IRAN National Cancer Control Program (IrNCCP): Goals, Strategies, and Programs.

Background: Annually, over 131000 new cases of cancer have been identified in Iran, with an increasing trend that is predicted to grow by 40% by 2025. The most important contributing factors to this increase are the improvement of the health service delivery system, increased life expectancy, and the aging of the population. The aim of this study was to develop Iran's "National Cancer Control Program" (IrNCCP). Methods: The present study is a cross-sectional study that was conducted in 2013 using the method of reviewing studies and documents and focused group discussions and a panel of experts. In this study, the available evidence related to cancer status and its care in Iran and other countries, as well as national and international upstream documents, were reviewed and analyzed. Then, by analyzing the current situation in Iran and other countries and conducting stakeholder analysis with the strategic planning approach, the IrNCCP was developed with a 12-year horizon consisting of goals, strategies, programs, and performance indicators. Results: This program has 4 main components, including Prevention, Early Detection, Diagnosis and Treatment, and Supportive and Palliative care, as well as 7 supporting components including Governance and policy-making, Cancer Research, Developing facilities, equipment, and service delivery network, Providing and managing human resources, Providing and managing financial resources, Cancer information system management and registry, and Participation of NGOs, charities, and the private sector. Conclusion: Iran's National Cancer Control Program has been developed comprehensively with cross-sectoral cooperation and stakeholder participation. However, like any long-term health intervention, strengthening its governance structure both in terms of implementation and achievement of expected goals and evaluation and modification during the implementation of the program is essential.

Molecular epidemiology of hepatitis C virus among injection drug users in Iran: a slight change in prevalence of HCV genotypes over time.

Injecting drug users (IDUs) are the main at-risk population for hepatitis C virus (HCV) transmission. We studied HCV infection, risk factors, and genotype distribution in relation to the year of first injection among Iranian IDUs. Of a total of 126 specimens positive for HCV antibody, 93 (74 %) had detectible HCV RNA, and the NS5B gene was sequenced for 83, with genotype 3a (n = 48, 58 %) being predominant, followed by 1a (n = 35, 42 %). Tattooing was an independent predictor for HCV infection. No significant difference was found between HCV genotypes and IDU characteristics. Although there was no change in the distribution of prevalent genotypes before and after 1997, a slight variation in the prevalence was observed (p = 0.71). The difference in the prevalence of subtypes 1a and 3a (9.1 % in the period 1984-1996 and 18.2 % in the period 1997-2009) during 25 years was 9.1 %. These findings indicate a high prevalence of HCV infection among Iranian IDUs and highlights HCV-3a as the most prevalent subtype for the past 25 years. Harm-reduction strategies appear to be the most important measures to reduce the transmission of HCV in Iran.

Temporal analysis of the incidence of meningitis in the Tehran metropolitan area, 1999-2005.

OBJECTIVES: The aim of this study was to describe the temporal determinants of meningitis incidence in the population living in the Tehran metropolis. METHODS: All cases of meningitis reported to health districts throughout the Tehran metropolis from 1999 to 2005 were abstracted from patient files. Referral cases (patients who did not reside in the Tehran metropolis) were excluded. For each year, sex- and age-specific incidences were estimated. Temporality and its determinants were analyzed using Poisson regression. RESULTS: Age-specific incidence is highest among males younger than 5 years of age at 10.2 cases per 100,000 population per year. The lowest incidence was among females aged 30 to 40 years at 0.72 cases per 100,000 population per year, with an overall male-to-female incidence ratio of 2.1. The temporal analysis showed seasonality, with a higher risk of meningitis in spring at a rate ratio of 1.31 with a 95% confidence interval (CI) of 1.20 to 1.41 and in autumn (rate ratio = 1.16, 95% CI 1.06, 1.27). For periodicity, we found a peak of occurrence around the years 2000 and 2003. CONCLUSION: The epidemiology of meningitis in Iran follows similar patterns of age, sex, and seasonality distribution as found in other countries and populations.

Patient-to-Patient Transmission of Hepatitis C at Iranian Thalassemia Centers Shown by Genetic Characterization of Viral Strains.

BACKGROUND: Hepatitis C is prevalent among thalassemia patients in Iran. It is mainly transfusion mediated, in particular among patients treated before 1996 when blood screening was introduced. OBJECTIVES: The current study aimed to investigate why patients still seroconvert to anti-HCV in Iranian thalassemia centers. PATIENTS AND METHODS: During 2006-2007 sera were sampled from 217 anti-HCV positive thalassemia patients at nine thalassemia centers in Tehran and Amol city, where 34 (16%) patients had been infected after 1996. The HCV subtype could be determined by sequencing and phylogenetic analysis of partial NS5B and/or 5׳NCR-core region in 130 strains. RESULTS: 1a (53%) was predominant followed by 3a (30%), 1b (15%), and one strain each of 2k, 3k and 4a. Phylogenetic analysis revealed 19 clades with up to five strains diverging with less than six nucleotides from each other within subtypes 1a and 3a. Strains in seven clades were from nine patients infected between 1999 and 2005 and similar to strains from eight patients infected before 1996, indicating ongoing transmission at the centers. Further epidemiological investigation revealed that 28 patients infected with strains within the same clade had frequently been transfused at the same shift sitting on the same bed. An additional eight patients with related strains had frequently been transfused simultaneously in the same room. CONCLUSIONS: The results suggest nosocomial transmission at these thalassemia centers both before and after the introduction of blood screening. Further training of staff and strict adherence to preventive measures are thus essential to reduce the incidence of new HCV infections.