Global Dilemma and Needs Assessment Toward Achieving Sustainable Development Goals in Controlling Leishmaniasis

Leishmaniasis is a disease of poverty that imposes a devastating medical, social, and economic burden on over 1 billion people nationwide. To date, no in-depth study to analyze the major global challenges and needs assessment has been carried out. This investigation aimed to explore a comprehensive narrative review of leishmaniasis's main challenges and initially highlight obstacles that might impede the implementation of control measures. Also, we propose a specific list of priorities for needs assessment. The presence of socioeconomic factors, multiple clinical and epidemiological forms, various Leishmania species, the complexity of the life cycle, the absence of effective drugs and vaccines, and the lack of efficient vector and reservoir control make this organism unique and sophisticated in playing a tangled role to react tricky with its surrounding environments, despite extensive efforts and implementation of all-inclusive former control measures. These facts indicate that the previous strategic plans, financial support, and basic infrastructures connected to leishmaniasis surveillance are still insufficient. Strengthening the leishmaniasis framework in a context of accelerated programmatic action and intensification of cross-cutting activities along with other neglected tropical diseases (NTDs) is confidently expected to result in greater effectiveness, cost-benefit, and fruitful management. Sensitive diagnostics, effective therapeutics, and efficacious vaccines are vital to accelerating advancement toward elimination, and reducing morbidity/mortality and program costs. Collective actions devoted by all sectors and policy-makers can hopefully overcome technical and operational barriers to guarantee that effective and coordinated implementation plans are sustained to meet the road map for NTDs 2021- 2030 goals.

Cutaneous leishmaniasis situation analysis in the Islamic Republic of Iran in preparation for an elimination plan

Iran has invariably been under the growing public health threat of cutaneous leishmaniasis (CL), a significant barrier to local development that hinders the prevention and control efforts toward eliminating the disease. So far, no comprehensive and in-depth epidemiological analysis of the CL situation has been carried out nationwide. This study aimed to employ advanced statistical models to analyze the data collected through the Center for Diseases Control and Prevention of Communicable Diseases during 1989-2020. However, we emphasized the current trends, 2013-2020, to study temporal and spatial CL patterns. In the country, the epidemiology of CL is incredibly intricate due to various factors. This fact indicates that the basic infrastructure, the preceding supports, and the implementation plan related to preventive and therapeutic measures need crucial support. The leishmaniasis situation analysis is consistent with desperate requirements for efficient information on the control program in the area. This review provides evidence of temporally regressive and spatially expanding incidence of CL with characteristic geographical patterns and disease hotspots, signifying an urgent need for comprehensive control strategies. This information could be a suitable model and practical experience in the Eastern Mediterranean Region, where over 80% of CL is reported.

Emerging and Re-emerging Infectious Diseases in the WHO Eastern Mediterranean Region, 2001-2018

BACKGROUND

Countries in the World Health Organization (WHO) Eastern Mediterranean Region (EMR) are predisposed to highly contagious, severe and fatal, emerging infectious diseases (EIDs), and re-emerging infectious diseases (RIDs). This paper reviews the epidemiological situation of EIDs and RIDs of global concern in the EMR between 2001 and 2018.

METHODS

To do a narrative review, a complete list of studies in the field was we prepared following a systematic search approach. Studies that were purposively reviewed were identified to summarize the epidemiological situation of each targeted disease. A comprehensive search of all published studies on EIDs and RIDs between 2001 and 2018 was carried out through search engines including Medline, Web of Science, Scopus, Google Scholar, and ScienceDirect.

RESULTS

Leishmaniasis, hepatitis A virus (HAV) and hepatitis E virus (HEV) are reported from all countries in the region. Chikungunya, Crimean Congo hemorrhagic fever (CCHF), dengue fever, and H5N1 have been increasing in number, frequency, and expanding in their geographic distribution. Middle East respiratory syndrome (MERS), which was reported in this region in 2012 is still a public health concern. There are challenges to control cholera, diphtheria, leishmaniasis, measles, and poliomyelitis in some of the countries. Moreover, Alkhurma hemorrhagic fever (AHF), and Rift Valley fever (RVF) are limited to some countries in the region. Also, there is little information about the real situation of the plague, Q fever, and tularemia.

CONCLUSION

EIDs and RIDs are prevalent in most countries in the region and could further spread within the region. It is crucial to improve regional capacities and capabilities in preventing and responding to disease outbreaks with adequate resources and expertise.

Imported tires; a potential source for the entry of Aedes invasive mosquitoes to Iran

INTRODUCTION

International trade of tires has been responsible for the introduction of invasive Aedes species into many countries. The present study aimed to determine the sources and volume of such trading in Iran and to establish and map points of entry for entomological surveillance.

METHOD

A list of tire importers, type and number of tires and source of their shipment was compiled, and the map of the main location(s) of their depot in the country was produced from 2017 to 2018. Contamination of imported tires with mosquito eggs or larvae was also determined. The samples from all parts of the warehouse were taken randomly from 4 to 20 tires every 15 days. In tires with a trace of water inside, the existence of the egg and larva of Aedes mosquitoes was investigated by sticking the glue band to the hot spot of left water inside the unpacked tires.

RESULTS

Approximately one-third of the annual tire requirements of Iran were imported from 15 countries, most of which were endemic to Aedes aegypti and or Ae. albopictus. It is obligatory to import only wrapped tires. About 10% of total country consumption is imported through informal markets and smuggled. However, the unofficially imported tires are usually not wrapped. The majority of tire imports were made through the southern ports of the country. The main sites for depots of imported tires were located in four Iranian provinces, namely Tehran, Isfahan, Fars, and Sistan and Baluchestan. The latter is extremely important given its border with Pakistan. Depot locations were mostly unstructured, and tires were kept in the open air. All these depot locations were at the edge of towns and residential areas. Priority areas for routine entomological surveillance were established. Such as the previous studies, surveillance of imported tires for the presence of Aedes eggs or larvae was negative in this study.

DISCUSSION

Mapping the entry points of imported tires and their origin is crucial to determine and prioritize sites for entomological surveillance of invasive mosquito species. Strengthening collaboration with customs authorities and the association of tire importers is imperative in this effort. The development of national rules and regulations for tire import is necessary to minimize the danger of the introduction of invasive vector species into the country.

SARS-Cov-2 and COVID-19, Basic and Clinical Aspects of the Human Pandemic: A Review

In the last two decades, we have witnessed three major epidemics of the coronavirus human disease namely, severe acute respiratory syndrome (SARS), Middle Eastern respiratory syndrome, and more recently an ongoing global pandemic of coronavirus disease 2019 (COVID-19). Iran, a country of nearly 84 million, in the Middle East, severely involved with the COVID-19 disease. A documented multidimensional approach to COVID-19 disease is therefore mandatory to provide a well-balanced platform for the concerned medical community in our county and beyond. In this review, we highlight the disease status in Iran and attempt to provide a multilateral view of the fundamental and clinical aspects of the disease including the clinical features of the confirmed cases, virology, pathogenesis, epidemiology, and laboratory methods needed for diagnosis.

Efficient production of a lentiviral system for displaying Crimean-Congo hemorrhagic fever virus glycoproteins reveals a broad range of cellular susceptibility and neutralization ability

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne disease with a mortality rate of up to 50% in humans. To avoid safety concerns associated with the use of live virus in virus neutralization assays and to detect human serum neutralizing antibodies, we prepared lentiviral particles containing the CCHF glycoprotein (lenti-CCHFV-GP). Incorporation of the GP into the lentiviral particle was confirmed by electron microscopy and Western blotting. Lenti-CCHFV-GP was found to be able to infect a wide range of cell lines, including BHK-21, HeLa, HepG2, and AsPC-1 cells. In addition, lenti-CCHFV-GP was successfully used as an alternative to CCHFV for the detection of neutralizing antibodies. Sera collected from CCHF survivors neutralized lenti-CCHFV-GP particles in a dose-dependent manner. Our results suggest that the lenti-CCHFV-GP pseudovirus can be used as a safe tool for neutralization assays in low-containment laboratories.

Survival and associated factors among people living with HIV/AIDS: A 30-year national survey in Iran

Background:

The survival in Iranian HIV/AIDS patients based on data from Iran National HIV/AIDS Case Registry System has not been evaluated. This study assessed the survival rates and associated factors among people living with HIV/AIDS in Iran.

Materials and Methods:

The population in this observational study included 32168 patients diagnosed with HIV/AIDS registered in Iran disease registry system between 1986 and 31 December 2015. Data until June 2016 (the cutoff date of our last data linkage) were investigated to estimate survival and related factors following HIV diagnosis.

Results:

Of registered patients, 17.7% were diagnosed at AIDS stage. By June 2016, 27.2% of study population progressed to AIDS, and 8081 (25.1%) of patients died. The survival rate was 88%, 85%, 77%, and 67% for 1, 2, 5, and 10 years, respectively. Cumulative proportion surviving was significantly lower in males than in females (P = 0.0001). A higher rate of survival was seen in female patients, who diagnosed after 2010, infected in sexual route, and had CD4 cell count more than 500, nonconfected patients with tuberculosis (TB), and those who received antiretroviral therapy (ART). Based on multivariate model, the mortality risk in female patients, those with CD4 cell count more than 500, patients who received ART, and those with TB and injection drug uses (IDUs) was higher.

Conclusion:

The survival in studied patients increased in recent time periods, and ART reduced AIDS-related mortality in these patients. The survival can be increased by focus on improvements in patient care among male patients, IDUs, and patients with TB coinfection.

A Review of Impact of Bam Earthquake on Cutaneous Leishmaniasis and Status: Epidemic of Old Foci, Emergence of New Foci and Changes in Features of the Disease

BACKGROUND

Global findings indicate that incidence rate of cutaneous leishmaniasis (CL) has significantly increased during the past decade, as documented in many countries. This review was aimed to evaluate the trend of CL cases in terms of demographic and clinical characteristics during a decade after the earthquake (2003-2012) compared to the corresponding period before the earthquake in Bam (1993-2003).

METHODS

Direct smear preparations along with different intrinsic methods were used for detection and identification of the causative agents.

RESULTS

Overall, 20999 cases of CL have occurred during the last 20 years (1993-2012), 6731 cases before and 14268 cases after the earthquake (P< 0.001).

CONCLUSIONS

Following a major earthquake, several risk factors could activate epidemics of cutaneous leishmaniasis in old foci and induce emerging foci in new areas.

Problems of providing services to people affected by HIV/AIDS: service providers and recipients perspectives

This qualitative study aimed to identify the health-care problems of people living with HIV (PLHIV) in 2 large cities: Tehran and Kermanshah. Two main groups of stakeholders - service providers (policy-makers, managers, physicians and counsellors) and service recipients (PLHIV and their relatives) - participated in focus group discussions and in-depth interviews. We identified 24 themes covering the major health problems of PLHIV, including: incomplete and inadequate coverage of health-care services; patients' substance abuse; patients' fear of stigma; occupational burnout of certain service providers; patients' dissatisfaction with some of the services provided by counselling centres/clinics; medical staff's failure to observe confidentiality; and patients' lack of access to required specialized services. The problems and needs identified can inform the design and implementation of health programmes in our country and elsewhere in the Eastern Mediterranean Region.

HIV trend among Iranian prisoners in 1990s and 2000s; analysis of aggregated data from HIV sentinel sero-surveys

BACKGROUND

Using the aggregated data of all sentinel sero-surveys (1991 to 2007), this study aimed to report the HIV trend among Iranian prisoners.

METHOD

Overall, we analysed the aggregated data from 397 HIV sero-surveys conducted in 72 prisons (included 155,771 prisoners) from 1991 through 2007.

RESULTS

The overall HIV prevalence was 2.8% (95% CI: 1.8%-4.3%). In 1998, HIV prevalence dramatically increased to 4.5% (95% CI: 1.1%-16.8%), which later became stable at level of 2.8%. Prisons were so heterogeneous regarding HIV prevalence (0% to 13.2%).

CONCLUSION

Since the outbreak, the ministry of health has acknowledged prisoners as one of the high-risk groups for HIV, increased the number of sentinel surveys and on-site harm reduction services to better monitor and response to the HIV epidemic. The downward trend of HIV prevalence after 2005 suggests the effectiveness of such interventions which need to be continued.

Mortality from Pandemic Influenza A (H1N1) in Iran

BACKGROUND

Due to worldwide spread of influenza A (H1N1) virus, the World Health Organization declared the first pandemic of influenza in four decades. This study aims to report the mortality from pandemic influenza A (H1N1) in Iran population and its epidemiologic and clinical characteristics up to December 21, 2009.

METHODS

The data were obtained from all provinces and reported to center for disease control of Ministry of Health and Medical Education (MOHME) of Iran through nationwide surveillance system for influenza A (H1N1) was implemented by MOHME since April 2009.

RESULTS

Of 3672 confirmed cases of influenza A (H1N1) in Iran between 22 May and 21 December 2009, 140 (3.8%) deaths were reported, mostly in 15-65 year old (yo) age group (67%). The highest admission mortality rate was in > 65 yo group (107 deaths/1000 hospitalized cases). Of decedent patients, 54% had no long term condition or risk factor, 34% had one, 11% had two, and 1% had three. Diabetes mellitus, pregnancy, chronic respiratory diseases and hypertension were the most common underlying conditions. The most common clinical pictures of death were acute respiratory distress syndrome and viral pneumonia. Although 66% of decedent patients received oseltamivir, enough information was not available about time of onset of antiviral therapy.

CONCLUSION

As death due to influenza A (H1N1) occurs in all age groups and in those with and without any predisposing factors, we recommend health policy makers to provide influenza vaccination for people with underlying conditions and respiratory hygiene for all people.

Hepatitis B vaccination coverage among Iranian children aged 15-26 months in 2006

This study in 2006 estimated the hepatitis B virus (BHV) vaccination coverage in the Islamic Republic of Iran at the national and district levels in urban, rural and remote populations of 41 university health service areas. Of 21 905 children recruited to the study, vaccination coverage based on vaccination card records was 100% in 14, 15 and 10 of the 41 university areas for the 1st, 2nd and 3rd doses of HBV respectively. National levels of HBV1, HBV2 and HBV3 coverage were 98.9%, 98.8% and 98.4% respectively. The lowest HBV vaccination coverage rate was 90.7% (in a remote district). HBV vaccination coverage was at an acceptable level in Iranian children.

Cancer incidence and mortality in Iran

BACKGROUND

Cancer is the third main cause of death in Iran. This report was provided for explaining cancer incidence and mortality.

PATIENTS AND METHODS

The National Cancer Registry reports from 2003 to 2006, population-based cancer registry reports from five provinces in 2006 and National Death Registry reports from 1999 to 2004 have been applied in this report.

RESULTS

The age-standardized incidence rate of cancers was 98 and 110 per 100,000 among females and males. The male to female standard ratio was 1.12. The most common cancer among women and men was breast cancer (24) and stomach cancer (15), respectively. The estimated mortality rate for cancer was 41.1 and 65 per 100,000 for females and males in 2004.

CONCLUSION

The current low cancer incidence rates in Iran might be due to lack of national cancer screening programs for prostate, colorectal or breast cancer, a consequence of incomplete registration as well as incomplete diagnosis of cancer patients; it is expected that it will rise dramatically in the future because of anticipated increase in life expectancy and westernized lifestyle. The first priorities for health policy makers should be developing, establishing and implementing national cancer control; or else, the health system could not respond to the demands regarding to diagnosis, treatment and palliation for these patients in the future.

Thinness, overweight and obesity in a national sample of Iranian children and adolescents: CASPIAN Study

BACKGROUND

This study was conducted to assess the national prevalence of different grades of nutritional status (underweight, normal weight, overweight and obesity) among Iranian school-students and to compare the prevalence of overweight and obesity using three different sets of criteria.

METHODS

This cross-sectional national survey was conducted on a representative sample of 21 111 school students including 10 253 boys (48.6%) and 10 858 girls (51.4%) aged 6-18 years, selected by multistage random cluster sampling from urban (84.6%) and rural (15.4%) areas of 23 provinces in Iran The percentage of subjects in the corresponding body mass index (BMI) categories of the Centers of Disease Control and Prevention (CDC), the International Obesity Task Force (IOTF) and the obtained national percentiles were assessed and compared.

RESULTS

There was no gender differences in BMI, but was higher in boys living in urban than in rural areas (18.4 +/- 3.88 vs. 17.86 +/- 3.66 kg/m(2) respectively, P < 0.05). The prevalence of underweight was 13.9% (8.1% of boys and 5.7% of girls) according to the CDC percentiles, and 5% (2.6% of boys and 2.4% of girls) according to the obtained percentiles. According to the CDC, IOTF and national cut-offs, the prevalence of overweight was 8.82%, 11.3% and 10.1% respectively; and the prevalence of obesity was 4.5%, 2.9% and 4.79% respectively. The prevalence of overweight was highest (10.98%) in the 12-year-old group and that of obesity (7.81%) in the 6-year-old group. The kappa correlation coefficient was 0.71 between the CDC and IOTF criteria, 0.64 between IOTF and national cut-offs, and 0.77 between CDC and national cut-offs.

CONCLUSIONS

The findings of this study warrant the necessity of paying special attention to monitoring of the time trends in child obesity based on uniform definitions, as well as to design programmes to prevent and control associated factors.

The diabetes prevention and control programme of the Islamic Republic of Iran

Diabetes mellitus has become a monumental problem and a major health concern throughout the world. We report on the programme developed by the Islamic Republic of Iran for control and management of diabetes, which involves screening for type 2 diabetes in adults at risk and a systematic approach for delivery of health care to people with diabetes.