title: Seroprevalence and Risk Factors of Varicella Zoster Infection in Iranian Adolescents: A Multilevel Analysis; The CASPIAN-III Study.
abstract: The objective of this study was to evaluate the varicella zoster virus (VZV) immunity in Iranian adolescents. It was conducted as a primary study for vaccine implementation, and to investigate the association of climatic and socioeconomic factors with the epidemiology of this infection. In this cross- sectional study, anti VZV antibodies were measured in serum samples obtained in a national school-based health survey (CASPIAN- III). Association of demographic, socio-economic, and climate of the living region with the frequency of VZV was investigated by multivariate multilevel analysis. Overall, sera of 2753 individuals aged 10-18 were tested for VZV antibodies, from those 87.4% were positive. The prevalence was statistically different in four socio-geographic regions (P<0.001), varying between 85.24% in West region (mostly mountainous areas with cold climate) to 94.59% in Southeast region (subtropical climate). Among variables studied, only age and mean daily temperature of the living area were positively associated with the VZV seroprevalence. Our findings show that most Iranians develop immunity to VZV before the age of 10, but a substantial proportion of them are yet susceptible to the infection. Therefore, it seems that the best strategy to reduce the burden of the disease is to vaccinate high- risk adults, i.e. those without a history of varicella infection. The regional temperature might be the only determinant of VZV epidemiology in Iran.
authors.affiliation: Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Shervin Ghaffari
authors.initials: SG
authors.lastname: Hoseini
authors.affiliation: Pediatrics Department, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Roya
authors.initials: R
authors.lastname: Kelishadi
authors.affiliation: Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Amir
authors.initials: A
authors.lastname: Kasaeian
authors.affiliation: Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Behrooz
authors.initials: B
authors.lastname: Ataei
authors.affiliation: Acquired Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Majid
authors.initials: M
authors.lastname: Yaran
authors.affiliation: Pediatrics Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
authors.forename: Mohammad Esmaeil
authors.initials: ME
authors.lastname: Motlagh
authors.affiliation: Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ramin
authors.initials: R
authors.lastname: Heshmat
authors.affiliation: Pediatrics Department, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Gelayol
authors.initials: G
authors.lastname: Ardalan
authors.affiliation: Pediatrics Department, Alborz University of Medical Sciences, Karaj, Iran.
authors.forename: Omid
authors.initials: O
authors.lastname: Safari
authors.affiliation: Dietary Supplements and Probiotics Research Center, Alborz University of Medical Sciences, Karaj, Iran.|Endocrinology & Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Qorbani
authors.affiliation: Pediatrics Department, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Seyed Naseredin
authors.initials: SN
authors.lastname: Mostafavi
mesh_terms: D000293:Adolescent; D000914:Antibodies, Viral / Q000097:blood; D002644:Chickenpox / Q000453:epidemiology* / Q000517:prevention & control; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D005843:Geography; D014645:Herpesvirus 3, Human; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D055361:Multilevel Analysis; D012307:Risk Factors; D016036:Seroepidemiologic Studies
chemical_list: D000914:Antibodies, Viral