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Report of International training course on

Tularemia 15-17 December 2015

Akanlu, Kabudar Ahang, Hamadan, Iran

International training course on Tularemia was held in collaboration with scholars from

Sweden, France, Turkey, and Iran in the national reference laboratory for tularemia,

plague and Q fever, Research Centre for Emerging and Reemerging infectious diseases.

Infectious disease specialists, microbiologists, epidemiologists, rodentologist, and

medical entomologist from 9 countries (Sudan, Bulgaria, Pakistan, China, Turkey,

Malaysia, Sweden, France and Iran) and participants from 7 universities and local

institutions attended the course. Various aspects of the disease including biology and

epidemiology of the causing agent F. tularensis, vector-borne transmission, reservoirs,

symptoms, treatment, and diagnosis methods as well as international joints projects in

this field were discussed.

Introduction

Tularemia is a zoonotic disease transmitted by direct contact with infected animals, or

through arthropod bites, inhalation of contaminated aerosols, ingestion of contaminated

meat or water, or skin contact with any infected material. This disease has a wide

distribution covering much of the northern hemisphere including Iran and its northern,

northeastern, and northwestern neighboring countries. Despite outbreaks in various

countries in recent years, the disease remains underreported as physicians, infectious

disease specialists, microbiologist, and health care workers’ knowledge on natural cycle

of the agent and clinical manifestations of the disease is not enough and updated to help

them recognize the disease.

The participants of the course improved their knowledge and practice on surveillance,

diagnosis, and clinical management of tularemia and enhanced their abilities to

investigate future outbreaks in their countries.

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Team of Instructors

- Dr Anders Johansson, Clinical Bacteriologist,

Assistant Professor, Umeå University, Department

of Clinical Microbiology, Umeå, Sweden and

Department Head, Infection Control Västerbotten

County, Sweden.

- Dr Max Maurin, Clinical Bacteriologist,

Professor, Grenoble Alpes University, Grenoble,

France.

- Dr Aynur Karadenizli, Infectious Disease

specialist and Clinical Microbiologist, Professor,

Kocaeli University, Department of Medical

Microbiology, Kocaeli, Turkey.

- Dr Ehsan Mostafavi, Epidemiologist, Associate

Professor, Director of Research centre of

Emerging and Reemerging Infectious Diseases,

Pasteur Institute of Iran, Tehran, Iran.

- Dr Abdolrazagh Hashemi Shahraki,

Microbiologist, Assistant Professor, Department of

Epidemiology, Pasteur Institute of Iran, Tehran,

Iran

- Dr Saied Reza Naddaf, Entomologist, Associate

Professor, Department of Parasitology, Pasteur

Institute of Iran, Tehran, Iran.

- Dr Roohollah Siahsarvie, Rodentologist,

Rodentology Research group, Ferdowsi University

of Mashhad, Mashhad, Iran.

Organizers

Research Centre for Emerging and Reemerging infectious diseases, Pasteur

Institute of Iran, Tehran, Iran

Centre for Communicable Diseases Control and Prevention, Ministry of Health

and Medical Education, Tehran, Iran

Partners

Umeå University, Department of Clinical Microbiology, Umeå, Sweden

Grenoble Alpes University, Grenoble University Hospital, Department of Clinical

Microbiology, Grenoble, France

Kocaeli University, Department of Medical Microbiology, Kocaeli, Turkey.

Ferdowsi University of Mashhad, Rodentology Research group, Mashhad, Iran.

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Sponsors

Centre for Communicable Diseases Control and Prevention, Ministry of Health

and Medical Education, Tehran, Iran

Research Centre for Emerging and Reemerging infectious diseases, Pasteur

Institute of Iran, Tehran, Iran

World Health Organization

Embassy of France in Iran

Venue

The course was held in the Research

Centre for Emerging and

Reemerging infectious diseases,

which is the national reference

center for diagnosis and research on

Plague, Tularemia and Q fever in

Iran.

It is a branch of Pasteur Institute of

Iran located in Western Iran located

in Akanlu village in Kabudrahang

district.

Duration

The course took place in 3 working days (15-17 December 2015).

Participants and Sessions

There were 25 participants from China (1),

Sudan (1), Bulgaria (1), Pakistan (1), Turkey

(1), Malaysia (1), Sweden (1), France (1) and

Iran (17).

The tutors presented the topics in 13 lectures

and 6 practical sessions.

Course Manual, PPTs and pictures

The course materials included key educational papers and related guidelines were

provided during the course and files were shared with the participants in a flash-drive.

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Social Events

Visiting the Rural Homes of the Region

The Participants of the course visited one of the

houses in the Akanlu village and closely met the

lifestyle of the villagers and their agricultural

products.

Visiting the Snowy Mountains

Snowing made a perfect opportunity to make

real treasured memories outdoors.

The participants had this opportunity to walk and

play around the snowy mountains near the

course venue.

It was more interesting for those who had never

seen snow!

Alisadr Cave

At the end of the course the participants visited

the Alisadr Cave.

This cave is the world's largest water cave which

attracts millions of visitors every year. The cave

is located 75 kilometers northwest of Hamadan

and 70 km from Akanlu village.

Traditional Restaurant

Participants of the course took last day lunch in a

traditional restaurant eating Ābgoosht.

Ābgoosht (literally "meat juice") is a Persian and

Mesopotamian stew. It is also called Dizi, which

refers to the traditional stone crocks it is served

in. Ābgoosht is usually made with lamb,

chickpeas, white beans, onion, potatoes,

and tomatoes, turmeric, and dried lime.

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List of the Participants

Name Country Education Institute

Aynur Karadenzli Turkey Medical Microbiology Kocaeli University

Anders Johansson Sweden Physician Umea University

Mohamed Elamin Abdelmagid Sudan MD Community Medicine FMOH

Mohammad Ishaq Pakistan MD, MSPH Ministry of Health

Rukumani Devi Velayuthan Malaysia MBBS, MPATH University Malaya

Max Maurin France Medical Microbiology Université Grenoble

Yanhua Wang China Medical Microbiology China CDC

Hristo Najdenski Bulgaria Veterinarian Institute of Microbiology

Ehsan Mostafavi Iran Epidemiology Pasteur institute of Iran

Abdolrazagh Hashemi Shahraki

Iran Medical Microbiology Pasteur institute of Iran

Saber Esmaeili Iran Medical Microbiology Pasteur institute of Iran

Badri Mohseni Iran Veterinarian Iranian Veterinary Organization

Saied Reza Naddaf Iran Medical Entomology Pasteur institute of Iran

Ahmad Ghasemi Iran Medical Microbiology Pasteur institute of Iran

Shabnam Tehrani Iran MD- Infectious Disease Shahid Beheshti University of Medical Sciences

Arash Seifi Iran MD- Infectious Disease Tehran University of Medical Sciences

Mohammad Javad Nasiri Iran Medical Microbiology Shahid Beheshti University of Medical Sciences

Hossein Kazemian Iran Medical Microbiology Tehran University of Medical Sciences

Jalil Kardan Yamchi Iran Medical Microbiology Tehran University of Medical Sciences

Hossein Akbari Iran Epidemiology Iranian CDC

Hossein Ansari Iran Epidemiology Zahedan University of Medical Sciences

Zakaria Bameri Iran Medical Microbiology Pasteur institute of Iran

Mohammad Ali Malekan Iran Medical Microbiology Pasteur institute of Iran

Roohollah Siahsarvie Iran Rodentologist Ferdowsi University of Mashhad

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Group photos

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Schedule of the course

Presenter Program Hour Time

- Opening and welcome 8:00-8:15 M

orn

ing

Th

e fi

rst

da

y

(15

th D

ecem

ber

)

Film An Introduction to Pasteur institute of Iran 8:15-8:45

Dr Ehsan Mostafavi An Introduction to Research Centre of Emerging and

Reemerging infectious diseases

8:45-9:30

Dr Anders Johansson The distribution of Tularemia in the world 9:30 – 9:50

Dr Ehsan Mostafavi The situation of Tularemia in Iran 9:50-10:10

Dr Aynur Karadenizli The situation of Tularemia in Turkey 10:10-10:30

Refreshments 10:30 - 11:11

Dr Abdolrazagh Hashemi Bacteriology 11:00 – 12:00

Dr SaeedReza Naddaf Vectors and of Tularemia in the nature 12:00-13:00

Aft

ern

oo

n

Lunch 13:00 – 14:00

Dr Roohollah Siahsarvie Reservoirs of Tularemia in the nature 14:00 – 15:00

Dr Mostafavi,

Dr Naddaf

Practical section (Epidemiologists and Bacteriologists

Group1)

Field investigation (Hunting, Blood sampling and tissue

sampling from the rodents, wild animals, water, vectors)

15:00-18:00

Dr Hashemi,

Dr Maurin

Practical section (Bacteriologists Group 2)

Laboratory procedures (processing the samples, culturing,

DNA extraction, Real time PCR)

Dr Karadenizli, Dr Johansson, Scenario (Physicians)

Visiting the rural homes of the region 19:00-20:00

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Dr Max Maurin Source of infection, infectious routes, and clinical outcome

according to F. tularensis subspecies

8:00 – 9:00

Mo

rnin

g

Th

e se

con

d d

ay

(16

th D

ecem

ber

) Dr Anders Johansson Clinical expression in humans (Signs and symptoms,

Differential diagnoses, Case definitions) 9:00-10:00

Reception and Refreshments 10:00 – 10:30

Dr Max Maurin Laboratory diagnostics 10:30 – 12:15

Dr Max Maurin Biosafety considerations 12:15 – 13:00

Lunch 13:00 – 14:00

Dr Hashemi,

Dr Maurin,

Bacteriologists Group1: Laboratory procedures (processing

the samples, culturing, DNA extraction, Real time PCR)

15:00-18:00

Aft

ern

oo

n

Dr Mostafavi,

Dr Naddaf

Practical section (Bacteriologists Group2)

Field investigation (Hunting, Blood sampling and tissue

sampling from the rodents, wild animals, water, vectors) Dr Johansson, Dr Karadenizli Scenario (Physicians and Epidemiologists)

Dr Anders Johansson Treatment, prophylaxis and vaccination against Tularemia 8:30 – 9:30

Mo

rnin

g

Th

e T

hir

d d

ay

(17

th D

ecem

ber

)

Dr Aynur Karadenizli Investigation of the waterborne tularemia outbreaks 9:30 – 10:30

Refreshment 10:15 – 10:30

Conclusion and closing 10:30 – 12:00

Lunch in a traditional restaurant 13:00 – 14:00

Aft

ern

oo

n

Visiting Alisadr Cave 14:00-17:00

Coming back to Tehran 17:00-22:00