Research Centre for Emerging and Reemerging Infectious Diseases
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Results of carried out research projects managed by this center includes reports on plague in rodents and dogs in the western part of the country, a report on tularemia seropositivity in human high-risk groups in Kurdistan and Sistan and Baluchestan provinces and the first report of clinical Q fever in Tehran.

In addition, this research center and the department of epidemiology have a close scientific relationship with the national reference laboratory of Arboviruses and viral haemorrhagic fever in Pasteur Institute of Iran to monitor other emerging and reemerging infectious diseases such as Crimean Congo haemorrhagic fever, dengue fever, West Nile fever, Rift Valley fever, etc.

To monitor other emerging and reemerging infectious diseases, studies have been done on diseases such as HIV, tuberculosis and hepatitis and those results have been published in international journals.

A summary of performed studies coordinated by the center is as follows:

- Seroepidemiological study of human high-risk groups in Kurdistan province

Since there was not much information about the plague, tularemia, Q fever and brucellosis disease in most parts of Iran, this study aimed to evaluate the serologic status of the disease in 2011inpopulations at risk of Kurdistan province.

A total of 250 serum samples along with questionnaires containing personal and behavior information of hunters and their families, butchers and health workers (as groups at risk) and referred people to medical diagnostic laboratories (as representative of the general population) were collected. Using the ELISA method, specialized antibody (IgG) against plague, tularemia, brucellosis, leptospirosis and Coxiella burnetii (Phase I and II) were tested in the serum collected. ELISA positive and suspicious samples of brucellosis were confirmed by standard tube agglutination test.

The prevalence of IgG in plague, tularemia, brucellosis, leptospirosis, and Q fever were 0.08%, 4.14%, 6.40 %, 27.83% and 20.80%, respectively(prevalence of IgG of Coxiella burnetii, Phase I was 20% and Phase II 52/14%), respectively.

- Study of plague infection in animals in Northwestern Iran

This study aimed to assess the current state of infection of an old center of plague in Iran, on the border of Kurdistan and Hamadan provinces.

This study was performed in two phases in 2011 and in 2012. Live traps were used for hunting rodents. After collecting fleas on the bodies of rodents, blood samples were taken from each rodent. Blood samples from cattle dogs were taken after obtaining the consent of their owners. Wild animals were hunted to obtain samples.

In 56 geographic regions, 98 rodents (63 Meriones persicus, 3 Meriones vinogradovi and 5 Microtus socialis irani, 26 Meriones libycus and 1 Ellobius lutescens) in 2162 traps were caught.279 fleas Xenopsylla cheopis were found on the bodies of these rodents.2 jackals, 3 foxes, 8 rabbits and one porcupine were hunted and blood samples were taken from 117 cattle dogs. In total, 1.02% of the 98 tested rodents had antibodies against Yersinia pestis. Additionally, 6.48% of 117 dogs tested positive to the presence of Yersinia pestis antibodies and 4.27% were suspected (border line) to have anti-plague. None of the wild animals tested positive for the presence of antibodies against Yersinia pestis using ELISA.

This study was the first official report on the continued presence of plague in wild areas of the West after a decades-long lack in reporting the disease.

- Serological survey of tularemia in rodents in western Iran

Francisella tularensis is the causative agent of tularemia. Tularemia has the potential to cause high morbidity and mortality. Since the Kurdistan province in the western region of Iran has been the historical foci of tularemia, the aim of this study was to evaluate the current situation of the rodents living in this region with regard to tularemia.

In this study, conducted in 2014 in five districts – Marivan, Saghez, Sarvabad and Sanandaj in Kurdistan province and Sonqor in Kermanshah province – rodents were captured using live traps. Ectoparasites, spleen and serum samples were collected from the rodents. Genus and species of the rodents and their ectoparasites were identified. A serological survey of tularemia was performed using standard tube agglutination tests. Real Time PCR was used for detection of Francisella tularensis DNA.

Of 246 captured rodents, the most were from the genus Apodemus (39.84%), Mus (24.39%) and Meriones (12.60%). 78 fleas, 73 mites and 14 ticks were collected from the studied rodents. Seroprevalence of tularemia in the studied rodents was 4.8% (8/164) with 1/80 or higher antibody titers. Suspected tularemia seropositive rodents (1/40 antibody titers) were identified in nine cases. The results of microscopic examination and Real Time PCR were negative for all the samples.

This was the first report of tularemia infection in rodents in Iran. Further studying the rodents and the environmental conditions such as water can better clarify the epidemiological aspects of tularemia in the future.

- Molecular evidence of Francisella tularensis in rodents in Iran

Tularemia disease is caused by the bacterium Francisella tularensis. Our understanding of the life cycle of the organism in nature and its natural reservoirs is still limited in Iran. The main objective of this study was to obtain information about the occurrence of F. tularensis in rodents in Iran.

In2014, 96 spleen samples were collected from 96 different species of hunted rodents throughout Iran. Rodents were hunted from 15 locations in seven different provinces in Iran including Fars, Chaharmahal and Bakhtiari, Gorgan, Kermanshah Khuzestan, Zanjan and North Khorasan. After DNA extraction, the samples were subjected to Real Time PCR for detection of Francisella tularensis.

The hunted rodents were 24 Microtus paradoxus, 15 Microtus irani, 13 Microtus socialis, 13 Mus musculus, 10 Apodemus witherbyi, 6 Crocidura suaveolens, 3 Calomyscus bailwardi, 3 Mus macedonicus, 3 Microtus qazvinensis, 2 Meriones persicus, 2 Neomys anumalus, 1 Microtus mystacinus and 1 Rattus rattus.

Real Time PCR screening demonstrated the presence of Francisella tularensis tul4 and fopA genes in one rodent (1%), Microtus paradoxus in Golestan province, northern Iran.

Our results indicate that Microtus paradoxus can carry Francisella tularensis. Thus, they may have a role in the ecological cycle of this pathogen. This finding confirmed the presence of Francisella tularensis among rodent populations in Iran. Further serological and molecular surveys of rodents are needed to reveal pathogen dynamics in rodent populations in Iran.

- Investigation of rodents in Saravan for possible infection with plague

In 2013 the center’s research team and epidemiology department were sent to the earthquake-stricken area in Sistan and Baluchestan Province after an earthquake to visit and investigate emerging and reemerging infectious diseases. They moved to the areas between Khash and Saravan cities where flooding in 1990 and an earthquake in 2013 occurred.

In surrounding that had a history of tularemia outbreaks in 2007, rodents were hunted and trapped. The radius of each trapping area was about 7 kilometers. Trapping for rodents was performed surrounding and inside the Shirkhan village in Khash, in the villages around Saravan, Abkaokan village in the Gasht district and Saravan country. Six regions out of 13 studied regions were assigned to outbreak location in 2007, so that two regions were inside the village and 4 outside the villages to monitor rodent infection within a complete investigation. Field visits, the trapping operation and sampling from rodents continued around the Shirkhan village (district of Khash country), Gasht city and Abkaokan and Anarak (district of Saravan country).

In 13 studied regions, a total of 200 traps/days were placed. Nine rodents were hunted. 48 fleas and 10 ticks were acquired from the rodents. Ticks were from the Ixodidae family, Hyalomma, and the fleas were one type, Xenopsylla cheopis. On average, five fleas and one tick could be found on each rodent. All rodents were Tatera indica.

In KamalAbad village, a porcupine was trapped as well and after sampling this animal, 5 ticks were picked from it. It was autopsied to investigate its inside organs. No pathologic lesions were observed on any animal. The results of the ELISA test to find antibody (IgG) against plague were negative for all samples.

- Survey on the rodent’s fauna and infection with plague in Bandar Abbas city

The first report of plague arrival in Iran was from south harbors more than 100 years ago. The purpose of this study was to determine the rodent fauna and amount of infection with plague in rodents of Bandar Abbas city in 2011.

During this study, 20 sites in various parts of the city (East, West, Center, Coastal and North) were randomly selected. The trapping method in the selected areas constituted 100 traps 30 meters apart in a range of 200 meters in length. All were traditional live traps. All the rodents were checked by using ELISA for IgG anti-plague.

In this study, using 297 traps, 27 rodents (9% success in hunting) were caught, 21 (77.8 %) Rattus norvegicus and 6 (22.2%) Rattus rattus. All rodents were free of plague infection.

- Checking fauna and infection of rodents in western Iran with Cutaneous leishmaniasis

Cutaneous Leishmaniasis is an infection of a single-cell parasite of the Leishmania type and the reservoir is usually rodents in the Gerbillinae family. This disease is considered a health problem in more than half of the provinces of Iran. Given that, there is no complete information on the infection status of Cutaneous Leishmaniasis among rodents of western Iran, the aim of this study was to check rodent fauna and infection levels in western regions of the country (the border between Hamadan and Kurdistan provinces) of Cutaneous leishmaniasis.

In this study, in 22 geographic regions within an approximately 20 kilometer radius of Kabudar-Ahang city in Hamadan province in the summer of 2011, with 952 traps/days, rodents were trapped and studied relying on diagnostic keys. Samples were taken from ears of rodents and were studied with Nested PCR to search for the cause of coetaneous leishmaniasis.

From 40 rodents captured, 32 were Meriones persicus, 4 Meriones vinogradovi and 4 Microtus socialisirani, respectively. The results of tests on the rodents' ears were negative for cutaneous leishmaniasis [88].

- Study of the infection of butchers and slaughterhouse workers in southeastern Iran

The aim of this study was to investigate the seroprevalence of infection history with tularemia, Q fever, brucellosis, leptospirosis and Crimean Congo haemorrhagic fever among butchers and slaughterhouse workers in southeastern Iran and to assess the risk factors for this disease in 2011.

In this sectional study, 190 serum samples with a questionnaire containing individual and behavioral information of butchers and slaughterhouse workers in several parts of Sistan-Baluchestan province were collected. Using ELISA antibody (IgG) against tularemia, brucellosis, leptospirosis, hemorrhagic fever, and Crimean Congo and Coxiella burnetii (phases I and II) were tested in the serum collected. Suspicious and positive ELISA brucellosis samples were confirmed using standard tube agglutination test.

The seroprevalence of tularemia, brucellosis, leptospirosis, Q fever, Crimean Congo haemorrhagic fever phases I and II were 6.52%, 7.9% ,4.2%, 16%, 1.18% and 14.4%, respectively.

- Seroepidemiological survey of Q fever in sheep in northwestern Iran

Coxiella burnetii causes Q fever in a range of animal species and humans. This disease is a significant public health issue and there is not enough epidemiological information on this disease in most parts of Iran, including cattle rich northwestern Iran. This study was performed for seroepidemiological survey of Q fever in sheep in northwestern Iran.

In this study, 256 serum samples were collected from sheep indifferent geographic regions (north, center and south) of Ardabil province. Collected serums using the ELISA method were tested to detect anti-Coxiella burnetii antibodies (IgG).

33.6% of studied sheep had Coxiella burnetii antibodies. There was a significant difference between areas of infection with Q fever (P <0.001) and most infection was observed in the southern regions (58.6%) and the least infection in the central regions (23.3%).A significant correlation was observed between Q fever infection and age groups (P = 0.03) and the highest infection was found in the age group 3 to 5 years. No significant relationship was observed between sex and infection with Q fever.

- Seroepidemiological survey of Q fever in Mazandaran sheep

The purpose of this study was to determine the seroepidemiological status of Q fever in sheep in Mazandaran in northern Iran.

In this study, 253 serum samples were collected from sheep in different geographical areas of Mazandaran province. Serum samples were tested using the ELISA kit to assess antibody IgG against Coxiella burnetii.

The Q fever infection rate in this study was 23.7%. Data analysis showed a statistically significant correlation between the studied areas (P 0.001) as the central (33.8%) and eastern (27.2%) regions showed more infection than the western regions (8.5%).Most infection was observed in Babol city with 40.5% and Savadkooh with 35%, and the lowest infection was observed in Ramsar with 2.6%.

- Case report of chronic endocarditis of Q fever in Iran

Endocarditis is the most common manifestation of chronic Q fever. This report details the first case in Iran of a patient with Q fever endocarditis. The patient was a 72-year old female with a medical history of aortic valve replacement, mitral valve replacement, coronary artery bypass graft surgery, tricuspid valve replacement and severe cardiac failure. At the initial consultation, the existence of fever, cough, and radiographic changes in the lung, especially in right lower lobe, led to a differential diagnosis focused on atypical pneumonia, side effects of previous radiotherapy, pulmonary infarction and tuberculosis reactivation. Endocarditis was also suspected due to a history of heart valve surgery. No vegetation was present in the echocardiography. Blood cultures were negative, but serologic titers (IgG phase I 1:32768) confirmed a diagnosis of Q fever endocarditis. The patient was treated with doxycycline and hydroxyl chloroquine. In addition, antibodies against C. burnetii and the treatment progress were monitored.

- Serology survey of Coxiella burnetii in feverous patients in Tabriz

Due to the clinical similarities of patients infected with Coxiella burnetii and other diseases like the flu, the differential diagnosis is very difficult. In this study, the prevalence of acute Q fever in different parts of East Azerbaijan was tested.

In this investigation, subjects were feverous with lower respiratory tract infection, had high-risk jobs or similar and had symptoms such as chest pain, chills, headache, cough, or breathing problems. They were selected for sampling and serology tests were performed on them.

The prevalence of acute Q fever (95% CI) in the study was 13% (0.06-0.17). Among women (14.8%), people over 60 years (28.5%), city dwellers (15.3%) and married (12.3%) had the highest infection.28% (95% CI: 36-21%) of the women had a history of infection with Q fever.

- Survey of the rodent fauna in the Sistan region

In November 2011, rodents in Sistan (Zabol, Zahak, and Hirmand) were investigated. These counties are located in northern Sistan and Baluchestan and in the eastern edge of the country, which is conterminous with Afghanistan and has a dry and desert climate.

Since Zabol have four districts (Shib Ab, Posht Ab, Markazi and Mian Kangi) and four cities (Mohammadabad, Adimi, Banjar and Doost Mohammad) and Zahak has two districts (Jazink and Markazi) and four villages (Zahak, Khomak, Khaje Ahmad and Jazink), all with appropriate geographic division, using live traps, rodents were hunted in several regions in three counties and using identification keys, the type of rodent was identified.

In this study, the sampling of 27 regions in these three counties was completed and 437 trap/days were set. 11 mice were hunted. Ten of them (91%) were Tatera indica type and one was Gerbillus nenus. In addition to trapping mice, a group worked every night in collaboration with the environmental protection agency to hunt wild carnivores around Zabol, Khaje Mountain and succeeded to trap one Lepus capensis rabbit.

132 fleas (on average, 12 on each mouse) were collected from the mice, after removing fleas, the bloodletting of mice was performed and serum samples were also separated. Autopsies of these mice were done and after inspecting several organs and observing possible lesions, blood sampling from several tissues was performed for supplementary tests.

- Survey on the rodents of Kurdistan in the point of infection to the plague

This study was a cross sectional survey in summer 2013 and it was conducted in the historical focuses of plague in Iran. Rodents were hunted using live traps, their types and species were recognized by key identification and their ectoparasites were separated. Information such as sampling place, topography, time of collection, vegetation, trapping step and geographic coordinates were registered; microscopic studies and culture samples of spleen were performed. ELISA tests were done for antibody recognition IgG against Yersinia pestis and finally, obtained spleen samples were studied in the cases of plague bacillus after extracting DNA using Real Time PCR.

In this study, 216 rodents were collected, 78 fleas, 73 mites and 14 ticks were separated from the rodents.

- Survey of northern provinces in terms of plague and tularemia

In this sectional study performed in summer 2013 in three Northern provinces, a total of 400 rodents were hunted and blood and tissue samples were taken for supplementary studies to investigate reemerging and emerging diseases in them.


I did not choose the plague, but it desired me!

Marcel Baltazard (1907-1971), founder of research centre