Adherence of healthcare workers to COVID-19 infection prevention practices and its relationship with SARS-CoV-2 seropositivity.

Background: Infection prevention and control (IPC) practices against COVID-19 should be adopted by healthcare workers (HCWs) at their workplaces to protect themselves, their patients, and their families from infection. Purpose: This study aimed to describe the relationship between the healthcare-related COVID-19 infection prevention measures adopted by HCWs and their SARS-CoV-2 seropositivity. Research Design: This cross-sectional study was conducted during the second and third COVID-19 waves in Egypt. Study Sample: The study included 416 unvaccinated HCWs from 39 hospitals in Egypt. Data Collection: Sociodemographic data, as well as COVID-19 IPC measures done at work, and protective measures performed by their healthcare facilities were collected. SARS-CoV-2 spike protein antibodies were measured by ELISA. Results: 58.2% of participants were seropositive for SARS-CoV-2. Among the previously undiagnosed HCWs, 125/271 (46.1%) were seropositive. Predictors of seropositivity were rural residence (aOR = 5.096; 95% CI: 1.583-16.403, p = 0.006), previous COVID-19 infection (aOR = 4.848, 95% CI: 2.933-8.015, p = 0.000), and examining 10-20 suspected COVID-19 patients daily (aOR = 2.329; 95% CI: 1.331-4.077, p = 0.003. Reporting low satisfaction (25-50%) with infection control implementation, working more than 40 h per week, reporting to "sometimes abiding by hand hygiene" compared to those who reported to "always" adhere to hand hygiene and shorter duration of hand washing (<20 s) were associated with significantly higher odds of seropositivity. Conclusions: Poor infection control measures and the high workload of HCWs (longer working hours and examining more patients) were modifiable risk factors for SARS-CoV-2 seropositivity among HCWs. Hand hygiene was better among HCWs working in urban versus rural areas.

Asymptomatic versus symptomatic SARS-CoV-2 infection: a cross-sectional seroprevalence study.

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.

COVID-19 vaccine acceptance rates and predictors among the Egyptian general population and Healthcare workers, the intersectionality of age and other factors.

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.

Determining the SARS-CoV-2 Anti-Spike Cutoff Level Denoting Neutralizing Activity Using Two Commercial Kits.

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.

Seroprevalence of Hepatitis A, B and C Among a Sample of Refugees in Egypt: An Exploratory Survey.

BACKGROUND: Estimating the prevalence of infectious diseases, including viral hepatitis, among refugees is important for evaluating their health needs and predicting the burden on the health system of the host country. This study aimed at estimating the seroprevalence of viral hepatitis among refugees in Egypt. METHODS: This cross-sectional study involved a heterogeneous group of 501 refugees. Enzyme-linked immunosorbent assays were used to detect IgG antibodies against hepatitis A virus (HAV), B virus (HBV) surface antigen (anti-HBsAg), C virus (HCV), and HBV surface antigen (HBsAg). RESULTS: Anti-HAV was the most prevalent marker (n = 482, 96.2%), followed by anti-HBs (n = 142, 28.3%) and HBsAg (n = 21, 4.2%), while only four refugees (0.8%) had positive anti-HCV IgG. Anti-HBs was higher in males (p < 0.05). Older refugees and non-working subjects had significantly higher seropositive rates of anti-HAV (p = 0.051 and p = 0.023, respectively), while students and those below 15 years of age had higher rates of anti-HBs (p < 0.05). Positive HBsAg results were associated with history of hepatitis (p < 0.001). Obese participants were more likely to be positive for HBsAg (p = 0.025) and anti-HBs (p < 0.05). Sudanese refugees had significantly higher rates of anti-HAV antibodies (p = 0.049), while Yemini refugees had significantly higher rates for HBsAg (p = 0.019) positivity. Residents of Dakahlia had significantly higher rates of anti-HAV (p = 0.008) and anti-HBs (p < 0.05). None of the studied risk factors was significantly associated with anti-HCV. CONCLUSION: Refugees in Egypt have poor immunity against HBV with intermediate to high HBV and low HCV prevalence rates. Despite that 65% of refugees received the HAV vaccine, almost all had IgG anti-HAV, denoting previous infection.

A pre-vaccine exploratory survey of SARS-CoV-2 humoral immunity among Egyptian general population.

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 < 0.001), living in urban areas, having primary education (p = 0.009), and reporting a history of COVID-19 infection, especially if based on chest CT or PCR (p < 0.001). CONCLUSIONS: High seroprevalence rates indicate increased COVID-19 infection and immune response among a considerable percentage of the community. Age, gender, residence, educational level, and previous PCR-confirmed COVID-19 infections were all determinants of the immune response.

Prevalence of severe acute respiratory syndrome coronavirus 2 spike antibodies in some healthcare settings in Egypt.

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.

Determinants of the Development of SARS-CoV-2 Anti-Spike Immune-Response after Vaccination among Healthcare Workers in Egypt.

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.

Predictors of anti-SARS-CoV-2 seropositivity: An Egyptian population-based study.

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.

Prevalence and Risk Factors of HBV and HCV Co-Infection Among People Living with HIV in an Egyptian Setting.

BACKGROUND: Human Immune Deficiency Virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) infections constitute a global health concern. They share common modes of transmission, increasing the likelihood of co-infection. Co-infection accelerates viral replication, promotes the progression of chronic liver diseases and challenges antiviral therapy. There are no available data addressing the magnitude of chronic viral hepatitis co-infection in people living with HIV in Egypt. Nor is there a mandate for HCV/HBV screening. This cross-sectional study provides needed data on HBV and/or HCV co-infection in Egyptian people living with HIV. SUBJECTS AND METHODS: The study was conducted at the HIV clinic in Alexandria Fever Hospital. The investigation included 168 confirmed HIV cases. All cases were interviewed and tested for HCV-Ab and HBsAg by ELISA. RESULTS: There were 52 (31%) persons who were anti-HCV positive. 40 of them had detectable HCV RNA (76.9%). HIV/HCV co-infection was significantly higher among males (40.7%) compared to only (10.9%) among females (OR = 3). History of imprisonment (OR = 4.84, CI: 1.33-17.62), accidental puncture with protruding needle contaminated with blood (OR = 3.35, CI: 0.99-11.72), alcohol use (OR = 3.03, CI: 1.13-8.09) and male gender (OR = 2.96, CI: 0.99-8.88) were all significant predictors for HIV/HCV co-infection. On the other hand, HIV/HCV co-infection was inversely associated with high education level (OR = 0.28, CI: 0.10-0.76). HBsAg was detected in 4 (2.4%), and anti-HBc in 49 (29.2%) of HIV patients. Previous HBV infection (positive anti-HBc/negative anti-HBs) was significantly associated with a history of female genital mutilation circumcision, injection drug use, invasive procedures, non-specific fatigue and HCV-Ab seropositivity. CONCLUSION: Egyptian people living with HIV have an increased frequency of HCV antibody and HCV infection compared to the general population indicating a higher risk of infection and suggest a higher risk of HCV exposure. Past or present HBV co-infections are also elevated. Routine screening of these viruses in the management protocol of people living with HIV in Egypt is recommended.

Geospatial epidemiology of hepatitis C infection in Egypt 2017 by governorate.

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.

Validation of EGCRISC for Chronic Hepatitis C Infection Screening and Risk Assessment in the Egyptian Population.

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.

Prevalence of hepatitis C virus infection among pregnant women in a rural district in Egypt.

BACKGROUND: Egypt has the highest prevalence of hepatitis C virus (HCV) infection in the world. Screening of HCV during pregnancy is not as routinely done in Egypt compared with many other countries, although pregnancy is an important period where screening of HCV infection is important owing to low immunity, the possibility of vertical transmission and possible horizontal transmission to the baby or other household contacts at a later stage. AIM: To determine the seroprevalence of HCV antibodies (HCV-Ab) and risk factors associated with infection among pregnant women in Egypt. PATIENTS AND METHOD: A total of 360 pregnant women visiting the healthcare units for routine antenatal care were tested using third generation ELISA test for detection of HCV-Ab. Polymerase chain reaction (PCR) was done for seropositive cases. RESULTS: A total of 6.1% (22/360) of pregnant women were HCV seropositive; of them only 45% (9/20) had viraemia. Risk factors were their age, the age of their husband and the presence of chronic liver disease in the husband. CONCLUSION: The prevalence of HCV infection in pregnant women in Egypt appears to be lower than previously reported. The detected risk factors are old age of the pregnant women and their husbands, and chronic liver disease in the husbands. None of the other known risk factors was found to be significantly associated with HCV infection in pregnant women.

Evaluation of commercialized rapid diagnostic testing for some Hepatitis B biomarkers in an area of intermediate endemicity.

Hepatitis B virus (HBV) is a major public health threat. Enzyme immune assay (EIA) of HBsAg is the screening method used in most settings, including in blood banks. Other markers are used to evaluate the HBV replication, immunity and the infectious level of the patient. Testing negative for HBsAg, however, does not always mean the absence of infection, and testing other markers using EIA is costly. This study evaluated the diagnostic reliability of commercially available non-HBsAg HBV biomarkers to detect their usefulness to screen for HBV infection. INTEC rapid tests for HBV markers were evaluated in 508 HBsAg negative blood donors and were compared to EIA as a reference method. Only anti-HBs, anti-HBc and anti-HBe could be evaluated. Sensitivities of all tests (64.2, 85.48, and 82.78 respectively) were much lower than those claimed by the manufacturer. The specificities and negative predictive values for all tests exceeded 95% and 93% respectively and were lowest for anti-HBs. Anti-HBe had the highest accuracy (99.02%), while anti-HBs had the lowest (90.16%). It was concluded that the rapid test performance was lower than the manufacturer's reports. They are reliable tools to prove negativity, but less efficient to confirm reactivity. The best performance was for anti-HBe. The positive results of anti-HBs was significantly associated with higher ELISA titer levels, which is therefore recommended to be used for screening of immunity.