Cluster of Middle East respiratory syndrome coronavirus infections in Iran, 2014.

During January 2013-August 2014, a total of 1,800 patients in Iran who had respiratory illness were tested for Middle East respiratory syndrome coronavirus. A cluster of 5 cases occurred in Kerman Province during May-July 2014, but virus transmission routes for some infections were unclear.

Vaccine-associated paralytic poliomyelitis in immunodeficient children, Iran, 1995-2008.

To determine the prevalence of vaccine-associated paralytic poliomyelitis (VAPP) in immunodeficient infants, we reviewed all documented cases caused by immunodeficiency-associated vaccine-derived polioviruses in Iran from 1995 through 2008. Changing to an inactivated polio vaccine vaccination schedule and introduction of screening of neonates for immunodeficiencies could reduce the risk for VAPP infection.

Isolation of a type 3 vaccine-derived poliovirus (VDPV) from an Iranian child with X-linked agammaglobulinemia.

Type 3 immunodeficiency-associated vaccine-derived polioviruses (iVDPVs) were isolated from a 15-month-old Iranian boy with acute flaccid paralysis (AFP) who was subsequently diagnosed with X-linked agammaglobulinemia (XLA). VP1 nucleotide sequences of the two isolates differed from Sabin 3 by 2.0% and 2.1% and from each other by 0.6%. Although the key determinant of attenuation and temperature sensitivity in the 5'-untranslated region (U(472)-->C) had reverted, a second capsid-region determinant (VP3:Phe(091)) was unchanged, but a presumptive suppressor (VP1:Ala(054)-->Val) was found. The isolates were Sabin 3/Sabin 1 recombinants, sharing a single recombination breakpoint in the 2C region. Although the two isolates were antigenically distinct from Sabin 3, only one amino acid replacement was found in the neutralizing antigenic sites (VP3:Ser(059)-->Asn in site 3). The patient was placed on intravenous immunoglobulin (IVIG) therapy within 9 days of onset of AFP, and iVDPV excretion ceased thereafter, but the patient remained severely paralyzed until his death approximately 11 months after paralysis. No secondary AFP cases were found, and none of the seven tested contacts of the patient were found to be infected with poliovirus.

Novel BTK mutation presenting with vaccine-associated paralytic poliomyelitis.

Oral polio vaccine (OPV) has been used safely and efficiently for more than 40 years in preventive medicine. Vaccine-associated paralytic poliomyelitis (VAPP) is a rare adverse event of OPV due to reversion of the vaccine strain virus to a neurovirulent strain. VAPP can occur in healthy recipients or their close contacts. However, persons with primary humoral immunodeficiencies are at a much higher risk. X-linked agammaglobulinemia (XLA) is a prototypic humoral deficiency caused by mutations in the Bruton's tyrosine kinase (BTK) gene. In addition to susceptibility to bacterial infections, patients with XLA are especially prone to enteroviruses. Here, we describe the occurrence of VAPP in a 15-month old Iranian boy. The child had received four doses of OPV, administered at birth, 2, 4, and 6 months of age. The patient's infectious history was unremarkable. Laboratory evaluation revealed low levels of immunoglobulin G and CD19(+) B cells of less than 1% of the lymphocyte population. A novel insertion (c.685_686insTTAC) in the SH3 domain of the BTK gene was detected as the underlying cause. Immunodeficient recipients of OPV can excrete poliovirus vaccine strains for a long period and are at risk of developing flaccid paralysis. They could also serve as a source of reverted virulent poliovirus to be reintroduced into the general population. This patient presented for the first time with VAPP, without any history of other major infections in 15 months. This suggests that a negative history for recurrent infections does not exclude the presence of a primary defect in the immune system.

Mosquito Surveillance and the First Record of the Invasive Mosquito Species Aedes (Stegomyia) albopictus (Skuse) (Diptera: Culicidae) in Southern Iran.

BACKGROUND: Epidemics of mosquito-borne viral infections such as dengue, chikungunya, West Nile and Rift Valley fevers in neighbouring countries and risk of introduction of exotic vectors into Iran have placed this country at a significant risk for these mosquito-borne diseases. METHODS: After the first dengue case reported in Iran in 2008, active entomological surveillance of Aedes albopictus (Skuse) and Ae. aegypti (Linnaeus) were conducted in May/Jun, Sep, and Oct/Nov, 2008-2014. Based on occurrence of dengue cases and the presence of potential entry sides including ports and boarder gates, 121 sites in eight provinces were monitored for mosquito vectors. Larval collections were carried out using droppers or dippers and adult collections with CDC light traps, human landing catches, aspirator and Pyrethrum spray space catches. RESULTS: A total of 8,186 larvae and 3,734 adult mosquitoes were collected belonging to 23 Culicinae species, including 13 of the genus Culex, 1 Culiseta, 1 Uranotaenia, and 8 of the genus Aedes. Five Aedes albopictus larvae were identified from the Sistan & Baluchestan province bordering Pakistan in 2009. In 2013, seven Ae. albopictus adult mosquitoes were also collected in a coastal locality near the city of Chabahar in the same province. CONCLUSION: The detection of larvae and adults of this species in different parts of this province reveal its probable establishment in southeast Iran, which has implications for public health and requires active entomological surveillance as well as the implementation of vector control to prevent the further spread of this critical vector.

Sexual and reproductive health needs of HIV-positive people in Tehran, Iran: a mixed-method descriptive study.

BACKGROUND: People Living with HIV (PLHIV) are highly stigmatized and consequently hard-to-access by researchers and importantly, public health outreach in Iran, possibly due to the existing socio-cultural situation in this country. The present study aimed to evaluate the sexual and reproductive health needs of PLHIV in Tehran, the capital of Iran. METHODS: As a mixed-method descriptive study, this project was conducted in 2012 in Tehran, Iran. In this study, we evaluated and discussed socio-demographic characteristics, family and social support, sexual behaviors, fertility desires and needs, PMTCT services, contraceptive methods, unintended pregnancy and safe abortion, and Pap smear tests among 400 participants referring to the behavioral disorders consulting centers. RESULTS: Of the sample 240 (60%) were male and 160 (40%) were female. About 50% of women and 40% of men were 25-34 years old. More than 60% of men and 96% of women were married, while more than 50% of the participants had HIV-positive spouses at the time of study. According to the results, fertility desire was observed among more than 30% of female and 40% of male participants. Results of the in-depth interviews indicate that the participants are not satisfied with most of the existing services offered to address their sexual and reproductive health needs. CONCLUSION: Despite the availability of services, most of sexual and reproductive health needs of the PLHIV are overlooked by the health system in Iran. Paying attention to sexual and reproductive health needs of PLHIV in Iran not only protects their right to live long and healthy lives, but also may prevent the transmission of HIV from the patients to others within the community.

Seroepidemiological survey of tularemia among different groups in western Iran.

BACKGROUND: The first human case of tularemia in Iran was reported in 1980 and there have been no subsequent reports of tularemia in the country. The aim of this study was to carry out a survey of tularemia among different groups in the province of Kurdistan in western Iran. METHODS: The following information was collected by means of an in-house questionnaire: participant demographic characteristics, exposure to risks, and use of appropriate personal protective equipment and disinfectant in their occupation. A blood sample was collected from each participant. Sera were tested using an ELISA kit (Virion\Serion) to detect specific IgG antibodies against Francisella tularensis. RESULTS: Of a total of 250 serum samples, 14.40% had anti-tularemia IgG antibodies. The highest seroprevalence was found in hunters (18%) and the lowest in health care workers (12%). Age had a significant positive association with tularemia seroprevalence (p<0.001). The seroprevalence of tularemia in people exposed to foxes (hunting or eating the meat) (25%) was significantly higher than in others (8.65%) (p = 0.01). CONCLUSIONS: According to the findings of this study, it is highly recommended that physicians and health care workers are informed about bacteria circulating in this area. By sensitizing the health system, it is expected that some cases of the clinical disease will be reported in the near future. Similar studies in other parts of the country and on domestic and wild animals will clarify the epidemiology of tularemia in Iran.

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.

Hepatitis B vaccination of adolescents: a report on the national program in Iran.

Since 2007, Iran's Ministry of Health carried out a nationwide hepatitis-B vaccination campaign for 17-year-old adolescents in four stages. We report the outcomes of the second and third stages targeting adolescents born during 1990 and 1991. The National Committee for Hepatitis selected a passive approach--media education--for mass vaccination. (A community mobilization strategy, for example, would be termed active.) The target populations in 2008 and 2009 included 1 709 337 and 1 673 571 adolescents. In each year, Iran organized three rounds of vaccination throughout the country. At the end of each round, data were collected and sent to Ministry of Health for analysis. The overall coverage rate was 74.9 per cent for one dose of vaccination, and 62.76 per cent for all three doses in 2008; 75.7 per cent and 55.6 per cent, respectively in 2009. Coverage rates in rural areas were significantly higher (P<0.001). The media education approach achieved acceptable outcomes in current campaign. Constant performance monitoring, and perhaps a new catch-up vaccination campaign are warranted to expand coverage.

Influenza A (H1N1) pandemic in Iran: report of first confirmed cases from June to November 2009.

BACKGROUND: Since the declaration of a swine flu pandemic by the World Health Organization (WHO), the Islamic Republic of Iran has launched a surveillance system to test all suspected cases, both in community and hospital settings. METHODS: From June 1st to November 11th, 2009, there were 2662 (1307 females and 1355 males) RT-PCR confirmed cases of pandemic influenza A (H1N1) detected in Iran. Of these cases, 75% were 5-40 years-old. During this period, 58 patients (2.18%) died. Of the total number of cases, 33 were pregnant women with no reported mortalities amongst them. The prevalence of death had no significance correlation with sex and age (P=0.720 and 0.194, respectively). RESULTS: Geographic distribution of the reported cases showed the highest rates in central and eastern provinces of Iran. There were two disease phases until November 2009, including an initial exogenous wave which blended into a second wave of indigenous disease, with a peak of cases after the start of the educational year. A review of the epidemiology of these initial phases of disease in Iran can help for better planning and more efficient action in future phases of the disease. CONCLUSION: It is of utmost importance to strengthen the surveillance system for this disease and appropriately transfer the resultant knowledge to the medical professionals, stakeholders and the general population, accordingly.

Modelling of H1N1 flu in Iran.

BACKGROUND: This year's new H1N1 flu strain has rapidly become a serious threat worldwide. This pandemic calls for urgent preparedness to mitigate its impact as much as possible. Employing this knowledge, we simulated a model of the outbreak of H1N1 in two cities of Iran (middle size: Kerman and metropolitan: Tehran). METHODS: We developed a compartmental model to predict the expected number of patients who might develop severe (S), very severe (VS) disease or die (D). We assumed that, in winter, the Basic Reproductive Number (R0w) would reach 1.6 in Kerman and 1.8 in Tehran, respectively. Corresponding figures in summer varied from 1.2 (R0sMin) to 1.4 (R0sMax) in Kerman and from 1.3 to 1.5 in Tehran. Moreover, we checked the effect of the number of imported infectious cases at the beginning of the outbreak based on predictions. RESULTS: A minimum lag of six months was observed between introduction of the virus (June 2009) and beginning of the outbreak (December 2009). The lag was sensitive to the number of infectious cases and the R0: a lower R0 postponed the peak. In Kerman, with R0sMax of 1.4, the number of S, VS, and D were 2,728, 546 and 468 respectively. Corresponding numbers in Tehran with R0sMax of 1.5 were 83,363, 16,673, and 14,291. CONCLUSION: Since the number of S and VS cases would be crowded over a short period of time, the health care system most probably would not be able to provide appropriate services unless special measures are taken in advance. By reduction of R0 and the number of introduced infectious cases the peak of the outbreak might be postponed to the end of 2010. This would provide a golden opportunity to vaccinate a considerable proportion of the population.