Journal of School of Public Health and Institute of Public Health Research

SERO-EPIDEMICAL SURVEY ON RUBELLA AND CHARACTERIZING THE BEST STRATEGY FOR IMMUNIZATION

H Eftekhar Ardebilli

A community-based rubella serological survey of 795 individuals selected by cluster sampling technique from rural areas of Ourmia ,the center of West Azerbaijan province located in the northwestern Iran , was carried out from December 2001 to March 2002. The aims of the study were to characterize rubella epidemiology in a representative non- immunized community in northwest Iran and also to determine national vaccination strategy against rubella. The survey comprised a seroprevalence study, with stratification by age (0-45 years) and sex. Sera from 392 female and 378 male were tested for rubella IgG antibody using enzyme linked immunosorbent assay (ELISA) technique. "Rubella seropositivity" was defined as serum rubella IgG antibody level > or =13 IU/ml. Of the 770 cases, 58.1% were seropositive. Due to mathernal derived antibodies, 100% of the newborns was seropositive. This figure decreased with time until it became zero by 9 months of age. Then from the age of 4y, it began to rise until it peaked at 93.4% in the age group of 15-19 years. Then the seropositivity decreased to 85.7% in the age group of >35 years. Of women in the reproductive age groups (15-45 years), 89.6% were seropositive. No statistically significant difference in seroprevalence was found between the two sexes. This small preliminary study indicates that like many other countries, rubella is endemic in Iran and eliminating rubella and congenital rubella syndrome in the country will require international efforts, including vaccination of preschool- and school-age children and all susceptible young adults.

KALA-AZAR CASE TINDING USING DIRECT AGGLUTINATION TEST

Gh.H Edrissian

Visceral leishmaniasis (VL) has been found as an endemic disease in some areas in northwest and south parts of Iran during recent two decades. The species of the Leishmania has been characterized as L.infantum and the main sources of human infection in the endemic areas is dog. The majority of kala-azar cases are found among children in the age group of 1-4 years. As the delay in diagnosis and treatment of kala-azar cause high mortality in the patients, serological surveillance, using direct agglutination test (DAT), and treatment of seropositive cases who have clinical symptoms are carrying out with cooperation of Provincial Health Services in the endemic foci of Ardebil and East Azerbaijan Provinces in the northwest and Bushehr in the south parts of Iran since 1997.
DAT Leishmania antigen is made in the Protozoology Unit of the School of Public Health with the strain of L.infantum isolated from an infected dog in Iran. The finger prick blood samples are collected by trained Health Workers (Behwarz) from suspected kala-azar patients in the Rural Health Houses. The collected samples are transferred to the near district kala-azar laboratory and tested (using DAT) by the trained technicians. The sero -positive patients are referred to pediatricains or trained general physicians in district hospital or health center for clinical examination and treatment of the seropositive cases (DAT titers of 1:3200 or higher) with kala-azar clinical symptos. For the treatment, usually, meglomine antimongtc (Glucantime) is used via intra-muscular in dosss of 20mg/kg/day for 20 days.
In kala-azar case finding in the serological surveyed areas of Ardebil, East-Azerbaijan and Bushehr provinces during 1997-2001, altogether, 19693 blood samples were collected from suspected kala-azar patients and tested by DAT. Totally , 1274 cases (6.74%) were seropositive in titers of 1:3200 or higher. In the clinical examination of seropositive cases 690 patients (54.16% of sero-positive cases and 3.50% of the total samples) had kala-azar clinical symptoms and therefore they were treated.
This seroloeical surveillance of kala-azar in the endemic area as have detected high number of kala-azar patients among children up to 12 years old, who were subsequently treated on time . This ptoject has prevented the mortality of the disease in the studied areas.

MONITORING GROWTH IN CHILDREN AGED UP TO 5 YEARS IN ISLAMSHAHR , REY AND QOM

K Holakoui Naieni

This is a descriptive and analytic study of growth and nutrition indices in 1624 children under 5 years of age who received servicesfromPHCcentersknownasHealthHouses) in Islamshahr, Qom and Rey catchment areas.We used data from family health files to construct standardized Z-scores for the following indices: weight for age,heightfor age, and weight for height Analysis of data showed that : some 5.4 percent of children were underweight (1.6% , 4.4% , 6.6% in Islamshahr, ReyandQomerespectively). Overall, 24.4 percent were suffering from low height for age (stunting) (11.5% , 19.1% , 28.6% in Islamshahr, Rey and Qom respectively) and 4.45 percent of children had low weight for height (wasting) 6.3% , 2.2% , 5% in Islamshahr, Rey and Qom).There was a statistically significant relationship between low weight and :a) higher birth order (p= 0.009).b) the presence of frequent plateaus (0.003) and downslopes (p=0.01) on the child's growthchart (p=0.01). In Qom, there was also a significantly greater risk of low weight for children with longer nursing periods (p= 0.0005) and those who spent more time on exclusive breastfeeding (p= 0.005).

BROMIDE REMOVING FROM WATER RESOURCES USING GAC COLUM AND RESIN

K Azizi

Bromide which is present in many water resources has the potential to create adverse health effects after water disinfection by oxidizing agents, and it is considered to be the most important mineral in this respect. Bromide removal is not feasible in conventional water treatment plants. This survey with the aim of removing Br" from water has been accomplished by performing pilot tests in which a GAC fixed - bed contactor and two different resins have been employed. Synthetic water samples of known concentrations of Br" (1-10 mgL -&apos) and TDS (250 - 1000 mg/L-1) have been treated, at the first phase of this study.
Results showed that the best efficiency of GAC treatment was for samples having more than 1 mgL"1 Br" and less than 1000 mgL-1 TDS.
At the second phase of the study, a strong anionic-cathionic resin had been used for Br" removal. Either low or high concentrations of Br", in the influent a considerable reduction in Br" content was always observed at the first 5 minutes of contact.
At the third phase of the study a weak anionic resin (WBA) has been employed. Using this resin in the treatment of synthetic samples proved that WBA is also very effective for Br" removal during 10 min contact while , Br- was reached less than 0.4 mgL"1 . Simultaneous removing of TDS was also showed well efficiency. However, TDS has never decreased to near zero as it was possible for the strong resins.
Finally in the 4th phase of this research, natural samples from four water resources supplying potable water for the city of Qom have been chosen to continue the process of Br" removal by above-mentioned pilots. Despite of high levels of TDS of the samples, there was no important problem in the process of Br" treatment. The acceptable removal efficiencies of bromide were minimum 50% and maximum around 100% .

INTESTINAL PARASITIC INFECTION IN FERAYDOON KENAR, MAZANDARAN

T Razavyoon

The aim of this study was clearing the pattern of parasitic infections in Feraydoon-Kenar, a 30,000 population town on the Caspian sea area.Atotalof2568persons,refered to Feraydoon Kenar Laboratory for rutine stool examination by Direct Smear, scotsch tests for children and formalin ether, and Floatationtests.Atotalof321infectedpersons were in divided 2 groups living in urban and rural area. Also 386 Scotch tape tests were used in school children in different age and sex groups. Prevalences of parasites were : Giardia lamblia 16.93% , Enterebius vermicularis (pinworm) 4.71% , E. histolytica 4.28% , Strengyloides 0.74%, H. nana 0.42%, Hook worms 0.19% and Taenia 0.19%. Non pathogen protozoa prevalences were : E.coli 3.5% , Blastocystis hominis 3.15%, Iodamoeba butschlii 0.66%, Endolimax nana0.15% ,andDientamoebafragilis 0.11%.The highest prevalence were (41.2%) belong to 5 to 9 years old children, and 4.1% of them had both Giardia and E.vermicularisatthesametime.Giardiaprevalence during spring and summer (18.9%) had significant difference comparing with autumn and winter (14.81% )P<0.005, but prevalences of E. vermicularis showdnoseasonal variation.In rural area Prevalences (28.39% ) and in urban area (23.8%) showed significant difference. P<0.005.In rural area "prevalences of Ehistolytica (4.32%), Strengyloides stercolaris (1.85%), and Hook worms (0.62%) had significant difference with urban area (2.51 %, 0.6%, 0%). H.nana (1.26%), E.vermicularis (8.17%) prevalence in town had significant difference with urban area (0%, 6.17%,P<0.005).In 386 scotch tape tests the prevalence of E.vermicularis in young male was 23.46% butin yuung female was 32.63% , demonstrated significant difference (P<0.005).

MALARIA HISTORY AND STATUS IN IRAN

Gh.H Edrissian

Malaria has been prevalent for a long time in Iran. About 1000 years ago, the Iranian physicians such as Avicenna (979-1037) were acquainted to the clinical feature of the disease. The scientific study of malaria in Iran was started by Latycheve in 1921. Later on up to 1944, malaria have been studied by some Iranian and foreign investigators and it was found hyper-endemic in some littoral parts of Caspian Sea in the north and Persian Golf in the south and hypo-or meso-endemic in the central parts of the country. From 1941 to 1948 the anti-malaria campaign were using quinine for chemotherapy and chemoprophylaxis as well as anti-larval measures for vector control. From 1949 DDT was used for the control of the Anopheles vectors which were determined at that time as A.maculipennis and A.superpictus in the north and some central parts of Iran, A. sacharovi in the west and A.stephensi and A. culicifacies in the south parts of the country. At the present time A.d&aposthali and A.fluviatilis are also considered as malaria vectors and A.pulcherrimus as a suspected vector in the south parts of Iran.
Spraying (using DDT) and malaria surveillance (case finding and treatment) caused a great reduction in malaria incidence in the malarious areas, particularly in the north and central parts of the country. The Institute of Malariology was established in the Department of Medical Parasitology, Medical School of Tehran University for training and research works on malaria in 1952.Malaria Eradication Programme (MEP) was recommended by the World Health Organization in 1956 and actually started in 1957 in Iran under General Office of Malaria Eradication (GOME) in the Ministry of Health.
Anti-malaria campaign in MEP during 1957-1971 caused interruption of transmission of malaria in the north parts of Zagross mountains, approximately, half north parts of Iran, and reduced, greatly, the incidence of the disease in the south parts of Iran which were considered as problem or refractory areas.
In 1973, GOME became a division of CDC in Ministry of Health and this integration caused some standstill in the activities of MEP. Thus, the incidence of malaria increased in the refractory areas in the south as well as in consolidation areas in the north parts of the country and the total diagnosed cases of malaria in Iran raised from less than 35,000 to approximately 100,000 cases per year. Therefore, the Ministry of Health strengthened the MEP again. Actually, from 1980 the anti-malaria campaign from MEP changed to malaria control programme , because in the refractory areas due to some behaviors or resistance of vectors to insecticides and, partly, due to the resistance of P.falciparum to chloroquine at RI & RII levels, the interruption of transmission was not possible. However, there was about 80% reduction of annual malaria incidence as well as percentage of P.falciparum during the recent decade. The prevalent species of Plasmodia are P.vivax & P.falciparum in the malarious areas of south and P.vivax in the north parts of Iran. P.malariae is rarely found at present time.