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HOSPITAL-BASED SURVEILLANCE FOR ACUTE FEBRILE ILLNESS IN EGYPT: A FOCUS ON COMMUNITY-ACQUIRED BLOODSTREAM INFECTIONS

Acute febrile illness (AFI) is a common syndrome in Egypt. However its etiologies are not well characterized. To determine the relative frequency of pathogen etiologies and possibly improve diagnostic, clinical management and public health measures, we implemented laboratory-based surveillance in a network of infectious disease hospitals throughout Egypt. Admitted patients with AFI provided background details and a blood sample for bacterial culture and serologic analysis. Case definitions were based on laboratory results. Of 10,130 patients evaluated between 1999 and 2003, 5% were culture positive for Salmonella enterica serogroup Typhi, 3% for Brucella, and 2% for other pathogens. An additional 18% of patients had positive serologic results for typhoid and 11% for brucellosis. Risk factor analysis identified availability of municipal water to be significantly (P < 0.05) associated with protection against typhoid. Animal contact and consumption of raw dairy products were significantly associated with brucellosis. The surveillance network identified typhoid fever and brucellosis as the most common bacterial causes of AFI in Egypt, allowed better description of their epidemiology, and may lead to the development of targeted prevention strategies.

Received September 12, 2004. Accepted for publication February 28, 2005.

Acknowledgments: We express our sincere appreciation and thanks to the many physicians, nurses, and clinical laboratory staff of the infectious disease hospitals involved in this study. We also thank Dr. Yehia Sultan, Dr. Atef Sadaka, Dr. Abdel Halim Abdel Hamid, Dr. Bothaina Bakry, Dr. Mohamed El Ragaby, Dr. Ragaa Sakr, Dr. Mohamed Abdel Hady, Dr. Mofreh Ramzy, Dr. Ahmed Ibrahim, Dr. Said Ibrahim, Dr. Mokhtar Wahba, and Dr. Abdel Fattah Ibrahim (all directors of infectious disease hospitals) for their cooperation. We also acknowledge support from the staff of the Preventive Sector and the Central Public Health Laboratory of the Ministry of Health and Population who assisted with training and monitoring the activities within the infectious disease hospitals. Appreciation is extended to the staff of the United States Agency for International Development (USAID) for their guidance, especially that of Dr. Emad Yanni and Mark White. We are especially grateful to United States Naval Medical Research Unit No. 3 staff members (Walid William, Mohamed Abdel Maksoud, Dr. Mostafa Abdel Fadeel) and to Dr. Rana Hajjeh and Dr. G. Pimentel for their critical review of the manuscript.

Financial support: The work was supported by a grant from the USAID and the Department of Defense Global Emerging Infectious Systems (DoD-GEIS) (work unit number E022).

Disclaimer: The opinions and assertions contained herein are the private ones of the authors and are not to be construed as official or reflecting the views of the Navy Department or the naval service at large, or the Egyptian Ministry of Health and Population.

^* Address correspondence to Dr. Salma Afifi, U.S. Naval Medical Research Unit No. 3, Ramsis Street Extension, Cairo, Egypt. E-mail: afifisalma{at}yahoo.com

Authors’ addresses: Salma Afifi, Ken Earhart, Mohamed A. Azab, Fouad G. Youssef, Hammam El Sakka, Momtaz Wasfy, Hoda Mansour, and Francis Mahoney, United States Naval Medical Research Unit No. 3, Ramsis Street Extension, Cairo, Egypt, Telephone: 20-2-342-8933, Fax: 20-2-342-3426. Magda Rakha and Said El Oun, Ministry of Health and Population, Magles El-Shaab Street, Tahrir, Cairo, Egypt.

Reprint requests: Research Publications Division, U.S. Naval Medical Research Unit No. 3, Attn: Code 101F, PSC 452, Box 5000, FPO AE 09835-0007.

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