Context: Hepatitis B Virus EXPANDED PROGRAM on immunization (EPI) started on 1993 in Iran. Most surveys have assessed the level of response to vaccine by measuring the titers of anti-HBs. This meta- analysis aimed to summarize the Iranian published data on the rate of vaccine-responders versus non-responders. Moreover, the impact of variables such as age, gender, type of vaccine, etc. on the levels of responsiveness was evaluated.Evidence Acquisition: All published papers on this topic in Iranian and international journals with affiliation of “Iran” were reviewed using standard keywords up to 2014. We included our study to healthy participants with no previous HBV infection and who had already received a complete course of HB vaccine. The estimated prevalence and 95% confidence intervals in 28 eligible articles for HBV vaccine responders (anti-HBs>10 IU/mL) and non-responders (10<) were analyzed by random effect method due to between-study heterogeneity.Results: The age of subjects was between 6 months and 15 years old. Overall, 5991 (51.5%) were male and 4571 (48.5%) females. Overall, 80% were responders to vaccine versus 20% nonresponders. With increase in age, the number of responders to vaccine decreased significantly (P = 0.001). There was no strong difference between responders versus nonresponders to vaccine for gender, types of vaccine, ethnicity and living area.Conclusions: The results arose from this meta-analysis highlighted the safety of vaccine and its effectiveness in stimulating immune response of vaccines, despite being different in generation, manufacturers and types. Moreover, there was no substantial difference between Iranian and other international investigations in the rate of nonresponsiveness to HBV vaccine.

Background: Most studies evaluated the vaccine coverage, but the time of VACCINATION is im-portant as coverage. This study was conducted to evaluate the EXPANDED PROGRAM of Immuniza-tion (EPI) in outskirt of Iranian cities regarding to incidence of delayed VACCINATION among chil-dren less than 4 years.Methods: This cross sectional descriptive study was conducted among children 24-47 months old, living in the suburbs of five metropolises of Iran. Totally, 3610 eligible children selected with proportioned cluster sampling method and data of VACCINATION card extracted after the interview with children's parents. Delayed incidence rate reported and predictive factors assessed by the Chi square test and Multivariate logistic regression.Results: Overall, 56.6% to 93.2% vaccines were administered out of time. Delayed VACCINATION incidence with more than one-week delay varies from 5.5% to 74.9% of polio at birth and MMR2 at 18 months, respectively. Mother’s educational level and birth order were the most important predictors of delayed VACCINATION. Incidence of delayed VACCINATION was enlarged by increasing birth order and decreased in lower educated mothers.Conclusions: Incidence rate of delayed VACCINATION is more than expectation. Regarding to high coverage vaccines in Iran, health officers and health policy makers should attempt for on-time VACCINATION beside of high immunization coverage, especially in slum areas with more con-centrated immigrants due to low literature and crowded families.

This brief commentary seeks to develop the analysis of Daniels, Porteny and Urrutia of the implications of expansion of the scope of health technology assessment (HTA) beyond issues of safety, efficacy, and cost-effectiveness. Drawing in particular on experience in the United Kingdom, it suggests that such expansion can be understood not only as a response to the problem of insufficiency of evidence, but also to that of legitimacy. However, as expansion of HTA also renders it more visibly political in character, it is plausible that its legitimacy may be undermined, rather than enhanced by, independence from the policy process.

Newcastle disease (ND) is among the most common and deadliest poultry diseases worldwide. Thermostable Newcastle disease virus (NDV) vaccines have been widely used to protect village chickens against ND due to their decreased dependence on cold chains for transport and storage. The NDV4 Heat-Resistant (NDV4HR) vaccine is an apathogenic, heat-resistant, live vaccine that can induce immunity in chickens. In this study, 60 one-day-old Arain local hybrid broilers were divided into three groups of 20. Group A had the usual VACCINATION PROGRAM in broiler flocks (seven days old: B1 type by eye drop and ND killed vaccine intramuscularly,18 and 28 days old: LaSota strain orally). Group B did not receive any vaccine, and group C received the NDV4HR vaccine orally, six times from the first day to the 35th day of rearing. All groups were nasally challenged with acute Newcastle virus (genotype VIId) on the 35th rearing day. Regarding the hemagglutination inhibition serum antibody titer of the birds after the challenge, group B had the highest (7. 12±1. 05), and group C (6. 37±1. 31) had a higher titer than group A (6±1. 22). After the challenge with the Newcastle virus, the necropsy findings and clinical symptoms of the disease were almost similar in groups A and C. Group B showed the most signs, with higher casualties than other groups. Regarding weight gain, group C had the highest weight at the end of the study (2204±106). On the second day after the challenge, groups A and B had virus shedding through the trachea and cloaca, while group B shed the virus only through the trachea. Furthermore, on the seventh day after the challenge, group A shed the virus through the cloaca, whereas group B did it through the trachea and the cloaca. On the other hand, there was no virus shedding in group C. This study showed that the NDV4HR vaccine provokes an antibody response that protects the birds against a virulent virus challenge.