Egypt is a low-middle-income country. It has a per capita gross national inc.ome (GNI) of US$ 3.160 (2013)1. It has a large geographic area and a population of 82.06 million (2013)1. The Human Development Index rank is 112 out of 186 countries (2012)2.
Egypt is one of the countries that have experienced a large epizootic of highly pathogenic avian influenza in poultry caused by the influenza A (H5N1) virus. Since 2006, Egypt has reported over 100 human cases of avian influenza A (H5N1) and tens of deaths (Table 1). Prior to the avian influenza crisis, about 2.2 to 2.5 million chickens were produced daily in Egypt by around 75 000 licensed breeders.
The National Influenza Pandemic Executive Committee is responsible for developing strategies appropriate to the country's needs and situations, drawing expertise from the WHO and relevant international and local multidisciplinary expert groups. An integrated national plan for avian and pandemic influenza was developed in response to the rapid spread of avian influenza in Egypt. A well-structured communication plan exists within the Pandemic Influenza Preparedness Plan. This can serve as a model for a broader preparedness plan for a public health emergency of international concern.
The Central Public Health Laboratory in Egypt has been recognized as a national influenza centre since 2009. All possible tests such as virus isolation, polymerase chain reaction, serology and sequencing exist and are currently functioning. The sequencing at the Central Public Health Laboratory is only for measles and rubella, not for influenza, but the laboratory is working to include seasonal influenza soon. In addition, VACSERA has been recognized as a national influenza centre in Egypt since 1951: virus isolation, polymerase chain reaction and serology are available and functioning; only sequencing is not available. It has conventional polymerase chain reaction which is used in the WHO External Quality Assessment Project.
Strengths
The Egyptian government is enhancing the capacity of its national public health system to respond rapidly if there are suspicions that a highly pathogenic influenza virus can be transmitted between humans in a sustained way. Egypt’s national influenza centres are functioning well and its severe acute respiratory infection and influenza-like illness surveillance system provides good quality representative baseline data on influenza epidemiology with support from the Partnership Contribution funds.
The Central Public Health Laboratory has established and supervises influenza laboratories in several governorates in line with a detailed action plan. These laboratories have recently established a quality management unit to lead efforts to implement a national laboratory quality management strengthening strategy. They are participating in the (regional) WHO microbiology external quality assessment scheme for the countries of the Region and the (international) WHO external quality assessment programme for the detection of influenza A virus subtypes by polymerase chain reaction.
Gaps and recommendations
Egypt attracts a large number of tourists every year so there is a probability of acquiring different patterns of circulating influenza viruses, especially during the winter season. Reinforcement of the effectiveness of the influenza surveillance system and mobilization of the capacity of general hospitals to prepare for an influenza pandemic are the main objectives of the Human Pandemic Influenza Preparedness Plan in the country.
Seasonal influenza vaccine is recommended for high risk groups; these include health workers in fever and chest hospitals, people working on poultry farms, rapid response teams, veterinarians and pilgrims going to Saudi Arabia for Hajj.
Seven regional laboratories will be upgraded to increase the diagnostic capacity of the Central Laboratory for Veterinary Quality Control of Poultry Production and assist in active surveillance. Efforts should be made to upgrade the capacity of the laboratory and provide in-country and out-of-country training of laboratory analysts and introduce new technologies for the diagnosis of avian influenza. All staff in poultry farms and chest and fever hospitals, surveillance teams and rapid response teams should receive the annual vaccine against seasonal influenza.
