Epidemiology of SARS-CoV-2 in Egypt.

BACKGROUND: On 30 January 2020, the World Health Organization declared the novel severe acute respiratory syndrome coronavirus-2 to be a Public Health Emergency of International Concern. Egypt is among the five countries reporting the highest number of cases in Africa. AIMS: We aimed to provide an overview of the epidemic features of COVID-19 in Egypt in order to help guide an effective lockdown-exit strategy. METHODS: The incidence proportions, case fatality rates (CFR), growth rates, doubling time (Td), basic reproductive number (R0) and Herd Immunity Threshold (HIT) were calculated weekly and reviewed. RESULTS: As of 21 May 2020, the epidemic growth rate and R0 have decreased significantly; the averages (±SD) were 0.35 (±0.33) and 2.6 (±1.55) respectively. However, the incidence proportion has increased to 14 cases /100 000 population. CONCLUSION: COVID-19 transmissibility has declined but the incidence rate has increased, underscoring that any lockdown-exit strategy should include measures to strengthen physical distancing, and case-based interventions to prevent an uncontrolled upsurge of COVID-19 cases.

Biomarkers of Secondhand Smoke Exposure in Waterpipe Tobacco Venue Employees in Istanbul, Moscow, and Cairo.

Background: Most smoke-free legislation to reduce secondhand smoke (SHS) exposure exempts waterpipe (hookah) smoking venues. Few studies have examined SHS exposure in waterpipe venues and their employees. Methods: We surveyed 276 employees of 46 waterpipe tobacco venues in Istanbul, Moscow, and Cairo. We interviewed venue managers and employees and collected biological samples from employees to measure exhaled carbon monoxide (CO), hair nicotine, saliva cotinine, urine cotinine, urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and urine 1-hydroxypyrene glucuronide (1-OHPG). We estimated adjusted geometric mean ratios (GMR) of each SHS biomarker by employee characteristics and indoor air SHS measures. Results: There were 73 nonsmoking employees and 203 current smokers of cigarettes or waterpipe. In nonsmokers, the median (interquartile) range concentrations of SHS biomarkers were 1.1 (0.2, 40.9) µg/g creatinine urine cotinine, 5.5 (2, 15) ng/mL saliva cotinine, 0.95 (0.36, 5.02) ng/mg hair nicotine, 1.48 (0.98, 3.97) pg/mg creatinine urine NNAL, 0.54 (0.25, 0.97) pmol/mg creatinine urine 1-OHPG, and 1.67 (1.33, 2.33) ppm exhaled CO. An 8-hour increase in work hours was associated with higher urine cotinine (GMR: 1.68, 95% CI: 1.20, 2.37) and hair nicotine (GMR: 1.22, 95% CI: 1.05, 1.43). Lighting waterpipes was associated with higher saliva cotinine (GMR: 2.83, 95% CI: 1.05, 7.62). Conclusions: Nonsmoking employees of waterpipe tobacco venues were exposed to high levels of SHS, including measurable levels of carcinogenic biomarkers (tobacco-specific nitrosamines and PAHs). Implications: Smoke-free regulation should be extended to waterpipe venues to protect nonsmoking employees and patrons from the adverse health effects of SHS.

Secondhand smoke in waterpipe tobacco venues in Istanbul, Moscow, and Cairo.

OBJECTIVE: The prevalence of waterpipe tobacco smoking has risen in recent decades. Controlled studies suggest that waterpipe secondhand smoke (SHS) contains similar or greater quantities of toxicants than cigarette SHS, which causes significant morbidity and mortality. Few studies have examined SHS from waterpipe tobacco in real-world settings. The purpose of this study was to quantify SHS exposure levels and describe the characteristics of waterpipe tobacco venues. METHODS: In 2012-2014, we conducted cross-sectional surveys of 46 waterpipe tobacco venues (9 in Istanbul, 17 in Moscow, and 20 in Cairo). We administered venue questionnaires, conducted venue observations, and sampled indoor air particulate matter (PM2.5) (N=35), carbon monoxide (CO) (N=23), particle-bound polycyclic aromatic hydrocarbons (p-PAHs) (N=31), 4-methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) (N=43), and air nicotine (N=46). RESULTS: Venue characteristics and SHS concentrations were highly variable within and between cities. Overall, we observed a mean (standard deviation (SD)) of 5 (5) waterpipe smokers and 5 (3) cigarette smokers per venue. The overall median (25th percentile, 75th percentile) of venue mean air concentrations was 136 (82, 213) µg/m(3) for PM2.5, 3.9 (1.7, 22) ppm for CO, 68 (33, 121) ng/m(3) for p-PAHs, 1.0 (0.5, 1.9) ng/m(3) for NNK, and 5.3 (0.7, 14) µg/m(3) for nicotine. PM2.5, CO, and p-PAHs concentrations were generally higher in venues with more waterpipe smokers and cigarette smokers, although associations were not statistically significant. CONCLUSION: High concentrations of SHS constituents known to cause health effects indicate that indoor air quality in waterpipe tobacco venues may adversely affect the health of employees and customers.

Implementation, barriers and challenges of smoke-free policies in hospitals in Egypt.

BACKGROUND: Tobacco use is a serious public health challenge in North Africa, and health professionals play a vital role in tobacco control. In Egypt, limited data are available on the knowledge and attitudes of health care providers regarding tobacco control policies. Such data are especially relevant due to Egypt's tobacco control laws, adopted in 2007, prohibiting smoking in hospitals and other public places. This study surveyed 49 senior administrative staff, 267 physicians, 254 nurses, and 109 administrative employees working in El-Kasr El-Aini Hospital in Cairo, assessing their knowledge and attitudes regarding Egypt's tobacco control laws and barriers to their effective implementation in health care facilities. We also investigated the hospital's compliance with smoke-free policies. RESULTS: The majority (>90%) of the hospital workers knew that exposure to second-hand smoke is harmful to health. Physicians and nurses had a more favorable attitude towards the smoking ban when compared to administrative employees. Hospital staff identified the following barriers to successfully implementing the smoking ban: lax enforcement of tobacco control laws, the lack of penalties for violators, the lack of cessation programs, and the prevalence of smoking among physicians. CONCLUSIONS: Overall, smoke-free policies were poorly enforced in this large teaching hospital in Cairo, Egypt. Interventions to address the identified barriers to their implementation could include the provision of cessation training and services as well as effective communication programs to educate health care workers at all levels regarding the dangers of second-hand smoke exposure and effective measures for protection.

Knowledge, attitudes, and practices of avian influenza among backyard poultry breeders in Fayoum Governorate, Egypt.

BACKGROUND: Avian influenza (H5N1) (AI) is becoming a serious public health threat in Egypt. The current study aimed to assess the existing knowledge, attitudes, and various practices regarding AI in household backyard poultry breeders residing in Fayoum Governorate, in rural Egypt. MATERIAL AND METHODS: Of the 149 cases confirmed to date in Egypt, 51 have been fatal. This study was implemented in El Gendy and Manshat Abdllah villages in Fayoum Governorate. The latter village is the one in which a case of AI was confirmed in February 2007. A group of 150 women aged 15 years and above were recruited. A structured Arabic questionnaire was used to collect data. RESULTS: All interviewed women (N=150) had heard about AI. TV\radio was the common source of information (83.3%). Nearly all interviewed women knew that AI is transmitted from birds to humans (99%). Most of the participants (>90%) correctly identified saliva, nasal secretions, feces, and contaminated vehicles as the modes of AI transmission. The knowledge regarding biosecurity measures (>70%) and measures of prevention (>90%) was generally good. More than 90% of the interviewed housewives agreed that AI is a serious disease that can be prevented, and that sanitary precautions during breeding and food preparation practices are effective measures for prevention of AI infection. Protective measures such as the use of gloves and masks, which minimize the risk of transmission of AI from poultry to humans, were seldom used by housewives in all their breeding, slaughtering, and cooking practices. However, washing hands either with water or with soap and water was reported by the vast majority of the respondents (>90%). CONCLUSION AND RECOMMENDATION: There was a good level of knowledge and favorable attitude of the study participants regarding AI; however, practices appear to be inadequate to achieve full protection against AI. Comprehensive and multidisciplinary interventions should be widely used to enhance the complex behavior change process among the village residents.