Original Article

Incidence, Mortality, and Burden of Crimean Congo Hemorrhagic Fever and Its Geographical Distribution in Iran during 2009-2015


Background: This study aimed at estimating the incidence, mortality, burden, and geographical distribution of Crimean Congo Hemorrhagic Fever (CCHF) using Disability Adjusted Life Years (DALYs) in Iran 2009-2015.

Methods: CCHF-related DALYs was calculated using a method developed by WHO for the investigation of Global Burden of Diseases (GBD). DALYs was calculated through adding years of life lost due to premature death (YLLs) to years lived with disability (YLDs). To calculate YLD, the average duration of the disease and its disability weight were set at 25 d and 0.613, respectively. The data on the incidence and mortality were collected from the CCHF surveillance system from the governmental section.

Results: The highest and the lowest incidence rates of CCHF were observed in 2009 (122 cases) and 2010 (254 cases), respectively. Moreover, the lowest and highest mortality rates were reported in 2009 (20 cases) and 2012 (52 cases), respectively. The mean rate of fatality from CCHF observed between 2009 and 2015 was about 21.1%. In addition, the lowest and highest DALYs were observed in 2009 (483 cases) and 2010 (1156 cases), respectively. CCHF incidence, DALYs, and mortality rate over the studied period were higher among males than females. CCHF-related DALYs did not have an equal distribution in all provinces of Iran; some provinces were suffering from a higher burden of the disease.

Conclusion: It is recommended to improve the CCHF surveillance system, identify high-risk areas, practice early diagnosis and intervention, develop vaccines, control, and fight tick, and screen livestock to control and prevent the spread of this disease. 


1. Al-Abri SS, Al Abaidani I, Fazlalipour M et al (2017). Current status of Crimean-Congo haemorrhagic fever in the World Health Organization Eastern Mediterranean Region: issues, challenges, and future directions. Int J Infect Dis, 58:82-9.
2. World Health Organization (2013). Crimean-Congo haemorrhagic fever. Media Center. http://www.who.int/mediacentre/factsheets/fs208/en/
3. Hoogstraal H (1979). The Epidemiology of Tick-Borne Crimean-Congo Hemorrhagic Fever in Asia, Europe, and Africa. J Med Entomol, 15(4):307-417.
4. Ergönül Ö (2006). Crimean-Congo haemorrhagic fever. Lancet Infect Dis, 6(4):203-214.
5. World Health Organization (2017). Geographic distribution of Crimean-Congo Haemorrhagic Fever. http://www.who.int/csr/disease/crimean_congoHF/Global_CCHFRisk_2017.jpg?ua=1
6. Dokuzoguz B, Celikbas AK, Gök ŞE et al (2013). Severity scoring index for Crimean-Congo hemorrhagic fever and the impact of ribavirin and corticosteroids on fatality. Clin Infect Dis, 57(9):1270-1274.
7. Humolli I, Dedushaj I, Zupanac TA, Muçaj S (2010). Epidemiological, serological and herd immunity of Crimean-Congo haemorrhagic fever in Kosovo. Med Arh, 64(2): 91-93.
8. Salomon JA, Vos T, Hogan DR et al (2013). Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burdenof Disease Study 2010. Lancet, 380(9859): 2129-2143.
9. Murray CJ (1994). Quantifying the burden of disease: the technical basis for disability-adjusted life years. Bull World Health Organ, 72(3): 429-45.
10. Murray CJ, Vos T, Lozano R et al (2012). Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 380(9859): 2197-2223.
11. Naghavi M, Abolhassani F, Pourmalek F et al (2009). The burden of disease and injury in Iran 2003. Popul Health Metr, 7:9.
12. Iran Statistical Yearbook (2016). Statistical Center of Iran. https://www.amar.org.ir/english/Iran-Statistical-Yearbook
13. Chinikar S, Ghiasi SM, Hewson R et al (2010). Crimean-Congo hemorrhagic fever in Iran and neighboring countries. J Clin Virol, 47(2):110-4.
14. Fajs L, Humolli I, Saksida A et al (2014). Prevalence of Crimean-Congo hemorrhagic fever virus in healthy population, livestock and ticks in Kosovo. PLoS One, 9(11):e110982.
15. Yilmaz GR, Buzgan T, Irmak H et al (2009). The epidemiology of Crimean-Congo hemorrhagic fever in Turkey, 2002–2007. Int J Infect Dis, 13(3):380-6.
16. World Health Organization (2010). Crimean-Congo haemorrhagic fever and Dengue in Pakistan. Emergencies preparedness, response. http://www.who.int/csr/don/2010_10_25a/en/.
17. Mostafavi E, Haghdoost A, Khakifirouz S, Chinikar S (2013). Spatial analysis of Crimean Congo hemorrhagic fever in Iran. Am J Trop Med Hyg, 89(6): 1135-1141.
18. Nabeth P, Cheikh DO, Lo B et al (2004). Crimean-Congo hemorrhagic fever, mauritania. Emerg Infect Dis, 10(12):2143-49.
19. Vescio FM, Busani L, Mughini-Gras L et al (2012). Environmental correlates of Crimean-Congo haemorrhagic fever incidence in Bulgaria. BMC Public Health, 12: 1116.
20. Ansari H, Shahbaz B, Izadi S et al (2014). Crimean-Congo hemorrhagic fever and its relationship with climate factors in southeast Iran: a 13-year experience. J Infect Dev Ctries, 8(6): 749-757.
21. Hijmans RJ, Cameron SE, Parra JL et al (2005). Very high resolution interpolated climate surfaces for global land areas. Int J Climatol, 25:1965-1978.
22. Messina JP, Pigott DM, Golding N et al (2015). The global distribution of Crimean-Congo hemorrhagic fever. Trans R Soc Trop Med Hyg, 109(8):503-513.
23. Estrada-Pena A, Zatansever Z, Gargili A et al (2007). Modeling the spatial distribution of Crimean-Congo hemorrhagic fever outbreaks in Turkey. Vector Borne Zoonotic Dis, 7(4): 667-678.
24. Yagci-Caglayik D, Korukluoglu G, Uyar Y (2014). Seroprevalence and risk factors of Crimean–Congo hemorrhagic fever in selected seven provinces in Turkey. J Med Virol, 86(2): 306-314.
25. Nabeth P,Thior M,Faye O,Simon F (2004). Human crimean-congo hemorrhagic fever, senegal. Emerg Infect Dis, 10(10):1881-82.
IssueVol 48 No Supple 1 (2019) QRcode
SectionOriginal Article(s)
Incidence Mortality Disability-adjusted life years Crimean Congo hemorrhagic fever Iran

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
MORADI G, PIROOZI B, ALINIA C, SAFARI H, NABAVI M, ZEINALI M, GHANBRI MK, MOHAMADI BOLBANABAD A, ZAREI B, GOUYA MM. Incidence, Mortality, and Burden of Crimean Congo Hemorrhagic Fever and Its Geographical Distribution in Iran during 2009-2015. Iran J Public Health. 2019;48(Supple 1):44-52.