Epidemiology and Health

Original Article

Prevalence of latent tuberculosis infection among tuberculosis laboratory workers in Iran: Mahshid Nasehi, Abdolrazagh Hashemi-Shahraki, Amin Doosti-Irani, Saeed Sharafi, Ehsan Mostafavi; Epidemiol Health. 2017;39:e2017002. Published online December 30, 2016; DOI: https://doi.org/10.4178/epih.e2017002

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367 Download
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Abstract

OBJECTIVES
The risk of transmission of <i>Mycobacterium tuberculosis</i> from patients to health care workers (HCWs) is a neglected problem in many countries, including Iran. The aim of this study was to estimate the prevalence of latent tuberculosis (TB) infection (LTBI) among TB laboratory staff in Iran, and to elucidate the risk factors associated with LTBI.

METHODS

All TB laboratory staff (689 individuals) employed in the TB laboratories of 50 Iranian universities of medical sciences and a random sample consisting of 317 low-risk HCWs were included in this cross-sectional study. Participants with tuberculin skin test indurations of 10 mm or more were considered to have an LTBI.

RESULTS

The prevalence of LTBI among TB laboratory staff and low-risk HCWs was 24.83% (95% confidence interval [CI], 21.31 to 27.74%) and 14.82% (95% CI, 11.31 to 19.20%), respectively. No active TB cases were found in either group. After adjusting for potential confounders, TB laboratory staff were more likely to have an LTBI than low-risk HCWs (prevalence odds ratio, 2.06; 95% CI, 1.35 to 3.17).

CONCLUSIONS

This study showed that LTBI are an occupational health problem among TB laboratory staff in Iran. This study reinforces the need to design and implement simple, effective, and affordable TB infection control programs in TB laboratories in Iran.

Summary

Citations

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Eni Hilário da Silva, Ercilia Lima, Talita Raquel dos Santos, Maria Clara Padoveze
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Prevalence of modifiable risk factors of tuberculosis and their population attributable fraction in Iran: A cross-sectional study
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Occupational Tuberculosis Among Laboratory Workers in South Africa: Applying a Surveillance System to Strengthen Prevention and Control
Jennica Garnett, David Jones, Graham Chin, Jerry M. Spiegel, Annalee Yassi, Nisha Naicker
International Journal of Environmental Research and Public Health.2020; 17(5): 1462. CrossRef
Latent tuberculosis infection in healthcare workers in low- and middle-income countries: an updated systematic review
Lika Apriani, Susan McAllister, Katrina Sharples, Bachti Alisjahbana, Rovina Ruslami, Philip C. Hill, Dick Menzies
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Nawfal Hussein, Amer A Balatay , Lokman A Almizori, Hilbeen H Saifullah
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Is latent tuberculosis infection challenging in Iranian health care workers? A systematic review and meta-analysis
Mohammad Hossein YektaKooshali, Farahnaz Movahedzadeh, Ali Alavi Foumani, Hoda Sabati, Alireza Jafari, HASNAIN SEYED EHTESHAM
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Review

Plague in Iran: its history and current status: Abdolrazagh Hashemi Shahraki, Elizabeth Carniel, Ehsan Mostafavi; Epidemiol Health. 2016;38:e2016033. Published online July 24, 2016; DOI: https://doi.org/10.4178/epih.e2016033

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308 Download
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Abstract PDF

Abstract

OBJECTIVES
Plague remains a public health concern worldwide, particularly in old foci. Multiple epidemics of this disease have been recorded throughout the history of Iran. Despite the long-standing history of human plague in Iran, it remains difficult to obtain an accurate overview of the history and current status of plague in Iran.

METHODS

In this review, available data and reports on cases and outbreaks of human plague in the past and present in Iran and in neighboring countries were collected, and information was compiled regarding when, where, and how many cases occurred.

RESULTS

This paper considers the history of plague in Persia (the predecessor of today’s Iran) and has a brief review of plague in countries in the World Health Organization Eastern Mediterranean Region, including a range of countries in the Middle East and North Africa.

CONCLUSIONS

Since Iran has experienced outbreaks of plague for several centuries, neighboring countries have reported the disease in recent years, the disease can be silent for decades, and the circulation of Yersinia pestis has been reported among rodents and dogs in western Iran, more attention should be paid to disease monitoring in areas with previously reported human cases and in high-risk regions with previous epizootic and enzootic activity.

Summary

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The surveillance of plague among rodents and dogs in Western Iran
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Original Articles

Comparison of the tuberculin skin test and the QuantiFERON-TB Gold test in detecting latent tuberculosis in health care workers in Iran: Ehsan Mostafavi, Mahshid Nasehi, Abdolrazagh Hashemi Shahraki, Saber Esmaeili, Ebrahim Ghaderi, Saeed Sharafi, Amin Doosti-Irani; Epidemiol Health. 2016;38:e2016032. Published online July 24, 2016; DOI: https://doi.org/10.4178/epih.e2016032

16,193 View
220 Download
9 Web of Science
8 Crossref

Abstract PDF

Abstract

OBJECTIVES
The tuberculin skin test (TST) and the QuantiFERON-TB Gold test (QFT) are used to identify latent tuberculosis infections (LTBIs). The aim of this study was to determine the agreement between these two tests among health care workers in Iran.

METHODS

This cross-sectional study included 177 tuberculosis (TB) laboratory staff and 67 non-TB staff. TST indurations of 10 mm or more were considered positive. The Student’s t-test and the chi-square test were used to compare the mean score and proportion of variables between the TB laboratory staff and the non-TB laboratory staff. Kappa statistics were used to evaluate the agreement between these tests, and logistic regression was used to assess the risk factors associated with positive results for each test.

RESULTS

The prevalence of LTBIs according to both the QFT and the TST was 17% (95% confidence interval [CI], 12% to 21%) and 16% (95% CI, 11% to 21%), respectively. The agreement between the QFT and the TST was 77.46%, with a kappa of 0.19 (95% CI, 0.04 to 0.34).

CONCLUSIONS

Although the prevalence of LTBI based on the QFT and the TST was not significantly different, the kappa statistic was low between these two tests for the detection of LTBIs.

Summary

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Mohammad Hossein YektaKooshali, Farahnaz Movahedzadeh, Ali Alavi Foumani, Hoda Sabati, Alireza Jafari, HASNAIN SEYED EHTESHAM
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Prevalence of latent tuberculosis infection among tuberculosis laboratory workers in Iran
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Tularemia and plague survey in rodents in an earthquake zone in southeastern Iran: Behzad Pourhossein, Saber Esmaeili, Miklós Gyuranecz, Ehsan Mostafavi; Epidemiol Health. 2015;37:e2015050. Published online November 17, 2015; DOI: https://doi.org/10.4178/epih/e2015050

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125 Download
7 Web of Science
18 Crossref

Abstract PDF

Abstract

OBJECTIVES
Earthquakes are one the most common natural disasters that lead to increased mortality and morbidity from transmissible diseases, partially because the rodents displaced by an earthquake can lead to an increased rate of disease transmission. The aim of this study was to evaluate the prevalence of plague and tularemia in rodents in the earthquake zones in southeastern Iran.

METHODS

In April 2013, a research team was dispatched to explore the possible presence of diseases in rodents displaced by a recent earthquake magnitude 7.7 around the cities of Khash and Saravan in Sistan and Baluchestan Province. Rodents were trapped near and in the earthquake zone, in a location where an outbreak of tularemia was reported in 2007. Rodent serums were tested for a serological survey using an enzyme-linked immunosorbent assay.

RESULTS

In the 13 areas that were studied, nine rodents were caught over a total of 200 trap-days. Fortyeight fleas and 10 ticks were obtained from the rodents. The ticks were from the Hyalomma genus and the fleas were from the Xenopsylla genus. All the trapped rodents were Tatera indica. Serological results were negative for plague, but the serum agglutination test was positive for tularemia in one of the rodents. Tatera indica has never been previously documented to be involved in the transmission of tularemia.

CONCLUSIONS

No evidence of the plague cycle was found in the rodents of the area, but evidence was found of tularemia infection in rodents, as demonstrated by a positive serological test for tularemia in one rodent.

Summary

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Review

Do the tuberculin skin test and the QuantiFERON-TB Gold in-tube test agree in detecting latent tuberculosis among high-risk contacts? A systematic review and meta-analysis: Erfan Ayubi, Amin Doosti-Irani, Ehsan Mostafavi; Epidemiol Health. 2015;37:e2015043. Published online October 3, 2015; DOI: https://doi.org/10.4178/epih/e2015043

18,693 View
219 Download
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10 Crossref

Abstract PDF

Abstract

OBJECTIVES
The QuantiFERON-TB Gold in-tube test (QFT-GIT) and the tuberculin skin test (TST) are used to diagnose latent tuberculosis infection (LTBI). However, conclusive evidence regarding the agreement of these two tests among high risk contacts is lacking. This systematic review and meta-analysis aimed to estimate the agreement between the TST and the QFT-GIT using kappa statistics.

METHODS

According to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, scientific databases including PubMed, Scopus, and Ovid were searched using a targeted search strategy to identify relevant studies published as of June 2015. Two researchers reviewed the eligibility of studies and extracted data from them. The pooled kappa estimate was determined using a random effect model. Subgroup analysis, Egger’s test and sensitivity analysis were also performed.

RESULTS

A total of 6,744 articles were retrieved in the initial search, of which 24 studies had data suitable for meta-analysis. The pooled kappa coefficient and prevalence-adjusted bias-adjusted kappa were 0.40 (95% confidence interval [CI], 0.34 to 0.45) and 0.45 (95% CI, 0.38 to 0.49), respectively. The results of the subgroup analysis found that age group, quality of the study, location, and the TST cutoff point affected heterogeneity for the kappa estimate. No publication bias was found (Begg’s test, p=0.53; Egger’s test, p=0.32).

CONCLUSIONS

The agreement between the QFT-GIT and the TST in diagnosing LTBI among high-risk contacts was found to range from fair to moderate.

Summary

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Original Article

An epidemiological comparative study on diagnosis of rodent leptospirosis in Mazandaran Province, northern Iran: Behzad Esfandiari, Mohammad Reza Pourshafie, Mohammad Mehdi Gouya, Pejvak Khaki, Ehsan Mostafavi, Jamshid Darvish, Soheila Moradi Bidhendi, Hamed Hanifi, Hossein Nahrevanian; Epidemiol Health. 2015;37:e2015012. Published online February 23, 2015; DOI: https://doi.org/10.4178/epih/e2015012

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Abstract PDF

Abstract

OBJECTIVES
Leptospirosis is a zoonosis caused by leptospires, in which transmission occurs through contact with contaminated biological fluids from infected animals. Rodents can act as a source of infection for humans and animals. The disease has a global distribution, mainly in humid, tropical and sub-tropical regions. The aim of this study was to compare culture assays, the microscopic agglutination test (MAT), polymerase chain reaction (PCR), and nested PCR (n-PCR), for the diagnosis of leptospirosis in rodents in Mazandaran Province, northern Iran.

METHODS

One hundred fifty-one rodents were trapped alive at 10 locations, and their urine and kidney samples were collected and used for the isolation of live Leptospira. The infecting serovars were identified and the antibody titres were measured by MAT, using a panel of 20 strains of live Leptospira species as antigens. The presence of leptospiral DNA was evaluated in urine and kidney samples using PCR and n-PCR.

RESULTS

No live leptospires were isolated from the kidney and urine samples of the rodents. Different detection rates of leptospirosis were observed with MAT (21.2%), PCR (11.3%), and n-PCR (3.3%). The dominant strain was Leptospira serjoehardjo (34.4%, p=0.28), although other serotypes were also found. The prevalence of positive leptospirosis tests in rodents was 15.9, 2.6, and 2.6% among Rattus norvegicus, R. rattus, and Apodemus sylvaticus, respectively.

CONCLUSIONS

Leptospirosis was prevalent in rodents in Mazandaran Province, northern Iran. MAT was able to detect leptospires more frequently than culture or PCR. The kidney was a more suitable site for identifying leptospiral DNA by n-PCR than urine. Culture was not found to be an appropriate technique for clinical diagnosis.

Summary

Citations

Citations to this article as recorded by

Clinico epidemiological study of human leptospirosis in hilly area of South India-A population based case control study
SharvananE Udayar, NarasimhaB Chengalarayappa, Ashwini Madeshan, Manjunatha Shivanna, Krishnaveni Marella
Indian Journal of Community Medicine.2023; 48(2): 316. CrossRef
Seroepidemiology of leptospirosis in livestock and workers of high-risk occupation in Kurdistan, Iran
Shadi Aghamohammad, Arian Hajijafari Anaraki, Maryam Rahravani, Mojtaba Rastin, Reza Atashin Sadaf, Meysam Moravedji, Mahdi Rohani
Comparative Immunology, Microbiology and Infectious Diseases.2022; 82: 101758. CrossRef
Epidemiology of Leptospirosis: The First Literature Review of the Neglected Disease in the Middle East
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Rodent Species Diversity and Occurrence of Leishmania in Northeastern Iran
Seyed Farzad Motevalli-Haghi, Ghorban Mohammad Ozbaki, Nasibeh Hosseini-Vasoukolaei, Seyed Hassan Nikookar, Omid Dehghan, Jamshid Yazdani-Charati, Roohollah Siahsarvie, Reza Dehbandi, Mahmoud Fazeli-Dinan, Ahmadali Enayati
Polish Journal of Ecology.2021;[Epub] CrossRef
Leptospirosis: Increasing importance in developing countries
Zoey May Pheng Soo, Naveed Ahmed Khan, Ruqaiyyah Siddiqui
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Azar Shokri, Sadaf Sabzevari, Seyed Ahmad Hashemi
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Reviews

Tularemia, a re-emerging infectious disease in Iran and neighboring countrie: Afsaneh Zargar, Max Maurin, Ehsan Mostafavi; Epidemiol Health. 2015;37:e2015011. Published online February 22, 2015; DOI: https://doi.org/10.4178/epih/e2015011

21,041 View
201 Download
31 Web of Science
25 Crossref

Abstract PDF

Abstract

OBJECTIVES
Tularemia is a zoonotic disease transmitted by direct contact with infected animals and through arthropod bites, inhalation of contaminated aerosols, ingestion of contaminated meat or water, and skin contact with any infected material. It is widespread throughout the northern hemisphere, including Iran and its neighbors to the north, northeast, and northwest.

METHODS

In this paper, the epidemiology of tularemia as a re-emerging infectious disease in the world with a focus on Iran and the neighboring countries is reviewed.

RESULTS

In Iran, positive serological tests were first reported in 1973, in wildlife and domestic livestock in the northwestern and southeastern parts of the country. The first human case was reported in 1980 in the southwest of Iran, and recent studies conducted among at-risk populations in the western, southeastern, and southwestern parts of Iran revealed seroprevalences of 14.4, 6.52, and 6%, respectively.

CONCLUSIONS

Several factors may explain the absence of reported tularemia cases in Iran since 1980. Tularemia may be underdiagnosed in Iran because Francisella tularensis subspecies holarctica is likely to be the major etiological agent and usually causes mild to moderately severe disease. Furthermore, tularemia is not a disease extensively studied in the medical educational system in Iran, and empirical therapy may be effective in many cases. Finally, it should be noted that laboratories capable of diagnosing tularemia have only been established in the last few years. Since both recent and older studies have consistently found tularemia antibodies in humans and animals, the surveillance of this disease should receive more attention. In particular, it would be worthwhile for clinical researchers to confirm tularemia cases more often by isolating F. tularensis from infected humans and animals.

Summary

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Major infectious diseases affecting the Afghan immigrant population of Iran: a systematic review and meta-analysis: Behzad Pourhossein, Amin Doosti Irani, Ehsan Mostafavi; Epidemiol Health. 2015;37:e2015002. Published online January 7, 2015; DOI: https://doi.org/10.4178/epih/e2015002

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228 Download
8 Web of Science
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Abstract PDF

Abstract

OBJECTIVES
As Afghans make up the largest group of foreign nationals in Iran, the aim of this study was to assess the proportion of Afghan immigrants among those afflicted by the most prevalent infectious diseases in Iran.

METHODS

National and international online scientific databases were searched through November 2013. The reference lists of included studies were also searched. All descriptive studies concerning the most common infectious diseases in Iran, including tuberculosis, multiple-drug-resistant tuberculosis, malaria, cholera, Crimean-Congo hemorrhagic fever, leishmaniasis, and hepatitis B were retrieved. The nationality of patients was not considered. The selection of studies and data extraction was performed separately by two authors. Results were reported using a random effect model with a 95% confidence interval (CI).

RESULTS

The overall proportion of Afghan immigrants with the aforementioned infectious diseases was 29% (95% CI, 21 to 37). According to a stratified analysis, the proportion of Afghan immigrants afflicted with tuberculosis was (29%), multiple-drug-resistant tuberculosis (56%), malaria (40%), cholera (8%), Crimean-Congo hemorrhagic fever (25%), leishmaniasis (7%), and hepatitis B (14%).

CONCLUSIONS

It is highly recommended to monitor the health status of the Afghan immigrants when entering Iran, to reduce the spread of communicable diseases, which are viewed as serious in international health regulations.

Summary

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