|Year : 2019 | Volume
| Issue : 4 | Page : 213-216
Entomological studies for the surveillance of dengue in Iran, 2006–2016
Mohammad Reza Shirzadi1, Mohammad Mehdi Gouya2, Mohammad Reza Yaghoobi-Ershadi3, Faranak Gharachorloo2
1 Center for Communicable Diseases Control, Ministry of Health and Medical Education; Center for Research of Endemic Parasites of Iran, Tehran University of Medical Sciences, Tehran, Iran
2 Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
3 Department of Medical Entomology and Vector Control, Tehran University of Medical Sciences, Tehran, Iran
|Date of Submission||31-Jul-2019|
|Date of Acceptance||18-Sep-2019|
|Date of Web Publication||03-Dec-2019|
Dr. Mohammad Reza Shirzadi
Center for Communicable Diseases Control, Ministry of Health and Medical Education, Eyvanak St. Shahrak Gharb, Tehran
Source of Support: None, Conflict of Interest: None
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.
Keywords: Aedes, dengue, Iran, mosquito-borne disease
|How to cite this article:|
Shirzadi MR, Gouya MM, Yaghoobi-Ershadi MR, Gharachorloo F. Entomological studies for the surveillance of dengue in Iran, 2006–2016. Biomed Biotechnol Res J 2019;3:213-6
|How to cite this URL:|
Shirzadi MR, Gouya MM, Yaghoobi-Ershadi MR, Gharachorloo F. Entomological studies for the surveillance of dengue in Iran, 2006–2016. Biomed Biotechnol Res J [serial online] 2019 [cited 2019 Dec 9];3:213-6. Available from: http://www.bmbtrj.org/text.asp?2019/3/4/213/272180
Dengue is the most quickly distributing mosquito-borne disease, with a thirty-fold increase in universal occurrence. Dengue is a febrile infection caused by serotypes 1, 2, 3, and 4 of flaviviruses. The mosquito Aedes aegypti is the essential vector for disease transmission.
During the current century, dengue infected nearly 100 countries of the tropical and subtropical areas of the world. However, no intensive battle has been taken against the infection. In 2012, the WHO introduced an international protocol to prevent, control and decrease the burden of dengue. Several economic and social elements that can enhance the transmission rate of dengue are as follows: quick movement of competent mosquito vectors and rapid transferring of humans infected with the virus (globalization), overabundance of the vector breeding sites and high density of susceptible individuals (urbanization), and climate factors such as temperature that can affect the capacity of mosquitoes to transmit the virus. Almost 75% of the worldwide population exposed to the infection is in the Asian–Pacific region. In spite of increased public consciousness and vector control plans, dengue outbreaks have happened in some highly urbanized regions of the world.,,
The aim of this review was to describe dengue in Iran. Data were compiled for the occurrence of dengue and the incriminated mosquito vectors in Iran. Summarized risk maps, vectors, surveillance, and risk plans of the disease in Iran were described.
Dengue surveillance and risk plans 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 (Dracaena sanderiana [Asparagaceae]) and other agricultural products and the need for approval from the Ministry of Agriculture of the origin country in terms of the plant spraying (2006). Introduction of the exotic Aedes spp. to a particular region can be mediated by international trade of lucky bamboo and other ornamental plants.,, Therefore, there is an association between Aedes and lucky bamboo that may be important in the aspect of public health concerns and mosquito control tasks.,, In-home infestations may be caused by the breeding and feeding of the vector on ornamental plants.,,
The Ministry of the Health of Iran coordinated with the Department of Arbovirus of Pasteur Institute of Iran, Tehran, Iran, to investigate the humans' samples in cases suspected for dengue disease. It was also coordinated with the department of entomology of the University of Tehran to study the Aedes mosquitoes and investigation of the dengue vectors. The suspicious cases were followed and registered.
The regions of the country in which the surveillance of the dengue is necessary were detected in 2006 [Figure 1]. The area of Iran in which the dengue was studied in 2008–2014 is shown in [Figure 2].
|Figure 1: The regions of Iran detected in 2006 in which the surveillance of the dengue was necessary|
Click here to view
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.
In 2015, a national program for disease control was prepared. A form for epidemiological study of patients suspected for hemorrhagic fever with a history of traveling to other countries and the information of patients suspected for dengue were prepared and imparted.
Other plans that were done in the center for communicable diseases control, Ministry of Health and Medical education to control the disease, were as follows: preparation of the health messages about dengue disease and sending them to the medical universities, cooperation with the Department of Entomology, Faculty of Health, University of Tehran to hold national educational workshops, holding two workshops in the University of Medical Sciences of Zahedan and Abadan in 2013 and 2014, and holding a workshop on the case management at faculty of Health, University of Tehran in 2014.
The credit for equipping of entomology laboratories was provided. Reports about the disease cases were sent to different universities of medical sciences in Iran. Diagnostic kits were prepared, and equipment of diagnostic laboratories in the Reference Laboratory of Health, Pasteur Institute of Iran and Faculty of Health, and Tehran University of Medical Sciences were set up.
The center sent a request for the presence of a WHO adviser to examine the state of disease control in the country. The control program of dengue was translated into English. Educational leaflets and pamphlets were provided.
Health messages about dengue disease were assigned to install at the terrestrial, aerial, and marine boundaries of Iran. The health messages were as follows: the most important viral disease transmitted by arthropods is dengue, the number of dengue cases in the world has increased thirty-fold in the past 50 years, over 100 million people in the world are infected with dengue virus annually, over 2.3 million people have symptoms of the disease, and more than 20,000 people die, travelers to Pakistan, India, Saudi Arabia, Oman, and Yemen are at risk of dengue, travelers to Thailand, Singapore, Malaysia, the Philippines, Vietnam, Cambodia, Laos, Bengal and Nepal, Japan, China, and Australia are also at risk of dengue, travelers to African countries, especially Sudan, Somalia, Ethiopia, Tanzania, Nigeria, Mali, Sri Lanka, Senegal, and Madagascar are at risk, travelers to America's continent countries, in particular, South America, Mexico, Brazil, Peru, Bolivia, Colombia, and Costa Rica, are at risk of the disease, dengue is transmitted by mosquitoes, the vector of the dengue exists in Iran, unfortunately, despite the control of many viral diseases, dengue is increasing worldwide, travelers to the most affected countries are at a high risk for dengue disease, symptoms of dengue are similar to symptoms of flu, there is no vaccine or antiviral treatment for dengue, dengue symptoms occur in <10 days after traveling to contaminated countries, dengue symptoms suddenly appear and include fever, muscle pain, and back pain, the patient may die due to the shock, failure of the organs (heart, lung, kidney, and liver), disorders in the body electrolytes, and bleeding.
In 2015, a national plan for the prevention and control of dengue was prepared in the Center for Communicable Disease Control (Ministry of Health and Medical Education) in the English language and with the WHO cooperation. The national plan included different sections such as the global burden of the disease, national situation in Iran, plan of disease control, disease transmission, clinical symptoms, differential diagnosis, and treatment. The activities at each level of the health-care system in Iran were outlined. Integrated surveillance and outbreak preparedness, as well as the establishment and improvement of the surveillance system, were explained. The plan also included definition of dengue cases and strategies for sustainable vector control using the source reduction. The challenges in dengue control were explained in the plan.
A national plan for the vector control was prepared in 2015 and included situation analysis, introduction of the endemic and emerging vector-borne diseases, policies and strategies for vector control, planning, coordination and implementation for vector control, human resources, external and other resources, financial resources, analysis of strengths and weaknesses of the plan, needs for the institution building, main actions and targets, budget, monitoring, and evaluation of the national plan.
Records and report cases showed that all seropositive Iranian patients recognized in 2013 have had a history of travel to the endemic areas of the disease, including India, Malaysia, Indonesia, Thailand, Iraq, Saudi Arabia, and Bahrain. The presence of a vector in Iran was proved in 2013 when the Aedes albopictus larva was isolated in Nikshahr and Sarbaz areas of Sistan and Baluchestan province.
The activities of medical universities of Iran after the workshops in Chabahar and Abadan and the Faculty of Health (Tehran University of Medical Sciences) were as follows: providing a university-level operational program (for disease surveillance and vector control), providing an entomology checklist (mosquitoes and larvae at specified times), sending the adult vectors and larvae samples from Zahedan, Bushehr, Hormozgan, Isfahan, Gorgan, Mazandaran, Gilan to Tehran University of Medical Sciences, cooperation with the medical deputies of the mentioned universities to control the possible cases of the disease, educational measures, including conducting educational workshops for the target groups, sending leaflets and instructions to the covered hospitals and placing educational notes on the universities' websites, and reporting the diseases cases.
The surveillance activities against dengue were defined in three levels, including surveillance in the cities, surveillance in the provinces, and surveillance in the country. In the surveillance of cities, the surveillance activities against dengue were as follows: collecting the larvae from inside and around of the cities, collecting the adult insects from airplanes and ships arrived from Malaysia, Thailand, India, Saudi Arabia, Pakistan, and China to Iran, and installing traps and transferring the insect eggs to the provincial health centers.
In the province level, surveillance activities against dengue were as follows: setting up a center for entomological studies on Aedes in the provincial health centers. Such centers should have different ability to detect larvae and adult vector, calculating the composition of Culicidae, preparing the map of Aedes distribution in urban and rural areas of each province, training the staff in the cities, monitoring and evaluation of programs for fighting the vector (while identifying the vector), and cooperation with other related centers.
In the country level, surveillance activities against dengue were as follows: cooperation with the infectious disease management center to supervise and control of the laboratories, analyzing the percentage of the larvae and matured Aedes that were detected in the provinces, detecting the possible contamination of the adult vectors with the virus using reverse transcription-polymerase chain reaction, determination of the vector's sensitivity to insecticides, identification of the suitable host of the disease, advising on the best method for fighting to the vector, spraying time and type of the poisons, doing advanced research projects on ecology, providing directions for hunting and sampling of Aedes, supervising the physicians' training in different provinces, sending entomologists to the high-risk areas if necessary, holding the practical training workshops on the vector identification, and methods to fight them and establishing scientific communication with international institutions.
Other follow-up actions included planning for continued educational program in aspects of dengue in different universities of medical sciences, equipping of the entomology laboratories of the universities, and visiting the universities to conduct the entomological checks and educational activities.
By the end of 2015, the universities were expected to develop their entomological laboratories, do extensive training programs for physicians and other health-care workers aimed to identify suspected cases and treat them, continue the vector checking, train travelers to the high-risk countries to take protective actions and hospitalize the patients who appear the dengue symptoms.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Schaffner F, Mathis A. Dengue and dengue vectors in the WHO European region: Past, present, and scenarios for the future. Lancet Infect Dis 2014;14:1271-80.
Gubler DJ. Dengue and dengue hemorrhagic fever. Clin Microbiol Rev 1998;11:480-96.
World Health Organization. Global Strategy for Dengue Prevention and Control, 2012–2020. Geneva: World Health Organization; 2012.
Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, et al.
The global distribution and burden of dengue. Nature 2013;496:504-7.
Halstead SB. Dengue. Curr Opin Infect Dis 2002;15:471-6.
Barbosa da Silva J Jr., Siqueira JB Jr., Coelho GE, Vilarinhos PT, Pimenta FG Jr. Dengue in Brazil: Current situation and prevention and control activities. Epidemiol Bull 2002;23:3-6.
Guzman MG, Kouri G. Dengue and dengue hemorrhagic fever in the Americas: Lessons and challenges. J Clin Virol 2003;27:1-13.
Linthicum KJ, Kramer VL, Madon MB, Fujioka K, Surveillance-Control Team. Introduction and potential establishment of Aedes albopictus
in California in 2001. J Am Mosq Control Assoc 2003;19:301-8.
Hofhuis A, Reimerink J, Reusken C, Scholte EJ, Boer AD, Takken W. The hidden passenger of lucky bamboo: Do imported Aedes albopictus
mosquitoes cause dengue virus transmission in the Netherlands? Vector Borne Zoonotic Dis 2009;9:217-20.
Qualls WA, Xue RD, Beier JC, Müller GC. Survivorship of adult Aedes albopictus
(Diptera: Culicidae) feeding on indoor ornamental plants with no inflorescence. Parasitol Res 2013;112:2313-8.
Doosti S, Yaghoobi-Ershadi MR, Schaffner F, Moosa-Kazemi SH, Akbarzadeh K, Gooya MM, et al.
Mosquito surveillance and the first record of the invasive mosquito species Aedes
) albopictus (Skuse) (Diptera: Culicidae) in Southern Iran. Iran J Public Health 2016;45:1064-73.
[Figure 1], [Figure 2]