Fahim Manal, Abu ElSood Hanaa, AbdElGawad Basma, Deghedy Ola, Naguib Amel, Roshdy Wael H, Showky Shymaa, Kamel Reham, Elguindy Nancy, Abdel Fattah Mohammad, Afifi Salma, Kandeel Amr, Abdelghaffar Khaled
Department of Epidemiology and Surveillance, Preventive Sector, Ministry of Health and Population, 3 Magles ElShaab Street, Kasr Alainy, Cairo, Egypt.
Central Public Health Laboratory, Ministry of Health and Population, Elsheikh Rehan Street, Cairo, Egypt.
Public Health Pract (Oxf). 2023 Jun;5:100358. doi: 10.1016/j.puhip.2023.100358. Epub 2023 Jan 18.
In Egypt, an integrated surveillance for acute respiratory infections (ARIs) was established in 2016 to identify the causes of ARIs. The surveillance system includes 19 governmental hospitals. In response to the coronavirus disease 2019 (COVID-19) pandemic, the World Health Organisation (WHO) requested surveillance adaptation to address the emerging challenges. This study aims to describe the experience in Egypt of adapting ARI surveillance to the COVID-19 pandemic.
WHO case definitions were used to identify patients with ARIs. Nasopharyngeal/oropharyngeal swabs were collected for SARS-CoV-2 and influenza testing. Demographic and clinical information were obtained by interviewing patients at the hospitals. During the COVID-19 pandemic, the first two outpatients daily and every fifth admitted patient were enrolled in the study. To determine the status of ARIs in Egypt during the pandemic, patient demographic, clinical and laboratory data from 2020 to 2022 were obtained and descriptive analyses were performed.
Overall, 18,160 patients were enrolled in the study, including 7923 (43.6%) seen at outpatient clinics and 10,237 (56.4%) inpatients. Of the study participants, 6453 (35.5%) tested positive for ARIs, including 5620 (87.1%) for SARS-CoV-2, 781 (12.1%) for influenza and 52 (0.8%) for SARS-CoV-2/influenza coinfection. SARS-CoV-2 was the cause for 95.3% of admitted patients and 65.4% of outpatients. Influenza subtypes included A/H3 (55.7%), Influenza-B (29.1%) and H1/pdm09 (14.2%). Compared with influenza, SARS-CoV-2 tended to infect the elderly, in warm weather and in urban governorates, and resulted in more hospitalisations, longer hospital stays and higher case fatalities (16.3% vs 6.6%, p < 0.001).
ARI surveillance in Egypt was successfully adapted to the COVID-19 pandemic and effectively described the clinical characteristics and severity of circulating viruses. Surveillance reported the re-emergence of influenza with a severe course and high fatality. Surveillance is essential for monitoring the activity of respiratory viruses with the aim of guiding clinical management, including preventative and control measures.
2016年埃及建立了急性呼吸道感染（ARI）综合监测体系以确定ARI病因。该监测系统包括19家政府医院。为应对2019冠状病毒病（COVID-19）大流行，世界卫生组织（WHO）要求对监测进行调整以应对新出现的挑战。本研究旨在描述埃及将ARI监测调整以应对COVID-19大流行的经验。
采用WHO病例定义来识别ARI患者。采集鼻咽/口咽拭子进行严重急性呼吸综合征冠状病毒2（SARS-CoV-2）和流感检测。通过在医院对患者进行访谈获取人口统计学和临床信息。在COVID-19大流行期间，每天的前两名门诊患者和每五名住院患者中抽取一名纳入研究。为确定大流行期间埃及的ARI状况，获取了2020年至2022年患者的人口统计学、临床和实验室数据并进行描述性分析。
总体而言，18160名患者纳入研究，其中7923名（43.6%）为门诊患者，10237名（56.4%）为住院患者。在研究参与者中，6453名（35.5%）ARI检测呈阳性，其中5620名（87.1%）为SARS-CoV-2阳性，781名（12.1%）为流感阳性，52名（0.8%）为SARS-CoV-2/流感合并感染。SARS-CoV-2是95.3%住院患者和65.4%门诊患者的病因。流感亚型包括A/H3（55.7%）、乙型流感（29.1%）和H1/pdm09（14.2%）。与流感相比，SARS-CoV-2倾向于在温暖天气下在城市省份感染老年人，导致更多住院、更长住院时间和更高病死率（16.3%对6.6%，p<0.001）。
埃及的ARI监测成功适应了COVID-19大流行，并有效描述了流行病毒的临床特征和严重程度。监测报告了流感的再次出现，其病程严重且病死率高。监测对于监测呼吸道病毒活动以指导临床管理（包括预防和控制措施）至关重要。
