Epidemiology incidence and geographical distribution of leptospirosis using GIS and its incidence prediction in Iran in 2021.

Background: Leptospirosis is known as a public health problem in developing and developed countries. The aim of this study was to investigate the incidence and geographical distribution of leptospirosis using the Geographic Information System (GIS) and to predict its incidence in Iran in 2021. Methods: This was a descriptive analytical study. Information on leptospirosis was obtained from the Center for Communicable Diseases Control during 2009-2015. In the next step, The 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 results showed that the highest incidence of leptospirosis during 2009-2015 was observed in Gilan, Mazandaran, and Golestan provinces, respectively. The incidence of the disease had an increasing trend from 2013 to 2015. Based on the results of the modeling in Iran, the provinces of Gilan, Mazandaran, and Golestan, with 72.18%, 8.54%, and 4.95% of their area, respectively, have the largest areas at a high-risk for leptospirosis in the coming years. Conclusion: The prevalence of leptospirosis is affected by geographical and climatic conditions of every region; thus, the incidence of the disease is higher in the provinces located at the Caspian coastal side and in some regions in Semnan province. Hence, if health authorities pay more attention to developing health plans to prevent the disease, the risk of disease in these areas will be reduced in the future.

Iran in transition.

Being the second-largest country in the Middle East, Iran has a long history of civilisation during which several dynasties have been overthrown and established and health-related structures have been reorganised. Iran has had the replacement of traditional practices with modern medical treatments, emergence of multiple pioneer scientists and physicians with great contributions to the advancement of science, environmental and ecological changes in addition to large-scale natural disasters, epidemics of multiple communicable diseases, and the shift towards non-communicable diseases in recent decades. Given the lessons learnt from political instabilities in the past centuries and the approaches undertaken to overcome health challenges at the time, Iran has emerged as it is today. Iran is now a country with a population exceeding 80 million, mainly inhabiting urban regions, and has an increasing burden of non-communicable diseases, including cardiovascular diseases, hypertension, diabetes, malignancies, mental disorders, substance abuse, and road injuries.

Antimicrobial investigation on the multi-state outbreak of salmonellosis and shigellosis in Iran.

Background: Foodborne diseases are caused by indigestion of contaminated food. In some cases they may result in either hospitalization or death. The Centers for Disease Control (CDC) and Prevention in 2017 stated that 10% reduction in foodborne illness would prevent nearly five million illnesses every year. Approximately one out of six Americans become ill from contaminated foods or beverages every year. Another problem is drug resistance which is responsible for approximately 2 million illnesses and around 23000 dead every year. Nearly 400,000 Americans acquire antibiotic-resistant Salmonella or Campylobacter each year. The aim of this study was to evaluate the outbreak of salmonellosis and shigellosis along with their antibiotic susceptibility patterns in different provinces of Iran. Methods: Over a period of 2 years from 2015 to 2016, a total of 1055 cases in 249 outbreaks reported in 20 provinces of Iran, as a part of surveillance by the National Institute of Health (NIH). The stool samples of patients were taken and tested for Salmonella spp. and Shigella spp. by conventional standard techniques. Disk diffusion was used for the antibiotic sensitivity test. Results: Of 1055 cases, 118 (11.2%) contained Shigella and 74 (7%) contained Salmonella. Antibiotic susceptibility tests showed that entirely 100% of Salmonella and Shigella isolates were susceptible to ciprofloxacin; whereas 12.2% of Salmonella and 98.2% of Shigella were resistant to cotrimoxazole. Conclusion: Our results show that there is a need for more food handling practices to minimize the exposure of consumers to Salmonella and Shigella , at all points along the distribution chain.

National Minimum Data Set for Antimicrobial Resistance Management: Toward Global Surveillance System.

BACKGROUND: Success of infection treatment depends on the availability of accurate, reliable, and comprehensive data, information, and knowledge at the point of therapeutic decision-making. The identification of a national minimum data set will support the development and implementation of an effective surveillance system. The goal of this study was to develop a national antimicrobial resistance surveillance minimum data set. METHODS: In this cross-sectional and descriptive study, data were collected from selected pioneering countries and organizations which have national or international antimicrobial resistance surveillance systems. A minimum data set checklist was extracted and validated. The ultimate data elements of the minimum data set were determined by applying the Delphi technique. RESULTS: Through the Delphi technique, we obtained 80 data elements in 8 axes. The resistance data categories comprised basic, clinical, electronic reporting, infection control, microbiology, pharmacy, World Health Organization-derived, and expert-recommended data. Relevance coding was extracted based on the Iranian electronic health record coding system. CONCLUSION: This study provides a set of data elements and a schematic framework for the implementation of an antimicrobial resistance surveillance system. A uniform minimum data set was created based on key informants' opinions to cover essential needs in the early implementation of a global antimicrobial resistance surveillance system in Iran.

Double-stranded RNA viral infection of Trichomonas vaginalis (TVV1) in Iranian isolates.

The Totiviridae family includes a number of viruses that can infect protozoan parasites such as Leishmania and Giardia and fungi like Saccharomyces cerevisiae. Some isolates of Trichomonas vaginalis are also infected with one or more double-stranded RNA (dsRNA) viruses. In this study, the frequency of Trichomonas vaginalis virus (TVV1) was evaluated in Iranian isolates of T. vaginalis in Tehran, Iran. One thousand five hundred vaginal samples were collected from patients attending obstetrics and gynaecology hospitals associated with Iran University of Medical Sciences in Tehran, Iran from October 2015 to September 2016. Trichomonas vaginalis isolates were cultured in Diamond's modified medium. Nucleic acids were extracted using a DNA/RNA extraction kit and RT-PCR was performed. Among 1500 collected vaginal samples, 8 (0.53%) cases of T. vaginalis infection were found. Half (4/8) of the T. vaginalis positive cases were infected with TVV1. Phylogenetic mapping indicated that the Iranian isolates were most closely related to TVV1-OC5, TVV1-UR1. Iranian isolates of T. vaginalis were infected with TVV1. The frequency of viral infection (TVV1) in T. vaginalis isolates found in this study is higher than previously reported in Iran.

Methanol mass poisoning in Iran: role of case finding in outbreak management.

BACKGROUND: There are no guidelines addressing the public health aspects of methanol poisoning during larger outbreaks. The current study was done to discuss the role of active case finding and a national guideline that organizes all available resources according to a triage strategy in the successful management of a methanol mass poisoning in Rafsanjan, Iran, in May 2013. METHODS: A retrospective cross-sectional study was performed reviewing the outbreak Emergency Operation Center files. The objectives were to describe the characteristics, management and outcome of a methanol outbreak using Active Case Finding to trace the victims. RESULTS: A total of 694 patients presented to emergency departments in Rafsanjan after public announcement of the outbreak between 29th May and 3rd June 2013. The announcement was mainly performed via short message service (SMS) and local radio broadcasting. A total of 361 cases were observed and managed in Rafsanjan and 333 were transferred to other cities. Seventy-five and 100 patients underwent hemodialysis (HD), retrospectively. The main indication for HD was refractory metabolic acidosis. Eight patients expired due to the intoxication. Except for the deceased cases, no serum methanol level was available. CONCLUSION: In developing countries, where diagnostic resources are limited, use of active case finding and developing national guidelines can help in the management of large outbreaks of methanol poisonings.

QuantiFERON-TB Gold and Tuberculin Skin Test for the Diagnosis of Latent Tuberculosis Infection in Children.

BACKGROUND: Appropriate diagnosis and treatment of latent tuberculosis infection (LTBI) play the most important role in the control of tuberculosis. This study aimed to determine the prevalence of LTBI among healthy tuberculosis unexposed children vaccinated with BCG using the tuberculin skin test (TST) and QuantiFERON TB Gold In-Tube (QFT-GIT) and comparing the agreement between the two tests. METHODS: A cross-sectional study was carried out between October 2009 and March 2010 in 24 schools and 11 daycare centers. A total of 967 children were divided into 15 age groups, with a minimum of 64 children per group. RESULTS: The prevalence rates of LTBI with TST were 3.8%, and 2.2% with QFT-GIT. One case was positive in TST and QFT-GIT, 20 cases were QFT-GIT positive, but TST negative and 36 cases were TST positive, but QFT-GIT negative, and finally, 910 cases were negative in both. There was poor agreement between TST and QFT-GIT (1.8%, 95%, CI: 0%-5.3%, k=0.007). The specificity of QFT-GIT in the BCG vaccinated, children aged 1-15 years old, was 97.8% (97.8%, 95% CI: 96.8%-98.8%). After three months, 2/17 (11.8%) of those initially QFT-GIT negative converted, and 10/15 (66%) of those initially QFT-GIT positive reverted. CONCLUSION: It seems that TST and QFT-GIT are not appropriate tests for the diagnosis of LTBI among healthy tuberculosis unexposed BCG vaccinated children. There was a low reproducibility rate of QFT-GIT. The cause of the the poor agreement requires further studies.

Surveillance for foodborne disease outbreaks in Iran, 2006-2011.

BACKGROUND: The outbreaks of foodborne diseases is a major health problem and occur daily in all countries, from the most to the least developed. This study is the first report of foodborne outbreaks in Iran that carried out from 2006 to 2011. METHODS: A retrospective, longitudinal study carried out using foodborne disease national surveillance system data from 2006-2011, which have been reported by all provincial health centers to the Center for Communicable Disease Control. Collected data were analyzed using SPSS version 18 software. RESULTS: Since 2006 to 2011, a total of 2250 outbreaks were reported in Iran. Analyzed data showed that the outbreak rate has increased from 0.07/100000 in 2006 to 1.38/100000 population in 2011. Khuzestan, Kermanshah and Qazvin were three provinces that reported more outbreaks than nationally expected outbreak incidence rate during 2011. Analysis of epidemiological characteristics of foodborne outbreaks during 2011 indicated that the numbers of outbreaks were highest in warm months, e.g. 17.8% of total outbreaks was just reported in August. Females and age group of 16-30 years old were more affected and 55% of cases occurred in rural area. Among 684 human samples which have been tested, E. coli, Shigella, Hepatitis A and Vibrio cholera were predominant etiologic agents respectively. CONCLUSION: Increasing the detection rate of foodborne outbreaks imply the expansion of surveillance activities and improved primary health care in Iran in recent years. Foodborne disease surveillance system is a new program in Iran that should be continued and strengthened including diagnostic laboratory capacities.

Frequency of five Escherichia Coli pathotypes in Iranian adults and children with acute diarrhea.

BACKGROUND: Knowledge about the distribution of Escherichia Coli (E. coli) pathotypes in Iran is limited. This nation-wide survey aims to provide a comprehensive description of the distribution of five pathogenic E. coli in Iran. METHODS: Stool samples were collected from 1,306 acute diarrhea cases from 15 provinces (2013-2014). E. coli-positive cultures underwent PCR testing for the detection of STEC, ETEC, EPEC, EAEC, and EIEC pathotypes. Pathotype frequency by province, age-group, and season was estimated. RESULTS: 979 diarrhea samples (75.0%) were culture-positive for E. coli (95% CI: 72.6, 77.3%), and 659 (50.5%) were pathogenic E. coli (95% CI: 47.8, 53.2%). STEC was the most frequent pathotype (35.4%). ETEC (14.0%) and EPEC (13.1%) were the second and the third most frequent pathotypes, respectively. EAEC (4.3%) and EIEC (0.3%) were not highly prevalent. Fars (88.7%) and Khorasan-e-Razavi (34.8%) provinces had the highest and lowest frequencies, respectively. E. coli pathotypes were more frequent in warmer than cooler seasons, showed the highest frequency among children under five years of age (73%), and had no significant association with participants' gender. CONCLUSIONS: Diarrheagenic E. coli may be an important cause of acute diarrhea in adults and children in Iran. STEC and ETEC seem to be widespread in the country with a peak in warmer seasons, impacting the recommended use of seasonal STEC and ETEC vaccines, especially in high-risk groups. Monitoring the incidence of E. coli pathotypes, serotypes, and antibiotic resistance over time is highly recommended for evaluation of interventions.

The epidemiology of cholera in the Islamic Republic of Iran, 1965-2014.

BACKGROUND: Cholera is endemic in the Islamic Republic of Iran. According to surveillance system records and historical documents, cholera epidemics have led to thousands of deaths throughout the country in past centuries. AIMS: The aim of this study was an overview of cholera disease during the last 5 decades (1965-2014) and the epidemiological features of the most recent large-scale outbreaks. METHODS: In this descriptive study, cholera incidence data provided by the National Surveillance Database were extracted and significant fluctuating trends for 1965-2014 were tested using the Cochran-Armitage test. To identify the factors most associated with cholera incidence in the outbreaks, adjusted odds ratios were computed by ordinal logistic regression. RESULTS: Analysis of data has shown a tremendous decrease in incidence trends, from 19.7/100 000 to 0.01/100 000 over the 9 cholera epidemics that occurred at 5-6 year intervals during 1965-2014. Younger age groups (15-44 years) and inhabitants in urban areas have been more vulnerable to cholera in recent epidemics. The virulence of the pathogen and the case fatality rates have not changed during the last 3 epidemics. CONCLUSION: The burden of cholera in terms of case load has dramatically reduced during 1965-2014. Furthermore, the epidemiological feature of cholera with regard to transmission route, domicile, age, immigration, mortality and antimicrobial resistance has changed considerably in recent epidemics. While the number of epidemic regions has diminished, some areas are still susceptible to cholera outbreaks.

Enteric Opportunistic Infection and the Impact of Antiretroviral Therapy among HIV/AIDS Patients from Tehran, Iran.

BACKGROUND: Opportunistic parasites have been identified as human pathogens, especially in immunodeficient patients. Microsporidian and coccidian infections cause chronic diarrhea as common clinical manifestation in HIV positive patients. In this study, the frequency of opportunistic infections, including microsporidian and coccidian infections, was evaluated in HIV/AIDS patients from Tehran and phylogenic analysis was performed for E. bieneusi isolates from these patients. METHODS: One hundred and two stool samples were collected from confirmed HIV/AIDS patients, referred to Consult Center of Behavior Diseases, West Health Center, Iran University of Medical Sciences in Tehran, Iran. The samples were transferred to Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences from Jan 2016 to Dec 2016. After conventional formalin-ether concentration, aniline blue staining method and acid-fast staining technique were used for detection of microsporidian spores and Cyclospora oocysts. DNA was extracted and nested PCR was performed. RESULTS: Two (1.96%) cases were found to be positive for intestinal microsporidia infection using aniline blue staining method and were confirmed as E. bieneusi by nested PCR. One patient was found with Cyclospora cayetanensis infection by acid-fast staining method and PCR. Giardia lamblia and Blastocystis hominis were detected as non-opportunistic parasites in 1/102 (0.98%) and 2/102 (1.96%) of the HIV positive patients, respectively. CONCLUSION: With respect to the use of antiretroviral therapy (ART) in HIV positive patients, we found a low frequency of infection.

Prevalence and Genotyping of Trichomonas vaginalis Infected to dsRNA Virus by PCR-Restriction Fragment Length Polymorphism (RFLP).

BACKGROUND: Trichomonas vaginalis is a prevalent sexually transmitted infection cause trichomoniasis. In this study prevalence and genotype of Iranian isolates of T. vaginalis infected (dsRNA) viruses were evaluated by PCR-RFLP and obtained patterns were then confirmed by sequence analysis and genotype of these Iranian isolates confirmed again. METHODS: Ten strains of T.vaginalis were collected from 1700 vaginal samples of women referred to hospitals associated with Iran University of Medical Sciences in Tehran, Iran during Feb 2016 to Jul 2017, evaluated in points of infection to T. vaginalis Virus (TVV-1) were used in a PCR-RFLP. All of ten isolates of T. vaginalis were examined by designed nested PCR for actin gene and then digestion patterns of three endonuclease enzymes of HindII, MseI and RsaI were evaluated and genotype of these isolates was defined. RESULTS: By combination of fragments pattern of three enzymes of HindII, RsaI and MseI, three genotypes were found; six genotypes E, two genotypes G and two genotypes I. The most dominant genotypes were genotype E. Among four TVV infected isolates two genotype E, one genotype G and one genotype I were found, however among six uninfected T. vaginalis isolates to TVV-1, all of three genotypes were also found. CONCLUSION: Three genotypes E, G and I in T. vaginalis infected with dsRNA isolates were found, however, these three genotypes in T. vaginalis without virus were also observed. Further study is needed to evaluate genotypes of T. vaginalis, which infected virus in more great T. vaginalis population.

The design and evaluation of an antimicrobial resistance surveillance system for neonatal intensive care units in Iran.

INTRODUCTION: Neonatal intensive care units (NICUs) have complex patients in terms of their diagnoses and required treatments. Antimicrobial treatment is a common therapy for patients in NICUs. To solve problems pertaining to empirical therapy, antimicrobial stewardship programs have recently been introduced. Despite the success of these programs in terms of data collection, there is still inefficiency in terms of analyzing and reporting the data. Thus, to successfully implement these stewardship programs, the design of antimicrobial resistance (AMR) surveillance systems is recommended as a first step. As a result, this study aimed to design an AMR surveillance system for use in the NICUs in northwestern Iranian hospitals to cover these information gaps. METHODS: The recommended system is compatible with the World Health Organization (WHO) guidelines. The business intelligence (BI) requirements were extracted in an interview with a product owner (PO) using a valid and reliable checklist. Following this, an AMR surveillance system was designed and evaluated in relation to user experiences via a user experience questionnaire (UEQ). Finally, an association analysis was performed on the database, and the results were reported by identifying the important multidrug resistances in the database. RESULTS: A customized software development methodology was proposed. The three major modules of the AMR surveillance are the data registry, dashboard, and decision support modules. The data registry module was implemented based on a three-tier architecture, and the Clinical Decision Support System (CDSS) and dashboard modules were designed based on the BI requirements of the Scrum product owner (PO). The mean values of UEQ measures were in a good range. This measures showed the suitable usability of the AMR surveillance system. CONCLUSION: Applying efficient software development methodologies allows for the systems' compatibility with users' opinions and requirements. In addition, the construction of interdisciplinary communication models for research and software engineering allows for research and development concepts to be used in operational environments.

Health care-associated infections in Iran: A national update for the year 2015.

BACKGROUND: A national surveillance system for health care-associated infections (HAIs) in Iran is relatively new, and an update on incidence and mortality rates can aid clinicians and stakeholders in development of new guidelines and imperative modifications to be made. METHODS: Data were extracted from the national HAIs surveillance software for more than 7 million hospitalizations during 2015. Data regarding age, gender, deaths, ward of admission, and microbiologic findings were collected and analyzed. RESULTS: From 491 hospitals, 7,018,393 hospitalizations were reported during 2015; 82,950 patients had been diagnosed with at least 1 HAI, 6,355 of whom died (crude fatality rate, 7.7). Men comprised 51.4% of the patients. The incidence rate was calculated to be 1.18. Urinary tract infections and pneumonia were the most commonly reported infections (27.9% and 23.8%) and 33% of patients were older than age 65 years. Intensive care units had the highest incidence rates, followed by burn units with incidence rates close to 9. Highest percentages of deaths were reported among patients with an HAI in the intensive care unit (20.6%) and those with pneumonia (39.6%). CONCLUSION: Although the underreporting of HAIs hinders accurate calculation of incidence, the present study provides a general update. The results can help in modification of national guidelines and appropriate choice of antimicrobial agents in the management of HAIs.

Eliminating Healthcare-Associated Infections in Iran: A Qualitative Study to Explore Stakeholders' Views.

BACKGROUND: Although preventable, healthcare-associated infections (HAIs) continue to pose huge health and economic burdens on countries worldwide. Some studies have indicated the numerous causes of HAIs, but only a tiny literature exists on the multifaceted measures that can be used to address the problem. This paper presents stakeholders' opinions on measures for controlling HAIs in Iran. METHODS: We used the qualitative research method in studying the phenomenon. Through a purposive sampling approach, we conducted 24 face-to-face interviews using a semi-structured interview guide. Participants were mainly key informants, including policy-makers, health professionals, and technical officers across the national and subnational levels, including the Ministry of Health (MoH), medical universities, and hospitals in Iran. We performed thematic framework analysis using the software MAXQDA10. RESULTS: Four main interdisciplinary themes emerged from our study of measures of controlling HAIs: strengthening governance and stewardship; strengthening human resources policies; appropriate prescription and usage of antibiotics; and environmental sanitation and personal hygiene. CONCLUSION: According to our findings, elimination of HAIs demands multifactorial interventions. While the ultimate recommendation of policy-makers is to have HAIs among the priorities of the national agenda, financial commitment and the creation of an enabling work environment in which both patients and healthcare workers can practice personal hygiene could lead to a significant reduction in HAIs in Iran.

A national framework for an antimicrobial resistance surveillance system within Iranian healthcare facilities: Towards a global surveillance system.

OBJECTIVES: The threat of antimicrobial resistance (AMR) is growing rapidly, perhaps more dramatically in developing countries. A demand to monitor, surveil and predict AMR has prompted the design and implementation of AMR surveillance systems (AMRSSs) at all geographic levels, especially in the national context. This study reviewed AMRSSs in leading countries and organisations in order to customise a comprehensive framework for a national system in Iran. METHODS: The research was conducted in two phases: a review of the literature and comparative analysis; and a knowledge, attitude and practice study. In the first phase, the AMRSSs of pioneering organisations and countries were reviewed by examining related documents. In the second phase, important components for the Iranian national system were determined on the basis of the World Health Organization's Global Antimicrobial Resistance Surveillance System (WHO GLASS). RESULTS: This study determined the surveillance methods, priority specimens and pathogens, testing methods, reporting protocols and scheduling, recommended data sets, and tools and information flow necessary for the Iranian system. On this basis, a national framework was developed using the class and activity diagrams in Unified Modelling Language. A context diagram was also designed on the basis of a generic biosurveillance architecture. CONCLUSIONS: The design and implementation of a national AMRSS for Iranian healthcare facilities is critically required because of irrational antimicrobial use in Iran and insufficient data regarding its consequences.

Prophylactic efficacy of primaquine for preventing Plasmodium falciparum and Plasmodium vivax parasitaemia in travelers: A meta-analysis and systematic review.

BACKGROUND: With increased international travel over the world the need for safe and effective chemoprophylaxis for malaria is as great as ever. The choice of regimen is difficult, as effectiveness should be weighted against potential adverse effects. Although, some studies have reported high prophylactic efficacy of primaquine, there is no comprehensive evidence comparing its prophylactic effectiveness as well as toxicity. To fill the gap, this systematic review and meta-analysis study was carried out. METHODS: Using MeSH terms, 756 records were detected through searching "Pubmed", "Embase","Web of Science"and "Cochrane" databases. From these,7 relevant full-text articles with 14 comparisons for final quantitative meta-analysis were included in our review. In order to make a comparison between the studies, Risk Ratios(RRs) and their 95% confidence intervals(CIs) were estimated. RESULTS: Overall,74% reduction in the incidence of parasitaemia by primaquine versus other prophylactic regimens was estimated(RRoverall = 0.26, CI 95%:0.16-0.41--RRvivax = 0.16, CI 95%:0.07-0.36--RRfalciparum = 0.31, CI 95%:0.18-0.55). The incidence rate ratios for adverse effects showed no statistically significant difference between primaquine and control groups (p > 0.05). CONCLUSIONS: For persons without G6PD deficiency, who are not pregnant, primaquine is the most effective presently available prophylactic for P. vivax malaria and comparable to such regimens as doxycycline, mefloquine and atovaquone-proguanil for the prevention of P. falciparum malaria.

The epidemiology and antimicrobial resistance of cholera cases in Iran during 2013.

BACKGROUND AND OBJECTIVES: Cholera is an endemic diarrheal disease in Iran, caused by Vibrio Cholerae. The epidemiology, transmission route, environmental determinants and antimicrobial resistant pattern of cholera have been changed during recent years. In this study the epidemiology and antimicrobial resistance of cholera in Iran during 2013 outbreak was investigated. MATERIALS AND METHODS: A retrospective, cross-sectional study was carried out using cholera national surveillance system collected data in 2013. Bacterial identification and antimicrobial susceptibility testing were done on 60 Vibrio cholerae isolates, serotype Inaba. RESULTS: During July to November 2013, 256 confirmed cholera cases were diagnosed by stool culture. Two hundred and eleven out of 256 (83%) cases were imported from Afghanistan and Pakistan. The prevalent age group was 16-30 years old, 90% were male, 98.8% affected by Inaba serotype and case fatality rate was 2.7%. The results of antimicrobial susceptibility testing on 60 V. cholerae, serotype Inaba showed that all isolates were resistant to nalidixic acid, tetracyclin and trimethoprim-sulfamethoxazole and intermediate resistance to erythromycin but sensitive to ciprofloxacin, cefixime and ampicillin. CONCLUSION: Migrants from neighboring countries played a key role in cholera outbreak in Iran during 2013. The results of antimicrobial susceptibility testing on 60 V. cholerae, serotype Inaba showed an increasing resistance rate in comparison with previous years.

Prevention and control of health care-associated infections in Iran: A qualitative study to explore challenges and barriers.

BACKGROUND: Globally, the health and economic burden posed by health care-associated infections (HAIs) remains wide and severe. To curb the burden associated with HAIs, countries, including Iran, aim at HAI prevention and control. This study explores the challenges faced by the Iranian health system in addressing the issues associated with the prevention and control of HAIs. METHODS: A qualitative research method was adopted in exploring the phenomenon. We used the purposive sampling approach in reaching 24 key informants at the national and subnational levels. The thematic framework analysis was conducted for analyzing the interviews. RESULTS: Five main themes emerged from our study demonstrating the obstacles toward the prevention and control of HAIs. They include governance and stewardship, resources, safety culture, monitoring and surveillance systems, and inappropriate prescription of antibiotics. CONCLUSIONS: Strengthening of reporting and surveillance systems for HAIs coupled with proper governance and stewardship are crucial in order to improve the health and safety of patients. However, the availability of resources, through an intersectoral approach, is essential to achieve sustained output.

Knowledge, Attitude, and Practice regarding Food, and Waterborne Outbreak after Massive Diarrhea Outbreak in Yazd Province, Iran, Summer 2013.

Objective. This Study was conducted after a diarrhea outbreak that occurred in Yazd Province, Iran. The aim of the study was to compare knowledge, attitude, practice, and other risk factors of the affected communities regarding diarrhea outbreak (the cities of Zarch, Meybod, and Ardakan) to nonaffected communities (the cities of Yazd and Taft). Methods. A knowledge, attitude, and practice (KAP) survey study was conducted from August to September 2013 enrolling 505 subjects who were referred to health centers anonymously during the epidemic. The questionnaire included the following four parts: (a) general characteristics such as gender, education level, source of health information obtaining; (b) 12 questions on knowledge (Min = 0, Max = 36); (c) 10 questions on attitude (Min = 0, Max = 50); and (d) nine questions on practice (Min = 0, Max = 27). Results. The overall mean score of knowledge, attitude, and practice was 28.17 (SD = 4.58), 37.07 (SD = 4.39), and 21.31 (SD = 3.81), respectively. Practice on food- and waterborne outbreaks was significantly higher in females (P = 0.001) and in nonaffected communities (P = 0.031). Conclusions. Nonaffected communities had a considerably better practice score. With the increase in the score of knowledge about food- and waterborne outbreaks, the score of practice increased slightly.