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Background: Pandemic flu is a concerning problem with potentially high mortality and morbidity rates, so needs a proper health system response in each country. Objectives: To evaluate the nationwide health system response in Iran after declaration of H1N1/Swine flu pandemic in June 2009. Patients and Methods: A surveillance system in all regions of country was implemented upon declaration of pandemic flu by the World Health Organization; RT-PCR methods in National influenza reference laboratory in the capital were used to diagnose all types of circulating influenza viruses. Epidemiological data as well as laboratory response, performances of 40 medical universities all over the country concerning case detection and timing of admission were analyzed. Results: 3847 confirmed cases of H1N1/Swine flu were detected up to November 2009, which 140 cases died (i.e.; 3.8% mortality rate), highest mortality rates were observed in infants (7.4%) and those older than 50 years (9%). For about 78% of confirmed cases of Swine flu, the result had been notified within 3 days after sample submission, despite the fact, most of mortalities had occurred in this group of “short result gap”. Conclusions: Although overall mortality rate in such a pandemic was comparable or better than other developing countries, it was shown that late hospital admission and late laboratory diagnosis were associated with higher mortality rates. Better case detection and earlier admission with more available and equipped laboratories seems necessary to improve the health system response for future pandemics in Iran.

Pandemic Flu in Islamic Republic of Iran; A Review of Health System Response From July to November