Is Herpes Simplex virus (HSV) a sign of Encephalitis in Iranian Newborns? Prevalence of HSV Infection in Pregnant Women in Iran: A Systematic Review and Meta-Analysis

How to Cite This Article: Arabsalmani M, Behzadifar M, Baradaran HR, Toghae M, Beyranvand Gh, Olyaeemanesh A, Behzadifar M. Is Herpes Simplex virus (HSV) a sign of Encephalitis in Iranian Newborns? Prevalence of HSV Infection in Pregnant Women in Iran: A Systematic Review and Meta-Analysis. Iran J Child Neurol.Spring 2017; 11(2):1-7. AbstractObjectiveHerpes Simplex virus (HSV) is one of the most common sexually transmitted diseases in the world. This study aimed to determine the prevalence of herpes simplex virus in pregnant women in Iran.Materials & MethodsA systematic literature review was conducted to study the HSV subtypes in Persian and English papers through several databases. We searched Pub Med, Scopus, Ovid, Science Direct and national databases as Magiran, Iranmedex and Science Information Database (SID) up to October 2015. Random-effects model were applied to calculate the pooled prevalence of HSV subtypes.ResultsFive eligible studies were identified, including 1140 participants. The pooled prevalence of HSV infection in pregnant women was 0.64% (95% CI: 0.10- 1.18) in Iran. The pooled prevalence of studies on both HSV-1 and HSV-2 was 0.91% (CI: 0.81-1.02) and studies on only HSV-2 was 0.23% (CI: -0.61-0.63), respectively.ConclusionThe prevalence of HSV infection in pregnant women in Iran was higher. HSV infection of the central nervous system, especially with HSV-2, can also cause recurrent aseptic meningitis and monophasic, as well as radiuculitis or myelitis. The performance of screening to detect infection in pregnant women can play an important role in the prevention and treatment of patients and help to prevent the transmission of HSV infection to infants in Iran.References 1.Xu F, Sternberg MR, Kottiri BJ, McQuillan GM, Lee FK, Nahmias AJ, et al. Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States. JAMA Neurol 2006; 296:964-73.2.Bochner AF, Madhivanan P, Niranjankumar B, Ravi K, Arun A, Krupp K, et al. The Epidemiology of Herpes Simplex Virus Type-2 Infection among Pregnant Women in Rural Mysore Taluk, India. J Sex Transm Dis 2013; 2013:1-6.3.Kulhanjian JA, Soroush V, Au DS, Bronzan RN, Yasukawa LL, Weylman LE, et al. Identification of women at unsuspected risk of primary infection with herpes simplex virus type 2 during pregnancy. N Engl J Med 1992; 326 :916–20.4.Whitley RJ, Corey L, Arvin A, Lakeman FD, Sumaya CV, Wright PF, et al. Changing presentation of herpes simplex virus infection in neonates. J Infect Dis 1988; 158:109–16.5.Cusini M, Ghislanzoni M. The importance of diagnosing genital herpes. J Antimicrob Chemother 2001; 47:9-16.6.Cherpes TL, Meyn LA, Krohn MA, Lurie JG, Hillier SL. Association between acquisition of herpes simplex virus type 2 in women and bacterial vaginosis. Clin Infect Dis 2003; 37:319-25.7.Gottlieb SL, Douglas JM, Schmid DS, Bolan G, Iatesta M, Malotte CK, et al. Seroprevalence and correlates of herpes simplex virus type 2 infection in five sexually transmitted–disease clinics. J Infect Dis 2002; 186:1381-9.8.Arvaja M, Lehtinen M, Koskela P, Lappalainen M, Paavonen J, Vesikari T. Serological evaluation of herpes simplex virus type 1 and type 2 infections in pregnancy. J Sex Transm Infect 1999;75:168-71.9.Brown ZA, Selke S, Zeh J, Kopelman J, Maslow A, Ashley RL, et al. The acquisition of herpes simplex virus during pregnancy. N Engl J Med 1997; 337:509-16.10.Anzivino E, Fioriti D, Mischitelli M, Bellizzi A, Barucca V, Chiarini F, et al. Herpes simplex virus infection in pregnancy and in neonate: status of art of epidemiology, diagnosis, therapy and prevention. Virol J 2009; 6: 68-74.11.Weiss H. Epidemiology of herpes simplex virus type 2 infection in the developing world. Herpes 2004;11:24-35.12.Swetha G, Pinninti, David W, Kimberlin. Preventing HSV in the Newborn. Clin Perinatol 2014; 41:945–55.13.Sheffield JS, Hill JB, Hollier LM, Laibl VR, Roberts SW, Sanchez PJ. Valacyclovir prophylaxis to prevent recurrent herpes at delivery: a randomized clinical trial. Obstet Gynecol 2006; 108:141-7.14.Watts DH, Brown ZA, Money D, Selke S, Huang ML, Sacks SL. A double-blind, randomized, placebo-controlled trial of acyclovir in late pregnancy for the reduction of herpes simplex virus shedding and cesarean delivery. Am J Obstet Gynecol 2003; 188:836-43.15.Bulletin AP. Clinical management guidelines for obstetrician-gynecologists. Obstet Gynecol 2003; 45:102- 13.16.Curtis N, Finn A, Pollard A. Neonatal herpes simplex virus infections: where are we now? Hot Topics in Infection and Immunity in Children VII. 2nd ed. New York: Springer; 2011. P.146.17.Allen UD, Robinson JL. Prevention and management of neonatal herpes simplex virus infections. Pediatr Child Health 2014;19:19-31.18.Bernstein DI, Bellamy AR, Hook EW, Levin MJ, Wald A, Ewell MG, et al. Epidemiology, Clinical Presentation, and Antibody Response to Primary Infection With Herpes Simplex Virus Type 1 and Type 2 in Young Women. Clin Infect Dis 2013; 56:344-51.19.Whitley R, Arvin A, Prober C, Corey L, Burchett S, Plotkin S, et al. Predictors of morbidity and mortality in neonates with herpes simplex virus infections. N Engl J Med 1991; 324:450-4.20.Von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 2007;147:573–7.21.Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions. 5thed. London, UK: The Cochrane Collaboration; 2011.P.420.22.Danesh Shahraki A, Moghim S, Akbari P. Evaluation of the Serum Level of Herpes Simplex Type 2 Antibody among Pregnant Women in Shahid Beheshti Hospital, Isfahan. J Red Med Sci 2010;15:243.23.Bagheri Josheghani S, Moniri R, Baghbani Taheri F, Sadat S, Heidarzadeh Z. The Prevalence of Serum antibodies in TORCH Infections during the First Trimester of Pregnancy in Kashan, Iran. Iran J Neonatol 2015; 6:8-12.24.Ghasemi FS, Rasti S, Piroozmand A, Fakhrie-Kashan Z, Mousavi GA. Relationship between the prevalence of antibodies against cytomegalo, rubella, and herpes simplex viruses in women with spontaneous abortion compared to normal delivery. J Feyz 2015;19:86-92.25.Pourmand D, Janbakhsh A, Hamzehi K, Dinarvand F, Ahmadi D. Seroepide Miological Study of Herpes Simplex Virus in Pregnant Women Referring to Health and Care Center in Kermanshah. J Kermanshah Univ Med Sci 2008;11:462-9.26.Golalipour MJ, Khodabakhshi B, Ghaemi E. Possible role of TORCH agents in congenital malformations in Gorgan, northern Islamic Republic of Iran. East Mediterr Health J 2009;15:330-6.27.Chen KT, Segu M, Lumey LH, Kuhn L, Carter RJ, Bulterys M, et al. Genital herpes simplex virus infection and perinatal transmission of human immunodeficiency virus. Obstet Gynecol 2005; 106:1341-8.28.Ali S, Khan FA, Mian AA, Afzal MS. Seroprevalence of cytomegalovirus, herpes simplex virus and rubella virus among pregnant women in KPK province of Pakistan. J Infect Dev Ctries 2014;18:389-90.29.Hezarjaribi HZ, Fakhar M, Shokri A, Teshnizi SH, Sadough A, Taghavi M. Trichomonas vaginalis infection among Iranian general population of women: a systematic review and meta-analysis. Parasitol Res 2015;114:1291- 300.30.Sauerbrei A, Wutzler P. Herpes simplex and varicella-zoster virus infections during pregnancy: current concepts of prevention, diagnosis and therapy. Part 1: herpes simplex virus infections. Med Microbiol Immunol 2007; 196:89–9431.Büchner S, Erni P, Garweg J, Gerber S, Kempf W, Lauper U, et al. Swiss recommendations for the management of genital herpes and herpes simplex virus infection of the neonate. Swiss Medi Wkly 2004; 134:205–21432.Meerbach A, Sauerbrei A, Meerbach W, Bittrich HJ, Wutzler P. Fatal outcome of herpes simplex virus type 1-induced necrotic hepatitis in a neonate. Med Microbiol Immunol 2006; 195:101–10533.Tyler KL. Herpes simplex virus infections of the central nervous system: encephalitis and meningitis, including Mollaret’s. Herpes 2004. ; 11:57A-64A34.Corey L, Whitley RJ, Stone EF, Mohan K. Difference between herpes simplex virus type 1 and type 2 neonatal encephalitis in neurological outcome. Lancet 1988; 1:1-435.Berger JR, Houff S. Neurological complications of herpes simplex virus type 2 infection. Arch Neurol 2008.; 65:596-60036.Gallo MF, Warner L, Macaluso M, Stone KM, Brill I, Fleenor ME. Risk factors for incident herpes simplex type 2 virus infection among women attending a sexually transmitted disease clinic. J Sex Transm Dis 2008; 35:679–85.37.Riley LE. Herpes simplex virus. Semin Perinatal 1998; 22:284-92.38.Lankarani KB, Alavian SM, Peymani P. Health in the Islamic Republic of Iran, challenges and progresses. Med J Islamic Repub Iran 2013; 27:42.39.Hoaglin DC. Assessment of heterogeneity in meta-analyses. JAMA Neurol 2014; 312:2286-7

Assessing Iran’s health system according to the COVID-19 strategic preparedness and response plan of the World Health Organization: health policy and historical implications

Background: The role of health systems in the management of disasters including natural hazards like outbreaks and pandemics, is crucial and vital. Healthcare systems which are unprepared to properly deal with crises are much more likely to expose their public health workers and health personnel to harm and will not be able to deliver healthcare provisions in critical situations. This can lead to a drammatic toll of deaths, even in developed countries. The possible occurrence of global crises has prompted the WHO to devise instruments, guidelines and tools to assess the capacity of countries to deal with disasters. Iran’s health system has been hit hardly by the COVID-19 pandemic. In this study, we aimed to assess its preparedness and response to the outbreak. Methods: The present investigation was designed as a qualitative study. We utilized the “COVID-19 Strategic Preparedness and Response Plan” devised by WHO as a conceptual framework. Results: The dimension/pillars which scored the highest was national laboratories, followed by surveillance, rapid response teams and case investigations. Risk communication and community engagement was another pillar receiving a high score, followed by infection prevention and control and by country-level coordination, planning and monitoring. The pillar/dimensions receiving the lowest scores were operational support and logistics; case management; and points of entry. Discussion: The COVID-19 pandemic has represented an unprecedent event that has challenged healthcare systems and facilities worldwide, highlighting their weaknesses and the need for inter-sectoral cooperation and collaboration during the crisis. Analyzing these experiences and capitalizing on them, by strengthening them,will help countries to be more prepared to face opossible future crises

Iran's Health System Transformation Plan: A SWOT analysis

Background: Societies are characterized by evolving health needs, which become more challenging throughout time, to which health system should respond. As such, a constant monitoring and a periodic review and reformation of healthcare systems are of fundamental importance to increase the efficiency and effectiveness of healthcare services delivery, equity, and sustainable funding. The establishment of President Rouhani's government in Iran, on May 5, 2014, the settlement of the new Ministry of Health and Medical Education administration (MoHME) and the need for change in the provision of healthcare services has led to the "Health System Transformation Plan" (HSTP). The aim of the current investigation was to critically evaluate the health transformation plan in Iran. Methods: Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis enables to identify and assess the strengths and weaknesses within an organization or program, as well as the threats and opportunities outside the given organization or program. To identify SWOT of the HSTP in Iran, all articles concerning this program published in scholarly databases as well as in the gray literature were systematically searched. Subsequently, all factors identified at the first round were thematically classified into four categories and for reaching consensus on this classification, the list of points and factors was sent to 40 experts - policy- and decisionmakers, professors and academicians, health department workers, health activists, journalists. Results: Thirty-four subjects expressed comments on classification. Incorporating their suggestions, the SWOT analysis of Iran's HSTP was revised, finalized and then performed. Conclusion: HSTP in Iran, like many of the initiatives that have been recently introduced and not fully implemented, have various challenges, difficulties and pitfalls that health policymakers need to pay attention to. Interacting with criticisms, taking into account public opinion and strengthening the plan can make the project more effective, and it can be anticipated that in the future, better conditions in the health sector will be achieved

Strategic planning, components and evolution in zoonotic diseases frameworks: one health approach and public health ethics

Zoonotic diseases are seen as a major public health concern. Routes of the rapid transmission of zoonotic diseases and the economic damage they cause to communities are all reasons why health institutions and systems need to pay more attention to these diseases. Strategic planning is one of the important tasks of policymakers in every organization and system. It is a very reliable and useful tool for leading all kinds of organizations, including health organizations. Countries with clear policy plans have succeeded in controlling and reducing zoonotic diseases. Such countries used appropriate strategic planning and pursued annual goals to control and prevent diseases. Three important steps (strategy development, strategy implementation and strategy evaluation) should be considered in developing a strategic planning for controlling and prevention of zoonotic diseases. Health systems need to develop strategic planning in order to upgrade their capabilities in combating zoonotic diseases. These programs must be flexible, in line with the one health approach, based on the current needs, and aligned with the new challenges faced with health systems. The strategic planning is directly related to national and international policies, organizational goals and missions, dynamism, degree of complexity, and organizational structure of each country's health system

General health status in Iranian diabetic patients assessed by short-form-36 questionnaire : A systematic review and meta-analysis

Peer reviewedPublisher PD

Analysis and evolution of health policies in Iran through policy triangle framework during the last thirty years: a systematic review of the historical period from 1994 to 2021

Background: Health policy analysis as a multi-disciplinary approach to public policy illustrates the need for interventions that highlight and address important policy issues, improve the policy formulation and implementation process and lead to better health outcomes. Various theories and frameworks have been contributed as the foundation for the analysis of policy in various studies. This study aimed to analyze health policies during the historical period of the almost last 30 years in Iran using policy triangle framework. Method: To conduct the systematic review international databases (PubMed / Medline, Scopus, Web of Sciences, CINAHL, PsycINFO, Embase, The Cochran Library) and Iranian databases from January 1994 to January 2021 using relevant keywords. A thematic qualitative analysis approach was used for the synthesis and analysis of data. Results: Out of 731 articles, 25 articles were selected and analyzed. Studies used health policy triangle framework to analyze policies in the Iranian health sector has been published since 2014. All the included studies were retrospective. The main focus of most of studies for the analysis was on the context and process of polices as the elements of the policy triangle. Conclusion: The main focus of health policy analysis studies in Iran over the last thirty years was on the context and process of polices. Although range of actors within and outside the Iran government influence health policies but in many policy processes the power and the role of all actors or players involved in the policy are not recognized carefully. Also, Iran's health sector suffers from lack of a proper framework for evaluating various implemented policies

A policy analysis of agenda-setting of Brucellosis in Iran using multiple streams framework: health policy and historical implications

Background: Brucellosis, a major zoonotic disease, is highly present in Iran, especially in Lorestan province. The aim of this study was to understand the issues related to Brucellosis utilizing the multiple streams framework. Methods: A two-step method was adopted: i) assessment of brucellosis-related documents and ii) interviews with stakeholders. Results: The problem stream was characterized by: 1) high prevalence of the disease, 2) traditional livestock production, 3) unsafe animal slaughtering, 4) centers for the sale and distribution of non-authorized dairy products, 5) raw milk and 6) traditional unsafe dairy products consumption, 7) incomplete livestock vaccination, 8) lack of knowledge of Brucellosis, 9) neighboring countries with high prevalence of Brucellosis, 10) lack of livestock quarantine, and 10) nomadic immigration. The policy stream was characterized by 1) primary healthcare networks, 2) guidelines, 3) medicines, insurance, and 4) diagnostic services. Finally, the political stream was characterized by: 1) support of the University of Medical Sciences, 2) sponsorship by the Ministry of Health and Medical Education, 3) Health transformation plan, and 4) Working Group on Health and Food Security in Lorestan. Conclusion: This study examined the brucellosis-related agenda setting: if different issues are taken into consideration, it can be perceived as a health priority

History of primary health care in Iran

Background: The history of the primary healthcare system in Iran portrays a journey of strategic development and implementation that has resulted in significant advancements in healthcare access and overall population well-being. Starting in the early 1980s, Iran embarked on a comprehensive approach to health care delivery prioritizing universal access, equity, and community participation. Introduction: The foundation of this system was established during the Alma-Ata Conference in 1978, which placed a strong emphasis on the role of primary health care in attaining health for all. Iran's unwavering commitment to this approach led to the creation of an extensive network of rural and urban health centers designed to offer essential health services and preventive care to all citizens. Discussion: Over the years, the expansion of Iran's primary healthcare system has yielded noteworthy accomplishments. Maternal and child mortality rates have seen substantial declines, attributed to improved access to maternal care and immunization services. The effectiveness of the system in reaching diverse populations has been enhanced through community engagement and the integration of traditional medicine. Furthermore, Iran's focus on health education and disease prevention has resulted in heightened public awareness and the adoption of healthier lifestyles. Despite these achievements, challenges continue to persist. Disparities in the quality and accessibility of services between urban and rural areas remain a concern. Moreover, the ongoing necessity for infrastructure development, training of the health workforce, and efficient resource allocation underscore the continuous efforts required to strengthen the primary healthcare system. Conclusion: The history of Iran's primary health care system is marked by progress and achievements, underscored by an unwavering commitment to providing comprehensive, community-based care. Iran's journey serves as an exemplary model, highlighting the positive impact of prioritizing primary health care in achieving better health outcomes for its population. As Iran continues to evolve its health system, addressing challenges and building upon successes, the history of its primary health care system serves as a valuable lesson in the pursuit of accessible and equitable health care for all

Universal Health Coverage to counteract the economic impact of the COVID-19 infection

In December 2019, the first case of Coronavirus was identified. The novel virus appears to be highly contagious and is rapidly spreading worldwide, becoming a pandemic. The disease is causing a high toll of deaths. Effective public health response to a new infectious disease is expected to mitigate and counteract its negative impact on the population. However, time and economic-financial constraints, as well as uncertainty, can jeopardize the answer. Appropriate financing of the health system and ensuring equitable access to health services for all can protect individuals against high medical costs, which is one of the most important goals of any health system. Financing profoundly affects the performance of the health system, and any policy that the health system decides to implement or not directly depends on the amount of available funding. Various countries are injecting new funding to cope with the disease and prevent it faster. In addition to psychological support and increased social participation for the prevention, control, and treatment of COVID-19, extensive financial support to governments by the community should be considered. Developed and rich countries should support countries that do not have financial viability. This disease cannot be controlled without international cooperation. The experience of the COVID-19 should be a lesson for further developing universal health coverage in all countries. In addition to promoting equity in health, appropriate infrastructure is provided to address these crises. Governments should make a stronger political commitment to implement this crucial policy fully

Effective Medicinal Plant in Cancer Treatment, Part 2.

Cancer is the second cause of death after cardiovascular diseases. With due attention to rapid progress in the phytochemical study of plants, they are becoming popular because of their anticancer effects. The aim of this study was to investigate the effective medicinal plants in the treatment of cancer and study their mechanism of action. In order to gather information the keywords "traditional medicine," "plant compounds," "medicinal plant," "medicinal herb," "toxicity," "anticancer effect," "cell line," and "treatment" were searched in international databases such as ScienceDirect, PubMed, and Scopus and national databases such as Magiran, Sid, and Iranmedex, and a total of 228 articles were collected. In this phase, 49 nonrelevant articles were excluded. Enhancement P53 protein expression, reducing the expression of proteins P27, P21, NFκB expression and induction of apoptosis, inhibition of the PI3K/Akt pathway, and reduction of the level of acid phosphatase and lipid peroxidation are the most effective mechanisms of herbal plants that can inhibit cell cycle and proliferation. Common treatments such as radiotherapy and chemotherapy can cause some complications. According to results of this study, herbal extracts have antioxidant compounds that can induce apoptosis and inhibit cell proliferation by the investigated mechanisms