Iranian Journal of Public Health
Volume:33 Issue: 4, Winter 2004

Since 1999, many cases of Crimean-Congo Hemorrhagic Fever have been reported from different parts of Iran. This study intended to define CCHF seroprevalence, incidence rates, and the most important risks in Sistan- Baluchestan province, Iran. Using cluster sampling with probability proportional to size, 310 subjects were selected from various districts of Zahedan and Zabol in the northern part of the province. Blood samples were drawn from consenting subjects, once at the beginning of the study and then 6 months later. The study began on 22 April 2003 and continued till 17 February 2004. A total of 18 out of 285 subjects who consented to give blood samples were actually positive by IgM and IgG capture ELISA tests. The calculated seroprevalence was 6.32% (95% CI: 3.24% to 9.40%). The calculated incidence was 0.48% (95% CI: 0.00% to 1.44%). Fourteen out of the 18 subjects with definitely positive IgG or IgM were female. In multivariate analysis, age, education, and history of slaughtering livestock were significantly related to the risk of infection. Only one of the seropositive subjects had a history of tick bite. This study shows the importance of subclinical infections in the epidemiology of this disease in Iran. It also seems that the risk of infection for housewives is high. Regardless of the high female to male ratio of seropositive subjects, it appears that the epidemiologic characteristics of the infection in this region are not so different compared to other parts of the world.

This cross-sectional study was designed to isolate of Leishmania spp from cutaneous leishmaniasis patients and characterized them by RAPD-PCR technique. Eighty- seven Leishmania isolates from 112 samples were collected from cutaneous leishmaniasis (CL) patients who referred to Mashhad Health Centers from August 2002 to May 2004. Desirable samples (87 isolates) were characterized by RAPD-PCR method using four selected oligoprimers. Electrophoresis patterns from each isolate were compared with reference strains of L. major, L. tropica and L. infantum. The results showed that 94.2% and 5.8% of isolates were similar to L.tropica and L.major reference strain, respectively. Four isolates that were determined by RAPD-PCR as L.major, could produce ulcer at the base tail of BALB/c mice, 4 - 12 weeks after inoculation but none of L. tropica isolates produced any lesions at the site of injection in the animals. The results indicate that L. tropica species are dominant in the studied areas of Mashhad city and RAPD-PCR technique is a suitable tool for Leishmania characterization in epidemiological studies.

Early diagnosis of human hydatid disease by detecting the specific antibodies in patients’ sera is considered as an important step in treatment of infection. But the diagnostic efficiencies of assays greatly depend on the characteristics of antigen that is used and various conditions in performance. In present study, we tried to standardize an indirect haemagglutination test, using antigen B for diagnosis of hydatid disease. Sera from 80 patients with surgically confirmed hydatidosis and 40 sera from healthy donors were examined. To detect the cross-reactant antibodies, 53 sera from patients with other parasitic infectious and diseases were applied in this study. IHA was performed with sheep RBC that was sensitized by various concentrations of crude antigen and antigen B. The best results were obtained by IHA with applying antigen B (10μg/ml) for 40 min at 37˚C or 60 min at room temperature. Diagnostic value of antigen B (sensitivity 93.75%, specificity 100% and efficiency 97.12%) was significantly higher than related value of crude antigen (sensitivity 65%, specificity 100% and efficiency 83.81%) in IHA under the optimum condition. Sensitivity and specificity of ELISA using crude antigen (10μg/ml) were obtained 80% and 94.62%, respectively. Corresponding values of ELISA using antigen B were also obtained as 72.5% and 98.92%, respectively. It is suggested that the IHA, as a serological assay, is a valuable method with high diagnostic efficiency for serodiagnosis of hydatid disease, when is performed by purified antigen B. It is a rapid diagnostic assay with any needs neither for expensive instruments nor expert personnel so is useful for seroepidemiological studies and field trial in endemic areas.

The 35delG mutation in the Connexin 26 gene (Cx26), at the DNFB1 locus is the most common mutation in the patients with autosomal recessive non-syndromic hearing loss (ARNSHL). We have studied a total of 224 deaf cases from 189 families in two populations of Iran (Sistan va Bluchestan and Hormozgan provinces) by prescreening nested PCR, polyacrylamide gel electrophoresis and consequent direct sequencing method for all cases. The aim of the present work was to find prevalence of GJB2 mutations in the populations studied. Four different GJB2 mutations including 35delG, W24X, R127H and (V27I + E114 G) were identified in 11 of 189 families (5.8%). Two polymorphisms (V27I and V153I) also were detected in 14 families. A polymorphism S86T was determined in all cases. Homozygote 35delG mutation was found only in 1 of 189 families (0.5%).The rate of Cx26 mutations found in this study was lower than other Iranian populations. So the cause of deafness in the populations studied remains to be detected in other loci or genes.

Following the occurrence of two large outbreaks in Gilan province, northern Iran, the public health importance of human fascioliasis has increased significantly. The mixed infections of Fasciola gigantica and F. hepatica within a given domestic animal individual suggest a very complicate picture of possible circulation ways of the parasite and the possibility for humans to be infected with both species. Elucidating these circulation ways is very critical for understanding the epidemiology and transmission of the disease and being ascertain how animals and humans enter the different liver fluke circulations in this endemic zone. The main objective of the present study was to investigate the distribution and natural infections of local lymnaeids, environmental characteristics related to the disease transmission and determining the most prevalent fasciolids and definitive hosts in human endemic areas of Gilan province. Bandar-Anzali and Rasht are the most important endemic areas with most of the cases of human disease during the epidemics and inter-epidemic periods. Sheep raising is not normal in these regions, while cattle is the most common definitive host. According to the data obtained from slaughterhouse observations in Bandar-Anzali and Rasht, the main fasciolid in local cattle is F. gigantica. Of 928 adult liver flukes collected from 13 infected livers of cattle, in Rasht and Bandar-Anzali slaughterhouses, 91.1% were diagnosed as F. gigantica and 8.9% as F. hepatica. L. gedrosiana and L. palustris were the most prevalent lymnaeid snails in this endemic zone. It appears that L. truncatula is not prevalent in Bandar-Anzali and Rasht and surroundings of these endemic cities. Of 4830 different snails studied, only seven L. gedrosiana were found to be infected with larval stages (rediae and cercariae) of Fasciola sp. Experimental infections of 15 common laboratory mice by metacercariae, obtained from those naturally infected snails, were carried out and all trematodes recovered at necropsy, 8 weeks post-exposure, appeared to be F. gigantica based on morphology. The high temperature, moisture and rainfall during the year, especially in Bandar-Anzali, support the establishment and transmission of the disease in the zone. Although the species involved in human infections in endemic areas of Gilan has been usually referred to as F. hepatica, the results of this study as well as some interesting epidemiological evidences related to the disease, support that Fasciola gigantica might be the main causal agent of fascioliasis in this important endemic zone.

The transfusion transmitted infections are potentially dangerous complications of transfusion therapy in immunocompromised patients. The aim of this study was to determine the prevalence of transmissible infections in blood donor population in Kashan, Iran. A total of 600 consecutive sera were tested for CMV-IgM antibody, HBsAg, hepatitis B core (HBc) antibody, hepatitis C (HCV) antibody, and HIV antibody with standard methods. Of the sera tested, 14 specimens (2.3%) were CMV-IgM positive. The frequency of seropositive revealed no significant differences between male and female donors. The frequency rates of CMV-IgM seropositive tests tend to decline with increasing the age. There was no relation between the frequency rates of CMV-IgM seropositive with the educational level, socioeconomic status, marital status, urban dweller and rural resident patients. The prevalence of HBV, HCV, and HIV antibody was 0.5%, 0.5%, and 0%, respectively. These findings implied important clinical applications because detection of CMV positive sera may reduce the risk for transmission of CMV in blood transfusion and thereby decrease the risk on CMV-induced complications.

The contamination of water by toxic heavy metals is a world-wide environmental problem. Discharges containing cadmium, in particular, are strictly controlled due to the highly toxic nature of this element and its tendency to accumulate in the tissues of living organisms. Low concentration (below 5 mg`/L) of cadmium is difficult to treat economically using chemical precipitation methodologies. Ion exchange and reverse Osmosis which can guarantee the metal concentration limits required by regulatory standards, have high operation and maintenance costs. The goal of this research was to determination of efficacy of using GAC, Biofilm and BAC columns to treat low concentration cadmium bearing water streams and was to determination of the effects of temperature and pH on the adsorption isotherms. Studies were conducted to delineate the effect of pH, temperature, initial Cd and adsorbent concentration on adsorption of Cd2+ by GAC, BAC and Biofilm. Breakthrough curves for removal of 0.5 mg/L Cd2+ by GAC, Biofilm and BAC columns at two contact times were plotted. Batch adsorption and column data are compared, pH is shown to be the decisive parameter in Cd removal for GAC but not for BAC or biofilter. Lagergren plots confirm applicability of first-order rate expression for adsorption of Cd by GAC, BAC and Biofilm. The adsorption coefficient (Kad) for BAC was 2-3 times greater than those with plain GAC. Bed Volumes of water containing 0.5 mg/L Cd2+ treated at breakthrough for GAC, Biofilm and BAC columns were 45, 85 and 180 BV respectively. BAC is more efficient than GAC in the removing of Cd from water environment.

Type E hepatitis is caused by an unclassified virus producing acute self-limited hepatitis in different parts of the world. In order to estimate the prevalence of hepatitis E virus seropositivity in Tehran blood donors, a cross– sectional study was performed by the enzyme immunoassay method from 2003 to 2004 in a group of 90 blood donors. We noticed that 7 cases (7.8%) were anti-HEV Ab positive. This figure correlates with the prevalence ratio of endemic parts. There was no association between seropositivity and sex. The commonest age group was 40-49 years. We conclude that Iran can be considered as an endemic area for type E hepatitis (prevalence>5%), and type E hepatitis is more common in Iran than Israel and Turkey, but less common than Saudi Arabia, Iraq and Pakistan; therefore, it should be regarded in the differential diagnosis of acute hepatitis.

Patients with chronic low back pain (LBP) hold various knowledge, perceptions and beliefs about their pain which are based on prior learning and social conditions. Since LBP is a bio- psycho-social phenomenon and there are not any reports about awareness and attitude of Iranian patients’ views regarding it, this descriptive study was employed to earn this information P to apply its results in health education planning. For data gathering, deeply interviewing with 24 patients were performed. Volunteer patients were from Rheumatology Research Center of Tehran University of Medical Science from July 1st to Sep 1st 2003 who had inclusive criteria such as: 18 years old or more, suffering from LBP more than 90 d and not having experience of surgical operation in last two years. Interviews were individually held at rheumatic disease center which was convenient to the participants and were being continued to earn data saturation regarding patient’s knowledge, perception and belief about LBP. The findings showed that the most popular risky behavior for LBP was hard manual activities, also this study revealed that knowledge of the patients about LBP and its risk factors was little and LBP was not understood by the majority of patients (74%).Only a few people (11%) believed risk factors and risky behaviors could deteriorate it. From this study it can be concluded that health educators should emphasize on perception and attitude of the patients regarding LBP for changing behavior and complying of recommended body mechanics.

CT.Scan examinations cause high patient absorbed dose from x-ray ionizing radiation. Therefore it is necessary to obtain superficial dose profile in Z-line. In this research 11 thermoluminecent dosimeter (TLD), after calibration were located on Z line perpendicular to slice thickness. CT.Scan machines did X-ray exposures. The resultant dose profiles showed gussian shape apperience, which has severed dose reduction off the slice thickness. By attention to high patient absorbed dose in CT.Scan machines, it is better to referre that patients towards any other diagnostic methods with lower risk and reasonable quality.

Tick are considered as the main vector for transmission of various diseases to human being. This study was carried out to investigate the fauna of species belonging to two families of ticks, Ixodidae and Argasidae in west Azerbaijan province, Iran. A total number of 62 villages were selected randomly, from the study area 3278 ticks were collected with cluster sampling method, after collection they were identified by morphological characteristics using stereomicroscope device. The ticks were classified into seven genera and 15 species including following species: Concerning Ixodidae families, Rhipicephalus (42%), Hyalomma (41%), Boophilus (7%), Dermacentor (7%), and Haemaphysalis (3%). Genus Rhipicephalus, comprised R. bursa (73%), R. sanguineus (27%), had the highest prevalence in summer. The species of Hyalomma were H. asiaticum (27%), H. marginatum (25%), H. aegyptium (14%), H. dromedarii (13%), H. schulzei (12%) and H. detritum (9%). Their peak frequency occurred in autumn. The single species of genus Boophilus was B. annulatus. Its activity occurred in spring and summer seasons. In genus Dermacentor, D. marginatus (61%) and D. niveus (39%) were total species of this genus that had the highest prevalence in summer and autumn. In genus Haemaphisalis, H. sulcata (61%) and H. inermis (39%) were recorded as the main species. Their highest seasonal frequency occurred in summer. Among soft ticks only Argas persicus and Ornithodoros lahorensis were collected. A.persicus was active during the summer and winter during the nights and the second species was active during the spring and winter. In conclusion, it should be emphasized that prevalence of the families Argazidae and Ixodidae ticks were more evident in mountainous area in west Azerbaijan province.

An investigation was carried out in Ahar district, (a new focus of visceral leishmaniasis), Eastern Azerbaijan, North-West of Iran in order to determine the vector(s) of the disease, during the summer of 2003 sand-flies were collected using sticky papers, CDC light traps and aspirators. All of the collected sand-flies were dissected in a drop of normal saline for surveying of promastigotes. Head and two last abdomen segments of-sandflies were mounted in a drop of Puri’s Medium for species identification. Totally 215 sandflies were collected including: Phlebotomus kandelakii (57.2%), P.perfiliewi (18.1%), P.caucasicus (11.2%), P. sergenti (7.9%), P. papatasi (3.3%) and P.(adlerius) sp.(2.3%). Only 1 of 24 P. caucasicus species (4.2%) was found naturally infected with parasite. This is the first infection report of P. caucasicus in this region. Some behavioral aspects of the mentioned sandfly have been discussed in details.