Rabies Prophylaxis Strategy in Iran, a Need for an Alternative Strategy: Would the Essen Regimen be Replaced by Zagreb Protocol?

BACKGROUND: Rabies is a fatal zoonotic infectious disease, which can be prevented by prompt post-exposure prophylaxis that could be expensive in countries with a large population. The Essen protocol with injection of 5 single doses of human rabies vaccine on separate days is a well-known rabies prophylaxis schedule. Decreasing the number of vaccine doses and the number of clinical visits due to an effective alternative schedule is strongly needed. The 2-1-1 regimen, known as Zagreb, is one of the best candidates to succeed Essen. METHODS: To evaluate the effectiveness of Zagreb regimen in the Iranian population by using the Purified Vero cell Rabies Vaccine (PVRV), anti-rabies antibody titer was measured in volunteers with second and third exposure through Rapid Fluorescent Focus Inhibition Test (RFFIT) and Enzyme Linked Immunosorbent Assay (ELISA) test and compared with patients, who were treated according to the Essen protocol. RESULTS: In all participants, anti-rabies antibody titer reached the protective level with no suppressive effect of rabies immunoglobulin in patients with third exposure in Zagreb regimen. CONCLUSIONS: Zagreb regimen could be considered a suitable alternative for the Essen protocol.

Potential Risk Areas of Aedes albopictus in South-Eastern Iran: A Vector of Dengue Fever, Zika, and Chikungunya.

The possibility of the rapid and global spread of Zika, chikungunya, yellow fever, and dengue fever by Aedes albopictus is well documented and may be facilitated by changes in climate. To avert and manage health risks, climatic and topographic information can be used to model and forecast which areas may be most prone to the establishment of Ae. albopictus. We aimed to weigh and prioritize the predictive value of various meteorological and climatic variables on distributions of Ae. albopictus in south-eastern Iran using the Analytical Hierarchy Process. Out of eight factors used to predict the presence of Ae. albopictus, the highest weighted were land use, followed by temperature, altitude, and precipitation. The inconsistency of this analysis was 0.03 with no missing judgments. The areas predicted to be most at risk of Ae. albopictus-borne diseases were mapped using Geographic Information Systems and remote sensing data. Five-year (2011-2015) meteorological data was collected from 11 meteorological stations and other data was acquired from Landsat and Terra satellite images. Southernmost regions were at greatest risk of Ae. albopictus colonization as well as more urban sites connected by provincial roads. This is the first study in Iran to determine the regional probability of Ae. albopictus establishment. Monitoring and collection of Ae. albopictus from the environment confirmed our projections, though on-going field work is necessary to track the spread of this vector of life-threatening disease.