Investigating the recent outbreak of dengue fever in Iran: a systematic review

Yari A., Mohseni S., Ezati Rad R., Hosseini Z., Shahabi N., Aghamolaei T.

ABSTRACTBackground and AimsDiseases transmittable by Aedes mosquito affect the health of millions of people every year, however, they can be effectively prevented. This study aimed to apply the Health Belief Model (HBM) in promoting preventive behaviors against dengue fever in southern Iran.MethodsIn this quasi‐experimental study, 320 people were randomly selected through multi‐stage cluster sampling in 2022 (161 in the intervention group and 159 in the control group). The data were collected using a researcher‐made questionnaire based on the HBM constructs before and 1 month after an educational intervention. Content validity index (CVI), content validity ratio (CVR), and Cronbach alpha coefficient were used for psychometric evaluation of the questionnaire. The educational intervention was made on a daily basis in a WhatsApp group in August and September 2022. Descriptive and inferential statistical tests were used for data analysis.ResultsAfter the educational intervention, the mean score increased in the constructs of behavior (38.42 ± 1.54), knowledge (10.77 ± 0.98), attitude (24.30 ± 1.59), perceived susceptibility (20.05 ± 1.42), perceived severity (21.31 ± 2.01), perceived benefits (28.00 ± 2.16), self‐efficacy (14.77 ± 0.51) of the intervention group. Moreover, after the intervention, the scores of perceived barriers (8.96 ± 1.31) decreased in the intervention group (p < 0.05). The analysis of covariance showed education had a statistically significant effect on HBM constructs.ConclusionsThe participants' knowledge about preventive behavior of dengue fever increased. They managed to remove the barriers to healthy behavior and began to show the desired preventive behavior with the self‐efficacy they gained; thus, the educational intervention based on the HBM can improve the behaviors to preventi of dengue fever, which is transmitted by the Aedes mosquito.

Seyed-Khorami S., Mostafavi E., Gerdooei S., Sajadi S.M., Asadi L.F., Jalali T., Pouriayevali M.H., Nikpour F., Mirolyaei A., Raeisi A., Arshi S., Gouya M.M., Enayati A., Zaim M., Salehi-Vaziri M.

Dengue virus (DENV) and Chikungunya virus (CHIKV) are the most common arthropod-borne viruses (Arboviruses) globally. So far, no autochthonous cases of DENV and CHIKV infections have been reported in Iran. Nevertheless, due to the recent identification of Aedes aegypti in the south and Aedes albopictus in the north of Iran, the country is at a serious risk of local outbreaks of these infections. Between 2020 and 2023, a comprehensive cross-sectional study was conducted to explore the anti-DENV and CHIKV IgG antibodies in the general populations of both southern and northern regions of Iran using ELISA. A total of 11,192 participants were included, of whom 2.3% (256 individuals) and 0.1% (11 cases) were DENV seropositive and CHIK seropositive, respectively. Across the eight examined provinces, Sistan and Baluchestan province displayed the highest prevalence of dengue seropositive cases (6.80%) (P < 0.001). Samples collected in 2022 demonstrated a notably higher seropositive rate of 5.5% (P < 0.001). Interestingly, all 11 CHIKV seropositive cases were from Sistan and Baluchestan province. The seroprevalence of DENV was notably higher in southern regions, particularly in Sistan and Baluchestan province and CHIKV seropositive cases were exclusively found in Sistan and Baluchestan province. This study furnishes crucial insights into the seroepidemiology of DENV and CHIKV in Iran, which in conjunction with the presence of Ae. aegypti in the south and Ae. albopictus in the north of Iran, emphasizes the requirement of improving integrated surveillance and control systems in the whole of the country, especially in the south of Iran.

Heydarifard Z., Heydarifard F., Mousavi F.S., Zandi M.

Since the first reported traveler case of Dengue in Tehran in 2008, the virus has gradually spread across Iran, driven by factors including international travel, climate change, and Aedes mosquito vectors. The disease has manifested in various forms, ranging from mild fever to severe dengue, with notable cases identified in Sistan and Baluchistan Province. Despite the increasing prevalence, Iran faces significant challenges in surveillance, diagnosis, and vector control. This perspective comprehensively analyzes dengue virus epidemiology in Iran, emphasizing the need for enhanced public health strategies, including genomic surveillance, targeted interventions, and health education. The findings highlight the critical importance of addressing these challenges to mitigate the potential for large-scale dengue epidemics and protect public health.

Gurgel-Gonçalves R., Oliveira W.K., Croda J.

Javadzadeh M., Moghadam F.R., Erfanifar E., Abadi S.H., Sheikh S., Khazaei R., Saremi G., Naderi M.

Female infertility is a major public health concern, and viral infections have been suggested as a potential cause. The recent emergence of coronaviruses, such as SARS-CoV-2, has raised concerns about their potential impact on female fertility. This systematic review aimed to evaluate the existing literature on the relationship between female infertility and viral diseases, with a particular focus on coronaviruses. A systematic review was conducted using relevant databases, including PubMed, Scopus, Web of Science, and Google Scholar. Studies published between 2009 and 2023 were included. The Critical Appraisal Skills Program (CASP) tool was used to assess the quality of the studies. Data extraction and synthesis was carried out to summarize the findings. 13 studies met the inclusion criteria and were included in the review. The review demonstrated that many type viruses including human papillomavirus (HPV), human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and coronaviruses van affect female reproductive system. Moreover, findings revealed that some viral infections such as HPV and HIV may be associated with female infertility. However, evidence on the effect of coronaviruses on female infertility was limited and inconclusive.

Abbasi M., Zaim M., Moosazadeh M., Alizadeh M., Dorosti A., Khayatzadeh S., Nikookar S.H., Raeisi A., Nikpoor F., Mirolyaie A., Hokmabad B.N., Bazmani A., Kaveh F., Azimi S., Enayati A.

Background Dengue fever (DF) is increasingly recognized as one of the world’s major mosquito-borne diseases and causes significant morbidity and mortality in tropical and subtropical countries. Appropriate and timely diagnosis and risk stratification for severe disease are crucial in the appropriate management of this illness. Healthcare providers (HCPs) play a key role in dengue fever diagnosis, management and prevention. The present study was conducted to determine the knowledge, attitudes and practices (KAP) among HCPs in East Azerbaijan Province, Iran. Methods A cross-sectional survey among 948 HCPs, using a structured questionnaire, was conducted in East Azerbaijan Province from May to July 2022. Data analysis was undertaken using descriptive methods, the Chi-square test or Fisher’s exact test, and logistic regression. A P-value <0.05 was considered for statistical significance. Results Out of the 948 (68.5% female) respondents, 227 were physicians and 721 were health professionals. The knowledge level of DF was found to be largely inadequate in the present study population (80.4%). The physician vs. health professional were a significant factor in differentiating attitude scores. The mean practice score regarding DF prevention and control measures among respondents was 8.40±1.97. Conclusion The findings call for urgent continuous education and training courses to increase KAP levels and increased capacity and capability for DF prevention and control. This is of outmost importance for the first point of care of DF patients.

Samsudin N.A., Othman H., Siau C.S., Zaini Z.I.

Abstract Background Aedes mosquitoes are the main vector of dengue infection, a global health threat affecting millions of people annually. Conventional prevention and control methods against dengue outbreaks have only achieved marginal success. Recognizing the complex issue at hand, a multilevel participatory approach is crucial. Thus, alternative strategies that involve community engagement are increasingly being considered and attempted. While community-based vector control programs have been conducted, sustaining behavioral changes among the population remains a challenge. This study aimed to identify the specific community needs in combating Aedes mosquitoes and dengue fever as a basis to guide the development of community-driven initiatives and foster a deeper sense of ownership in the fight against dengue. Methods Between 1 August 2022 and 30 November 2022, we conducted a study in Hulu Langat district, Selangor, using a mixed-method design. All participants consented to the study, which comprised 27 participants (FGDs) and 15 participants (IDIs). The IDIs included two participants with a history of dengue fever, one community leader, one faith leader, seven local authorities, and four district health officers. Semi-structured interviews and discussions were performed among stakeholders and community members recruited via purposive and snowball sampling techniques. All interviews were audio-recorded before being analyzed using reflexive thematic analysis. Results These results derived from qualitative data explored the perspectives and needs of communities in combating Aedes mosquitoes and dengue fever. Interviews were conducted with various stakeholders, including community members, leaders, and health officers. The study identified the necessity of decisive actions by authorities to address the impact of the dengue epidemic, the importance of community engagement through partnerships and participatory approaches, the potential benefits of incentives and rewards to enhance community participation, and the need for sustained community engagement and education, especially via the involvement of young people in prevention efforts. These findings provide valuable insights into the design of effective strategies against Aedes mosquitoes and dengue fever. Conclusions In short, there is an urgent need for a comprehensive approach involving multiple stakeholders in the fight against Aedes mosquitoes and dengue fever. The approach should incorporate efforts to raise awareness, provide practical resources, and foster community responsibility. The active involvement of teenagers as volunteers can contribute to long-term prevention efforts. Collaboration, resource allocation, and community engagement are crucial for effective dengue control and a healthier environment.

Past V., Naderi M., Saremi G., Azizi P., Javadzadeh M., Shahveh S., Hosseini P., Sokhanvaran S., Shahveh S., Moghimi S., Hedeshi S., Jalalpour A., Bayat Z.

Erfanifar E., Abbaspoor Z., Khaksar Boldaji S., Mortezapoor M., Hosseini P., Saremi G., Naderi M., Sokhanvaran S., Moghimi S., Javadzadeh M.

This review aimed to investigate the effect of mindfulness-based cognitive therapy (MBCT) on sexual performance and sexual self-efficacy of postpartum women. A comprehensive literature search was conducted using electronic databases, including PubMed, Cochrane Library, PsycINFO, Scopus, Web of Science and Google Scholar to identify relevant studies published between 2016 and 2023. The quality assessment of the selected studies was performed using the Critical Appraisal Skills Program (CASP) tool. Data extraction and synthesis were conducted to summarize the results of the included studies. A total of 12 studies were included in this systematic review. The studies selected for this review were interventional (n = 9) and review studies (n = 3). Quality assessment in most studies showed medium to high quality. The results demonstrated that MBCT interventions have a positive effect on the sexual performance and sexual self-efficacy of postpartum women. Improvements in libido, arousal, psychosis, orgasm and overall sexual satisfaction were reported after MBCT intervention. Moreover, the interventions increased postpartum women’s self-efficacy in sexual relationships and communication. The results also showed that MBCT interventions have a promising effect on improving sexual performance and sexual self-efficacy in postpartum women. Incorporating MBCT into postpartum care may help address the sexual health concerns that this population faces.

Kiwanuka G.N., Bajunirwe F., Alele P.E., Oloro J., Mindra A., Marshall P., Loue S.

AbstractResearch ethics education is critical to developing a culture of responsible conduct of research. Many countries in sub-Saharan Africa (SSA) have a high burden of infectious diseases like HIV and malaria; some, like Uganda, have recurring outbreaks. Coupled with the increase in non-communicable diseases, researchers have access to large populations to test new medications and vaccines. The need to develop multi-level capacity in research ethics in Uganda is still huge, being compounded by the high burden of disease and challenging public health issues. Only a few institutions in the SSA offer graduate training in research ethics, implying that the proposed ideal of each high-volume research ethics committee having at least one member with in-depth training in ethics is far from reality. Finding best practices for comparable situations and training requirements is challenging because there is currently no “gold standard” for teaching research ethics and little published information on curriculum and implementation strategies. The purpose of this paper is to describe a model of research ethics (RE) education as a track in an existing 2-year Master of Public Health (MPH) to provide training for developing specific applied learning skills to address contemporary and emerging needs for biomedical and public health research in a highly disease-burdened country. We describe our five-year experience in successful implementation of the MPH-RE program by the Mbarara University Research Ethics Education Program at Mbarara University of Science and Technology in southwestern Uganda. We used curriculum materials, applications to the program, post-training and external evaluations, and annual reports for this work. This model can be adapted and used elsewhere in developing countries with similar contexts. Establishing an interface between public health and research ethics requires integration of the two early in the delivery of the MPH-RE program to prevent a disconnect in knowledge between research methods provided by the MPH component of the MPH-RE program and for research in ethics that MPH-RE students are expected to perform for their dissertation. Promoting bioethics education, which is multi-disciplinary, in institutions where it is still “foreign” is challenging and necessitates supportive leadership at all institutional levels.

Paquette S., Simon A.Y., XIII A., Kobinger G.P., Shahhosseini N.

Vector-borne viral diseases (VBVDs) continue to pose a considerable public health risk to animals and humans globally. Vectors have integral roles in autochthonous circulation and dissemination of VBVDs worldwide. The interplay of agricultural activities, population expansion, urbanization, host/pathogen evolution, and climate change, all contribute to the continual flux in shaping the epidemiology of VBVDs. In recent decades, VBVDs, once endemic to particular countries, have expanded into new regions such as Iran and its neighbors, increasing the risk of outbreaks and other public health concerns. Both Iran and its neighboring countries are known to host a number of VBVDs that are endemic to these countries or newly circulating. The proximity of Iran to countries hosting regional diseases, along with increased global socioeconomic activities, e.g., international trade and travel, potentially increases the risk for introduction of new VBVDs into Iran. In this review, we examined the epidemiology of numerous VBVDs circulating in Iran, such as Chikungunya virus, Dengue virus, Sindbis virus, West Nile virus, Crimean–Congo hemorrhagic fever virus, Sandfly-borne phleboviruses, and Hantavirus, in relation to their vectors, specifically mosquitoes, ticks, sandflies, and rodents. In addition, we discussed the interplay of factors, e.g., urbanization and climate change on VBVD dissemination patterns and the consequent public health risks in Iran, highlighting the importance of a One Health approach to further surveil and to evolve mitigation strategies.

Jafari F., Khalilzadeh S., Nejatbakhsh F.

Complementary and alternative medicine, including Persian medicine (PM), offers a variety of disease prevention and treatment methods, including the application of medicinal plants. The health of the reproductive system is an important issue for women, and understanding the potential effect of garlic (Allium sativum) for preventive and therapeutic purposes in this field is of interest. This systematic review focused on the effects of garlic on the female reproductive system. The method involved a comprehensive search of relevant literature on experimental animal studies using electronic databases from January 2010 to September 2023, followed by selection of eligible studies and data extraction. A total of 18 studies met the inclusion criteria and were included in the review. This review reported that garlic may have positive effects on women's reproductive health, such as improving hormonal balance, relieving PMS symptoms, and potentially supporting fertility outcomes. This review revealed that garlic compounds such as allicin and ajoene can modulate various aspects of the female reproductive system, including regulation of the menstrual cycle, hormonal balance, fertility, and reproductive disorders. This review determined that further research is needed to elucidate the molecular pathways and direct effects of garlic on the female reproductive system. Although garlic has many potential health benefits, it should not be used as a substitute for medications.

Lun X., Yang R., Lin L., Wang Y., Wang J., Guo Y., Xiu P., Zhu C., Liu Q., Xu L., Meng F.

Abstract Background Strengthening the mosquito control measures undertaken by residents of an area where dengue fever is present can significantly decrease the spread of this disease. The aim of this study was to explore the effects of the source of information and knowledge of dengue fever on the mosquito control behavior of residents of areas at high risk of this disease to determine effective ways of enhancing this behavior. Methods A survey was conducted via face-to-face interviews or questionnaires between March and May 2021 in three regions of the province of Yunnan, China. The survey included basic information about the respondents, the source(s) of their dengue fever information, the level of their dengue fever knowledge, and the measures they had implemented to control mosquitoes. Principal component analysis was used to extract the main components of the sources of information. Correlation analysis and structural equation analysis were used to explore the impact of the sources of information and residents’ dengue fever knowledge on their mosquito control behavior. Results Publicity achieved through mass media, including official WeChat accounts, magazines/newspapers, poster leaflets, television/radio and the Internet, had a direct effect on dengue fever knowledge and mosquito control behavior, and indirectly affected mosquito control behavior through dengue fever knowledge. Organized publicity campaigns, including information provided by medical staff and through community publicity, had a direct effect on dengue fever knowledge and indirectly affected mosquito control behavior through dengue fever knowledge. The residents’ level of dengue fever knowledge had a significant, positive, direct effect on their mosquito control behavior. Conclusions Mosquito control is an important measure for the prevention and control of outbreaks of dengue fever. An effective source of information can improve the level of dengue fever knowledge among residents and thus enhance their mosquito control behavior. Graphical Abstract

Nikookar S.H., Moosazadeh M., Fazeli-Dinan M., Zaim M., Sedaghat M.M., Enayati A.

BackgroundDengue fever is a rapidly emerging infection worldwide with a high public health burden. Adequate training of healthcare workers is essential to warrant the timely provision of health services to improve the outcome of dengue management.MethodsThis is an analytical cross-sectional study, conducted to assess the knowledge, attitudes and practice (KAP) of healthcare workers regarding dengue from April 2021 to March 2022 in Mazandaran Province, northern Iran. Data was collected using a researcher-made structured questionnaire, prepared as Google Forms, and sent to target groups through social media and email. Data analysis was performed by SPSS 22 software using descriptive and inferential statistics (Chi-square) at a significant level of 5%.ResultsMost of the respondents had heard about dengue (83.8%); media (32.7%) and academic education (25%) were the main sources of information. Respondents had less knowledge associated with dengue symptoms (52%) than prevention and control (69%), transmission (72.2%) and clinical management (81%). Based on the 70% cut-off point, the majority of the participants had a good attitude (81%) and practice (73%). However, only 49.6% of the respondents showed good practice regarding dengue local transmission. A significant difference was observed between participants knowledge on clinical management with occupation; attitude with gender and occupation; and practice with gender (p &lt; 0.05).ConclusionThe results of this study revealed gaps in some dimensions of KAP in healthcare workers, therefore, a greater focus should be placed on future training programs to raise knowledge and attitude leading to sound practice and behavior for adequate management of dengue.

Past V., Yaghmaeian K., Naderi M., Naderi N.

Naderi M., Naderi M., Keramati Jamal M., Past V., Esmaeili A., Khabazian A., Hashemi Ali Abadi S., Saremi G., Asghari S., Moghimi S., Parnianfard N., Parnianfard M.