Dengue Fever as an Emerging Infection in Southeast Iran

Recent advances in the control of dengue fever using herbal and synthetic drugs

Dengue virus represents a global public health threat, being prevalent in tropical and subtropical regions, with an increasing geographical distribution and rising incidence worldwide. This mosquito-borne viral agent causes a wide range of clinical manifestations, from mild febrile illness to severe cases and potentially fatal outcomes due to hemorrhage and shock syndrome. The etiological agent, dengue virus (DENV), has four distinct serotypes, each capable of inducing severe clinical outcomes. The current therapeutic landscape remains limited, with management strategies mainly focused on supportive cares. However, recent advances in pharmaceutical research have yielded promising developments in anti-dengue drugs. Extensive investigations have been conducted on various synthetic compounds, including JNJ-1802, 1,4-pyran naphthoquinones, and arylnaphthalene lignan derivatives. Additionally, natural compounds derived from medicinal plants such as Hippophae rhamnoides, Azadirachta indica, and Cymbopogon citratus have demonstrated potential antiviral properties in both in vitro and in vivo studies, based on inhibition of DENV replication. However, none of these compounds are to date approved by the U.S. Food and Drug Administration (FDA). Although many vaccines have been recognized as candidates in various stages of clinical trials, only a limited number of these have demonstrated a protective efficacy against the infection. This aspect underscores the need for both highly effective immunization strategies and therapeutic interventions, whether derived from botanical sources or through synthetic manufacturing, that exhibit low adverse effects. This review examines innovative approaches to DENV prevention and treatment, encompassing both phytochemical and synthetic therapeutic strategies.

Evaluating the burden and transmission dynamics of chikungunya virus infections in the Eastern Mediterranean Region: a systematic review and meta-analysis

The Chikungunya virus (CHIKV) presents substantial public health challenges in the Eastern Mediterranean Region (EMR), with its prevalence and interaction with other arboviruses (ABVs) remaining poorly understood. This systematic review and meta-analysis aimed to assess the prevalence of CHIKV and its association with other ABVs, such as dengue virus (DENV), Rift Valley fever virus (RVFV), malaria, and yellow fever virus (YFV), in the EMR. We systematically searched databases including PubMed, Embase, Web of Science, Scopus, Cochrane Library, CINAHL, PsycINFO, and ScienceDirect to identify epidemiological studies that report CHIKV prevalence and provide odds ratios (ORs) for CHIKV compared to other ABVs. Data analysis was performed using a random-effects model. Heterogeneity was evaluated using the χ2 test and I2 statistic. The GRADE approach was used to evaluate the quality of the studies while the AXIS tool, NOS tool, and AHRQ checklist assessed the risk of bias. The meta-analysis revealed a significant prevalence of CHIKV in the EMR. However, the studies exhibited heterogeneity, indicating variability in the results. A comparison of CHIKV with other ABVs did not show any statistically significant differences in prevalence. The meta-analysis found a notable prevalence of CHIKV in the EMR. The results also indicated that the prevalence of CHIKV is comparable to that of other ABVs in the region. These findings provide an overview of the burden of CHIKV in the EMR.

Urgent Alert: Potential Risk of Dengue Infection Transmission Through Blood Transfusion in Iran

Dengue infection is an emerging public health issue in Iran, with about 149 confirmed newly infected cases. It can be transmitted by the bite of infected Aedes mosquitoes and even nosocomial routes. Due to the rapid replication and geographical spread of the mosquito, there is a potential risk of increased infected individuals. Given the possibility of the transmission of dengue infection through transfusion, it is important to implement policies to improve blood safety. Proper donor selection by utilizing appropriate blood donor questionnaires and performing general physical examinations, along with performing sensitive diagnostic tests on blood donor samples, utilizing pathogen reduction techniques, and implementing lookback programs, can be effective in reducing the risk of transfusion-transmitted dengue virus (TT-DENV).

Dengue fever: a decade of burden in Iran

Since the first reported traveler case of Dengue in Tehran in 2008, the virus has gradually spread across Iran, driven by factors including international travel, climate change, and Aedes mosquito vectors. The disease has manifested in various forms, ranging from mild fever to severe dengue, with notable cases identified in Sistan and Baluchistan Province. Despite the increasing prevalence, Iran faces significant challenges in surveillance, diagnosis, and vector control. This perspective comprehensively analyzes dengue virus epidemiology in Iran, emphasizing the need for enhanced public health strategies, including genomic surveillance, targeted interventions, and health education. The findings highlight the critical importance of addressing these challenges to mitigate the potential for large-scale dengue epidemics and protect public health.

Knowledge, attitudes, and practices of healthcare professionals regarding dengue fever in high-risk regions of southeastern Iran

BACKGROUND

Dengue fever (DF) is one of the most prevalent arboviral infections worldwide. In Iran, the dengue-positive serological cases as well as the presence of the dengue vector Aedes aegypti have raised health concerns, highlighting the need to enhance the dengue surveillance system. This study aims to assess the knowledge, attitudes, and practices (KAP) of healthcare professionals (HCPs) regarding dengue fever in a large and high-risk region of southeastern Iran.

METHODS

A total of 492 HCPs were recruited using a multi-stage sampling method from May 2022 to July 2023. Data were collected using a self-administered questionnaire. Data analysis was done using independent t-tests, one-way analysis of variance (ANOVA), one-factor and multi-factor general linear models, and simple and multiple regression models.

RESULTS

About two-thirds (71%) of the participants did not receive any training on DF. A small percentage of participants were familiar with ovitrap (32.6%) and only 21.7% knew that destroying larval breeding sites could not eliminate the dengue vector. The knowledge of disease symptoms among HCPs was found to be lower in border areas compared to non-border areas (P = 0.018). However, the practice situation in HCPs working in border areas was better than in non-borders (P = 0.003). According to the multiple regression model, the most influential factors associated with knowledge, attitude, and practice were the type of healthcare facility and passing the DF training course. Additionally, education level, work experience, and gender were identified as other factors associated with it, respectively. Significant correlations were found between knowledge and practice (P < 0.001), indicating that higher knowledge led to better practice. Similarly, a positive attitude was significantly linked to better practice (P < 0.001).

CONCLUSION

Regular, targeted, and continuous training courses are necessary to improve the knowledge level of HCPs, particularly those with lower education levels working in low-level health centers. Utilizing comprehensive dengue KAP studies to evaluate the status and impact of health education programs and identify gaps between knowledge and practice should be a research priority.

Assessing dengue risk globally using non-Markovian models

Dengue is a vector-borne disease transmitted by Aedes mosquitoes. The worldwide spread of these mosquitoes and the increasing disease burden have emphasized the need for a spatio-temporal risk map capable of assessing dengue outbreak conditions and quantifying the outbreak risk. Given that the life cycle of Aedes mosquitoes is strongly influenced by habitat temperature, numerous studies have utilized temperature-dependent development rates of these mosquitoes to construct virus transmission and outbreak risk models. In this study, we contribute to existing research by developing a mechanistic model for the mosquito life cycle that accurately captures its non-Markovian nature. Beginning with integral equations to track the mosquito population across different life cycle stages, we demonstrate how to derive the corresponding differential equations using phase-type distributions. This approach can be further applied to similar non-Markovian processes that are currently described with less accurate Markovian models. By fitting the model to data on human dengue cases, we estimate several model parameters, allowing the development of a global spatiotemporal dengue risk map. This risk model employs temperature and precipitation data to assess the environmental suitability for dengue outbreaks in a given area.

Uncovering the knowledge gap: A web-based survey of healthcare providers' understanding and management of dengue fever in East Azerbaijan, Iran

BACKGROUND

Dengue fever (DF) is increasingly recognized as one of the world's major mosquito-borne diseases and causes significant morbidity and mortality in tropical and subtropical countries. Appropriate and timely diagnosis and risk stratification for severe disease are crucial in the appropriate management of this illness. Healthcare providers (HCPs) play a key role in dengue fever diagnosis, management and prevention. The present study was conducted to determine the knowledge, attitudes and practices (KAP) among HCPs in East Azerbaijan Province, Iran.

METHODS

A cross-sectional survey among 948 HCPs, using a structured questionnaire, was conducted in East Azerbaijan Province from May to July 2022. Data analysis was undertaken using descriptive methods, the Chi-square test or Fisher's exact test, and logistic regression. A P-value <0.05 was considered for statistical significance.

RESULTS

Out of the 948 (68.5% female) respondents, 227 were physicians and 721 were health professionals. The knowledge level of DF was found to be largely inadequate in the present study population (80.4%). The physician vs. health professional were a significant factor in differentiating attitude scores. The mean practice score regarding DF prevention and control measures among respondents was 8.40±1.97.

CONCLUSION

The findings call for urgent continuous education and training courses to increase KAP levels and increased capacity and capability for DF prevention and control. This is of outmost importance for the first point of care of DF patients.

First report on the molecular phylogenetics and population genetics of Aedes aegypti in Iran

BACKGROUND

Aedes aegypti, the primary vector of various human arboviral diseases, is a significant public health threat. Aedes aegypti was detected in Iran in 2018, in Hormozgan province, but comprehensive information regarding its genetic diversity and origin within the country remains scarce. This study aimed to determine the origin and genetic diversity of Ae. aegypti in southern Iran.

METHODS

Aedes aegypti mosquitoes were collected from Bandar Abbas City, Hormozgan Province, southern Iran, between May and July 2022. Specimens were morphologically identified. Origin and assess genetic diversity were assessed based on the mitochondrial DNA-encoded cytochrome c oxidase subunit I (mtDNA-COI) gene.

RESULTS

BLAST (basic local alignment search tool) analysis confirmed the accuracy of the morphological identification of all specimens as Ae. aegypti, with 100% similarity to GenBank sequences. Calculated variance and haplotype diversity were 0.502 and 0.00157, respectively. Among the 604 examined nucleotide sequences, only a single site was non-synonymous. Total nucleotide diversity and average pairwise nucleotides were determined as 0.00083 and 0.502, respectively. Fu and Li's D test values were not statistically significant. Strobeck's S statistic value was 0.487, and Tajima's D value was 1.53395; both were not statistically significant (P > 0.10).

CONCLUSIONS

Phylogenetic analysis revealed two distinct clades with minimal nucleotide differences and low haplotype diversity, suggesting the recent establishment of Ae. Aegypti in the southern region of Iran. The phylogenetic analysis also indicated an association between Ae. aegypti populations and mosquitoes from Saudi Arabia and Pakistan.

Medically Significant Vector-Borne Viral Diseases in Iran

Vector-borne viral diseases (VBVDs) continue to pose a considerable public health risk to animals and humans globally. Vectors have integral roles in autochthonous circulation and dissemination of VBVDs worldwide. The interplay of agricultural activities, population expansion, urbanization, host/pathogen evolution, and climate change, all contribute to the continual flux in shaping the epidemiology of VBVDs. In recent decades, VBVDs, once endemic to particular countries, have expanded into new regions such as Iran and its neighbors, increasing the risk of outbreaks and other public health concerns. Both Iran and its neighboring countries are known to host a number of VBVDs that are endemic to these countries or newly circulating. The proximity of Iran to countries hosting regional diseases, along with increased global socioeconomic activities, e.g., international trade and travel, potentially increases the risk for introduction of new VBVDs into Iran. In this review, we examined the epidemiology of numerous VBVDs circulating in Iran, such as Chikungunya virus, Dengue virus, Sindbis virus, West Nile virus, Crimean-Congo hemorrhagic fever virus, Sandfly-borne phleboviruses, and Hantavirus, in relation to their vectors, specifically mosquitoes, ticks, sandflies, and rodents. In addition, we discussed the interplay of factors, e.g., urbanization and climate change on VBVD dissemination patterns and the consequent public health risks in Iran, highlighting the importance of a One Health approach to further surveil and to evolve mitigation strategies.

Knowledge, attitude, and practice of healthcare workers regarding dengue fever in Mazandaran Province, northern Iran

Background

Dengue fever is a rapidly emerging infection worldwide with a high public health burden. Adequate training of healthcare workers is essential to warrant the timely provision of health services to improve the outcome of dengue management.

Methods

This is an analytical cross-sectional study, conducted to assess the knowledge, attitudes and practice (KAP) of healthcare workers regarding dengue from April 2021 to March 2022 in Mazandaran Province, northern Iran. Data was collected using a researcher-made structured questionnaire, prepared as Google Forms, and sent to target groups through social media and email. Data analysis was performed by SPSS 22 software using descriptive and inferential statistics (Chi-square) at a significant level of 5%.

Results

Most of the respondents had heard about dengue (83.8%); media (32.7%) and academic education (25%) were the main sources of information. Respondents had less knowledge associated with dengue symptoms (52%) than prevention and control (69%), transmission (72.2%) and clinical management (81%). Based on the 70% cut-off point, the majority of the participants had a good attitude (81%) and practice (73%). However, only 49.6% of the respondents showed good practice regarding dengue local transmission. A significant difference was observed between participants knowledge on clinical management with occupation; attitude with gender and occupation; and practice with gender (p < 0.05).

Conclusion

The results of this study revealed gaps in some dimensions of KAP in healthcare workers, therefore, a greater focus should be placed on future training programs to raise knowledge and attitude leading to sound practice and behavior for adequate management of dengue.

"Acute Bilateral Neuroretinitis and Panuveitis in A Patient with Coronavirus Disease 2019: A Case Report"- Few Comments

During the Coronavirus Disease 2019 (COVID-19) pandemic, we have witnessed increase in number of reports of a known uveitic entity being associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Causal relation is yet to be proven for many reports. Perhaps, occurrence of a previously known region-specific endemic disease or closely resembling manifestations of a known disease in a non-endemic region during the COVID-19 pandemic might suggest a causal relationship. Epidemic retinitis (ER) or post fever retinitis is such condition with geographic variation. Occurrence of ER or ER-like manifestations in a non-endemic country during the pandemic should instigate further studies to consider SARS-CoV-2 as a causative organism.

Epidemiological Evidence of Mosquito-Borne Viruses among Persons and Vectors in Iran: A Study from North to South

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The overall seroprevalence of DENV, WNV and CHIKV in Iran were 5.9%, 18.8% and 1.8% between 2017 and 2018.

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No proof of viral RNAs was presence in vectors.

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Gilan and Hormozgan were high risk regions and the elderlies were at higher risk of infection by WNV and CHIKV.

Vector-borne diseases in Iran: epidemiology and key challenges

Vector-borne diseases have become a global health concern in recent decades as a result of global warming, globalization, growth in international trade and travel, use of insecticide and drug resistance. This review study addressed the key vector-borne diseases and their current status in Iran to emphasize the requirements for further research on vector-borne diseases. The dispersion patterns of these diseases differ in various regions. Some of them such as Crimean-Congo hemorrhagic fever, and Q fever are distributed all across Iran, whereas some others such as plague, leishmaniasis, tularemia, and malaria are restricted to specific areas. The high prevalence of vectors throughout the country necessitates enhancing the monitoring and surveillance of emerging and reemerging vector-borne diseases and their potential vectors.

Detection of arboviruses in mosquitoes: Evidence of circulation of chikungunya virus in Iran

Mosquitoes are vectors of viruses affecting animal and human health. In Iran, the prevalence of mosquito-borne viruses remains poorly investigated. Once infected, mosquito females remain infected for all their life making virus detections possible at early steps before infections are reported in vertebrate hosts. In this study, we used a recently developed high-throughput chip based on the BioMark Dynamic arrays system capable of detecting 37 arboviruses in a single experiment. A total of 1,212 mosquitoes collected in Mazandaran, North-Khorasan, and Fars provinces of Iran were analyzed. Eighteen species were identified, belonging to five genera; the most prevalent species were Anopheles maculipennis s.l. (42.41%), Culex pipiens (19.39%), An. superpictus (11.72%), and Cx. tritaeniorhynchus (10.64%). We detected chikungunya virus (CHIKV) of the Asian genotype in six mosquito pools collected in North Khorasan and Mazandaran provinces. To our knowledge, this is the first report of mosquitoes infected with CHIKV in Iran. Our high-throughput screening method can be proposed as a novel epidemiological surveillance tool to identify circulating arboviruses and to support preparedness to an epidemic in animals and humans.

High Transmission Potential of West Nile Virus Lineage 1 for Cx. pipiens s.l. of Iran

: Vector competence is an important parameter in evaluating whether a species plays a role in transmission of an arbovirus. Although the protocols are similar, interpretation of results is unique given the specific interactions that exist between a mosquito population and a viral genotype. Here, we assessed the infection (IR), dissemination (DR), and transmission (TR) rates of Cx. pipiens s.l., collected from Iran, for West Nile virus (WNV) lineage 1a. We showed that Cx. pipiens s.l. mosquitoes in Iran were susceptible to WNV with IR up to 89.7%, 93.6%, and 83.9% at 7, 14, and 21 days post-infection (dpi) respectively. In addition, DR and TR reached respectively 92.3% and 75.0% at 21 dpi, and the number of viral particles delivered with saliva reached up to 1.33 × 105 particles. Therefore, an unexpected high risk of WNV dissemination in the region where Cx. pipiens s.l. mosquitoes are well established should be considered carefully and surveillance measures implemented accordingly.

Impacts of flood on health of Iranian population: Infectious diseases with an emphasis on parasitic infections

Background

Outbreaks of infectious diseases are the major concern after flooding. Flood makes people displacement which would be more complicated with inadequate sanitation. Settling in crowded shelters in absence of clean water and inaccessibility to health care services makes people more vulnerable to get infection. This review aimed to discuss about potential undesirable outcomes of flooding occurred in 2019 in Iran.

Methods

A comprehensive search was carried out in databases including PubMed, Google scholar, Scopus, Science Direct, Iran medex, Magiran and SID (Scientific information database) from 2000 to 2019. All original descriptive articles on flood were concerned. Related articles on flood disturbance were considered. Also, publication of red cross society was considered as only reliable reference in evaluation of consequences of flood occurred in 2019 in Iran.

Results

Flooding in Iran, was started in March 2019 and lasted to April 2019. Flood affected 31 provinces and 140 rivers burst their banks, and southwestern Iran being hit most severely. According the reports of international federation of red cross society, 3800 cities and villages were affected by the floods with 65,000 destroyed houses and 114,000 houses partially damaged. Also 70 hospitals or health care centers with 1200 schools were damaged along with many infrastructures including 159 main roads and 700 bridges.

Conclusions

Considering 365,000 displaced persons and estimation of mentioned damages, it was one of the greatest natural disaster during the last 20 years. Various risk factors in favor of infectious diseases such as overcrowding, disruption of sewage disposal, poor standards of hygiene, poor nutrition, negligible sanitation and human contact among refugees provide suitable conditions for increased incidence of infectious diseases after flooding and also cause epidemics.More attention is needed to provide hygienic situation for people after natural disasters including flood.

Possible viral infections in flood disasters: a review considering 2019 spring floods in Iran

Floods are one of the natural disasters occurring worldwide which have a massive range of health impacts. In addition to immediate dangers such as drowning, floods can increase the transmission of some communicable diseases. Up to now there was no report of viral infection outbreaks after 2019 spring floods in Iran. This review explains the possible viral infections which may occur during or after floods.