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Background: The High Institute of Public Health (HIPH), as a post-graduate academic institute, was affected by the COVID-19 pandemic in several aspects. This paper describes the effect of COVID-19 on the three main domains of HIPH: research, education, and community services. Documenting the activities and practices of the HIPH during the pandemic reflects the degree of resilience and preparedness against possible future global emergencies. Despite its importance for policymakers, such data is lacking from similar institutes in the Middle East, including Egypt. Methods: An extensive search in four popular scientific databases (Google Scholar, PubMed, Scopus, and Scival) was conducted to extract publications by authors affiliated with the HIPH using relevant keywords. Records were reviewed to collect data on the educational process as well as data on community services (convoys, campaigns, seminars, and workshops held by HIPH staff). All the mentioned activities were described, analyzed and compared before and during the pandemic to study the impact of the pandemic on the HIPH, as an example of a postgraduate institute. Results: The total numbers of COVID-19-related publications in Scopus by authors affiliated with the HIPH were 115 publications, the majority of which were research articles in the ‘Medicine’ and ‘Immunology and Microbiology’ domains. Most of them focused on assessing the relationship between the pandemic and quality of life, and prevention and treatment of COVID-19 (22.2% each). Publications on COVID-19 by HIPH researchers during the pandemic constituted 33.1% (115 publications) of the total publications by Alexandria University. Among the top ten authors on COVID-19 at Alexandria University, four were HIPH affiliated. The year 2022 witnessed the most frequent publications on COVID-19 by HIPH (51/115 publications, 44.3% of all COVID-19 publications by the HIPH on Scopus). All program courses were taught online during the year 2019–2020 (343 courses). HIPH provided several community services during the pandemic, which included 16 convoys in the poorer areas of Alexandria that served more than 1250 beneficiaries. Their goals were raising health awareness on COVID-19 vaccination, health education, and environmental assessment. Implications for Policy & Practice: This paper is the first of its kind by members of the High Institute of Public Health, Alexandria University. It provides baseline data for future similar work and is a documentation of the compilation of efforts during the COVID-19 pandemic that gives baseline data for public health assessment and planning by policy makers.

Abstract Background Although symptomatic SARS-CoV-2 infection predisposes patients to develop complications, the asymptomatic SARS-CoV-2 infection state is of public health importance being a hidden source of infection. Moreover, the asymptomatic state may camouflage the actual burden of the disease. Methods Data of 1434 seropositive participants for SARS-CoV-2 spike (anti-S) and/or nucleocapsid antibodies (anti-N) were retrieved from a larger cross-sectional survey on COVID-19. Relevant data were retrieved from records including socio-demographic, medical, and behavioral characteristics of seropositive participants as well as history of COVID-19 symptoms during the last 6 months. Symptomatic/asymptomatic SARS-CoV-2 infection was categorized based on the history of the presence or absence of COVID-19 symptoms. Results The rate of asymptomatic SARS-CoV-2 infection was 34.9%. There was a statistically significant difference between symptomatic and asymptomatic participants regarding age, residence, medical conditions, habits, and infection control measures. The number of symptoms was positively correlated with anti-S titer and both were positively correlated with adult body mass index. Slum areas residence, client-facing occupation or being a healthcare worker, having lung disease, having blood group type A, never practicing exercise or social distancing, never using soap for hand washing, and minimal engagement in online working/studying were independent factors associated with the symptomatic state. Patients having less than three symptoms were less likely to be diagnosed by any means. Conclusions One-third of SARS-CoV-2 infections in our study were asymptomatic. This mandates applying proper measures to prevent transmission even from apparently healthy individuals. Modifiable factors associated with symptomatic infection should be controlled to reduce the risk of COVID-19 complications.

Abstract The promise of COVID-19 vaccines in ending the pandemic can only be achieved by overcoming the challenge of vaccine refusal. Healthcare workers (HCWs) are the trusted advisors of vaccination decisions. Recommendations for vaccinating children against COVID-19 are recently gaining more public health attention due to the role of children in disease transmission and associated morbidities. Vaccination is one of the first medical decisions parents or guardians make on behalf of their children. To investigate the determinants associated with vaccine acceptability among the general population through a direct interview questionnaire and assess guardians’ views towards childhood COVID-19 vaccinations. This cross-sectional study included 2919 participants A pre-designed structured questionnaire about COVID-19 vaccination acceptability was completed by trained interviewers and interviewing the participants or their guardians (for those below 18 years old). Nearly two-thirds of participants (66.5%) accepted vaccination, 20.2% were refusing and 13.3% were hesitant. Most participants who were guardians of children below 12 years and from 13 to 17 years reported that they would accept vaccination of their children (72.5% and 70.5%, respectively). The acceptance rate among HCWs was 58.2%. The main reasons beyond vaccine refusal were mistrust of vaccine efficacy (39.5%) and having concerns regarding vaccine safety (38.8%). In a multivariable regression model, being male (OR 1.362, 95% CI 1.082–1.714, p = 0.008) resident in rural area (OR 1.796, 95% CI 1.435–2.247, p = 0.000), and lower education (OR 1.245, 95% CI 1.018–1.523, p = 0.033) were associated with an increased acceptance to be vaccinated. The acceptance rate for vaccinating children reported among their guardians was higher than adults for themselves. Extremes of age showed higher vaccine acceptance compared to young adults. Upper Egypt governorates (Faiyum and Giza) were outpacing Lower Egypt governorates in vaccination acceptance rates.

Abstract Background Population-based studies on COVID-19 have important implications for modeling the pandemic and determining vaccination policies. Limited data are available from such surveys in Egypt. Methods This cross-sectional was conducted throughout the period between January and June 2021, which coincided with the second and third waves of the COVID-19 pandemic in Egypt. At that time, vaccines against COVID-19 were not available to the general population. The study was carried out in eight Egyptian governorates and included 2360 participants, who were recruited through a multistage stratified cluster sample technique, based on gender, age, and district followed by a random sample within each district. Socio-demographic data were recorded and serum samples were collected and tested for SARS-Co-V2 spike (S) antibodies. Results The overall adjusted prevalence of anti-S was 46.3% (95% CI 44.2–48.3%), with significant differences between governorates. Factors associated with anti-S seropositivity were: being female (p = 0.001), living in a rural area (p = 0.008), and reporting a history of COVID-19 infection (p = 0.001). Higher medians of anti-S titers were significantly associated with: extremes of age (p

Background: Population-based studies on the determinants of COVID-19 seroprevalence constitute a cornerstone in guiding appropriate preventive measures. Such studies are scarce in Egypt, thus we conducted this study to explore risk factors for SARS-CoV-2 seropositivity. Methods: This survey included 2919 participants from 10 Egyptian governorates. Sera were tested for SARS-CoV-2 spike (S) and nucleocapsid (N) antibodies. Univariate and multivariate analyses were performed to identify associated factors and predictors of seropositivity regarding sociodemographic factors, clinical data, and personal practices of participants. A subgroup analysis was performed to investigate the occupational risks of seropositivity. Results: Seropositivity was recorded in 1564 participants (53.6%). Independent predictors of seropositivity included non-smokers (aOR = 1.817; 95% CI: 1.407–2.346, p = 0.000), having blood group A (aOR = 1.231; 95% CI: 1.016–1.493, p = 0.034), a history of COVID-19 infection (aOR = 2.997; 95% CI: 2.176–4.127, p = 0.000), COVID-19 vaccination (aOR = 4.349; 95%CI: 2.798–6.759, p = 0.000), higher crowding index (aOR = 1.229; 95% CI: 1.041–1.451, p = 0.015), anosmia and/or ageusia (aOR = 3.453; 95% CI: 2.661–4.481, p = 0.000) and history of fever (aOR = 1.269; 95% CI: 1.033–1.560, p = 0.023). Healthcare worker and Obesity/overweight were additional significant predictors of seropositivity among the working participants (aOR = 1.760; 95% CI: 1.301–2.381, p = 0.000 and aOR = 1.384; 95% CI: 1.059–1.808, p = 0.019, respectively). Additional factors showing association with seropositivity in the univariate analysis were: female gender, age group (15–39 years), higher educational level (preparatory and above), lack of environmental disinfection and having roommates at the workplace. There was a positive correlation between the titers of both antibodies. Age was weakly correlated with anti-S titer, while anti-N was significantly correlated with the number of protective measures applied by the participants. Both antibodies were significantly correlated with adult BMI, while both were significantly negatively correlated with the smoking index. Conclusions: SARS-CoV-2 seropositivity was associated with some personal and behavioral and occupation-related factors. Fever and anosmia and/or ageusia were the symptoms mostly associated with seropositivity.

Abstract Background Healthcare workers (HCWs) are at the front line in battling infection transmission, such as that in coronavirus disease 19 (COVID-19). Additionally, they may act as potential carriers passing the virus on to others. Anti-spike (anti-S) antibodies for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are formed either as a result of infection or vaccination with both indicating immunity against future COVID-19 infection. Aim This study aimed to identify the prevalence of COVID-19 seropositivity among HCWs. Methods This cross-sectional study included 559 HCWs from 39 hospitals with variable degrees of COVID-19 exposure risk (depending on the occupation, department, and hospital type). Demographic data were recorded as well as history of COVID-19 infection and vaccination. Serum samples were collected and tested for SARS-CoV-2 spike antibodies. Results Anti-S positivity was found in 59.0% of the participating 559 HCWs, indicating a high level of seroprotection. Of the 559 HCWs, 34.1% had reported previous infection with COVID-19. Following infection, only 46 (24.0%) of those affected received vaccination. Anti-S seropositivity was found in 39.1% of participants who were unvaccinated and had no history of infection. Physicians had the highest median anti-S titers (58.0 relative units (RU)/mL), whereas pharmacists and office staff had the lowest (25.7 and 38.2 RU/mL, respectively). Conclusions Overall, 59.0% of the 559 HCWs were anti-S positive, indicating a relatively high seroprotective status. Among those who were unvaccinated and had no history of infection, 39.1% were seropositive for anti-S, denoting a high rate of silent/asymptomatic infections. Screening of HCWs for SARS-CoV-2 anti-S is recommended, along with the vaccination of seronegative individuals.

Background: The viral neutralization assay is the gold standard to estimate the level of immunity against SARS-CoV-2. This study analyzes the correlation between the quantitative Anti-SARS-CoV-2 QuantiVac ELISA (IgG) and the NeutraLISA neutralization assay. Methods: 650 serum samples were tested for both SARS-CoV-2 anti-spike (anti-S) immunoglobulin G (IgG) and neutralizing antibodies (nAbs) using kits by EUROIMMUN, Germany. Results: There was a significant correlation between levels of anti-S and nAbs (Spearman’s rho = 0.913). Among the positive samples for anti-S, 77.0% (n = 345) were positive for nAbs. There was a substantial agreement between anti-S and nAbs (Cohen’s kappa coefficient = 0.658; agreement of 83.38%). Considering NeutraLISA as a gold standard, anti-S had a sensitivity of 98.57%, specificity of 65.66%, NPV of 97.5%, and PPV of 77.0%. When the anti-S titer was greater than 18.1 RU/mL (57.9 BAU/mL), nAbs were positive, with a sensitivity of 90.0% and specificity of 91%. Conclusions: A titer of SARS-CoV-2 anti-S IgG can be correlated with levels of nAbs.

Background: Hepatitis C virus (HCV) is a known risk factor for hepatocellular carcinoma. Several epidemiological studies have pointed out to an association of HCV infection with other extrahepatic malignancies. The role of chronic HCV in breast cancer causation is less clear. Egypt is an endemic area of HCV infection with resulting significant morbidity. The association between HCV status and breast cancer risk in Egyptian women is hitherto unknown. Methods: A retrospective study was performed. The prevalence of anti-HCV seropositivity was estimated in a sample of women with a breast cancer diagnosis, retrieved from the hospital records, and was compared to the raw data of a population study in Egypt. Anti-HCV negative and positive patients were compared regarding the disease course and outcome. Results: Retrospective analysis revealed a markedly high prevalence of anti-HCV seropositivity in young breast cancer patients. In patients younger than 45 years, 13.4% were anti-HCV positive. Seropositivity was 6-fold higher in these patients than in adult females of the same age without cancer diagnosis ( P = .003). The biological type, tumor size, nodal status, and disease-free survival were not affected by the patients’ HCV status. Conclusion: Young Egyptian breast cancer patients have a dramatically high prevalence of HCV seropositivity. Further population studies are strongly required to investigate the epidemiological association of these two significant health problems.

Background: Understanding the factors affecting humoral immune response to COVID-19 vaccines among healthcare workers (HCWs) is essential to predict their level of protection. Vaccination elicits antibodies against SARS-CoV-2 spike protein (anti-S). Aim: To investigate the factors associated with the presence of SARS-CoV-2 anti-S antibodies among vaccinated HCWs. Methods: This cross-sectional study included 143 vaccinated HCWs, with or without a history of previous COVID-19 infection (clinically, radiologically, or by laboratory results) from different departments. Socio-demographic, clinical, as well as vaccine-related data, were recorded. Serum samples were collected and tested for SARS-CoV-2 spike antibodies. Results: Vaccination provoked an immunogenic response, where the overall anti-S positivity was 83.9% (95% CI: 77.8–90.0%). The response was not affected either by the age or gender of HCWs. Out of the 143 HCWs, 46 (32.1%; 95% CI: 24.4–39.9%) reported a previous history of COVID-19 infection, and seropositivity was significantly higher among them (p = 0.002), and it was associated with the frequency of infection (p = 0.044) and duration since diagnosis of COVID-19 infection (p = 0.065). They had higher median anti-S titers (111.8 RU/mL) than those without infection (39.8 RU/mL). Higher seropositivity was observed with Oxford/AstraZeneca vaccine (AZD1222) (88.9%; 95% CI: 83.1–95.0%) than Sinopharm (BBIBP-CorV) (67.7%; 95% CI: 50.3–85.2%), and with receiving two doses of vaccine (92.3%; 95% CI: 87.1–97.5%). Conclusions: Antibody positivity was significantly affected by the previous history of COVID-19 infection, type of vaccine, the number of doses received, and duration since vaccination.

Introduction: More than one third of travelers to developing countries report health problems when traveling. The Egyptian Ministry of Health reports the occurrence of 400 cases of malarial infection yearly among Egyptian travelers. This article aimed to assess the knowledge, attitude, and practice (KAP) of Egyptian travelers towards infectious diseases, vaccination, and malaria chemoprophylaxis. Methods: A survey was conducted at Cairo International Airport and included 1500 travelers. The questionnaire inquired about the travelers’ knowledge about infectious diseases at their destinations and their KAP regarding vaccination, malaria, and its prophylaxis. Results: Most travelers (68%) had poor knowledge, specifically; 90.2%, 85.6%, 88.5% did not know the endemic diseases at their destinations, the modes of disease transmission, or the protective measures against disease, respectively. Knowledge about malaria prevalence, symptoms, modes of transmission, and prevention was good in only 18%, 29.8%, 6.7%, and 21.4% of travelers, respectively. Poor practice of malaria prophylactic measures was found in 66.3% of travelers. Although 91.3% did not receive any vaccination, the general attitude towards vaccination was good. The total travel health knowledge, practice, general attitude toward vaccination, and the perceived benefits of malarial prophylaxis scores were significantly correlated with older age and high socioeconomic level. Most of the studied travelers (90.4%) did not carry or use malaria chemoprophylaxis. Ignorance was the main barrier to receiving vaccines (65.3%) and to adherence to malaria chemoprophylaxis (88.3%). Conclusion: Egyptian travelers have poor travel health knowledge and practices. Their knowledge and practice scores improve with older age, urban residence, and higher educational levels. They have a good attitude towards vaccination, and ignorance was the main barrier to sound practices.

Background: Geographic Information Systems (GIS) and spatial epidemiological methods may provide a basis for disease investigation through which hotspots and disease determinants can be identified. Applying these methods for hepatitis C virus (HCV) in Egypt would support a more effective strategy to control its transmission. Therefore, this study used GIS software to draw one of the first HCV maps in Egypt elucidating and analyzing geographical and epidemiological differences in HCV distribution within the country. Methods: A cross-sectional survey of 21 governorates (n = 12169, 8080 rural, 3733 urban and 356 slums areas) was completed. All participants were interviewed regarding potential exposures to HCV. Third generation ELISA was used to test serum for HCV antibody. Quantitative real-time RT-PCR was used to test anti-HCV positive subjects for HCV-RNA. Results: The participants ranged in age from 14-90 years. Overall, anti-HCV sero-prevalence was 14.8%. The prevalence of HCV-RNA, was 9.5%. Proportionally, 65.8% of anti-HCV positives were positive for HCV-RNA. The map of Egyptian governorates highlighted the darkest spot of HCV infection in Menoufeya (37.8%) followed by Beni Suef (29.2%) and Minya (28.6%). Anti-HCV prevalence was higher among males and logistic regression models revealed a strong independent association with increasing age, rural residence and parenteral anti-schistosomal therapy. Conclusions: Rural residences and HCV hotspots should be prioritized for HCV prevention programs. The unique age distribution first shown in this study shows that the older age groups (≥60 years old) constitutes a considerable reservoir of infection and must not be neglected.

Chronic HCV infection, a highly endemic disease in Egypt, is usually asymptomatic for decades after infection. Prediction questionnaire tool was proofed to be a valuable, feasible and efficient instrument for the screening of several diseases. We previously developed an Egyptian HCV risk screening tool (EGCRISC). This study aims to validate/modify EGCRISC. A cross-sectional study testing 4579 individuals by EGCRISC as well as ELISA/PCR was performed. The sample was a stratified cluster sampling from urban and rural areas in Upper and Lower Egypt using a proportional allocation technique. The degree of agreement and positive and negative posttest probabilities were calculated. ROC curve was done and the cutoff points were customized for best performance. The total score was further classified into three levels according to the risk load. The mean age of the participants was 41.1±12.2 in whom HCV prevalence was 8.6%. EGCRISC, particularly after modifying the cutoff points, has a good discriminating ability. The degree of agreement was at least 68.1% and the positive posttest probability ranged from 5% to 37.2% whereas the negative posttest probability was in the range 1% to 17%. We conclude that EGCRISC is a valid tool that can potentially screen for HCV infection risk in Egypt and could diminish the demand for mass serologic screening in those apparently at minimal risk. Extensive use of electronic and self- or interviewer-administered risk-based screening strategy may simplify and promote overall screening and detection of HCV dissimilar communities.