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Rejali M.,Isfahan University of Medical Sciences | Mohammadbeigi A.,Qom University of Medical Sciences | Mokhtari M.,Isfahan University of Medical Sciences | Zahraei S.M.,Center for Communicable Disease Control | Eshrati B.,Arak University of Medical Sciences
Journal of Research in Health Sciences | Year: 2015

Background: Most studies evaluated the vaccine coverage, but the time of vaccination is important as coverage. This study was conducted to evaluate the Expanded Program of Immunization (EPI) in outskirt of Iranian cities regarding to incidence of delayed vaccination among children less than 4 years. Methods: This cross sectional descriptive study was conducted among children 24-47 months old, living in the suburbs of five metropolises of Iran. Totally, 3610 eligible children selected with proportioned cluster sampling method and data of vaccination card extracted after the interview with children's parents. Delayed incidence rate reported and predictive factors assessed by the Chi square test and Multivariate logistic regression. Results: Overall, 56.6% to 93.2% vaccines were administered out of time. Delayed vaccination incidence with more than one-week delay varies from 5.5% to 74.9% of polio at birth and MMR2 at 18 months, respectively. Mother’s educational level and birth order were the most important predictors of delayed vaccination. Incidence of delayed vaccination was enlarged by increasing birth order and decreased in lower educated mothers. Conclusions: Incidence rate of delayed vaccination is more than expectation. Regarding to high coverage vaccines in Iran, health officers and health policy makers should attempt for ontime vaccination beside of high immunization coverage, especially in slum areas with more concentrated immigrants due to low literature and crowded families. © 2015 Health Hamadan University of Medical Sciences. All rights reserved.


Zahraei S.M.,Center for Communicable Disease Control | Eshrati B.,Arak University of Medical Sciences | Gouya M.M.,Center for Communicable Disease Control | Mohammadbeigi A.,Qom University of Medical Sciences | Kamran A.,Ardabil University of Medical Sciences
Archives of Iranian Medicine | Year: 2014

As there is a significant number of Iranian immigrant and illegal refugees living in marginal areas of large cities that might induce immunization gap in these areas. The aim of this study was to provide reliable information on vaccination status of these people.A cross sectional study was conducted on children 24-47 month old who lived in the suburb areas of five large cities of Iran in 2013. Proportional cluster sampling method was used in each city and standard questionnaire of the World Health Organization applied for the purpose of data collection. The survey counts immunizations based on immunization card plus the history of vaccination according to the mother's memory. All gathered data were analyzed using SPSS software (version 16).Overall, 4502 children (49.2% female) aged 24-47 month participated in this survey among which 88.1% were Iranian and 11.9% were Afghan or other nationalities. Totally, 4479 (99.4%, CI 95%: 99.2%-99.6%) of the children had a vaccination card while 828 (18.5%, CI 95%; 15.8%-21.1%) could not present it to the interviewers. 96.8% of children were fully immunized, 3.2% were partially immunized and 0.1% were not immunized. There was no significant difference in terms of vaccine coverage among males and females. The prevalence of partially immunization in non-Iranian children was six fold of Iranian children (11.9% vs. 2%).Immunization program is implemented appropriately with high coverage rates in suburb areas of the country. However, there is still an immunity gap in non-Iranian immigrants, which should be considered as a high-risk group by the health system. © 2014 Academy of Medical Sciences of I.R. Iran. All rights reserved.


PubMed | Isfahan University of Medical Sciences, Qom University of Medical Sciences, Center for Communicable Disease Control and Arak University of Medical Sciences
Type: | Journal: International journal of preventive medicine | Year: 2016

Today, beside immunization coverage the age appropriate vaccination is another helpful index in public health. Evidences have shown that high immunization coverage rates do not necessarily imply age-appropriate vaccination status. The current study aimed to show the predictive factors of delayed vaccination by survival models.A historical cohort study conducted on 3610 children aged between 24 and 47 months who was living in the suburbs of five big cities of Iran. Time of delay in vaccination of first dose of mumps-measles-rubella (MMR) was calculated from date of vaccination minus age appropriate time according to vaccine card. Kaplan-Maier and Log rank tests were used for comparison the median of delay time. For controlling of confounding variables, multivariate cox model was used and hazard ratio with 95% confidence interval (95%) was reported.The mean standard deviation and median interquartile range of delay time was 38.34 73.1 and 16 (11-31) days in delayed group. The Log rank test showed that city of living, nationality, parents education, and birth order are related with prolonged delay time in MMR vaccination (P < 0.05). Nevertheless, child sex, prior living place (rural or city) and parents job are not related with delay time of vaccination (P > 0.05). Cox regression showed that city of living, mother education, and nationality are the most predictive factors of delay time duration in MMR vaccination.Delay time duration of vaccination increased by faring from capital to the east south. Moreover, concentration of foreign immigrants in big cities and low level of mother education are the most predictors of delayed vaccination. Educational intervention should focus on immigrants and mothers with low education level.


PubMed | Iranian Society for Support of Patients with Infectious Disease, Tehran University of Medical Sciences, Pasteur Institute of Iran, Shahid Beheshti University of Medical Sciences and Center for Communicable Disease Control
Type: Journal Article | Journal: Archives of virology | Year: 2016

A nationwide hepatitis B virus (HBV) vaccination program for neonates was launched in Iran in 1993. Despite the success of this program, concern about its long-term success still remains, because breakthrough infections due to emergence of surface mutants have been reported in immunized children. We aimed to evaluate the seroprevalence of HBV and vaccine escape mutants among individuals born after the initiation of the nationwide vaccination program in Iran. This study included 1115 participants younger than 23 years old, with 223 in each age cohort. The presence of HBsAg, anti-HBs and anti-HBc was evaluated using an ELISA kit. HBV-DNA levels were measured in anti-HBc and/or HBsAg-positive subjects. PCR products were sequenced and mutations were identified. The overall HBsAg prevalence was 0.27%. Anti-HBs and anti-HBc positive rates were 48% and 0.18%, respectively. Two individuals were positive for anti-HBc, one of whom was also positive for HBsAg, and the other was positive for anti-HBc only. HBV DNA was detected in three out of four anti-HBc-and /or HBsAg-positive subjects. An I195M mutation within the S gene was detected in two of the three HBV-DNA-positive cases. A very low prevalence of HBsAg and isolated anti-HBc were found in this study. The I195M mutation found in the surface gene could have been induced by immune pressure. Although the number of vaccine escape mutants found in this cohort was low, ongoing surveillance of breakthrough infections and escape mutants is still needed.


PubMed | World Health Organization, University of Washington, Tehran University of Medical Sciences, Shahid Beheshti University of Medical Sciences and 4 more.
Type: | Journal: Vaccine | Year: 2015

Although the mortality from diarrheal diseases has been decreasing dramatically in Iran, it still represents an important proportion of disease burden in children <5 years old. Rotavirus vaccines are among the most effective strategies against diarrheal diseases in specific epidemiological conditions. This study aimed to evaluate the cost-effectiveness of the introduction of rotavirus vaccine (3 doses of pentavalent RotaTeq (RV5)) in Iran, from the viewpoints of Irans health system and society.The TRIVAC decision support model was used to calculate total incremental costs, life years (LYs) gained, and disability-adjusted life years (DALYs) averted due to the vaccination program. Necessary input data were collected from the most valid accessible sources as well as a systematic review and meta-analysis on epidemiological studies. We used WHO guidelines to estimate vaccination cost. An annual discount rate of 3% was considered for both health gain and costs. A deterministic sensitivity analysis was performed for testing the robustness of the models results.Our results indicated that total DALYs potentially lost due to rotavirus diarrhea within 10 years would be 138,161, of which 76,591 could be prevented by rotavirus vaccine. The total vaccination cost for 10 cohorts was estimated to be US$ 499.91 million. Also, US$ 470.61 million would be saved because of preventing outpatient visits and inpatient admissions (cost-saving from the society perspective). We estimated a cost per DALY averted of US$ 2868 for RV5 vaccination, which corresponds to a highly cost-effective strategy from the government perspective. In the sensitivity analysis, all scenarios tested were still cost-saving or highly cost-effective from the society perspective, except in the least favorable scenario and low vaccine efficacy and disease incidence scenario.Based on the findings, introduction of rotavirus vaccine is a highly cost-effective strategy from the government perspective. Introducing the vaccine to the national immunization program is an efficient use of available funds to reduce child mortality and morbidity in Iran.


PubMed | Tehran University of Medical Sciences and Center for Communicable Disease Control
Type: | Journal: Medical journal of the Islamic Republic of Iran | Year: 2016

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.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.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.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.


Shahcheraghi F.,Pasteur Institute of Iran | Nobari S.,Pasteur Institute of Iran | Asl H.M.,Center for Communicable Disease Control | Aslani M.M.,Pasteur Institute of Iran
Archives of Iranian Medicine | Year: 2013

Background: Botulism is a serious neuroparalytic disease caused by toxins of Clostridium botulinum. Botulinum toxin is produced under anaerobic conditions and it is the most dangerous toxin in the world. Rapid diagnosis of botulism is very essential for successful therapy. In this study, we reviewed data of cases of botulism in Iran from April 2004 through March 2010. Materials and Methods: From a total of 1140 samples of suspected botulism samples, 477 serum, 294 stool, 111 gastric secretions, and 258 food samples were collected from 21 provinces. These samples belonged to 432 distinct patients. All samples were tested for botulism by mouse bioassay, a gold standard method for detection of botulism. Results: From 1140 received samples, 64 (5.6 %) positive samples of botulism were identified. Of these, 14 (21.8 %) cases had toxin type A, seven (11 %) cases had toxin type B, 22 (34.3 %) cases had toxin type E, and seven (11 %) cases had toxin type AB. The toxin type could not been identified in 14 (21.8 %) cases. The highest positive results were in Gilan, Tehran, Golestan, and Hamedan provinces. Seafoods and locally- made cheese were the most implicated foods in type E and type A botulism, respectively. Conclusion: Accurate and rapid diagnosis of botulism is very important because every case of botulism can be a public health emergency. During the study period, the median number of positive cases per year was 2.7 (range: one to18). Therefore, it is suggested that all clinicians are required to submit the collected samples from patients with botulism symptoms to the botulism reference laboratory for specific diagnosis and confirmation of botulism.


Izadi S.,Zahedan University of Medical Sciences | Zahraie S.-M.,Center for Communicable Disease Control | Sartipi M.,Zahedan University of Medical Sciences
Japanese Journal of Infectious Diseases | Year: 2012

In 2009 and 2010 a series of measles outbreaks, involving different age groups, occurred in rural areas of the Chabahar district in southeast Iran. These outbreaks raised questions regarding the effectiveness of immunization programs in these areas. To determine the most important factors leading to these outbreaks, and to determine the effectiveness of the measles vaccination program, the present study analyzed surveillance data and performed a case-control study. The total number of reported cases during the study period was 126. The estimated vaccine effectiveness, based on the adjusted odds ratio of the case-control study, was 74.2z (95z CI, 10.2-92.6). On two occasions, both primary and secondary cases of the outbreaks were vaccinated school children. In total, 42z of all cases were aged above 7 years, and 6.3zwere above 20 years.With regard to the important role of schools as the foci of contact between uninfected and infected children, supplementary immunization of children before starting in school could be effective in preventing measles outbreaks. In addition, implementation of supplementary immunization every 5-10 years in older age groups might be effective in preventing future outbreaks.


PubMed | Zabol University of Medical Sciences, Center for Communicable Disease Control and Mazandaran University of Medical Sciences
Type: Journal Article | Journal: Osong public health and research perspectives | Year: 2016

During recent decades, there has been limited attention on the seasonal pattern of pertussis within a high vaccine coverage population. This study aimed to compare the seasonal patterns of clinical suspected pertussis cases with those of laboratory confirmed cases in Iran.The current study was conducted using time series methods. Time variables included months and seasons during 2011-2013. The effects of seasons and months on the incidence of pertussis were estimated using analysis of variance or Kruskal-Wallis.The maximum average incidence of clinically confirmed pertussis was 23.3 in July (p=0.04), but the maximum incidence of clinical suspected pertussis was 115.7 in May (p=0.6). The maximum seasonal incidences of confirmed and clinical pertussis cases were reported in summer (average: 12, p=0.004), and winter (average: 108.1; p=0.4), respectively.The present study showed that the seasonal pattern of laboratory confirmed pertussis cases is highly definite and different from the pattern of clinical suspected cases.


PubMed | Ministry of Health and Medical Education, Babol University of Medical Sciences and Center for Communicable Disease Control
Type: Journal Article | Journal: Asian Pacific journal of tropical medicine | Year: 2016

To aim to determine the status and epidemiological aspects of malaria in Iran in favour of gaining a better understanding of the national control of malaria.This epidemiological study examined the status of malaria from 2011 to 2014 in Iran. Data were collected from the Ministry of Healths protocol for controlling and eliminating malaria, which is currently in use. This malaria information reporting system is automated in all Iranian provinces and cities, and all information is submitted online to the center for communicable disease control in the Ministry of Health. Information about malaria is available for researchers to evaluate.The incidence rates decreased from 2011 to 2014. There were 4.76, 2.12, 1.80, and 1.59 per 100000 people, respectively from 2011 to 2014. During the four-year period (2011-2014), the highest numbers of cases occurred in those aged 16-25 years, by age, and in men, by sex. Most of the cases were workers and located in rural areas. An average 52.58% of cases were Iranian. The highest incidence rates from 2011 to 2014 were located in Sistan and Baluchestan province. There were 89.94, 43.9, 38.3, and 30.66 per 100000 people. The highest numbers of malaria cases were recorded in the cities Sarbaz, Nickshahr, and Chabahar in Sistan and Baluchestan province and Bandar Abbas, Bandar Jask, and Bandar Lengeh in Hormozgan province. During the four-year period, 57.05% of cases were caused by imported factors. The majority of cases were related to the trophozoite lifecycle of parasites. Regarding surveillance, there was inactive care in the majority of cases. Vivax malaria was the most prevalent.Despite the recently declining trend in reported cases, the expansion of local transmission, especially in areas with cross-border travel, is very worrying. Improved malaria control interventions can be effective for elimination of malaria in Iran; these can include programs to control border travel and focused interventions for high incidence areas and high-risk groups such as rural residents, men, workers, and people <35 years old.

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