Ramadan Umrah is the second largest Islamic pilgrimage with 2.75 million pilgrims allowed in 2022. This report presents the results of a survey among Egyptian pilgrims returning from Ramadan Umrah to monitor SARS-CoV-2 and influenza activity and identify prevalent SARS-CoV-2 variants after this mass gathering. Cross‐sectional survey conducted at Cairo airport from 30th April 2022–5 th May 2022. Pilgrims were invited to participate voluntarily. After consenting, participants interviewed using questionnaire including demographics, health status, and vaccination information and asked to provide NP/OP swabs for SARS-CoV-2 and influenza testing by RT-PCR. Whole-genome sequencing performed for 29 SARS-CoV-2 isolates. Incidence calculated, descriptive data analysis performed, and SARS-CoV-2 patients were compared to negatively tested participants using chi² and p value< 0.05. Overall, 1003 subjects participated, their mean age 50.9 ± 13 years, 594 (59.2%) were males. Of them, 76(7.6%) tested positive including 67(6.7%) SARS-CoV-2, 7(0.7%) influenza and 2(0.2%) SARS-CoV-2/influenza coinfection. Omicron sublineage BA.2 was the prevalent variant with no difference in severity identified between BA.1 and BA.2. No difference was identified between COVID-19 incidence among receivers of different vaccine types or between fully vaccinated and booster dose receivers. Survey indicated a low incidence of SARs-CoV-2 and influenza among Egyptian pilgrims returning from Ramadan Umrah. Patients had mild or no symptoms with no hospitalization or deaths reported. Full vaccination and booster doses of COVID-19 vaccines proved equally effective. Enhancing COVID-19 and influenza vaccination before mass gatherings and close monitoring of respiratory viruses among pilgrims returning from Hajj and Umrah are crucial for outbreak early detection and mitigation.

Introduction: Influenza burden (IB) estimates are crucial for monitoring disease trends, allocating limited resources, and promoting influenza vaccination. However, IB in Egypt is poorly understood. This study estimates the mean‐seasonal IB in Egypt, across levels of severity by age and regions using sentinel surveillance data between 2016 and 2019.Methods: Influenza surveillance was implemented among patients hospitalized with severe acute respiratory infection (SARI) at eight sentinel hospitals across Egypt. We estimated the influenza‐associated SARI hospitalization in two governorates and then extrapolated nationally using the World Health Organization (WHO)–recommended methods. Thereafter, we estimated IB‐associated mild/moderate illness and deaths using IB pyramid tool developed by WHO and the John Hopkins Center for Health Security. Rates were reported per 100,000 population.Results: The estimated mean seasonal number of influenza‐associated mild/moderate illness, hospitalized noncritically and critically ill patients, and deaths was 16,425,938 (95% CI: 1,150,888–40,409,614), 30,335 (95% CI: 9971–670,288), 9110 (95% CI: 580–16,321), and 2660 (95% CI: 154–9908), respectively. The highest rate of influenza‐associated mild/moderate illness was among aged 5–14 year (22,932; 95% CI: 825–25,546.3), whereas the highest rates of severe influenza were among aged > 65 years (hospitalizations: 159.4, 95% CI: 121.7–205.0; deaths: 56.0, 95% CI: 0.6–111.0). Children aged < 5 years also experience high rates of influenza‐associated hospitalization (52.0, 95% CI: 43.0–62.0).Conclusions: The WHO method estimated a high burden of severe influenza among aged ≥ 65 and aged < 5 years in Egypt. To reduce severe IB, increased influenza vaccine uptake together with enhanced immunization strategies implementations among the elderly and children are warranted.

Introduction: For a decade, avian influenza (AI) viruses were major concern for Egypt since they are endemic in poultry and have caused 359 human infections, accounting for 40% of cases globally. Interventions implemented before 2015 proved to have minor impact on the spread of infection. Since 2015, a Supported Intervention Package (SIP) was implemented to reduce the risk of human exposure by reducing infections in poultry. The intervention package included enhanced surveillance and laboratory capacity, early outbreak detection, and raised community awareness. This study aims to evaluate SIP’s effectiveness by comparing number and rates of AI in humans and poultry before and after intervention package implementation. Methods: AI surveillance data for poultry and humans from 2006 to 2021 was obtained and linked. Human AI data include patients’ demographics, clinical picture, risk factors, lab results and outcome, while poultry data include number prevent of positive specimens for AI by time and place. Confirmation performed by testing oropharyngeal swabs collected from suspected patients and poultry using RT-PCR in the affiliated laboratory. Positive rates were calculated, descriptive data analysis was performed and rate of infection was plotted against demographics and risk factors. Results compared before and after implementation of using Chi² and t-test with p < 0.05 significance. Results: Among all confirmed cases, 346(96.4%) reported before and 13(3.6%) after SIP implementation with no cases reported after 2017. A significant reduction in positivity rate of both human and poultry cases (2.0 vs. 0.2% and 2.4 vs. 1.2%, p < 0.001) found after 2015. Percent of housewives decreased from 30.9 to 7.7%, p < 0.05 and positive specimens’ rates from backyards decreased from 61.1 to 47.9%, p < 0.001. Median days to laboratory confirmation reduced from 3.6 to 2.8 days. The genetic analysis indicated a major genetic drift occurred before 2015, possibly due to inadequate control measures. Conclusions: The Study indicated reduced infections in humans and poultry suggesting effectiveness of SIP, which also raised community awareness as shown by reducing infections among housewives and enhancing surveillance as shown by case earlier detection. Continued coordinated efforts between human and poultry sectors are needed to contribute to the elimination of the disease in Egypt.