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Abstract 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.

Rationale: Rabies is a zoonotic disease with a high mortality, primarily transmitted through the bite of infected mammals, particularly dogs and cats. Despite being a well-known disease since ancient times, it continues to cause a significant number of human deaths worldwide, with approximately 65 000 fatalities reported annually. Patient concerns: We present two fatal cases of rabies in a 12-year- old immigrant boy and a 7-year-old boy. The first case was subject to a 24-hour delay in receiving appropriate medical attention and rabies preventive measures due to the lack of awareness among emergency hospital staff, leading to the administration of wound dressing only. The second case received timely rabies immunoglobulin administration; however, there was a 4-day delay in administering the fourth dose of the rabies vaccine, despite presenting evident symptoms of rabies. Diagnosis: Postmortem examination of brain samples from both patients confirmed the presence of rabies virus. Interventions: Post-exposure prophylaxis for rabies. Outcomes: Both patients were admitted to the hospital after the manifestation of rabies-related symptoms, with the 12-year-old child seeking medical care 47 days after the animal bite and the 7-year-old child seeking medical care 58 days after the exposure. Finally, the first patient died after 27 days and the second patient died after 40 days of hospitalization. Lessons: There is an urgent need for heightened awareness and education among both healthcare professionals and the public regarding the urgency of seeking immediate medical attention after potential rabies exposure. Timely recognition and initiation of post-exposure prophylaxis are pivotal in preventing the progression of the disease. Strengthening surveillance and reporting systems, coupled with continuous training for healthcare professionals, can contribute to early detection and management of rabies cases.

Abstract Climate change will affect the distribution of species in the future. To determine the vulnerable areas relating to CL in Iran, we applied two models, MaxEnt and RF, for the projection of the future distribution of the main vectors and reservoirs of CL. The results of the models were compared in terms of performance, species distribution maps, and the gain, loss, and stable areas. The models provided a reasonable estimate of species distribution. The results showed that the Northern and Southern counties of Iran, which currently do not have a high incidence of CL may witness new foci in the future. The Western, and Southwestern regions of the Country, which currently have high habitat suitability for the presence of some vectors and reservoirs, will probably significantly decrease in the future. Furthermore, the most stable areas are for T. indica and M. hurrianae in the future. So that, this species may remain a major reservoir in areas that are present under current conditions. With more local studies in the field of identifying vulnerable areas to CL, it can be suggested that the national CL control guidelines should be revised to include a section as a climate change adaptation plan.

Abstract Background Cutaneous leishmaniasis (CL) is a wide-reaching infection of major public health concern. Iran is one of the six most endemic countries in the world. This study aims to provide a spatiotemporal visualization of CL cases in Iran at the county level from 2011 to 2020, detecting high-risk zones, while also noting the movement of high-risk clusters. Methods On the basis of clinical observations and parasitological tests, data of 154,378 diagnosed patients were obtained from the Iran Ministry of Health and Medical Education. Utilizing spatial scan statistics, we investigated the disease’s purely temporal, purely spatial, spatial variation in temporal trends and spatiotemporal patterns. At P = 0.05 level, the null hypothesis was rejected in every instance. Results In general, the number of new CL cases decreased over the course of the 9-year research period. From 2011 to 2020, a regular seasonal pattern, with peaks in the fall and troughs in the spring, was found. The period of September–February of 2014–2015 was found to hold the highest risk in terms of CL incidence rate in the whole country [relative risk (RR) = 2.24, P

Background: Cutaneous leishmaniasis (CL) is a parasitic disease that presents a broad spectrum of clinical features. Treatment of CL is problematic. We aimed to compare the field therapeutic efficacy of topical nanoliposomes containing 0.4% amphotericin B (Nano Lip-AmB) alone and in combination with cryotherapy and/or Glucantime® on human CL in the endemic areas of Iran. Methods: This retrospective study was performed based on the results of using Nano Lip-AmB alone or with Glucantime® and/or cryotherapy in the treatment of zoonotic cutaneous leishmaniasis (ZCL) in patients referred to health centers of Isfahan, Golestan and Ilam Provinces of Iran as endemic foci of ZCL caused by Leishmania major besides Mashhad and Bam cities as endemic foci of anthroponotic cutaneous leishmaniasis (ACL) caused by with L. tropica. Results: Two hundred and seventy-eight patients with CL were included in the current study. All of the patients (100%) who received Nano Lip-AmB alone or in combination with Glucantime® and/or cryotherapy based on guideline of Iranian national committee for the treatment of CL. Two patients with 7 skin lesions, who was resident in ACL endemic area and received Nano Lip-AmB plus Glucantime® and another patient was a resident of ZCL endemic area and received Nano Lip-AmB plus cryotherapy showed clinical relapses after treatment. Conclusion: Sina Ampholeish® in combination with other standard protocols of treatment of CL is well tolerated and with acceptable clinical efficacy rate.

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.

Negligible data are available following major social activities and environmental changes on leishmaniasis. Therefore, how interactions between these events influence cutaneous leishmaniasis (CL) risk is not well-known. This longitudinal study was undertaken to explore the impact of interventions conducted between 1971 and 2020 in Bam county, which has had the highest disease burden in Iran. Only confirmed CL cases during this period were taken into account. Data were analyzed by SPSS 22 using the X2 test to assess the significance of the difference between proportions. Moreover, we used interrupted time series (ITS) to assess the impact of three environmental events during this period. Overall, 40,164 cases of CL occurred in the past five decades. Multiple complex factors were among the leading causes that synergistically induced the emergence/re-emergence of CL outbreaks in Bam. The main factors attributed negatively to CL control were cessation of malaria spraying activity, expansion of the city spaces, and a massive earthquake creating new breeding potentials for the vectors. The highest impact on CL incidence during these years was related to the earthquake [coefficient = 17.8 (95% CI: 11.3, 22.7); p-value < 0.001]. Many factors can contribute to CL outbreaks in endemic foci. They also can cause new foci in new areas. Since humans are the single reservoir for CL in this area, early detection and effective management significantly contribute to controlling CL to reduce the disease burden. However, essential evidence gaps remain, and new tools are crucial before the disease can ultimately be controlled. Nevertheless, sustained funding and more trained task forces are essential to strengthen surveillance and case management and monitor the interventions' impact.

Background: Cutaneous leishmaniasis is an ancient endemic disease in Iran and continues to be a growing health threat to community development and the environment. This paper explains how to use the facilities of health centers for developing a laboratory network on vectors and reservoir hosts of cutaneous leishmaniasis in Iran. Methods: A literature search was performed of the relevant multiple databases to include studies on vectors and reservoirs of cutaneous leishmaniasis in Iran. A team of experienced experts was performed. After holding several meetings, field visits and organizing workshops, the activities of laboratories were determined at three levels. Results: Entomological studies showed that 5 species of the genus Phlebotomus and 10 species of the genus Sergentomyia are active in the south, 4 species of the genus Phlebotomus and one species of the genus Sergentomyia in the central part and 5 species of the genus Phlebotomus and 2 species of the genus Sergentomyia in the north east. Reservoir hosts were identified in the study areas. The tasks of laboratories were regulated at different levels. Conclusion: The Iranian Ministry of Health and Medical Education should prioritize the employment of capable persons in the field of Medical Entomology and Vector Control. The survival of this laboratory network depends on hiring and employing interested and persistent people. The universities of Medical Sciences that have the facilities to set up this network will be a very effective partner in the control of the disease in high risk areas. The results can be used in neighboring countries.

Cutaneous leishmaniasis is a neglected and parasitic vector borne diseases that is endemic in tropical and subtropical countries, including Iran. The aim of this study was to explain the present status of CL in Iran. This report is based on data that recorded by cutaneous leishmaniasis surveillance system in 2019, and evalu­ated in Center for Communicable Diseases Management in Ministry of Health in Iran. Iran has been considered an endemic area for cutaneous leishmani­asis in the world. Dependent to activities for cutaneous leishmaniasis control the number of cases decreased from 23202 in 2008 (Incidence rate 32 per 100000) to 13124 in 2019 (Incidence rate 15.8 per 100000), more cases reported from September to December, in 2019, 46% of cases had one lesion and 21% had 2 lesions, 85% of cases diagnosed when the diameter of lesions had 3 centimeters and bellows. Although the Leishmania control program began in 1977, the incidence of the disease has dropped dramat­ically since 2008 when the new cutaneous leishmaniasis control program have been implemented. Although in some areas the inci­dence of the disease increased, but the implementation of the new program has reduced the number of cas­es, in order to continue reducing the disease, permanent support for the control programs is needed.

Dengue is the most quickly distributing mosquito-borne disease caused by flaviviruses. The mosquito Aedes aegypti is the essential vector for disease transmission. The aim of this report was to describe dengue in Iran. In 2006, the Ministry of Health of Iran conducted a coordinated series of meetings with the Ministry of Agriculture of Iran about the correct way of importing the lucky bamboo and other agricultural products. The Ministry of Health of Iran coordinated with the Department of Arbovirus of Pasteur Institute of Iran to investigate the human samples in cases suspected for dengue disease. In 2013, the guideline to control the dengue was prepared in the center for communicable diseases control, Ministry of Health and Medical education, Iran. In 2014, an operational program to disease control was prepared. A network of laboratories to entomological surveillance was established in 2014. The credit for equipping of entomology laboratories was provided. In 2015, a national plan for the prevention and control of dengue was prepared in the English language and with the WHO cooperation. Other plans such as preparation of the health messages about dengue and sending them to the medical universities were done. The surveillance activities against dengue were defined in three levels, including surveillance in the cities, surveillance in the provinces, and surveillance in the country. Other follow-up actions included planning for continued educational program for dengue in different universities of medical sciences, equipping of the entomology laboratories of the universities, and conducting the entomological checks and educational activities of the universities.

BackgroundRabies is one of the oldest zoonosis viral diseases, which still remains as one of the most important threats to public health in the 21st century.MethodsThis cross-sectional study examined epidemiologic features of all 33,996 cases of persons bitten by animals and referred to the rabies prophylaxis centers in Golestan province between March 2017 and March 2020. Factors included demographic information of the victim (age, gender, and occupation), type of invasive animals (dog, cat, and other types), time of bite (year, month, and hour), place of residence (urban or rural), and injury and treatment statuses. We also obtained national and provincial animal bite incidence data for all of Iran and for Golestan province for the longer interval 2013-2020 to examine broader time trends. We used SPSS version 19, QGIS version 3.1, and Excel 2013 to generate frequency distributions and descriptive statistics.ResultsThe incidence rates of animal bites in Golestan province and Iran as a whole both increased smoothly. The latest incidence rate of animal bites in Golestan was 652 per 100,000 people, almost three times the overall national figure for 2020. Most cases of animal bites (67.6%) occurred in rural areas, and 36% of the victims aged under 19 years old. Dog and cat bites accounted for the great majority of cases (89% and 8%, respectively). The highest rate of animal bites was reported in the spring (30.8%). The lower limb was the most commonly bitten area in these individuals (64.6%). Of note, 87% of the cases received incomplete prophylactic post-exposure treatment, and 18% received immunoglobulin.ConclusionThe increasing rates of animal bites in the study area as well as the higher rate compared to the national average indicates the need for further review of animal bite control programs.

Cutaneous leishmaniasis (CL) is an emergent public health concern, particularly in tropical and subtropical regions. Reports of pregnancy complications are scarce; however, as the endemic range of CL expands in Iran, there is concern of possible detrimental effects on fetal development amongst infected mothers through placental transmission of the parasite or enhanced maternal immune responses. We herein describe the first known case of persistent anthroponotic CL, plausibly responsible for pregnancy complications, preterm birth, and neonatal death in a healthy Iranian primigravida woman. Diagnosis was based on physical examinations of the lesions on the back of both calves of the patient and laboratory analyses including direct smear, culture, and PCR. During active CL infection, the patient gave birth to a premature female neonate who passed three days post-delivery due to immature lung development and subsequent respiratory distress syndrome. This report highlights the challenges associated with CL infection during pregnancy, exacerbation of lesions, and subsequent complications.

Rabies virus, as a neurotropic agent, is transmitted to humans usually after animal biting. Rabies is endemic in most Middle Eastern countries. Pre-exposure Prophylaxis (PrEP) program is recommended for high-risk populations in endemic areas. The present study reported 7 deaths from rabies infection despite human Post-Exposure Prophylaxis (PEP) and the evolution of their possible etiologies from 2014 to 2018 in Iran. In this study, 29 rabid human deaths were evaluated despite PEP in 2014-2018. Seven people deceased despite receiving PEP. The most damaged organs were hands and face (71.43%). Injecting anti-Rabies Immunoglobulin (RIG) around the wound, improper cleansing, and delayed PEP were the main causes of PEP failure. In addition, immunodeficiency in a patient was another cause of failure. Our obtained data suggested that immediate precise measures after exposure based on the World Health Organization (WHO) recommendation, maintaining the temperature integrity (cold chain) of vaccines, and RIGs during transportation, and performing detailed injection schedule could prevent PEP failure in most cases. Furthermore, society’s awareness plays a key role in controlling the disease, especially in endemic areas.

Objective: To investigate the distribution and trends associated with brucellosis incidence rates in Iran from 2011 to 2014. Methods: The reported incidence rates of brucellosis for the years 2011–2014 were collected and entered into GIS 10.1. The Cochran–Armitage test for linear trends, choropleth maps, hot-spot analysis, and high–low clustering analysis were used to investigate patterns of the disease over the study period and by season, and to identify high-risk areas and any clustering of the disease. The significance level was set at p

Introduction: In Iran, 95% of animal bites are attributed to domestic dogs and cats, while one-third of rabies victims are from wildlife. The wolf is one of the primary vectors of wildlife in the country. This study was aimed to assess the impact of wildlife on rabies transmission and to evaluate the efficacy of an oral rabies vaccine (ORV) in the gray wolf (Canis lupus pallipes). Methods: We studied the incidence of wolf attacks by analyzing a 10-year period of data (2000 to 2009) available in the Ministry of Health and Medical Education, the Veterinary Organization and Pasteur Institute of Iran. In the next step, five captive gray wolves were fed by Raboral V-RG® vaccine baits (Merial®, part of Boehringer Ingelheim, Germany) and monitored for rabies neutralizing antibodies over 20 months by rapid fluorescent focus inhibition test (RFFIT). Results: Our analysis showed that 55% of animal bites occurred in rural areas and the remaining in urban areas. The most rabid wolves were from Fars province in southern Iran. The vaccine baits were palatable for the hungry wolves. Seroconversion with antibodies titers ≥0.5 IU/ml occurred after 12 weeks and maintained for 78 weeks indicating potential protection against rabies after receiving a single ORV bait. Conclusion: Our results suggested that a single dose of vaccination with V-RG®, though initially designed for foxes and raccoons, can protect the gray wolf against rabies as well.

Background: Nowadays, geographic information system (GIS) is one of the most useful epidemiological tools for identifying high-risk areas of cutaneous leishmaniasis. The aim of this study was to determine the spatial distribution of cutaneous leishmaniasis in northeastern Iran. Methods: In this cross-sectional study, information on positive cases of cutaneous leishmaniasis in the three provinces located in northeastern Iran during Jul 2011 to Jul 2017 was obtained from the Iranian Ministry of Health. Based on the postal address of each case, the geographical coordinates of each patient were determined for spatial analysis of cutaneous leishmaniasis. For spatial analysis, Moran’s index autocorrelation and Kriging interpolation method were used in GIS software. Results: Moran’s index autocorrelation showed that spatial distribution of disease incidence in the study area was cluster pattern (Z-score > 1). In addition, Kriging interpolation method revealed that 90% of southern parts of North Khorasan province and northern parts of Razavi Khorasan Province formed hot spots. Conclusion: The CL incidence is a function of spatial and geographical trends. In addition, spatial trends in the disease incidence distribution indicate that it is not greatly increased or decreased from one area to another. It appears as hot spots areas. Spatial analysis by showing high risk areas can be useful tools for controlling and preventing CL incidence.

Background: Leishmaniasis represents the important public health problem in the world. One of the main objectives of World Health organization is capacity building of managers and authorities who are involved with diseases control ac­tivities. Methods: The course was conducted in Esfahan Health Research and Training Center (E.H.R.T.C) in summer 2005 and 2009. The course carried out jointly by the Ministry of Health and Medical Education (MOH) of Iran, World Health Or­ganization-Eastern Mediterranean Regional Office (WHO-EMRO) and School of Public health, Tehran University of Med­ical Sciences (SPH-TUMS) and designed for medical officers, senior technicians and managers involved in leish­mania­sis control. Prior to initiate the course, pre-test evaluations including different subjects on leishmaniasis and its control were carried out. The examinations include multiple choice questions. The duration of the course was 3 weeks. A total of 206 contact hours were taught. The main subjects were Basic epidemiology, Leishmaniasis parasitology, Leishmaniasis en­tomology, control of vectors and reservoirs, principles of integrated pest management, Field work and Planning. Dif­ferent methods of teaching including lecture, laboratory, workshop, team work, field exercise and presen­tation were used. Requirement for achievement of the course was to have at least 60% of the total mark for awarding the diploma certificate. Results: A total of 45 participants from Iraq, Afghanistan and Iran graduated from this course. Conclusion: The course is providing the skill for managers, how to combat against disease in their country and is paral­lel to the policy of the leishmaniasis control for capacity building in endemic areas of their countries.

Cutaneous leishmaniasis (CL) is one of the prevalent parasitic diseases in Iran principally caused by two species, Leishmania major and L. tropica. Here, we present a rare case of a congenital form of CL around the glans penis from the central part of Iran in 2017. A 24-yr-old male patient from the central part of Iran presented with biennial ulceration of the glans penis. Diagnostic methods included physical and preclinical examination, microscopic observation, leishmanin skin test (LST), and serological tests including direct agglutination test (DAT). Nested PCR and sequencing analysis were used on the positive smears for confirmation of CL and Leishmania species identification. The preclinical results were normal, and no anti-Leishmania antibodies were detected in the peripheral blood of the patient using DAT. In abdominal ultrasonography, the spleen and liver size were normal. LST was positive (≥5 mm) after 72 h, and a few amastigote forms of Leishmania sp. were demonstrated under light microscopy. L. major was confirmed using nested PCR and sequencing analysis. The patient responded to oral administration of miltefosine (2.5 mg/kg/d) for 28 days. To the best of our knowledge, genital CL due to L. major has not been previously reported from Iran.

Background: Cutaneous leishmaniasis (CL) is a dermal and parasitic disease.. The aim of this study was to determine the effect of environmental and climate factors on spatial distribution of CL in northeastern Iran by utilizing remote sensing from 20 March 2016 to 19 March 2017. Methods: In this ecological study, the data were divided into two parts: The descriptive data on human CL cases were gathered from Communicable Diseases center of Iran. The remote sensing techniques and satellite imagery data (TRMM, MODIS-Aqua, MODIS-Terra and AMSR-2 with spatial resolution 0.25°, 0.05°, 5600m and 10km) of environ­mental and climate factors were used to determine the spatial pattern changes of cutaneous leishmaniasis inci­dence. Results: The incidence of CL in North Khorasan, Razavi Khorasan, and South Khorasan was 35.80 per 100,000 people (309/863092), 34.14 per 100,000 people (2197/6,434,501) and 7.67 per 100,000 people (59/768,898), respectively. The incidence of CL had the highest correlation with soil moisture and evapotranspiration. Moreover, the incidence of dis­ease was significantly correlated with Normalized Difference Vegetation Index (NDVI) and air humidity while it had the lowest correlation with rainfall. Furthermore, the CL incidence had an indirect correlation relation with the air tem­perature meaning that with an increase in the temperature, the incidence of disease decreased. Conclusion: As such, the incidence of disease was also higher in the northern regions; most areas of North Khorasan and northern regions of Razavi Khorasan; where the rainfall, vegetation, specific humidity, evapotranspiration, and soil moisture was higher than the southern areas.

BackgroundThe control of cutaneous leishmaniasis (CL) is facilitated by knowledge of factors associated with the treatment failures in endemic countries. The aim of this evaluation was to identify the potential risk determinants which might affect the significance of demographic and clinical characteristics for the patients with anthroponotic CL (ACL) and the outcome of meglumine antimoniate (MA) (Glucantime) treatment.Methodology/principal findingsThis current was executed as a cohort spanning over a period of 5 years which centered in southeastern part of Iran. Altogether, 2,422 participants were evaluated and 1,391 eligible volunteer patients with ACL caused by Leishmania tropica were included. Overall, 1,116 (80.2%) patients received MA intraleisionally (IL), once a week for 12 weeks along with biweekly cryotherapy, while 275 (19.8%) patients received MA alone (20 mg/kg/day for 3 weeks) (intramuscular, IM). The treatment failure rate in ACL patients was 11% using IL combined with cryotherapy plus IM alone, whilst 9% and 18.5% by IL along with cryotherapy or IM alone, respectively. Multivariate logistic regression model predicted 5 major associated-risk determinants including male (odds ratio (OR) = 1.54, confidence interval (CI) = 1.079-2.22, p = 0.018), lesion on face (OR = 1.574, CI = 1.075-2.303, p = 0.02), multiple lesions (OR = 1.446, CI = 1.008-2.075, p = 0.045), poor treatment adherence (OR = 2.041, CI = 1.204-3.46, p = 0.008) and disease duration > 4 months (OR = 2.739, CI = 1.906-3.936, p≤0.001).Conclusions/significanceThe present study is the original and largest cohort of ACL patients who treated with MA. A comprehensive intervention and coordinated action by the health authorities and policy-makers are crucial to make sure that patients strictly follow medical instructions. Early detection and effective therapy < 4 months following the onset of the lesion is critical for successful treatment of the patients. Since a significant number of patients are still refractory to MA, reducing man-vector exposure and development of new effective alternative drugs are essential measures against ACL due to L. tropica.

Leptospirosis is a zoonotic disease found wherever human is in direct or indirect contact with contaminated water and environment. Considering the increasing number of cases of this disease in the northern part of Iran, identifying areas characterized by high disease incidence risk can help policy-makers develop strategies to prevent its further spread. This study presents an approach for generating predictive risk maps of leptospirosis using spatial statistics, environmental variables and machine learning. Moran's I demonstrated that the distribution of leptospirosis cases in the study area in Iran was highly clustered. Pearson’s correlation analysis was conducted to examine the type and strength of relationships between climate and topographical factors and incidence of the disease. To handle the complex and nonlinear problems involved, machine learning based on the support vector machine classification algorithm and multilayer perceptron neural network was exploited to generate annual and monthly predictive risk maps of leptospirosis distribution. Performance of both models was evaluated using receiver operating characteristic curve and Kappa coefficient. The output results demonstrated that both models are adequate for the prediction of the probability of leptospirosis incidence.

Background: Human brucellosis is the most common zoonotic disease worldwide. This study aimed at estimating the incidence, mortality, and burden of human brucellosis as well as its distribution in Iran from 2009 to 2015. Methods: Disability Adjusted Life Years (DALYs) index was used to estimate the burden of human brucellosis. To calculate DALYs, years lost due to disability (YLDs) was added to years of life lost due to premature death (YLLs); they were calculated based on the Global Burden of Disease (GBD) formula recommended by the WHO. The data on incidence and mortality were collected from the national surveillance system of brucellosis disease in the Center for Communicable Diseases Control (CCDC), Ministry of Health and Medical Education (MOHME), expert panels, and related literature. Results: There is an increasing trend in human brucellosis-related DALYs (34.6 per 100,000 in 2009, and 71.4 per 100,000 in 2015), incidence (88450 in 2009, and 198030 in 2015), and mortality (244 in 2009, and 578 in 2015) from 2009 to 2015. Human brucellosis-related DALYs, incidence, and mortality were higher among males than females. About 51% of DALYs was attributed to YLLs. The burden of human brucellosis disease was not equally distributed among all provinces of Iran and it was largely concentrated in a number of provinces. Conclusion: Burden of human brucellosis is significantly high in Iran, and it has also increased during the recent years. It is alarming for health system managers and policymakers, and they are recommended to pay more attention to this issue.

Background: Iran is among the first six countries in the world with the highest annual incidence of cutaneous leishmaniasis. This study aimed at estimating the incidence, burden, and trend of cutaneous leishmaniasis at the national level in Iran from 1977 to 2015. Methods: This study was conducted in 2017, used Disability Adjusted Life Years (DALYs) index, recommended by the WHO for assessing the Global Burden of Diseases, to estimate the burden of cutaneous leishmaniasis. The data on the incidence of the disease and the number of cases was obtained from the communicable diseases surveillance system (Center for Communicable Diseases Control (CCDC), Ministry of Health and Medical Education (MOHME) of Iran) that routinely collects data from all over the country; in addition, some data was extracted by reviewing the texts. Considering the views expressed in a panel of experts, to calculate the actual incidence of the disease, the number of registered cases was multiplied by 5. Results: The incidence of cutaneous leishmaniasis varied from approximately 50 to 250 cases per 100,000 population during the studied period. During these years, the incidence of the disease was higher in males than females. Moreover, the burden of cutaneous leishmaniasis varied between 1.18 and 5.7 DALYs per 100000 population during the studied period. The incidence and burden of cutaneous leishmaniasis have not significantly decreased in recent years. Conclusion: Despite the implementation of a program for controlling cutaneous leishmaniasis in Iran since 1977, the incidence and burden of the disease are still high in the country; it is seriously alarming for policy makers and managers of the health system in Iran, indicating the presence of some problems in controlling the disease.

Background & objectives: Phlebotomus papatasi is the main vector of the zoonotic cutaneous leishmaniasis (ZCL) in Qom Province and many other provinces of Iran. Attractive toxic sugar baits (ATSB) treated barrier fence is one of the new methods for controlling the vectors such as sandflies. The present study was designed to evaluate the residual activity of ATSB-treated barrier fence that was used in control of P. papatasi. Methods: Following the selection of villages in Markazi district of Qom Province, central Iran during 2015 for ATSB and ASB (bait containing no active ingredient) methods; barrier fences on the ground in front of the rodent′s colony were installed. A total of four conical tubes were installed and fixed on surfaces of treated barrier net of dimension 25 Χ 25 cm at biweekly interval. In each conical tube, 10 sand flies were released and after 3 min of exposure they were transferred to sterile cups. After 24 h, the obtained results were recorded according to the survival and mortality rate of sandflies. These tests were carried out five days after the installation of barrier fences, and repeated every 15 days until the mortality rate decreased to 60-65%. Results: The bioassay tests results showed that the mortality rate of P. papatasi on ATSB-treated barrier fence for 5, 15, 30 and 45 days after spraying was 100, 95.83, 88.18 and 66.67% respectively, which decreased to 50.83% after 60 days. Interpretation & conclusion: Persistence and residual activity of the active ingredient of the bait in the hot and dry climatic conditions of Qom Province remained significantly effective for at most 45 days, which subsequently decreased at a high rate. Hence, every 45 days barrier fences need to be impregnated with ATSB bait. The method also appeared cost-effective and could be practical in implementation of vector control programmes against ZCL.

Background: Rodents are one of the most important hosts for some zoonotic diseases and also act as a reservoir of some ectoparasites and endoparasites. They cause damage to the farms and inflict public health. The aim of this study was to investigate the faunal composition of rodent in North Khorasan Province, Northeast of Iran.Methods: The sampling was carried out between 2011 to 2013. The specimens were collected using different methods including rodent death and live traps, digging of their burrow, and hand net from 75 different sample sites.Results: The total number of 396 specimens belonging to 22 species and six families were identified. The results illustrated the high numbers and densities of Meriones persicus (17.68%), Meriones libycus (15.15%), Nesokia indica (7.32%) and Rhombomys opimus (6.82%), as the most important reservoirs for different zoonotic diseases. Moreover, significant number of other rodent species including Mus musculus (15.66%), Apodemus witherbyi (13.89%), A. hyrcanicus (0.25%), Rattus norvegicus (1.01%), Meriones crassus (0.25%), Gerbillus nanus (0.51%), Microtus paradoxus (2.27%), M. transcaspicus (0.76%), Ellobius fuscocapillus (0.25%), Cricetulus migratorius (4.29%), Calomyscus elburzensis (4.29%), C. mystax (1.26%), Spermophilus fulvus (0.25%), Dryomys nitedula (3.54%), Allactaga elater (3.54%), Jaculus blanfordi (0.25%), Meriones zarudnyi (0.25%), M. meridianus (0.51%), and Hystrix indica as hosts for parasites and zoonotic diseases were identified.Conclusion: The high biodiversity including at least 22 species and six families of rodents were found in North Khorasan Province, some of them were medically important species.

Cutaneous Leishmaniasis (CL) is a neglected tropical disease that continues to be a health problem in Iran. Nearly 350 million people are thought to be at risk. We investigated the impact of the environmental factors on CL incidence during the period 2007- 2015 in a known endemic area for this disease in Isfahan Province, Iran. After collecting data with regard to the climatic, topographic, vegetation coverage and CL cases in the study area, a decision tree model was built using the classification and regression tree algorithm. CL data for the years 2007 until 2012 were used for model construction and the data for the years 2013 until 2015 were used for testing the model. The Root Mean Square error and the correlation factor were used to evaluate the predictive performance of the decision tree model. We found that wind speeds less than 14 m/s, altitudes between 1234 and 1810 m above the mean sea level, vegetation coverage according to the normalized difference vegetation index (NDVI) less than 0.12, rainfall less than 1.6 mm and air temperatures higher than 30°C would correspond to a seasonal incidence of 163.28 per 100,000 persons, while if wind speed is less than 14 m/s, altitude less than 1,810 m and NDVI higher than 0.12, then the mean seasonal incidence of the disease would be 2.27 per 100,000 persons. Environmental factors were found to be important predictive variables for CL incidence and should be considered in surveillance and prevention programmes for CL control.

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Background: Cystic Echinococcosis (CE) is a serious zoonotic parasitic disease in Iran. This study aimed to show the trend of the confirmed disease from 1995 to 2014 and to describe some of epidemiological aspects of the disease in Iran. Methods: This retrospective study has been designed based on data collected from 8518 cases of CE among various geographical locations of Iran. Results: The average annual number of human cases of CE was 274.8. Among 31 provinces of Iran, Razavi Khorasan from northeast part of Iran was the highest human CE infected province with the 1801 cases and Hormozgan Province in south part of the country showed the lowest the disease with the only one case of CE in 2009. Liver and lungs with the infection rate of 61% and 20%, respectively are the most infected organs, 53% of patients had one cyst in the bodies and the number of cysts in 8% of cases was more than 3 cysts. Altogether, 41% of CE cases were treated by surgery, 11% with chemotherapy and 48 % with mixed surgery and chemotherapy. Conclusion: Human CE is a major health problem in Iran and it is necessary to establish basic control programs. It is crucial to setting up standard diagnostic methods for early diagnosis, effective treatment, plan educational schedule for different social levels and control the disease in both definitive and intermediate hosts.

Leishmaniasis is a parasitic disease caused by different species of protozoan parasites. Cutaneous leishmaniasis (CL) is still a great public health problem in Iran, especially in Isfahan Province. Distribution and abundance of vectors and reservoirs of this disease is affected by different factors such as climatic, socioeconomic and cultural. This study aimed to identify the hotspot areas for CL in Isfahan and assess the relations between the climatic and topographic factors with CL incidence using spatial analysis. We collected data on the total number of CL cases, population at risk, vegetation coverage, altitude and climatic data for each district of the province from 2011 to 2015. Global Moran’s Index was used to map clustering of CL cases across districts and the Getis-Ord (Gi*) statistics was used to determine hotspots areas of the disease in Isfahan. We applied overlay analysis to assess the correlation between the climatic and topographic factors with CL incidence. We found the CL distribution significantly clustered (Moran’s Index=0.17, P

Treatment of Cutaneous Leishmaniasis in Persian Medicine

Background: Cutaneous leishmaniasis (CL) is one of the most important health problems in many areas of Iran. There are two forms of the disease in Iran, anthroponotic and zoonotic CL. This study conducted to assess the epi­demiological situation of CL in an endemic area of Qom Province, central Iran from Apr to Nov 2015. Methods: The sticky paper traps and aspirating tubes were used for collecting adult sand flies. Sherman traps and small insect nets were used to capture rodents and small mammals. Giemsa staining was used for preparing the ex­panded smear and followed by PCR for identifying the causative agent in human, vectors, and reservoirs. In this study, relative frequency of CL was also calculated. Results: Fourteen species of Phlebotomine sand flies were collected. Phlebotomus papatasi (61.74%) was the pre­dominant species through the period of activity. Overall, 62 Meriones libycus, 8 Nesokia indica, 4 Mus musculus, 16 Allactaga elater and 2 Hemiechinus auritis were caught. PCR technique showed 6 out of 150 P. papatasi (2%), two out of 62 M. libycus (3.23%) and all of suspected human's skin tissue samples (100%) were infected with Leishmania major. The relative frequency of CL was 0.30%. Conclusion: This is the first detection of L. major within P. papatasi, M. libycus and human in Kahak District in Qom Province of Iran. Zoonotic cycle of CL exists in this area, L. major is the causative agent, P. papatasi is the main vector and M. libycus is the main reservoir of the disease.

Background: Rodents are an important source of zoonotic diseases for human. The aim of this study was to determine the infectivity of rodents with intestinal helminths in North Khorasan Province, Iran. Methods: One hundred and thirteen rodents were collected using different collection methods such as kill and live traps, digging of their burrow, filling of their hiding places with water and hand net during 2011-2013. Their alimentary canals were removed in the laboratory and helminths were determined in the department of parasitology, Tehran University of Medical Sciences. Results: Thirteen species of helminths parasites were found in 13 species of rodents, including Aspiculuris tetraptera, Hymenolepis diminuta, Nippostrongylus brasiliensis, Protospirura Seurat, Rictolaria ratti, Skrjabinitaenia lobata, Streptopharagus kuntzi, Syphacia obvelata, Taenia taeniaeformis, Trichuris muris, Cysticercus fasciolaris, Acanthocephal. spp and Trichuris spp. Some of them were reported for the first time in new host in Iran. S. obvelata and A. tetraptera were the most frequent parasites and P. Seurat, R. ratti and C. fasciolaris were found only in one rodent. Conclusion: This is the first study to investigate the intestinal parasites in rodents in this area. Among different species identified, some of helminths were reported in new host.

Attractive Toxic Sugar Baits (ATSB) is a new vector control method that meets Integrated Vector Management (IVM) goals. In an experimental design, this study aimed to determine effects of ATSB on control of Phlebotomus papatasi, as a main vector of Zoonotic Cutaneous Leishmaniasis (ZCL), in Qom Province, center of Iran.In a cross-sectional design, boric acid was mixed with brown sugar solution and tested as toxic baits for P. papatasi. Two methods were utilized to use the baits: (a) spraying ATSB on vegetation, bushes, and shrubs; and (b) setting ATSB-treated barrier fences in front of colonies at 500 m distance from the houses in outskirts of villages. In order to examine the residual efficacy rate of ATSB-treated barrier fences, the bioassay test was used. Density of P. papatasi sandflies was measured using sticky and light traps biweekly. For data analysis, Mann-Whitney U Test and Kruskal-Wallis were used. Results ATSB-treated barrier fences led to 3 times reduction in P. papatasi population. Besides that, ATSB spraying on plants led to more than 5 times reduction in P. papatasi population.Comparing the incidence of leishmaniasis in treated villages before and after the study showed that the incidence was statistically reduced. Therefore, ATSB is an effective method to control vectors and prevent leishmaniasis.

Background: Zoonotic cutaneous leishmaniasis (ZCL) is a neglected disease with public health importance that is common in many rural areas of Iran. In recent years, behavioral resistance and/or bait shyness against the common rodenticide among reservoir hosts of ZCL have been reported. The aim of this study was to evaluate the effectiveness of Klerat® and zinc phosphide against natural reservoir of ZCL. Methods: This survey was carried out in four villages located 45 to 95 km far from Esfahan City Esfahan province, central Iran from April to November 2011. The rodent burrows were counted destroyed and reopened holes baited around all villages. Effect of rodent control operation on the main vector density and incidence of ZCL were evaluated. Results: The reduction rate of rodent burrows after intervention calculated to be at 62.8% in Klerat® and 58.15% in zinc phosphide treated areas. Statistical analysis showed no difference between the densities of the vector in indoors and outdoors in intervention and control areas. The incidence of the disease between treated and control areas after intervention was statistically different (P< 0.05). Conclusion: Klerat® could be a suitable alternative for zinc phosphide in a specific condition such as behavior resistance or occurrence of bait shyness.

Background: Epidemics of mosquito-borne viral infections such as dengue, chikungunya, West Nile and Rift Valley fevers in neighbouring countries and risk of introduction of exotic vectors into Iran have placed this country at a significant risk for these mosquito-borne diseases. Methods: After the first dengue case reported in Iran in 2008, active entomological surveillance of Aedes albopictus (Skuse) and Ae. aegypti (Linnaeus) were conducted in May/Jun, Sep, and Oct/Nov, 2008-2014. Based on occurrence of dengue cases and the presence of potential entry sides including ports and boarder gates, 121 sites in eight provinces were monitored for mosquito vectors. Larval collections were carried out using droppers or dippers and adult collections with CDC light traps, human landing catches, aspirator and Pyrethrum spray space catches. Results: A total of 8,186 larvae and 3,734 adult mosquitoes were collected belonging to 23 Culicinae species, including 13 of the genus Culex, 1 Culiseta, 1 Uranotaenia, and 8 of the genus Aedes. Five Aedes albopictus larvae were identified from the Sistan & Baluchestan province bordering Pakistan in 2009. In 2013, seven Ae. albopictus adult mosquitoes were also collected in a coastal locality near the city of Chabahar in the same province. Conclusion: The detection of larvae and adults of this species in different parts of this province reveal its probable establishment in southeast Iran, which has implications for public health and requires active entomological surveillance as well as the implementation of vector control to prevent the further spread of this critical vector.

Background: There are nearly 1000 species of Phlebotomine sand flies in 6 genera, of which only two, Phlebotomus in the old world and Lutzomyia in the new world are medically important. Globally, leishmaniasis prevalent in 98 countries and affects estimated 12 million people with almost two million new cases per year. Some rural areas of Azarshahr District in East Azarbaijan Province have been reported to be endemic for visceral leishmaniasis. This study is the first attempt to determine the species diversity and density in a new focus of visceral leishmaniasis in Azarshahr District, East Azarbaijan Province, Iran. Methods: Sand flies were collected form indoor and outdoor biweekly using sticky traps. Diversity index of the collected sand flies within different villages were estimated by the Shannon-Weaver. Results: The activity of the sand flies extended from April to October with one peak in August. Diversity of sand flies within study area were estimated as 0.917, 1.867, 1.339, 1.673, and 1.562 in Almalodash, Jaragil, Segaiesh, Amirdizaj, and Germezgol Vvillages, respectively. Conclusion: Identifying the diversity and seasonal abundance of the collected species is of importance for prediction of the period of maximum risk for leishmaniasis transmission and for the successful implementation of a control program. Species diversity is one of the most important factors in ecological studies.

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.

INTRODUCTION:Cutaneous leishmaniasis (CL) is among the top 10 infectious disease priorities in the world, and the leading cause of morbidity in Iran. The present study was conducted to assess the risk of CL, and to determine some epidemiological features of the disease in endemic areas of Qom Province in Central Iran during 2009 to 2013. METHODS:Data regarding human cases of the disease were obtained from the Qom Province Health Center, prepared and stored in a spatial database created in ArcGIS10.3. A total of 9 out of 212 Leishmania spp. positive slides taken in 2013 from patients residing in Qom city were examined using molecular methods and the species of Leishmania was identified by PCR-RFLP. Those 9 patients had no history of travel outside the city. Spatial analysis and clustering methods were applied to find major hot spots and susceptible areas for the establishment of novel foci of the disease. Transmission patterns were examined for spatial autocorrelation using the Moran's I statistical application, and for the clustering of high or low values using the Getis-Ord Gi* statistics. RESULTS:During the period of study, a total of 1767 CL cases were passively reported in the area, out of which were 65% males and 35% females. The highest and lowest numbers of cases were reported in 2010 and 2013, respectively. Importantly, 979 cases were reported from urban areas, while the remainder came from rural areas. Leishmania major was detected as the causative agent of CL in the city of Qom. Remarkably, most patients recorded in Qom city were associated with a history of travel to the endemic areas of CL within the province, or to other endemic areas of the disease in Iran. Spatial distribution of CL cases revealed northeastern and southwestern quarters of the city were the major hot spots of the disease (P

Background: Despite the effective pre- and post-exposure treatments, at least 60,000 deaths from rabies occur worldwide every year. Post-exposure treatment is considered as one of the most significant measures for preventing human deaths in exposed individuals. The 2-1-1 rabies post-exposure treatment schedule known as Zagreb regimen is an abbreviated immunization plan in which a tissue culture rabies vaccine is administered intramuscularly at two sites on day 0 and at one site on days 7 and 21. Objectives: In this study the efficacy of rabies vaccine administration under Zagreb regimen in an Iranian group of patients attending Pasteur Institute of Iran was evaluated. Methods: Rabies neutralizing antibody titer was measured in 75 serum samples collected from 25 volunteers receiving post exposure treatment by rapid fluorescent focus inhibition test (RFFIT), and ELISA. Results: All patients were negative for rabies antibody in both ELISA and FRRIT tests on day 0 . A satisfactory rabies virus antibody response with the titer of ≥0.5 IU/ml was detected in all patients on day 21 and two weeks after the completion of vaccination (day 35). Conclusions: Rabies immunization with rabies Vero-cell vaccine (PVRV) under the 2-1-1 schedule (Zagreb regimen) could result in an adequate immune response without any adverse effect. However a more comprehensive comparative study is underway to confirm these findings . Vac Res , 2014, 1 (1): 26-28

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Background: Cutaneous leishmaniasis (CL) represents the most frequent vector borne parasitoses in Iran. The ob-jective of this study was to determine the epidemiological features of CL including human infection and the reservoir host in the city of Bushehr, Bushehr Province, Iran during 2010–2011. Methods: Studies on human infection was carried out on 2962 school children aged 7–14 years old from 60 primary schools and among 400 households with a total population of 1568 in four infected districts of the city in December 2010. Serosity materials from patients on glass slides were collected for molecular identification of causative agent. Rodents were caught by Sherman traps and examined for identification of the parasite. Results: Prevalence of scars and ulcers among the inhabitants were 5.86% and 0.12% respectively. Molecular study indicated the presence of two coexisting species: Leishmania major and L. tropica among patients. The scar rate was 1.24% but no ulcers were seen among the students. Nineteen rodents were caught and identified as Tatera indica (47.4%) and Rattus norvegicus (52.6%). Specimens from 7 T. indica and 9 R. norvegicus were examined by two techniques, microscopic examination and nested-PCR. Out of 7 T. indica, 14.3% were infected with L. major and 42.9% with L. turanica by nested-PCR. Out of 9 R. norvegicus 22.2% were infected with L. turanica and 11.1% with L. gerbilli. Conclusion: Based on this survey L. major and L. tropica are the causative agents of the disease among patients and T. indica plays a predominant role in the dissemination of L. major in the city.

Background: Sand flies of subgenus Adlerius has a wide geographical distribution in Iran and are mostly found in wild form in mountainous areas. They are always considered as probable vectors of visceral leishmaniasis. The ob- jective of this study was to determine the Adlerius species and its composition in an endemic focus of zoonotic vis- ceral leishmaniasis in northwest of the country. Methods: Sand flies were collected from 6 different areas of Azarbaijan-e-Sharqi Province using sticky paper traps from August to September which is active season for sand flies in this area, in 2009. The flies were mounted and identified. The length of third antennal segments, ascoid, labrum, coxite, surstyle, style, aedeagus, genital filament, genital pump, width of style, and the end of aedeagus were measured and the number of costal hairs group was also counted as the morphological characters. Results: A total of 30 adult sand flies, (26 males and 4 females) including Phlebotomus halepensis (46.8%), P. longiductus (13.3%), P. balcanicus (23.3%), P. comatus (3.3%), and Adlerius spp. (13.3%) belong to subgenus Adlerius were identified respectively in 6 counties. One P. comatus male was captured in front of a cave located in the hillside of a mountain covered with the vegetation in Varzeqan area. Conclusion: The presence of at least 5 species of the subgenus Adlerius in Azarbaijan-e-Sharqi Province, an en- demic focus of zoonotic visceral leishmaniasis in Iran, shows that the risk of parasite transmission among man and reservoir animals is high during the active season of sand flies. P. comatus is a new record for Iran and needs to be added to the list of Iranian phlebotomines of subgenus Adlerius.