Prevalence and risk factors for HBV and HCV in prisoners in Iran: a national bio-behavioural surveillance survey in 2015.

OBJECTIVES: To provide more accurate estimates of the prevalence of Hepatitis B (HBV) and Hepatitis C (HCV) and their contributing factors among prisoners in Iran. METHODS: Cross-sectional study of 6200 Iranian prisoners in 2015. Data were collected through questionnaires and interviews. HBV infection and HCV exposure status of the participants was determined by HBsAg and HCV antibodies blood tests using enzyme-linked immunosorbent assay (ELISA). Data were analysed in STATA-12. RESULT: Prevalence of HCV exposure was 9.48% (95% CI: 8.73-10.27), and prevalence of HBV was 2.48% (95% CI: 2.07-2.89) in the general prison population. In multivariate analysis, the most important risk factor for HBV was a history of drug use in lifetime (adjusted odds ratio, AOR: 1.8, 95% CI: 1.17-3.02). The main risk factors for HCV exposure were a history of drug use in lifetime (AOR: 4.08, CI: 2.56-6.27), age over 30 (AOR: 2.68, CI: 2.01-3.56), and having tattoos (AOR = 1.67, CI: 1.35-2.07). CONCLUSION: Although vaccination is used to control HBV among prisoners, prevalence of HCV exposure is alarming in the prison population of Iran, especially among people who inject drugs. Eliminating viral hepatitis in Iran by 2030 requires a national commitment and rapid measures for targeting this high-risk group. Given the increased efficiency of HCV treatment in recent years, prisons provide an opportunity to access patients for treatment.

Low prevalence of hepatitis B vaccine escape mutants among individuals born after the initiation of a nationwide vaccination program in Iran.

A nationwide hepatitis B virus (HBV) vaccination program for neonates was launched in Iran in 1993. Despite the success of this program, concern about its long-term success still remains, because breakthrough infections due to emergence of surface mutants have been reported in immunized children. We aimed to evaluate the seroprevalence of HBV and vaccine escape mutants among individuals born after the initiation of the nationwide vaccination program in Iran. This study included 1115 participants younger than 23 years old, with 223 in each age cohort. The presence of HBsAg, anti-HBs and anti-HBc was evaluated using an ELISA kit. HBV-DNA levels were measured in anti-HBc and/or HBsAg-positive subjects. PCR products were sequenced and mutations were identified. The overall HBsAg prevalence was 0.27 %. Anti-HBs and anti-HBc positive rates were 48 % and 0.18 %, respectively. Two individuals were positive for anti-HBc, one of whom was also positive for HBsAg, and the other was positive for anti-HBc only. HBV DNA was detected in three out of four anti-HBc-and /or HBsAg-positive subjects. An I195M mutation within the S gene was detected in two of the three HBV-DNA-positive cases. A very low prevalence of HBsAg and isolated anti-HBc were found in this study. The I195M mutation found in the surface gene could have been induced by immune pressure. Although the number of ''vaccine escape'' mutants found in this cohort was low, ongoing surveillance of breakthrough infections and escape mutants is still needed.

Sinopharm (HB02)-associated vaccine-induced immune thrombotic thrombocytopenia: a case report.

BACKGROUND: Vaccine-induced thrombotic thrombocytopenia is associated with the coronavirus disease 2019 vaccines. It has been reported by vector-based vaccines. To the best of our knowledge, there is no report about vaccine-induced thrombotic thrombocytopenia in whole-virus vaccines. We are presenting the first case of vaccine-induced thrombotic thrombocytopenia with this type of vaccine. CASE PRESENTATION: An 18-year-old male Caucasian patient with complaints of severe abdominal, low back, and lower extremity pain presented to the medical center. He received the first dose of the Sinopharm (HB02) vaccine against coronavirus disease 2019 10 days before hospital attendance. In the laboratory examination, decreased platelet count and increased D-dimer were observed. During hospital admission, the diagnosis of pulmonary embolism was reached. He received vaccine-induced thrombotic thrombocytopenia therapy consisting of intravenous immune globulin and direct oral anticoagulant. Platelet count increased and he was discharged after 1 month. CONCLUSION: This case highlights the possibility of vaccine-induced thrombotic thrombocytopenia occurrence by whole-virus coronavirus disease 2019 vaccines. Compared with vector-based vaccines, this phenomenon is rare for whole-virus vaccines. More studies on this type of vaccine regarding thrombotic thrombocytopenia should be considered.

A randomized controlled clinical trial on efficacy and safety of anakinra in patients with severe COVID-19.

INTRODUCTION: Hyperinflammatory state has a role in the pathogenesis of COVID-19. Anakinra could reduce inflammation and help to combat the condition. In this study, we aimed to assess the safety and efficacy of anakinra (PerkinRA®) in severe COVID-19. METHOD: The study was an open-label, randomized, controlled trial conducted in Imam Hossein Medical Center from May to July 2020. Patients with a confirmed diagnosis of COVID-19 were included in this study. We administered anakinra 100 mg daily intravenously. All patients received COVID-19 pharmacotherapy based on the represented national guideline. The need for invasive mechanical ventilation is considered the primary outcome. RESULTS: Thirty patients were included in this study, and 15 of them received Anakinra. Nineteen patients were male (63.3%), and 11 were female (36.7%). The mean age of patients was 55.77 ± 15.89 years. In the intervention group, the need for invasive mechanical ventilation was significantly reduced compared to the control group (20.0% vs. 66.7%, p = .010). Also, these patients had a significantly lower length of hospital stay (p = .043). No significant higher rate of infection was recorded. CONCLUSION: Anakinra as an immunomodulatory agent has been associated with the reduced need for mechanical ventilation in patients admitted to intensive care units because of severe COVID-19. The medication reduced the hospital length of stay. Furthermore, no increased risk of infection was observed. Further randomized placebo-controlled trials with a larger sample size are needed to confirm these findings.

Low-Dose Whole-Lung Irradiation for COVID-19 Pneumonia: Short Course Results.

PURPOSE: The COVID-19 outbreak is affecting people worldwide. Many infected patients have respiratory involvement that may progress to acute respiratory distress syndrome. This pilot study aimed to evaluate the clinical efficacy of low-dose whole-lung radiation therapy in patients with COVID-19 pneumonia. METHODS AND MATERIALS: In this clinical trial, conducted in Iran, we enrolled patients with COVID-19 who were older than 60 years and hospitalized to receive supplementary oxygen for their documented pneumonia. Participants were treated with whole-lung irradiation in a single fraction of 0.5 Gy plus the national protocol for the management of COVID-19. Vital signs (including blood oxygenation and body temperature) and laboratory findings (interleukin-6 and C-reactive peptide) were recorded before and after irradiation. RESULTS: Between May 21, 2020 and June 24, 2020, 5 patients received whole-lung irradiation. They were followed for 5 to 7 days to evaluate the response to treatment and toxicities. The clinical and paraclinical findings of 4 of the 5 patients (patient 4 worsened and died on day 3) improved on the first day of irradiation. Patient 3 opted out of the trial on the third day after irradiation. The mean time to discharge was 6 days for the other 3 patients. No acute radiation-induced toxicity was recorded. CONCLUSIONS: With a response rate of 80%, whole-lung irradiation in a single fraction of 0.5 Gy had encouraging results in oxygen-dependent patients with COVID-19 pneumonia.

Demographic, clinical, and virological characteristics of patients with a laboratory-confirmed diagnosis of influenza during three consecutive seasons, 2015/2016-2017/18, in the Islamic Republic of Iran.

BACKGROUND: There are minimal data on the differences in demographics, clinical presentations and outcomes for patients with different types and sub-types of influenza in the Middle East. OBJECTIVES: To use population-based data from Iran to investigate factors associated with unfavorable disease outcome. STUDY DESIGN: Clinical data were compiled from the Iranian Ministry of Health for patients of all ages who fulfilled the severe acute respiratory infections (SARI) definition according to World Health Organization criteriatested for any reason and found to have and had laboratory proven influenza September 21, 2015 through March 20, 2018. Pulmonary, cardiac, renal, hematologic and neurologic complications were recorded. Results were compared by type, age, gender and health status. Multivariate analysis was used to analyze risk factors for complications and death. RESULTS: Of 11,080 enrolled patients, 10,046 (90.7 %) were inpatients, 2254 (20.4 %) were children, 8403 (75.8 %) had influenza A, 2599 (23.5 %) had influenza B, and 78 (0.7 %) had unidentified types. Fever was less common in older patients (OR 0.99; 95 % CI 0.98-0.99, p < 0.001 and in those with comorbidity (OR 0.87; 95 % CI 0.77-0.97, p = 0.013). Although the rate of complications was lower with A(H1N1) pdm09 influenza than with A(H3N2) infection (12.8 % versus 15.6 %, p = 0.001), the mortality rate was higher (7.0 % versus 3.0 %, p < 0.001). Complications occurred more often during late versus early influenza season (OR 1.22; 95 % CI 1.08-1.37, p = 0.002). Patients with type B influenza (OR 0.85; 95 % CI 0.74-0.98, p = 0.025), or who presented with sore throat (OR 0.74; 95 % CI 0.65-0.84, p < 0.001) were less likely to develop complications. The risk of developing complications was increased in patients who had chronic heart disease (OR 1.51; 95 % CI 1.29-1.76, p < 0.001), chronic pulmonary disease (OR 1.62; 95 % CI 1.37-1.91, p < 0.001), diabetes (OR 1.24; 95 % CI 1.03-1.50, p = 022), or epilepsy (OR 1.55; 95 % CI 1.17-2.05). Older age and male gender increased the risk of death but not of complications. CONCLUSIONS: The clinical features, complications and outcomes of influenza vary by age and by viral type and sub-type. Comorbidites appear to be more important than age in predicting complications.

Epidemiological, Risk Factors, Clinical, and Laboratory Features of Brucellosis in the Southwest of Iran within 2009-2015.

BACKGROUND: Brucellosis is a serious disease affecting many individuals in the world and in Iran. The aim of this study was to investigate the epidemiological and clinical features of patients diagnosed with brucellosis in Kohgilouyeh and Boyerahmad province, southwest of Iran. METHODS: This retrospective descriptive-analytic study included all individuals diagnosed with brucellosis during 2009-2015. The clinical and epidemiological information were gathered from recorded data available in the health center of Kohgilouyeh and Boyerahmad province, the southwest of Iran. RESULTS: The total number of patients diagnosed with brucellosis during the study period was 658, of whom, 339 (51.5%) were males. A total of 541 (82.2%) patients resided in rural and tribal areas, and the others lived in urban regions. The mean age of diagnosis was 39.59 ± 17.28 years and the most prevalent age groups were 31-50 (277, 42.1%) and 11-30 (178, 27.1%)-year olds. The most affected groups were housekeeper women (229, 34.8%) and ranchers (152, 23.1%). The relationship between jobs and disease was significant (P < 0.001). Transmission through either suspected dairy products (582, 88.4%) or close contact with infected livestock (537, 81.6%) comprised the most common routes of brucellosis dissemination. The clinical presentation was acute in the majority (581, 88.3%) of the patients. The highest titer for both wright and Coombs wright tests was 1:320. The most frequently administrated drugs were doxycycline and streptomycin (183, 27.8%). The most commonly observed clinical symptom was bone pain (477, 72.5%). Arthritis (12, 1.8%) comprised the most frequent drug-associated complication. Either relapse or treatment failure was recorded collectively in four (0.6%) patients. CONCLUSIONS: Due to the prevalence of the disease in the nomadic areas, timely detection and control of the disease is essential. Furthermore, livestock vaccination along with educating farmers and physicians about brucellosis can be helpful.

The Communicable Diseases Surveillance System in Iran: Challenges and Opportunities.

BACKGROUND: The aim of this study was to determine the challenges and opportunities of the Communicable Diseases Surveillance System (CDSS) in Iran. METHODS: This qualitative study was conducted using semi-structured interviews and focus group discussions (FGD) with 64 participants from October 2016 to April 2017. Purposeful sampling was used to recruit participants. The collected data were analyzed via the content analysis method. Data analysis was performed using MAXQDA10 software. RESULTS: The results of this qualitative study were categorized in two parts: Challenges and opportunities. The CDSS is facing challenges in the fields of stewardship, reporting, information analysis, information, interventions, and education. Good infrastructures and structure, the technical support provided by the Centre for Communicable Disease Control (CCDC), the achievements of the CDSS, and the suitable electronic systems are among the opportunities of CDSS. CONCLUSION: The results of this study showed that CDSS has several major challenges. Authorities and policymakers must not ignore communicable diseases and their management tools, including CDSS because of their focus on non-communicable diseases. Some important strategies to overcome the challenges of CDSS can be the following: motivating policy makers to put emphasis on communicable diseases as a national security issue, the ratification and modification of laws and regulations on reporting, the involvement of the CDSS in the accreditation of hospitals and the renewal of the license for healthcare professionals, and motivating organizations outside the health sector to participate in the programs through inter-institutional agreements.

Using Predictive Model for Screening Bacterial Meningitis in National Surveillance System in Iran.

Bacterial meningitis is a dangerous infectious disease that the entire community can be influenced by its epidemics. The objective of this study is to develop a predictive model as a screening tool to accelerate distinguishing between patients with acute bacterial meningitis and non-bacterial ones to prevent bacterial meningitis epidemics in Iran. This study was conducted on Iranian meningitis registry, which consists of 7,945 suspected cases of the disease between 2009 and 2011. Each sample has 8 predictive and a target variables. The predictive model was developed by decision tree algorithm and, the overall accuracy was 78%, with a sensitivity of 87%, and a specificity of 70%, respectively. This model can help health policymakers and epidemiologists to identify bacterial meningitis outbreaks and support them to make a decision in infection dynamics. In conclusion, we developed and validated a predictive model that can be used in meningitis surveillance system in Iran. However, further research is needed to use the model in practice with different pathogen types of bacterial meningitis in order to proper antimicrobial therapy planning.

Recommendations for the Clinical Management of Hepatitis C in Iran: A Consensus-Based National Guideline.

CONTEXT: Hepatitis C virus (HCV) infection is a major public health issue worldwide, including Iran. The new direct-acting antiviral agents (DAAs) with high efficacy have changed the landscape of HCV treatment. This guideline provides updated recommendations for clinical management of HCV infection in Iran. EVIDENCE ACQUISITION: The recommendations of this guideline are based on international and national scientific evidences and consensus-based expert opinion. Scientific evidences were collected through a systematic review of studies that evaluated efficacy and safety of DAA regimens, using PubMed, Scopus and Web of Science. Expert opinion was based on the consensus of Iran Hepatitis Scientific Board (IHSB) in the 3rd national consensus on management of Hepatitis C in Iran, held on 22nd of July 2016. RESULTS: Pegylated Interferon alpha (PegIFN), Ribavirin (RBV), Sofosbuvir (SOF), Ledipasvir (LDV) and Daclatasvir (DCV) are currently available in Iran. Pre-treatment assessments include HCV RNA level, HCV genotype and resistance testing, assessment of liver fibrosis, and underlying diseases. In HCV genotype 1 and 4, DCV/SOF and LDV/SOF are recommended. In HCV genotype 2, SOF plus RBV and in HCV genotype 3, DCV/SOF is recommended. Additional care for underlying diseases should be considered. CONCLUSIONS: Affordable new HCV treatment regimens are available in Iran, providing an opportunity for HCV elimination. Recommendations provided in this current national guideline can facilitate evidence-based management of HCV infection.

Epidemiology of Typhoid Fever in Iran during Last Five Decades from 1962-2011.

BACKGROUND: 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. METHODS: A retrospective cross-sectional study was conducted using typhoid fever national surveillance data. RESULTS: 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 between 1969-1996 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. CONCLUSION: 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.

The knowledge and attitudes of a female at-risk population towards the prevention of AIDS and sexually transmitted infections in Tehran.

BACKGROUND: The female at-risk population represents a subgroup that is both a crucial determining factor in acquired immune deficiency syndrome (AIDS) transmission and a gap in the existing literature in Iran. The objective of this study was to evaluate the level of sex workers' knowledge towards to safe procedures of sexually transmitted infection and AIDS prevention as well as attitudes towards AIDS. METHODS: A sample of 256 female sex workers working in Tehran was obtained by a variety of methods. Appropriate questions for the assessment of knowledge and attitude were developed based on previous studies. RESULTS: The mean age of the subjects was 26.8 ± 6.1 years (ranging from 16 to 45). Methods of transmission were widely recognized, despite the exception that few realized oral (23.4%) and anal (44.9%) intercourse as methods of human immunodeficiency virus (HIV) transmission. Most subjects knew that AIDS currently has no cure (81.2%) and no vaccine (73.4%). Most also acknowledged that HIV is transmissible from people who do not know they are HIV positive (59.4%), proper condom use can reduce the possibility of infection (78.1%), and so can having a single sexual partner (68.8%). Of the participants, 43.4% knew that an HIV-positive person can seem perfectly healthy. CONCLUSIONS: Knowledge towards sexually transmitted infections (STIs) and condom use is still inadequate, especially regarding risky behaviors such as anal sex, and attitudes are mainly negative. Identifying at-risk populations, HIV-positive sex workers, education and campaigns to change the attitudes towards AIDS should be regarded a high priority in Iran.