To develop better estimates of brucellosis incidence, we conducted population-based surveillance for acute febrile illness (AFI) in Fayoum governorate (population 2347249), Egypt during two summer periods (2002 and 2003). All hospitals and a representative sample of community healthcare providers were included. AFI patients without obvious etiology were tested for brucellosis by culture and serology. Incidence estimates were calculated adjusting for sampling methodology and study period. Of 4490 AFI patients enrolled, 321 (7%) met the brucellosis case definition. The estimated annual incidence of brucellosis per 100000 population was 64 and 70 in 2002 and 2003, respectively. The median age of brucellosis patients was 26 years and 70% were male; 53% were initially diagnosed as typhoid fever. Close contact with animals and consumption of unpasteurized milk products were associated with brucellosis. The high incidence of brucellosis in Fayoum highlights its public health importance, and the need to implement prevention strategies in humans and animals.
We report the occurrence of concurrent infections with multiple acute febrile illness (AFI) pathogens during an ongoing prospective laboratory-based surveillance in four infectious disease hospitals in urban and rural areas of Egypt from June 2005 to August 2006. Patients were screened for Leptospira, Rickettsia typhi, Brucella, or Salmonella enterica serogroup Typhi by various methods including serology, culture, and PCR. One hundred eighty-seven of 1,510 patients (12.4%) evaluated had supporting evidence for the presence of co-infections; 20 (1%) of these patients had 2 or more pathogens based upon confirmatory 4-fold rise in antibody titer, culture, and/or PCR. Most coinfected patients lived or worked in rural agricultural areas. The high coinfection rates suggest that defining the etiologies of AFI is imperative in guiding proper disease treatment, prevention, and control strategies in Egypt.
Introduction
Zoonotic diseases are an important cause of human morbidity and mortality. Animal populations at locations with high risk of transmission of zoonotic pathogens offer an opportunity to study viral and bacterial pathogens of veterinary and public health concern.
Methods
Blood samples were collected from domestic and imported livestock slaughtered at the Muneeb abattoir in central Egypt in 2009. Samples were collected from cattle (n = 161), buffalo (n = 153), sheep (n = 174), and camels (n = 10). Samples were tested for antibodies against Leptospira spp. by a microscopy agglutination test, Coxiella burnetii by enzyme immunoassay, Brucella spp. by standard tube agglutination, and Rift Valley Fever virus (RVFV), Crimean–Congo hemorrhagic fever virus (CCHFV), sandfly fever Sicilian virus (SFSV), and sandfly fever Naples virus (SFNV) by enzyme-linked immunosorbent assay.
Results
Antibodies against Leptospira spp. were identified in 64 (40%) cattle, 45 (29%) buffalo, 71 (41%) sheep, and five (50%) camels; antibodies against C. burnetii in six (4%) buffalo, 14 (8%) sheep, and seven (70%) camels; and antibodies against Brucella spp. in 12 (8%) cattle, one (1%) buffalo, seven (4%) sheep, and one (10%) camel. Antibodies against RVFV were detected in two (1%) cattle and five (3%) buffalo, and antibodies against CCHFV in one (1%) cow. No antibodies against SFSV or SFNV were detected in any species.
Discussion
Results indicate that livestock have been exposed to a number of pathogens, although care must be taken with interpretation. It is not possible to determine whether antibodies against Leptospira spp. and RVFV in cattle and buffalo are due to prior vaccination or natural exposure. Similarly, antibodies identified in animals less than 6 months of age may be maternal antibodies transferred through colostrum rather than evidence of prior exposure. Results provide baseline evidence to indicate that surveillance within animal populations may be a useful tool to monitor the circulation of pathogens of veterinary and public health concern in Egypt.
BackgroundIdentification of risk factors of acute hepatitis C virus (HCV) infection in Egypt is crucial to develop appropriate prevention strategies.MethodsWe conducted a case–control study, June 2007-September 2008, to investigate risk factors for acute HCV infection in Egypt among 86 patients and 287 age and gender matched controls identified in two infectious disease hospitals in Cairo and Alexandria. Case-patients were defined as: any patient with symptoms of acute hepatitis; lab tested positive for HCV antibodies and negative for HBsAg, HBc IgM, HAV IgM; and 7-fold increase in the upper limit of transaminase levels. Controls were selected from patients’ visitors with negative viral hepatitis markers. Subjects were interviewed about previous exposures within six months, including community-acquired and health-care associated practices.ResultsCase-patients were more likely than controls to have received injection with a reused syringe (OR=23.1, CI 4.7-153), to have been in prison (OR=21.5, CI 2.5-479.6), to have received IV fluids in a hospital (OR=13.8, CI 5.3-37.2), to have been an IV drug user (OR=12.1, CI 4.6-33.1), to have had minimal surgical procedures (OR=9.7, CI 4.2-22.4), to have received IV fluid as an outpatient (OR=8, CI 4–16.2), or to have been admitted to hospital (OR=7.9, CI 4.2-15) within the last 6 months. Multivariate analysis indicated that unsafe health facility practices are the main risk factors associated with transmission of HCV infection in Egypt.ConclusionIn Egypt, focusing acute HCV prevention measures on health-care settings would have a beneficial impact.
Acknowledgments: We thank the Ministry Of Health, Provincial Medical Office, Northeastern Province Kenya and Liboi area community leaders who assisted in this investigation.
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