OBJECTIVES:To achieve a polio-free certification in Iran, a nationwide active surveillance program for acute flaccid paralysis (AFP) was set up following World Health Organization guidelines. This article describes the results of an eight-year surveillance of AFP in Hamadan, in the west of Iran. METHODS:A standard set of minimum core variables were collected. All cases of non-polio AFP in children aged < 15 years old were reported. Two stool specimens were collected within 14 days of the onset of paralysis. RESULTS:During the eight-year survey, 88 AFP cases aged < 15 years old were reported. About 40% (35/88) of cases were aged ≤ 5 years, 56% (49/88) were boys, 19 (21.6%) had fever at the onset of paralysis, 74 (84.0%) had complete paralysis within four days of onset, and 22 (24.7%) had asymmetric paralysis. More than one AFP case was detected per 100,000 children aged < 15 years old in all years. The risk of AFP in patients aged < 5 years old was almost double that of older patients. Guillain-Barré Syndrome was the major leading cause of AFP (66/88). Adequate stool specimens were collected from 85% of AFP patients. All stool specimens were tested virologically, but no wild polioviruses were detected. CONCLUSION:The active surveillance of non-polio AFP was efficient over the last eight years and exceeded 1.0 case per 100,000 children aged < 15 years old. Nonetheless, there was a decreasing trend in the detection of AFP cases during the last two years and should be the focus of the policymakers' special attention, although AFP cases were still above the target level.

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Our results support the role of HP in ITP of children, and urea breath test or Ag detection of HP in stool of these patients is recommended.

Purpose: Lung cancer is considered as a common cause of cancer mortality. The disease represents the second and third causes of deaths from cancer among Iranian women and men, respectively. The present study aimed to evaluate the spatial variations in relative risk of lung cancer mortality in Iran and its relation to common risk factors between men and women and specific risk factors among women. Methods: In this ecological study, the lung cancer mortality data were analyzed in Iran during 2011-2014. Besag, York, and Mollie's (BYM) model and shared component model (SCM) were used to compare the spatial variations of the relative risk of lung cancer mortality by applying OpenBUGS version 3.2.3 and R version 3.6.1. Results: The median age for death due to lung cancer in Iran is 74 years. During 2011-2014, the age-standardized lung cancer mortality rates among men and women were 12 and 5 per 100,000 individuals, respectively. In addition, almost similar spatial patterns were observed for both men and women. Further, risk factors, which are shared between men and women, were considered as the main cause of variation of lung cancer mortality relative risk in the regions under study for both men and women. The highest impact of the women-specific risk factors was estimated in northeastern and southwestern of the country while the lowest was related to Gilan province in northern part of Iran. Conclusion: Based on the spatial pattern, lung cancer risk factors are at relatively high levels in most parts of Iran, especially in the northwest of the country. Regarding the women, the high-risk regions were considerably extended. Further, the highest concentration of the specific risk factors among women was observed in the eastern, central, and southwestern parts. The smoking effect, and the second-smoking effect and environmental pollutions could play more significant roles for men and women, respectively.

Background: Disease mapping has a long history in epidemiology. Evaluating the spatial pattern of several diseases, as well as shared and specific risk factors in mortality, is considered as one of the applications of disease mapping. Stomach, esophageal, and lung cancers are among the five most common cancers among both genders in Iran, but no study is available on the spatial distribution of their mortality rate in Iran. The present study aimed to investigate the geographical distribution of the relative risk of mortality and to define the spatial pattern of shared and specific risk factors for the above-mentioned three cancers by sharing their mortality data at the county level in Iran.Method: This study analyzed the mortality data of stomach, esophageal, and lung cancers in Iran from March 2013 - March 2015. The Besag, York, and Mollie’s (BYM) model and Shared Component (SC) models were used for investigating the spatial changes of cancer mortality and determining the spatial pattern of their shared and specific risk factors. Data analysis was conducted using R and OpenBUGS software.Results: The number of deaths for the esophageal, stomach, and lung cancers in Iran from March 2013 -March 2014, was 11,720 of which stomach and lung cancers were 50% and 30%, respectively. The spatial pattern of the stomach and esophageal cancer mortality was more similar to that of lung cancer due to the risk factors shared only between esophageal and stomach cancers.Conclusion: The effects of smoking on lung cancer mortality were higher than the other two cancers. The available data indicated that esophageal cancer mortality was more affected by nutritional factors than stomach cancer mortality in Iran. The effect of nutritional factors on stomach and esophageal cancer mortality in the northern half of Iran was higher than the southern half. As a result, the relative risk of these cancers mortality in the southern half was more affected by smoking than nutritional factors.