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Downloaded from http://journals.tums.ac.ir/ on Tuesday, October 09, 2012 University of Med of University Tehran 82 Keywords: and prevention in of re Conclusion: infectionhighest of rate wasmalaria (21.3%) in seen . Afghanis 2001 in served w 163(20.07%), 2001 in rate, seen infection highest The years. three last 2011. during in cases anycases reported 3 not to had decreased cities then Some and 2005 to 1997 from increased cases malaria of number The (97.4%). Results: Rate Examination Blood Annual and were(ABER) analyzed. (API) Incidence Parasite Annual (SPR), Rate Positive Slide including lig by examined and Giemsa with stained who registered at health Methods: 2012 1997 during northern Province, in malaria of trend the determine to was study this of aim Background: ABSTRACT Original Article Sciences Public Sciences Malaria in Mazandaran,Malariain NorthernPassive Iran: FindingCase http:// tums.ac.ir http:// 7 . 6 . . S Ghaffari S 1 Cellular Cellular Molecularand tan and South and tan 3 In total, 844 cases of malaria were reported. malariawere 844cases of total, In . Infection and Tropical Disease Research Center; Infectious Diseases Department, Faculty of Medicine; University of . This retrospective study retrospective This Malaria, - Department of Parasitology Mycology,and of Faculty Department of Laboratory Sciences, of Faculty Para 02. The SPR had the highest value (0.54%) in 2004 in (0.54%) value highest the had SPR The 02. Extensive malaria control should be continued to Mazandaran to become malaria become to Mazandaran to continued be should control malaria Extensive Malaria is one of the most important parasitic diseases in tropical and temperate regions. The regions. temperate and tropical in diseases parasitic important most the of one is Malaria - 2 n 1997 and 02 a * Corresponding author:Corresponding tion 1 , SA Mahdavi SA , P. falciparum,P. vivax, - - introduction i and 94 (11.1%) mala (11.1%) 94 and Iran eastern centers of . cal 2 . 4 Research Center, Babol University of Medical Sciences; Department of Laboratory Sciences, Faculty . Health Center,Health Mazandaran University of Medical Sciences, , Iran - 98. of Para Iranian J Parasitol: Vol. Parasitol: J Iranian Health Center,Health (Received 641(75.9%) was conducted from 1997 to 2012. to 1997 conducted from was 2 stage. - , Z Moulana Z , Medicine; Babol University of Medical Sciences, Babol, Iran During 1997 During Iran ht microscope. ht 5 Iranian J Parasitol J Iranian . Tel.: 21 Open access Journal at Journal access Open Babol University of Medical Sciences, Babol, Iran http:// ijpa.tums.ac.ir http:// *N Kalantari *N Nov Health Center,Health Babolsar, Iran Medical Sciences, Babol, Iran of +98 1112234274 201 ae wr ipre fo hprnei aes uh as such areas hyperendemic from imported were cases 3 , S Mouodi S , Plasmodium 1 ; accepted - 7 Medicine, Babol University of Medical Sciences, Babol, Iran Medicine, Babol Universityof Medical Sciences, Babol, Iran , No. , Peripheral bloodPeripheral weresmear for each prepared case, ria pa ria In addition to demographic data, other parameters other data, demographic to addition In - 3 201 7 , 20 , tients were recorded as introduced cases. The cases. introduced as recorded were tients - 11 vivax 05. The maxi The 05. 12 Jun 4 2 , , H Karimi H , , pp , Email: was predominant species with 821withwaspredominantspecies cases 201 The population's study was individualswas population'sstudy The Available at: .82 2 ) - 88 [email protected] mum API and ABER were ob were ABER and API mum - Nia Iranian So Iranian http://ijpa.tums.ac.ir 5 , M Bayani M , http:// isp.tums.ac.ir http:// Parasito of ciety - free region free 6 , as - - l ogy Downloaded from http://journals.tums.ac.ir/ on Tuesday, October 09, 2012 Available at: malaria of rates incidence and some prevalence the under is it moment poten the at and past the in Iran, northern of parts other like ince, Prov Mazandaran in problematic was Malaria potential risk of malaria transmission ex area where the impo (5). Armenia from extent some to and of Republic the 1994 nately, country the of parts north the malaria eliminated almost and transmission 1950 program' control ria maculipennis vivax reg endemic hyper malaria a as considered been had ture, 10 and humidity, tive 800 with weather Mediterranean has which tains, Moun of slops north of areas forest littoral the Iran, ern country sections four into divided been has entire the Control, Malaria for Plan nowadays, and past the in malaria of with endemicity various regions different three to divided been Ira conditions, epidemiological on Based someof in its relow countries the is endemicity malaria which area of this in placed one is Iran malaria. of risk popula Region's Mediterranean Howe Sub are in malaria of seen rate mortality and morbidity mala from die people million one and diagnosed disease mil 250 About malaria. pot in currently are Approximately M Introduction - 1200 mm annual rainfall, 70% rainfall, annual mm 1200 - after a large displacement of people from of people displacement large a after 79s a te rvln seis and species prevalent the was tial risk of transmission. of risk tial e, prxmtl 6% f h Eastern the of 60% approximately ver, malaria re malaria any n h devel the in mainly infec tant impor most the of one still is alaria ed o nearly to lead i anal i te world the in annually ria according to the National Strategy National the to according was malaria vector. National mala National vector. malaria was o bfr 15 (3). 1950 before ion - http://ijpa.tums.ac.ir aaa Arc constitutes Africa Saharan half of the world's populations world's the of half - emerges tious diseases in the world, the in diseases tious Now, it is consideredan isas itNow, rted cases are found and the gions en ws are out carried was s plain of and Sea Caspian of plain - 35 °C average tempera average °C 35 il ik f contracting of risk tial in e css f the of cases new lion Ghaffari (2 nerpe disease interrupted in in Iran northern in - 4) pn countries. oping (2, 3) (2, at also are tions . In Mazanda In et al.: et - (3) 100% rela 100% Plasmodium . Unfortu . (1) Anopheles ists (3). . Malaria in Mazandaran, No Mazandaran, in Malaria North High . during n had n (2) ran in ------. as te re the cause activities holidays for ince prov this to countries other and Iran of parts Further particular refugees. mor for hospitality has and tions Mazandaran geographi However, in 0.05/1000 (7). respectively 2003, and 129 to 1999 in 0.02/1000 rate (API) incidence The (6). increased then num and 1993 in 66 to gradually decreased was cases positive of ber num the and Researchers there from cases 3291 years. reported different during vary are June and August and June and September Januar between peaks season rainy The mm. 1274 to 718 annual from are ranges while rainfall 20°C, to 12.5 between varying 1). (Fig. rural 102 and cities 16 of consists and gions) ( situations and region conditions climate diverse has province This travelers. and populations of placement re in role important has it Therefore, tively. provinces respec south, and Tehran northwest northeast, from and Gilan km Golestan, 23,831 the has t at area and Sea Caspian The to closed 2012. from to Iran 1997 northern Province, Mazandaran study retrospective This area Study and MethodsMaterials during 1997 Province zandaran case tofindout passive on based detec malaria on per studies formed all near and world the in grams with according reason, that For there. in performed be should region , oeet f epe rm different from people of movement e, e o mlra ae ad a and cases malaria of ber tion (PCD), the present study was carried was study present the (PCD), tion y, while the driest months are between are months driest the while y, (3,5) rthern Iran rthern may cal condition and has tourist's attrac tourist's has and condition cal the curren the - Hne rglry mo regularly Hence, . nrdcin f aai it this into malaria of introduction fet aaie ouain and populations parasite affect nearly all malaria control pro control malaria all nearly (8) en nul eprtr is temperature annual Mean job , il, aly n pan re plain and valley hilly, … . t malaria situation in Ma in situation malaria t nrae fo 6 and 66 from increased - ekn ad financial and seeking was conducted in the in conducted was - he interface of interface he 2012. nnual nitoring parasite 83 2 ------, Downloaded from http://journals.tums.ac.ir/ on Tuesday, October 09, 2012 84 s the including parameters other data, demographic recorded. accurately were and microscopy by obtained results The microscope. light by examined and Giemsa with stained case, each Peri Health to attended cases suspected all was study population's The population Study Total 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 ( Table 1:Table http://tabarestan.4t.com/english hrl lo ser ee rprd for prepared were smear blood pheral Year ie oiie ae SR, h annual the (SPR), rate positive lide ------Fig.1: 12 11 2010 09 08 07 06 05 04 03 02 01 2000 9 8 Prevalence of Map ofMap Mazandaran P annual examination blood rate (ABER) 2,756,466 2,724,858 2,69 2,662,724 2,632,191 3,091,047 3,055,602 3,020,563 2 2,951,687 2,922,432 2,886,609 2,853,508 2,820,787 2,788,441

,985,927 Population Percentage 3,612 demographic Number 470424 etr o te province. the of centers Number of Plasmodium 42,386 38,407 41,739 45,676 64,420 21,232 23,381 28,199 22,603 41,214 15363 20461 21554 21364 22425

Slide Vol. Parasitol: J Iranian n diin to addition In rovince - informa map.htm) species, species, positiveslide (SPR), rate 163 100 844 153 131 60 59 54 58 10 11 12 40 83 3 4 3 Positive tion 97.4 8 150 127 161 10 11 10 40 82 58 55 54 54

21 3 4 3 vivax in in Mazandaran 7 1.9 16 Plasmodium 2 1 1 4 2 2 4 ------falciparum No. , 16(1.9%) were due to due were16(1.9%) these,822(97.4%) were dueto Ofparasites.malaria forpositive were (0.18%) 1997 microscopicallyduring amined peripher 470,424 the Of Results analyzed V.18. SPSS by were Iran. Data Babol, Sciences, Medical of University Babol of Department Research the of Committee ics Eth regional the by approved was study The examined of slides number slides/total positi of number the as expressed was SPR inhabitants 1,000 of per incidence malaria the as calculated was API The analyzed (ABER) rate were examination blood annual the and (API) incidence parasite identified in 2 (0.2%) patients (Table 1). cas to due was 3 es had mixed infection and species was not was species andinfection mixed had es 0.1 , 20 , 1 1 ------malariae 12 0.4 3 ------2 ------1 , pp , P rovince, annual incidence parasite

Available at: Mixed .82 . malariae P. - 88 0.2 2 2 ------Unknown Iran, 1997 P. falciparum SPR I adto, (0.4%) 3 addition, In . 0.02 0.02 0.05 0.05 0.01 0.05 0.17 0.54 0.37 0.32 0.38 0.16 0.14 0.12 0.09 http://ijpa.tums.ac.ir l lo ser ex smear blood al - 2012 API 0.001 0.001 0.003 0.004 0.001 0.004 0.013 0.053 0.029 0.046 0.059 0.022 0.021 0.020 0.022 Plasmodium vivax, (9 - 10) (API) and(API) and 1(0.1%)and - 2012, 844 2012, ABER 4.9701 n the and 6.696 7.135 7.154 7.597 7.265 8.099 9.882 8.013 14.78 15.3 17.15 24.47 15. 5 14.1 (11) (9) 9 . . ve - - Downloaded from http://journals.tums.ac.ir/ on Tuesday, October 09, 2012 N.B. Total Immigrant Iranian Nationality 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 Total 2011 2010 2009 2008 2007 data age on and gender 774 of out 844casesof recorded. were correctly Available at: was (39.4%) rate 11.33 positive ± highest 26.1 The was years. patients the The of recorded. age not mean were patients (1.8%) 15 of gender and female were 103(12.2%) male while were cases positive of 726(86%) Further more, cases. introduced patients as (11.1%) recorded were 94 mainly and countries other from from cases im as ported considered were 641(75.9%) 844, Of 2004 in seen was (0.54%) SPR of amount highest The 2004 in cases 153 to increased then and de slightly and 2001 in occurred cases 2007 during constant almost was it but years early in ried va SPR the and cases malaria of number The year Iran, 1997 Iran, 2: Table ------Table 2012 2011 2002 2000 1999 1998 2010 2009 2008 2007 2006 2005 2004 2003 2001 - 3: 05 Ohr nomto' sc as such information's Other 2005. Nationality, age and genderof malaria in cases reported Mazandaran 1997 Province, Iran, Frequency of malaria ca - - 2012. (Ais imported from cases countriesother is and B imported cases from other provinces) Age (yr)/GenderAge 2012. The highest peak of malaria of peak highest The 2012. F 2 67.7 1 33.3 10 90.9 10 83.3 90 68.7 49 81.7 48 81.4 24 44.4 24 41.4 641 75.9 138 90.2 130 79.8 3 75 26 65 78 94 12 32 6 8 8 80 6 24 http://ijpa.tums.ac.ir N N % 0 creased - 10 A M 27 192 10 156 F M F 17 36 n h to et years next two the in - Ghaffari 02 ih 6 cases 163 with 2002 11 0 0 0 0 0 0 1 25 2 20 1 6 3.9 2 2.4 3 2.3 4 2. 1 1.7 5 8.5 2 3.7 4 6.9 32 3.8 1 33.3 N N % - 20 B 9.1 5 ses in associated in withses some epidemiological data, Mazandaran province, et al.: et 14 39 23 282 F 9 243 21 Introduced N 6 3.9 2 2.4 4 6.7 2 66.7 7 11.6 94 11.1 13 32.5 32 24.4 28 17.2 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Malaria in Mazandaran, No Mazandaran, in Malaria 30 - M 2005. F - - - 5 96 13 21 18 117 31 % - 40 M 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13 1.5 N N % 13 22.4 over the years. the over greatly those varied (A), or nationals foreign (B), in found provinces other from ported 2. Table in shown are cases introduced and provinces, of number from imported cases the about data Moreover, 1. ble Ta in shown also were ABER and API SPR, rna ad 4 (59) ee immi were (75.9%) Afghanist 641 from mainly born grant/foreign and Iranian were cases 203 (24.1%) decreased. rapidly then and increased gradually groups old year cases) 31 and 58) to 10 (from 30 to 1997 21 among cases malaria During of number the 3). 2004, (Table groups old year 11 by lowed 21 in seen Local F 8 12 2 25 10 37 41 - 0 50 M The proportion cases considered im considered cases proportion The rthern Iran rthern N N % Unknown - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0.6 2 3.3 4 3.1 7 12.1 2 16.7 14 25.9 3 2 34 4 1 0ya odgop 35 ae) fol cases) (305 group old year 30 F 3 5 3 5 6 10 - 51 0 2.% ad 31 and (28.3%) 20 - 60 1.2 M … other countries or other or countries other F 1 4 0 1 1 3 61 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1.7 2 3.4 1 2.5 2 1.5 30 3.5 14 25.9 10 17.2 N N % Relapse - 70 - 40 (from 18 to 60 to 18 (from 40 M 0 F 0 3 0 1 0 2 - >70 0 (17.4%) 40 M 3 100 4 100 3 100 60 100 59 100 54 1 58 100 10 100 11 100 12 100 40 100 83 100 163 100 844 100 153 100 131 100 - N N % 2012 Total 85 F 97 677 62 126 35 551 an. Total 00 - - - - - M Downloaded from http://journals.tums.ac.ir/ on Tuesday, October 09, 2012 86 and to due Afghanistan in Pakis cases of majority The Regio nean Mediterra Eastern WHO malaria the high in transmission with area in placed which tries coun of neighborhood in is it but grammes transmis malaria limited geographically low, with area in cated re malaria to According Discussion Babol years. three last during Sari and cities as some such Province in Mazandaran reported among not were cases ria mala addition, In Ramsar. excepting province the of west at located cities in observed larly wa 2004 to 2001 during rate dence increas The cities. the of 2001 in creased in cases malaria results of number These the that city). revealed each in cases (2 vadkoh Sa and Ramsar in observed were cases Fewer 1997 Iran, Province, Mazandaran ) each cities (two of east and center west, the in located cities the to relation 2 Fig. cases). and (102 patients) bon (107 health Babolsar ca malaria the the at registered of were most cases that showed 2 Figure e etr 10 ae) olwd y Toneka by followed cases) (180 center re - 2012 a, n ams al ae i te rn are Iran the in cases all almost and tan, : P. vivaxP. h nme o mlra oiie ae in cases positive malaria of number The n such as Afghanistan and . and Afghanistan as such n (12) - sion and effective malaria pro malaria effective sion and 02ad 2004 and 2002 . port in 2011, Iran lo Iran 2011, in port n o mlra inci malaria of ing Iranian J Parasitol: Vol. Parasitol: J Iranian - 05 n most in 2005 particu s ------7 , No. , rdal dcesd o 896 ih 12% with falciparum 18,966 to decreased gradually 45% with 96,340 malar total country the of part agree 1986 in formed pre was which (0.22%) study a from obtained in results with comparison in decrease significant 0.18% was slide Mazan examined of mean the number to the slide of positive of ratio number the mean that showed findings Our WHO and malar find of among (97.3%) prevalent most the that demonstrated study current The in contrast with a study from Altamim Prov Altamim from study a with contrast in respectively grants, immi were cases malaria of % 20.7 and 40% Khoras in example, For reports. other or Iran of parts compa were patients non malaria of 25% from indicated that mainly decade last from obtained amount than higher born Afghanis were patients immigrant/foreign malaria of 75.7% about Also, 2005 to 1995 during Mazandaran to emigrate persons 199,508 that revealed Iran of Center Statistical Mazandara to Iran of region endemic malaria from immigration as well as people Afghan of immigration to due 2001 in rate incidence malaria in increasing However, 2011(12,15). elimination in the stage in be to lead which country well as Mazandaran in performed malaria of control and prevention for grams pro effective that indicated data These 1). ble (Ta 2011 in 3 to decreased gradually and 2006 2005 in cases 40 2001 to decreased suddenly during then increased was it but positive of 2000 to 1997 during similar and low number was cases the that demonstrated 3 , 20 , - ns r i areet ih te studies other with agreement in are ings rna oii () Ti rsl i also is result This (6). origin Iranian et ih idns band rm other from obtained findings with ment aa drn 19 t 1997 during daran 12 al t a td cnutd n other in conducted study a to rable n aai n Hrogn provinces, Hormozgan and Razavi an (16) which confirme this confirme which (16) , pp , a. This tan. n 2005 in - a ae i te nie onr were country entire the in cases ia Plasmodium Available at: world malaria report malaria world .82 - 88 - 97 6. hs eut s in is result This (6). 1997 P. falciparum P. (3) ucm ws significantly was outcome (14,17) 3 14) (3, I adto, hs study this addition, In . . aa band from obtained Data n. pce was species http://ijpa.tums.ac.ir . Furthermore, it is it Furthermore, . 21. t showed It 2012. o patients ia Fr ntne the instance, For . - n 91 which 1991 in 05 ol be could 2005 (6, 7, 12 7, (6, as the entire the as explanation - 05 and 2005 . vivax P. . These - 14) P. ------. . Downloaded from http://journals.tums.ac.ir/ on Tuesday, October 09, 2012 Available at: stage. introduction malaria become Mazandaran to continued be should this strategy control malaria Moreover, that suggested study incidence. control malaria of stages various in are province regions this different among that revealed also It ment. improveme the and control disease in system of health surveillance the main to due is achievement great The this of reason countries. endemic malaria most the and stage) (elimination Iran of parts other Maz 2005 in malaria, of trend demonstrated the that findings these conclusion, In the risk malaria highest people, groups at young and poten male are cases ria stud many from obtained results with agreement in are findings These (87%). the male were of patients majority the data, these with cording 11 in then and years 21 of group age in seen was rate infected (3.7%) (Tabl 30 cases fected was cases indicat relapse of Number stage. introduction province malaria are this of three parts last some the indicating in years Ramsar and Behshar Sari, Babo including cities some in reported were come out this explain may which and Ramsar as such cities other to than higher was Noshar and to immigrants of number The with Babolsa comparison in Noshar) and Noor bon, (Toneka province the of west the where in located in particularly years the different in in cities different was patients malaria of rate the to immigration that demonstrated high which of ince n h ohr ad te iig r decreasing or rising the hand, other the On ies which revealed that the most of mala of most the that revealed which ies est cases were infected locally and not d not and locally infected were cases est - 02 flo te anr f aai in malaria of manner the follow 2012, tially working groups, are the population the are groups, working tially n o ipoe tetet f h in the of treatment improper of ing (16) - wih lcd n h cne (i. 2). (Fig. center the in placed which r f e rgo ad n rvnin f re of prevention in and region ree Frhroe ay aai cases malaria any Furthermore, . - re n i te rvnin f re of prevention the in and free http://ijpa.tums.ac.ir (18) 2. oevr te highest the Moreover, 2). e . nts in diagnosis and treat and diagnosis in nts - 20 and 31 and 20 Ghaffari (6,13,14,17, 19) (6,13,14,17, - 40 years. Ac years. 40 et al.: et naa in andaran Malaria in Mazandaran, No Mazandaran, in Malaria - 30 ue . l, ------References of interests. flict Iran. Babol, Sciences, Medical of University Babol Research by supported Province was study Mazandaran in centers care thank to like would We Acknowledgements The authors declare that there is no con no is there that declare authors The 2 1 9 8 7 6 5 4 3 ...... rthern Iran rthern 13 Iran. theeastern Mediterranean regionand in in world, the in Malaria Sadrizadeh B. malaria. 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