Influenza is a major cause of respiratory illness in Africa, especially in children. Further strengthening influenza surveillance, along with conducting special studies on influenza burden, cost of illness, and role of other respiratory pathogens will help detect novel influenza viruses and inform and develop targeted influenza prevention policy decisions in the region.

The epidemiology, seasonality and risk factors for influenza virus infection remains poorly defined in countries such as Egypt. Between 1 January and 31 December 2013, we used surveillance data on patients hospitalized with severe acute respiratory infection in three Egyptian government hospitals in Damanhour district to estimate the incidence rate of laboratory-confirmed seasonal influenza. Samples were taken from 1727 of 1856 patients; of these, 19% were influenza virus positive. The overall incidence of influenza virus-associated SARI during the study period was estimated to be 44 cases per 100 000 person-years (95% CI: 39-48). The highest incidence of 166 cases per 100 000 person year (95% CI: 125-220) was observed in children aged 2 to 4 years. The incidence of influenza-virus associated SARI cases in pregnant women was estimated to be 17.3 cases per 100 000 person-years (95% CI: 6-54). Majority of influenza virus-associated SARI occurred in autumn and early winter, and influenza A(H3N2) virus predominated. This was the first ever description of the epidemiology of seasonal influenza in Egypt. However, additional works are needed for greater understanding of influenza burden in Egypt. RÉSUMÉ L'épidémiologie, la saisonnalité et les facteurs de risque liés à l'infection par le virus de la grippe demeurent mal définis dans des pays tels que l'Égypte. Entre le 1 er janvier et le 31 décembre 2013, nous avons utilisé les données de la surveillance des patients hospitalisés pour une infection respiratoire aiguë sévère (IRAS) dans trois hôpitaux publics égyptiens dans le district de Damanhour afin d'estimer le taux d'incidence de la grippe saisonnière confirmée en laboratoire. Des prélèvements ont été réalisés sur 1727 des 1856 patients ; 19 % étaient positifs au virus de la grippe. L'incidence globale des IRAS associées au virus de la grippe durant la période étudiée s'élevait, selon les estimations, à 44 cas pour 100 000 personnes-années (IC 95 % : 39-48). L'incidence la plus élevée, en l'occurrence 166 cas pour 100 000 personnes-années (IC 95 % : 125-220), a été observée chez les enfants âgés de 2 à 4 ans. L'incidence des cas d'IRAS associées au virus de la grippe chez les femmes enceintes s'élevait, selon les estimations, à 17 cas pour 100 000 personnes-années (IC 95 % : 6-54). La majorité des cas d'IRAS associées au virus de la grippe sont survenus en automne et au début de l'hiver, et le virus de la grippe A(H3N2) était prédominant. Toutefois, des études complémentaires sont nécessaires pour mieux comprendre la charge de la grippe en Égypte. 2013

This study demonstrates the utility of combining a healthcare utilization survey and population-based surveillance data to estimate disease incidence. Estimating incidence and outcomes of RSV disease is critical to establish the burden of RSV in Egypt.

Please cite this paper as: Lohiniva et al. (2012) Poultry rearing and slaughtering practices in rural Egypt: an exploration of risk factors for H5N1 virus human transmission. Influenza and Other Respiratory Viruses DOI: 10.1111/irv.12023. Background  Highly pathogenic avian influenza (H5N1) virus continues to cause infections in Egypt. This study describes the practices associated with raising and slaughtering household poultry to identify risk factors for H5N1 infection and reasons for non‐compliance with preventive measures. Methods  An investigation was conducted of 56 households with household flocks (19 households with human H5N1 cases, 19 with poultry H5N1 cases, and 18 with no reported poultry or human H5N1 cases). Data were collected via structured observations and in‐depth interviews. Results  Half of the households kept at least some free‐range poultry and mixed at least some different species of poultry as it was considered beneficial for the poultry. Feeding and cleaning practices exposed children to contact with poultry; slaughtering contaminated homes; use of personal protective barriers was not a norm; waste management exposed the communities to slaughtering waste and dead chickens; and reporting of sick and dead poultry was not a practice. Only minor changes in poultry‐handling took place following H5N1 virus outbreaks. Discussion  H5N1 virus prevention in Egypt represents both an epidemiological and socio‐cultural challenge. Traditional poultry‐rearing practices that likely increase exposures to H5N1‐infected poultry are common throughout Egypt. Despite education campaigns following sporadic H5N1 outbreaks, no differences in these practices could be detected between households with previous H5N1 human or poultry cases and those households with any previous experience with H5N1. Development of H5N1 infection–related education campaign strategies should focus on perceptions underlying traditional practices in order to tailor public awareness messages that are meaningful for communities.

In 2014, after several years of maintaining zero malaria indigenous cases, Egypt had an outbreak of Plasmodium vivax: 21 confirmed cases during May-June 2014. In response to the outbreak, the Ministry of Health and Population (MoHP) launched an emergency response through early detection and prompt treatment of cases, vector control, public education and intersectoral collaboration. Twenty cases (95.2%) were residents of El-Sheikh Mostafa village, Edfu district, Aswan governorate, southern Egypt. All cases, consequent to the index case were identified through house-to-house surveillance visits. One P. falciparum-infected case was also identified in the same village. Treatment of all infected cases was initiated following laboratory confirmation. The MoHP's rapid response to and containment of the outbreak demonstrates the institutional capacity for detection and control of outbreaks which can occur after elimination.Lutte contre une flambée de paludisme à Plasmodium vivax dans le Gouvernorat d'Assouan (Égypte) Résumé En 2014, après s'être maintenue plusieurs années sans aucun cas autochtone de paludisme, l'Égypte a connu une flambée de Plasmodium vivax : 21 cas confirmés entre mai et juin 2014. En réponse à la flambée, le ministère égyptien de la Santé publique et de la Population a mis en place un plan d'urgence comprenant le dépistage précoce et le traitement rapide des cas, la lutte antivectorielle, la sensibilisation du public et la collaboration intersectorielle. Vingt de ces cas (95,2 %) se sont déclarés chez des résidents du village d'El-Sheikh Mostafa, dans la circonscription d'Edfou (Gouvernorat d'Assouan, au sud de l'Égypte). Suite au cas indicateur, la totalité des cas a été identifiée grâce aux visites de surveillance effectuées au porte-à-porte. Un cas d'infection à P. falciparum a également été identifié dans le même village. Après confirmation en laboratoire, le traitement de l'ensemble des cas infectés a été entrepris. La réponse rapide du ministère de la Santé publique et de la Population et l'endiguement de la flambée attestent de ses moyens institutionnels pour la détection, la confirmation et le traitement du paludisme, ainsi que la maîtrise des flambées susceptibles de survenir après l'élimination de la maladie.