A prospective longitudinal study on the elimination trend of rural cutaneous leishmaniasis in southeastern Iran: Climate change, population displacement, and agricultural transition from 1991 to 2021.

Leishmaniasis is a complex disease. Any change in weather conditions affects the humans' social and agricultural expansion and, consequently, the parasite's life cycle in terms of ecology, biodiversity, social stigma, and exclusion. This population-based prospective longitudinal investigation was conducted between 1991 and 2021 in a well-defined CL (cutaneous leishmaniasis) focus in Bam County, southeastern Iran. A robust health clinic and health surveillance system were responsible for the ongoing systematic documentation, detection, identification, and management of CL cases. The exponential smoothing method via the state space model was used in the univariate time series. The TTR, smooth, and forecast packages were used in R software. Landsat satellite images from 1991, 2001, 2011, and 2021 were employed in the physical development. During this period, the temperature increased while the rainfall and humidity decreased. The findings showed a downward trend in the standardized drought index. Also, the results showed that climate warming and ecological changes profoundly affected the area's agricultural patterns and topographical features. Furthermore, the last three decades witnessed an elimination trend for zoonotic CL (ZCL) and the predominance of anthroponotic CL (ACL). The present findings showed that the critical factors in the predominance of ACL and elimination of ZCL were rising temperature, drought, migration, unplanned urbanization, earthquake, and agrarian reform. The wall-enclosed palm tree gardens excluded the primary ZCL reservoir host. They controlled the disease while providing suitable conditions for the emergence/re-emergence of ACL in the newly established settlements and the unplanned ecozone. Therefore, robust health infrastructures, sustained financial support, and evidence-based research studies are crucial to facilitating the necessary surveillance, monitoring, and evaluation to control and eliminate the disease.

Exploring the spatial pattern of animal bites in Iran (2021-2022).

OBJECTIVE: Knowledge of the spatial pattern of animal bites can be helpful for targeted resource allocation and to develop and deliver effective intervention programs. The aim of this study was to explore the spatial pattern of the animal bites in Iran during 2021-2022. METHODS: Animal bite cases from all provinces and counties in Iran were obtained from a nationally based registry. Global Moran's I was applied to check spatial autocorrelation. The spatially adjusted standardized incidence ratios (SIRs) were estimated using the Besag, York, and Mollie (BYM) model. Spatial clusters were identified by local indicators of spatial association (LISA) and purely spatial scan statistic. RESULTS: A total of 260,470 animal bites were registered during the study period. There was a positive spatial autocorrelation (global Moran's I=0.27, p-value=0.001). The majority of SIRs greater than 1.00 was found in counties in the northern belt of Iran (e.g., observed greater than expected animal bites). LISA found that approximately 7% of counties in the north and northeast, 18% in the west and south, and 3% in the central part of Iran were significant hot spots, cold spots, and spatial outliers (p-value≤0.05). Spatial scan statistic detected primary hot spot cluster in the counties in the Mazandaran and Alborz provinces (Relative Risk=2.56, p-value<0.001), while primary cold spot cluster involved counties in Kurdistan and Kermanshah province (0.37, <0.001). CONCLUSION: Animal bites were unevenly distributed in Iran. Further prevention and control programs as well as appropriately resource allocation are needed in order to reduce the observed animal bites spatial disparity.

Epidemiologic Aspects of Animal Bite, Rabies, and Predictors of Delay in Post-exposure Prophylaxis: A National Registry-based Study in Iran.

BACKGROUND: The increasing trend in animal bites and rabies in recent years makes the disease a public health concern in Iran. The objectives of the current study were to investigate the epidemiologic aspects of the animal bite and determine the associated risk factors of the delay in initiation of post-exposure prophylaxis (PEP) against rabies in Iran. STUDY DESIGN: National registry-based cross-sectional study. METHODS: This study included all registered cases of animal bites between March 2021 and March 2022 at the Ministry of Health and Medical Education in Iran. We retrieved epidemiologic data on person, time, place, and PEP outcome. RESULTS: A total of 260470 animal bite cases (approximately 334 per 100000 populations, and 11 deaths) were registered during the study period. About 77.2% of them were reported in males, 4.3% in children aged less than 5 years, 56.4% occurred in urban areas, 98% in domestic animals, and mostly in north and northeast areas of Iran. Additionally, 2.8% of cases had a delay of more than 48 hours in the initiation of PEP. Significant determinants of the increase in delay were female gender (OR=1.43, 95% CI: 1.36, 1.51, P<0.001), foreign nationality (OR=1.19, 95% CI: 1.01, 1.12, P=0.001), rural residence (OR=1.07, 95% CI: 1.01, 1.12, P=0.010), and the wild animals (OR=1.22, 95% CI: 1.12, 1.34, P<0.001). CONCLUSION: The observed frequency of animal bites in a year indicates a serious public health concern and the need for targeted interventions, especially in at-risk areas and vulnerable populations.

Cutaneous leishmaniasis situation analysis in the Islamic Republic of Iran in preparation for an elimination plan.

Iran has invariably been under the growing public health threat of cutaneous leishmaniasis (CL), a significant barrier to local development that hinders the prevention and control efforts toward eliminating the disease. So far, no comprehensive and in-depth epidemiological analysis of the CL situation has been carried out nationwide. This study aimed to employ advanced statistical models to analyze the data collected through the Center for Diseases Control and Prevention of Communicable Diseases during 1989-2020. However, we emphasized the current trends, 2013-2020, to study temporal and spatial CL patterns. In the country, the epidemiology of CL is incredibly intricate due to various factors. This fact indicates that the basic infrastructure, the preceding supports, and the implementation plan related to preventive and therapeutic measures need crucial support. The leishmaniasis situation analysis is consistent with desperate requirements for efficient information on the control program in the area. This review provides evidence of temporally regressive and spatially expanding incidence of CL with characteristic geographical patterns and disease hotspots, signifying an urgent need for comprehensive control strategies. This information could be a suitable model and practical experience in the Eastern Mediterranean Region, where over 80% of CL is reported.

Trends in the Epidemiology of Brucellosis Cases in Iran during the Last Decade.

Background: Brucellosis is one of the most important zoonotic diseases that impose a serious public health burden on some countries in the world. Annually, the WHO reports more than 500000 new cases of human brucellosis. The disease is endemic in most parts of Iran; especially, in areas where people live in close contact with infected animals. According to data from the Iranian Ministry of Health, the average incidence of brucellosis in Iran was 22 cases per 100000 population, with a decreasing trend of surveillance. Methods: This cross-sectional survey was carried out within 2011-2020 in all provinces of Iran and from patients with clinical symptoms. Results: During the last decade, a total of 173526 cases were reported from different provinces of Iran, with a higher frequency of occurrence in males (58.2%) living in rural areas (77%), as compared to those in urban areas (23%). Moreover, brucellosis was more common in the summer season (June) and most of the cases were via contact with infected livestock (91%) and consumption of unpasteurized dairy products (78% in rural areas and 76% in the urban areas). Conclusion: The failure to effectively control brucellosis may be attributed to lack of knowledge about the disease, consumption of unpasteurized dairy and raw meat, lack of proper and safe vaccines for prevention and eradication programs, lack of rapid detection systems, and ineffective methods of isolating infected animals. Therefore, education and advancement of people's knowledge are key to the prevention and control of the disease.

Geographical distribution of Anthrax using Geographic Information System (GIS) during 2010-2015 in Iran.

Background: Anthrax is a zoonotic infectious disease that is still considered as a health problem in developing countries. Therefore, the aim of this study was to investigate the incidence and geographical distribution of anthrax using the Geographic Information System (GIS) and predict its incidence in Iran in 2021. Methods: This study is descriptive analytical study. Information on anthrax was obtained from the Center for Communicable Diseases Control during 2010-2015. In the next step, ArcGIS 9.3 was used to prepare geographic maps of the disease incidence and frequency. Therefore, using the Raster Calculator tool, the disease prediction map was drawn. Results: The highest incidence of anthrax during 2010-2015 was observed in the provinces of Kurdistan, North Khorasan, and Chaharmahal and Bakhtiari, respectively. The trend of the incidence of anthrax in Iran had increased from 2010 to 2013, while its incidence decreased in 2014. Based on the results of modeling in Iran, the provinces of Kurdistan, West Azarbaijan, Tehran, and Zanjan, respectively, with 37.16%, 33.83%, 16.78%, and 10.49% of their area (km2) had the highest risk of anthrax disease in the country in the year 2021. Conclusion: Since the provinces of Kurdistan, West Azerbaijan, Tehran, and Zanjan are among the high-risk areas in the country in the coming years, the cooperation between the veterinary organization and the health care system and the vaccination of livestock in these areas can significantly help to control and prevent the disease.

Human Cutaneous Leishmaniosis in Iran, Up to Date-2019.

Cutaneous leishmaniasis is a neglected and parasitic vector borne diseases that is endemic in tropical and subtropical countries, including Iran. The aim of this study was to explain the present status of CL in Iran. This report is based on data that recorded by cutaneous leishmaniasis surveillance system in 2019, and evaluated in Center for Communicable Diseases Management in Ministry of Health in Iran. Iran has been considered an endemic area for cutaneous leishmaniasis in the world. Dependent to activities for cutaneous leishmaniasis control the number of cases decreased from 23202 in 2008 (Incidence rate 32 per 100000) to 13124 in 2019 (Incidence rate 15.8 per 100000), more cases reported from September to December, in 2019, 46% of cases had one lesion and 21% had 2 lesions, 85% of cases diagnosed when the diameter of lesions had 3 centimeters and bellows. Although the Leishmania control program began in 1977, the incidence of the disease has dropped dramatically since 2008 when the new cutaneous leishmaniasis control program have been implemented. Although in some areas the incidence of the disease increased, but the implementation of the new program has reduced the number of cases, in order to continue reducing the disease, permanent support for the control programs is needed.

Epidemiological Features of Human Brucellosis in Iran (2011-2018) and Prediction of Brucellosis with Data-Mining Models.

BACKGROUND: Brucellosis is known as the major zoonotic disease. We aimed to compare the performance of some data-mining models in predicting the monthly brucellosis cases in Iran. STUDY DESIGN: Population-based cohort study. METHODS: Three data mining techniques including the Support Vector Machine (SVM), Multivariate Adaptive Regression Splines (MARS), and Random Forest (RF) besides to one classic model including Auto-Regressive Integrated Moving Average (ARIMA) was used to predict the monthly incidence of brucellosis in Iran during 2011-2018. We used several criteria (root mean square error (RMSE), mean absolute error (MAE), coefficient of determination (R2) and intra-class correlation coefficient (ICC) for appraising the accuracy of prediction and performance of our models. All analysis was done using free statistical software of R3.4.0 RESULTS: Overall 118867 cases (with a mean age of 34.01±1.65 yr) of brucellosis were observed and seven-year incidence rate of brucellosis in Iran was 21.78 (95% CI: 21.66, 21.91). The majority of patients (58.84%) were male and 25-29 yr old. The first three provinces with the highest incidence rate of brucellosis included the following; Kurdistan (71.39 per 100000), Lorestan (68.09 per 100000) and Hamadan (56.24 per 100000). CONCLUSION: Brucellosis was more common in males, 25-29 aged yr, western provinces and spring months. The disease had a decreasing trend in the last years. MARS model was more appropriate rather than data mining models for prediction of monthly incidence rate of brucellosis.

Epidemiology of Leprosy in Iran from 2005 to 2015.

BACKGROUND: Leprosy is a chronic infectious disease with permanent complications that mainly affect the skin, peripheral nerves, mucosal surfaces of the upper respiratory tract, and eyes. The aim of this study was to investigate the epidemiology and trends of leprosy in Iran from 2005 to 2015. MATERIALS AND METHODS: This was a cross-sectional study analyzing leprosy records from the Center for Communicable Disease Control, Ministry of Health and Medical Education, during 2005-2015. RESULTS: Of the 433 cases of leprosy diagnosed from 2005 to 2014, 87.1% were Iranian, and 56.2% of the Iranian cases were male. Furthermore, 82.5% of cases were multibacillary. The paucibacillary leprosy cases had a better remission rate in most years of the study. The annual prevalence and case detection rates of leprosy (per 100,000 population) significantly decreased in Iran between 2005 and 2015: from 0.2 to 0.02 and from 0.11 in 2005 to 0.02, respectively. The geographical distribution of leprosy cases in 2014 showed that leprosy is more common in the west, north, northwest, and south of Iran. CONCLUSION: Although Iran is currently an area in which leprosy is not a serious problem, new cases of leprosy are still diagnosed in Iran. Considering that Iran is attempting to eradicate the disease, careful attention to all aspects of the disease is essential.

Suicide and associated risk factors in Hamadan province, west of Iran, in 2008 and 2009.

BACKGROUND: Hamadan is a province with high incidence rate of suicide. The present study was conducted to assess suicide and its associated risk factors in this province. METHODS: In this cross-sectional study, all cases of suicide occurred in the province, were investigated from April 2008 to March 2010. The data were collected from Provincial Health Center and Forensic Medicine's databases using a checklist developed according to the available records. RESULTS: A number of 5414 suicide attempts had occurred (with 8.4% deaths) including 2753 women (with 3.4% death) and 2660 men (with 13.7% death). Majority of the suicide attempts and completed suicides occurred among adults aged 20-29 years. About 6.7% of the cases who attempted for suicide and 14.2% of the cases who died from suicide had a previous history of suicide attempt (P<0.001). Familial problems (49.7%) and psychiatric disorders (31.6%) were among the most common reasons of suicide attempt. Using drugs (74.0%) were the most common method of attempting suicide while hanging (83.6%), burning (74.2%), and gunshot (52.4%) were the most common leading causes of completed suicide (P<0.001). Adjusted odds ratio estimate of completed suicide in males against females was 2.27 (95% CI: 1.63, 3.14). The odds of completed suicide increased 1.43 (95% CI: 1.30, 1.57) fold per 10 years of age. CONCLUSION: This survey identified and highlighted the most common and important potential risk factors for suicide. In addition, the effects of various demographic risk factors on suicide attempt and completed suicide were examined. These evidences may be useful for future research, policy, and treatment efforts aimed at understanding and preventing suicide.