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Abstract Cutaneous leishmaniasis (CL) is a disease transmitted by mosquitoes and is endemic in many regions of the world and Iran, and annually imposes a large burden on the health system. This study was conducted to identify the effective factors in the preventive behaviors of CL based on the BASNEF model in endemic areas in the northwest of Iran. This cross-sectional study was conducted in Bileh-Savar, ‘endemic areas of Ardabil Province, Iran’, from June 2022 to October 2022. 200 non-patients were included in the study by a multi-stage sampling method. A standard questionnaire based on the BASNEF model was applied for data collection. The data were analyzed using SPSS version 25. Means and standard deviations were calculated to describe the continuous variables, and multivariate linear regression analysis was used to determine the prediction of intention and behavior by the model structures. The BASNEF constructs predict 27% of behavioral intention changes. Among the constructs, attitude has a greater contribution in predicting changes (R2 = 0.27, p

Background and Purpose: Myiasis is an infestation of vertebrates caused by the feeding of fly larvae on the living or necrotic tissue of hosts. Human myiasis is more prevalent among people who live in unsanitary conditions or have close contact with domestic animals. In this report, a case of nasopharyngeal myiasis in a 63-year-old patient admitted to the intensive care unit is presented. Case Presentation: A case of nasopharyngeal myiasis in a 63-year-old man with heart and respiratory failure in a hospital in Tehran City, Iran, is reported. By investigating the morphological characteristics of the isolated larvae and cultivating the pupa, Lucilia sericata was identified. Conclusion: It is recommended that necessary operations be carried out to prevent the entry of insects, including flies, into hospitals and control of them.

Abstract Objective The report of the outbreak of body louse in northwestern Iran after three decades reminds us again of the danger of the re-emerging of previous epidemics. Results The results of the study that nearly 70% of the patients in a rehabilitation Centre were infected with body louse. In this study, scientific measures were taken to prevent the spread of body lice to healthy people, including isolation of the patients, washing the clothes of those infected at high temperatures, and spraying the rest area, beddings, and blankets. This is a more recent report on an outbreak of body louse in Iran in 2023.

Abstract Background Suicide is a serious public health problem in the world. This study aims to describe the characteristics of suicide attempters in North-Western Iran and identify latent classes of suicide attempts. Methods This cross-sectional study was conducted in Ardabil Province (Northwest Iran) during 2017–2021 based on a registration system for suicide attempts. We performed latent class analysis (LCA) using a procedure for LCA (PROC LCA) in SAS to investigate the subgroups of suicide attempters based on their characteristics and method, history, and outcome of suicide. Results Three latent classes were identified for males and females; the first class (non-lethal attempters with lower educational levels) comprised 41.3% of males and 55.4% of females. The second class (non-lethal attempters with higher educational levels) described 52.4% of males and 42.7% of females. Finally, the third class (lethal attempters) included 6.4% of males and 1.9% of females. The main method of suicide attempts was poisoning with medications (87.3%). The results show that only 2.8% of people have a history of suicide attempts. Also, the suicide rate reached 8.26 per 100,000 population in 2021. Conclusion The present study showed an increasing trend of suicide attempt incidence rate in Ardabil Province from 2017 (99.49 per 100,000 population) to 2021 (247.41 per 100,000 population). This means that the rate of change was 147.92 per 100,000 population during the study period. The findings of LCA, stress the necessity of identification and prioritization of unmet needs of people who had an incomplete suicide in Ardabil.

Abstract Background Iran is a country with a high prevalence of visceral leishmaniasis (VL) and seven endemic provinces. In this study, we tried to identify unobserved classes of knowledge among Iranians toward VL and assess the predictors of each latent class. Methods This cross-sectional study was conducted among randomly selected participants from endemic and non-endemic areas of VL in Iran in 2020 and 2021. The collected data included demographic characteristics and questions about knowledge, attitude, and practice toward VL. We performed latent class analysis using a procedure for latent class analysis (PROC LCA) in SAS to identify the class membership of knowledge of participants toward VL. Results Five latent classes were identified: very low (38.9%), low (15.5%), moderate (6.2%), high (14.1%), and very high (25.2%) knowledge about VL. Living in endemic areas significantly increased the odds of belonging to the low (adjusted OR (AOR = 7.23; 95% confidence interval (CI):4.52–11.58), high (AOR = 2.71; 95%CI: 1.73–4.23), and very high (AOR = 8.47; 95%CI: 5.78–12.41) classes compared to the very low class. Also, having academic education increased the odds of membership in the very high class (AOR = 2.36; 95%CI: 1.61–3.47) compared to the very low class. Conclusion This study revealed that more than 50% of the participants fell into the latent classes of very low and low knowledge toward VL. Some educational workshops in the endemic areas could be effective in enhancing knowledge about VL.

Abstract Background Head lice are a main public health problem and the most important human ectoparasites and the use of pediculicides is the most common way to control it. One of the possible causes of treatment failure is the lack of improper application of pediculicide. The aim of this study was to assess the effect of education on efficacy of 1% permethrin or 4% dimeticone lotion to treat head lice infestation. Methods This quasi-experimental study included 100 individuals with head lice infestation from comprehensive urban health centers in Ardabil as the intervention group, and 400 individuals from East Azerbaijan and West Azerbaijan provinces as the control group, from April to March 2019. The data collection tools included a demographic questionnaire and an examination recording sheet, which documented the presence of adult lice or nits. Due to the inability to perform random assignment and control for numerous observed covariates, propensity score matching (PSM) was used. Results The outcome of treatment included elimination of head lice infestation on is 7, and in the case of recurrence, it was considered on days 14 and 30 after treatment. The results showed that the educational intervention program had a significant positive effect on the efficacy of both treatments. The likelihood of improvement was approximately three times greater in the intervention group compared to the control group. Conclusion Participants who received the training intervention (OR = 3.29; CI 95%: 2.21–4.88) were more likely to have a successful treatment than control group. In the case of providing proper training on the use of pediculicides and observing hygiene tips to patients with pediculosis, could help to successful treatment of pediculosis.

Brucellosis is recognized as a significant global zoonotic infection that disproportionately affects low-income settings. A community cross-sectional survey was carried out in a rural setting of northwest Iran between February and May 2023. Rural individuals were interviewed according to a questionnaire with questions about demographic characteristics, knowledge, attitudes, and practices relating to human brucellosis. We employed descriptive statistics to study knowledge, attitudes, and practice patterns. In addition, we applied a multivariable logistic regression model to assess potential predictors of knowledge, attitudes, and practice related to brucellosis using odds ratios and 95% confidence intervals. Among 700 participants, 91.1% were aware of brucellosis, and 85.7% identified cows, sheep, and goats as primary transmission sources. 75.6% and 78.7% recognized transmission risks via unpasteurized and raw milk products. 60.5% understood the benefits of boiling milk and using gloves. Attitudinally, 64.3% perceived higher risk for livestock owners and supported practices like milk pasteurization (70.5%), protective gear (84.4%), handwashing (92.2%), and animal vaccination (71.0%). 90% expressed a need for more information. In practice, 44.8% exclusively consumed boiled and pasteurized milk, 37.8% consumed fresh cheese, and 92.2% solely consumed thoroughly cooked animal meat. Logistic regression revealed that higher education and no prior history of the disease correlated with good knowledge and attitudes, while older participants displayed inappropriate practices compared to their younger counterparts. This study highlights the reasonably high awareness of brucellosis, particularly regarding transmission sources and preventive measures. However, the gaps in knowledge, attitudes, and practices still exist, with education level emerging as a significant factor. To improve prevention practices, tailored interventions addressing age-related disparities are necessary.

Abstract Mosquitoes are the most important vectors of serious infectious diseases in the world. Dengue, Zika, chikungunya and yellow fever are emerging and re-emerging infectious diseases, associated with the distribution of two key vectors i.e. Aedes aegypti and Aedes albopictus throughout the world including countries neighbouring Iran. Entomological surveillance was planned and performed monthly from May to December during 2014–2020 in selected counties of Mazandaran Province, North of Iran, by ovitrap, larval collection, hand catch and human baited trap. Overall, 4410 Aedes specimens including 2376 larvae (53.9%) and 2034 (46.1%) adults belonging to six species, namely Aedes vexans, Aedes geniculatus, Aedes caspius, Aedes echinus, Aedes pulcritarsis and Aedes flavescence were collected and morphologically identified. Over the seven years of surveillance, Ae. aegypti and Ae. albopictus were not found by any sampling method. Aedes vexans and Ae. geniculatus were the most abundant species, their populations peaked in October and November and was positively correlated with precipitation and relative humidity. Aedes flavescence was a new species record for the province. A flowchart for planning and implementation of invasive mosquito surveillance for provincial health authorities in the country is proposed. These surveillance efforts provide basic and timely information for the health system to act promptly on integrated and intensified surveillance and control programs should Ae. aegypti and Ae. albopictus detected in the province.

Introduction Brucellosis is one of the most prevalent infectious diseases in the world that infects humans directly through contaminated livestock or indirectly through animal products and induces high medical and economic damage annually. Objective Using geographic information system (GIS) software to determine the hot spots of brucellosis and the spatial correlation and type of disease distribution. Methods We extracted the incidence cases of the disease from 2016 to 2020 in this retrospective cross-sectional study using the disease registration system of Ardabil University of Medical Sciences. The interpolation method (IDW) was employed for spatial analysis and disease distribution and determination of hotspot points, Moran I and General G analysis were used to determine spatial autocorrelation at a significant level ( P

Abstract Introduction : This study aimed to investigate overall and age group/region/sex-specific excess all-cause mortality from the inception of the COVID-19 pandemic in Iran until February 2022. Methods Weekly all-cause mortality data were obtained for the period March 2015 until February 2022. We conducted interrupted time series analyses, using a generalized least-square regression model to estimate excess mortality after the COVID-19 pandemic. Using this approach, we estimated the expected post-pandemic death counts based on five years of pre-pandemic data and compared the results with observed mortality during the pandemic. Results After the COVID-19 pandemic, we observed an immediate increase (1,934 deaths per week, p = 0.01) in weekly all-cause mortality. An estimated 240,390 excess deaths were observed in two years after the pandemic. Within the same period, 136,166 deaths were officially attributed to COVID-19. The excess mortality was greatest among males compared with females (326 versus 264 per 100k), with an increasing trend by age group. There is a clear increased excess mortality in the central and northwestern provinces. Conclusion We found that the full mortality burden during the outbreak has been much heavier than what is officially reported, with clear differences by sex, age group, and geographical region.

Background & Objective: Hepatitis B virus [HBV] infection is one of the most important public health concerns. The present study was conducted to provide a descriptive analysis of detected HBV infection in Ardabil province. Methods: In this retrospective longitudinal study, the hepatitis B surveillance database of Ardabil province was examined from 2014 to 2018. The frequency of hepatitis B virus infections was presented based on age, gender, marital status, place of residence, primary symptoms, and reporting sources. Also, the trend of changes in the number of detected cases over time was investigated using time series analysis. Results: A total of 817 positive cases with a mean age of 43.1 years were reported. Most of them were male [n=503, 61.5]. The Frequency of identified positive cases decreased over time. Most of the infections were asymptomatic [87.5%]. Almost 90.0% of patients with HBV were married and the majority of the identified patients were resided in urban settings [n=598, 73.2%]. Most diagnostic tests were done voluntarily [n=219, 26.8%] or during prenatal care [n=109, 13.3%]. Most cases were identified and reported by the health network [n=292, 35.7%] and blood transfusion organization [n=190, 23.2%]. Conclusion: Decision-makers of the health sector of the province can use this information as a source for evidence-based decision-making in the effective management of the disease.

Background: Owing to chitosan properties such as biocompatibility and antimicrobial activities, and several applications in biomedical field, some physicochemical and anti-bacterial properties, and the level of chitosan from three species of American cockroach, Periplaneta americana (Dictyoptera: Blattidae), the German cockroach, Blattella germanica (Dictyoptera: Ectobiidae) and the Mealworm beetle, Tenebrio molitor (Coleoptera: Tenebrionidae) were investigated. Methods: The cuticle of adults derived from specimens was dried and grounded. The powders were demineralized as well as deproteinized after deacetylation via NaOH. At last, the chitosan yields from insects were studied for anti-bacterial activity on Gram-positive bacteria (Proteus mirabilis, Klebsiella pneumoniae), and Gram-negative bacteria (Enterococcus faecalis and Staphylococcus epidermidis). The Fourier transform infrared spectroscopy (FTIR) was used to analyze the chitosan composition. Results: The chitosan ratios of the American and German cockroaches and the mealworm beetle were 5.80, 2.95, and 1.70% per 3 g of the dried bodies respectively. The chitin DD’s for the American cockroach, the German cockroach and the mealworm beetle were 36.8%, 31.5% and 27.3%, respectively. The bactericidal activity of chitosan obtained from the American cockroach at a concentration of 1% had the greatest effect on P. mirabilis compared to other concentrations, while chitosan obtained from the German cockroach at a concentration of 0.01% had the greatest effect on K. pneumoniae compared to other concentrations. Conclusion: According to the results, the anti-bacterial influence of the chitosan is based upon the insect species and chitosan concentration. Probably, the variation relates to the changes in the chitin structure among the three insect species.

Abstract Background Coronavirus disease highly contagious, is prevalent in all age and sex groups infecting the respiratory system. The present study seeks to investigate the epidemiology and effective factors in mortality of patients with COVID-19 in Ardabil province, northwestern Iran. Methods In a retrospective study, the hospitalized patients with laboratory-diagnosed COVID-19 between February to August 2020 were enrolled. The data registration portal was designated according to Iranian Ministry of Health and Medical Education guidelines. In this portal, demographic information, clinical presentation, laboratory and imaging data were registered for patients in all hospitals in the same format. The Hosmer-Lemeshow strategy was used for variable selection in a multiple model. Results Of the patients involved 2812(50.3%) were male and 150 (2.7%) had contact with a confirmed case of COVID-19 in the last 14 days. Pre-existing comorbidity was reported in 1310 (23.4%) patients. Of all patients, 477(8.5%) died due to COVID-19. the result of the multiple logistic regression model indicated that after adjusting for other factors, higher age (OR = 3.11), fever or chills (OR = 1.61), shortness of breath (OR = 1.82), fatigue (OR = 0.71), headache (OR = 0.64), runny nose (OR = 1.54), Skeletal muscle pain (OR = 1.53), hospitalization (OR = 5.66), and hospitalization in ICU (OR = 5.12) were associated with death. Conclusions Hospitalization had the strongest effect on mortality followed by hospitalization in ICU, and higher age. This study showed that having some extra-pulmonary symptoms in contrast with pulmonary symptoms can predict as good prognostic factors.

OBJECTIVES Early diagnosis is essential for effective tuberculosis (TB) control programs. Therefore, this study examined the risk of delays in TB diagnosis and associated factors in Ardabil Province in northwest Iran from 2005 to 2016. METHODS This longitudinal retrospective cohort study was conducted using data obtained from the Iranian National Tuberculosis Control Program at the provincial level between 2005 and 2016. The total delay in diagnosis was defined as the time interval (days) between the onset of symptoms and TB diagnosis. Survival analysis was conducted to analyze the delay in diagnosis. Associated factors were identified using a Cox proportional hazards model. RESULTS A total of 1,367 new TB cases were identified. The 12-year median diagnostic delay was 45 days (interquartile range [IQR], 30-87). The annual median diagnostic delay decreased from 68 days (IQR, 33-131) in 2005 to 31 days (IQR, 30-62) in 2016. The probability of a delay in TB diagnosis decreased by 5.0% each year (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.04 to 1.07). Residence in a non-capital county (HR, 0.83; 95% CI, 0.74 to 0.92) and referral from the private health system (HR, 0.74%; 95% CI, 0.65 to 0.84) were significantly associated with an increased risk of delay in TB diagnosis over the 12-year study period. CONCLUSIONS The median delay decreased during the study period. We identified factors associated with a longer delay in TB diagnosis. These findings may be useful for further TB control plans and policies in Iran.

Abstract Background Crimean-Congo hemorrhagic fever (CCHF) is highly fatal to humans and an acute viral disease. The CCHF disease has been reported in occupations such as butchers, slaughterhouse butchers and workers. The aim of this study was to investigate the pattern of CCHF related high risk behaviors among butchers and determine the effects of perceived self-efficacy of the participants on their membership in latent classes. Methods The participants of this cross-sectional study were recruited from all the meat distribution centers in Ardabil Province in 2019–2020. The LCA approach was used to observe the CCFH related high risk behaviors patterns. Results The statistical significance level was assigned at P-value < 0.05 in all the analyses. Three latent classes were identified; namely, 1) low risk (16.1%), 2) high risk (53.6%), and 3) very high risk (30.2%). After adjusting for other possible confounders higher score of perceived self-efficacy significantly decrease the odds of membership in high risk class (OR = 0.74) and very high risk class (OR = 0.62) compared to the low risk class. Also, age (OR = 1.07) and experience (OR = 0.91) associate with very high risk class. Conclusions This study revealed the co-occurrence of CCHF related high risk behaviors in the majority of workers in the livestock and meat industry. It is necessary to provide butchers and slaughterhouse workers with general education, force them to use protective equipment and investigate the rate of tick bites in risky occupations.

Background and Purpose: Poisoning with pesticides, drugs, and chemicals is one of the most important health problems in the world, causing a varying mortality rate in different regions. Easy access to a variety of drugs and poisons has caused some people to be hurt by using such things. The aim of this study was to evaluate the poisoning and mortality rate by using poisons, drugs, and chemicals in Meshkinshahr, a city in Ardabil Province. Materials and Methods: This descriptive and analytical cross-sectional study was conducted in Meshkinshahr Hospital from 2017 until the end of 2018. All information of people who were poisoned with pesticides, drugs, and chemicals was extracted from hospital case, and then was analyzed by SPSS 23. Results: Totally, 453 cases were referred to hospital with 173 (38.20 %) male and 280 (61.80 %) female. 73% of the cases were poisoned by using medications and drugs , 18% by using other chemicals and 9% by poisons and pesticides. The mortality rate was 4%, with 70% due to exposure to pesticides and toxics, and 60% pertaining to deliberate suicide. Conclusion: According to the results of this study, most of the poisoning cases occurred as a result of using drugs; however, more than 70% of mortality was due to pesticides which indicated the toxicity of the pesticides. Also, the findings emphasized that the knowledge of target people is low.

Objectives Obesity is regarded as one of the most prominent health threats worldwide and a serious risk factor for non-communicable diseases, such as diabetes mellitus type 2, high blood pressure, cardiovascular diseases, and some types of cancer. Given the role that societal development—as reflected by the Human Development Index (HDI)—may play in the prevalence of obesity and overweight, this study aimed to investigate the degree to which the prevalence of obesity and overweight is affected by HDI and its components. Methods In this ecological study, the required data on HDI and its components were gathered from the latest report of the United Nations Development Program, and data on obesity and overweight were acquired from the latest reports published on the World Health Organization website. Statistical analyses were conducted using SPSS version 24.0. Results The prevalence of obesity was determined to be significantly higher among females than males, and the gross national index per capita was found to be significantly higher for males than females (p

Background: Vector borne diseases (VBDs) are the infectious diseases reported from all parts of the world and Iran. The main vectors of VBDs belong to the phylum of arthropod and insects. The aim of this study was providing the database of important VBDs and vectors and geographical distribution model in Ardabil, northwest of Iran. Methods: This retrospective cross–sectional study was conducted from 2001–2018. All the ear- lier published studies, reports and documentations related to vectors and vector–borne diseases searched systematically as well as the data of diseases was collected from the Center for Disease Control (CDC) of Ardabil University of Medical Sciences. ArcGIS 10.4.2 (http://www.esri.com/ arcgis) were used to spatial analysis mapping, Normalized Difference Vegetation Index (NDVI) index and high/low clustering. Results: Totally 110076 cases of VBDs reported in Ardabil Province during the past 18 years including malaria, visceral leishmaniasis (VL), cutaneous leishmaniasis (CL), Crimean Congo hemorrhagic fever (CCHF), tick–borne relapsing fever (TRF), pediculosis, scorpionism, scabies and anthrax. These diseases were transmitted in Ardabil Province by eight arthropod families, 19 genera and 70 spices of arthropods. Most species belonged to Culicidae with 24 species followed by Psycodidae with 22 and Ixodidae with 16 species. The incidence rate of VBDs was 63/100000 in 2001 which decreased to 7/100000 in 2010 and then increased to 21 /100000 in 2018. Conclusion: The distribution model of the VBDs was plotted based on the geographical and ecological of the vectors will help the authorities for decision.

Background: Ticks are forced vertebrate ectoparasites, including humans, and are vectors of serious diseases such as Crimean Congo Hemorrhagic Fever, Relapsing Fever, and various forms of encephalitis. Spatial assessment of the prevalence of ticks and detection of high risk areas for tick-borne disease transmission and evaluation of ecological measures are key aims of this research. Methods: Ticks were collected using standard methods from 27 villages in the region of Sarab County in north-eastern Iran during the four seasons of 2018–2019 and identified using valid keys. The calculations of indices for biodiversity were based on the Margalef index, Shannon-Weiner index and Simpson index. R2.15 Statistical software was used for statistical analysis of indices of biodiversity, and ArcMap10.4.1 software, IDW and GeneralG methods were used. Analysis were used to investigate spatial distribution and to determine important tick hotspots. Results: A total of 2500 animals surveyed, 35% of them were infected. In total, 1416 ticks were caught, 74.6 %, 23.9% and 1.4 % were adult, nymph and larvae respectively. 94% of the ticks were hard ticks including 6 genera. According to the Margalef diversity index, the highest species biodiversity was related to summer (1.4234), and the lowest was relat­ed to winter (0.7379), Conclusion: Large hotspot area was found in the central part of the study area. The area of study was very prone to tick-borne disease transmission in terms of tick diversity and tick species richness. Tick-borne disease control is an im­portant measure.

Background: This study was performed to evaluate in vitro and in vivo Leishmanicidal potential of morphine (Mph), imiquimod (IQ), and their combination. Methods: Leishmania infantum promastigote and amastigote assays were performed at the presence of 0.015–150µM Mph, 0.04–416µM IQ, and their combination. The inhibition effects of these drugs on promastigotes were evaluated after 24, 48, and 72h. The cytotoxic effects of the drugs were evaluated by MTT as well as flow cytometry after 72h. We explored the therapeutic effects of Mph and IQ in BALB/c mice at the end of the treatment using parasite load de­termination and cytokine assay. One group of mice received Mph for three weeks before infection. Results: The results of promastigote and amastigote assays showed the cytotoxic effects of the drugs at low concentra­tions. The cytotoxic effects were higher on promastigotes than amastigotes (p< 0.05). There was a negative correlation between drug concentration and amastigote/promastigote viability. Imiquimod alone or combined with Mph showed remarkable cytotoxic effects at all concentrations (p< 0.05). Flow cytometry results revealed apoptosis in the parasite following exposure to the drug combinations. Accordingly, the reduction of parasite loads in the spleen and liver was observed (p< 0.05) with simultaneous increases in IFN-γ and IL-4. We believe that the in vivo leishmanicidal effect was mediated by Mph through IL-4 and by IQ through both IL-4 and IFN-γ. Conclusion: Results pointed out the promising effects of Mph and IQ at low concentrations, especially when combined.

Background and Aim: Pediculus humanus capitis has been prevalent throughout the world, especially in developing countries among elementary students and societies with a weak socio-economic status. This study aimed to forecast head lice (Pediculidae: P. capitis) infestation incidence hotspots based on spatial correlation analysis in Ardabil Province, Northwest Iran. Materials and Methods: In this retrospective analytical study, all cases of head lice infestations who were confirmed by Centers for Disease Control office have been studied from 2016 to 2018. Head lice infestation incidence hotspots in the province should be detected based on general G statistics in ArcMap GIS10.4.1. Furthermore, MaxEnt.3.3.3 model was used for modeling the high-risk areas. Results: The prevalence rate of pediculosis was 14.90/100,000 populations. The general G statistics revealed that the head lice infestation in this study area has a high cluster pattern. The analysis showed that the Parsabad and Germi counties were identified as a head lice infestation incidence hotspots. Statistical and spatial analyses of head lice infestation incidence showed a significant positive correlation with head lice infestation incidence hotspots and the altitudes (15-500 m), annual temperature range (14-16.5°C), and slope and average diurnal temperature (12-18°C). Conclusion: The results of this study showed that the most ecologically suitable areas of head lice occurrence were identified in two hotspots (Parsabad and Germi) in the Northern areas of Ardabil Province (Parsabad and Germi counties); in the borderline of Iran and the Republic of Azerbaijan.

Objectives: West Nile virus (WNV) is a microorganism and the leading cause of the spread of fatal diseases in horses, birds, and humans. The etiologic agent of West Nile fever belongs to the genus Flavivirus that is transmitted by Culex mosquitoes in Iran and throughout the world. We aimed to evaluate the distribution of WNV vectors in northwest of Iran ecological niche modeling. Methods: This cross-sectional study was conducted in Ardabil province in one year, from January to December with the samples captured from May to November 2017. Forty-five locations from all 10 counties of the province were selected randomly to determine the seasonal activity of mosquitoes. Larval collection was carried out twice a month. MaxEnt version 3.3, ArcMap 10.3 software, jackknife, and crew methods were used to determine the impact of climatic change and environmental factors on the distribution of mosquito species. Results: A total of 2000 larva were collected, 1789 (89.5%) of which were Culex larvae. Seven species of Culex genus were identified, including Culex pipiens, Cx. modestus, Cx. theileri, Cx. hortensis, Cx. perexiguus, Cx. tritaeniorhynchus, and Cx. mimeticus. Two important ecological niche areas were identified in the north and south of the province. The annual temperature and rainfall in the cold seasons were the most important factors affecting the distribution of Culex species larva. Cx. pipiens was identified as the main vector of WNV vectors with high frequency in Ardabil province. Conclusions: Two large areas were found as the ecological niches of larvae of these species. It is recommended that additional investigations be carried out on infection in adult female Cx. pipiens and its hosts in these areas.

Introduction: Crimean-Congo hemorrhagic fever (CCHF) is a viral disease that is transmitted to humans through the tick bite, contact with blood and tissues of infected animals in slaughterhouses as well as infected patients in hospital. The mortality rate of CCHF is 20 - 50%. Case Report: The patient was a 20-year-old man, an Iranian farmer, who lived in Ardabil County. The epidemiologic survey showed that his right leg has been bitten by a tick in the past week. The onset of the disease was a sudden high fever, chills and muscle pain. Molecular analysis of blood by RT-PCR showed that it was positive for CCHF disease. Conclusion: Clinical and epidemiological findings are the most important strategies for diagnosis of CCHF disease.

Background and Objectives: Visceral leishmaniasis is a zoonotic diseases and is endemic in northwest of Iran and annually 100-300 positive cases are reported. The aim of this study was to determine the spatial distribution of visceral leishmaniasis in East Azerbaijan province. Material and Methods: This is a retrospective cross-sectional study that was done on visceral leishmaniasis patients from 2009-2016 which is analyzed based on interpolation and SPSS v.25 and ArcMap10.4.1 have been used. Results: Totally 78 patients were identified during the study, of which 57.7% were living in rural areas and 42.3% in urban areas. More than 90% of cases have occurred in children under the age of 5 years. The northeastern part of the province, which has a higher average rainfall and a moderate temperature, was identified as a high risk area of the disease and a hot spot of disease among the Kalibar and Ahar counties. Conclusion: Visceral leishmaniasis has increased by 3-4 times since 2013 in East Azarbaijan province and residents of border areas with Ardebil province and Azerbaijan Republic are at the risk of transmitting the disease.

Background and Aim: Zoonotic rodents (Rodentia: Muridae: Gerbillinae) and Phlebotominae sand flies are the major reservoir hosts and vectors of Leishmania major causing zoonotic cutaneous leishmaniasis, respectively. This study was carried out to evaluate the epidemiological aspects of cutaneous leishmaniasis (CL) in Tangestan County, Southwest Iran. Materials and Methods: This descriptive cross-sectional study was carried out on human cases, probable reservoirs, and vectors of CL at Tangestan County in 2017. The data of patients were taken on health centers and analyzed. To determination faunistic of sand flies, they were collected using sticky paper traps and identified using identification keys. The rodent samples were captured using Sherman live traps and determined for amastigote infection. Results: A total of 436 cases occurred during 2005-2017 and the incidence rate of disease was 0.2-12/100,000 people. Six species of sand flies including three species of Phlebotomus and three species of Sergentomyia including Phlebotomus papatasi, Phlebotomus sergenti, Phlebotomus alexandri, Sergentomyia tiberiadis, Sergentomyia baghdadis, and Sergentomyia clydei were identified. From 185 trapped rodents, 9 species were identified. We founded, 2 out of 132 Tatera indica (1.53%) were positive with Leishmania spp. using the microscopic method. Conclusion: According to the existence of human leishmaniasis cases as a host, T. indica with high abundance and infected to Leishmania as a reservoir, and existence of P. papatasi with high abundance as a suspected vector of disease; there is a potential for transmission of disease in the area. Design of exact control and prevention strategies is highly recommended.

Background: The Crimean-Congo Hemorrhagic Fever (CCHF) is one of the most important arthropod-borne viral dis­eases with a mortality rate of about 30% among humans. The disease, caused by a Nairovirus, is transmitted to humans and animals by hard and soft ticks. This study aimed to determine the distribution of soft and hard ticks in the past three decades in Iran with an emphasis on the vectors of the CCHF virus. Methods: In this review, all studies that were carried out in different regions of Iran from 1979 to 2018 and their results were published in prestigious journals were used to create a database. The distribution of ticks was mapped using ArcMap10.3. Results: Based on the results, nine genera and 37 species of soft and hard ticks were recorded in Iran. So far, six genera and 16 species of hard and soft ticks were reported to be infected with the CCHF virus. The infection to this virus was reported from 18 out of 31 provinces, with a high rate in Sistan and Baluchistan as well as Khuzestan provinces. The highest levels of CCHF infection belonged to Hyalomma marginatum and H. anatolicum. Conclusion: The main vectors of CCHF, H. marginatum and H. anatolicum, were reported in more than 38.7% of Iran's provinces, and these two species were identified as invasive species in Iran. Thus, control activities should be strength­ened to avoid the outbreaks of CCHF.

Background: Phlebotomus kandelakii and Phlebotomus perfiliewi transcaucasicus sand flies are the vectors of vis­ceral leishmaniasis in Iran. The aim of this study was to evaluate the susceptibility of Ph. kandelakii and Ph. perfil­iewi trans­caucasicus, collected from an endemic focus of visceral leishmaniasis (VL) in the northwest of Iran, to different select­ed insecticides. Methods: Sand flies were collected from the villages of Meshkinshahr and Germi Counties using light traps and aspira­tors from May to October 2019. The sand flies were identified as Ph. kandelakii and Ph. perfiliewi transcauca­sicus us­ing standard identification keys. Susceptibility test was carried out against DDT (4%), Malathion (5%), Propoxur (0.1%) and Lambda-cyhalothrin (0.05%) according to the WHO standard method. MedCalc statistical software was employed to calculate LT50 and LT90 and to compare the chances of sand flies surviving the exposure to the studied in­secticides. Results: A total of 1,278 female specimens were used for the susceptibility tests. Out of which 1,063 samples were used for the test and 215 for the control group. The estimated LT50 values for DDT (4%), Malathion (5%), Propoxur (0.1%), and Lambda-cyhalothrin (0.05%) for Ph. kandelakii were 15.1, 13.4, 15.4 and 5.8 minutes respectively, and for Ph. per­filiewi transcaucasicus were 11.9, 15.6, 15.9 and 5.8 minutes respectively. Conclusion: This susceptibility studies revealed different LT50 values for different insecticides efficient against Ph. kandelakii and Ph. perfiliewi transcaucasicus. The regular monitoring for the resistance of Ph. kandelakii and Ph. per­filiewi transcaucasicus sand flies seems necessary in diseases control programs in this area.

Background: Visceral leishmaniasis (VL) is a zoonotic disease that currently occurs in some parts of Europe, Asia, Africa, and America. This study aimed to determine the distribution of the canine visceral leishmaniasis in dogs (Canis lupus familiaris) in northwestern Iran. Methods: The data were collected from 1994 to 2018 in Ardabil Province from electronic databases. An extensive literature search was conducted in different international and national databases, including Cochrane, MEDLINE/PubMed, Scopus, Web of Science, and Iran Medex to find articles with the words “visceral leishmaniasis in Ardabil” in their titles, and “canine visceral leishmaniasis in Ardabil” or “accidental reservoir hosts of visceral leishmaniasis in Ardabil” in their subtitles, irrespective of the type and duration of study. The GIS software and MaxEnt model were used to determine the ecologically suitable niches for the disease. Results: In total, 9088 dogs were examined, and the overall prevalence rate of CVL in dogs was estimated to be 14.56%. The most ecologically suitable areas of CVL occurrence were identified in four hotspots in Meshkinshahr, Germi, and two spots in Parsabad counties. The results of jackknife test showed that the environmental and climate variables with the highest gain, when used in isolation, were Isothermality, Bio3, Bio13, and Bio 4. Conclusion: A widely epidemic CVL has emerged among dogs, making a lot of risks on inhabitants of this area and increasing the probability of an outbreak of VL in humans.

Objective: To determine the spatial distribution and infection rate of sand flies as vectors of Leishmania parasite in Ardabil province, northwest of Iran. Methods: This was a descriptive cross-sectional study. The sand flies were collected from 30 areas in all 10 districts of Ardabil province during 2017. The specimens were caught using the sticky traps. The head and genitalia of sand flies were separated and mounted in Berlese solution for microscopic identification. The Geographical Information System ArcMap10.4.1 software was used to provide the spatial maps. Results: A total of 2 794 sand flies specimens were collected and 22 species of sand flies were identified from the two genera: Phlebotomus and Sergentomyia from Ardabil province. The highest frequency was found in Phlebotomus papatasi (23.7%) followed by Phlebotomus kandelakii (13.0%). The promastigote form of Leishmania infantum parasite has been reported from the three main vectors of visceral leishmaniasis (Phlebotomus kandelakii, Phlebotomus perfiliewi and Phlebotomus tobbi) from Ardabil province, where the spatial distribution map of these visceral leishmaniasis vectors was prepared. Some important species of sand flies such as Phlebotomus kandelakii, Phlebotomus perfiliewi and Phlebotomus tobbi were reported and identified as main and probable vectors of visceral leishmaniasis in Ardabil. Conclusions: According to the Geographic Information System based maps, the frequency of the sand flies as leishmaniasis vectors, the leishmania parasite infection rate and the prevalence of the disease in the central areas of Ardabil province are higher than in other areas in Ardabil province.

Objective: To determine spatial distribution of sand flies (Diptera: Psychodidae; Larroussius group), the vectors of visceral leishmaniasis in Ardabil province, Northwest of Iran. Methods: Sand flies were collected using sticky traps from the 30 selected points in Ardabil province, during May-November 2017. The MaxEnt model in GIS software was used for modeling. Results: A total of 2 794 specimens of sand flies were collected, of which 33% were Larroussius subgenus sand flies. Phlebotomus kandelakii and Phlebotomus wenyoni were the highest and lowest collected species respectively. Based on the modeling, four areas in the province were identified with more than 70% probability of the presence of Larroussius group vectors which were at risk of visceral leishmaniasis disease transmission. Conclusions: The distribution of Larroussius subgenus sand flies was observed in all parts of Ardabil. But the northern parts of the province (Germi and Bilesavar counties) as well as central part (Ardabil and Meshkinshahr counties) were of great importance in terms of the presence of Larroussius subgenus sand flies and the possibility of transmission of the visceral leishmaniasis.

Visceral leishmaniasis (VL) is a common infectious disease that is endemic in Iran. This study aimed to investigate the spatial autocorrelation of VL in the northwest of Iran. In this cross-sectional study, the data of all patients were collected in 2009-2017 and analyzed by SPSS23 and Moran's and General G Index. The MaxEnt3.3.3 software was used to determine the ecological niche. A big hot spot area was identified in five counties in the northwest of Iran. More than 70% of the cases were reported from these regions, and the incidence rate increased in the northwest of Iran from 2013 to 2017. Seasonal rainfall and average daily temperature were the most important climate variables affecting the incidence of VL in this region (p < 0.05). Therefore, it can be concluded that VL in the northwest of Iran is expanding to new areas along the border with the Republic of Azerbaijan, and the northeastern section of this region is a high-risk area.

Background: The impact of environmental factors and host on Hyalomma spp. community structure and abundance in the main Crimean-Congo haemorrhagic fever (CCHF) foci of Iran is largely unknown. Methods: Biotic and abiotic factors, including host, temperature, humidity, altitude, Köppen-Geiger climate types, sea­son, and precipitation on Hyalomma spp. community structure and abundances in 11 provinces of Iran were investigat­ed. Additionally, the possible infection of ticks with CCHF virus was evaluated using reverse transcription PCR tech­nique. Results: Species analyses demonstrated the presence of Hyalomma anatolicum, H. marginatum, H. dromedarii, H. asi­aticum, H. detritum and H. schulzei in the study area. Hyalomma anatolicum was the dominant species in the southern and northern parts, whereas H. dromedarii was distributed mostly in central parts of the country. The highest tick infestation was recognized in hot season. Spatial variation in tick relative density was observed between habitat types where more ticks were collected in deserts, semi-deserts, and Mediterranean habitats. Except for H. dromedarii, which was more preva­lent on camel (P= 0.044), there were no significant variations in the frequencies of other Hyalomma species on different hosts. Hyalomma anatolicum, H. dromedarii frequencies had significant positive and negative asso­ciation with tempera­ture and precipitation respectively. Also humidity has positive impact on H. asiaticum frequency. Conclusion: Data presented here will help improve ecological models to forecast the distribution of Hyalomma spp. ticks, to evaluate the risk of CCHF and other tick-borne diseases, and to design proper vector control measures to sup­press Hyalomma populations in Iran.

Background: Leishmaniasis diseases are known to be one of the most important public health problems in World and Iran. Visceral leishmaniasis is considered to be the most serious form and transmitted by sand flies species. The aim of this study was to investigate the dynamic activities of sandflies in northwestern Iran. Methods: This crass-sectional study was conducted from April to December 2018 in Meshkinshahr County, Ardabil Province. Sticky traps have been used to collect sand flies. They are stored in 70% alcohol and finally identified using valid keys. The aspects of the synoptic information were inquired from the Meshkin Shahr weather department and results analyzed for SPSS24. Results: Totally 259 sandflies were collected during study period. From collected samples 78.7% were male and 21.3% female. There were 8 different species. Phlebotomus kandelakii was the most prevalent one (30.8%). The average tem­perature, relative humidity, and average wind speed was 13.5 °C, 84%, and 2 meters per hour on the onset of sandflies’ activity, respectively. These values were 18.3 °C, 85% and 1.5 meters per hour at the peak of their activity and 16 °C, 62% and 5 meters per hour at the final stage of their activity. Sand flies had one peak in July which is strongly influ­enced by temperature and humidity conditions. Two species of Ph. kandelakii and Phlebotomus perfilewi transcaucasi­cus, had the highest activity in this endemic area. Conclusion: The results of current study will provide a guideline for control of diseases in the country.

Background: To investigate the diversity of the genus Aedes present in the natural areas of Ardabil Province, north-west of Iran. Methods: This cross-sectional study was carried out from Apr to Oct 2016 in North-western of Iran. Thirty-three areas of 10 cities which are border areas were selected randomly. The larvae were collected 2 times in each month during the seasonal activities of mosquitoes and the larvae were identified morphologically according to the ap­propriate identification keys. Results: Overall, 694 larvae were collected from four counties, from which only 7.2% were Aedes larvae. Three species of Aedes were identified which include Ae. caspius, Ae. vexans and Ae. flavescens. Aedes flavescens is reported from Ardabil Province for the first time. Conclusion: Aedes species were a high density in borderline of Iran and Azerbaijan. Therefore, the north parts of Ardabil Province are a suitable habitat for Aedes species mosquitoes. Care should be taken for vector control in the case of occurrence of any arboviruses transmitted by Aedes mosquitoes.

Background: Visceral leishmaniasis is one of the most important vector borne diseases in the world, transmitted by sand flies. Despite efforts to prevent the spread of the disease, cases continue worldwide. In Iran, the disease usually occurs in children under 10 years. In the absence of timely diagnosis and treatment, the mortality rate is 95–100%. The main objective of this study was to determine the spatial and temporal distribution of visceral leishmaniasis as well as its correlation with climatic factors for determining high-risk areas in an endemic focus in northwestern Iran. Methods: In this cross-sectional study, data on VL cases were collected from local health centers in Ardabil Prov­ince, Iran during 2001–2015 to establish a geodatabase using ArcGIS10.3. Data analysis was conducted using SPSS23 and ArcMap Spatial Analyst. MaxEnt model was used to determine ecologically suitable nichesfor the disease. Results: Two hotspots were found in Meshkinshahr and Germi counties with 59% and 23% of total cases, respec­tively. There was an increase in the incidence rate of VL in Ardabil County from 2.9 in 2009 to 9.2/100,000 population in 2015. There was no spa­tial autocorrelation between county and total number of cases (P> 0.05). Higher NDVI, lower altitude and southern as­pects had positive effects on the presence probability of VL. Conclusion: The number of cases of this disease have been rising since 2013 and doubled in 2015. According to the derived distribution maps, the disease is spreading to new locations such as Ardabil and Namin counties.