The epidemiology of cholera in the Islamic Republic of Iran, 1965�2014 �pidémiologie du choléra en République Islamique d�Iran (1965-2014)

Abstract

Background: Cholera is endemic in the Islamic Republic of Iran. According to surveillance system records and historical documents, cholera epidemics have led to thousands of deaths throughout the country in past centuries. Aims: The aim of this study was an overview of cholera disease during the last 5 decades (1965�2014) and the epidemiological features of the most recent large-scale outbreaks. Methods: In this descriptive study, cholera incidence data provided by the National Surveillance Database were extracted and significant fluctuating trends for 1965�2014 were tested using the Cochran�Armitage test. To identify the factors most associated with cholera incidence in the outbreaks, adjusted odds ratios were computed by ordinal logistic regression. Results: Analysis of data has shown a tremendous decrease in incidence trends, from 19.7/100 000 to 0.01/100 000 over the 9 cholera epidemics that occurred at 5�6 year intervals during 1965�2014. Younger age groups (15�44 years) and inhabitants in urban areas have been more vulnerable to cholera in recent epidemics. The virulence of the pathogen and the case fatality rates have not changed during the last 3 epidemics. Conclusion: The burden of cholera in terms of case load has dramatically reduced during 1965�2014. Furthermore, the epidemiological feature of cholera with regard to transmission route, domicile, age, immigration, mortality and antimicrobial resistance has changed considerably in recent epidemics. While the number of epidemic regions has diminished, some areas are still susceptible to cholera outbreaks. © World Health Organization (WHO) 2020