1. Title:An exploratory survey of COVID-19 humoral immunity among Egyptian general population and healthcare workers 
   Principal investigator: Prof. Engy El-Ghitany
   Co-investigators: Prof. Fahmy Charl, Prof. Azza Farghaly, Prof. Mona Hashish, Dr. Eman Omran, Dr. Shehata Farag
   Funding agency: Science, Technology & Innovation Funding Authority, project no. (43834) 2020 
   Duration: 9 months 

The global health COVID-19 pandemic is spreading at an alarming rate. The range of clinical presentations of COVID -19 varies from asymptomatic to severe respiratory distress syndrome or even death. Due to the unidentified number of asymptomatic viral-shedding and pauci- symptomatic people in the community, the total number of infections is uncertain. The currently used diagnostic confirmatory test for COVID-19 is the real –time RT-PCR. Serological testing of IgG antibodies has not been sufficiently evaluated yet. Antibodies to the virus could reveal the true extent of the pandemic and help scientists answer basic questions about COVID -19 natural history and real burden. Serological survey at the community level would measure the herd immunity level and subsequently entails decision makers what actions may actually be working to slow its spread. It is thought that countries where immune people are viewed as a resource early by decision makers are expected to perform comparatively better overtime than the others.

Therefore, this exploratory survey will be conducted over a period of 9 months aiming to study seroprevalence of IgG antibodies to COVID19 among a total of 2000 apparently healthy general population recruited from three different governorates representing Upper and Lower Egypt and frontier governorates with reference to ministry of health case load report, as well as among 500 healthcare workers who had previous contact with confirmed COVID19 patients. A predesigned questionnaire (one for the general population and another one for healthcare workers) will be used to collect data concerning socio-demographic, behavioral, clinical and others data related to COVID-19. IgG antibodies will be detected in serum using ELISA technique. Data will be analyzed and interpreted using appropriate statistical methods. The results of this study are expected to reflect an estimation of the COVID-19 herd immunity level among Egyptian population as well as reveal the real burden of infection by identifying the proportion of the population that have got the disease at a subclinical/ mild or were not identified by the current active surveillance method. Eventually, this would guide public health measures and policies showing where the epidemic is heading, to informatively take the right decisions when it is safe to lift shelter-in-place restrictions and how far away we are from “herd immunity” when the epidemic eventually starts to go to an end.

2- Title: Molecular Epidemiology of Campylobacter spp. in Broiler Meat and Quantitative Modeling of the Risk of Human Campylobacteriosis in the Egyptian Setting.

Principle investigators:

Prof. Neveen Agamy, High Institute of Public Health, Alexandria University, Egypt.

Prof. Ihab Habib, College of Veterinary Medicine, Murdoch University, Australia.

Prof. Sofia Boqvist, Swedish University of Agricultural Sciences, Sweden.

Co- investigators:

Prof. Ingrid Hansson, Prof. Ivar Vågsholm, Dr.  Lise-Lotte Fernström, Prof. Eglal Salem, Dr. Walaa Osama, Dr. Salma Adnan, Dr. Mohamed Anwar.

Funding Agency:  The Swedish Research Council (2015)

Duration: 3 years.

Assuring safe food resources and combating bacterial diarrheal pathogens are crucial for achieving healthy living in any country. Campylobacter spp. is possibly the most common bacterial zoonotic pathogen worldwide. Infected humans exhibit a range of clinical symptoms from mild, watery diarrhoea to severe inflammatory diarrhoea. In Egypt, Campylobacter is a leading cause of paediatric diarrhoea with infants and one year olds experiencing 1.2 and 0.4 episodes per year, respectively. In such hyper-endemic settings, the burden of Campylobacter diarrhoea could be substantial. The gap of knowledge about the epidemiology of Campylobacter in food sources hinders accurate assessment of the human health burden.

The specific tasks of this project were:

Task 1- To generate baseline survey data on prevalence and counts of Campylobacter in retail chicken meat, the most important source of campylobacteriosis, in Alexandria governorate in Egypt;

Task 2- To study the clonal population structure and genotypic diversity of Campylobacter jejuni isolates generated from the baseline survey (Task 1) in Alexandria governorate in Egypt;

Task 3- To characterize antimicrobial resistance patterns in a subset of Campylobacter jejuni isolated from retail broiler meat sampled from Alexandria markets;

Task 4- To screen for virulence and neuropathy associated determinants in a subset of Campylobacter jejuni isolated from retail broiler meat sampled from Alexandria markets;

Task 5- To develop a probabilistic quantitative assessment model for human campylobacteriosis infection risk arising from consumption of broiler meat in the setting of Alexandria, Northern Egypt.

References:

- Ihab Habib, Ali Harb, Ingrid Hanson , Ivar Vågsholm, Walaa Osama, Salma Adnan, Mohamed Anwar, Neveen Agamy and Sofia Boqvist. Challenges and Opportunities towards the Development of Risk   Assessment at the Consumer Phase in Developing Countries—The Case of Campylobacter Cross-Contamination during Handling of Raw Chicken in Two Middle Eastern Countries. Pathogens 2020, 9, 62; doi:10.3390/pathogens901.

3- Title: Development of an Effective Screening Tool to Improve the National Strategy of Hepatitis C Virus Infection Control in Egypt.
Principal investigator: Prof. Engy El-Ghitany
Co-investigators: Prof. Azza Farghaly, Dr. Ekram Waseem, Prof. Moataza Mahmoud, Dr. Shehata Farag, Dr. Yasmine AlKassabany
Funding agency: Science and technology development funds, project no. (3469) 2012
Duration: 4 years

The value of developing a simplified tool to assess HCV risk has been demonstrated in literature. This tool could diminish the need for antibody screening in patients who are at very low or no risk. Widespread use of the tool may facilitate and increase overall screening and detection of HCV. By targeting only patients at higher risk, it may lead to more cost-effective screening for a disease that is causing significant morbidity and mortality particularly in highly endemic area with poor resources like Egypt. Moreover, earlier identification in the course of the disease is associated with better efficacy. Early diagnosis together with patient education and subsequent lifestyle modifications may reduce the risk of transmission of HCV infection to other individuals.  Improved understanding of prevalence rates in particular populations will allow resources to be focused where they are needed. Finally, treatment earlier in the course of the disease is associated with acceptable cost per quality-adjusted life years estimates. Therefore, this study was conducted to determine the risk factors beyond HCV endemicity in Egypt through a case-control study. A model of significant risk factors was developed along with a meta-analysis(1) for HCV risk factor globally and in Egypt. The model was validated in a cross-sectional study. An impact analysis and cost-effectiveness (2) estimation of the model was done. The validated tool was applied through the media and internet to recruit high risk individuals for early detection. Throughout the study, awareness was targeted using different tools including media and internet. They were an integrated part wherever using the screening tool and elsewhere. Some of the media can be watched on our youtube channel (VirusC Egypt - YouTube) or accessed through our facebook page (undefined). The study results were published in scientific journals.(1-8)

References

1. El-Ghitany EM, Abdel Wahab MM, Abd El-Wahab EW, Hassouna S, Farghaly AG. A comprehensive hepatitis C virus risk factors meta-analysis (1989-2013); Do they differ in Egypt?. Liver Int.2015 Feb;35(2):489-501.doi: 10.1111/liv.12617. Epub 2014 Jul 8.
2. El-Ghitany EM.Cost-effectiveness of EGCRISC application versus hepatitis C virus mass screening in Egypt. J Infect Public Health. 2019;12(3):442-444. doi: 10.1016/j.jiph.2018.08.004.
3. El-Ghitany EM, Farghaly AG, El- Wahab EWA (2016) Knowledge of Hepatitis C and Awareness of Infection in the Egyptian Community. J Virol Antivir Res 2016; 5:1. doi:undefined
4. El-Ghitany EM, Farghaly AG, Abdel Wahab MM, Farag S, Abd El-Wahab EW. Towards a simple risk assessment screening tool for HCV infection in Egypt. J Med Virol 2016; 88(10):1767–1775. doi: 10.1002/jmv.24520.
5. El-Ghitany EM, Farghaly AG, Farag S, Abd El-Wahab EW. Validation of EGCRISC for Chronic Hepatitis C Infection Screening and Risk Assessment in the Egyptian Population. PLoS ONE. 2016;11(12):e0168649. doi:10.1371/journal.pone.0168649.
6. El-Ghitany EM, Farghaly AG, Farag S. Performance of the validated EGCRISC screening tool in chronic hepatitis C infection detection after application in the Egyptian setting. Journal of Hepatology 2017; 66(1): S279 - S280
7. El-Ghitany EM, Alkassabany YM, Farghaly AG (2020). Performance and modification of EGCRISC among hepatitis C virus high-risk groups. Epidemiology and Infection 148, e28, 1–7. undefined1017/S0950268820000175
8. El-Ghitany EM, Farghaly AG. Geospatial epidemiology of hepatitis C infection in Egypt 2017 by governorate. Heliyon 2019;5(8): undefined

4- Title:  A survey to estimate direct and indirect costs due to tuberculosis and proportion of tuberculosis-affected households experiencing catastrophic costs due to TB in Alexandria, Egypt

Principal investigator: Dr. Ramy Mohamed Ghazy

Co-Pi: Dr. Rasha Mossalem, Heba Khedr

Funding agency: Joint WHO-TDR Small Grants Scheme (SGS) for implementation research in infectious diseases of poverty

Year: 2020-2021 

General objective:

To conduct a survey to estimate the direct and indirect costs due to tuberculosis and proportion of tuberculosis-affected households experiencing catastrophic costs due to TB in Alexandria, Egypt

Specific objectives:

• To determine the magnitude and main drivers of patient costs in order to guide policy makers on cost mitigation for the purpose of reducing financial barriers to access and adherence.
• To determine baseline percentage of diagnosed TB patients treated in the NTP network (and their households) in Egypt, who incur direct and indirect costs beyond a defined threshold of their annual income.
• To determine the correlation between facing costs above different thresholds of annual household income and the borrowing or selling assets to finance health care expenditure (or dissaving), in order to assess if the measure of dissaving is a sufficient metric of catastrophic total costs.
• To design a standardized approach for periodic measurements of financial barriers to adherence based on baseline experience and to enable future reporting.

5. Ramy Ghazy, the Lecturer of Tropical Health is the principal investigator of The Eastern Mediterranean Regional Office Special Grant for Research in Priority Areas of Public Health, (COVID-19 research section (RPPH 20-31) entitled (GIS-Based Model for analyzing spatial pattern and predicting COVID occurrence) (2020-2021) (ongoing)

Co-investigators: Prof. Mahmoud Adel Hassan, Professor of Human Geography and GIS Institute of Graduate Studies & Research (IGSR) Alexandria University, Egypt.

General objective:
To develop GIS-Based Model for Analyzing Spatial Pattern and Predicting COVID Occurrence
Specific objectives:
a. Analyzing spatial variations of COVID19 cases and delineating the main hotspots.
b. Exploring various determinants of COVID-19 spatial pattern of occurrence.
c. Identifying the most significant predictors of COVID-19 occurrence. 
d. Spotting deaths and assess if there are death hot spot areas.

6. Ramy Ghazy, the assistant lecturer of Tropical Health is the principal investigator of WHO-RPPH Research priority in Public Health research grant entitled: "Causes and Distributions of Under-Five Mortality in Alexandria Governorate Using the Verbal Autopsy and Social Autopsy Studies Interview". (RPPH 18-83) (2018-2019)

Co-investigator: Mohamed Tahoun, Lecturer of Epidemiology

General objective:

To identify causes and distributions of under-five mortality in Alexandria Governorate using the verbal autopsy and social autopsy studies interviews.

Specific objectives:

• To identify age-specific cause of death among under-five children.
• To determine causes of mortality in rural, and urban areas.
• To Validate the role of VASA as a tool for determining the cause of under-five mortalities.

Results:

The response rate to VASA was 66%. Neonatal mortality, post-neonatal mortality, and child mortality represented 70.1%, 24.5%, and 5.4% of U5M respectively. There was no statistically significant difference between males and females in cause-specific mortality fraction (CSMF), P > 0.05. The main UCODs among neonates were preterm delivery (57.3%), congenital malformation (17.3%), congenital pneumonia (10.8%), birth asphyxia (8.4%), and stillbirth (3.1%). The most-reported UCODs among post-neonates and children were pneumonia (25.9%), childhood cardiovascular diseases (22.8%), digestive system diseases (11.9%), and diarrhea and dysentery (7.8%). The main UCODs among under-five children were preterm delivery (40.2%), followed by congenital malformation (12.1%), pneumonia (7.8%), congenital pneumonia (7.6%), childhood cardiovascular diseases (6.8%), and birth asphyxia (5.9%). Communicable diseases, maternal, neonatal, and nutritional diseases caused 72.0% of U5M, while non-communicable diseases and injuries caused 25.7% and 2.4% of all U5M, respectively.

7. Ramy Ghazy, the assistant lecturer of Tropical Health is the principal investigator of Joint WHO-TDR Small Grants Scheme (SGS) for implementation research in infectious diseases of poverty (SGS18-95) entitled: "Determinants of Schistosoma mansonitransmission in hotspots at the late stage of elimination, Kafr El Sheikh governorate". (2018-2019)

Co-investigators: Mai Badr, Lecturer of Environmental Chemistry & Biology

Nehad Taktak, Assistant Lecturer of Vector Control & Pesticides Risks

Mohamed Tahoun, Lecturer of Epidemiology

General objective:

To study the determinants of Schistosoma mansoni transmission in hotspots at late stage of elimination, Kafr El Sheikh governorate

Specific Objectives:

• To estimate the prevalence of human S. mansoni infection in correlation to environmental factors seasonally.
• To assess the prevalence of snail infection in correlation to environmental factors.
• To carry out a malacological survey of the intermediate host seasonally.
• To evaluate the role of socio-economic and behavioral factors affecting the prevalence of S. mansoni infection.

Results:

Prevalence of S. mansoni infection was significantly higher during summer (19.1%) than during fall (7.2%), p <0.01.   The intensity of infection (light, moderate, and high) during summer versus fall was (93.55% vs 89.38%, 6.45% vs 8.85, and 0.00% vs 1.77%), p<0.05. Higher prevalence of human infection was identified among males than females (OR=1.63), children aged 11-15 years than among counterparts aged 6-10 years, (OR=2.96), and if mothers were of low educational level (OR=2.83). The main identified risk factors were contacting the main body of water-canal for either washing clothes, land irrigation, collecting waters, bathing,  and garbage disposal, p<0.05.  The count of collected Biomphalaria Alexandrina was statistically different across seasons (p<0.01) in conjugation with a similar significant difference in water temperature, salinity, turbidity, total coliforms concentration, depth, velocity, and level, p<0.01. Presence of grasses and duckweeds had a significant association with snail infection (p = 0.00l). Water depth, pH, temperature, and total dissolved salts (TDS) significantly affected the snail count.

8. Noha Ossama, the assistant lecturer of School Health is the Principal Investigator of the WHO/EMRPPH grant  project number (RPPH 16-105), entitled: "Health Seeking Behavior and Medical Management of Pneumonia among under Five Children in Alexandria, Egypt; Mothers’ Perspective" (2016-2017).

Co-investigators: Yasmine Yousry Muhammad Ahmad Muhammad, Lecturer of Maternal & Child Health

Ayat Diaa El Din Mohamed Saber Ashour, Lecturer of Geriatric Health

General objective:

To identify health seeking behavior and medical management of pneumonia among under five children in Alexandria, Egypt; Mothers’ Perspective. 

Specific objectives:

• To address mothers’/ primary care givers’ health seeking behaviors for their suspected pneumonic/ pneumonic under-five children.
• To assess first medical management received for pneumonic under-five children from mothers’ perspective.
• To investigate barriers in management of pneumonic under-five children from mothers’ perspective.

Results:

We found that 57.2% of children received home treatment before seeking medical advice. Around 26% of mothersWe found that 57.2% of children received home treatment before seeking medical advice. Around 26% of motherswaited ≥ 2 days before seeking medical advice; insufficient knowledge about the disease was their main contention (89%).Factors significantly associated with the delay were: rural residence (P = 0.006); low income (P = 0.002); home treatmentgiven before seeking medical advice (P < 0.001) and previous episodes of pneumonia (P = 0.002). Diagnosis of pneumoniahad not been made by more than half of the first consulted sources (52.7%).

9. Ramy Ghazy, the assistant lecturer of Tropical Health is the principal investigator of Joint WHO-TDR Small Grants Scheme (SGS) for operational research in communicable diseases (SGS 16-27) (RPD. 11/1) entitled: "Evaluation of PCR Assay for Detection of Schistosoma mansoniDNA in Human Stool Samples". (2016-2017)

Co-investigator: Mohamed Tahoun, Lecturer of Epidemiology

This study aimed at:

• To determine the prevalence of S. mansoi in a single stool sample collected from the study group by Kato-Katz and PCR.
• To evaluate the validity of and performance of PCR in detection of S. mansoni.
• To determine the prevalence of S. mansoni after conventional therapy with PZQ.

Results:

The prevalence of S.mansoni after examination of single stool sample of 347 individuals aged (5-15 years old) based on four slides KK was (106/347) 30.5%. Regarding intensity of infection 87.7% of infected children were of low intensity meanwhile, high and moderate infection represented 5.7% and 6.6% respectively. The wet mount had a sensitivity and PPV of 5% and 40%, respectively, and had a specificity and NPV of 98.5% and 85.5%, respectively. Cohen’s Kappa coefficient (k) was 0.05 indicates poor agreement between wet mount and KK test. The cPCR had a sensitivity and PPV of 25.7% and 100%, respectively, and had a specificity and NPV of 100% and 71.4%, respectively. Cohen’s Kappa coefficient (k) was 0.31 which indicates poor agreement between cPCR and KK technique.