012

Leishmaniasis has a long history in the Islamic Republic of Iran. This study aimed to show the trend in leishmaniasis incidence from 1983 to 2012 and to describe the epidemiological characteristics in 2012. In a retrospective cross-sectional study, data were extracted from th%e national leishmaniasis surveillance system for the 3 clinical types-cutaneous [zoonotic and anthroponotic] and visceral [zoonotic]. The average annual number of cutaneous leishmaniasis cases was 18 884 [average annual incidence 32 cases per 100 000 inhabitants]. In 2012 the highest incidences were in age groups 1-4 and 5-9-years [43 and 40 per 100 000], and more males [57%] than females [43%] were infected. The annual average number of zoonotic visceral leishmaniasis cases was 175 [average annual incidence 0.18 per 100 000]. The incidences of cutaneous and zoonotic visceral leishmaniasis have decreased in recent years, which coincides with national leishmaniasis control efforts

Comparative study on the effectiveness of coumavec and zinc phosphide in controlling zoonotic cutaneous leishmaniasis in a hyperendemic focus in central Iran

Zoonotic cutaneous leishmaniasis [ZCL] is an increasing health problems in many rural areas of Iran. The aim of this study was to introduce a new alternative rodenticide to control the reservoirs of ZCL, its effect on the vector density and the incidence of the disease in hyperendemic focus of Esfahan County, central Iran. The study was carried out from January 2011 to January 2012. In intervention areas, rodent control operation was conducted using zinc phosphide or Coumavec. Active case findings were done by house-to-house visits once every season during 2011-2012. To evaluate the effect of rodent control operation on the vector density, sand flies were collected twice a month using sticky traps. The reduction rate of rodent holes in intervention areas with Coumavec and zinc phosphide were 48.46% and 58.15% respectively, whereas in control area results showed 6.66 folds intensification. The Incidence of ZCL significantly reduced in the treated areas. Totally, 3200 adult sand flies were collected and identified in the intervention and control areas. In the treated area with zinc phosphide, the density of Phlebotomus papatasi was higher in outdoors in contrast with the treated area by Coumavec which the density of the sand fly was higher in indoors. Both rodenticides were effective on the incidence of ZCL and the population of the reservoirs as well. Coumavec seems to be effective on the outdoor density of the vector. This combination of rodenticide-insecticide could be a suitable alternative for zinc phosphide while bait shyness or behavioral resistance is occurred

[Establishment and integration of a visceral leishmaniasis surveillance system in the primary health care system and its evaluation, Meshkin-Shahr District, Iran]

Visceral leishmaniasis is a systemic parasitic disease with a high fatality rate in under-5-year-old children. The disease is endemic in some parts of Iran, particularly in the north-west region. In 2001 a visceral leishmaniasis [VL] surveillance system was established for children aged>/=12 years in the primary health system in Meshkin-Shahr District, Ardebil Province, situated in the north-west of Islamic Republic of Iran. All cases with clinical signs and symptoms of VL and confirmed positive by the direct agglutination test [DAT] were referred for physical examination and treatment. The mean annual incidence of VL decreased significantly from 1.88 per 1000 children before [1985-2000], to 0.77 per 1000 child population after [2001-07], the intervention. In the control area with no surveillance, it increased from 0.11 to 0.23 per 1000. Early detection of VL using serological tests and timely treatment of cases can decrease the mortality and morbidity rates of VL in endemic areas

Cutaneous leishmaniasis in Bam: a comparative evaluation of pre- and post- earthquake years [1999-2008]

The recent devastating earthquake of December 26 in Bam, 2003 created various risk factors; caused a sharp increase in incidence of anthroponotic cutaneous leishmaniasis [ACL] cases and reached to an epidemic proportion. The objective of this study was to evaluate the status of ACL cases five years before the earthquake compared to the cases occurred five years after the earthquake [1999-2008]. Status of disease was assessed retrospectively for the five years before the earthquake and prospectively for the five years after the earthquake. Identification was confirmed by smear and polymerase chain reaction [PCR]. The mean annual incidence of ACL for the period from 1999 to 2003 was 1.9 per 1000 comparing to post earthquake period, which was 7.6 per 1000. Most of the infection was in individuals of <20 years, more frequently in females before the earthquake, whilst in contrast, there was a progressive rise in the number of cases, significantly in male individuals of >20 years [P< 0.0001] in post earthquake era. The anatomical distribution of lesions considerably changed during the two periods. Most of the cases were limited to three zones within the city prior to the earthquake, whereas it was spread throughout different zones after the earthquake. PCR indicated that the CL was due to Leishmania tropica in the city. The results strongly suggest that in natural disasters such as earthquakes various precipitating factors in favor of disease will be created, which in turn provide a suitable condition for propagation of the vector and the transmission of the parasite

Integrated visceral leishmaniasis surveillance system in primary care for children in Meshkin-Shahr district, north-western Islamic Republic of Iran

In 2001 a visceral leishmaniasis [VL] surveillance system was set up for children aged

Seroepidemiological study of visceral leishmaniasis in Booyerahmad district, south-west Islamic Republic of Iran

Visceral leishmaniasis [VL] is endemic in parts of Islamic Republic of Iran. A cross-sectional seroprevalence study was carried out in children in Booyerahmad district in the south-west of the country. Serum samples were taken from 1628 children up to 10 years old from different areas in Booyerahmad in 2005-06. Anti-Leishmania antibody was detected in 50 out of 1628 children [3.1%] by direct agglutination test [antibody titre > 1:3200]. There was no significant difference in seropositivity between the sexes [2.8% males and 3.3% females]. The highest rate of infection [5.2%] was in the age group 10 years. Further studies are needed to explore the reservoirs and vectors of the disease in this region

Adherence of the private sector to national tuberculosis guidelines in the Islamic Republic of Iran, 2001-02

We determined the knowledge and practice of private sector physicians in three cites regarding management of pulmonary tuberculosis [TB] and their determinants. A random sample questionnaire survey was conducted of 732 private physicians. Stratified analysis and logistic regression were used to identify the adjusted determinants of the two outcomes. A high proportion of the doctors had correct knowledge about the major diagnostic criteria but there was a low level of knowledge and practice of TB management. Significant risk factors for poor knowledge were age > / = 36 years, being a GP rather than a specialist and no attendance in TB training courses or attendance in courses held by institutions other than the public health system. Age > / = 36 years was the only significant risk factor for poor practice