Original Article

Incidence, Mortality, and Burden of Severe Acute Respiratory Infection in Iran in 2015


Background: Severe Acute Respiratory Infection (SARI) is responsible for mortality and hospital admissions in millions of people across the world. The present study, for the first time, aimed at estimating the incidence, mortality, and burden of SARI in Iran in 2015.

Methods: Disability Adjusted Life Years (DALYs) was used as an index to estimate the burden of SARI. The SARI-related DALYs was calculated using a method developed by the WHO for assessing the Global Burden of Diseases. DALYs are calculated as the sum of the Years Lost due to Disability (YLDs) and the Years of Life Lost (YLLs) due to premature mortality. The data on the incidence and mortality were obtained from the SARI surveillance system of Iran's Ministry of Health and Medical Education. The average duration until remission or death and the disease disability weight were set at four weeks and 0.373, respectively.

Results: In 2015, the incidence of SARI was 21309 and 20885 among males and females, respectively. Moreover, 773 males and 737 females died from this disease (Case fatality rate was about 0.035). Total SARI-related DALYs in males and females was 17264 and 16720, respectively. Furthermore, YLLs was responsible for more than 96% of SARI-related DALYs in 2015.

Conclusion: There was no significant difference between males and females in terms of the incidence, mortality, and burden of SARI in 2015. Epidemiological data are required to adopt appropriate policies and responses to prevent and control SARI. The incidence, mortality, fatality, and burden of SARI are significant in Iran. It is necessary to develop appropriate strategies, such as vaccination against major pathogens of the disease at least in high-risk groups, strengthening the disease surveillance system, and attracting the attention of policy makers and health authorities of the country.



1. Rudan I, Boschi-Pinto C, Biloglav Z et al (2008). Epidemiology and etiology of childhood pneumonia. Bull World Health Organ, 86:408-16.
2. World Health Organization (2004). The global burden of disease. Geneva: World Health Organization.
3. Nair H, Simões EA, Rudan Iet al (2013). Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: a systematic analysis. Lancet, 381(9875):1380-90.
4. Fitzner J, Qasmieh S, Mounts AWet al (2018). Revision of clinical case definitions: influenza-like illness and severe acute respiratory infection. Bull World Health Organ, 96(2):122-128.
5. Le Nguyen HK, Nguyen SV, Nguyen APet al (2017). Surveillance of Severe Acute Respiratory Infection (SARI) for Hospitalized Patients in Northern Vietnam, 2011–2014. Jpn J Infect Dis, 70(5):522-7.
6. Yu H, Huang J, Huai Yet al (2014). The substantial hospitalization burden of influenza in central C hina: surveillance for severe, acute respiratory infection, and influenza viruses, 2010–2012. Influenza Other Respir Viruses, 8(1):53-65.
7. Gooya MM, Soroush M, Mokhtari-Azad T et al (2010). Influenza A (H1N1) pandemic in Iran: report of first confirmed cases from June to November 2009. Arch Iran Med, 13(2):91-98.
8. Naghipour M, Cuevas LE, Bakhshinejad T et al (2007). Human bocavirus in Iranian children with acute respiratory infections. J Med Virol, 79(5):539-43.
9. Salomon JA, Vos T, Hogan DRet al (2012). Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010. Lancet, 380(9859):2129-43.
10. Haagsma JA, Graetz N, Bolliger Iet al (2016). The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013. Inj Prev, 22(1):3-18.
11. Murray CJ, Vos T, Lozano Ret 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):2197-223.
12. Naghavi M, Abolhassani F, Pourmalek Fet al (2009). The burden of disease and injury in Iran 2003. Popul Health Metr, 7:9.
13. Black RE, Cousens S, Johnson HLet al (2010). Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet, 375(9730):1969-87.
14. World Health Organization (2004). WHO guidelines for the global surveillance of severe acute respiratory syndrome (SARS): Updated recommendations, October 2004. Geneva: World Health Organization.
15. Iran Statistical Yearbook (2016). Statistical Center of Iran. https://www.amar.org.ir/english/Iran-Statistical-Yearbook
16. Dawa JA, Chaves SS, Nyawanda Bet al (2018). National burden of hospitalized and non‐hospitalized influenza‐associated severe acute respiratory illness in Kenya, 2012‐2014. Influenza Other Respir Viruses, 12(1):30-7.
17. Greenwood BM, Weber MW, Mulholland K (2007). Childhood pneumonia: preventing the world’s biggest killer of children. Bull World Health Organ, 85(7):502-3.
18. Centers for Disease Control and Prevention (2013). 2012-2013 Influenza Season Surveillance Summary. https://www.cdc.gov/flu/weekly/pdf/12-13%20season%20summary.pdf
19. Murray J, Cohen A, Walaza Set al (2015). Determining the provincial and national burden of influenza-associated severe acute respiratory illness in South Africa using a rapid assessment methodology. PLoS One, 10(7):e0132078.
20. Breiman RF, Cosmas L, Njenga MKet al (2015). Severe acute respiratory infection in children in a densely populated urban slum in Kenya, 2007–2011. BMC Infect Dis, 15:95.
21. Shi T, McAllister DA, O'Brien KLet al (2017). Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study. Lancet, 390(10098):946-58.
22. Alam N, van Ginneken JK, Timaeus I (2009). Determinants of perceived morbidity and use of health services by children less than 15 years old in rural Bangladesh. Matern Child Health J, 13(1):119-29.
23. Pandey A, Sengupta PG, Mondal SKet al (2002). Gender differences in healthcare-seeking during common illnesses in a rural community of West Bengal, India. J Health Popul Nutr, 20(4):306-11.
24. Razanajatovo NH, Guillebaud J, Harimanana Aet al (2018). Epidemiology of severe acute respiratory infections from hospital-based surveillance in Madagascar. PLoS One, 13(11):e0205124.
25. Sutanto A, Gessner BD, Djlantik Iet al (2002). Acute respiratory illness incidence and death among children under two years of age on Lombok Island, Indonesia. Am J Trop Med Hyg, 66(2):175-9.
26. Weber MW, Milligan P, Sanneh Met al (2002). An epidemiological study of RSV infection in the Gambia. Bull World Health Organ,80(7):562-8.
27. Kassebaum NJ, Arora M, Barber RMet al. (2016). Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet, 388(10053): 1603-1658.
IssueVol 48 No Supple 1 (2019) QRcode
SectionOriginal Article(s)
Incidence Mortality Disability adjusted life years Severe acute respiratory infection Iran

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How to Cite
PIROOZI B, ALINIA C, MORADI G, SAFARI H, HEMMATI P, SEROUSH M, ERFANI H, AKBARI H, REZAEI F, DADRAS MN, HEMMATPOUR S, NASIRI KALMARZI R. Incidence, Mortality, and Burden of Severe Acute Respiratory Infection in Iran in 2015. Iran J Public Health. 2019;48(Supple 1):62-68.