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/Title (Communicable Diseases Surveillance System in East Azerbaijan Earthquake: Strengths and Weaknesses � PLOS Currents Disasters)
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BT 15.000 718.042 Td /F2 21.0 Tf  [(Communicable Diseases Surveillance System in East )] TJ ET
BT 15.000 693.094 Td /F2 21.0 Tf  [(Azerbaijan Earthquake: Strengths and Weaknesses)] TJ ET
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BT 15.000 675.088 Td /F3 9.8 Tf  [(December 8, 2014)] TJ ET
BT 91.625 675.088 Td /F3 9.8 Tf  [(�)] TJ ET
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BT 96.500 675.088 Td /F3 9.8 Tf  [(Research Article)] TJ ET
BT 26.250 663.247 Td /F1 9.8 Tf  [(Javad Babaie)] TJ ET
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BT 85.325 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
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BT 90.746 663.247 Td /F1 9.8 Tf  [(Farin Fatemi)] TJ ET
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BT 145.463 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
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BT 150.884 663.247 Td /F1 9.8 Tf  [(Ali Ardalan)] TJ ET
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BT 198.026 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
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BT 203.447 663.247 Td /F1 9.8 Tf  [(Hamed Mohammadi)] TJ ET
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BT 291.216 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 296.637 663.247 Td /F1 9.8 Tf  [(Mahmood Soroush)] TJ ET
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BT 26.250 651.342 Td /F1 9.8 Tf  [(Babaie J, Fatemi F, Ardalan A, Mohammadi H, Soroush M. Communicable Diseases Surveillance System in East Azerbaijan )] TJ ET
BT 26.250 639.438 Td /F1 9.8 Tf  [(Earthquake: Strengths and Weaknesses. PLOS Currents Disasters. 2014 Dec 8 . Edition 1. doi: )] TJ ET
BT 26.250 627.533 Td /F1 9.8 Tf  [(10.1371/currents.dis.9085e38035f25b34f093f357ac2c3973.)] TJ ET
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BT 26.250 598.430 Td /F4 12.0 Tf  [(Abstract)] TJ ET
BT 26.250 578.476 Td /F1 9.8 Tf  [(Background: A Surveillance System was established for 19 diseases/syndromes in order to prevent and control communicable )] TJ ET
BT 26.250 566.571 Td /F1 9.8 Tf  [(diseases after 2012 East Azerbaijan earthquakes. This study was conducted to investigate the strengths and weaknesses of the )] TJ ET
BT 26.250 554.667 Td /F1 9.8 Tf  [(established SS.)] TJ ET
BT 26.250 535.262 Td /F1 9.8 Tf  [(Methods: This study was carried out on an interview-based qualitative study using content analysis in 2012. Data was collected )] TJ ET
BT 26.250 523.357 Td /F1 9.8 Tf  [(by semi-structured deep interviews and surveillance data. Fifteen interviews were conducted with experts and health system )] TJ ET
BT 26.250 511.452 Td /F1 9.8 Tf  [(managers who were engaged in implementing the communicable disease surveillance system in the affected areas. The )] TJ ET
BT 26.250 499.548 Td /F1 9.8 Tf  [(selection of participants was purposeful. Data saturation supported the sample size. The collected data was analyzed using the )] TJ ET
BT 26.250 487.643 Td /F1 9.8 Tf  [(principles suggested by Strauss and Corbin.)] TJ ET
BT 26.250 468.238 Td /F1 9.8 Tf  [(Results: Establishment of the disease surveillance system was rapid and inexpensive. It collected the required data fast. It also )] TJ ET
BT 26.250 456.333 Td /F1 9.8 Tf  [(increased confidence in health authorities that the diseases would be under control in earthquake-stricken regions. Non )] TJ ET
BT 26.250 444.429 Td /F1 9.8 Tf  [(estimated denominator for calculating the rates \(incidence & prevalence\), non-participation of the private sector and hospitals, )] TJ ET
BT 26.250 432.524 Td /F1 9.8 Tf  [(rapid turnover of health staff and unfamiliarity with the definitions of the diseases were the weak points of the established )] TJ ET
BT 26.250 420.619 Td /F1 9.8 Tf  [(disease SS.)] TJ ET
BT 26.250 401.214 Td /F1 9.8 Tf  [(Conclusion: During the time when surveillance system was active, no significant outbreak of communicable diseases was )] TJ ET
BT 26.250 389.310 Td /F1 9.8 Tf  [(reported. However, the surveillance system had some weaknesses. Thus, considering Iran�s susceptibility to various natural )] TJ ET
BT 26.250 377.405 Td /F1 9.8 Tf  [(hazards, repeated exercises should be conducted in the preparedness phase to decrease the weaknesses. In addition, other )] TJ ET
BT 26.250 365.500 Td /F1 9.8 Tf  [(types of surveillance system such as web-based or mobile-based systems should be piloted in disaster situations for future.)] TJ ET
BT 26.250 328.898 Td /F4 12.0 Tf  [(Funding Statement)] TJ ET
BT 26.250 308.943 Td /F1 9.8 Tf  [(The authors declare that they have no competing interests and received no financial support from any organizations and )] TJ ET
BT 26.250 297.039 Td /F1 9.8 Tf  [(individuals for this research.)] TJ ET
BT 26.250 267.936 Td /F4 12.0 Tf  [(Introduction)] TJ ET
BT 26.250 247.982 Td /F1 9.8 Tf  [(Two earthquakes with magnitudes of 6.3 and 6.4 in the Richter scale shook wide areas of East Azerbaijan in the northwest of )] TJ ET
BT 26.250 236.077 Td /F1 9.8 Tf  [(Iran, particularly Ahar, Heris, and Varzaghan counties on Aug 11, 2012 )] TJ ET
0.267 0.267 0.267 rg
BT 334.613 237.584 Td /F4 8.7 Tf  [(1)] TJ ET
0.271 0.267 0.267 rg
BT 339.432 236.077 Td /F1 9.8 Tf  [( . The earthquakes killed 228 persons and injured more )] TJ ET
BT 26.250 224.172 Td /F1 9.8 Tf  [(than 3000 )] TJ ET
0.267 0.267 0.267 rg
BT 72.328 225.680 Td /F4 8.7 Tf  [(2)] TJ ET
0.271 0.267 0.267 rg
BT 77.147 224.172 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 204.768 Td /F1 9.8 Tf  [(Disasters in the societies are usually followed by different adverse outcomes such as death, loss, physical and psychological )] TJ ET
BT 26.250 192.863 Td /F1 9.8 Tf  [(injuries, outbreak of infectious diseases, extensive movements of population, disruption of vital services, and destruction of )] TJ ET
BT 26.250 180.958 Td /F1 9.8 Tf  [(infrastructures)] TJ ET
0.267 0.267 0.267 rg
BT 88.016 182.465 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 92.835 180.958 Td /F1 9.8 Tf  [( . On the other hand, destruction of the houses leads to temporary settlement of homeless people and )] TJ ET
BT 26.250 169.053 Td /F1 9.8 Tf  [(inaccessibility or inadequate access of the population to health facilities and services)] TJ ET
0.267 0.267 0.267 rg
BT 390.959 170.561 Td /F4 8.7 Tf  [(4)] TJ ET
0.271 0.267 0.267 rg
BT 395.777 172.942 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 398.187 170.561 Td /F4 8.7 Tf  [(5)] TJ ET
0.271 0.267 0.267 rg
BT 403.005 169.053 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 149.649 Td /F1 9.8 Tf  [(The East Azerbaijan earthquakes confirmed the authenticity of mentioned points once more. The newly-established hospital of )] TJ ET
BT 26.250 137.744 Td /F1 9.8 Tf  [(Varzaghan, the second floor of Bagherololum Hospital in Ahar, and Imam Hossein Hospital in Haris were damaged and )] TJ ET
BT 26.250 125.839 Td /F1 9.8 Tf  [(evacuated. Eighty eight rural health houses)] TJ ET
0.267 0.267 0.267 rg
BT 213.226 127.346 Td /F4 8.7 Tf  [(1)] TJ ET
0.271 0.267 0.267 rg
BT 218.044 125.839 Td /F1 9.8 Tf  [( and 10 rural health centers were damaged, as well. Although none of the health )] TJ ET
BT 26.250 113.934 Td /F1 9.8 Tf  [(workers were injured, due to the difficult mental conditions, they were not able to render services. Thus, the routine health )] TJ ET
BT 26.250 102.030 Td /F1 9.8 Tf  [(systems in the earthquake-stricken areas were disordered.)] TJ ET
BT 26.250 82.625 Td /F1 9.8 Tf  [(Such conditions are more vulnerable to outbreaks of communicable diseases \(CD\). Several outbreaks of measles in refugees� )] TJ ET
BT 26.250 70.720 Td /F1 9.8 Tf  [(camps)] TJ ET
0.267 0.267 0.267 rg
BT 54.964 72.227 Td /F4 8.7 Tf  [(6)] TJ ET
0.271 0.267 0.267 rg
BT 59.782 70.720 Td /F1 9.8 Tf  [( , and the outbreak of diarrheal diseases in Texas following the Katrina, Bangladesh flood, earthquake of Haiti)] TJ ET
0.267 0.267 0.267 rg
BT 531.819 72.227 Td /F4 8.7 Tf  [(7)] TJ ET
0.271 0.267 0.267 rg
BT 536.638 70.720 Td /F1 9.8 Tf  [( are )] TJ ET
BT 26.250 58.815 Td /F1 9.8 Tf  [(examples of CD outbreaks after disasters.)] TJ ET
BT 26.250 39.411 Td /F1 9.8 Tf  [(Therefore, CD management is the most important component of the health system response to disasters and the surveillance )] TJ ET
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0.267 0.267 0.267 rg
BT 15.000 718.042 Td /F2 21.0 Tf  [(Communicable Diseases Surveillance System in East )] TJ ET
BT 15.000 693.094 Td /F2 21.0 Tf  [(Azerbaijan Earthquake: Strengths and Weaknesses)] TJ ET
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BT 15.000 675.088 Td /F3 9.8 Tf  [(December 8, 2014)] TJ ET
BT 91.625 675.088 Td /F3 9.8 Tf  [(�)] TJ ET
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BT 96.500 675.088 Td /F3 9.8 Tf  [(Research Article)] TJ ET
BT 26.250 663.247 Td /F1 9.8 Tf  [(Javad Babaie)] TJ ET
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BT 85.325 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 90.746 663.247 Td /F1 9.8 Tf  [(Farin Fatemi)] TJ ET
0.271 0.267 0.267 rg
BT 145.463 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 150.884 663.247 Td /F1 9.8 Tf  [(Ali Ardalan)] TJ ET
0.271 0.267 0.267 rg
BT 198.026 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 203.447 663.247 Td /F1 9.8 Tf  [(Hamed Mohammadi)] TJ ET
0.271 0.267 0.267 rg
BT 291.216 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 296.637 663.247 Td /F1 9.8 Tf  [(Mahmood Soroush)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 651.342 Td /F1 9.8 Tf  [(Babaie J, Fatemi F, Ardalan A, Mohammadi H, Soroush M. Communicable Diseases Surveillance System in East Azerbaijan )] TJ ET
BT 26.250 639.438 Td /F1 9.8 Tf  [(Earthquake: Strengths and Weaknesses. PLOS Currents Disasters. 2014 Dec 8 . Edition 1. doi: )] TJ ET
BT 26.250 627.533 Td /F1 9.8 Tf  [(10.1371/currents.dis.9085e38035f25b34f093f357ac2c3973.)] TJ ET
q
15.000 25.125 577.500 600.027 re W n
0.271 0.267 0.267 rg
BT 26.250 598.430 Td /F4 12.0 Tf  [(Abstract)] TJ ET
BT 26.250 578.476 Td /F1 9.8 Tf  [(Background: A Surveillance System was established for 19 diseases/syndromes in order to prevent and control communicable )] TJ ET
BT 26.250 566.571 Td /F1 9.8 Tf  [(diseases after 2012 East Azerbaijan earthquakes. This study was conducted to investigate the strengths and weaknesses of the )] TJ ET
BT 26.250 554.667 Td /F1 9.8 Tf  [(established SS.)] TJ ET
BT 26.250 535.262 Td /F1 9.8 Tf  [(Methods: This study was carried out on an interview-based qualitative study using content analysis in 2012. Data was collected )] TJ ET
BT 26.250 523.357 Td /F1 9.8 Tf  [(by semi-structured deep interviews and surveillance data. Fifteen interviews were conducted with experts and health system )] TJ ET
BT 26.250 511.452 Td /F1 9.8 Tf  [(managers who were engaged in implementing the communicable disease surveillance system in the affected areas. The )] TJ ET
BT 26.250 499.548 Td /F1 9.8 Tf  [(selection of participants was purposeful. Data saturation supported the sample size. The collected data was analyzed using the )] TJ ET
BT 26.250 487.643 Td /F1 9.8 Tf  [(principles suggested by Strauss and Corbin.)] TJ ET
BT 26.250 468.238 Td /F1 9.8 Tf  [(Results: Establishment of the disease surveillance system was rapid and inexpensive. It collected the required data fast. It also )] TJ ET
BT 26.250 456.333 Td /F1 9.8 Tf  [(increased confidence in health authorities that the diseases would be under control in earthquake-stricken regions. Non )] TJ ET
BT 26.250 444.429 Td /F1 9.8 Tf  [(estimated denominator for calculating the rates \(incidence & prevalence\), non-participation of the private sector and hospitals, )] TJ ET
BT 26.250 432.524 Td /F1 9.8 Tf  [(rapid turnover of health staff and unfamiliarity with the definitions of the diseases were the weak points of the established )] TJ ET
BT 26.250 420.619 Td /F1 9.8 Tf  [(disease SS.)] TJ ET
BT 26.250 401.214 Td /F1 9.8 Tf  [(Conclusion: During the time when surveillance system was active, no significant outbreak of communicable diseases was )] TJ ET
BT 26.250 389.310 Td /F1 9.8 Tf  [(reported. However, the surveillance system had some weaknesses. Thus, considering Iran�s susceptibility to various natural )] TJ ET
BT 26.250 377.405 Td /F1 9.8 Tf  [(hazards, repeated exercises should be conducted in the preparedness phase to decrease the weaknesses. In addition, other )] TJ ET
BT 26.250 365.500 Td /F1 9.8 Tf  [(types of surveillance system such as web-based or mobile-based systems should be piloted in disaster situations for future.)] TJ ET
BT 26.250 328.898 Td /F4 12.0 Tf  [(Funding Statement)] TJ ET
BT 26.250 308.943 Td /F1 9.8 Tf  [(The authors declare that they have no competing interests and received no financial support from any organizations and )] TJ ET
BT 26.250 297.039 Td /F1 9.8 Tf  [(individuals for this research.)] TJ ET
BT 26.250 267.936 Td /F4 12.0 Tf  [(Introduction)] TJ ET
BT 26.250 247.982 Td /F1 9.8 Tf  [(Two earthquakes with magnitudes of 6.3 and 6.4 in the Richter scale shook wide areas of East Azerbaijan in the northwest of )] TJ ET
BT 26.250 236.077 Td /F1 9.8 Tf  [(Iran, particularly Ahar, Heris, and Varzaghan counties on Aug 11, 2012 )] TJ ET
0.267 0.267 0.267 rg
BT 334.613 237.584 Td /F4 8.7 Tf  [(1)] TJ ET
0.271 0.267 0.267 rg
BT 339.432 236.077 Td /F1 9.8 Tf  [( . The earthquakes killed 228 persons and injured more )] TJ ET
BT 26.250 224.172 Td /F1 9.8 Tf  [(than 3000 )] TJ ET
0.267 0.267 0.267 rg
BT 72.328 225.680 Td /F4 8.7 Tf  [(2)] TJ ET
0.271 0.267 0.267 rg
BT 77.147 224.172 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 204.768 Td /F1 9.8 Tf  [(Disasters in the societies are usually followed by different adverse outcomes such as death, loss, physical and psychological )] TJ ET
BT 26.250 192.863 Td /F1 9.8 Tf  [(injuries, outbreak of infectious diseases, extensive movements of population, disruption of vital services, and destruction of )] TJ ET
BT 26.250 180.958 Td /F1 9.8 Tf  [(infrastructures)] TJ ET
0.267 0.267 0.267 rg
BT 88.016 182.465 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 92.835 180.958 Td /F1 9.8 Tf  [( . On the other hand, destruction of the houses leads to temporary settlement of homeless people and )] TJ ET
BT 26.250 169.053 Td /F1 9.8 Tf  [(inaccessibility or inadequate access of the population to health facilities and services)] TJ ET
0.267 0.267 0.267 rg
BT 390.959 170.561 Td /F4 8.7 Tf  [(4)] TJ ET
0.271 0.267 0.267 rg
BT 395.777 172.942 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 398.187 170.561 Td /F4 8.7 Tf  [(5)] TJ ET
0.271 0.267 0.267 rg
BT 403.005 169.053 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 149.649 Td /F1 9.8 Tf  [(The East Azerbaijan earthquakes confirmed the authenticity of mentioned points once more. The newly-established hospital of )] TJ ET
BT 26.250 137.744 Td /F1 9.8 Tf  [(Varzaghan, the second floor of Bagherololum Hospital in Ahar, and Imam Hossein Hospital in Haris were damaged and )] TJ ET
BT 26.250 125.839 Td /F1 9.8 Tf  [(evacuated. Eighty eight rural health houses)] TJ ET
0.267 0.267 0.267 rg
BT 213.226 127.346 Td /F4 8.7 Tf  [(1)] TJ ET
0.271 0.267 0.267 rg
BT 218.044 125.839 Td /F1 9.8 Tf  [( and 10 rural health centers were damaged, as well. Although none of the health )] TJ ET
BT 26.250 113.934 Td /F1 9.8 Tf  [(workers were injured, due to the difficult mental conditions, they were not able to render services. Thus, the routine health )] TJ ET
BT 26.250 102.030 Td /F1 9.8 Tf  [(systems in the earthquake-stricken areas were disordered.)] TJ ET
BT 26.250 82.625 Td /F1 9.8 Tf  [(Such conditions are more vulnerable to outbreaks of communicable diseases \(CD\). Several outbreaks of measles in refugees� )] TJ ET
BT 26.250 70.720 Td /F1 9.8 Tf  [(camps)] TJ ET
0.267 0.267 0.267 rg
BT 54.964 72.227 Td /F4 8.7 Tf  [(6)] TJ ET
0.271 0.267 0.267 rg
BT 59.782 70.720 Td /F1 9.8 Tf  [( , and the outbreak of diarrheal diseases in Texas following the Katrina, Bangladesh flood, earthquake of Haiti)] TJ ET
0.267 0.267 0.267 rg
BT 531.819 72.227 Td /F4 8.7 Tf  [(7)] TJ ET
0.271 0.267 0.267 rg
BT 536.638 70.720 Td /F1 9.8 Tf  [( are )] TJ ET
BT 26.250 58.815 Td /F1 9.8 Tf  [(examples of CD outbreaks after disasters.)] TJ ET
BT 26.250 39.411 Td /F1 9.8 Tf  [(Therefore, CD management is the most important component of the health system response to disasters and the surveillance )] TJ ET
Q
q
15.000 684.354 577.500 53.646 re W n
0.267 0.267 0.267 rg
BT 15.000 718.042 Td /F2 21.0 Tf  [(Communicable Diseases Surveillance System in East )] TJ ET
BT 15.000 693.094 Td /F2 21.0 Tf  [(Azerbaijan Earthquake: Strengths and Weaknesses)] TJ ET
Q
0.271 0.267 0.267 rg
BT 15.000 675.088 Td /F3 9.8 Tf  [(December 8, 2014)] TJ ET
BT 91.625 675.088 Td /F3 9.8 Tf  [(�)] TJ ET
0.267 0.267 0.267 rg
BT 96.500 675.088 Td /F3 9.8 Tf  [(Research Article)] TJ ET
BT 26.250 663.247 Td /F1 9.8 Tf  [(Javad Babaie)] TJ ET
0.271 0.267 0.267 rg
BT 85.325 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 90.746 663.247 Td /F1 9.8 Tf  [(Farin Fatemi)] TJ ET
0.271 0.267 0.267 rg
BT 145.463 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 150.884 663.247 Td /F1 9.8 Tf  [(Ali Ardalan)] TJ ET
0.271 0.267 0.267 rg
BT 198.026 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 203.447 663.247 Td /F1 9.8 Tf  [(Hamed Mohammadi)] TJ ET
0.271 0.267 0.267 rg
BT 291.216 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 296.637 663.247 Td /F1 9.8 Tf  [(Mahmood Soroush)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 651.342 Td /F1 9.8 Tf  [(Babaie J, Fatemi F, Ardalan A, Mohammadi H, Soroush M. Communicable Diseases Surveillance System in East Azerbaijan )] TJ ET
BT 26.250 639.438 Td /F1 9.8 Tf  [(Earthquake: Strengths and Weaknesses. PLOS Currents Disasters. 2014 Dec 8 . Edition 1. doi: )] TJ ET
BT 26.250 627.533 Td /F1 9.8 Tf  [(10.1371/currents.dis.9085e38035f25b34f093f357ac2c3973.)] TJ ET
q
15.000 25.125 577.500 600.027 re W n
0.271 0.267 0.267 rg
BT 26.250 598.430 Td /F4 12.0 Tf  [(Abstract)] TJ ET
BT 26.250 578.476 Td /F1 9.8 Tf  [(Background: A Surveillance System was established for 19 diseases/syndromes in order to prevent and control communicable )] TJ ET
BT 26.250 566.571 Td /F1 9.8 Tf  [(diseases after 2012 East Azerbaijan earthquakes. This study was conducted to investigate the strengths and weaknesses of the )] TJ ET
BT 26.250 554.667 Td /F1 9.8 Tf  [(established SS.)] TJ ET
BT 26.250 535.262 Td /F1 9.8 Tf  [(Methods: This study was carried out on an interview-based qualitative study using content analysis in 2012. Data was collected )] TJ ET
BT 26.250 523.357 Td /F1 9.8 Tf  [(by semi-structured deep interviews and surveillance data. Fifteen interviews were conducted with experts and health system )] TJ ET
BT 26.250 511.452 Td /F1 9.8 Tf  [(managers who were engaged in implementing the communicable disease surveillance system in the affected areas. The )] TJ ET
BT 26.250 499.548 Td /F1 9.8 Tf  [(selection of participants was purposeful. Data saturation supported the sample size. The collected data was analyzed using the )] TJ ET
BT 26.250 487.643 Td /F1 9.8 Tf  [(principles suggested by Strauss and Corbin.)] TJ ET
BT 26.250 468.238 Td /F1 9.8 Tf  [(Results: Establishment of the disease surveillance system was rapid and inexpensive. It collected the required data fast. It also )] TJ ET
BT 26.250 456.333 Td /F1 9.8 Tf  [(increased confidence in health authorities that the diseases would be under control in earthquake-stricken regions. Non )] TJ ET
BT 26.250 444.429 Td /F1 9.8 Tf  [(estimated denominator for calculating the rates \(incidence & prevalence\), non-participation of the private sector and hospitals, )] TJ ET
BT 26.250 432.524 Td /F1 9.8 Tf  [(rapid turnover of health staff and unfamiliarity with the definitions of the diseases were the weak points of the established )] TJ ET
BT 26.250 420.619 Td /F1 9.8 Tf  [(disease SS.)] TJ ET
BT 26.250 401.214 Td /F1 9.8 Tf  [(Conclusion: During the time when surveillance system was active, no significant outbreak of communicable diseases was )] TJ ET
BT 26.250 389.310 Td /F1 9.8 Tf  [(reported. However, the surveillance system had some weaknesses. Thus, considering Iran�s susceptibility to various natural )] TJ ET
BT 26.250 377.405 Td /F1 9.8 Tf  [(hazards, repeated exercises should be conducted in the preparedness phase to decrease the weaknesses. In addition, other )] TJ ET
BT 26.250 365.500 Td /F1 9.8 Tf  [(types of surveillance system such as web-based or mobile-based systems should be piloted in disaster situations for future.)] TJ ET
BT 26.250 328.898 Td /F4 12.0 Tf  [(Funding Statement)] TJ ET
BT 26.250 308.943 Td /F1 9.8 Tf  [(The authors declare that they have no competing interests and received no financial support from any organizations and )] TJ ET
BT 26.250 297.039 Td /F1 9.8 Tf  [(individuals for this research.)] TJ ET
BT 26.250 267.936 Td /F4 12.0 Tf  [(Introduction)] TJ ET
BT 26.250 247.982 Td /F1 9.8 Tf  [(Two earthquakes with magnitudes of 6.3 and 6.4 in the Richter scale shook wide areas of East Azerbaijan in the northwest of )] TJ ET
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BT 398.187 170.561 Td /F4 8.7 Tf  [(5)] TJ ET
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BT 403.005 169.053 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 149.649 Td /F1 9.8 Tf  [(The East Azerbaijan earthquakes confirmed the authenticity of mentioned points once more. The newly-established hospital of )] TJ ET
BT 26.250 137.744 Td /F1 9.8 Tf  [(Varzaghan, the second floor of Bagherololum Hospital in Ahar, and Imam Hossein Hospital in Haris were damaged and )] TJ ET
BT 26.250 125.839 Td /F1 9.8 Tf  [(evacuated. Eighty eight rural health houses)] TJ ET
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BT 213.226 127.346 Td /F4 8.7 Tf  [(1)] TJ ET
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BT 218.044 125.839 Td /F1 9.8 Tf  [( and 10 rural health centers were damaged, as well. Although none of the health )] TJ ET
BT 26.250 113.934 Td /F1 9.8 Tf  [(workers were injured, due to the difficult mental conditions, they were not able to render services. Thus, the routine health )] TJ ET
BT 26.250 102.030 Td /F1 9.8 Tf  [(systems in the earthquake-stricken areas were disordered.)] TJ ET
BT 26.250 82.625 Td /F1 9.8 Tf  [(Such conditions are more vulnerable to outbreaks of communicable diseases \(CD\). Several outbreaks of measles in refugees� )] TJ ET
BT 26.250 70.720 Td /F1 9.8 Tf  [(camps)] TJ ET
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BT 54.964 72.227 Td /F4 8.7 Tf  [(6)] TJ ET
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BT 59.782 70.720 Td /F1 9.8 Tf  [( , and the outbreak of diarrheal diseases in Texas following the Katrina, Bangladesh flood, earthquake of Haiti)] TJ ET
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BT 531.819 72.227 Td /F4 8.7 Tf  [(7)] TJ ET
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BT 536.638 70.720 Td /F1 9.8 Tf  [( are )] TJ ET
BT 26.250 58.815 Td /F1 9.8 Tf  [(examples of CD outbreaks after disasters.)] TJ ET
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BT 26.250 572.467 Td /F1 9.8 Tf  [(with experts and health system managers with previous coordination which were held in their official rooms in a quiet )] TJ ET
BT 26.250 560.562 Td /F1 9.8 Tf  [(environment. The selection of participants was purposeful and all of them were involved in the established surveillance system )] TJ ET
BT 26.250 548.658 Td /F1 9.8 Tf  [(in the earthquake-stricken areas. Table 1 highlights the demographic features of the study participants.)] TJ ET
q
26.250 525.040 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 527.788 Td /F1 9.8 Tf  [(Table 1: The demographic characteristics of the experts and managers participating in interviews)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 329.067 555.000 188.474 re f
0.965 0.965 0.965 rg
27.000 504.511 208.704 12.280 re f
0.267 0.267 0.267 rg
26.625 516.415 209.079 0.750 re f
26.625 504.136 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 507.267 Td /F4 9.8 Tf  [(Gender \(%\))] TJ ET
0.965 0.965 0.965 rg
235.704 504.511 206.291 12.280 re f
0.267 0.267 0.267 rg
235.704 516.415 206.291 0.750 re f
0.271 0.267 0.267 rg
BT 240.204 507.267 Td /F4 9.8 Tf  [(Male)] TJ ET
0.965 0.965 0.965 rg
441.995 504.511 138.505 12.280 re f
0.267 0.267 0.267 rg
441.995 516.415 138.880 0.750 re f
580.125 504.136 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 446.495 507.267 Td /F4 9.8 Tf  [(100%)] TJ ET
0.267 0.267 0.267 rg
26.625 504.136 209.454 0.750 re f
26.625 488.254 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 494.281 Td /F1 9.8 Tf  [(Job experience)] TJ ET
0.267 0.267 0.267 rg
235.329 504.136 207.041 0.750 re f
235.329 488.254 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 240.579 494.281 Td /F1 9.8 Tf  [(Mean)] TJ ET
0.267 0.267 0.267 rg
441.620 504.136 139.255 0.750 re f
441.620 488.254 0.750 16.631 re f
580.125 488.254 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 446.870 494.281 Td /F1 9.8 Tf  [(18.6 \(Year\))] TJ ET
0.267 0.267 0.267 rg
26.625 488.254 209.454 0.750 re f
26.625 472.373 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 478.399 Td /F1 9.8 Tf  [(Field of knowledge \(n\))] TJ ET
0.267 0.267 0.267 rg
235.329 488.254 207.041 0.750 re f
235.329 472.373 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 240.579 478.399 Td /F1 9.8 Tf  [(Medical science)] TJ ET
0.267 0.267 0.267 rg
441.620 488.254 139.255 0.750 re f
441.620 472.373 0.750 16.631 re f
580.125 472.373 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 446.870 478.399 Td /F1 9.8 Tf  [(8\(53.3%\))] TJ ET
0.267 0.267 0.267 rg
26.625 472.373 209.454 0.750 re f
26.625 456.492 0.750 16.631 re f
235.329 472.373 207.041 0.750 re f
235.329 456.492 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 240.579 462.518 Td /F1 9.8 Tf  [(Public health)] TJ ET
0.267 0.267 0.267 rg
441.620 472.373 139.255 0.750 re f
441.620 456.492 0.750 16.631 re f
580.125 456.492 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 446.870 462.518 Td /F1 9.8 Tf  [(4\(26.6%\))] TJ ET
0.267 0.267 0.267 rg
26.625 456.492 209.454 0.750 re f
26.625 440.611 0.750 16.631 re f
235.329 456.492 207.041 0.750 re f
235.329 440.611 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 240.579 446.637 Td /F1 9.8 Tf  [(Health management)] TJ ET
0.267 0.267 0.267 rg
441.620 456.492 139.255 0.750 re f
441.620 440.611 0.750 16.631 re f
580.125 440.611 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 446.870 446.637 Td /F1 9.8 Tf  [(3\(20.1%\))] TJ ET
0.267 0.267 0.267 rg
26.625 440.611 209.454 0.750 re f
26.625 424.729 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 430.756 Td /F1 9.8 Tf  [(Level of education \(n\))] TJ ET
0.267 0.267 0.267 rg
235.329 440.611 207.041 0.750 re f
235.329 424.729 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 240.579 430.756 Td /F1 9.8 Tf  [(General practitioner)] TJ ET
0.267 0.267 0.267 rg
441.620 440.611 139.255 0.750 re f
441.620 424.729 0.750 16.631 re f
580.125 424.729 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 446.870 430.756 Td /F1 9.8 Tf  [(8\(53.3%\))] TJ ET
0.267 0.267 0.267 rg
26.625 424.729 209.454 0.750 re f
26.625 408.848 0.750 16.631 re f
235.329 424.729 207.041 0.750 re f
235.329 408.848 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 240.579 414.874 Td /F1 9.8 Tf  [(Master of science)] TJ ET
0.267 0.267 0.267 rg
441.620 424.729 139.255 0.750 re f
441.620 408.848 0.750 16.631 re f
580.125 408.848 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 446.870 414.874 Td /F1 9.8 Tf  [(3\(20.1%\))] TJ ET
0.267 0.267 0.267 rg
26.625 408.848 209.454 0.750 re f
26.625 392.967 0.750 16.631 re f
235.329 408.848 207.041 0.750 re f
235.329 392.967 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 240.579 398.993 Td /F1 9.8 Tf  [(Bachelor of science)] TJ ET
0.267 0.267 0.267 rg
441.620 408.848 139.255 0.750 re f
441.620 392.967 0.750 16.631 re f
580.125 392.967 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 446.870 398.993 Td /F1 9.8 Tf  [(4\(26.6%\))] TJ ET
0.267 0.267 0.267 rg
26.625 392.967 209.454 0.750 re f
26.625 377.086 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 383.112 Td /F1 9.8 Tf  [(Level of work \(n\))] TJ ET
0.267 0.267 0.267 rg
235.329 392.967 207.041 0.750 re f
235.329 377.086 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 240.579 383.112 Td /F1 9.8 Tf  [(Province)] TJ ET
0.267 0.267 0.267 rg
441.620 392.967 139.255 0.750 re f
441.620 377.086 0.750 16.631 re f
580.125 377.086 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 446.870 383.112 Td /F1 9.8 Tf  [(7\(46.6%\))] TJ ET
0.267 0.267 0.267 rg
26.625 377.086 209.454 0.750 re f
26.625 361.204 0.750 16.631 re f
235.329 377.086 207.041 0.750 re f
235.329 361.204 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 240.579 367.231 Td /F1 9.8 Tf  [(County)] TJ ET
0.267 0.267 0.267 rg
441.620 377.086 139.255 0.750 re f
441.620 361.204 0.750 16.631 re f
580.125 361.204 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 446.870 367.231 Td /F1 9.8 Tf  [(5\(33.3%\))] TJ ET
0.267 0.267 0.267 rg
26.625 361.204 209.454 0.750 re f
26.625 345.323 0.750 16.631 re f
235.329 361.204 207.041 0.750 re f
235.329 345.323 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 240.579 351.349 Td /F1 9.8 Tf  [(Health center)] TJ ET
0.267 0.267 0.267 rg
441.620 361.204 139.255 0.750 re f
441.620 345.323 0.750 16.631 re f
580.125 345.323 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 446.870 351.349 Td /F1 9.8 Tf  [(1\(6.66%\))] TJ ET
0.267 0.267 0.267 rg
26.625 345.323 209.454 0.750 re f
26.625 329.442 209.454 0.750 re f
26.625 329.442 0.750 16.631 re f
235.329 345.323 207.041 0.750 re f
235.329 329.442 207.041 0.750 re f
235.329 329.442 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 240.579 335.468 Td /F1 9.8 Tf  [(Health team)] TJ ET
0.267 0.267 0.267 rg
441.620 345.323 139.255 0.750 re f
441.620 329.442 139.255 0.750 re f
441.620 329.442 0.750 16.631 re f
580.125 329.442 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 446.870 335.468 Td /F1 9.8 Tf  [(2\(13.33%\))] TJ ET
0.965 0.965 0.965 rg
26.250 126.662 555.000 157.405 re f
0.267 0.267 0.267 rg
0.267 0.267 0.267 RG
26.250 284.067 m 581.250 284.067 l 581.250 283.317 l 26.250 283.317 l  f
26.250 126.662 m 581.250 126.662 l 581.250 127.412 l 26.250 127.412 l  f
q
112.500 0 0 112.500 35.250 161.817 cm /I3 Do
Q 
q
35.250 137.912 537.000 17.905 re W n
0.271 0.267 0.267 rg
BT 35.250 146.293 Td /F4 9.8 Tf  [(Fig. 1: Flow of information and reports of the disease surveillance after 2012East Azerbaijan earthquake.)] TJ ET
Q
BT 26.250 109.638 Td /F1 9.8 Tf  [(Data saturation supported the sample size and the interviews were continued until saturation of each concept was achieved. )] TJ ET
BT 26.250 97.734 Td /F1 9.8 Tf  [(Each interview lasted between 35 to 60 minutes \(mean: 48 minutes\). The interviews were conducted in local language \(Turkish\) )] TJ ET
BT 26.250 85.829 Td /F1 9.8 Tf  [(and transcribed by the same interviewer for analysis.)] TJ ET
BT 26.250 66.424 Td /F1 9.8 Tf  [(The interviews were deep and semi-structured. We used an interview guide that included a list of general questions \(see )] TJ ET
BT 26.250 54.519 Td /F1 9.8 Tf  [(appendix\).)] TJ ET
Q
q
15.000 44.638 577.500 732.362 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(system \(SS\) is its critical division. Hence, health systems commonly try to set up a system for the surveillance of CD very soon )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(after the disaster. For instance, such surveillance was established following the Hurricane Katrina in Louisiana and New )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(Orleans, the 2010 Haiti earthquake, the 2010 Pakistan floods)] TJ ET
0.267 0.267 0.267 rg
BT 289.646 745.174 Td /F4 8.7 Tf  [(8)] TJ ET
0.271 0.267 0.267 rg
BT 294.465 747.555 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 296.874 745.174 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 301.693 743.667 Td /F1 9.8 Tf  [( , the 2008 Sichuan earthquake)] TJ ET
0.267 0.267 0.267 rg
BT 437.198 745.174 Td /F4 8.7 Tf  [(10)] TJ ET
0.271 0.267 0.267 rg
BT 446.836 743.667 Td /F1 9.8 Tf  [( , the 2011 Japan earthquake )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(and tsunami)] TJ ET
0.267 0.267 0.267 rg
BT 79.358 733.269 Td /F4 8.7 Tf  [(11)] TJ ET
0.271 0.267 0.267 rg
BT 88.996 731.762 Td /F1 9.8 Tf  [( , and Bam and Zarand earthquakes)] TJ ET
0.267 0.267 0.267 rg
BT 245.083 733.269 Td /F4 8.7 Tf  [(12)] TJ ET
0.271 0.267 0.267 rg
BT 254.721 735.650 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 257.130 733.269 Td /F4 8.7 Tf  [(13)] TJ ET
0.271 0.267 0.267 rg
BT 266.767 731.762 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 712.357 Td /F1 9.8 Tf  [(In this earthquake, the health center of East Azerbaijan in collaboration with the Ministry of Health designed and implemented a )] TJ ET
BT 26.250 700.452 Td /F1 9.8 Tf  [(communicable diseases surveillance system in the affected areas. Although disasters are terrible events, they can be very )] TJ ET
BT 26.250 688.548 Td /F1 9.8 Tf  [(informative and learning from them can reduce their adverse effects in future disasters. Therefore, response programs and the )] TJ ET
BT 26.250 676.643 Td /F1 9.8 Tf  [(performed actions must be carefully assessed and their pitfalls should be extracted. We can provide an effective response by )] TJ ET
BT 26.250 664.738 Td /F1 9.8 Tf  [(avoiding previous challenges and using strengths. Therefore, this article focuses on the disease surveillance system in East )] TJ ET
BT 26.250 652.833 Td /F1 9.8 Tf  [(Azerbaijan earthquake and its strengths and weaknesses.)] TJ ET
BT 26.250 616.231 Td /F4 12.0 Tf  [(Methods)] TJ ET
BT 26.250 596.277 Td /F1 9.8 Tf  [(This study was carried out in 2012. We used content analysis as a research method for the subjective interpretation of the )] TJ ET
BT 26.250 584.372 Td /F1 9.8 Tf  [(interview data through a systematic classification process of coding and identifying concepts. We conducted fifteen interviews )] TJ ET
BT 26.250 572.467 Td /F1 9.8 Tf  [(with experts and health system managers with previous coordination which were held in their official rooms in a quiet )] TJ ET
BT 26.250 560.562 Td /F1 9.8 Tf  [(environment. The selection of participants was purposeful and all of them were involved in the established surveillance system )] TJ ET
BT 26.250 548.658 Td /F1 9.8 Tf  [(in the earthquake-stricken areas. Table 1 highlights the demographic features of the study participants.)] TJ ET
q
26.250 525.040 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 527.788 Td /F1 9.8 Tf  [(Table 1: The demographic characteristics of the experts and managers participating in interviews)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 329.067 555.000 188.474 re f
0.965 0.965 0.965 rg
27.000 504.511 208.704 12.280 re f
0.267 0.267 0.267 rg
26.625 516.415 209.079 0.750 re f
26.625 504.136 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 31.500 507.267 Td /F4 9.8 Tf  [(Gender \(%\))] TJ ET
0.965 0.965 0.965 rg
235.704 504.511 206.291 12.280 re f
0.267 0.267 0.267 rg
235.704 516.415 206.291 0.750 re f
0.271 0.267 0.267 rg
BT 240.204 507.267 Td /F4 9.8 Tf  [(Male)] TJ ET
0.965 0.965 0.965 rg
441.995 504.511 138.505 12.280 re f
0.267 0.267 0.267 rg
441.995 516.415 138.880 0.750 re f
580.125 504.136 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 446.495 507.267 Td /F4 9.8 Tf  [(100%)] TJ ET
0.267 0.267 0.267 rg
26.625 504.136 209.454 0.750 re f
26.625 488.254 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 494.281 Td /F1 9.8 Tf  [(Job experience)] TJ ET
0.267 0.267 0.267 rg
235.329 504.136 207.041 0.750 re f
235.329 488.254 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 240.579 494.281 Td /F1 9.8 Tf  [(Mean)] TJ ET
0.267 0.267 0.267 rg
441.620 504.136 139.255 0.750 re f
441.620 488.254 0.750 16.631 re f
580.125 488.254 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 446.870 494.281 Td /F1 9.8 Tf  [(18.6 \(Year\))] TJ ET
0.267 0.267 0.267 rg
26.625 488.254 209.454 0.750 re f
26.625 472.373 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 478.399 Td /F1 9.8 Tf  [(Field of knowledge \(n\))] TJ ET
0.267 0.267 0.267 rg
235.329 488.254 207.041 0.750 re f
235.329 472.373 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 240.579 478.399 Td /F1 9.8 Tf  [(Medical science)] TJ ET
0.267 0.267 0.267 rg
441.620 488.254 139.255 0.750 re f
441.620 472.373 0.750 16.631 re f
580.125 472.373 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 446.870 478.399 Td /F1 9.8 Tf  [(8\(53.3%\))] TJ ET
0.267 0.267 0.267 rg
26.625 472.373 209.454 0.750 re f
26.625 456.492 0.750 16.631 re f
235.329 472.373 207.041 0.750 re f
235.329 456.492 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 240.579 462.518 Td /F1 9.8 Tf  [(Public health)] TJ ET
0.267 0.267 0.267 rg
441.620 472.373 139.255 0.750 re f
441.620 456.492 0.750 16.631 re f
580.125 456.492 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 446.870 462.518 Td /F1 9.8 Tf  [(4\(26.6%\))] TJ ET
0.267 0.267 0.267 rg
26.625 456.492 209.454 0.750 re f
26.625 440.611 0.750 16.631 re f
235.329 456.492 207.041 0.750 re f
235.329 440.611 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 240.579 446.637 Td /F1 9.8 Tf  [(Health management)] TJ ET
0.267 0.267 0.267 rg
441.620 456.492 139.255 0.750 re f
441.620 440.611 0.750 16.631 re f
580.125 440.611 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 446.870 446.637 Td /F1 9.8 Tf  [(3\(20.1%\))] TJ ET
0.267 0.267 0.267 rg
26.625 440.611 209.454 0.750 re f
26.625 424.729 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 430.756 Td /F1 9.8 Tf  [(Level of education \(n\))] TJ ET
0.267 0.267 0.267 rg
235.329 440.611 207.041 0.750 re f
235.329 424.729 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 240.579 430.756 Td /F1 9.8 Tf  [(General practitioner)] TJ ET
0.267 0.267 0.267 rg
441.620 440.611 139.255 0.750 re f
441.620 424.729 0.750 16.631 re f
580.125 424.729 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 446.870 430.756 Td /F1 9.8 Tf  [(8\(53.3%\))] TJ ET
0.267 0.267 0.267 rg
26.625 424.729 209.454 0.750 re f
26.625 408.848 0.750 16.631 re f
235.329 424.729 207.041 0.750 re f
235.329 408.848 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 240.579 414.874 Td /F1 9.8 Tf  [(Master of science)] TJ ET
0.267 0.267 0.267 rg
441.620 424.729 139.255 0.750 re f
441.620 408.848 0.750 16.631 re f
580.125 408.848 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 446.870 414.874 Td /F1 9.8 Tf  [(3\(20.1%\))] TJ ET
0.267 0.267 0.267 rg
26.625 408.848 209.454 0.750 re f
26.625 392.967 0.750 16.631 re f
235.329 408.848 207.041 0.750 re f
235.329 392.967 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 240.579 398.993 Td /F1 9.8 Tf  [(Bachelor of science)] TJ ET
0.267 0.267 0.267 rg
441.620 408.848 139.255 0.750 re f
441.620 392.967 0.750 16.631 re f
580.125 392.967 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 446.870 398.993 Td /F1 9.8 Tf  [(4\(26.6%\))] TJ ET
0.267 0.267 0.267 rg
26.625 392.967 209.454 0.750 re f
26.625 377.086 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 383.112 Td /F1 9.8 Tf  [(Level of work \(n\))] TJ ET
0.267 0.267 0.267 rg
235.329 392.967 207.041 0.750 re f
235.329 377.086 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 240.579 383.112 Td /F1 9.8 Tf  [(Province)] TJ ET
0.267 0.267 0.267 rg
441.620 392.967 139.255 0.750 re f
441.620 377.086 0.750 16.631 re f
580.125 377.086 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 446.870 383.112 Td /F1 9.8 Tf  [(7\(46.6%\))] TJ ET
0.267 0.267 0.267 rg
26.625 377.086 209.454 0.750 re f
26.625 361.204 0.750 16.631 re f
235.329 377.086 207.041 0.750 re f
235.329 361.204 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 240.579 367.231 Td /F1 9.8 Tf  [(County)] TJ ET
0.267 0.267 0.267 rg
441.620 377.086 139.255 0.750 re f
441.620 361.204 0.750 16.631 re f
580.125 361.204 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 446.870 367.231 Td /F1 9.8 Tf  [(5\(33.3%\))] TJ ET
0.267 0.267 0.267 rg
26.625 361.204 209.454 0.750 re f
26.625 345.323 0.750 16.631 re f
235.329 361.204 207.041 0.750 re f
235.329 345.323 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 240.579 351.349 Td /F1 9.8 Tf  [(Health center)] TJ ET
0.267 0.267 0.267 rg
441.620 361.204 139.255 0.750 re f
441.620 345.323 0.750 16.631 re f
580.125 345.323 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 446.870 351.349 Td /F1 9.8 Tf  [(1\(6.66%\))] TJ ET
0.267 0.267 0.267 rg
26.625 345.323 209.454 0.750 re f
26.625 329.442 209.454 0.750 re f
26.625 329.442 0.750 16.631 re f
235.329 345.323 207.041 0.750 re f
235.329 329.442 207.041 0.750 re f
235.329 329.442 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 240.579 335.468 Td /F1 9.8 Tf  [(Health team)] TJ ET
0.267 0.267 0.267 rg
441.620 345.323 139.255 0.750 re f
441.620 329.442 139.255 0.750 re f
441.620 329.442 0.750 16.631 re f
580.125 329.442 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 446.870 335.468 Td /F1 9.8 Tf  [(2\(13.33%\))] TJ ET
0.965 0.965 0.965 rg
26.250 126.662 555.000 157.405 re f
0.267 0.267 0.267 rg
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BT 26.250 490.443 Td /F1 9.8 Tf  [(highest level of the Ministry of Health. During this process, feedback was met from each layer and this trend was repeated on a )] TJ ET
BT 26.250 478.539 Td /F1 9.8 Tf  [(daily basis. All the data was recorded manually by health teams in the National Emergency Operation Plan)] TJ ET
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BT 494.878 478.539 Td /F1 9.8 Tf  [( \(E.O.P\) forms.)] TJ ET
BT 26.250 459.134 Td /F1 9.8 Tf  [(Nineteen diseases/syndromes that required surveillance in this system were diarrhea, dysentery, water and food-borne )] TJ ET
BT 26.250 447.229 Td /F1 9.8 Tf  [(outbreaks, animal bites, snake and scorpion bites, botulism, acute respiratory infection, influenza-like illness \(ILI\), anthrax, )] TJ ET
BT 26.250 435.324 Td /F1 9.8 Tf  [(pertussis, meningitis, cutaneous leishmaniasis, malaria, tuberculosis, acute flaccid paralysis, sexually transmitted disease, )] TJ ET
BT 26.250 423.420 Td /F1 9.8 Tf  [(contamination by louse, acute jaundice, and other cases.)] TJ ET
BT 26.250 386.817 Td /F4 12.0 Tf  [(Results)] TJ ET
BT 26.250 366.863 Td /F5 9.8 Tf  [(Surveillance Data)] TJ ET
BT 26.250 347.458 Td /F1 9.8 Tf  [(The surveillance duration was divided to two phase. The first phased started from Aug 15 to September 21, 2012, and the )] TJ ET
BT 26.250 335.553 Td /F1 9.8 Tf  [(second phase from September 22 to December 20, 2012. Within the first 40 days after the earthquake \(until September 21, )] TJ ET
BT 26.250 323.649 Td /F1 9.8 Tf  [(2012\), the reported diseases were watery diarrhea \(1332 cases\), acute respiratory infection \(ARI\) \(1156 cases\), influenza-like )] TJ ET
BT 26.250 311.744 Td /F1 9.8 Tf  [(illness \(ILI\) \(164 cases\) and animal bite \(56 cases\). In the second phase \(from September 22 until December 20\), the majority of )] TJ ET
BT 26.250 299.839 Td /F1 9.8 Tf  [(the diseases were 206 cases of acute watery diarrhea, 95 cases of influenza-like illness, and 92 cases of acute respiratory )] TJ ET
BT 26.250 287.934 Td /F1 9.8 Tf  [(infections. Moreover, 5 cases of limited food-borne outbreak were diagnosed and certified within a 4-month surveillance period, )] TJ ET
BT 26.250 276.030 Td /F1 9.8 Tf  [(which were stopped immediately by undertaking controlling measures. There was no specific problem in terms of epidemics in )] TJ ET
BT 26.250 264.125 Td /F1 9.8 Tf  [(the earthquake-stricken areas, which made authorities and people confident that the diseases were under control.)] TJ ET
BT 26.250 244.720 Td /F5 9.8 Tf  [(Interview data)] TJ ET
BT 26.250 225.315 Td /F4 9.8 Tf  [(Strengths)] TJ ET
BT 26.250 205.911 Td /F5 9.8 Tf  [(1- Rapid establishment:)] TJ ET
BT 136.230 205.911 Td /F1 9.8 Tf  [( The mentioned surveillance system was operational within three days after the earthquake. It could )] TJ ET
BT 26.250 194.006 Td /F1 9.8 Tf  [(provide the officials and decision makers with the required information for the management of communicable diseases in )] TJ ET
BT 26.250 182.101 Td /F1 9.8 Tf  [(affected areas. One of the participants in this study stated: )] TJ ET
BT 280.433 182.101 Td /F6 9.8 Tf  [(�It was the third day that experts came from the Ministry of Health. )] TJ ET
BT 26.250 170.196 Td /F6 9.8 Tf  [(We collaborated with each other and commissioned this system. Because we did not know what would happen, we were )] TJ ET
BT 26.250 158.292 Td /F6 9.8 Tf  [(worried about the future of the region, but this system gave us the information and data we required day after day.�)] TJ ET
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BT 26.250 767.476 Td /F1 9.8 Tf  [(Depending on the responses to initial questions, additional clarifying questions were asked for better clearance during )] TJ ET
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0.271 0.267 0.267 rg
BT 561.520 755.571 Td /F1 9.8 Tf  [( . )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(Data collection and data analysis took place simultaneously in order to identify ideas, which then guided the next interview.)] TJ ET
BT 26.250 724.262 Td /F1 9.8 Tf  [(During the open coding phase, all the interviews were read several times and key words were determined in the text. Primary )] TJ ET
BT 26.250 712.357 Td /F1 9.8 Tf  [(codes were extracted. After that, codes and data were compared for similarities and differences. Categories and sub-categories )] TJ ET
BT 26.250 700.452 Td /F1 9.8 Tf  [(were developed. In conformity with the methodology of content analysis)] TJ ET
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BT 344.241 700.452 Td /F1 9.8 Tf  [( , they were all performed by the same investigator for )] TJ ET
BT 26.250 688.548 Td /F1 9.8 Tf  [(all interviews. Data validation was carried out by member check)] TJ ET
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0.271 0.267 0.267 rg
BT 310.057 688.548 Td /F1 9.8 Tf  [( . During this process, the transcriptions and a summary of )] TJ ET
BT 26.250 676.643 Td /F1 9.8 Tf  [(primary results \(codes and categories\) were checked by the participants in order to improve trustworthiness.)] TJ ET
BT 26.250 657.238 Td /F1 9.8 Tf  [(Eleven categories were extracted from interviews analysis. Four and seven categories were classified as strengths and )] TJ ET
BT 26.250 645.333 Td /F1 9.8 Tf  [(weaknesses.)] TJ ET
BT 26.250 625.929 Td /F1 9.8 Tf  [(We also investigated documents and regularly collected data by the surveillance system during September to calculate the )] TJ ET
BT 26.250 614.024 Td /F1 9.8 Tf  [(trend of the prevalence of the CD.)] TJ ET
BT 26.250 577.421 Td /F4 12.0 Tf  [(Description of Established Surveillance System)] TJ ET
BT 26.250 557.467 Td /F1 9.8 Tf  [(Three days after the earthquakes in East Azerbaijan, the surveillance system of CD was designed for detecting and monitoring )] TJ ET
BT 26.250 545.562 Td /F1 9.8 Tf  [(19 diseases/syndromes in the affected areas. Thirty health teams in 10 health centers were involved in establishing the SS. All )] TJ ET
BT 26.250 533.658 Td /F1 9.8 Tf  [(health teams had general physicians, obstetricians/nurses, environmental health and disease control technicians/specialists.)] TJ ET
BT 26.250 514.253 Td /F1 9.8 Tf  [(Communications and reports were two-sided, meaning that the data was collected from health teams, and concluded and )] TJ ET
BT 26.250 502.348 Td /F1 9.8 Tf  [(analyzed in the health centers and districts level. Then, the report was sent to the health center of the province and finally to the )] TJ ET
BT 26.250 490.443 Td /F1 9.8 Tf  [(highest level of the Ministry of Health. During this process, feedback was met from each layer and this trend was repeated on a )] TJ ET
BT 26.250 478.539 Td /F1 9.8 Tf  [(daily basis. All the data was recorded manually by health teams in the National Emergency Operation Plan)] TJ ET
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BT 485.241 480.046 Td /F4 8.7 Tf  [(17)] TJ ET
0.271 0.267 0.267 rg
BT 494.878 478.539 Td /F1 9.8 Tf  [( \(E.O.P\) forms.)] TJ ET
BT 26.250 459.134 Td /F1 9.8 Tf  [(Nineteen diseases/syndromes that required surveillance in this system were diarrhea, dysentery, water and food-borne )] TJ ET
BT 26.250 447.229 Td /F1 9.8 Tf  [(outbreaks, animal bites, snake and scorpion bites, botulism, acute respiratory infection, influenza-like illness \(ILI\), anthrax, )] TJ ET
BT 26.250 435.324 Td /F1 9.8 Tf  [(pertussis, meningitis, cutaneous leishmaniasis, malaria, tuberculosis, acute flaccid paralysis, sexually transmitted disease, )] TJ ET
BT 26.250 423.420 Td /F1 9.8 Tf  [(contamination by louse, acute jaundice, and other cases.)] TJ ET
BT 26.250 386.817 Td /F4 12.0 Tf  [(Results)] TJ ET
BT 26.250 366.863 Td /F5 9.8 Tf  [(Surveillance Data)] TJ ET
BT 26.250 347.458 Td /F1 9.8 Tf  [(The surveillance duration was divided to two phase. The first phased started from Aug 15 to September 21, 2012, and the )] TJ ET
BT 26.250 335.553 Td /F1 9.8 Tf  [(second phase from September 22 to December 20, 2012. Within the first 40 days after the earthquake \(until September 21, )] TJ ET
BT 26.250 323.649 Td /F1 9.8 Tf  [(2012\), the reported diseases were watery diarrhea \(1332 cases\), acute respiratory infection \(ARI\) \(1156 cases\), influenza-like )] TJ ET
BT 26.250 311.744 Td /F1 9.8 Tf  [(illness \(ILI\) \(164 cases\) and animal bite \(56 cases\). In the second phase \(from September 22 until December 20\), the majority of )] TJ ET
BT 26.250 299.839 Td /F1 9.8 Tf  [(the diseases were 206 cases of acute watery diarrhea, 95 cases of influenza-like illness, and 92 cases of acute respiratory )] TJ ET
BT 26.250 287.934 Td /F1 9.8 Tf  [(infections. Moreover, 5 cases of limited food-borne outbreak were diagnosed and certified within a 4-month surveillance period, )] TJ ET
BT 26.250 276.030 Td /F1 9.8 Tf  [(which were stopped immediately by undertaking controlling measures. There was no specific problem in terms of epidemics in )] TJ ET
BT 26.250 264.125 Td /F1 9.8 Tf  [(the earthquake-stricken areas, which made authorities and people confident that the diseases were under control.)] TJ ET
BT 26.250 244.720 Td /F5 9.8 Tf  [(Interview data)] TJ ET
BT 26.250 225.315 Td /F4 9.8 Tf  [(Strengths)] TJ ET
BT 26.250 205.911 Td /F5 9.8 Tf  [(1- Rapid establishment:)] TJ ET
BT 136.230 205.911 Td /F1 9.8 Tf  [( The mentioned surveillance system was operational within three days after the earthquake. It could )] TJ ET
BT 26.250 194.006 Td /F1 9.8 Tf  [(provide the officials and decision makers with the required information for the management of communicable diseases in )] TJ ET
BT 26.250 182.101 Td /F1 9.8 Tf  [(affected areas. One of the participants in this study stated: )] TJ ET
BT 280.433 182.101 Td /F6 9.8 Tf  [(�It was the third day that experts came from the Ministry of Health. )] TJ ET
BT 26.250 170.196 Td /F6 9.8 Tf  [(We collaborated with each other and commissioned this system. Because we did not know what would happen, we were )] TJ ET
BT 26.250 158.292 Td /F6 9.8 Tf  [(worried about the future of the region, but this system gave us the information and data we required day after day.�)] TJ ET
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BT 310.057 688.548 Td /F1 9.8 Tf  [( . During this process, the transcriptions and a summary of )] TJ ET
BT 26.250 676.643 Td /F1 9.8 Tf  [(primary results \(codes and categories\) were checked by the participants in order to improve trustworthiness.)] TJ ET
BT 26.250 657.238 Td /F1 9.8 Tf  [(Eleven categories were extracted from interviews analysis. Four and seven categories were classified as strengths and )] TJ ET
BT 26.250 645.333 Td /F1 9.8 Tf  [(weaknesses.)] TJ ET
BT 26.250 625.929 Td /F1 9.8 Tf  [(We also investigated documents and regularly collected data by the surveillance system during September to calculate the )] TJ ET
BT 26.250 614.024 Td /F1 9.8 Tf  [(trend of the prevalence of the CD.)] TJ ET
BT 26.250 577.421 Td /F4 12.0 Tf  [(Description of Established Surveillance System)] TJ ET
BT 26.250 557.467 Td /F1 9.8 Tf  [(Three days after the earthquakes in East Azerbaijan, the surveillance system of CD was designed for detecting and monitoring )] TJ ET
BT 26.250 545.562 Td /F1 9.8 Tf  [(19 diseases/syndromes in the affected areas. Thirty health teams in 10 health centers were involved in establishing the SS. All )] TJ ET
BT 26.250 533.658 Td /F1 9.8 Tf  [(health teams had general physicians, obstetricians/nurses, environmental health and disease control technicians/specialists.)] TJ ET
BT 26.250 514.253 Td /F1 9.8 Tf  [(Communications and reports were two-sided, meaning that the data was collected from health teams, and concluded and )] TJ ET
BT 26.250 502.348 Td /F1 9.8 Tf  [(analyzed in the health centers and districts level. Then, the report was sent to the health center of the province and finally to the )] TJ ET
BT 26.250 490.443 Td /F1 9.8 Tf  [(highest level of the Ministry of Health. During this process, feedback was met from each layer and this trend was repeated on a )] TJ ET
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0.271 0.267 0.267 rg
BT 494.878 478.539 Td /F1 9.8 Tf  [( \(E.O.P\) forms.)] TJ ET
BT 26.250 459.134 Td /F1 9.8 Tf  [(Nineteen diseases/syndromes that required surveillance in this system were diarrhea, dysentery, water and food-borne )] TJ ET
BT 26.250 447.229 Td /F1 9.8 Tf  [(outbreaks, animal bites, snake and scorpion bites, botulism, acute respiratory infection, influenza-like illness \(ILI\), anthrax, )] TJ ET
BT 26.250 435.324 Td /F1 9.8 Tf  [(pertussis, meningitis, cutaneous leishmaniasis, malaria, tuberculosis, acute flaccid paralysis, sexually transmitted disease, )] TJ ET
BT 26.250 423.420 Td /F1 9.8 Tf  [(contamination by louse, acute jaundice, and other cases.)] TJ ET
BT 26.250 386.817 Td /F4 12.0 Tf  [(Results)] TJ ET
BT 26.250 366.863 Td /F5 9.8 Tf  [(Surveillance Data)] TJ ET
BT 26.250 347.458 Td /F1 9.8 Tf  [(The surveillance duration was divided to two phase. The first phased started from Aug 15 to September 21, 2012, and the )] TJ ET
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BT 26.250 299.839 Td /F1 9.8 Tf  [(the diseases were 206 cases of acute watery diarrhea, 95 cases of influenza-like illness, and 92 cases of acute respiratory )] TJ ET
BT 26.250 287.934 Td /F1 9.8 Tf  [(infections. Moreover, 5 cases of limited food-borne outbreak were diagnosed and certified within a 4-month surveillance period, )] TJ ET
BT 26.250 276.030 Td /F1 9.8 Tf  [(which were stopped immediately by undertaking controlling measures. There was no specific problem in terms of epidemics in )] TJ ET
BT 26.250 264.125 Td /F1 9.8 Tf  [(the earthquake-stricken areas, which made authorities and people confident that the diseases were under control.)] TJ ET
BT 26.250 244.720 Td /F5 9.8 Tf  [(Interview data)] TJ ET
BT 26.250 225.315 Td /F4 9.8 Tf  [(Strengths)] TJ ET
BT 26.250 205.911 Td /F5 9.8 Tf  [(1- Rapid establishment:)] TJ ET
BT 136.230 205.911 Td /F1 9.8 Tf  [( The mentioned surveillance system was operational within three days after the earthquake. It could )] TJ ET
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BT 26.250 170.196 Td /F6 9.8 Tf  [(We collaborated with each other and commissioned this system. Because we did not know what would happen, we were )] TJ ET
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BT 35.250 767.476 Td /F4 9.8 Tf  [(Fig. 2: Incidence of communicable diseases in East Azerbaijan earthquake stricken areas, 23 Aug-22 Sep,2012)] TJ ET
Q
BT 26.250 730.821 Td /F5 9.8 Tf  [(2- No need for additional facilities and resources:)] TJ ET
BT 254.897 730.821 Td /F1 9.8 Tf  [( The system was built based on the available facilities. No additional )] TJ ET
BT 26.250 718.917 Td /F1 9.8 Tf  [(resources were employed for its establishment that could incur costs upon the health system. Furthermore, the system experts )] TJ ET
BT 26.250 707.012 Td /F1 9.8 Tf  [(had prior familiarity with its execution process. One of experts said: )] TJ ET
BT 317.775 707.012 Td /F6 9.8 Tf  [(�In fact, we used available facilities and caused no other )] TJ ET
BT 26.250 695.107 Td /F6 9.8 Tf  [(extra costs. Everything was available from the past. We only explained the procedure to the personnel and distributed the )] TJ ET
BT 26.250 683.202 Td /F6 9.8 Tf  [(forms. The data was collected and sent by teams. It caused no extra expenses for us.�)] TJ ET
BT 26.250 663.798 Td /F5 9.8 Tf  [(3- Capability of quick data collection)] TJ ET
BT 195.296 663.798 Td /F4 9.8 Tf  [(:)] TJ ET
BT 198.542 663.798 Td /F1 9.8 Tf  [( This system collected and transferred the data related to diseases quickly so that the )] TJ ET
BT 26.250 651.893 Td /F1 9.8 Tf  [(information was supplied to the responders at most within one day. One participant said)] TJ ET
BT 403.965 651.893 Td /F6 9.8 Tf  [(: �Our information was almost up-to-)] TJ ET
BT 26.250 639.988 Td /F6 9.8 Tf  [(date. We were completely aware of the region with a one-day delay. If there was a concern, they informed us immediately by )] TJ ET
BT 26.250 628.083 Td /F6 9.8 Tf  [(phone. In general, the disease status in the area was under control.�)] TJ ET
BT 26.250 608.679 Td /F5 9.8 Tf  [(4- Increase confidence in the health system:)] TJ ET
BT 231.068 608.679 Td /F1 9.8 Tf  [( This system made officials confident about controlling the health status of )] TJ ET
BT 26.250 596.774 Td /F1 9.8 Tf  [(earthquake-stricken areas. Thus, they were assured there was no outbreak of communicable diseases. Moreover, data related )] TJ ET
BT 26.250 584.869 Td /F1 9.8 Tf  [(to the occurrence and incidence of communicable diseases indicated that performed actions were appropriate and efficient. One )] TJ ET
BT 26.250 572.964 Td /F1 9.8 Tf  [(of the physicians stated: )] TJ ET
BT 133.558 572.964 Td /F6 9.8 Tf  [(�For the first time, we faced such conditions. Since there was much destruction and it was in the )] TJ ET
BT 26.250 561.060 Td /F6 9.8 Tf  [(summer, we were concerned about the prevalence of diarrheal diseases but day after day, we became certain that the )] TJ ET
BT 26.250 549.155 Td /F6 9.8 Tf  [(conditions were controlled well.�)] TJ ET
BT 164.417 549.155 Td /F1 9.8 Tf  [( Another expert said: )] TJ ET
BT 257.091 549.155 Td /F6 9.8 Tf  [(�At the beginning, there were rumors about some diseases in the region, )] TJ ET
BT 26.250 537.250 Td /F6 9.8 Tf  [(but this system ended these rumors upon providing timely information. The officials confidently declared that there was no )] TJ ET
BT 26.250 525.345 Td /F6 9.8 Tf  [(concerning case.�)] TJ ET
BT 26.250 505.941 Td /F4 9.8 Tf  [(Weaknesses)] TJ ET
BT 26.250 486.536 Td /F5 9.8 Tf  [(1-Non-estimated denominator:)] TJ ET
BT 167.635 486.536 Td /F1 9.8 Tf  [( The region population was not specified. A lot of people from other cities were present in the )] TJ ET
BT 26.250 474.631 Td /F1 9.8 Tf  [(damaged villages and the region population changed every day. Consequently, the rates \(prevalence and incidence rates\) could )] TJ ET
BT 26.250 462.726 Td /F1 9.8 Tf  [(not be calculated. Only the raw statistics of diseases were used and the trend of the diseases was controlled based on number. )] TJ ET
BT 26.250 450.822 Td /F1 9.8 Tf  [(One participant in this study said: )] TJ ET
BT 172.568 450.822 Td /F6 9.8 Tf  [(�The population changed every day. A lot of people came from other places and resided in the )] TJ ET
BT 26.250 438.917 Td /F6 9.8 Tf  [(villages. Plenty of these villagers immigrated to Tabriz. Due to the current status of the region, they returned for a lot of reasons )] TJ ET
BT 26.250 427.012 Td /F6 9.8 Tf  [(and then resided in the villages. We truly did not know how many people resided in the region.)] TJ ET
BT 432.152 427.012 Td /F1 9.8 Tf  [(� Another expert said: )] TJ ET
BT 26.250 415.107 Td /F6 9.8 Tf  [(�We didn�t know to apply which number in the denominator. We were obliged to apply the number of all daily visits, but it was )] TJ ET
BT 26.250 403.203 Td /F6 9.8 Tf  [(not a correct number and depended on the number of visits which health teams paid on that day. If the number of visits was )] TJ ET
BT 26.250 391.298 Td /F6 9.8 Tf  [(high, the statistics of our diseases increased as well. If there were fewer visits, the number of patients decreased, too. Daily )] TJ ET
BT 26.250 379.393 Td /F6 9.8 Tf  [(statistics were not comparable at all. We knew it, but didn�t know what to do.�)] TJ ET
BT 26.250 359.988 Td /F5 9.8 Tf  [(2-)] TJ ET
BT 34.918 359.988 Td /F5 9.8 Tf  [(Non-participation of the private sector and general hospitals:)] TJ ET
BT 320.437 359.988 Td /F1 9.8 Tf  [( In this SS, the data was collected and sent only by health )] TJ ET
BT 26.250 348.084 Td /F1 9.8 Tf  [(teams which were dispatched to the region by the province health center. The private sector and public hospitals available in the )] TJ ET
BT 26.250 336.179 Td /F1 9.8 Tf  [(region did not participate in the SS. Therefore, the diseases statistics only included part of the clients who were consulted by the )] TJ ET
BT 26.250 324.274 Td /F1 9.8 Tf  [(health team and no statistics of total patients existed in the region.)] TJ ET
BT 26.250 304.869 Td /F1 9.8 Tf  [(One of the participants stated: )] TJ ET
BT 159.035 304.869 Td /F6 9.8 Tf  [(�We collected daily statistics only from our teams and didn�t intervene in clinics and hospitals. If )] TJ ET
BT 26.250 292.965 Td /F6 9.8 Tf  [(the disease was reportable according to the WHO, they informed us, but we have received no report yet.�)] TJ ET
BT 26.250 273.560 Td /F5 9.8 Tf  [(3- Non-participation of the staff of health houses)] TJ ET
BT 251.065 273.560 Td /F4 9.8 Tf  [(:)] TJ ET
BT 254.312 273.560 Td /F1 9.8 Tf  [( Despite activating the health houses and establishing health sites in all )] TJ ET
BT 26.250 261.655 Td /F1 9.8 Tf  [(villages with a population over 20 households, the implemented surveillance system did not use the health staff for data )] TJ ET
BT 26.250 249.750 Td /F1 9.8 Tf  [(collection and their relationship with the system was not defined although they were relatively familiar with the disease reporting )] TJ ET
BT 26.250 237.846 Td /F1 9.8 Tf  [(system. One of the experts said: )] TJ ET
BT 168.775 237.846 Td /F6 9.8 Tf  [(�We didn�t know at all how to communicate with the region�s rural health houses staff. They )] TJ ET
BT 26.250 225.941 Td /F6 9.8 Tf  [(also didn�t know how and what to report. It is not also clear now.�)] TJ ET
BT 26.250 206.536 Td /F5 9.8 Tf  [(4- Lack of inter-sectoral collaboration:)] TJ ET
BT 203.417 206.536 Td /F1 9.8 Tf  [( The established surveillance system had no communication with other health sites in )] TJ ET
BT 26.250 194.631 Td /F1 9.8 Tf  [(the earthquake-stricken regions and no effort was observed to communicate with them or attract their participation. For example )] TJ ET
BT 26.250 182.727 Td /F1 9.8 Tf  [(there were some other relief teams from Red Crescent that provided health care. But their patients didn�t include the SS. )] TJ ET
BT 26.250 170.822 Td /F1 9.8 Tf  [(Consequently our data about the disease incidence and prevalence was incomplete. One of the participants said: )] TJ ET
BT 516.714 170.822 Td /F6 9.8 Tf  [(�We didn�t )] TJ ET
BT 26.250 158.917 Td /F6 9.8 Tf  [(know how to communicate with health sites at all. They also didn�t know how and what to report. It is not also clear now.�)] TJ ET
BT 26.250 139.512 Td /F5 9.8 Tf  [(5- Rapid turnover of health staff:)] TJ ET
BT 176.849 139.512 Td /F1 9.8 Tf  [( Physicians and members of the health centers came from other cities of the province and )] TJ ET
BT 26.250 127.608 Td /F1 9.8 Tf  [(were usually present in the area for three days before replacing by another team. The new health teams were not familiar with )] TJ ET
BT 26.250 115.703 Td /F1 9.8 Tf  [(data collection and reporting procedures in spite of brief training on the communicable diseases SS, definitions of )] TJ ET
BT 26.250 103.798 Td /F1 9.8 Tf  [(diseases/syndromes and daily report process before starting their task. It lasted at least one day to become acquainted with the )] TJ ET
BT 26.250 91.893 Td /F1 9.8 Tf  [(tasks. As a result, the information continuity was disturbed and new and repeated cases created problems in patient )] TJ ET
BT 26.250 79.989 Td /F1 9.8 Tf  [(classification. One of the interviewees said: )] TJ ET
BT 215.371 79.989 Td /F6 9.8 Tf  [(�Almost every day, we had a new team. It took one day to brief them, and the data )] TJ ET
BT 26.250 68.084 Td /F6 9.8 Tf  [(on that day was not useful any more. It was our problem and we were compelled to modify their data which was not correct.�)] TJ ET
BT 26.250 48.679 Td /F5 9.8 Tf  [(6-Poor adherence by physicians on agreed case definition:)] TJ ET
BT 299.338 48.679 Td /F1 9.8 Tf  [( When health teams entered the region and before they )] TJ ET
BT 26.250 36.774 Td /F1 9.8 Tf  [(undertook their daily tasks, the definitions of under surveillance diseases were explained to them but in practice, some )] TJ ET
Q
q
15.000 22.489 577.500 754.511 re W n
0.965 0.965 0.965 rg
26.250 747.845 555.000 29.155 re f
0.267 0.267 0.267 rg
0.267 0.267 0.267 RG
26.250 747.845 m 581.250 747.845 l 581.250 748.595 l 26.250 748.595 l  f
q
35.250 759.095 537.000 17.905 re W n
0.271 0.267 0.267 rg
BT 35.250 767.476 Td /F4 9.8 Tf  [(Fig. 2: Incidence of communicable diseases in East Azerbaijan earthquake stricken areas, 23 Aug-22 Sep,2012)] TJ ET
Q
BT 26.250 730.821 Td /F5 9.8 Tf  [(2- No need for additional facilities and resources:)] TJ ET
BT 254.897 730.821 Td /F1 9.8 Tf  [( The system was built based on the available facilities. No additional )] TJ ET
BT 26.250 718.917 Td /F1 9.8 Tf  [(resources were employed for its establishment that could incur costs upon the health system. Furthermore, the system experts )] TJ ET
BT 26.250 707.012 Td /F1 9.8 Tf  [(had prior familiarity with its execution process. One of experts said: )] TJ ET
BT 317.775 707.012 Td /F6 9.8 Tf  [(�In fact, we used available facilities and caused no other )] TJ ET
BT 26.250 695.107 Td /F6 9.8 Tf  [(extra costs. Everything was available from the past. We only explained the procedure to the personnel and distributed the )] TJ ET
BT 26.250 683.202 Td /F6 9.8 Tf  [(forms. The data was collected and sent by teams. It caused no extra expenses for us.�)] TJ ET
BT 26.250 663.798 Td /F5 9.8 Tf  [(3- Capability of quick data collection)] TJ ET
BT 195.296 663.798 Td /F4 9.8 Tf  [(:)] TJ ET
BT 198.542 663.798 Td /F1 9.8 Tf  [( This system collected and transferred the data related to diseases quickly so that the )] TJ ET
BT 26.250 651.893 Td /F1 9.8 Tf  [(information was supplied to the responders at most within one day. One participant said)] TJ ET
BT 403.965 651.893 Td /F6 9.8 Tf  [(: �Our information was almost up-to-)] TJ ET
BT 26.250 639.988 Td /F6 9.8 Tf  [(date. We were completely aware of the region with a one-day delay. If there was a concern, they informed us immediately by )] TJ ET
BT 26.250 628.083 Td /F6 9.8 Tf  [(phone. In general, the disease status in the area was under control.�)] TJ ET
BT 26.250 608.679 Td /F5 9.8 Tf  [(4- Increase confidence in the health system:)] TJ ET
BT 231.068 608.679 Td /F1 9.8 Tf  [( This system made officials confident about controlling the health status of )] TJ ET
BT 26.250 596.774 Td /F1 9.8 Tf  [(earthquake-stricken areas. Thus, they were assured there was no outbreak of communicable diseases. Moreover, data related )] TJ ET
BT 26.250 584.869 Td /F1 9.8 Tf  [(to the occurrence and incidence of communicable diseases indicated that performed actions were appropriate and efficient. One )] TJ ET
BT 26.250 572.964 Td /F1 9.8 Tf  [(of the physicians stated: )] TJ ET
BT 133.558 572.964 Td /F6 9.8 Tf  [(�For the first time, we faced such conditions. Since there was much destruction and it was in the )] TJ ET
BT 26.250 561.060 Td /F6 9.8 Tf  [(summer, we were concerned about the prevalence of diarrheal diseases but day after day, we became certain that the )] TJ ET
BT 26.250 549.155 Td /F6 9.8 Tf  [(conditions were controlled well.�)] TJ ET
BT 164.417 549.155 Td /F1 9.8 Tf  [( Another expert said: )] TJ ET
BT 257.091 549.155 Td /F6 9.8 Tf  [(�At the beginning, there were rumors about some diseases in the region, )] TJ ET
BT 26.250 537.250 Td /F6 9.8 Tf  [(but this system ended these rumors upon providing timely information. The officials confidently declared that there was no )] TJ ET
BT 26.250 525.345 Td /F6 9.8 Tf  [(concerning case.�)] TJ ET
BT 26.250 505.941 Td /F4 9.8 Tf  [(Weaknesses)] TJ ET
BT 26.250 486.536 Td /F5 9.8 Tf  [(1-Non-estimated denominator:)] TJ ET
BT 167.635 486.536 Td /F1 9.8 Tf  [( The region population was not specified. A lot of people from other cities were present in the )] TJ ET
BT 26.250 474.631 Td /F1 9.8 Tf  [(damaged villages and the region population changed every day. Consequently, the rates \(prevalence and incidence rates\) could )] TJ ET
BT 26.250 462.726 Td /F1 9.8 Tf  [(not be calculated. Only the raw statistics of diseases were used and the trend of the diseases was controlled based on number. )] TJ ET
BT 26.250 450.822 Td /F1 9.8 Tf  [(One participant in this study said: )] TJ ET
BT 172.568 450.822 Td /F6 9.8 Tf  [(�The population changed every day. A lot of people came from other places and resided in the )] TJ ET
BT 26.250 438.917 Td /F6 9.8 Tf  [(villages. Plenty of these villagers immigrated to Tabriz. Due to the current status of the region, they returned for a lot of reasons )] TJ ET
BT 26.250 427.012 Td /F6 9.8 Tf  [(and then resided in the villages. We truly did not know how many people resided in the region.)] TJ ET
BT 432.152 427.012 Td /F1 9.8 Tf  [(� Another expert said: )] TJ ET
BT 26.250 415.107 Td /F6 9.8 Tf  [(�We didn�t know to apply which number in the denominator. We were obliged to apply the number of all daily visits, but it was )] TJ ET
BT 26.250 403.203 Td /F6 9.8 Tf  [(not a correct number and depended on the number of visits which health teams paid on that day. If the number of visits was )] TJ ET
BT 26.250 391.298 Td /F6 9.8 Tf  [(high, the statistics of our diseases increased as well. If there were fewer visits, the number of patients decreased, too. Daily )] TJ ET
BT 26.250 379.393 Td /F6 9.8 Tf  [(statistics were not comparable at all. We knew it, but didn�t know what to do.�)] TJ ET
BT 26.250 359.988 Td /F5 9.8 Tf  [(2-)] TJ ET
BT 34.918 359.988 Td /F5 9.8 Tf  [(Non-participation of the private sector and general hospitals:)] TJ ET
BT 320.437 359.988 Td /F1 9.8 Tf  [( In this SS, the data was collected and sent only by health )] TJ ET
BT 26.250 348.084 Td /F1 9.8 Tf  [(teams which were dispatched to the region by the province health center. The private sector and public hospitals available in the )] TJ ET
BT 26.250 336.179 Td /F1 9.8 Tf  [(region did not participate in the SS. Therefore, the diseases statistics only included part of the clients who were consulted by the )] TJ ET
BT 26.250 324.274 Td /F1 9.8 Tf  [(health team and no statistics of total patients existed in the region.)] TJ ET
BT 26.250 304.869 Td /F1 9.8 Tf  [(One of the participants stated: )] TJ ET
BT 159.035 304.869 Td /F6 9.8 Tf  [(�We collected daily statistics only from our teams and didn�t intervene in clinics and hospitals. If )] TJ ET
BT 26.250 292.965 Td /F6 9.8 Tf  [(the disease was reportable according to the WHO, they informed us, but we have received no report yet.�)] TJ ET
BT 26.250 273.560 Td /F5 9.8 Tf  [(3- Non-participation of the staff of health houses)] TJ ET
BT 251.065 273.560 Td /F4 9.8 Tf  [(:)] TJ ET
BT 254.312 273.560 Td /F1 9.8 Tf  [( Despite activating the health houses and establishing health sites in all )] TJ ET
BT 26.250 261.655 Td /F1 9.8 Tf  [(villages with a population over 20 households, the implemented surveillance system did not use the health staff for data )] TJ ET
BT 26.250 249.750 Td /F1 9.8 Tf  [(collection and their relationship with the system was not defined although they were relatively familiar with the disease reporting )] TJ ET
BT 26.250 237.846 Td /F1 9.8 Tf  [(system. One of the experts said: )] TJ ET
BT 168.775 237.846 Td /F6 9.8 Tf  [(�We didn�t know at all how to communicate with the region�s rural health houses staff. They )] TJ ET
BT 26.250 225.941 Td /F6 9.8 Tf  [(also didn�t know how and what to report. It is not also clear now.�)] TJ ET
BT 26.250 206.536 Td /F5 9.8 Tf  [(4- Lack of inter-sectoral collaboration:)] TJ ET
BT 203.417 206.536 Td /F1 9.8 Tf  [( The established surveillance system had no communication with other health sites in )] TJ ET
BT 26.250 194.631 Td /F1 9.8 Tf  [(the earthquake-stricken regions and no effort was observed to communicate with them or attract their participation. For example )] TJ ET
BT 26.250 182.727 Td /F1 9.8 Tf  [(there were some other relief teams from Red Crescent that provided health care. But their patients didn�t include the SS. )] TJ ET
BT 26.250 170.822 Td /F1 9.8 Tf  [(Consequently our data about the disease incidence and prevalence was incomplete. One of the participants said: )] TJ ET
BT 516.714 170.822 Td /F6 9.8 Tf  [(�We didn�t )] TJ ET
BT 26.250 158.917 Td /F6 9.8 Tf  [(know how to communicate with health sites at all. They also didn�t know how and what to report. It is not also clear now.�)] TJ ET
BT 26.250 139.512 Td /F5 9.8 Tf  [(5- Rapid turnover of health staff:)] TJ ET
BT 176.849 139.512 Td /F1 9.8 Tf  [( Physicians and members of the health centers came from other cities of the province and )] TJ ET
BT 26.250 127.608 Td /F1 9.8 Tf  [(were usually present in the area for three days before replacing by another team. The new health teams were not familiar with )] TJ ET
BT 26.250 115.703 Td /F1 9.8 Tf  [(data collection and reporting procedures in spite of brief training on the communicable diseases SS, definitions of )] TJ ET
BT 26.250 103.798 Td /F1 9.8 Tf  [(diseases/syndromes and daily report process before starting their task. It lasted at least one day to become acquainted with the )] TJ ET
BT 26.250 91.893 Td /F1 9.8 Tf  [(tasks. As a result, the information continuity was disturbed and new and repeated cases created problems in patient )] TJ ET
BT 26.250 79.989 Td /F1 9.8 Tf  [(classification. One of the interviewees said: )] TJ ET
BT 215.371 79.989 Td /F6 9.8 Tf  [(�Almost every day, we had a new team. It took one day to brief them, and the data )] TJ ET
BT 26.250 68.084 Td /F6 9.8 Tf  [(on that day was not useful any more. It was our problem and we were compelled to modify their data which was not correct.�)] TJ ET
BT 26.250 48.679 Td /F5 9.8 Tf  [(6-Poor adherence by physicians on agreed case definition:)] TJ ET
BT 299.338 48.679 Td /F1 9.8 Tf  [( When health teams entered the region and before they )] TJ ET
BT 26.250 36.774 Td /F1 9.8 Tf  [(undertook their daily tasks, the definitions of under surveillance diseases were explained to them but in practice, some )] TJ ET
Q
q
15.000 22.489 577.500 754.511 re W n
0.965 0.965 0.965 rg
26.250 747.845 555.000 29.155 re f
0.267 0.267 0.267 rg
0.267 0.267 0.267 RG
26.250 747.845 m 581.250 747.845 l 581.250 748.595 l 26.250 748.595 l  f
q
35.250 759.095 537.000 17.905 re W n
0.271 0.267 0.267 rg
BT 35.250 767.476 Td /F4 9.8 Tf  [(Fig. 2: Incidence of communicable diseases in East Azerbaijan earthquake stricken areas, 23 Aug-22 Sep,2012)] TJ ET
Q
BT 26.250 730.821 Td /F5 9.8 Tf  [(2- No need for additional facilities and resources:)] TJ ET
BT 254.897 730.821 Td /F1 9.8 Tf  [( The system was built based on the available facilities. No additional )] TJ ET
BT 26.250 718.917 Td /F1 9.8 Tf  [(resources were employed for its establishment that could incur costs upon the health system. Furthermore, the system experts )] TJ ET
BT 26.250 707.012 Td /F1 9.8 Tf  [(had prior familiarity with its execution process. One of experts said: )] TJ ET
BT 317.775 707.012 Td /F6 9.8 Tf  [(�In fact, we used available facilities and caused no other )] TJ ET
BT 26.250 695.107 Td /F6 9.8 Tf  [(extra costs. Everything was available from the past. We only explained the procedure to the personnel and distributed the )] TJ ET
BT 26.250 683.202 Td /F6 9.8 Tf  [(forms. The data was collected and sent by teams. It caused no extra expenses for us.�)] TJ ET
BT 26.250 663.798 Td /F5 9.8 Tf  [(3- Capability of quick data collection)] TJ ET
BT 195.296 663.798 Td /F4 9.8 Tf  [(:)] TJ ET
BT 198.542 663.798 Td /F1 9.8 Tf  [( This system collected and transferred the data related to diseases quickly so that the )] TJ ET
BT 26.250 651.893 Td /F1 9.8 Tf  [(information was supplied to the responders at most within one day. One participant said)] TJ ET
BT 403.965 651.893 Td /F6 9.8 Tf  [(: �Our information was almost up-to-)] TJ ET
BT 26.250 639.988 Td /F6 9.8 Tf  [(date. We were completely aware of the region with a one-day delay. If there was a concern, they informed us immediately by )] TJ ET
BT 26.250 628.083 Td /F6 9.8 Tf  [(phone. In general, the disease status in the area was under control.�)] TJ ET
BT 26.250 608.679 Td /F5 9.8 Tf  [(4- Increase confidence in the health system:)] TJ ET
BT 231.068 608.679 Td /F1 9.8 Tf  [( This system made officials confident about controlling the health status of )] TJ ET
BT 26.250 596.774 Td /F1 9.8 Tf  [(earthquake-stricken areas. Thus, they were assured there was no outbreak of communicable diseases. Moreover, data related )] TJ ET
BT 26.250 584.869 Td /F1 9.8 Tf  [(to the occurrence and incidence of communicable diseases indicated that performed actions were appropriate and efficient. One )] TJ ET
BT 26.250 572.964 Td /F1 9.8 Tf  [(of the physicians stated: )] TJ ET
BT 133.558 572.964 Td /F6 9.8 Tf  [(�For the first time, we faced such conditions. Since there was much destruction and it was in the )] TJ ET
BT 26.250 561.060 Td /F6 9.8 Tf  [(summer, we were concerned about the prevalence of diarrheal diseases but day after day, we became certain that the )] TJ ET
BT 26.250 549.155 Td /F6 9.8 Tf  [(conditions were controlled well.�)] TJ ET
BT 164.417 549.155 Td /F1 9.8 Tf  [( Another expert said: )] TJ ET
BT 257.091 549.155 Td /F6 9.8 Tf  [(�At the beginning, there were rumors about some diseases in the region, )] TJ ET
BT 26.250 537.250 Td /F6 9.8 Tf  [(but this system ended these rumors upon providing timely information. The officials confidently declared that there was no )] TJ ET
BT 26.250 525.345 Td /F6 9.8 Tf  [(concerning case.�)] TJ ET
BT 26.250 505.941 Td /F4 9.8 Tf  [(Weaknesses)] TJ ET
BT 26.250 486.536 Td /F5 9.8 Tf  [(1-Non-estimated denominator:)] TJ ET
BT 167.635 486.536 Td /F1 9.8 Tf  [( The region population was not specified. A lot of people from other cities were present in the )] TJ ET
BT 26.250 474.631 Td /F1 9.8 Tf  [(damaged villages and the region population changed every day. Consequently, the rates \(prevalence and incidence rates\) could )] TJ ET
BT 26.250 462.726 Td /F1 9.8 Tf  [(not be calculated. Only the raw statistics of diseases were used and the trend of the diseases was controlled based on number. )] TJ ET
BT 26.250 450.822 Td /F1 9.8 Tf  [(One participant in this study said: )] TJ ET
BT 172.568 450.822 Td /F6 9.8 Tf  [(�The population changed every day. A lot of people came from other places and resided in the )] TJ ET
BT 26.250 438.917 Td /F6 9.8 Tf  [(villages. Plenty of these villagers immigrated to Tabriz. Due to the current status of the region, they returned for a lot of reasons )] TJ ET
BT 26.250 427.012 Td /F6 9.8 Tf  [(and then resided in the villages. We truly did not know how many people resided in the region.)] TJ ET
BT 432.152 427.012 Td /F1 9.8 Tf  [(� Another expert said: )] TJ ET
BT 26.250 415.107 Td /F6 9.8 Tf  [(�We didn�t know to apply which number in the denominator. We were obliged to apply the number of all daily visits, but it was )] TJ ET
BT 26.250 403.203 Td /F6 9.8 Tf  [(not a correct number and depended on the number of visits which health teams paid on that day. If the number of visits was )] TJ ET
BT 26.250 391.298 Td /F6 9.8 Tf  [(high, the statistics of our diseases increased as well. If there were fewer visits, the number of patients decreased, too. Daily )] TJ ET
BT 26.250 379.393 Td /F6 9.8 Tf  [(statistics were not comparable at all. We knew it, but didn�t know what to do.�)] TJ ET
BT 26.250 359.988 Td /F5 9.8 Tf  [(2-)] TJ ET
BT 34.918 359.988 Td /F5 9.8 Tf  [(Non-participation of the private sector and general hospitals:)] TJ ET
BT 320.437 359.988 Td /F1 9.8 Tf  [( In this SS, the data was collected and sent only by health )] TJ ET
BT 26.250 348.084 Td /F1 9.8 Tf  [(teams which were dispatched to the region by the province health center. The private sector and public hospitals available in the )] TJ ET
BT 26.250 336.179 Td /F1 9.8 Tf  [(region did not participate in the SS. Therefore, the diseases statistics only included part of the clients who were consulted by the )] TJ ET
BT 26.250 324.274 Td /F1 9.8 Tf  [(health team and no statistics of total patients existed in the region.)] TJ ET
BT 26.250 304.869 Td /F1 9.8 Tf  [(One of the participants stated: )] TJ ET
BT 159.035 304.869 Td /F6 9.8 Tf  [(�We collected daily statistics only from our teams and didn�t intervene in clinics and hospitals. If )] TJ ET
BT 26.250 292.965 Td /F6 9.8 Tf  [(the disease was reportable according to the WHO, they informed us, but we have received no report yet.�)] TJ ET
BT 26.250 273.560 Td /F5 9.8 Tf  [(3- Non-participation of the staff of health houses)] TJ ET
BT 251.065 273.560 Td /F4 9.8 Tf  [(:)] TJ ET
BT 254.312 273.560 Td /F1 9.8 Tf  [( Despite activating the health houses and establishing health sites in all )] TJ ET
BT 26.250 261.655 Td /F1 9.8 Tf  [(villages with a population over 20 households, the implemented surveillance system did not use the health staff for data )] TJ ET
BT 26.250 249.750 Td /F1 9.8 Tf  [(collection and their relationship with the system was not defined although they were relatively familiar with the disease reporting )] TJ ET
BT 26.250 237.846 Td /F1 9.8 Tf  [(system. One of the experts said: )] TJ ET
BT 168.775 237.846 Td /F6 9.8 Tf  [(�We didn�t know at all how to communicate with the region�s rural health houses staff. They )] TJ ET
BT 26.250 225.941 Td /F6 9.8 Tf  [(also didn�t know how and what to report. It is not also clear now.�)] TJ ET
BT 26.250 206.536 Td /F5 9.8 Tf  [(4- Lack of inter-sectoral collaboration:)] TJ ET
BT 203.417 206.536 Td /F1 9.8 Tf  [( The established surveillance system had no communication with other health sites in )] TJ ET
BT 26.250 194.631 Td /F1 9.8 Tf  [(the earthquake-stricken regions and no effort was observed to communicate with them or attract their participation. For example )] TJ ET
BT 26.250 182.727 Td /F1 9.8 Tf  [(there were some other relief teams from Red Crescent that provided health care. But their patients didn�t include the SS. )] TJ ET
BT 26.250 170.822 Td /F1 9.8 Tf  [(Consequently our data about the disease incidence and prevalence was incomplete. One of the participants said: )] TJ ET
BT 516.714 170.822 Td /F6 9.8 Tf  [(�We didn�t )] TJ ET
BT 26.250 158.917 Td /F6 9.8 Tf  [(know how to communicate with health sites at all. They also didn�t know how and what to report. It is not also clear now.�)] TJ ET
BT 26.250 139.512 Td /F5 9.8 Tf  [(5- Rapid turnover of health staff:)] TJ ET
BT 176.849 139.512 Td /F1 9.8 Tf  [( Physicians and members of the health centers came from other cities of the province and )] TJ ET
BT 26.250 127.608 Td /F1 9.8 Tf  [(were usually present in the area for three days before replacing by another team. The new health teams were not familiar with )] TJ ET
BT 26.250 115.703 Td /F1 9.8 Tf  [(data collection and reporting procedures in spite of brief training on the communicable diseases SS, definitions of )] TJ ET
BT 26.250 103.798 Td /F1 9.8 Tf  [(diseases/syndromes and daily report process before starting their task. It lasted at least one day to become acquainted with the )] TJ ET
BT 26.250 91.893 Td /F1 9.8 Tf  [(tasks. As a result, the information continuity was disturbed and new and repeated cases created problems in patient )] TJ ET
BT 26.250 79.989 Td /F1 9.8 Tf  [(classification. One of the interviewees said: )] TJ ET
BT 215.371 79.989 Td /F6 9.8 Tf  [(�Almost every day, we had a new team. It took one day to brief them, and the data )] TJ ET
BT 26.250 68.084 Td /F6 9.8 Tf  [(on that day was not useful any more. It was our problem and we were compelled to modify their data which was not correct.�)] TJ ET
BT 26.250 48.679 Td /F5 9.8 Tf  [(6-Poor adherence by physicians on agreed case definition:)] TJ ET
BT 299.338 48.679 Td /F1 9.8 Tf  [( When health teams entered the region and before they )] TJ ET
BT 26.250 36.774 Td /F1 9.8 Tf  [(undertook their daily tasks, the definitions of under surveillance diseases were explained to them but in practice, some )] TJ ET
Q
q
0.000 0.000 0.000 rg
BT 291.710 19.825 Td /F1 11.0 Tf  [(4)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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15.000 32.587 577.500 744.413 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(physicians categorized and reported the diseases based on their former information which was different from standard )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(definitions used in the SS. Some physicians did not also accept the definitions at all. They believed that these definitions were )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(not acceptable academically. One of the experts stated his opinion as below: )] TJ ET
BT 359.544 743.667 Td /F6 9.8 Tf  [(�Someday, I noticed that one of the health teams )] TJ ET
BT 26.250 731.762 Td /F6 9.8 Tf  [(reported 17 cases of influenza-like illness \(ILI\) whilst we didn�t have any cases until then. I was astonished and concerned, and I )] TJ ET
BT 26.250 719.857 Td /F6 9.8 Tf  [(followed up the report immediately and realized that the problem was the definition of the disease and they were not really )] TJ ET
BT 26.250 707.952 Td /F6 9.8 Tf  [(influenza-like illness \(ILI\). Such cases were intensively observed in animal bite cases.�)] TJ ET
BT 26.250 688.548 Td /F5 9.8 Tf  [(7- Inconsistency of data collection tools:)] TJ ET
BT 214.796 688.548 Td /F1 9.8 Tf  [( After the surveillance system was implemented, data collection forms changed. As )] TJ ET
BT 26.250 676.643 Td /F1 9.8 Tf  [(a result, the collected data was different from previous data and the trend of some under supervision diseases/syndromes was )] TJ ET
BT 26.250 664.738 Td /F1 9.8 Tf  [(not comparable to the previous trends anymore. This variety in the forms hindered the trend of disease control within the next )] TJ ET
BT 26.250 652.833 Td /F1 9.8 Tf  [(days in practice. One of the interviewees said: )] TJ ET
BT 227.841 652.833 Td /F6 9.8 Tf  [(�We changed our forms on September 22)] TJ ET
BT 407.212 656.722 Td /F6 8.7 Tf  [(nd)] TJ ET
BT 416.849 652.833 Td /F6 9.8 Tf  [(. After that, we set aside the daily )] TJ ET
BT 26.250 640.929 Td /F6 9.8 Tf  [(disease surveillance. We saw the reports but the data was not comparable to previous data anymore.�)] TJ ET
BT 26.250 604.326 Td /F4 12.0 Tf  [(Discussion)] TJ ET
BT 26.250 584.372 Td /F1 9.8 Tf  [(Following the twin earthquakes in the northwest of Iran in East Azerbaijan, a surveillance system was implemented by )] TJ ET
BT 26.250 572.467 Td /F1 9.8 Tf  [(governmental health organization for 19 communicable diseases/syndromes with a minimal delay. One of the most important )] TJ ET
BT 26.250 560.562 Td /F1 9.8 Tf  [(strong points of the implemented system was the familiarity of the health staff with it. Quick implementation with minimum costs )] TJ ET
BT 26.250 548.658 Td /F1 9.8 Tf  [(was another advantage of the established SS. Nevertheless, some weaknesses were recognized about the surveillance system )] TJ ET
BT 26.250 536.753 Td /F1 9.8 Tf  [(such as non estimated denominator, non-participation of the private sector and general hospitals, non-participation of the staff of )] TJ ET
BT 26.250 524.848 Td /F1 9.8 Tf  [(health houses, lack of inter-sectoral collaboration, and inconsistency of data collection tools.)] TJ ET
BT 26.250 505.443 Td /F1 9.8 Tf  [(The established surveillance system could successfully control the region�s health condition and lack of no serious epidemics )] TJ ET
BT 26.250 493.539 Td /F1 9.8 Tf  [(confirmed its success and effectiveness. The surveillance system was designed and implemented by the Ministry of Health in )] TJ ET
BT 26.250 481.634 Td /F1 9.8 Tf  [(collaboration with other subsidiary levels whilst in the 2010 Haiti earthquake)] TJ ET
0.267 0.267 0.267 rg
BT 352.466 483.141 Td /F4 8.7 Tf  [(18)] TJ ET
0.271 0.267 0.267 rg
BT 362.103 481.634 Td /F1 9.8 Tf  [( , international organizations such as PAHO, the )] TJ ET
BT 26.250 469.729 Td /F1 9.8 Tf  [(USA Diseases Management Center \(CDC\), etc also participated in establishing the SS. However, it should be considered that )] TJ ET
BT 26.250 457.824 Td /F1 9.8 Tf  [(the intensity and extent of the affected areas and people in the Haiti earthquake)] TJ ET
0.267 0.267 0.267 rg
BT 369.333 459.332 Td /F4 8.7 Tf  [(18)] TJ ET
0.271 0.267 0.267 rg
BT 378.970 457.824 Td /F1 9.8 Tf  [( was much more than the East Azerbaijan )] TJ ET
BT 26.250 445.920 Td /F1 9.8 Tf  [(earthquake.)] TJ ET
BT 26.250 426.515 Td /F1 9.8 Tf  [(The most common diseases in this earthquake were watery diarrhea, acute respiratory infections, influenza-like illness and )] TJ ET
BT 26.250 414.610 Td /F1 9.8 Tf  [(animal bite. While in the 2010 Haiti earthquake, acute respiratory infections and suspected cases of malaria and fever due to )] TJ ET
BT 26.250 402.705 Td /F1 9.8 Tf  [(unknown causes had higher incidence rates)] TJ ET
0.267 0.267 0.267 rg
BT 215.927 404.213 Td /F4 8.7 Tf  [(18)] TJ ET
0.271 0.267 0.267 rg
BT 225.564 406.594 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 227.973 404.213 Td /F4 8.7 Tf  [(23)] TJ ET
0.271 0.267 0.267 rg
BT 237.611 402.705 Td /F1 9.8 Tf  [( . In 2010 Pakistan floods, however, skin diseases, acute respiratory infections, )] TJ ET
BT 26.250 390.801 Td /F1 9.8 Tf  [(and acute diarrhea were the most frequent diseases)] TJ ET
0.267 0.267 0.267 rg
BT 251.153 392.308 Td /F4 8.7 Tf  [(10)] TJ ET
0.271 0.267 0.267 rg
BT 260.791 390.801 Td /F1 9.8 Tf  [( and during Hurricane Katrina, influenza-like syndrome showed the )] TJ ET
BT 26.250 378.896 Td /F1 9.8 Tf  [(highest incident rate)] TJ ET
0.267 0.267 0.267 rg
BT 113.503 380.403 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 118.321 378.896 Td /F1 9.8 Tf  [( . Although due to the deviation in the diseases/syndromes under surveillance, the precise comparison of )] TJ ET
BT 26.250 366.991 Td /F1 9.8 Tf  [(common diseases is not possible major common diseases in all investigated disasters included acute respiratory infections, )] TJ ET
BT 26.250 355.086 Td /F1 9.8 Tf  [(acute diarrheas and influenza-like syndrome)] TJ ET
0.267 0.267 0.267 rg
BT 217.535 356.594 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 222.354 355.086 Td /F1 9.8 Tf  [( . The speed of setting up the communicable diseases surveillance system in the )] TJ ET
BT 26.250 343.182 Td /F1 9.8 Tf  [(East Azerbaijan earthquakes was very high and it was operational within only 3 days after the earthquakes. In the Haiti )] TJ ET
BT 26.250 331.277 Td /F1 9.8 Tf  [(earthquake, the designed surveillance system was implemented after over 2 weeks in the affected areas)] TJ ET
0.267 0.267 0.267 rg
BT 476.037 332.784 Td /F4 8.7 Tf  [(23)] TJ ET
0.271 0.267 0.267 rg
BT 485.674 331.277 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 311.872 Td /F1 9.8 Tf  [(Another advantage of this surveillance system was its adaptation with the current surveillance system in Iran. Therefore, )] TJ ET
BT 26.250 299.967 Td /F1 9.8 Tf  [(familiarity with this system helped involved health staff to act more skillfully and efficiently. Data was collected manually and )] TJ ET
BT 26.250 288.063 Td /F1 9.8 Tf  [(reported daily according to the registry system of patient referral. This manual registry system could have human bias. In a )] TJ ET
BT 26.250 276.158 Td /F1 9.8 Tf  [(study about Hurricane Katrina, a syndromic surveillance system was implemented utilizing a web-based data bank and the data )] TJ ET
BT 26.250 264.253 Td /F1 9.8 Tf  [(of the diseases was recorded daily from existing population centers in the site. Although the web-based surveillance system has )] TJ ET
BT 26.250 252.348 Td /F1 9.8 Tf  [(some advantages including increased coverage, accurate and timely collected data and offering regularly feedback, the main )] TJ ET
BT 26.250 240.444 Td /F1 9.8 Tf  [(shortage of the web-bases surveillance system is disruption of telecommunication infrastructures and damaging computers. In )] TJ ET
BT 26.250 228.539 Td /F1 9.8 Tf  [(Sichuan earthquake in China, the web-based surveillance system disabled. Thus, a mobile-based surveillance system was )] TJ ET
BT 26.250 216.634 Td /F1 9.8 Tf  [(developed for monitoring communicable diseases)] TJ ET
0.267 0.267 0.267 rg
BT 240.292 218.141 Td /F4 8.7 Tf  [(20)] TJ ET
0.271 0.267 0.267 rg
BT 249.929 220.522 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 252.338 218.141 Td /F4 8.7 Tf  [(28)] TJ ET
0.271 0.267 0.267 rg
BT 261.976 216.634 Td /F1 9.8 Tf  [( . In 2010 Pakistan floods, the �Diseases Quick Warning System�, which )] TJ ET
BT 26.250 204.729 Td /F1 9.8 Tf  [(was available from the past, was strengthened)] TJ ET
0.267 0.267 0.267 rg
BT 226.759 206.237 Td /F4 8.7 Tf  [(10)] TJ ET
0.271 0.267 0.267 rg
BT 236.396 204.729 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 185.325 Td /F1 9.8 Tf  [(In the Iranian system, 19 health threatening diseases/syndromes were monitored by 30 health teams while in the established )] TJ ET
BT 26.250 173.420 Td /F1 9.8 Tf  [(surveillance system in the Haiti earthquake, 25 health conditions were monitored by 51 clinics and hospitals)] TJ ET
0.267 0.267 0.267 rg
BT 489.570 174.927 Td /F4 8.7 Tf  [(18)] TJ ET
0.271 0.267 0.267 rg
BT 499.207 173.420 Td /F1 9.8 Tf  [( . In 2010 )] TJ ET
BT 26.250 161.515 Td /F1 9.8 Tf  [(Pakistan floods, 13 diseases and syndromes were monitored. Different types and number of diseases were considered for )] TJ ET
BT 26.250 149.610 Td /F1 9.8 Tf  [(surveillance in the past disasters. These differences seem to be due to executive capabilities of the affected countries and )] TJ ET
BT 26.250 137.706 Td /F1 9.8 Tf  [(health conditions in the disaster-stricken areas. The CD incidence in the Azerbaijan earthquake had a descending trend similar )] TJ ET
BT 26.250 125.801 Td /F1 9.8 Tf  [(to past disasters \(USA, Pakistan, Haiti, etc.\). The major problem of implementing the surveillance system was related to the lack )] TJ ET
BT 26.250 113.896 Td /F1 9.8 Tf  [(of agreement on case definitions for monitoring diseases among physicians. This problem was observed in pervious disasters, )] TJ ET
BT 26.250 101.991 Td /F1 9.8 Tf  [(as well. Challenges of the surveillance system in the Pakistan floods were non-application of standard definitions for disease )] TJ ET
BT 26.250 90.087 Td /F1 9.8 Tf  [(cases, consequent differences in the reports, lack of acceptability of designed forms, and lack of data analysis in the cities. )] TJ ET
BT 26.250 78.182 Td /F1 9.8 Tf  [(More attention should be paid to training the individuals who are supposed to be involved in visiting patients at the start of the )] TJ ET
BT 26.250 66.277 Td /F1 9.8 Tf  [(surveillance system.)] TJ ET
BT 26.250 46.872 Td /F1 9.8 Tf  [(Excessive focusing on the daily reports wasted the resources. Several studies have also confirmed this finding)] TJ ET
0.267 0.267 0.267 rg
BT 501.494 48.380 Td /F4 8.7 Tf  [(8)] TJ ET
0.271 0.267 0.267 rg
BT 506.313 50.761 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 508.722 48.380 Td /F4 8.7 Tf  [(22)] TJ ET
0.271 0.267 0.267 rg
BT 518.360 50.761 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 520.769 48.380 Td /F4 8.7 Tf  [(24)] TJ ET
0.271 0.267 0.267 rg
BT 530.406 50.761 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 532.816 48.380 Td /F4 8.7 Tf  [(29)] TJ ET
0.271 0.267 0.267 rg
BT 542.453 46.872 Td /F1 9.8 Tf  [( . On )] TJ ET
Q
q
15.000 32.587 577.500 744.413 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(physicians categorized and reported the diseases based on their former information which was different from standard )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(definitions used in the SS. Some physicians did not also accept the definitions at all. They believed that these definitions were )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(not acceptable academically. One of the experts stated his opinion as below: )] TJ ET
BT 359.544 743.667 Td /F6 9.8 Tf  [(�Someday, I noticed that one of the health teams )] TJ ET
BT 26.250 731.762 Td /F6 9.8 Tf  [(reported 17 cases of influenza-like illness \(ILI\) whilst we didn�t have any cases until then. I was astonished and concerned, and I )] TJ ET
BT 26.250 719.857 Td /F6 9.8 Tf  [(followed up the report immediately and realized that the problem was the definition of the disease and they were not really )] TJ ET
BT 26.250 707.952 Td /F6 9.8 Tf  [(influenza-like illness \(ILI\). Such cases were intensively observed in animal bite cases.�)] TJ ET
BT 26.250 688.548 Td /F5 9.8 Tf  [(7- Inconsistency of data collection tools:)] TJ ET
BT 214.796 688.548 Td /F1 9.8 Tf  [( After the surveillance system was implemented, data collection forms changed. As )] TJ ET
BT 26.250 676.643 Td /F1 9.8 Tf  [(a result, the collected data was different from previous data and the trend of some under supervision diseases/syndromes was )] TJ ET
BT 26.250 664.738 Td /F1 9.8 Tf  [(not comparable to the previous trends anymore. This variety in the forms hindered the trend of disease control within the next )] TJ ET
BT 26.250 652.833 Td /F1 9.8 Tf  [(days in practice. One of the interviewees said: )] TJ ET
BT 227.841 652.833 Td /F6 9.8 Tf  [(�We changed our forms on September 22)] TJ ET
BT 407.212 656.722 Td /F6 8.7 Tf  [(nd)] TJ ET
BT 416.849 652.833 Td /F6 9.8 Tf  [(. After that, we set aside the daily )] TJ ET
BT 26.250 640.929 Td /F6 9.8 Tf  [(disease surveillance. We saw the reports but the data was not comparable to previous data anymore.�)] TJ ET
BT 26.250 604.326 Td /F4 12.0 Tf  [(Discussion)] TJ ET
BT 26.250 584.372 Td /F1 9.8 Tf  [(Following the twin earthquakes in the northwest of Iran in East Azerbaijan, a surveillance system was implemented by )] TJ ET
BT 26.250 572.467 Td /F1 9.8 Tf  [(governmental health organization for 19 communicable diseases/syndromes with a minimal delay. One of the most important )] TJ ET
BT 26.250 560.562 Td /F1 9.8 Tf  [(strong points of the implemented system was the familiarity of the health staff with it. Quick implementation with minimum costs )] TJ ET
BT 26.250 548.658 Td /F1 9.8 Tf  [(was another advantage of the established SS. Nevertheless, some weaknesses were recognized about the surveillance system )] TJ ET
BT 26.250 536.753 Td /F1 9.8 Tf  [(such as non estimated denominator, non-participation of the private sector and general hospitals, non-participation of the staff of )] TJ ET
BT 26.250 524.848 Td /F1 9.8 Tf  [(health houses, lack of inter-sectoral collaboration, and inconsistency of data collection tools.)] TJ ET
BT 26.250 505.443 Td /F1 9.8 Tf  [(The established surveillance system could successfully control the region�s health condition and lack of no serious epidemics )] TJ ET
BT 26.250 493.539 Td /F1 9.8 Tf  [(confirmed its success and effectiveness. The surveillance system was designed and implemented by the Ministry of Health in )] TJ ET
BT 26.250 481.634 Td /F1 9.8 Tf  [(collaboration with other subsidiary levels whilst in the 2010 Haiti earthquake)] TJ ET
0.267 0.267 0.267 rg
BT 352.466 483.141 Td /F4 8.7 Tf  [(18)] TJ ET
0.271 0.267 0.267 rg
BT 362.103 481.634 Td /F1 9.8 Tf  [( , international organizations such as PAHO, the )] TJ ET
BT 26.250 469.729 Td /F1 9.8 Tf  [(USA Diseases Management Center \(CDC\), etc also participated in establishing the SS. However, it should be considered that )] TJ ET
BT 26.250 457.824 Td /F1 9.8 Tf  [(the intensity and extent of the affected areas and people in the Haiti earthquake)] TJ ET
0.267 0.267 0.267 rg
BT 369.333 459.332 Td /F4 8.7 Tf  [(18)] TJ ET
0.271 0.267 0.267 rg
BT 378.970 457.824 Td /F1 9.8 Tf  [( was much more than the East Azerbaijan )] TJ ET
BT 26.250 445.920 Td /F1 9.8 Tf  [(earthquake.)] TJ ET
BT 26.250 426.515 Td /F1 9.8 Tf  [(The most common diseases in this earthquake were watery diarrhea, acute respiratory infections, influenza-like illness and )] TJ ET
BT 26.250 414.610 Td /F1 9.8 Tf  [(animal bite. While in the 2010 Haiti earthquake, acute respiratory infections and suspected cases of malaria and fever due to )] TJ ET
BT 26.250 402.705 Td /F1 9.8 Tf  [(unknown causes had higher incidence rates)] TJ ET
0.267 0.267 0.267 rg
BT 215.927 404.213 Td /F4 8.7 Tf  [(18)] TJ ET
0.271 0.267 0.267 rg
BT 225.564 406.594 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 227.973 404.213 Td /F4 8.7 Tf  [(23)] TJ ET
0.271 0.267 0.267 rg
BT 237.611 402.705 Td /F1 9.8 Tf  [( . In 2010 Pakistan floods, however, skin diseases, acute respiratory infections, )] TJ ET
BT 26.250 390.801 Td /F1 9.8 Tf  [(and acute diarrhea were the most frequent diseases)] TJ ET
0.267 0.267 0.267 rg
BT 251.153 392.308 Td /F4 8.7 Tf  [(10)] TJ ET
0.271 0.267 0.267 rg
BT 260.791 390.801 Td /F1 9.8 Tf  [( and during Hurricane Katrina, influenza-like syndrome showed the )] TJ ET
BT 26.250 378.896 Td /F1 9.8 Tf  [(highest incident rate)] TJ ET
0.267 0.267 0.267 rg
BT 113.503 380.403 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 118.321 378.896 Td /F1 9.8 Tf  [( . Although due to the deviation in the diseases/syndromes under surveillance, the precise comparison of )] TJ ET
BT 26.250 366.991 Td /F1 9.8 Tf  [(common diseases is not possible major common diseases in all investigated disasters included acute respiratory infections, )] TJ ET
BT 26.250 355.086 Td /F1 9.8 Tf  [(acute diarrheas and influenza-like syndrome)] TJ ET
0.267 0.267 0.267 rg
BT 217.535 356.594 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 222.354 355.086 Td /F1 9.8 Tf  [( . The speed of setting up the communicable diseases surveillance system in the )] TJ ET
BT 26.250 343.182 Td /F1 9.8 Tf  [(East Azerbaijan earthquakes was very high and it was operational within only 3 days after the earthquakes. In the Haiti )] TJ ET
BT 26.250 331.277 Td /F1 9.8 Tf  [(earthquake, the designed surveillance system was implemented after over 2 weeks in the affected areas)] TJ ET
0.267 0.267 0.267 rg
BT 476.037 332.784 Td /F4 8.7 Tf  [(23)] TJ ET
0.271 0.267 0.267 rg
BT 485.674 331.277 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 311.872 Td /F1 9.8 Tf  [(Another advantage of this surveillance system was its adaptation with the current surveillance system in Iran. Therefore, )] TJ ET
BT 26.250 299.967 Td /F1 9.8 Tf  [(familiarity with this system helped involved health staff to act more skillfully and efficiently. Data was collected manually and )] TJ ET
BT 26.250 288.063 Td /F1 9.8 Tf  [(reported daily according to the registry system of patient referral. This manual registry system could have human bias. In a )] TJ ET
BT 26.250 276.158 Td /F1 9.8 Tf  [(study about Hurricane Katrina, a syndromic surveillance system was implemented utilizing a web-based data bank and the data )] TJ ET
BT 26.250 264.253 Td /F1 9.8 Tf  [(of the diseases was recorded daily from existing population centers in the site. Although the web-based surveillance system has )] TJ ET
BT 26.250 252.348 Td /F1 9.8 Tf  [(some advantages including increased coverage, accurate and timely collected data and offering regularly feedback, the main )] TJ ET
BT 26.250 240.444 Td /F1 9.8 Tf  [(shortage of the web-bases surveillance system is disruption of telecommunication infrastructures and damaging computers. In )] TJ ET
BT 26.250 228.539 Td /F1 9.8 Tf  [(Sichuan earthquake in China, the web-based surveillance system disabled. Thus, a mobile-based surveillance system was )] TJ ET
BT 26.250 216.634 Td /F1 9.8 Tf  [(developed for monitoring communicable diseases)] TJ ET
0.267 0.267 0.267 rg
BT 240.292 218.141 Td /F4 8.7 Tf  [(20)] TJ ET
0.271 0.267 0.267 rg
BT 249.929 220.522 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 252.338 218.141 Td /F4 8.7 Tf  [(28)] TJ ET
0.271 0.267 0.267 rg
BT 261.976 216.634 Td /F1 9.8 Tf  [( . In 2010 Pakistan floods, the �Diseases Quick Warning System�, which )] TJ ET
BT 26.250 204.729 Td /F1 9.8 Tf  [(was available from the past, was strengthened)] TJ ET
0.267 0.267 0.267 rg
BT 226.759 206.237 Td /F4 8.7 Tf  [(10)] TJ ET
0.271 0.267 0.267 rg
BT 236.396 204.729 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 185.325 Td /F1 9.8 Tf  [(In the Iranian system, 19 health threatening diseases/syndromes were monitored by 30 health teams while in the established )] TJ ET
BT 26.250 173.420 Td /F1 9.8 Tf  [(surveillance system in the Haiti earthquake, 25 health conditions were monitored by 51 clinics and hospitals)] TJ ET
0.267 0.267 0.267 rg
BT 489.570 174.927 Td /F4 8.7 Tf  [(18)] TJ ET
0.271 0.267 0.267 rg
BT 499.207 173.420 Td /F1 9.8 Tf  [( . In 2010 )] TJ ET
BT 26.250 161.515 Td /F1 9.8 Tf  [(Pakistan floods, 13 diseases and syndromes were monitored. Different types and number of diseases were considered for )] TJ ET
BT 26.250 149.610 Td /F1 9.8 Tf  [(surveillance in the past disasters. These differences seem to be due to executive capabilities of the affected countries and )] TJ ET
BT 26.250 137.706 Td /F1 9.8 Tf  [(health conditions in the disaster-stricken areas. The CD incidence in the Azerbaijan earthquake had a descending trend similar )] TJ ET
BT 26.250 125.801 Td /F1 9.8 Tf  [(to past disasters \(USA, Pakistan, Haiti, etc.\). The major problem of implementing the surveillance system was related to the lack )] TJ ET
BT 26.250 113.896 Td /F1 9.8 Tf  [(of agreement on case definitions for monitoring diseases among physicians. This problem was observed in pervious disasters, )] TJ ET
BT 26.250 101.991 Td /F1 9.8 Tf  [(as well. Challenges of the surveillance system in the Pakistan floods were non-application of standard definitions for disease )] TJ ET
BT 26.250 90.087 Td /F1 9.8 Tf  [(cases, consequent differences in the reports, lack of acceptability of designed forms, and lack of data analysis in the cities. )] TJ ET
BT 26.250 78.182 Td /F1 9.8 Tf  [(More attention should be paid to training the individuals who are supposed to be involved in visiting patients at the start of the )] TJ ET
BT 26.250 66.277 Td /F1 9.8 Tf  [(surveillance system.)] TJ ET
BT 26.250 46.872 Td /F1 9.8 Tf  [(Excessive focusing on the daily reports wasted the resources. Several studies have also confirmed this finding)] TJ ET
0.267 0.267 0.267 rg
BT 501.494 48.380 Td /F4 8.7 Tf  [(8)] TJ ET
0.271 0.267 0.267 rg
BT 506.313 50.761 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 508.722 48.380 Td /F4 8.7 Tf  [(22)] TJ ET
0.271 0.267 0.267 rg
BT 518.360 50.761 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 520.769 48.380 Td /F4 8.7 Tf  [(24)] TJ ET
0.271 0.267 0.267 rg
BT 530.406 50.761 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 532.816 48.380 Td /F4 8.7 Tf  [(29)] TJ ET
0.271 0.267 0.267 rg
BT 542.453 46.872 Td /F1 9.8 Tf  [( . On )] TJ ET
Q
q
15.000 32.587 577.500 744.413 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(physicians categorized and reported the diseases based on their former information which was different from standard )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(definitions used in the SS. Some physicians did not also accept the definitions at all. They believed that these definitions were )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(not acceptable academically. One of the experts stated his opinion as below: )] TJ ET
BT 359.544 743.667 Td /F6 9.8 Tf  [(�Someday, I noticed that one of the health teams )] TJ ET
BT 26.250 731.762 Td /F6 9.8 Tf  [(reported 17 cases of influenza-like illness \(ILI\) whilst we didn�t have any cases until then. I was astonished and concerned, and I )] TJ ET
BT 26.250 719.857 Td /F6 9.8 Tf  [(followed up the report immediately and realized that the problem was the definition of the disease and they were not really )] TJ ET
BT 26.250 707.952 Td /F6 9.8 Tf  [(influenza-like illness \(ILI\). Such cases were intensively observed in animal bite cases.�)] TJ ET
BT 26.250 688.548 Td /F5 9.8 Tf  [(7- Inconsistency of data collection tools:)] TJ ET
BT 214.796 688.548 Td /F1 9.8 Tf  [( After the surveillance system was implemented, data collection forms changed. As )] TJ ET
BT 26.250 676.643 Td /F1 9.8 Tf  [(a result, the collected data was different from previous data and the trend of some under supervision diseases/syndromes was )] TJ ET
BT 26.250 664.738 Td /F1 9.8 Tf  [(not comparable to the previous trends anymore. This variety in the forms hindered the trend of disease control within the next )] TJ ET
BT 26.250 652.833 Td /F1 9.8 Tf  [(days in practice. One of the interviewees said: )] TJ ET
BT 227.841 652.833 Td /F6 9.8 Tf  [(�We changed our forms on September 22)] TJ ET
BT 407.212 656.722 Td /F6 8.7 Tf  [(nd)] TJ ET
BT 416.849 652.833 Td /F6 9.8 Tf  [(. After that, we set aside the daily )] TJ ET
BT 26.250 640.929 Td /F6 9.8 Tf  [(disease surveillance. We saw the reports but the data was not comparable to previous data anymore.�)] TJ ET
BT 26.250 604.326 Td /F4 12.0 Tf  [(Discussion)] TJ ET
BT 26.250 584.372 Td /F1 9.8 Tf  [(Following the twin earthquakes in the northwest of Iran in East Azerbaijan, a surveillance system was implemented by )] TJ ET
BT 26.250 572.467 Td /F1 9.8 Tf  [(governmental health organization for 19 communicable diseases/syndromes with a minimal delay. One of the most important )] TJ ET
BT 26.250 560.562 Td /F1 9.8 Tf  [(strong points of the implemented system was the familiarity of the health staff with it. Quick implementation with minimum costs )] TJ ET
BT 26.250 548.658 Td /F1 9.8 Tf  [(was another advantage of the established SS. Nevertheless, some weaknesses were recognized about the surveillance system )] TJ ET
BT 26.250 536.753 Td /F1 9.8 Tf  [(such as non estimated denominator, non-participation of the private sector and general hospitals, non-participation of the staff of )] TJ ET
BT 26.250 524.848 Td /F1 9.8 Tf  [(health houses, lack of inter-sectoral collaboration, and inconsistency of data collection tools.)] TJ ET
BT 26.250 505.443 Td /F1 9.8 Tf  [(The established surveillance system could successfully control the region�s health condition and lack of no serious epidemics )] TJ ET
BT 26.250 493.539 Td /F1 9.8 Tf  [(confirmed its success and effectiveness. The surveillance system was designed and implemented by the Ministry of Health in )] TJ ET
BT 26.250 481.634 Td /F1 9.8 Tf  [(collaboration with other subsidiary levels whilst in the 2010 Haiti earthquake)] TJ ET
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BT 362.103 481.634 Td /F1 9.8 Tf  [( , international organizations such as PAHO, the )] TJ ET
BT 26.250 469.729 Td /F1 9.8 Tf  [(USA Diseases Management Center \(CDC\), etc also participated in establishing the SS. However, it should be considered that )] TJ ET
BT 26.250 457.824 Td /F1 9.8 Tf  [(the intensity and extent of the affected areas and people in the Haiti earthquake)] TJ ET
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BT 369.333 459.332 Td /F4 8.7 Tf  [(18)] TJ ET
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BT 378.970 457.824 Td /F1 9.8 Tf  [( was much more than the East Azerbaijan )] TJ ET
BT 26.250 445.920 Td /F1 9.8 Tf  [(earthquake.)] TJ ET
BT 26.250 426.515 Td /F1 9.8 Tf  [(The most common diseases in this earthquake were watery diarrhea, acute respiratory infections, influenza-like illness and )] TJ ET
BT 26.250 414.610 Td /F1 9.8 Tf  [(animal bite. While in the 2010 Haiti earthquake, acute respiratory infections and suspected cases of malaria and fever due to )] TJ ET
BT 26.250 402.705 Td /F1 9.8 Tf  [(unknown causes had higher incidence rates)] TJ ET
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BT 227.973 404.213 Td /F4 8.7 Tf  [(23)] TJ ET
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BT 237.611 402.705 Td /F1 9.8 Tf  [( . In 2010 Pakistan floods, however, skin diseases, acute respiratory infections, )] TJ ET
BT 26.250 390.801 Td /F1 9.8 Tf  [(and acute diarrhea were the most frequent diseases)] TJ ET
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BT 260.791 390.801 Td /F1 9.8 Tf  [( and during Hurricane Katrina, influenza-like syndrome showed the )] TJ ET
BT 26.250 378.896 Td /F1 9.8 Tf  [(highest incident rate)] TJ ET
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BT 26.250 366.991 Td /F1 9.8 Tf  [(common diseases is not possible major common diseases in all investigated disasters included acute respiratory infections, )] TJ ET
BT 26.250 355.086 Td /F1 9.8 Tf  [(acute diarrheas and influenza-like syndrome)] TJ ET
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BT 217.535 356.594 Td /F4 8.7 Tf  [(9)] TJ ET
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BT 222.354 355.086 Td /F1 9.8 Tf  [( . The speed of setting up the communicable diseases surveillance system in the )] TJ ET
BT 26.250 343.182 Td /F1 9.8 Tf  [(East Azerbaijan earthquakes was very high and it was operational within only 3 days after the earthquakes. In the Haiti )] TJ ET
BT 26.250 331.277 Td /F1 9.8 Tf  [(earthquake, the designed surveillance system was implemented after over 2 weeks in the affected areas)] TJ ET
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BT 485.674 331.277 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 311.872 Td /F1 9.8 Tf  [(Another advantage of this surveillance system was its adaptation with the current surveillance system in Iran. Therefore, )] TJ ET
BT 26.250 299.967 Td /F1 9.8 Tf  [(familiarity with this system helped involved health staff to act more skillfully and efficiently. Data was collected manually and )] TJ ET
BT 26.250 288.063 Td /F1 9.8 Tf  [(reported daily according to the registry system of patient referral. This manual registry system could have human bias. In a )] TJ ET
BT 26.250 276.158 Td /F1 9.8 Tf  [(study about Hurricane Katrina, a syndromic surveillance system was implemented utilizing a web-based data bank and the data )] TJ ET
BT 26.250 264.253 Td /F1 9.8 Tf  [(of the diseases was recorded daily from existing population centers in the site. Although the web-based surveillance system has )] TJ ET
BT 26.250 252.348 Td /F1 9.8 Tf  [(some advantages including increased coverage, accurate and timely collected data and offering regularly feedback, the main )] TJ ET
BT 26.250 240.444 Td /F1 9.8 Tf  [(shortage of the web-bases surveillance system is disruption of telecommunication infrastructures and damaging computers. In )] TJ ET
BT 26.250 228.539 Td /F1 9.8 Tf  [(Sichuan earthquake in China, the web-based surveillance system disabled. Thus, a mobile-based surveillance system was )] TJ ET
BT 26.250 216.634 Td /F1 9.8 Tf  [(developed for monitoring communicable diseases)] TJ ET
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BT 26.250 204.729 Td /F1 9.8 Tf  [(was available from the past, was strengthened)] TJ ET
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BT 26.250 185.325 Td /F1 9.8 Tf  [(In the Iranian system, 19 health threatening diseases/syndromes were monitored by 30 health teams while in the established )] TJ ET
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BT 499.207 173.420 Td /F1 9.8 Tf  [( . In 2010 )] TJ ET
BT 26.250 161.515 Td /F1 9.8 Tf  [(Pakistan floods, 13 diseases and syndromes were monitored. Different types and number of diseases were considered for )] TJ ET
BT 26.250 149.610 Td /F1 9.8 Tf  [(surveillance in the past disasters. These differences seem to be due to executive capabilities of the affected countries and )] TJ ET
BT 26.250 137.706 Td /F1 9.8 Tf  [(health conditions in the disaster-stricken areas. The CD incidence in the Azerbaijan earthquake had a descending trend similar )] TJ ET
BT 26.250 125.801 Td /F1 9.8 Tf  [(to past disasters \(USA, Pakistan, Haiti, etc.\). The major problem of implementing the surveillance system was related to the lack )] TJ ET
BT 26.250 113.896 Td /F1 9.8 Tf  [(of agreement on case definitions for monitoring diseases among physicians. This problem was observed in pervious disasters, )] TJ ET
BT 26.250 101.991 Td /F1 9.8 Tf  [(as well. Challenges of the surveillance system in the Pakistan floods were non-application of standard definitions for disease )] TJ ET
BT 26.250 90.087 Td /F1 9.8 Tf  [(cases, consequent differences in the reports, lack of acceptability of designed forms, and lack of data analysis in the cities. )] TJ ET
BT 26.250 78.182 Td /F1 9.8 Tf  [(More attention should be paid to training the individuals who are supposed to be involved in visiting patients at the start of the )] TJ ET
BT 26.250 66.277 Td /F1 9.8 Tf  [(surveillance system.)] TJ ET
BT 26.250 46.872 Td /F1 9.8 Tf  [(Excessive focusing on the daily reports wasted the resources. Several studies have also confirmed this finding)] TJ ET
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BT 501.494 48.380 Td /F4 8.7 Tf  [(8)] TJ ET
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BT 26.250 767.476 Td /F1 9.8 Tf  [(the other hand, in this system, outpatient diseases received more attention that has a higher sensitivity and lower specificity)] TJ ET
0.267 0.267 0.267 rg
BT 557.869 768.983 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 562.687 767.476 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(Lack of coordination among the cities in implementing the disease surveillance system caused several water and food borne )] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(outbreaks , but the results showed that the established surveillance system in East Azerbaijan was successful in timely )] TJ ET
BT 26.250 724.262 Td /F1 9.8 Tf  [(detection and control of the monitored diseases. Likewise, the result of another study showed the challenges of the surveillance )] TJ ET
BT 26.250 712.357 Td /F1 9.8 Tf  [(system for homeless people after the Haiti earthquake. Communication and coordination difficulties between public )] TJ ET
BT 26.250 700.452 Td /F1 9.8 Tf  [(organizations, limitations in using data, incomplete reports, and the multiplicity of reporting organizations were some examples )] TJ ET
BT 26.250 688.548 Td /F1 9.8 Tf  [(of these challenges)] TJ ET
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0.271 0.267 0.267 rg
BT 127.121 688.548 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 669.143 Td /F4 9.8 Tf  [(Conclusion)] TJ ET
BT 26.250 649.738 Td /F1 9.8 Tf  [(The established surveillance system functioned well in controlling CDs in the earthquake-stricken regions of East Azerbaijan. )] TJ ET
BT 26.250 637.833 Td /F1 9.8 Tf  [(Because, no significant outbreak was reported until the end of December 2012 \(when the surveillance system was active\) )] TJ ET
BT 26.250 625.929 Td /F1 9.8 Tf  [(although it was summer and the affected regions were susceptible to outbreaks of CD. However, there were some weaknesses )] TJ ET
BT 26.250 614.024 Td /F1 9.8 Tf  [(in implementing and developing the SS.)] TJ ET
BT 26.250 594.619 Td /F1 9.8 Tf  [(Considering the susceptibility of Iran to various natural hazards, designing a web-based surveillance system for recording and )] TJ ET
BT 26.250 582.714 Td /F1 9.8 Tf  [(collecting data is essential at the time of disaster.)] TJ ET
BT 26.250 563.310 Td /F1 9.8 Tf  [(The authors also suggest that repeated exercises should be associated with this new system to validate the mortality )] TJ ET
BT 26.250 551.405 Td /F1 9.8 Tf  [(estimations and acquainting experts with the performance of the system. Periodic censuses ensure that an accurate )] TJ ET
BT 26.250 539.500 Td /F1 9.8 Tf  [(denominator is used to obtain rates in order to prevent bias estimations and increase the acceptability of surveillance system in )] TJ ET
BT 26.250 527.595 Td /F1 9.8 Tf  [(the community.)] TJ ET
BT 26.250 490.993 Td /F4 12.0 Tf  [(Footnotes)] TJ ET
BT 26.250 471.039 Td /F1 9.8 Tf  [([1] -Islamic Republic of Iran has a unique health system in EMRO. It is divided to three levels. The first level includes Health )] TJ ET
BT 26.250 459.134 Td /F1 9.8 Tf  [(Houses and Rural Health Centers in rural areas. A Health House is set up in a village or a group of villages which is responsible )] TJ ET
BT 26.250 447.229 Td /F1 9.8 Tf  [(for providing PHC for 500-2500 rural population. There is a Rural Health Center for every 4-7 Health Houses. They have )] TJ ET
BT 26.250 435.324 Td /F1 9.8 Tf  [(general physicians and also health technicians. The staff of the Health House is trained for two years and is called �Behvarz�)] TJ ET
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BT 26.250 411.515 Td /F1 9.8 Tf  [(are staffed by technicians. The Districts Health Centers and General Hospitals are in the second level. This level is responsible )] TJ ET
BT 26.250 399.610 Td /F1 9.8 Tf  [(for having supervision on the first level of the health system and also providing more special treatment for referral patients. The )] TJ ET
BT 26.250 387.705 Td /F1 9.8 Tf  [(third level includes health deputies of medical universities, and educational and specialty hospitals)] TJ ET
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0.271 0.267 0.267 rg
BT 458.579 391.594 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 460.988 389.213 Td /F4 8.7 Tf  [(26)] TJ ET
0.271 0.267 0.267 rg
BT 470.626 387.705 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 351.103 Td /F4 12.0 Tf  [(Corresponding author)] TJ ET
BT 26.250 331.149 Td /F1 9.8 Tf  [(Ali Ardalan, MD, PhD. 78, Italia Ave, Department of Disaster Public Health, School of Public Health, Tehran University of )] TJ ET
BT 26.250 319.244 Td /F1 9.8 Tf  [(Medical Sciences, Tehran, Iran. E-mail: aardalan@tums.ac.ir)] TJ ET
BT 26.250 282.641 Td /F4 12.0 Tf  [(Acknowledgements)] TJ ET
BT 26.250 262.687 Td /F1 9.8 Tf  [(The authors wish to acknowledge the grammatical revision of the manuscript in English facilitated by the Consultation Unit, )] TJ ET
BT 26.250 250.782 Td /F1 9.8 Tf  [(Office of Publications and Scientometrics, Tehran University of Medical Sciences.)] TJ ET
BT 26.250 221.680 Td /F4 12.0 Tf  [(APPENDIX 1)] TJ ET
BT 26.250 184.528 Td /F4 12.0 Tf  [(Interview Guide)] TJ ET
BT 26.250 164.574 Td /F1 9.8 Tf  [(Interviewees name and family:���������������������������������������)] TJ ET
BT 26.250 145.169 Td /F1 9.8 Tf  [(Education:)] TJ ET
BT 26.250 125.764 Td /F1 9.8 Tf  [(Interview Date:)] TJ ET
BT 26.250 106.359 Td /F1 9.8 Tf  [(Starting Time:)] TJ ET
BT 26.250 86.955 Td /F1 9.8 Tf  [(Ending Time:)] TJ ET
BT 26.250 67.550 Td /F1 9.8 Tf  [(General Questions)] TJ ET
BT 32.206 48.163 Td /F1 9.8 Tf  [(1.)] TJ ET
BT 45.750 48.145 Td /F1 9.8 Tf  [(How was the process of establishing the disease surveillance system?)] TJ ET
Q
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0.267 0.267 0.267 rg
BT 557.869 768.983 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 562.687 767.476 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(Lack of coordination among the cities in implementing the disease surveillance system caused several water and food borne )] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(outbreaks , but the results showed that the established surveillance system in East Azerbaijan was successful in timely )] TJ ET
BT 26.250 724.262 Td /F1 9.8 Tf  [(detection and control of the monitored diseases. Likewise, the result of another study showed the challenges of the surveillance )] TJ ET
BT 26.250 712.357 Td /F1 9.8 Tf  [(system for homeless people after the Haiti earthquake. Communication and coordination difficulties between public )] TJ ET
BT 26.250 700.452 Td /F1 9.8 Tf  [(organizations, limitations in using data, incomplete reports, and the multiplicity of reporting organizations were some examples )] TJ ET
BT 26.250 688.548 Td /F1 9.8 Tf  [(of these challenges)] TJ ET
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BT 110.256 690.055 Td /F4 8.7 Tf  [(9)] TJ ET
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BT 115.075 692.436 Td /F1 8.7 Tf  [(,)] TJ ET
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BT 117.484 690.055 Td /F4 8.7 Tf  [(30)] TJ ET
0.271 0.267 0.267 rg
BT 127.121 688.548 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 669.143 Td /F4 9.8 Tf  [(Conclusion)] TJ ET
BT 26.250 649.738 Td /F1 9.8 Tf  [(The established surveillance system functioned well in controlling CDs in the earthquake-stricken regions of East Azerbaijan. )] TJ ET
BT 26.250 637.833 Td /F1 9.8 Tf  [(Because, no significant outbreak was reported until the end of December 2012 \(when the surveillance system was active\) )] TJ ET
BT 26.250 625.929 Td /F1 9.8 Tf  [(although it was summer and the affected regions were susceptible to outbreaks of CD. However, there were some weaknesses )] TJ ET
BT 26.250 614.024 Td /F1 9.8 Tf  [(in implementing and developing the SS.)] TJ ET
BT 26.250 594.619 Td /F1 9.8 Tf  [(Considering the susceptibility of Iran to various natural hazards, designing a web-based surveillance system for recording and )] TJ ET
BT 26.250 582.714 Td /F1 9.8 Tf  [(collecting data is essential at the time of disaster.)] TJ ET
BT 26.250 563.310 Td /F1 9.8 Tf  [(The authors also suggest that repeated exercises should be associated with this new system to validate the mortality )] TJ ET
BT 26.250 551.405 Td /F1 9.8 Tf  [(estimations and acquainting experts with the performance of the system. Periodic censuses ensure that an accurate )] TJ ET
BT 26.250 539.500 Td /F1 9.8 Tf  [(denominator is used to obtain rates in order to prevent bias estimations and increase the acceptability of surveillance system in )] TJ ET
BT 26.250 527.595 Td /F1 9.8 Tf  [(the community.)] TJ ET
BT 26.250 490.993 Td /F4 12.0 Tf  [(Footnotes)] TJ ET
BT 26.250 471.039 Td /F1 9.8 Tf  [([1] -Islamic Republic of Iran has a unique health system in EMRO. It is divided to three levels. The first level includes Health )] TJ ET
BT 26.250 459.134 Td /F1 9.8 Tf  [(Houses and Rural Health Centers in rural areas. A Health House is set up in a village or a group of villages which is responsible )] TJ ET
BT 26.250 447.229 Td /F1 9.8 Tf  [(for providing PHC for 500-2500 rural population. There is a Rural Health Center for every 4-7 Health Houses. They have )] TJ ET
BT 26.250 435.324 Td /F1 9.8 Tf  [(general physicians and also health technicians. The staff of the Health House is trained for two years and is called �Behvarz�)] TJ ET
0.267 0.267 0.267 rg
BT 562.198 436.832 Td /F4 8.7 Tf  [(26)] TJ ET
0.271 0.267 0.267 rg
BT 571.835 435.324 Td /F1 9.8 Tf  [( . )] TJ ET
BT 26.250 423.420 Td /F1 9.8 Tf  [(In urban areas, Health Posts and Urban Health Centers play the role of Health Houses and Rural Health Centers. Health Posts )] TJ ET
BT 26.250 411.515 Td /F1 9.8 Tf  [(are staffed by technicians. The Districts Health Centers and General Hospitals are in the second level. This level is responsible )] TJ ET
BT 26.250 399.610 Td /F1 9.8 Tf  [(for having supervision on the first level of the health system and also providing more special treatment for referral patients. The )] TJ ET
BT 26.250 387.705 Td /F1 9.8 Tf  [(third level includes health deputies of medical universities, and educational and specialty hospitals)] TJ ET
0.267 0.267 0.267 rg
BT 448.942 389.213 Td /F4 8.7 Tf  [(27)] TJ ET
0.271 0.267 0.267 rg
BT 458.579 391.594 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 460.988 389.213 Td /F4 8.7 Tf  [(26)] TJ ET
0.271 0.267 0.267 rg
BT 470.626 387.705 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 351.103 Td /F4 12.0 Tf  [(Corresponding author)] TJ ET
BT 26.250 331.149 Td /F1 9.8 Tf  [(Ali Ardalan, MD, PhD. 78, Italia Ave, Department of Disaster Public Health, School of Public Health, Tehran University of )] TJ ET
BT 26.250 319.244 Td /F1 9.8 Tf  [(Medical Sciences, Tehran, Iran. E-mail: aardalan@tums.ac.ir)] TJ ET
BT 26.250 282.641 Td /F4 12.0 Tf  [(Acknowledgements)] TJ ET
BT 26.250 262.687 Td /F1 9.8 Tf  [(The authors wish to acknowledge the grammatical revision of the manuscript in English facilitated by the Consultation Unit, )] TJ ET
BT 26.250 250.782 Td /F1 9.8 Tf  [(Office of Publications and Scientometrics, Tehran University of Medical Sciences.)] TJ ET
BT 26.250 221.680 Td /F4 12.0 Tf  [(APPENDIX 1)] TJ ET
BT 26.250 184.528 Td /F4 12.0 Tf  [(Interview Guide)] TJ ET
BT 26.250 164.574 Td /F1 9.8 Tf  [(Interviewees name and family:���������������������������������������)] TJ ET
BT 26.250 145.169 Td /F1 9.8 Tf  [(Education:)] TJ ET
BT 26.250 125.764 Td /F1 9.8 Tf  [(Interview Date:)] TJ ET
BT 26.250 106.359 Td /F1 9.8 Tf  [(Starting Time:)] TJ ET
BT 26.250 86.955 Td /F1 9.8 Tf  [(Ending Time:)] TJ ET
BT 26.250 67.550 Td /F1 9.8 Tf  [(General Questions)] TJ ET
BT 32.206 48.163 Td /F1 9.8 Tf  [(1.)] TJ ET
BT 45.750 48.145 Td /F1 9.8 Tf  [(How was the process of establishing the disease surveillance system?)] TJ ET
Q
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BT 26.250 767.476 Td /F1 9.8 Tf  [(the other hand, in this system, outpatient diseases received more attention that has a higher sensitivity and lower specificity)] TJ ET
0.267 0.267 0.267 rg
BT 557.869 768.983 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 562.687 767.476 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(Lack of coordination among the cities in implementing the disease surveillance system caused several water and food borne )] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(outbreaks , but the results showed that the established surveillance system in East Azerbaijan was successful in timely )] TJ ET
BT 26.250 724.262 Td /F1 9.8 Tf  [(detection and control of the monitored diseases. Likewise, the result of another study showed the challenges of the surveillance )] TJ ET
BT 26.250 712.357 Td /F1 9.8 Tf  [(system for homeless people after the Haiti earthquake. Communication and coordination difficulties between public )] TJ ET
BT 26.250 700.452 Td /F1 9.8 Tf  [(organizations, limitations in using data, incomplete reports, and the multiplicity of reporting organizations were some examples )] TJ ET
BT 26.250 688.548 Td /F1 9.8 Tf  [(of these challenges)] TJ ET
0.267 0.267 0.267 rg
BT 110.256 690.055 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 115.075 692.436 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 117.484 690.055 Td /F4 8.7 Tf  [(30)] TJ ET
0.271 0.267 0.267 rg
BT 127.121 688.548 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 669.143 Td /F4 9.8 Tf  [(Conclusion)] TJ ET
BT 26.250 649.738 Td /F1 9.8 Tf  [(The established surveillance system functioned well in controlling CDs in the earthquake-stricken regions of East Azerbaijan. )] TJ ET
BT 26.250 637.833 Td /F1 9.8 Tf  [(Because, no significant outbreak was reported until the end of December 2012 \(when the surveillance system was active\) )] TJ ET
BT 26.250 625.929 Td /F1 9.8 Tf  [(although it was summer and the affected regions were susceptible to outbreaks of CD. However, there were some weaknesses )] TJ ET
BT 26.250 614.024 Td /F1 9.8 Tf  [(in implementing and developing the SS.)] TJ ET
BT 26.250 594.619 Td /F1 9.8 Tf  [(Considering the susceptibility of Iran to various natural hazards, designing a web-based surveillance system for recording and )] TJ ET
BT 26.250 582.714 Td /F1 9.8 Tf  [(collecting data is essential at the time of disaster.)] TJ ET
BT 26.250 563.310 Td /F1 9.8 Tf  [(The authors also suggest that repeated exercises should be associated with this new system to validate the mortality )] TJ ET
BT 26.250 551.405 Td /F1 9.8 Tf  [(estimations and acquainting experts with the performance of the system. Periodic censuses ensure that an accurate )] TJ ET
BT 26.250 539.500 Td /F1 9.8 Tf  [(denominator is used to obtain rates in order to prevent bias estimations and increase the acceptability of surveillance system in )] TJ ET
BT 26.250 527.595 Td /F1 9.8 Tf  [(the community.)] TJ ET
BT 26.250 490.993 Td /F4 12.0 Tf  [(Footnotes)] TJ ET
BT 26.250 471.039 Td /F1 9.8 Tf  [([1] -Islamic Republic of Iran has a unique health system in EMRO. It is divided to three levels. The first level includes Health )] TJ ET
BT 26.250 459.134 Td /F1 9.8 Tf  [(Houses and Rural Health Centers in rural areas. A Health House is set up in a village or a group of villages which is responsible )] TJ ET
BT 26.250 447.229 Td /F1 9.8 Tf  [(for providing PHC for 500-2500 rural population. There is a Rural Health Center for every 4-7 Health Houses. They have )] TJ ET
BT 26.250 435.324 Td /F1 9.8 Tf  [(general physicians and also health technicians. The staff of the Health House is trained for two years and is called �Behvarz�)] TJ ET
0.267 0.267 0.267 rg
BT 562.198 436.832 Td /F4 8.7 Tf  [(26)] TJ ET
0.271 0.267 0.267 rg
BT 571.835 435.324 Td /F1 9.8 Tf  [( . )] TJ ET
BT 26.250 423.420 Td /F1 9.8 Tf  [(In urban areas, Health Posts and Urban Health Centers play the role of Health Houses and Rural Health Centers. Health Posts )] TJ ET
BT 26.250 411.515 Td /F1 9.8 Tf  [(are staffed by technicians. The Districts Health Centers and General Hospitals are in the second level. This level is responsible )] TJ ET
BT 26.250 399.610 Td /F1 9.8 Tf  [(for having supervision on the first level of the health system and also providing more special treatment for referral patients. The )] TJ ET
BT 26.250 387.705 Td /F1 9.8 Tf  [(third level includes health deputies of medical universities, and educational and specialty hospitals)] TJ ET
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BT 448.942 389.213 Td /F4 8.7 Tf  [(27)] TJ ET
0.271 0.267 0.267 rg
BT 458.579 391.594 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 460.988 389.213 Td /F4 8.7 Tf  [(26)] TJ ET
0.271 0.267 0.267 rg
BT 470.626 387.705 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 351.103 Td /F4 12.0 Tf  [(Corresponding author)] TJ ET
BT 26.250 331.149 Td /F1 9.8 Tf  [(Ali Ardalan, MD, PhD. 78, Italia Ave, Department of Disaster Public Health, School of Public Health, Tehran University of )] TJ ET
BT 26.250 319.244 Td /F1 9.8 Tf  [(Medical Sciences, Tehran, Iran. E-mail: aardalan@tums.ac.ir)] TJ ET
BT 26.250 282.641 Td /F4 12.0 Tf  [(Acknowledgements)] TJ ET
BT 26.250 262.687 Td /F1 9.8 Tf  [(The authors wish to acknowledge the grammatical revision of the manuscript in English facilitated by the Consultation Unit, )] TJ ET
BT 26.250 250.782 Td /F1 9.8 Tf  [(Office of Publications and Scientometrics, Tehran University of Medical Sciences.)] TJ ET
BT 26.250 221.680 Td /F4 12.0 Tf  [(APPENDIX 1)] TJ ET
BT 26.250 184.528 Td /F4 12.0 Tf  [(Interview Guide)] TJ ET
BT 26.250 164.574 Td /F1 9.8 Tf  [(Interviewees name and family:���������������������������������������)] TJ ET
BT 26.250 145.169 Td /F1 9.8 Tf  [(Education:)] TJ ET
BT 26.250 125.764 Td /F1 9.8 Tf  [(Interview Date:)] TJ ET
BT 26.250 106.359 Td /F1 9.8 Tf  [(Starting Time:)] TJ ET
BT 26.250 86.955 Td /F1 9.8 Tf  [(Ending Time:)] TJ ET
BT 26.250 67.550 Td /F1 9.8 Tf  [(General Questions)] TJ ET
BT 32.206 48.163 Td /F1 9.8 Tf  [(1.)] TJ ET
BT 45.750 48.145 Td /F1 9.8 Tf  [(How was the process of establishing the disease surveillance system?)] TJ ET
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BT 291.710 19.825 Td /F1 11.0 Tf  [(6)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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BT 32.206 767.494 Td /F1 9.8 Tf  [(2.)] TJ ET
BT 45.750 767.476 Td /F1 9.8 Tf  [(How is the operational trend of this surveillance system in collecting data?)] TJ ET
BT 32.206 751.839 Td /F1 9.8 Tf  [(3.)] TJ ET
BT 45.750 751.821 Td /F1 9.8 Tf  [(What is your idea about the strong points of the established surveillance system?)] TJ ET
BT 32.206 736.184 Td /F1 9.8 Tf  [(4.)] TJ ET
BT 45.750 736.167 Td /F1 9.8 Tf  [(What is your idea about the weak points of the established surveillance system?)] TJ ET
BT 26.250 713.012 Td /F1 9.8 Tf  [(Depending on responses to initial questions, additional clarifying questions will be asked for better clearance during interviews )] TJ ET
BT 26.250 701.107 Td /F1 9.8 Tf  [(whenever needed.)] TJ ET
BT 26.250 664.505 Td /F4 12.0 Tf  [(References)] TJ ET
BT 26.250 637.050 Td /F1 9.8 Tf  [(1.)] TJ ET
BT 38.132 637.050 Td /F1 9.8 Tf  [(East Azerbaijan Governor. The latest news from disaster affected areas. [Online] 2012. [Cited 2012 Sep 30]; available from: )] TJ ET
BT 26.250 625.146 Td /F1 9.8 Tf  [(https://ostan-as.gov.ir/?MD=218type=news&BasesId=TypeID=2&id=9305)] TJ ET
BT 26.250 605.741 Td /F1 9.8 Tf  [(2.)] TJ ET
BT 38.132 605.741 Td /F1 9.8 Tf  [(International institute of earthquake engineering and seismology \(2012\). Urgent report. Cited [2012/08/23],Available from: )] TJ ET
BT 26.250 593.836 Td /F1 9.8 Tf  [(www.iiees.ac.ir/images/stories/EQBank/EQreport/ahar/IIEES_Recon.Rep_Varzeghan _21-5-91-EQ.s_as_of_31-5-91.pdf)] TJ ET
BT 26.250 574.431 Td /F1 9.8 Tf  [(3.)] TJ ET
BT 38.132 574.431 Td /F1 9.8 Tf  [(Myint NW, Kaewkungwal J, Singhasivanon P, Chaisiri K, Panjapiyakul P, Siriwan P, Mallik AK, Nyein SL, Mu TT. Are there )] TJ ET
BT 26.250 562.527 Td /F1 9.8 Tf  [(any changes in burden and management of communicable diseases in areas affected by Cyclone Nargis. Confl Health. 2011; 5 )] TJ ET
BT 26.250 550.622 Td /F1 9.8 Tf  [(\(1\): 9.)] TJ ET
BT 26.250 531.217 Td /F1 9.8 Tf  [(4.)] TJ ET
BT 38.132 531.217 Td /F1 9.8 Tf  [(Kouadio IK, Aljunid S, Kamigaki T, Hammad K, Oshitani H. Infectious diseases following natural disasters: prevention and )] TJ ET
BT 26.250 519.312 Td /F1 9.8 Tf  [(control measures. Expert Rev Anti Infect Ther. 2012; 10 \(1\): 95-104.)] TJ ET
BT 26.250 499.908 Td /F1 9.8 Tf  [(5.)] TJ ET
BT 38.132 499.908 Td /F1 9.8 Tf  [(Schneider MC, Tirado Mc, Rereddy S, Dugas R, Borda MI, Peralta EA, Aldighieri S, Cosivi O. Natural disasters and )] TJ ET
BT 26.250 488.003 Td /F1 9.8 Tf  [(communicable diseases in the Americas: Contribution of veterinary public health. Veterinaria Italiana. 2012; 48 \(2\): 193-218.)] TJ ET
BT 26.250 468.598 Td /F1 9.8 Tf  [(6.)] TJ ET
BT 38.132 468.598 Td /F1 9.8 Tf  [(Kouadio IK, Koffi AK, Attoh-Toure H, Kamigaki T, Oshitani H. Outbreak of measles and rubella in refugee transit camps. )] TJ ET
BT 26.250 456.693 Td /F1 9.8 Tf  [(Epidemiol Infect. 2009; 137 \(11\): 1593-601.)] TJ ET
BT 26.250 437.289 Td /F1 9.8 Tf  [(7.)] TJ ET
BT 38.132 437.289 Td /F1 9.8 Tf  [(Von Seidlein L, Deen JL. Considerations for oral cholera vaccine use during outbreak after Earthquake in Haiti, 2010?2011. )] TJ ET
BT 26.250 425.384 Td /F1 9.8 Tf  [(Emerging Infectious Diseases. 2012; 18\(7\): 1211-14.)] TJ ET
BT 26.250 405.979 Td /F1 9.8 Tf  [(8.)] TJ ET
BT 38.132 405.979 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention \(CDC\). Surveillance in hurricane evacuation centers-louisiana, September-)] TJ ET
BT 26.250 394.074 Td /F1 9.8 Tf  [(October 2005. MMWR. 2006; 55 \(02\): 32-5.)] TJ ET
BT 26.250 374.670 Td /F1 9.8 Tf  [(9.)] TJ ET
BT 38.132 374.670 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention \(CDC\). Surveillance for illness and injury after hurricane Katrina. New Orleans, )] TJ ET
BT 26.250 362.765 Td /F1 9.8 Tf  [(Louisiana, September 8-25, 2005. MMWR. 2005; 54 \(40\): 1018-20.)] TJ ET
BT 26.250 343.360 Td /F1 9.8 Tf  [(10.)] TJ ET
BT 43.553 343.360 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention \(CDC\). Early Warning Disease Surveillance after a Flood Emergency � )] TJ ET
BT 26.250 331.455 Td /F1 9.8 Tf  [(Pakistan 2010. MMWR. 2012; 61 \(49\): 1002-7.)] TJ ET
BT 26.250 312.051 Td /F1 9.8 Tf  [(11.)] TJ ET
BT 43.553 312.051 Td /F1 9.8 Tf  [(Yan G, Mei X. Mobile device-based reporting system for Sichuan earthquake-affected areas infectious diseases reporting in )] TJ ET
BT 26.250 300.146 Td /F1 9.8 Tf  [(China. Biomed Environ Sci. 2012; 25 \(6\): 724-29.)] TJ ET
BT 26.250 280.741 Td /F1 9.8 Tf  [(12.)] TJ ET
BT 43.553 280.741 Td /F1 9.8 Tf  [(Tohma K, Suzuki A, Otani K, Okamoto M, Nukiwa N, Kamigaki T, Kawamura K, Nakagawa H, Oshitani H. Monitoring of )] TJ ET
BT 26.250 268.836 Td /F1 9.8 Tf  [(influenza virus in the aftermath of Great East Japan earthquake. JPN J Infect Dis. 2012; 65: 542-44.)] TJ ET
BT 26.250 249.432 Td /F1 9.8 Tf  [(13.)] TJ ET
BT 43.553 249.432 Td /F1 9.8 Tf  [(Akbari A. Farshad A. Asadi-Lari M. The devastation of Bam: An overview of health issues 1 month after the earthquake. )] TJ ET
BT 26.250 237.527 Td /F1 9.8 Tf  [(Public Health. 2004; 118: 403-8)] TJ ET
BT 26.250 218.122 Td /F1 9.8 Tf  [(14.)] TJ ET
BT 43.553 218.122 Td /F1 9.8 Tf  [(Information bulletin. Iran: Earthquake. IRCS. [Online] 2005. [Cited 2012 Sep 30]; available from: )] TJ ET
BT 26.250 206.217 Td /F1 9.8 Tf  [(https://reliefweb.int/sites/reliefweb.int/files/resources/732905DEC8C4F81285256FB60057A30D-ifrc-irn-28feb.pdf)] TJ ET
BT 26.250 186.813 Td /F1 9.8 Tf  [(15.)] TJ ET
BT 43.553 186.813 Td /F1 9.8 Tf  [(Corbin A, Strauss J. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory 3rd ed. )] TJ ET
BT 26.250 174.908 Td /F1 9.8 Tf  [(Sage Publications. USA. 2008)] TJ ET
BT 26.250 155.503 Td /F1 9.8 Tf  [(16.)] TJ ET
BT 43.553 155.503 Td /F1 9.8 Tf  [(Elo S, Kyng�s H. The qualitative content analysis process. Journal of Advanced Nursing. 2008; 62 \(1\): 107-15.)] TJ ET
BT 26.250 136.098 Td /F1 9.8 Tf  [(17.)] TJ ET
BT 43.553 136.098 Td /F1 9.8 Tf  [(Ardalan A, Moradian MJ, Goya MM, Nadafi K, et al. National public health disaster and emergency operation plan. Tehran. )] TJ ET
BT 26.250 124.194 Td /F1 9.8 Tf  [(Razenahan; 2012.)] TJ ET
BT 26.250 104.789 Td /F1 9.8 Tf  [(18.)] TJ ET
BT 43.553 104.789 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention \(CDC\). Launching a National Surveillance System After an Earthquake Haiti, )] TJ ET
BT 26.250 92.884 Td /F1 9.8 Tf  [(2010. MMWR. 2010; 59 \(30\): 933-35.)] TJ ET
BT 26.250 73.479 Td /F1 9.8 Tf  [(19.)] TJ ET
BT 43.553 73.479 Td /F1 9.8 Tf  [(Malterud K. Qualitative research: Standards, challenges and guidelines. The Lancet. 2001; 358: 483-88.)] TJ ET
BT 26.250 54.075 Td /F1 9.8 Tf  [(20.)] TJ ET
BT 43.553 54.075 Td /F1 9.8 Tf  [(Townes D, Existe A, Boncy J, Magloire R, Vely JF, Amsalu R, De Tavernier M, Muigai J, Hoibak S, Albert M, McMorrow M, )] TJ ET
Q
q
15.000 39.789 577.500 737.211 re W n
0.271 0.267 0.267 rg
BT 32.206 767.494 Td /F1 9.8 Tf  [(2.)] TJ ET
BT 45.750 767.476 Td /F1 9.8 Tf  [(How is the operational trend of this surveillance system in collecting data?)] TJ ET
BT 32.206 751.839 Td /F1 9.8 Tf  [(3.)] TJ ET
BT 45.750 751.821 Td /F1 9.8 Tf  [(What is your idea about the strong points of the established surveillance system?)] TJ ET
BT 32.206 736.184 Td /F1 9.8 Tf  [(4.)] TJ ET
BT 45.750 736.167 Td /F1 9.8 Tf  [(What is your idea about the weak points of the established surveillance system?)] TJ ET
BT 26.250 713.012 Td /F1 9.8 Tf  [(Depending on responses to initial questions, additional clarifying questions will be asked for better clearance during interviews )] TJ ET
BT 26.250 701.107 Td /F1 9.8 Tf  [(whenever needed.)] TJ ET
BT 26.250 664.505 Td /F4 12.0 Tf  [(References)] TJ ET
BT 26.250 637.050 Td /F1 9.8 Tf  [(1.)] TJ ET
BT 38.132 637.050 Td /F1 9.8 Tf  [(East Azerbaijan Governor. The latest news from disaster affected areas. [Online] 2012. [Cited 2012 Sep 30]; available from: )] TJ ET
BT 26.250 625.146 Td /F1 9.8 Tf  [(https://ostan-as.gov.ir/?MD=218type=news&BasesId=TypeID=2&id=9305)] TJ ET
BT 26.250 605.741 Td /F1 9.8 Tf  [(2.)] TJ ET
BT 38.132 605.741 Td /F1 9.8 Tf  [(International institute of earthquake engineering and seismology \(2012\). Urgent report. Cited [2012/08/23],Available from: )] TJ ET
BT 26.250 593.836 Td /F1 9.8 Tf  [(www.iiees.ac.ir/images/stories/EQBank/EQreport/ahar/IIEES_Recon.Rep_Varzeghan _21-5-91-EQ.s_as_of_31-5-91.pdf)] TJ ET
BT 26.250 574.431 Td /F1 9.8 Tf  [(3.)] TJ ET
BT 38.132 574.431 Td /F1 9.8 Tf  [(Myint NW, Kaewkungwal J, Singhasivanon P, Chaisiri K, Panjapiyakul P, Siriwan P, Mallik AK, Nyein SL, Mu TT. Are there )] TJ ET
BT 26.250 562.527 Td /F1 9.8 Tf  [(any changes in burden and management of communicable diseases in areas affected by Cyclone Nargis. Confl Health. 2011; 5 )] TJ ET
BT 26.250 550.622 Td /F1 9.8 Tf  [(\(1\): 9.)] TJ ET
BT 26.250 531.217 Td /F1 9.8 Tf  [(4.)] TJ ET
BT 38.132 531.217 Td /F1 9.8 Tf  [(Kouadio IK, Aljunid S, Kamigaki T, Hammad K, Oshitani H. Infectious diseases following natural disasters: prevention and )] TJ ET
BT 26.250 519.312 Td /F1 9.8 Tf  [(control measures. Expert Rev Anti Infect Ther. 2012; 10 \(1\): 95-104.)] TJ ET
BT 26.250 499.908 Td /F1 9.8 Tf  [(5.)] TJ ET
BT 38.132 499.908 Td /F1 9.8 Tf  [(Schneider MC, Tirado Mc, Rereddy S, Dugas R, Borda MI, Peralta EA, Aldighieri S, Cosivi O. Natural disasters and )] TJ ET
BT 26.250 488.003 Td /F1 9.8 Tf  [(communicable diseases in the Americas: Contribution of veterinary public health. Veterinaria Italiana. 2012; 48 \(2\): 193-218.)] TJ ET
BT 26.250 468.598 Td /F1 9.8 Tf  [(6.)] TJ ET
BT 38.132 468.598 Td /F1 9.8 Tf  [(Kouadio IK, Koffi AK, Attoh-Toure H, Kamigaki T, Oshitani H. Outbreak of measles and rubella in refugee transit camps. )] TJ ET
BT 26.250 456.693 Td /F1 9.8 Tf  [(Epidemiol Infect. 2009; 137 \(11\): 1593-601.)] TJ ET
BT 26.250 437.289 Td /F1 9.8 Tf  [(7.)] TJ ET
BT 38.132 437.289 Td /F1 9.8 Tf  [(Von Seidlein L, Deen JL. Considerations for oral cholera vaccine use during outbreak after Earthquake in Haiti, 2010?2011. )] TJ ET
BT 26.250 425.384 Td /F1 9.8 Tf  [(Emerging Infectious Diseases. 2012; 18\(7\): 1211-14.)] TJ ET
BT 26.250 405.979 Td /F1 9.8 Tf  [(8.)] TJ ET
BT 38.132 405.979 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention \(CDC\). Surveillance in hurricane evacuation centers-louisiana, September-)] TJ ET
BT 26.250 394.074 Td /F1 9.8 Tf  [(October 2005. MMWR. 2006; 55 \(02\): 32-5.)] TJ ET
BT 26.250 374.670 Td /F1 9.8 Tf  [(9.)] TJ ET
BT 38.132 374.670 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention \(CDC\). Surveillance for illness and injury after hurricane Katrina. New Orleans, )] TJ ET
BT 26.250 362.765 Td /F1 9.8 Tf  [(Louisiana, September 8-25, 2005. MMWR. 2005; 54 \(40\): 1018-20.)] TJ ET
BT 26.250 343.360 Td /F1 9.8 Tf  [(10.)] TJ ET
BT 43.553 343.360 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention \(CDC\). Early Warning Disease Surveillance after a Flood Emergency � )] TJ ET
BT 26.250 331.455 Td /F1 9.8 Tf  [(Pakistan 2010. MMWR. 2012; 61 \(49\): 1002-7.)] TJ ET
BT 26.250 312.051 Td /F1 9.8 Tf  [(11.)] TJ ET
BT 43.553 312.051 Td /F1 9.8 Tf  [(Yan G, Mei X. Mobile device-based reporting system for Sichuan earthquake-affected areas infectious diseases reporting in )] TJ ET
BT 26.250 300.146 Td /F1 9.8 Tf  [(China. Biomed Environ Sci. 2012; 25 \(6\): 724-29.)] TJ ET
BT 26.250 280.741 Td /F1 9.8 Tf  [(12.)] TJ ET
BT 43.553 280.741 Td /F1 9.8 Tf  [(Tohma K, Suzuki A, Otani K, Okamoto M, Nukiwa N, Kamigaki T, Kawamura K, Nakagawa H, Oshitani H. Monitoring of )] TJ ET
BT 26.250 268.836 Td /F1 9.8 Tf  [(influenza virus in the aftermath of Great East Japan earthquake. JPN J Infect Dis. 2012; 65: 542-44.)] TJ ET
BT 26.250 249.432 Td /F1 9.8 Tf  [(13.)] TJ ET
BT 43.553 249.432 Td /F1 9.8 Tf  [(Akbari A. Farshad A. Asadi-Lari M. The devastation of Bam: An overview of health issues 1 month after the earthquake. )] TJ ET
BT 26.250 237.527 Td /F1 9.8 Tf  [(Public Health. 2004; 118: 403-8)] TJ ET
BT 26.250 218.122 Td /F1 9.8 Tf  [(14.)] TJ ET
BT 43.553 218.122 Td /F1 9.8 Tf  [(Information bulletin. Iran: Earthquake. IRCS. [Online] 2005. [Cited 2012 Sep 30]; available from: )] TJ ET
BT 26.250 206.217 Td /F1 9.8 Tf  [(https://reliefweb.int/sites/reliefweb.int/files/resources/732905DEC8C4F81285256FB60057A30D-ifrc-irn-28feb.pdf)] TJ ET
BT 26.250 186.813 Td /F1 9.8 Tf  [(15.)] TJ ET
BT 43.553 186.813 Td /F1 9.8 Tf  [(Corbin A, Strauss J. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory 3rd ed. )] TJ ET
BT 26.250 174.908 Td /F1 9.8 Tf  [(Sage Publications. USA. 2008)] TJ ET
BT 26.250 155.503 Td /F1 9.8 Tf  [(16.)] TJ ET
BT 43.553 155.503 Td /F1 9.8 Tf  [(Elo S, Kyng�s H. The qualitative content analysis process. Journal of Advanced Nursing. 2008; 62 \(1\): 107-15.)] TJ ET
BT 26.250 136.098 Td /F1 9.8 Tf  [(17.)] TJ ET
BT 43.553 136.098 Td /F1 9.8 Tf  [(Ardalan A, Moradian MJ, Goya MM, Nadafi K, et al. National public health disaster and emergency operation plan. Tehran. )] TJ ET
BT 26.250 124.194 Td /F1 9.8 Tf  [(Razenahan; 2012.)] TJ ET
BT 26.250 104.789 Td /F1 9.8 Tf  [(18.)] TJ ET
BT 43.553 104.789 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention \(CDC\). Launching a National Surveillance System After an Earthquake Haiti, )] TJ ET
BT 26.250 92.884 Td /F1 9.8 Tf  [(2010. MMWR. 2010; 59 \(30\): 933-35.)] TJ ET
BT 26.250 73.479 Td /F1 9.8 Tf  [(19.)] TJ ET
BT 43.553 73.479 Td /F1 9.8 Tf  [(Malterud K. Qualitative research: Standards, challenges and guidelines. The Lancet. 2001; 358: 483-88.)] TJ ET
BT 26.250 54.075 Td /F1 9.8 Tf  [(20.)] TJ ET
BT 43.553 54.075 Td /F1 9.8 Tf  [(Townes D, Existe A, Boncy J, Magloire R, Vely JF, Amsalu R, De Tavernier M, Muigai J, Hoibak S, Albert M, McMorrow M, )] TJ ET
Q
q
15.000 39.789 577.500 737.211 re W n
0.271 0.267 0.267 rg
BT 32.206 767.494 Td /F1 9.8 Tf  [(2.)] TJ ET
BT 45.750 767.476 Td /F1 9.8 Tf  [(How is the operational trend of this surveillance system in collecting data?)] TJ ET
BT 32.206 751.839 Td /F1 9.8 Tf  [(3.)] TJ ET
BT 45.750 751.821 Td /F1 9.8 Tf  [(What is your idea about the strong points of the established surveillance system?)] TJ ET
BT 32.206 736.184 Td /F1 9.8 Tf  [(4.)] TJ ET
BT 45.750 736.167 Td /F1 9.8 Tf  [(What is your idea about the weak points of the established surveillance system?)] TJ ET
BT 26.250 713.012 Td /F1 9.8 Tf  [(Depending on responses to initial questions, additional clarifying questions will be asked for better clearance during interviews )] TJ ET
BT 26.250 701.107 Td /F1 9.8 Tf  [(whenever needed.)] TJ ET
BT 26.250 664.505 Td /F4 12.0 Tf  [(References)] TJ ET
BT 26.250 637.050 Td /F1 9.8 Tf  [(1.)] TJ ET
BT 38.132 637.050 Td /F1 9.8 Tf  [(East Azerbaijan Governor. The latest news from disaster affected areas. [Online] 2012. [Cited 2012 Sep 30]; available from: )] TJ ET
BT 26.250 625.146 Td /F1 9.8 Tf  [(https://ostan-as.gov.ir/?MD=218type=news&BasesId=TypeID=2&id=9305)] TJ ET
BT 26.250 605.741 Td /F1 9.8 Tf  [(2.)] TJ ET
BT 38.132 605.741 Td /F1 9.8 Tf  [(International institute of earthquake engineering and seismology \(2012\). Urgent report. Cited [2012/08/23],Available from: )] TJ ET
BT 26.250 593.836 Td /F1 9.8 Tf  [(www.iiees.ac.ir/images/stories/EQBank/EQreport/ahar/IIEES_Recon.Rep_Varzeghan _21-5-91-EQ.s_as_of_31-5-91.pdf)] TJ ET
BT 26.250 574.431 Td /F1 9.8 Tf  [(3.)] TJ ET
BT 38.132 574.431 Td /F1 9.8 Tf  [(Myint NW, Kaewkungwal J, Singhasivanon P, Chaisiri K, Panjapiyakul P, Siriwan P, Mallik AK, Nyein SL, Mu TT. Are there )] TJ ET
BT 26.250 562.527 Td /F1 9.8 Tf  [(any changes in burden and management of communicable diseases in areas affected by Cyclone Nargis. Confl Health. 2011; 5 )] TJ ET
BT 26.250 550.622 Td /F1 9.8 Tf  [(\(1\): 9.)] TJ ET
BT 26.250 531.217 Td /F1 9.8 Tf  [(4.)] TJ ET
BT 38.132 531.217 Td /F1 9.8 Tf  [(Kouadio IK, Aljunid S, Kamigaki T, Hammad K, Oshitani H. Infectious diseases following natural disasters: prevention and )] TJ ET
BT 26.250 519.312 Td /F1 9.8 Tf  [(control measures. Expert Rev Anti Infect Ther. 2012; 10 \(1\): 95-104.)] TJ ET
BT 26.250 499.908 Td /F1 9.8 Tf  [(5.)] TJ ET
BT 38.132 499.908 Td /F1 9.8 Tf  [(Schneider MC, Tirado Mc, Rereddy S, Dugas R, Borda MI, Peralta EA, Aldighieri S, Cosivi O. Natural disasters and )] TJ ET
BT 26.250 488.003 Td /F1 9.8 Tf  [(communicable diseases in the Americas: Contribution of veterinary public health. Veterinaria Italiana. 2012; 48 \(2\): 193-218.)] TJ ET
BT 26.250 468.598 Td /F1 9.8 Tf  [(6.)] TJ ET
BT 38.132 468.598 Td /F1 9.8 Tf  [(Kouadio IK, Koffi AK, Attoh-Toure H, Kamigaki T, Oshitani H. Outbreak of measles and rubella in refugee transit camps. )] TJ ET
BT 26.250 456.693 Td /F1 9.8 Tf  [(Epidemiol Infect. 2009; 137 \(11\): 1593-601.)] TJ ET
BT 26.250 437.289 Td /F1 9.8 Tf  [(7.)] TJ ET
BT 38.132 437.289 Td /F1 9.8 Tf  [(Von Seidlein L, Deen JL. Considerations for oral cholera vaccine use during outbreak after Earthquake in Haiti, 2010?2011. )] TJ ET
BT 26.250 425.384 Td /F1 9.8 Tf  [(Emerging Infectious Diseases. 2012; 18\(7\): 1211-14.)] TJ ET
BT 26.250 405.979 Td /F1 9.8 Tf  [(8.)] TJ ET
BT 38.132 405.979 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention \(CDC\). Surveillance in hurricane evacuation centers-louisiana, September-)] TJ ET
BT 26.250 394.074 Td /F1 9.8 Tf  [(October 2005. MMWR. 2006; 55 \(02\): 32-5.)] TJ ET
BT 26.250 374.670 Td /F1 9.8 Tf  [(9.)] TJ ET
BT 38.132 374.670 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention \(CDC\). Surveillance for illness and injury after hurricane Katrina. New Orleans, )] TJ ET
BT 26.250 362.765 Td /F1 9.8 Tf  [(Louisiana, September 8-25, 2005. MMWR. 2005; 54 \(40\): 1018-20.)] TJ ET
BT 26.250 343.360 Td /F1 9.8 Tf  [(10.)] TJ ET
BT 43.553 343.360 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention \(CDC\). Early Warning Disease Surveillance after a Flood Emergency � )] TJ ET
BT 26.250 331.455 Td /F1 9.8 Tf  [(Pakistan 2010. MMWR. 2012; 61 \(49\): 1002-7.)] TJ ET
BT 26.250 312.051 Td /F1 9.8 Tf  [(11.)] TJ ET
BT 43.553 312.051 Td /F1 9.8 Tf  [(Yan G, Mei X. Mobile device-based reporting system for Sichuan earthquake-affected areas infectious diseases reporting in )] TJ ET
BT 26.250 300.146 Td /F1 9.8 Tf  [(China. Biomed Environ Sci. 2012; 25 \(6\): 724-29.)] TJ ET
BT 26.250 280.741 Td /F1 9.8 Tf  [(12.)] TJ ET
BT 43.553 280.741 Td /F1 9.8 Tf  [(Tohma K, Suzuki A, Otani K, Okamoto M, Nukiwa N, Kamigaki T, Kawamura K, Nakagawa H, Oshitani H. Monitoring of )] TJ ET
BT 26.250 268.836 Td /F1 9.8 Tf  [(influenza virus in the aftermath of Great East Japan earthquake. JPN J Infect Dis. 2012; 65: 542-44.)] TJ ET
BT 26.250 249.432 Td /F1 9.8 Tf  [(13.)] TJ ET
BT 43.553 249.432 Td /F1 9.8 Tf  [(Akbari A. Farshad A. Asadi-Lari M. The devastation of Bam: An overview of health issues 1 month after the earthquake. )] TJ ET
BT 26.250 237.527 Td /F1 9.8 Tf  [(Public Health. 2004; 118: 403-8)] TJ ET
BT 26.250 218.122 Td /F1 9.8 Tf  [(14.)] TJ ET
BT 43.553 218.122 Td /F1 9.8 Tf  [(Information bulletin. Iran: Earthquake. IRCS. [Online] 2005. [Cited 2012 Sep 30]; available from: )] TJ ET
BT 26.250 206.217 Td /F1 9.8 Tf  [(https://reliefweb.int/sites/reliefweb.int/files/resources/732905DEC8C4F81285256FB60057A30D-ifrc-irn-28feb.pdf)] TJ ET
BT 26.250 186.813 Td /F1 9.8 Tf  [(15.)] TJ ET
BT 43.553 186.813 Td /F1 9.8 Tf  [(Corbin A, Strauss J. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory 3rd ed. )] TJ ET
BT 26.250 174.908 Td /F1 9.8 Tf  [(Sage Publications. USA. 2008)] TJ ET
BT 26.250 155.503 Td /F1 9.8 Tf  [(16.)] TJ ET
BT 43.553 155.503 Td /F1 9.8 Tf  [(Elo S, Kyng�s H. The qualitative content analysis process. Journal of Advanced Nursing. 2008; 62 \(1\): 107-15.)] TJ ET
BT 26.250 136.098 Td /F1 9.8 Tf  [(17.)] TJ ET
BT 43.553 136.098 Td /F1 9.8 Tf  [(Ardalan A, Moradian MJ, Goya MM, Nadafi K, et al. National public health disaster and emergency operation plan. Tehran. )] TJ ET
BT 26.250 124.194 Td /F1 9.8 Tf  [(Razenahan; 2012.)] TJ ET
BT 26.250 104.789 Td /F1 9.8 Tf  [(18.)] TJ ET
BT 43.553 104.789 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention \(CDC\). Launching a National Surveillance System After an Earthquake Haiti, )] TJ ET
BT 26.250 92.884 Td /F1 9.8 Tf  [(2010. MMWR. 2010; 59 \(30\): 933-35.)] TJ ET
BT 26.250 73.479 Td /F1 9.8 Tf  [(19.)] TJ ET
BT 43.553 73.479 Td /F1 9.8 Tf  [(Malterud K. Qualitative research: Standards, challenges and guidelines. The Lancet. 2001; 358: 483-88.)] TJ ET
BT 26.250 54.075 Td /F1 9.8 Tf  [(20.)] TJ ET
BT 43.553 54.075 Td /F1 9.8 Tf  [(Townes D, Existe A, Boncy J, Magloire R, Vely JF, Amsalu R, De Tavernier M, Muigai J, Hoibak S, Albert M, McMorrow M, )] TJ ET
Q
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BT 291.710 19.825 Td /F1 11.0 Tf  [(7)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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BT 26.250 748.071 Td /F1 9.8 Tf  [(21.)] TJ ET
BT 43.553 748.071 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention \(CDC\). Surveillance in Hurricane Evacuation Centers - Louisiana, September-)] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(October 2005. MMWR. 2006; 55 \(02\): 32-35.)] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(22.)] TJ ET
BT 43.553 716.762 Td /F1 9.8 Tf  [(Tappero JW, Tauxe RV. Lessons learned during public health response to cholera epidemic in Haiti and the Dominican )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(Republic. Emerg Infect Dis. 2011; 17: 2105 �12.)] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(23.)] TJ ET
BT 43.553 685.452 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention \(CDC\). Rapid establishment of an internally displaced person's diseases )] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(surveillance system after an earthquake- Haiti 2010. MMWR. 2012; 59 \(30\): 939-45.)] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(24.)] TJ ET
BT 43.553 654.143 Td /F1 9.8 Tf  [(Brown C, Ripp J, Kazura J. Perspectives on Haiti Two Years after the Earthquake. Am J Trop Med Hyg. 2012; 86 \(1\): 5�6.)] TJ ET
BT 26.250 634.738 Td /F1 9.8 Tf  [(25.)] TJ ET
BT 43.553 634.738 Td /F1 9.8 Tf  [(Lyons S, Zidouh A, Ali Bejaoui M, Ben Abdallah M, Amine S, Garbouj M, Fitzner J.. Implications of the International Health )] TJ ET
BT 26.250 622.833 Td /F1 9.8 Tf  [(Regulations \(2005\) for communicable disease surveillance systems: Tunisia�s experience. Public Health. 2007; 121: 690�95.)] TJ ET
BT 26.250 603.429 Td /F1 9.8 Tf  [(26.)] TJ ET
BT 43.553 603.429 Td /F1 9.8 Tf  [(UNICEF. Iran�s Excellent Primary Health Care System. [Online] 2014. [Cited 2014 Aug 30]; available from: )] TJ ET
BT 26.250 591.524 Td /F1 9.8 Tf  [(https://www.unicef.org/iran/media_4427.html)] TJ ET
BT 26.250 572.119 Td /F1 9.8 Tf  [(27.)] TJ ET
BT 43.553 572.119 Td /F1 9.8 Tf  [(Mosadeghrad AM. Factors influencing healthcare service quality. Int J Health Policy Manag. 2014; 3\(2\): 77�89.)] TJ ET
BT 26.250 552.714 Td /F1 9.8 Tf  [(28.)] TJ ET
BT 43.553 552.714 Td /F1 9.8 Tf  [(Iwata O, Oki T, Ishiki A, Shimanuki M, Fuchimukai T, Chosa T, Chid S, et al. Infection surveillance after a natural disaster: )] TJ ET
BT 26.250 540.810 Td /F1 9.8 Tf  [(lessons learnt from the Great East Japan Earthquake of 2011. Bull World Health Organ. 2013; 91:784�789.)] TJ ET
BT 26.250 521.405 Td /F1 9.8 Tf  [(29.)] TJ ET
BT 43.553 521.405 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention \(CDC\). Surveillance in Hurricane Evacuation Centers - Louisiana, September-)] TJ ET
BT 26.250 509.500 Td /F1 9.8 Tf  [(October 2005. MMWR. 2006; 55 \(02\): 32-35.)] TJ ET
BT 26.250 490.095 Td /F1 9.8 Tf  [(30.)] TJ ET
BT 43.553 490.095 Td /F1 9.8 Tf  [(Lyons S, Zidouh A, Ali Bejaoui M, Ben Abdallah M, Amine S, Garbouj M, Fitzner J. Implications of the International Health )] TJ ET
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BT 26.250 748.071 Td /F1 9.8 Tf  [(21.)] TJ ET
BT 43.553 748.071 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention \(CDC\). Surveillance in Hurricane Evacuation Centers - Louisiana, September-)] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(October 2005. MMWR. 2006; 55 \(02\): 32-35.)] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(22.)] TJ ET
BT 43.553 716.762 Td /F1 9.8 Tf  [(Tappero JW, Tauxe RV. Lessons learned during public health response to cholera epidemic in Haiti and the Dominican )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(Republic. Emerg Infect Dis. 2011; 17: 2105 �12.)] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(23.)] TJ ET
BT 43.553 685.452 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention \(CDC\). Rapid establishment of an internally displaced person's diseases )] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(surveillance system after an earthquake- Haiti 2010. MMWR. 2012; 59 \(30\): 939-45.)] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(24.)] TJ ET
BT 43.553 654.143 Td /F1 9.8 Tf  [(Brown C, Ripp J, Kazura J. Perspectives on Haiti Two Years after the Earthquake. Am J Trop Med Hyg. 2012; 86 \(1\): 5�6.)] TJ ET
BT 26.250 634.738 Td /F1 9.8 Tf  [(25.)] TJ ET
BT 43.553 634.738 Td /F1 9.8 Tf  [(Lyons S, Zidouh A, Ali Bejaoui M, Ben Abdallah M, Amine S, Garbouj M, Fitzner J.. Implications of the International Health )] TJ ET
BT 26.250 622.833 Td /F1 9.8 Tf  [(Regulations \(2005\) for communicable disease surveillance systems: Tunisia�s experience. Public Health. 2007; 121: 690�95.)] TJ ET
BT 26.250 603.429 Td /F1 9.8 Tf  [(26.)] TJ ET
BT 43.553 603.429 Td /F1 9.8 Tf  [(UNICEF. Iran�s Excellent Primary Health Care System. [Online] 2014. [Cited 2014 Aug 30]; available from: )] TJ ET
BT 26.250 591.524 Td /F1 9.8 Tf  [(https://www.unicef.org/iran/media_4427.html)] TJ ET
BT 26.250 572.119 Td /F1 9.8 Tf  [(27.)] TJ ET
BT 43.553 572.119 Td /F1 9.8 Tf  [(Mosadeghrad AM. Factors influencing healthcare service quality. Int J Health Policy Manag. 2014; 3\(2\): 77�89.)] TJ ET
BT 26.250 552.714 Td /F1 9.8 Tf  [(28.)] TJ ET
BT 43.553 552.714 Td /F1 9.8 Tf  [(Iwata O, Oki T, Ishiki A, Shimanuki M, Fuchimukai T, Chosa T, Chid S, et al. Infection surveillance after a natural disaster: )] TJ ET
BT 26.250 540.810 Td /F1 9.8 Tf  [(lessons learnt from the Great East Japan Earthquake of 2011. Bull World Health Organ. 2013; 91:784�789.)] TJ ET
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BT 43.553 521.405 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention \(CDC\). Surveillance in Hurricane Evacuation Centers - Louisiana, September-)] TJ ET
BT 26.250 509.500 Td /F1 9.8 Tf  [(October 2005. MMWR. 2006; 55 \(02\): 32-35.)] TJ ET
BT 26.250 490.095 Td /F1 9.8 Tf  [(30.)] TJ ET
BT 43.553 490.095 Td /F1 9.8 Tf  [(Lyons S, Zidouh A, Ali Bejaoui M, Ben Abdallah M, Amine S, Garbouj M, Fitzner J. Implications of the International Health )] TJ ET
BT 26.250 478.191 Td /F1 9.8 Tf  [(Regulations \(2005\) for communicable disease SSs: Tunisia�s experience. Public Health. 2007; 121: 690�95.)] TJ ET
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BT 26.250 767.476 Td /F1 9.8 Tf  [(Slutsker L, Kachur SP, Chang M. Malaria survey in post earthquake Haiti-2010. Am J Trop Med Hyg. 2012; 86: 29 � 31.)] TJ ET
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BT 43.553 748.071 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention \(CDC\). Surveillance in Hurricane Evacuation Centers - Louisiana, September-)] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(October 2005. MMWR. 2006; 55 \(02\): 32-35.)] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(22.)] TJ ET
BT 43.553 716.762 Td /F1 9.8 Tf  [(Tappero JW, Tauxe RV. Lessons learned during public health response to cholera epidemic in Haiti and the Dominican )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(Republic. Emerg Infect Dis. 2011; 17: 2105 �12.)] TJ ET
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BT 43.553 685.452 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention \(CDC\). Rapid establishment of an internally displaced person's diseases )] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(surveillance system after an earthquake- Haiti 2010. MMWR. 2012; 59 \(30\): 939-45.)] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(24.)] TJ ET
BT 43.553 654.143 Td /F1 9.8 Tf  [(Brown C, Ripp J, Kazura J. Perspectives on Haiti Two Years after the Earthquake. Am J Trop Med Hyg. 2012; 86 \(1\): 5�6.)] TJ ET
BT 26.250 634.738 Td /F1 9.8 Tf  [(25.)] TJ ET
BT 43.553 634.738 Td /F1 9.8 Tf  [(Lyons S, Zidouh A, Ali Bejaoui M, Ben Abdallah M, Amine S, Garbouj M, Fitzner J.. Implications of the International Health )] TJ ET
BT 26.250 622.833 Td /F1 9.8 Tf  [(Regulations \(2005\) for communicable disease surveillance systems: Tunisia�s experience. Public Health. 2007; 121: 690�95.)] TJ ET
BT 26.250 603.429 Td /F1 9.8 Tf  [(26.)] TJ ET
BT 43.553 603.429 Td /F1 9.8 Tf  [(UNICEF. Iran�s Excellent Primary Health Care System. [Online] 2014. [Cited 2014 Aug 30]; available from: )] TJ ET
BT 26.250 591.524 Td /F1 9.8 Tf  [(https://www.unicef.org/iran/media_4427.html)] TJ ET
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