Iranian Journal of

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Background & Objectives: The DPT vaccine used in Iran is manufactured by the Razi Institute. So far, there have been no studies to determine the incidence and severity of adverse reactions to this vaccine. It was this lack of reliable information, plus concern for the unfavorable effects of such reactions on compliance with the vaccination schedule, that prompted the current study on DPT side effects.
Methods: In this cohort study, 1910 children aged 0 to 6 were divided into different groups (cohorts) on the basis of factors such as injection site and then monitored for the appearance of adverse effects. Data for this study were gathered through questionnaires filled by telephone or house-to-house interviews. We interviewed parents of children attending the 46 urban health clinics in Kermanshah. These interviews produced the data needed to fill the first part of the study questionnaire. The investigators then gave each parent an "information sheet" containing the data necessary for the second part of the questionnaire. The interviewee was asked to record on this sheet any adverse effects occurring over the following 48 hours. At the end of this period, the parent was contacted via telephone to fill the second part of the questionnaire. Data thus gathered were analyzed using the Statistical Package for Social Sciences (SPSS), version 11.5.
Results: In 1910 DTP immunizations given to children 0 to 6 years of age, followed for the development of adverse events occurring within 48 hours after immunization, the cumulative incidence rates were as follows: Swelling, 40.66% (38.43-42.89%) Redness, 43.08% (40.84-45.32%) Pain, 67.32% (65.20-69.40%) Fever (>38° C) 54.14% (51.89-56.40%) Fever (>40.5° C) 1.11% (0.64-1.59%) Drowsiness, 33.35% (31.21-35.48%) Persistent crying, 13.35% (11.81-14.88%) Local reactions, 75.79% (73.86-77.73%) and Systemic Reactions, 69.84% (67.76-71.97%). Only one child developed convulsion following immunization.
Conclusions: Varying reaction rates in different studies, such as high rate of pain and persistent crying in this study, may reflect the different preparations that were used or differenced in the methods for vaccine evaluation. Moreover, because of the severity of systemic reactions, DTP vaccine should be administered in the thigh region

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Normal 0 false false false EN-US X-NONE AR-SA Normal 0 false false false EN-US X-NONE AR-SA Background & Objectives: Epidemiological surveillance of infectious diseases through the mandatory-reporting system is crucial for disease prevention program and success in it related to physician, partnership. The aim of this study was to identify statues of notification system among general practitioners (physicians) in Qom.
Methods: In this analytical cross section study a self-administered questionnaire was used to assess knowledge and attitude of notifiable diseases, self-reported practices, reasons for noncompliance with reporting requirements, and suggestions to improve compliance. A total 140 general physicians completed the questionnaire. Appropriate statistical analyses were performed.
Results: 14/3% and 13/6% had a good knowledge and attitude about notification and only 47% had good performance. There was significant association between the participants' self-reported practices and knowledge total scores and participating in continuing medical education. The major barrier of reporting notifiable diseases was poor knowledge of the list of reportable diseases and reporting requirements. The most frequent suggestions for improving physicians' compliance with disease reporting were to simplify the reporting process and giving awareness about list of notifiable diseases.
Conclusion: Our findings suggest inappropriate knowledge, attitude and practices about disease notification requirements among GPs. Modifying physisicans' knowledge and motivation, eliminating barriers to disease reporting, and promoting some facilitating factors could help reduce the underreporting of notifiable diseases.

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Normal 0 false false false EN-US X-NONE AR-SA Background & Objectives: Human papillomavirus (HPV) infection seems to be the most common sexually transmitted infection. High-risk (HR) human papillomavirus (HPV) prevalence has been shown to correlate well with cervical cancer incidence rates. Since there is little known about the epidemiology of this infection in Tehran, we designed to estimate the prevalence of HPV in some areas in Tehran. 
Methods: Cervical specimens were obtained from 825 married women aged 21-59 years from the general population of Tehran, Iran according to the standardised protocol of the IARC International HPV surveys. HPV was detected using a GP5+/6+ PCR-based assay.
Results: HPV prevalence in the general population was 7.8% (5.1% of high-risk types), with no statistically significant variations by age. Cervical intraepithelial neoplasia was diagnosed in 4.1% of women, of whom 35.3% were HPV-positive. HPV16 was confirmed as the most common type among women with both normal (1.8%) and abnormal (8.8%) cytology. HPV positivity was significantly higher among divorced women, women in polygamous marriages and those reporting husbands' extramarital affairs.
Conclusion: However the prevalence of HPV seems not high in comparison with other international data, more molecular and seroepidemiological survey in national level needs to have a better perspective.

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Background and Objectives: Diabetes is a major health issue worldwide. This study evaluates whether a community-based participatory program may improve diabetes care in adult in west area of Yasouj.
Methods: A community based participatory research was designed. A local leading group was established consisted of academic researchers, local leaders, health providers and public representatives. All the 30-65 years old residents of designated area (2569 persons) were screened for detecting diabetes anthropometric measurements and biochemical tests were measured. Educational interventions about improving the diet and physical activities were performed for high risk individuals through a 3-months period.
Results: Out of 2569 individuals, 1336 were at high risk. Approximately 228 persons (17%) identified having diabetes. After the intervention, the mean FBS, HbA1C, TG and cholesterol of participant significantly decreased (p<0.05), decreasing in systolic and diastolic blood pressure and body mass index were seen however this was not statistically significant. The mean physical activity and exercise increased and consumption of frying foods, saturated oil decreased significantly.
Conclusion: Community-Based Participatory cares could be a feasible model for control of diabetes and its risk factors.

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Background and Objectives: Due to the importance of mortality statistics for planning, setting priorities and equal allocation of health services in population it is essential to assess quality of reporting mortality data in health systems. The aim of this study was to evaluate the completeness and accuracy of the Iranian Vital Horoscope reports for maternal and the under-five mortality (U5M) in rural areas through its comparison with other data sources in Iran.
Methods: The mortality data of Vital Horoscope reported from 30 selected cities over country was compared with the related data obtained from other data sources including Vital Horoscope's Fieldwork reports, Death Registration System and Maternal Mortality Surveillance System of Ministry of Health and Medical Education.
Results: Overall completeness of Vital Horoscope's Fieldwork reports for U5M in rural areas was about % 62.1. In terms of cause of death in children under-five,estimated sensitivity values were % 47.2 (95% CI: 22.9-72.2), % 66.6(95% CI: 22.7-95.7),  %78.2 (95% CI: 64.3-89.3)for respiratory infections, diarrhea and vomiting, and injuries-burning and poisoning respectively. The vital horoscope reports had 12.5% misclassification in determining the cause of maternal death.
Conclusion: Our findings indicate the Vital Horoscope's data might need some corrections because of underestimating of the mortality indicators. The comparison of this source with Death Registration System report for causes of death in children under-five (reported by Vital Horoscope) suggests that the vital horoscope might have suboptimal quality.

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Background and Objectives: Due to the importance of mortality statistics for planning, setting priorities and equal allocation of health services in population it is essential to assess quality of reporting mortality data in health systems. The aim of this study was to evaluate the completeness and accuracy of the Iranian Vital Horoscope reports for maternal and the under-five mortality (U5M) in rural areas through its comparison with other data sources in Iran.

 Methods: The mortality data of Vital Horoscope reported from 30 selected cities over country was compared with the related data obtained from other data sources including Vital Horoscope's Fieldwork reports, Death Registration System and Maternal Mortality Surveillance System of Ministry of Health and Medical Education.

 Results: Overall completeness of Vital Horoscope's Fieldwork reports for U5M in rural areas was about % 62.1. In terms of cause of death in children under-five,estimated sensitivity values were % 47.2 (95% CI: 22.9-72.2), % 66.6(95% CI: 22.7-95.7), %78.2 (95% CI: 64.3-89.3)for respiratory infections, diarrhea and vomiting, and injuries-burning and poisoning respectively. The vital horoscope reports had 12.5% misclassification in determining the cause of maternal death.

 Conclusion: Our findings indicate the Vital Horoscope's data might need some corrections because of underestimating of the mortality indicators. The comparison of this source with Death Registration System report for causes of death in children under-five (reported by Vital Horoscope) suggests that the vital horoscope might have suboptimal quality.

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Background & Objectives: Knowledge of the presence of seasonal trends and other explainable patterns in the prediagnostic data sources and removing such patterns before applying outbreak detection methods seem very important. This study aimed to detect and remove the explainable patterns such as seasonality, day-of-week (DOW) and holiday effects of the daily counts of suspected cases of measles in Iran.Methods: Data on daily counts of suspected cases of measles as a pre-diagnostic data source were obtained from Iranian national surveillance system between 21 March 2008 and 20 March 2011. We used lines plot, moving average chart, autocorrelation and partial autocorrelation functions for detecting explainable patterns. Moving average (MA) and Holt- Winters (HW) exponential smoothing method are used for removing explainable patterns.

Results: Our findings indicate the presence of seasonality, DOW effect, holidays and weekend effects in the daily counts of suspected cases of measles. The good performance of HW exponential smoothing technique in removing seasonal patterns is evident. MA technique showed better performance regarding assumption violation on outbreak detection methods.

 Conclusion: Because of the presence of explainable patterns in the daily counts of suspected cases of measles, considering such patterns before applying outbreak detection algorithms is very important. Implementing both MA (7 days) techniques for its simplicity as a pre- processing method and HW method for its efficacy in removing seasonal patterns is recommended.

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Background & Objectives: Evaluating the performance of outbreak detection methods using real data testing provide the highest degree of validity. The aim of this study was to determine the performance of the Exponentially Weighted Moving Average (EWMA) in real time detection of two local outbreaks in Iran.

Methods: The EWMA algorithm (both ƛ= 0.3 and 0.6) applied on daily counts of suspected cases of measles to detect local outbreaks which had been occurred in Mashhad and Bandar Abbas cities during 2010. The performance of The EWMA algorithms were evaluated using real data testing approach and reported by correlation analysis.

 Results: Mashhad outbreak was detected with a delay of about 2 to 7 days using EWMA algorithms as outbreak detection method while the utility of EWMA algorithms in real time detection of Bandar Abbas’ outbreak were on time good optimal. Maximum correlation value for EWMA 2 in relation to Mashhad outbreak was 0.60 at lag 2.

Conclusion: Applying the EWMA algorithm as an outbreak detection method at local levels is not suggested. However the characteristics of data are determinant of the performance of such detection methods.

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Background & Objectives: Knowledge of the magnitude of attributable burden of cardiovascular diseases (CVDs) due to diabetes is necessary for health policy, priority setting and preventing CVD deaths. Our study aimed at estimating the attribute of proportion of diabetes to the burden of cardiovascular diseases in Kermanshah, West of Iran.

Methods: World Health Organization Comparative Risk Assessment methodology was used to calculating Potential Impact Fraction (PIF). Data on the Prevalence of newly diagnosed diabetes mellitus (People who have fasting plasma glucose (FPG) equal or greater than 126 mg/dl) were obtained from 3rd Iranian surveillance of risk factors of non- communicable diseases and data on corresponding measures of effect were derived from a national- specific study with age and multivariate adjusted hazard ratios.

Results: Based on multivariate- adjusted hazard ratios, by reducing the percent of women with diabetes from 8.1 percent to the zero level and the feasible minimum risk level i.e. 4 percent, 11.2% and 5.7% of attributable Disability Adjusted Life Years (DALYs) to CVD are avoidable, respectively. The corresponding value for men at the theoretical (zero level) and feasible minimum risk level (3 percent) were 5.6% and 2.9%, respectively.

Conclusion: To better planning, decision making and priority setting, PIF should be applied to updated and revised burden of CVDs in Iranian Health system.

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Background & Objectives: Tuberculosis (TB) is the largest single cause of death from infectious diseases and has a ten rating of global burden of disease. Despite the availability of effective treatment for pulmonary TB, sputum conversion of patients affected by various factors. This study aimed to determine the time course of sputum conversion in patients and possible affected factors in this process. Methods: In this Retrospective cohort study, 440 patients with smear-positive pulmonary TB in Hamadan province from 21 March 2006 to 20 March 2012 referred to health centers were included. Demographic, clinical data and treatment status of patients, including the time of sputum smear negative were extracted using TB Register software from patient registry. Time to sputum conversion was considered monthly during the patient’s treatmentand shown by Kaplan-Meier survival curve. The effects of some determinants including gender, location, age group and number of bacilli in the sputum of patients at the beginning of treatment were determined using Cox proportional hazard regression model.
Results: From 440 patients with smear-positive pulmonary TB, 51% (221 patients) were male and 49% (219 patients) were female. Fifty seven percent (57%) were living in urban and others in rural. The median of sputum conversion was 3 months. Totally, sputum conversion rate at the end of month 2 and 3 were 69% and 88%, respectively.
Conclusion: Our findings revealed that there has been a considerable difference between the expected sputum conversion rate and the observed rate in Hamadan province, Iran.

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Background & Objectives: Timely response to emerging diseases and outbreaks are a major public health and health systems priority. There are few published studies that evaluate the performance of cumulative sum (CUSUM) on identical data using semi- synthetic simulation approach. This study was undertaken to determine the performance of the CUSUM in timely detection of 831 days of simulated outbreaks.
Methods: We evaluated the performances of the CUSUM as an outbreak detection method on simulated outbreaks injected to daily counts of suspected cases of measles as baseline data in Iran between 21 March 2008 till 20 March 2011. Data obtained from the Iranian national surveillance system. The performance of algorithms was evaluated using sensitivity, false alarm rate, likelihood ratios and Area under the Receiver Operating Characteristic (ROC) curve.
Results: Generally the sensitivity of the CUSUM algorithm in detecting simulated outbreaks was 50% (95% CI: 47- 54). The corresponding values are disaggregated according to outbreak size, shape and duration. The CUSUM algorithm detected the half of outbreaks after 13.84 days on average.
 Conclusion: We concluded that CUSUM algorithm performed good in detection of large outbreaks with short periods and poorly in detecting long period outbreaks, particularly those simulated outbreaks that did not begin with a surge of cases.

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  Background & Objectives : World Health Organization has recommended the main strategies for the prevention of road traffic injuries on some of the risk factors. This study aimed to prioritize the preventive interventions according to risk factors of road traffic injuries in Iran.

  Methods: The potential impact fraction (PIF) of the main strategies for prevention was analyzed from national traffic police data registry in 2011 in urban and rural roads. PIF was calculated for risk factors of road traffic injuries and joint effect at three counterfactual distributions: theoretical minimum risk level, plausible minimum risk level, and feasible minimum risk level. The priority setting of preventive intervention was performed based on contribution of each risk factor.

  Results : Based on the potential impact fraction of death (PIF calculated using odds ratio of death) the priorities were as follows in order: wearing a helmet by the motorcycle passenger, wearing a helmet by motorcycle rider, and lack of speed management. Risk factors in this study were more important in urban roads and joint effects of risk factors were close to 100 percent

  Conclusion: It is strongly recommended that future interventions focus on the use of the helmet by motorcycle passengers and riders, the use of the seat belt by the passengers, and speed management. Our findings indicated that laws and legislations should be pursued more seriously. Calculation of the potential impact fraction is better than the population attributable fraction and allows for more accurate prediction of the future.

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  Background & Objectives : Considering the high prevalence of hypertension and its increasing trend in Iran as the most important known modifiable risk factor of stroke, this study was performed to determine the pattern of hypertension and the related population attributable fraction (PAF) of stroke in Hamadan Province.

  Methods: Blood pressure data of over-19-year-old population of Hamadan Province from 2005 to 2009 was extracted from the non-communicable diseases risk factors surveillance system . The point prevalence and 95% confidence interval (95% CI) of hypertension was reported in the study population according to sex and age groups. The trend of hypertension was depicted using a line plot. To calculate PAF, the data of the prevalence of hypertension in 2009 was used. Corresponding hazard ratio was obtained from the available literature.

  Results : The prevalence of hypertension was 9.4 (8.2 – 10.6) in 2005, 7.5 (5.9 – 9.3) in 2006, 14.2
(12.1 – 16.5) in 2007, 13.8 (11.7 – 16.1) in 2008, and 12.2 (10.3- 14.5) in 2009. The mean and standard deviation of systolic blood pressure was 120.88 (19.73) and 124.19 (19.24) in the participants in 2005 and 2009, respectively. The study results showed that 19.84% of the strokes in Hamadan Province were due to hypertension .

  Conclusion: The results of this study confirmed the considerable contribution of hypertension to stroke in Hamadan Province. Accordingly, policy makers are strongly recommended to consider controlling and preventive strategies for hypertension as a priority .

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Background & Objectives: This study was conducted to evaluate the completeness and geographical representativeness of the hepatitis B surveillance system between 2007 and 2013 in Hamadan Province.

Methods: In this descriptive study, all reported cases in Hamadan Province were extracted. The analytical literature review method was used to examine completeness. We used studies on the prevalence and incidence of hepatitis in Iran published between 2007 and 2013. Sensitivity analysis of the results was performed by simulation program using the R software. Geographical representativeness was assessed and plotted by the ArcGIS software, as well.

Results: Totally, 1378 cases were reported to the hepatitis B surveillance system in Hamadan Province. Most cases were from urban areas and were men, married, and housewives mostly in the age group 20 to 29 and 30 to 39 years. Completeness of the hepatitis B surveillance system was 77%. The hepatitis B surveillance system was not representative in terms of occupation but was representative in terms of age, sex, marital status, and place of living.

Conclusion: We concluded that the hepatitis B surveillance system had a relatively good performance. Moreover, findings of the analytical literature review method are affected by the included studies and interpretation of the results should be performed with caution.

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Background and Objectives: Epidemiology is a tool and a field of science which provides evidences necessary to make decisions. It is known as one of the basic sciences of public health. This study aimed to identify strategies for the promotion of epidemiology by Iranian Epidemiological Association so that people graduated in this field would become able to play an effective and positive role in different parts of the country.

Methods: This study was conducted in 2015. The views and opinions of the members of Iranian Epidemiological Association were collected by email. The views of the members were classified using qualitative methods.

Results: The results of this study helped to identify some of the strategies for the promotion of the position of epidemiology in Iran’s health system by the members of Iranian Epidemiological Association.

Conclusion: Iranian Epidemiological Association can play a more effective role in the promotion of epidemiology in the health system. Effective communication with the members, holding group meetings, advocacy and negotiation, reporting the activities of the Association continuously, identifying national problems and seeking solutions are some of the strategies that can help to enhance the role of the Association and promote the position of epidemiologists in Iran.

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Background and Objectives: Syndromic surveillance systems are used to early detection of outbreaks. The purpose of this study was to determine the feasibility of clinical and non-clinical data sources used in influenza syndromic surveillance in Zanjan.

Methods: In this time series study, clinical and non-clinical data related to influenza like illness (ILI) as a potential data source of syndromic surveillance systems, including the number of missed school days collected from 12 schools and the data of over the counter (OTC) drug sale obtained from 15 pharmacies selected randomly in Zanjan during 2014 were used. We used the line plot and moving average chart to explore trends and detect potential explainable patterns of data sources. The autocorrelation function and cross correlation function besides corresponding graphs were used to assess the feasibility of school absenteeism and OTC sale in timely detection of influenza outbreaks. 

Results: Line plots indicated the presence of explainable patterns and the effect of the day of the week. The cross correlation value was 0.5 and cross correlogram revealed the similarity of both data sources in this study.

Conclusion: Our findings indicated the feasibility of influenza data sources, including school absenteeism and OTC, as potential data sources of syndromic surveillance systems.

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Background and Objectives: The Haemophilus influenzae (Hib) conjugate vaccine (HibCV) using a pentavalent formulation was introduced to the Iranian routine immunization program from November 2014. Iran is preparing to include Pneumococcal conjugate vaccines (PCV), as well. Measuring and monitoring the impact of HibCV and PCV are necessary to provide evidence for introduction and sustained administration of this vaccine.

Methods: We addressed the possibility of implementing the "3-tiered approach to IB VPD surveillance" as proposed by the World Health Organization using a feasibility study. Expert opinions were asked to address published literature regarding the study design and methods of measuring the impact of newly introduced vaccines.

Results: There are different methods and study designs to measure the impact of new vaccines, including population based active surveillance systems and vaccine effectiveness studies. The results of the feasibility study and expert opinions highlighted the superiority of a sentinel hospital-based surveillance system in Iran.

Conclusion: It is necessary to conduct some systematic reviews and meta-analyses to provide evidence for the trend of Hib and Streptococcus pneumonia related diseases, i.e. invasive bacterial diseases including meningitis, pneumonia, and sepsis. To monitor indirect effects of the PCV vaccine, implementing periodic surveys on the prevalence of nasopharyngeal carriers are recommended.

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Background and Objectives: Cardiac diseases are a major cause of death in Iran. The number of deaths from cardiac diseases can be reduced through controlling air pollution. The aim of this study was to determine the relationship between increased air pollution and mortality from respiratory and cardiac diseases in Tehran.

Methods: The average daily concentrations of five pollutants, including carbon monoxide (CO), nitrogen dioxide (NO2), ozone (O3), sulfur dioxide (SO2), and particulate matter less than 10 microns (PM10) were collected from 8 stations in Tehran, Iran. Then, their effects on the number of daily deaths due to cardiovascular and respiratory diseases were calculated using time series and Poisson GLARMA model (generalized linear autoregressive moving average). The climatic elements such as mean, maximum, and minimum temperature and daily humidity were considered as confounding factors.

Results: After adjustment for potential confounding variables of the final model of the pollutants, the mean daily ozone level (P = 0.02) and particulate matters less than 10 microns (P <0.001) had a significant correlation with the number of daily deaths.

Conclusion: According to the results of this study that addressed the relationship between air pollutants and death using new statistical methods, it is necessary to take more effective measures to control ozone and particulate matters less than 10 microns to reduce the mortality of heart and respiratory diseases in Tehran.

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Background and objective: Epidemiology is a tool and a field of Medical sciences  which provides evidences necessary to make scientific decisions.  This study aimed to identify strategies for the promotion of the epidemiology by Iranian Epidemiological Association (IrEA) so that people graduated in this field would become able to play an effective and positive role in different parts of the country.

Methods: This study was conducted in 2015. The views and opinions of the members of IrEA were collected by email. The views of the members  were classified using qualitative methods.

Results: The results of this study helped to identify some of the strategies for the promotion of the position of epidemiology in Iran health system by the members of IrEA.

Conclusion: IrEA can play a more effective role in the promotion of this field of study in the health system. Effective communication with the members, holding group meetings, advocacy and negotiation, reporting the activities of the association continuously, identifying national problems and seeking solutions are some of the strategies that can help to enhance the role of the community and promote the position of epidemiologists in Iran.

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