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Domènech-Montoliu S, Pac-Sa MR, Sala-Trull D, Del Rio-González A, Sanchéz-Urbano M, Satorres-Martinez P, Blasco-Gari R, Casanova-Suarez J, Gil-Fortuño M, López-Diago L, Notari-Rodríguez C, Pérez-Olaso Ó, Romeu-Garcia MA, Ruiz-Puig R, Aleixandre-Gorriz I, Domènech-León C, Arnedo-Pena A. Underreporting of Cases in the COVID-19 Outbreak of Borriana (Spain) during Mass Gathering Events in March 2020: A Cross-Sectional Study. EPIDEMIOLOGIA 2024; 5:499-510. [PMID: 39189253 PMCID: PMC11348374 DOI: 10.3390/epidemiologia5030034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 08/02/2024] [Accepted: 08/06/2024] [Indexed: 08/28/2024] Open
Abstract
Determining the number of cases of an epidemic is the first function of epidemiological surveillance. An important underreporting of cases was observed in many locations during the first wave of the COVID-19 pandemic. To estimate this underreporting in the COVID-19 outbreak of Borriana (Valencia Community, Spain) in March 2020, a cross-sectional study was performed in June 2020 querying the public health register. Logistic regression models were used. Of a total of 468 symptomatic COVID-19 cases diagnosed in the outbreak through anti-SARS-CoV-2 serology, 36 cases were reported (7.7%), resulting in an underreporting proportion of 92.3% (95% confidence interval [CI], 89.5-94.6%), with 13 unreported cases for every reported case. Only positive SARS-CoV-2 polymerase chain reaction cases were predominantly reported due to a limited testing capacity and following a national protocol. Significant factors associated with underreporting included no medical assistance for COVID-19 disease, with an adjusted odds ratio [aOR] of 10.83 (95% CI 2.49-47.11); no chronic illness, aOR = 2.81 (95% CI 1.28-6.17); middle and lower social classes, aOR = 3.12 (95% CI 1.42-6.85); younger age, aOR = 0.97 (95% CI 0.94-0.99); and a shorter duration of illness, aOR = 0.98 (95% CI 0.97-0.99). To improve the surveillance of future epidemics, new approaches are recommended.
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Affiliation(s)
| | - Maria Rosario Pac-Sa
- Public Health Center, 12003 Castelló de la Plana, Spain; (M.R.P.-S.); (M.A.R.-G.)
| | - Diego Sala-Trull
- Emergency Service University Hospital de la Plana, 12540 Vila-Real, Spain; (D.S.-T.); (M.S.-U.); (P.S.-M.); (R.B.-G.); (C.N.-R.); (R.R.-P.)
| | | | - Manuel Sanchéz-Urbano
- Emergency Service University Hospital de la Plana, 12540 Vila-Real, Spain; (D.S.-T.); (M.S.-U.); (P.S.-M.); (R.B.-G.); (C.N.-R.); (R.R.-P.)
| | - Paloma Satorres-Martinez
- Emergency Service University Hospital de la Plana, 12540 Vila-Real, Spain; (D.S.-T.); (M.S.-U.); (P.S.-M.); (R.B.-G.); (C.N.-R.); (R.R.-P.)
| | - Roser Blasco-Gari
- Emergency Service University Hospital de la Plana, 12540 Vila-Real, Spain; (D.S.-T.); (M.S.-U.); (P.S.-M.); (R.B.-G.); (C.N.-R.); (R.R.-P.)
| | | | - Maria Gil-Fortuño
- Microbiology Service University Hospital de la Plana, 12540 Vila-Real, Spain; (M.G.-F.); (Ó.P.-O.)
| | - Laura López-Diago
- Clinical Analysis Service University Hospital de la Plana, 12540 Vila-Real, Spain; (L.L.-D.); (I.A.-G.)
| | - Cristina Notari-Rodríguez
- Emergency Service University Hospital de la Plana, 12540 Vila-Real, Spain; (D.S.-T.); (M.S.-U.); (P.S.-M.); (R.B.-G.); (C.N.-R.); (R.R.-P.)
| | - Óscar Pérez-Olaso
- Microbiology Service University Hospital de la Plana, 12540 Vila-Real, Spain; (M.G.-F.); (Ó.P.-O.)
| | | | - Raquel Ruiz-Puig
- Emergency Service University Hospital de la Plana, 12540 Vila-Real, Spain; (D.S.-T.); (M.S.-U.); (P.S.-M.); (R.B.-G.); (C.N.-R.); (R.R.-P.)
| | - Isabel Aleixandre-Gorriz
- Clinical Analysis Service University Hospital de la Plana, 12540 Vila-Real, Spain; (L.L.-D.); (I.A.-G.)
| | - Carmen Domènech-León
- Department of Medicine, University CEU Cardenal Herrera, 12006 Castelló de la Plana, Spain;
| | - Alberto Arnedo-Pena
- Public Health Center, 12003 Castelló de la Plana, Spain; (M.R.P.-S.); (M.A.R.-G.)
- Department of Health Science, Public University Navarra, 31006 Pamplona, Spain
- Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
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Qiao H, Paansri P, Escobar LE. Global Mpox spread due to increased air travel. GEOSPATIAL HEALTH 2024; 19. [PMID: 38872388 DOI: 10.4081/gh.2024.1261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/04/2024] [Indexed: 06/15/2024]
Abstract
Mpox is an emerging, infectious disease that has caused outbreaks in at least 91 countries from May to August 2022. We assessed the link between international air travel patterns and Mpox transmission risk, and the relationship between the translocation of Mpox and human mobility dynamics after travel restrictions due to the COVID-19 pandemic had been lifted. Our three novel observations were that: i) more people traveled internationally after the removal of travel restrictions in the summer of 2022 compared to pre-pandemic levels; ii) countries with a high concentration of global air travel have the most recorded Mpox cases; and iii) Mpox transmission includes a number of previously nonendemic regions. These results suggest that international airports should be a primary location for monitoring the risk of emerging communicable diseases. Findings highlight the need for global collaboration concerning proactive measures emphasizing realtime surveillance.
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Affiliation(s)
- Huijie Qiao
- Institute of Zoology, Chinese Academy of Sciences, Beijing.
| | - Paanwaris Paansri
- Department of Fish and Wildlife Conservation, Virginia Tech, Blacksburg, VA.
| | - Luis E Escobar
- Department of Fish and Wildlife Conservation, Virginia Tech, Blacksburg, VA, United States; Global Change Center, Virginia Tech, Blacksburg, VA, United States; Center for Emerging Zoonotic and Arthropod-borne Pathogens, Virginia Tech, Blacksburg, VA, United States; Kellogg Center for Philosophy, Politics, and Economics, Virginia Tech, Blacksburg, VA.
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Naseralallah L, Isleem N, Aboelbaha S, Pallivalapila A, Alnaimi S, Al Hail M. Emergency pharmacy workforce views and experience related to the provision of pharmaceutical care during mass gathering events: the FIFA World Cup Qatar 2022™ experience. Front Public Health 2023; 11:1286637. [PMID: 38145068 PMCID: PMC10748417 DOI: 10.3389/fpubh.2023.1286637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Purpose This study aimed to explore emergency pharmacy workforce perspectives and experiences in providing pharmaceutical care during mass gathering events (i.e., FIFA World Cup Qatar 2022™). Methods A qualitative methodology was employed using focus groups discussions. Emergency pharmacists across Hamad Medical Corporation were invited to participate using a combination of purposive and snowball sampling. Focus groups were audio-recorded, transcribed verbatim, and validated. Inductive thematic analysis was undertaken to generate key themes and subthemes. Results Four focus groups were conducted which included 21 participants and generated five major themes. Whilst participants had mixed opinions in relation to their preparedness to practice during the World Cup, they perceived their experience as successful and smooth. The primary perceived facilitators were management support, mobile medical units, and high public health awareness. The main highlighted barriers were related to staff insufficiency, medications availability, and cultural and language challenges. Participants recommended pharmacist's role identification in mass gatherings, development of pharmacy action plan, and offering simulation training and pharmacy-specific training. Conclusion Despite the perceived barriers, pharmacists reported positive views in relation to their experience in providing pharmaceutical care during mass gatherings. Future research should focus on the development of theory-driven action framework for pharmacy departments to adopt during mass gatherings.
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Affiliation(s)
- Lina Naseralallah
- Department of Pharmacy, Hamad Medical Corporation, Doha, Qatar
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Nour Isleem
- Department of Pharmacy, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Shaikha Alnaimi
- Department of Pharmacy, Hamad Medical Corporation, Doha, Qatar
| | - Moza Al Hail
- Department of Pharmacy, Hamad Medical Corporation, Doha, Qatar
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Al-Thani H, Al Musleh AA, Khan NA, Asim M, Abdurahiman S, Morad YA, Massey A, El-Menyar A. FIFA Arab Cup tournament with full capacity of spectators during the COVID-19 pandemic: a cross-sectional study. SCI MED FOOTBALL 2023; 7:337-346. [PMID: 35950342 DOI: 10.1080/24733938.2022.2110276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/27/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND We sought to assess the risk of COVID-19 and seasonal flu including respiratory syncytial (RSV) and influenza viruses during the FIFA Arab Cup 2021 in Qatar with full capacity of spectators. We also, evaluated the post-event attitude toward resumption of mass football events. METHODS This was a cross-sectional study in which spectators (age ≥ 18 years) were invited for reverse-transcription PCR testing for COVID-19 and seasonal flu. At the same time, between 7 and 14 days after the event, the participants completed a self-administered questionnaire regarding their concerns during the tournament. RESULTS The tournament included 16 international football teams from the Arab countries. As per the study protocol, 10,000 spectators were approached and 6,475 participated. Among the participants, 4,195 (65.1%), 2,253 (34.9%) and 27 (0.4%) were vaccinated with 2 doses, vaccinated with 3 doses, and recovered from SARS-Cov-2 infection, respectively. There were 61 (0.9%), 41(0.6%) and 11(0.2%) participants who tested positive for COVID-19, RSV and influenza (A/B), respectively. The average cycle threshold (Ct) value for COVID-19 positive cases was 26.1±7.3. Among those who were electronically approached, 6,102 completed the survey whereas 373 had incomplete survey. Overall, 2069 (33.9%) participants reported symptoms that theoretically could be related to COVID-19, of them 39 had positive PCR test (1.9%). Spectators (94.3%) were optimistic about returning sport events to the pre-pandemic status. CONCLUSIONS There was no significant increase in the daily COVID-19 cases during FIFA Arab Cup 2021 with a full capacity of spectators. Therefore, upcoming mass football events can be held safely.
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Affiliation(s)
- Hassan Al-Thani
- Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | | | - Naushad Ahmad Khan
- Department of Surgery, Trauma &vascular Clinical Research, Hamad General Hospital, Doha, Qatar
| | - Mohammad Asim
- Department of Surgery, Trauma &vascular Clinical Research, Hamad General Hospital, Doha, Qatar
| | - Sameer Abdurahiman
- Department of Clinical Information Systems (CIS); Hamad Medical Corporation, Doha, Qatar
| | - Yasmin Ali Morad
- Corporate Project management, Primary Health Care Corporation &Corporate Project Management Office, Doha, Qatar
| | - Andrew Massey
- Department of Medicine, Fédération Internationale de Football Association (FIFA), Zürich, Switzerland
| | - Ayman El-Menyar
- Department of Surgery, Trauma &vascular Clinical Research, Hamad General Hospital, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
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Phalippou L, Zhang D. The cost of mass gatherings during a pandemic. SSM Popul Health 2023; 23:101460. [PMID: 37441004 PMCID: PMC10291856 DOI: 10.1016/j.ssmph.2023.101460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/05/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
In June 2020, the U.S., unlike other regions of the world, faced a surge in cases of COVID-19. Immediately prior to this wave of cases, the largest mass protests in U.S. history took place. We show that when holding other factors constant, COVID-19 cases increased most in places where more demonstrations occurred. We exploit variation in rainfall during the protest period as an exogenous source of variation in attendance. We find that good weather coincides with both more people protesting and more subsequent COVID-19 cases and deaths. Mass gatherings during a pandemic thus lead to more contraction and fatalities of COVID-19, and we quantify these effects.
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Affiliation(s)
- Ludovic Phalippou
- Said Business School, University of Oxford, Park End Street, Oxford, OX1 1HP, UK
| | - Dayin Zhang
- School of Business, University of Wisconsin-Madison, 975 University Avenue, Madison, WI, 53706, USA
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Malki-Epshtein L, Adzic F, Roberts BM, Hathway EA, Iddon C, Mustafa M, Cook M. Measurement and rapid assessment of indoor air quality at mass gathering events to assess ventilation performance and reduce aerosol transmission of SARS-CoV-2. BUILDING SERVICES ENGINEERING RESEARCH & TECHNOLOGY : BSER & T 2023; 44:113-133. [PMID: 38603254 PMCID: PMC9760526 DOI: 10.1177/01436244221137995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
To assess risk factors for COVID-19 transmission and address the closure of mass gathering events since March 2020, the UK Government ran the Events Research Programme (ERP), following which it reopened live events in sports, music, and culture in July 2021. We report the rapid post-occupancy evaluation of Indoor Air Quality (IAQ) and associated long-range airborne transmission risk conducted in the Environmental Study of the ERP. Ten large venues around the UK were monitored with CO2 sensors at a high spatial and temporal resolution during 90 events. An IAQ Index based on CO2 concentration was developed, and all monitored spaces were classified in bands from A to G based on their average and maximum CO2 concentrations from all events. High resolution monitoring and the IAQ Index depicted the overall state of ventilation at live events, and allowed identification of issues with ventilation effectiveness and distribution, and of spaces with poor ventilation and the settings in which long-range airborne transmission risk may be increased. In numerous settings, CO2 concentrations were found to follow patterns relating to event management and specific occupancy of spaces around the venues. Good ventilation was observed in 90% of spaces monitored for given occupancies. Practical applications: High-resolution monitoring of indoor CO2 concentrations is necessary to detect the spatial variation of indoor air quality (IAQ) in large mass gathering event venues. The paper summarises COVID-19 ventilation guidance for buildings and defines a methodology for measurement and rapid assessment of IAQ during occupancy at live events that can be implemented by venue managers. Comparisons of the CO2 concentrations measured during the events identified the spaces at high risk of long-range transmission of airborne pathogens. Building operators should be mindful of the ventilation strategies used relative to the total occupancy in different spaces and the occupant's activities.
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Affiliation(s)
- Liora Malki-Epshtein
- Department of Civil, Environmental and Geomatic Engineering, University College London, London, UK
| | - Filipa Adzic
- Department of Civil, Environmental and Geomatic Engineering, University College London, London, UK
| | - Ben M Roberts
- Building Energy Research Group, Loughborough University, Loughborough, UK
| | | | | | | | - Malcolm Cook
- Building Energy Research Group, Loughborough University, Loughborough, UK
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Bárcena-Martín E, Molina J, Muñoz-Fernández A, Pérez-Moreno S. Vulnerability and COVID-19 infection rates: A changing relationship during the first year of the pandemic. ECONOMICS AND HUMAN BIOLOGY 2022; 47:101177. [PMID: 36067676 PMCID: PMC9400383 DOI: 10.1016/j.ehb.2022.101177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/12/2022] [Accepted: 08/22/2022] [Indexed: 05/29/2023]
Abstract
In the first year of the COVID-19 pandemic, Spain was one of the worst-hit countries, although not all areas and social groups were affected equally. This study focuses on Malaga, a cosmopolitan tourist destination located on the southern Mediterranean coast that has the sixth largest population in Spain. Specifically, it examines the relationship between multidimensional vulnerability and COVID-19 infection rates across the city's census tracts for the period February 2020 to February 2021. The analysis uses high frequency (daily) data on the accumulated incidence of the disease at 14 days and shows that COVID-19 did not spread symmetrically across the census tracts of Malaga but had a greater impact on the most vulnerable neighbourhoods. However, the pattern of this relationship was not uniform in the period examined, with specific contextual factors driving the higher infection rates across time. Our findings show that pandemic containment regulations cannot overlook vulnerability considerations and universal restrictions to reduce the spread of disease should be supplemented by targeted regulations for specific areas.
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Affiliation(s)
| | - Julián Molina
- Applied Economics Department, Universidad de Málaga, Spain
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Bello P, Rocco L. Education and COVID-19 excess mortality. ECONOMICS AND HUMAN BIOLOGY 2022; 47:101194. [PMID: 36370500 PMCID: PMC9644421 DOI: 10.1016/j.ehb.2022.101194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 10/14/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
We study the role of education during the COVID-19 epidemic in Italy. We compare excess mortality in 2020 and 2021 compared to the pre-pandemic mortality between municipalities with different shares of educated residents. We find that education initially played a strong protective role, which however quickly faded out. After pondering several alternative explanations, we tentatively interpret this finding as the outcome of the interplay between education, information and public health communication, whose availability and coherence varied along the epidemic.
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Affiliation(s)
- Piera Bello
- University of Bergamo, Italy, and ZEW, Germany.
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Kandeel A, Fahim M, Deghedy O, Alim W, Roshdy WH, Khalifa MK, El Shesheny R, Kandeil A, Naguib A, Elguindy N, Abdel Fattah M, Afifi S, Mohsen A, Abdelghaffar K. Incidence, risk factors, and whole-genome sequence of SARs-CoV-2 and influenza virus among the Egyptian pilgrims returning from Umrah mass gathering in Saudi Arabia, April-May 2022. J Infect Public Health 2022; 15:1290-1296. [PMID: 36274370 PMCID: PMC9616792 DOI: 10.1016/j.jiph.2022.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/30/2022] [Accepted: 10/02/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Amr Kandeel
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt.
| | - Manal Fahim
- Department of Epidemiology and Surveillance, Preventive Sector, Ministry of Health and Population, Cairo, Egypt.
| | - Ola Deghedy
- Department of Epidemiology and Surveillance, Preventive Sector, Ministry of Health and Population, Cairo, Egypt.
| | - Walaa Alim
- Department of Epidemiology and Surveillance, Preventive Sector, Ministry of Health and Population, Cairo, Egypt.
| | - Wael H Roshdy
- Central Public Health Laboratory, Ministry of Health and Population, Cairo, Egypt.
| | - Mohamed K Khalifa
- Central Public Health Laboratory, Ministry of Health and Population, Cairo, Egypt.
| | - Rabeh El Shesheny
- Centre of Scientific Excellence for Influenza Viruses, National Research Centre, 12622 Dokki, Giza, Egypt.
| | - Ahmed Kandeil
- Centre of Scientific Excellence for Influenza Viruses, National Research Centre, 12622 Dokki, Giza, Egypt.
| | - Amel Naguib
- Central Public Health Laboratory, Ministry of Health and Population, Cairo, Egypt.
| | - Nancy Elguindy
- Central Public Health Laboratory, Ministry of Health and Population, Cairo, Egypt.
| | | | - Salma Afifi
- Ministry of Health and Population Consultant, Cairo, Egypt.
| | - Amira Mohsen
- World Health Organization, Egypt Country Office, Cairo, Egypt.
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