Communicable Disease Surveillance Systems in Disasters: Application of the Input, Process, Product, and Outcome Framework for Performance Assessment.

OBJECTIVE: One of the most important measures following disasters is setting up a communicable disease surveillance system (CDSS). This study aimed to develop indicators to assess the performance of CDSSs in disasters. METHOD: In this 3-phase study, firstly a qualitative study was conducted through in-depth, semistructured interviews with experts on health in disasters and emergencies, health services managers, and communicable diseases center specialists. The interviews were analyzed, and CDSS performance assessment (PA) indicators were extracted. The appropriateness of these indicators was examined through a questionnaire administered to experts and heads of communicable diseases departments of medical sciences universities. Finally, the designed indicators were weighted using the analytic hierarchy process approach and Expert Choice software. RESULTS: In this study, 51 indicators were designed, of which 10 were related to the input (19.61%), 17 to the process (33.33%), 13 to the product (25.49%), and 11 to the outcome (21.57%). In weighting, the maximum score was that of input (49.1), and the scores of the process, product, and outcome were 31.4, 12.7, and 6.8, respectively. CONCLUSION: Through 3 different phases, PA indicators for 4 phases of a chain of results were developed. The authors believe that these PA indicators can assess the system's performance and its achievements in response to disasters. (Disaster Med Public Health Preparedness. 2019;13:158-164).

A five-year study on the epidemiological approaches to cholera in Iran.

BACKGROUND: Cholera is considered a key indicator of social development but still is reported in various cities of Iran. The present study aimed to analyze the available information regarding cholera outbreaks since 2010 in Iran. METHODS: All cases reported to the Center for Disease Control and Prevention of Ministry of Health and Education who had been confirmed as cholera cases by the Health Reference Laboratory, were entered into this study since 2010. A specific spreadsheet was designed to ensure the safe keeping of the patient records. RESULTS: A total of 1522 patients were clinically diagnosed as cholera with laboratory confirmation over the study period. Cholera was detected in 26 Provinces and 115 cities during this period. Mean age of the patients was 35.1±17, both the Inaba and Ogawa strains were isolated. The highest mortality and the morbidity rate was 1.98% in 2013. The most cholera prevalent provinces in order of frequency were Baluchistan, Alborz, Gilan, Golestan and Qom, as well as Tehran. Inaba serotype was the most common cause of mortality and morbidity in 2013. CONCLUSION: These findings indicate significant outbreaks of cholera in some of the provinces of Iran and warrant appropriate treatment and preventive measures.

The new nano-complex, Hep-c, improves the immunogenicity of the hepatitis B vaccine.

Prevention of hepatitis B requires a vaccine that stimulates the humoral and cellular immune responses in a balanced manner, particularly those associated with Th1 and cytotoxic T cells. Alum adjuvant is currently used in the hepatitis B vaccine formulations but it lacks the efficiency of establishing such immune responses. Therefore, for accessing a suitable vaccine to prevent this fatal disease, it is essential to design and construct a new adjuvant which can overcome the limitations of the alum adjuvant and can stimulate a strong Th1 response as used along with it. In the present study, the adjuvant effect of Hep-c, the first nano-complex which was synthesized by nanochelating technology to improve the immunogenicity of the vaccine against hepatitis B, had been evaluated. Female Balb/c mice were divided into 7 groups and were injected with 10µg/ml of the hepatitis B vaccine and different doses of Hep-c for 3 times. Groups merely treated with the vaccine, Hep-c or phosphate buffered solution were used as control. Total specific antibody, IgG1, IgG2a, IgG2b, IgM, interleukin-4 (IL-4) and interferon-gamma (IFN-γ) levels were examined by the ELISA method. The proliferative response of the splenocytes was evaluated using bromodeoxyuridine assay. Results showed that immunization with hepatitis B vaccine and Hep-c increased the lymphocyte proliferation and specific IgM and IgG2a compared to the hepatitis B vaccine immunized group. Also, this nano-complex significantly increased the IFN-γ and IL-4 cytokine levels compared to the hepatitis B vaccine immunized group. Our findings show that Hep-c can not only preserve the alum capacity to effectively stimulate production of the antibodies but also cover its inefficiency in inducing Th1 response and prompting cellular immunity. Thus, by boosting the performance of the hepatitis B vaccine, it seemed that this nano-adjuvant has the suitable potential to be used in the commercial HBS vaccine formulation.