Molecular analysis of the bacille Calmette-Guérin vaccine strain currently being used in Iran.

BACKGROUND: In developing countries, tuberculosis (TB) infection control remains a challenge. The bacille Calmette-Guérin (BCG) vaccine is the only effective vaccine available for TB control. Iran uses a local BCG vaccine strain with an unknown substrain. OBJECTIVE: To investigate the molecular characteristics of the current BCG strain being used in Iran using comparative genomics of the evolutionarily late strains, including BCG vaccines Pasteur, BCG-Danish, BCG-Glaxo, BCG-Prague, BCG-Frappier, BCG-Connaught and BCG-Moreau. METHODS: A total of 67 different vials of BCG vaccine were cultured. DNA was extracted using the modified cetrimonium bromide (CTAB) method, and multiplex polymerase chain reaction (PCR) was performed to determine four target genomic regions of difference (RD) 1, RD8, RD16 and SenX3-RegX3, and to see whether RD2 and RD14 were present. RESULTS: Our results showed that all studied batches were Mycobacterium bovis; molecular analysis revealed that the Iranian vaccine strains possess RD8, RD16 and SenX3-RegX3 regions but not RD1, RD2 and RD14. All of the vaccine batches analysed were compatible with BCG-Pasteur 1173p2, the original strain. CONCLUSION: All of the BCG strains studied were recognised as the BCG-Pasteur 1173p2 strain. No genetic diversity among stocks and ready-for-use vaccine vials were detected.

Measles vaccination coverage and seroprevalence of anti-measles antibody in south-east Islamic Republic of Iran.

Discrepancies often exist between recorded immunization coverage and the real immunity level in a community. To estimate the vaccination coverage against measles in south-east Islamic Republic of Iran, a crosssectional study was conducted in 3 districts during summer 2011. Using probability proportional to size cluster sampling, 1368 children aged 30-54 months were selected. Serum samples of 663 who had received 2 injections of mumpsmeasles- rubella (MMR) vaccine were checked for anti-measles IgG. Vaccination coverage for the second dose of MMR vaccine was 93.7%. The prevalence of anti-measles IgG in those who had received at least 2 MMR vaccine doses was 94.6%. There was a statistically significant association between the serological results and variables that reflected poor accessibility to health services. Combining serological results with coverage data, the proportion of the community protected against measles was estimated as 88.6%, which was below the limits defined for the measles elimination goals.

Seroprevalence of poliovirus antibodies among 7-month-old infants after 4 doses of oral polio vaccine in Sistan-va-Baluchestan, Islamic Republic of Iran.

Despite high coverage rates of polio vaccine in the Islamic Republic of Iran, the seroconversion rates of infants may be inadequate. This study measured seroprevalence of antibodies against poliovirus serotypes 1 to 3 (PV1, PV2 and PV3) in 7-month-old infants who had received at least 4 doses of trivalent oral polio vaccine. A serosurvey was conducted in 2010 in rural areas of Chabahar, Sistan-va-Baluchestan province. Using cluster sampling, 72 eligible infants were tested for antibody against the 3 poliovirus serotypes according to WHO guidelines. Antibody titres ≥ 1:10 were considered positive. The seropositive rates for antibody against PV1, PV2 and PV3 were 84.7%, 95.8% and 70.8% respectively. Only 63.9% of participants were seropositive for antibodies against all 3 poliovirus serotypes. Except for PV2, the seroprevalence of antibody against the other 2 poliovirus serotypes, especially PV3, was unsatisfactory.

Measles vaccination coverage and seroprevalence of anti-measles antibody in south-east Islamic Republic of Iran

كثيراً ما توجد تباينات بين تغطية التطعيم المسجلة وبين المستوى الحقيقي للمناعة في المجتمع. ولتقدير تغطية التلقيح ضد الحصبة في جنوب شرق جمهورية إيران الإسلامية تم إجراء دراسة مقطعية في 3 مناطق خلال صيف عام 2011.فتم اختيار عينة عنقودية من 1368 طفلاً تتراوح أعمارهم ما بين 30-54 شهراً باستخدام الاحتمال المتناسب مع الحجم. وتم فحص عينات مصلية من 663 منهم - ممن تلقوا حقنتين من اللقاح الثلاثي ضد الحصبة والنكاف والحصبة الألمانية [MMR]- للتأكد من وجود الجلوبيولين المناعي G [IgG]المضاد للحصبة. لقد بلغت تغطية التطعيم بالجرعة الثانية من لقاح MMR 93.7%.وكان انتشار الجلوبيولين المناعي G المضاد للحصبة لدى أولئك الذين تلقوا جرعتين على الأقل من لقاح MMR 94.6%.وكان هناك ارتباط ذو دلالة إحصائية بين النتائج السيرولوجية وبين المتغيرات التي تعكس ضعف إمكانية الوصول إلى الخدمات الصحية. وبجمع النتائج السيرولوجية مع بيانات التغطية قُدِّرت نسبة الجمهور المحمي ضد الحصبة بـ 88.6%، والتي كانت أقل من الحدود المعينة لأهداف التخلص من الحصبة

Discrepancies often exist between recorded immunization coverage and the real immunity level in a community. To estimate the vaccination coverage against measles in south-east Islamic Republic of Iran, a crosssectional study was conducted in 3 districts during summer 2011. Using probability proportional to size cluster sampling, 1368 children aged 30–54 months were selected. Serum samples of 663 who had received 2 injections of mumpsmeasles-rubella (MMR) vaccine were checked for anti-measles IgG. Vaccination coverage for the second dose of MMRvaccine was 93.7%. The prevalence of anti-measles IgG in those who had received at least 2 MMR vaccine doses was 94.6%. There was a statistically significant association between the serological results and variables that reflected pooraccessibility to health services. Combining serological results with coverage data, the proportion of the community protected against measles was estimated as 88.6%, which was below the limits defined for the measles elimination goals.

Il existe souvent des écarts entre la couverture vaccinale enregistrée et le niveau réel d'immunité d'une communauté donnée. Afin d'estimer la couverture vaccinale antirougeoleuse dans le sud-est de la République islamique d'Iran, une étude transversale a été menée dans trois districts durant l'été 2011. En appliquantl'échantillonnage en grappes avec probabilité proportionnelle à la taille, 1368 enfants âgés de 30 à 54 mois ont été sélectionnés. Des prélèvements de sérum de 663 enfants de l'échantillonnage ayant reçu deux injections du vaccincontre la rougeole, les oreillons et la rubéole (ROR) ont été analysés à la recherche d'anticorps IgG antirougeoleux. La couverture vaccinale pour la deuxième dose de vaccin ROR était de 93,7 %. La prévalence des anticorps IgG antirougeoleux chez les enfants ayant reçu au moins deux doses du vaccin ROR était de 94,6 %. Il existait une association statistiquement significative entre les résultats sérologiques et les variables qui reflétaient l'accès insuffisant aux services de santé. En combinant les résultats sérologiques et les données de couverture, la proportion de la communauté protégée contre la rougeole a été estimée à 88,6 %, soit un taux inférieur aux seuils définis pour les objectifs d'élimination de la rougeole.

Risk of polio reintroduction to border regions of Islamic Republic of Iran: seroprevalence study of children with at least 5 doses of oral polio vaccine.

Movements of populations from countries where polio has not been eradicated is a concern in the Islamic Republic of Iran. A cross-sectional, community-based study was implemented in 2010 in 2 districts in Sistan-va-Baluchestan Province near the south-east border. The aim was to determine the seroprevalence of antibodies in children aged 20 (± 2) months who had received at least 5 doses of trivalent oral polio vaccine. Using cluster sampling, 365 children were enrolled for serological testing. Antibody titres ≥ 1:10 were considered positive. Seropositive rates for antibody against poliovirus serotypes 1, 2 and 3 were 94.1%, 96.7% and 78.3% respectively. The lowest seropositive rate was for antibody against polio serotype 3 (PV3) among boys (58.3%). Exclusive breastfeeding showed a direct relationship with antibody response to PV3 (OR = 2.0; 95% CI: 1.1-3.6). Improving community protection against PV3 is an urgent programme priority.

Risk of polio reintroduction to border regions of Islamic Republic of Iran: seroprevalence study of children with at least 5 doses of oral polio vaccine

تشعر جمهورية إيران الإسلامية بالقلق بسبب تحركات السكان من بلدان لم تحقق استئصال شلل الأطفال. وقد أجرى الباحثون دراسة مستعرضة مجتمعية في عام 2010 ، في مقاطعتي سيستان وبلوشستان التابعتين لولاية قريبة من الحدود الجنوبية الشرقية. وكان هدف الدراسة تحديد معدل الانتشار المصلي للأضداد لدى الأطفال بعمر 20 شهرا [+/- شهرين]، ممن تلقوا 5 جرعات على الأقل من لقاح شلل الأطفال. واستخدم الباحثون طريقة الاعتيان العنقودي، وأدرجوا في الدراسة 365 طفلا لإجراء الاختبارات المصلية؛ واعتبر الباحثون وجود عيارات تساوي أو تزيد على 1 إلى 10 نتيجة إيجابية. واتضح للباحثين أن معدلات الإيجابية المصلية لأضداد الأنماط المصلية لفيروس شلل الأطفال هي 94.1 % بالنسبة للنمط المصلي 1، وهي 96.7 % بالنسبة للنمط المصلي 2، وهي 78.3 % بالنسبة للنمط المصلي 3. وكان أخفض معدل للإيجابية المصلية للأضداد المضادة للنمط المصلي 3 بين الأطفال الذكور [58.3 %]. وقد اتضح أن الاقتصار على الرضاعة الطبيعية من الثدي له تأثر مباشر على الاستجابة بالأضداد المضادة للنمط المصلي الثالث من فيروس شلل الأطفال.[معدل الأرجحية = 0.2 ، فاصلة الثقة 95%، تراوح بين 1.1 و 3.6]. ويعد تحسن الحماية المجتمعية ضد النمط المصلي 3 لفيروس شلل الأطفال من الأولويات الملحة للبرنامج

ABSTRACT Movements of populations from countries where polio has not been eradicated is a concern in the Islamic Republic of Iran. A cross-sectional, community-based study was implemented in 2010 in 2 districts in Sistan-va-Baluchestan Province near the south-east border. The aim was to determine the seroprevalence of antibodies in children aged 20 (± 2) months who had received at least 5 doses of trivalent oral polio vaccine. Using cluster sampling, 365 children were enrolled for serological testing. Antibody titres ≥ 1:10 were considered positive. Seropositive rates for antibody against poliovirus serotypes 1, 2 and 3 were 94.1%, 96.7% and 78.3% respectively. The lowest seropositive rate was for antibody against polio serotype 3 (PV3) among boys (58.3%). Exclusive breastfeeding showed a direct relationship with antibody response to PV3 (OR = 2.0; 95% CI: 1.1–3.6). Improving community protection against PV3 is an urgent programme priority.

RÉSUMÉ Les déplacements de population en provenance d'autres pays où la poliomyélite n'a pas été éradiquée représentent une préoccupation en République islamique d'Iran. Une étude transversale communautaire a été menée en 2010 dans deux districts de la province du Sistan-Balouchistan près de la frontière du sud-est. L'objectif était de déterminer la séroprévalence des anticorps chez des enfants âgés de 20 (± 2) mois qui avaient reçu au moins cinq doses du vaccin antipoliomyélitique oral trivalent. L'échantillonnage en grappes était la méthode utilisée ; 365 enfants ont été recrutés pour une analyse sérologique. Des titres d'anticorps supérieurs ou égaux à 1:10 étaient considérés comme positifs. Les taux de séropositivité pour les anticorps dirigés contre les sérotypes des poliovirus 1, 2 et 3 étaient de 94,1 %, 96,7 % et 78,3 %, respectivement. Le taux de séropositivité le plus faible était celui correspondant aux anticorps contre le sérotype 3 du poliovirus chez les enfants de sexe masculin (58,3 %). L’allaitement au sein exclusif présentait un lien direct avec la réponse des anticorps au sérotype 3 du poliovirus (OR = 2,0 ; IC à 95 % : 1,1–3,6). Améliorer la protection de la communauté contre le sérotype 3 du poliovirus représente une priorité programmatique urgente.

Baseline evaluation of hand hygiene compliance in three major hospitals, Isfahan, Iran.

Hand hygiene is the mainstay of nosocomial infection prevention. This study was a baseline survey to assess hand hygiene compliance of healthcare workers by direct observation in three major hospitals of Isfahan, Iran. The use of different hand hygiene products was also evaluated. In 3078 potential opportunities hand hygiene products were available on 2653 occasions (86.2%). Overall compliance was 6.4% (teaching hospital: 7.4%; public hospital: 6.2%; private hospital: 1.4%). Nurses (8.4%) had the highest rates of compliance. Poor hand hygiene compliance in Isfahan hospitals necessitates urgent interventions to improve both hospital infrastructure and staff knowledge.

The epidemiology of tick-borne relapsing fever in Iran during 1997-2006.

BACKGROUND: Tick-borne relapsing fever is an acute febrile and endemic disease in Iran. For many reasons, the incidence of disease is on decrease, however tick-borne relapsing fever is still a health issue in the rural areas for travelers. This study was carried out during 1997-2006 to investigate the tick-borne relapsing fever in Iran. METHODS: Based on a cross-sectional, retrospective and descriptive study in all the provinces, the residents in the endemic areas who were febrile and suspicious to tick-borne relapsing fever were enrolled in the study. Tick-borne relapsing fever is a notifiable disease in Iran and the national communicable disease surveillance data were used through questionnaires. The infectivity of Ornithodoros species to Borrelia also was studied in two highly endemic areas including Hamadan and Qazvin provinces. RESULTS: During 1997-2006, a total of 1415 cases have been reported from the entire country. The highest prevalence was observed in year 2002 with the incidence rate of 0.41/100,000 population. Ardabil province is the first ranked infected area (625 out of 1415), followed by Hamadan, Zanjan, Kurdestan and Qazvin provinces sequentially. The disease is recorded during the whole year but its peak occurs during summer and autumn. There have been 87.6% of the cases recorded from June to November. Forty five percent of the infected cases were male and one third of the patients were under 5 years of age. Fifty four percent of the patients comprise the children under 10 years. Ninety two percent of the cases were living in rural areas where their dwellings were close to animal shelters. They were involved mainly with farming and animal husbandry activities. All the febrile patients with confirmed spirochetes in their blood samples were treated according to a national guideline for tick-borne relapsing fever treatment. Only 7% of the patients were hospitalized and 0.8% of them exhibited the Jarisch-Herxheimer reaction. The study of infectivity of Ornithodoros species to Borrelia revealed that Ornithodoros tholozani was infected with Borrelia persica and Ornithodoros erraticus with Borrelia microti. CONCLUSION: Travelers to the rural areas with high prevalence of the disease should be made aware of the risk of tick-borne relapsing fever and use of appropriate control measures. Communicable disease surveillance including tick-borne relapsing fever should be pursued as well.

Invasive Vibrio cholerae 01 E1 Tor Inaba in a 3-day-old neonate: case report.

A 3-day-old girl with invasive V. cholerae infection is described. Her mother had cholera in the perinatal period. Because of retracted nipples, she expressed milk and fed her infant by bottle. The infant died on the 2nd day of admission.