E

1
Environmental Surveillance in Egypt
E G Y P T
2
Confirmed Polio Cases OPV-3 Coverage Egypt
(1991- 2001)
3
Objectives

• Identify reservoir areas
• Identify areas of circulation missed by AFP
  surveillance
• Genetic characterization of viruses

4

• 1999
• 9 cases, 7 up to March
• one was due to P3 (Asyut, Feb 99) although last
  type 3 was 1996 in Qena Minya, (isolates 96
  identical).
• No cases between March and November
• November P3 in Minya and P1 in Asyut.
• 2000
• 2 cases (P1 and P3) from Asyut February 2000
• 1 case P1, Qena end May
• 1 case P3 Fayoum, Dec
• 2001
• 3 P1 Minya in Jan, Feb
• 2 P1 Qena in Oct

5
1999
2000
2001
No. cases
5
39
45
51
11
17
23
29
35
41
47
Week Number
Polio 3
6
Project Timeline
7
5
Tanta
0
Fayoum
Beni Sueif
Minya
Abu Qurkas
Number of Samples
Mallawy
Asiut
Dairut
Sohag
Qena
Aswan
8
Asiut
Dairut
Al Minya
Oct 2001
Abu Qurkas
Sohag
Qena
Al Fayoum
Tanta
Jan-Feb 2001
From Confirmed Polio Case
Oct '98 - Jan '99
May 2000
Nov '99 - Jan '00
Tanta
9
Conclusions end 2001

• No wild types 2 or 3 were found
• Only one genotype of type 1 was found
• More time is needed to identify reservoirs
• Same lineages found in cities and towns or
  villages
• Multiple independent chains of transmission (at
  least 10 chains and 4 lineages)
• Lineages in wastewater same as those from polio
  cases.
• Intensity of transmission is not matching with
  AFP surveillance (2 lineages, 2 chains)
• Virus circulating widely throughout Upper Egypt
• Lower Egypt?

10
Possible gaps in AFP surveillance
11
AFP Surveillance IndicatorsNon-polio AFP Rate
1997 - 2001
1.4
1.23
1.2
1.2
1.1
1.2
0.97
1
0.8
0.6
0.4
0.2
0
1997
1998
1999
2000
2001
12
Non-polio AFP Rate for 2001 1.1per 100,000 under
5
Culture of fear
144 silent districts
3.0
2.0
No actual active surveillance
Non-polio AFP Cases/100,000 lt15 yrs
1.0
0.0
Suez
Giza
Cairo
Minia
Qena
Luxor
Behira
Assuit
Sohag
P. Said
Qalubia
Aswan
N. sinai
Ismailia
Matrouh
Red Sea
Gharbia
Sharkia
Fayoum
S. Sinai
Damietta
N. Valley
Menoufia
Dakhalia
K. Sheikh
Bani Sueif
Alexandria
13
First TAG March 2002

• Structure and operating procedures for PE
• Strengthen Surveillance for wild virus
• Supplementary immunization activities
• Enhancing the role of partner agencies

14
Second TAG 31Jul-1 Aug 2002
Third TAG 2-3 February 2003
Fourth TAG June 2003
Surveillance review
15
Recommendations

• Confine sampling in Upper Egypt to the capital
  city in each governerate
• Add additional sampling sites in Lower Egypt (No
  more than 12 samples per month)

16
Map of Egypt showing location of collection
sites for environmental surveillance
Sites in 2001 - Asyut (2), Aswan, Beni Suef,
Fayum, Minya (2), Qena, Sohag, Tanta
17
Map of Egypt showing location of collection
sites for environmental surveillance
Sites in 2001 - Asyut (2), Aswan, Beni Suef,
Fayum, Minya (2), Qena, Sohag, Tanta
Additional Sites in 2002 - Alexandria,
Behira Cairo, Menofia, Sahrkia
18
P1 NSL positives in Egypt provinces, 2002
19/06/03
19
AFP Surveillance Indicators Non-polio AFP rate,
EGYPT 1997-2003
Till mid August
20
AFP Surveillance Indicators Non-polio AFP rate
by quarter Egypt, 2002-2003
Till end July
21
AFP Surveillance Indicators Non-polio AFP Rate
by Governorate Egypt, 2001-2003 (till July 13)
22

• 2002 Polio Cases
• Seven P1 cases occurred between Sept and Dec
• Upper Egypt
• 1 case Assiut
• Lower Egypt / Greater Cairo 6 cases Menooufia
  (1) , Giza (2), Sharkia (2), Alex. (1)
• Age
• 4 cases lt 12 months
• 2 cases 12- 24 months
• 1 case 14 years
• 6 boys 1 girl
• Vaccination status
• Range 3-9 doses

Lower
Upper
23
01E44V1
01E83S33
AFP 2002
01E79K16
01E61K83
Oct 02(Giza)
A
01E72V2
01E69K131
2003703860 EGY/467/02 Manshet El Kanater
13Oct02 AFP-Giza
01E75K33
01E72K3730
02E54K6609-As City 14 Apr 02
02E54V2-As City 14 Apr 02
01E107K88
01E68K128
01E49K14
01E53K35
01E49V1
02E85K7617 Cairo 26Jun02
Cairo Sharkia
AFP 2002
2003705309 EGY/574/02 Mashtool 31Dec02
AFP-Sharkia
Nov-Dec(Sharkia)
PAL02-5763
02E152K34 Cairo 17Dec02
02E97K4384 Cairo 01Aug02
Cairo
02E97V2 Cairo 1Aug02
B
02E85V1 Cairo 26Jun02
02E154V1 Sharkia 21Dec02
02E108K24 Cairo 31Aug02
02E154K39 Sharkia 21Dec02
2003705262 EGY/528/02 Belbis 26Nov02 AFP-Sharkia
03E18K2832 Sharkia Belbais, 2 February 2003
01E58K69
01E76K3745
01E67V1
01E10K1781
D
02E02K28 Sohag City 05Jan02
01E116V1
02E20K5484 Fayum 13Feb02
01E91K82
01E91K81
01E66K111
01E66V1
01E78K3740
AFP 2002
01E64K98
02E53V2 Fayum 14Apr02
02E70V2 Fayum 14May02
01E121V1
02E70K37 Fayum 14May02
01E118K16
01E108K91
02E20K5475 Fayum 13Feb02
Oct 02 (Giza),Dec(Alx)
2003705307 EGY/566/02 Montazah 27Dec02
AFP-Alexandria
2003703354 EGY/455/02 Giza 02Oct02 AFP-Giza
01E116K12
01E115V1
01E115K51
C
01E131K382
01E131V2
2002011765
02E01K5500 Qena 01Jan02
01E127K63
AFP 2002
2003703370 EGY/442/02 Abu Teig Asyut 24Sep02
AFP-Asyut
02E78K7506 Asyut City 9Jun02
Sep 02(Assiut)
EGYPT PV1 WILD AFP Cases and Environmental
Isolates VP1 sequences (906 nt) 10 June 2003
02E14V2 Beni Suif 04Feb02
01E47K2935
01E50K2987
01E56K2984
9999010251
2000022226
2000023372
01E35K2714
02E31K6745 Qena 4Mar02
PAL02-5816
01E72K17
02E13K53
01E52V1
01E111K108
02E114K60 Damanhour Behire 18Sep02
Red ENV 2003 Blue ENV 2003 Green AFP 2002
01E70K2991
E
02E119K234 Cairo 26Sep02
02E150K31 Beni Suif 2Dec02
2003703382
2003703382 02E109V1 Beni Suif 2Sep02
2003703382 02E109V1 Beni Suif 2Sep02
02E136V1 Alexandria 03Nov02
AFP 2002
2003705231 02E150V2 Beni Suif 2Dec02
02E125K232 Giza 9Oct02
Sept 02 (Ash/menoufia) June 03(Menia)
2003704464 02E125V2 Giza 9Oct02
02E86K3978 Fayum 30Jun02
02E108V1 Cairo 31Aug02
AFP 2002
02E139K53 Asyut City 10Nov02
2003703372 EGY/444/02 Ashmoon Menofia 26Sep02
AFP-Menofia
F
03E10V1 Sharkia Zakazeek, 26 January 2003
03E65K2143 Cairo, 20 April 2003
02E142V2 Cairo 20Nov02
01E14K31
2003705227 02E144V2 Shebeen Elkoum 20Nov02
Cases
01E40K31
01E49V2
01E65K103
01E112V1
01E70K138
02E63V2 Asyut City 04May02
01E71K3727
01E76K3734
01E89K70
01E77K45
01E86K45
01E109K98
01E92K85
01E88V2
01E88K58
01E103K64
01E54K2974
01E77V1
01E81K3036
01E127V1
01E132K372
01E132V1
01E102V1
01E109V2
01E46K78
01E96V1
01E108V1
24
01E44V1
01E83S33
AFP 2002
01E79K16
01E61K83
Oct 02(Giza)
A
01E72V2
01E69K131
2003703860 EGY/467/02 Manshet El Kanater
13Oct02 AFP-Giza
01E75K33
01E72K3730
02E54K6609-As City 14 Apr 02
02E54V2-As City 14 Apr 02
01E107K88
01E68K128
01E49K14
01E53K35
01E49V1
02E85K7617 Cairo 26Jun02
Cairo Sharkia
AFP 2002
2003705309 EGY/574/02 Mashtool 31Dec02
AFP-Sharkia
Feb 03(Sharkia)
PAL02-5763
02E152K34 Cairo 17Dec02
02E97K4384 Cairo 01Aug02
Cairo
02E97V2 Cairo 1Aug02
B
02E85V1 Cairo 26Jun02
02E154V1 Sharkia 21Dec02
02E108K24 Cairo 31Aug02
02E154K39 Sharkia 21Dec02
2003705262 EGY/528/02 Belbis 26Nov02 AFP-Sharkia
03E18K2832 Sharkia Belbais, 2 February 2003
01E58K69
01E76K3745
01E67V1
01E10K1781
Feb 02(Fayoum)
D
02E02K28 Sohag City 05Jan02
01E116V1
02E20K5484 Fayum 13Feb02
01E91K82
01E91K81
01E66K111
01E66V1
01E78K3740
AFP 2002
01E64K98
02E53V2 Fayum 14Apr02
02E70V2 Fayum 14May02
01E121V1
02E70K37 Fayum 14May02
01E118K16
01E108K91
02E20K5475 Fayum 13Feb02
Dec02(Alx)
2003705307 EGY/566/02 Montazah 27Dec02
AFP-Alexandria
2003703354 EGY/455/02 Giza 02Oct02 AFP-Giza
01E116K12
01E115V1
01E115K51
C
01E131K382
01E131V2
2002011765
02E01K5500 Qena 01Jan02
01E127K63
AFP 2002
2003703370 EGY/442/02 Abu Teig Asyut 24Sep02
AFP-Asyut
02E78K7506 Asyut City 9Jun02
EGYPT PV1 WILD AFP Cases and Environmental
Isolates VP1 sequences (906 nt) 10 June 2003
02E14V2 Beni Suif 04Feb02
01E47K2935
01E50K2987
01E56K2984
9999010251
2000022226
2000023372
01E35K2714
02E31K6745 Qena 4Mar02
PAL02-5816
01E72K17
02E13K53
Dec02(Beni Sweif)
01E52V1
01E111K108
02E114K60 Damanhour Behire 18Sep02
Red ENV 2003 Blue ENV 2003 Green AFP 2002
01E70K2991
E
02E119K234 Cairo 26Sep02
02E150K31 Beni Suif 2Dec02
2003703382
2003703382 02E109V1 Beni Suif 2Sep02
2003703382 02E109V1 Beni Suif 2Sep02
02E136V1 Alexandria 03Nov02
AFP 2002
2003705231 02E150V2 Beni Suif 2Dec02
02E125K232 Giza 9Oct02
2003704464 02E125V2 Giza 9Oct02
02E86K3978 Fayum 30Jun02
02E108V1 Cairo 31Aug02
AFP 2002
02E139K53 Asyut City 10Nov02
2003703372 EGY/444/02 Ashmoon Menofia 26Sep02
AFP-Menofia
F
03E10V1 Sharkia Zakazeek, 26 January 2003
03E65K2143 Cairo, 20 April 2003
02E142V2 Cairo 20Nov02
01E14K31
2003705227 02E144V2 Shebeen Elkoum 20Nov02
01E40K31
01E49V2
last isolate
01E65K103
01E112V1
June/July? 03(Menia/Cairo)
01E70K138
02E63V2 Asyut City 04May02
01E71K3727
01E76K3734
01E89K70
01E77K45
01E86K45
01E109K98
01E92K85
01E88V2
01E88K58
01E103K64
01E54K2974
01E77V1
01E81K3036
01E127V1
01E132K372
01E132V1
01E102V1
01E109V2
01E46K78
01E96V1
01E108V1
25
(No Transcript)
26
Social Mobilization
27
Sharkia
G Cairo
2002
2003
Mop-up
Mar
May
June
Sep
Sept
Oct
Dec
Aug
Oct
Dec
28
Lower Egypt n 12 sites
Greater Cairo Giza n 6 sites
Upper Egypt n 7 sites
Map of Egypt showing sampling sites
Map of Egypt Sampling sites including new
Environmental sampling sites Including sites
introduced in June 2003
29
Environment Data
ENV 6/122 P1 NSL (50 pending) in 2003 AFP 1
confirmed case in Abo Korkas, Minya 16-Jun-03
30
Egypt - Surveillance for wild polioviruses in
sewage
31
Greater Cairo
El Salam
Shobr Elkhima
Abo Rawash
Zenin
El Saf
32
Environmental Surveillance, Egypt,
20012003Number samples collected and number
wild virus positive
5
58
16
of samples with available results
33
Wild Poliovirus detection in environmental
surveillance by month, Egypt, Jul 2000-Aug 2003
Start up period

2003
2001
2000
2002
34
Wild Poliovirus Environmental Samples, Jun
00-Aug 03
Pos
Neg
Lower Egypt
Greater Cairo
Upper Egypt
58 of 130 samples
16 of 162 samples
5 of 122 samples
35
Vaccine Poliovirus detection rates in
environmental surveillance by month, Egypt, Jul
2000-Jun 2003
Start up period
2001
2002
2000
2003
Positive
36
01E44V1
01E83S33
AFP 2002
01E79K16
01E61K83
Oct 02(Giza)
A
01E72V2
01E69K131
2003703860 EGY/467/02 Manshet El Kanater
13Oct02 AFP-Giza
01E75K33
01E72K3730
02E54K6609-As City 14 Apr 02
02E54V2-As City 14 Apr 02
01E107K88
01E68K128
01E49K14
01E53K35
01E49V1
02E85K7617 Cairo 26Jun02
Cairo Sharkia
AFP 2002
2003705309 EGY/574/02 Mashtool 31Dec02
AFP-Sharkia
Feb 03(Sharkia)
PAL02-5763
02E152K34 Cairo 17Dec02
02E97K4384 Cairo 01Aug02
Cairo
02E97V2 Cairo 1Aug02
B
02E85V1 Cairo 26Jun02
02E154V1 Sharkia 21Dec02
02E108K24 Cairo 31Aug02
02E154K39 Sharkia 21Dec02
2003705262 EGY/528/02 Belbis 26Nov02 AFP-Sharkia
03E18K2832 Sharkia Belbais, 2 February 2003
01E58K69
01E76K3745
01E67V1
01E10K1781
Feb 02(Fayoum)
D
02E02K28 Sohag City 05Jan02
01E116V1
02E20K5484 Fayum 13Feb02
01E91K82
01E91K81
01E66K111
01E66V1
01E78K3740
AFP 2002
01E64K98
02E53V2 Fayum 14Apr02
02E70V2 Fayum 14May02
01E121V1
02E70K37 Fayum 14May02
01E118K16
01E108K91
02E20K5475 Fayum 13Feb02
Dec02(Alx)
2003705307 EGY/566/02 Montazah 27Dec02
AFP-Alexandria
2003703354 EGY/455/02 Giza 02Oct02 AFP-Giza
01E116K12
01E115V1
01E115K51
C
01E131K382
01E131V2
2002011765
02E01K5500 Qena 01Jan02
01E127K63
AFP 2002
2003703370 EGY/442/02 Abu Teig Asyut 24Sep02
AFP-Asyut
02E78K7506 Asyut City 9Jun02
EGYPT PV1 WILD AFP Cases and Environmental
Isolates VP1 sequences (906 nt) 10 June 2003
02E14V2 Beni Suif 04Feb02
01E47K2935
01E50K2987
01E56K2984
9999010251
2000022226
2000023372
01E35K2714
02E31K6745 Qena 4Mar02
PAL02-5816
01E72K17
02E13K53
Dec02(Beni Sweif)
01E52V1
01E111K108
02E114K60 Damanhour Behire 18Sep02
Red ENV 2003 Blue ENV 2003 Green AFP 2002
01E70K2991
E
02E119K234 Cairo 26Sep02
02E150K31 Beni Suif 2Dec02
2003703382
2003703382 02E109V1 Beni Suif 2Sep02
2003703382 02E109V1 Beni Suif 2Sep02
02E136V1 Alexandria 03Nov02
AFP 2002
2003705231 02E150V2 Beni Suif 2Dec02
02E125K232 Giza 9Oct02
2003704464 02E125V2 Giza 9Oct02
02E86K3978 Fayum 30Jun02
02E108V1 Cairo 31Aug02
AFP 2002
02E139K53 Asyut City 10Nov02
2003703372 EGY/444/02 Ashmoon Menofia 26Sep02
AFP-Menofia
F
03E10V1 Sharkia Zakazeek, 26 January 2003
03E65K2143 Cairo, 20 April 2003
02E142V2 Cairo 20Nov02
01E14K31
2003705227 02E144V2 Shebeen Elkoum 20Nov02
01E40K31
01E49V2
last isolate
01E65K103
01E112V1
June/July? 03(Menia/Cairo)
01E70K138
02E63V2 Asyut City 04May02
01E71K3727
01E76K3734
01E89K70
01E77K45
01E86K45
01E109K98
01E92K85
01E88V2
01E88K58
01E103K64
01E54K2974
01E77V1
01E81K3036
01E127V1
01E132K372
01E132V1
01E102V1
01E109V2
01E46K78
01E96V1
01E108V1
37
EGYPT PV1 WILD AFP Cases and Environmental
Isolates VP1 sequences (906 nt)
Cairo (17 Jun 03) ? Minya (7 Jul 03) ?
Damanhour, Behira (18 Sep 02)
Cairo (26 Sep 02)
E
Beni Suif (2 Dec 02)
Beni Suif (2 Sep 02)
Beni Suif (2 Sep 02)
Beni Suif (2 Sep 02)
Alexandria (03 Nov 02)
Beni Suif (2 Dec 02)
Minya (13 Jun 03)
Abo Korkas, Minya 16 Jun 03 AFP
Giza (9 Oct 02)
Giza (9 Oct 02)
Fayum (30 Jun 02)
F

• Environment and AFP surveillance
• Single genotype of WTPV1
• WPV detected from 3 /18 governorates
• Only 2 clusters (B-F) are active
• Cluster F-Cairo, Sharkia, Minya
• Remaining clusters not seen since December 2002
• WPV detected in Minya after 18 months
• One WPV case in Minya related to chains in
  cluster F

Cairo (31 Aug 02)
Asyut City (10 Nov 02)
Ashmoon, Menofia 26 Sep 02 AFP
Zakazeek, Sharkia (26 January 03)
Cairo (20 April 03)
Cairo (20 Nov 02)
Shebeen Elkoum, Menoufia (20 Nov 02)
0.01
38
Summary - 1

• From sequencing data
• Greater agreement in data from 2 surveillance
  sources WPV of similar lineages found in AFP
  cases and environment. Exception is Cairo and
  Beni Seuf with only WPV detected in environment

39
Summary - 2

• Evidence suggestive of reduced WPV transmission
• In Upper Egypt decrease in proportion of WPV
  positive environmental samples from 57 in 2001
  to 13 in 2002 to no WPV detected up to Aug
  2003, Except in Minya

40
24- Month Risk Evaluation (DRAFT)
E or C Wild PV virus from Environment or Case V
Sabin or EV isolated ? Pending results Blank
No sample taken lt2 yrs ltOPV5 doses of AFP
cases lt2 years of age with lt5 OPV doses
41
Conclusions- Egypt programme

• Eye opener
• Triggered field action
• AFP Surveillance
• SIA activities
• Used with other information
• as a tool for risk assessment
• Monitor progress towards interruption of
  transmission

42
Conclusions

• AFP-surveillance remains the gold standard
• Environmental surveillance
• Can provide valuable supplementary information
  where AFP surveillance is questionable
• Extra load on lab and field surveillance

43
(No Transcript)
44
EGYPT PV1 WILD AFP Cases and Environmental
Isolates VP1 sequences (906 nt) 19 April 2003
AFP 2002
01E75K33
02E54V2-As City 14 Apr 02
01E72K3730
A
02E54K6609-As City 14 Apr 02
2003703860 EGY/467/02 Manshet El Kanater
13Oct02 AFP-Giza
01E61K83
01E69K131- Asyut City 24 June 01
01E72V2
01E44V1
01E79K16
01E83K33
01E53K35
AFP 2002
01E49K14
01E68K128
02E85K7617 Cairo 26Jun02
01E49V1
02E152K34 Cairo 17Dec02
PAL02-5763
2003705309 EGY/574/02 Mashtool 31Dec02
AFP-Sharkia
02E97V2 Cairo 1Aug02
02E97K4384 Cairo 01Aug02
2003705262 EGY/528/02 Belbis 26Nov02 AFP-Sharkia
B
02E108K24 Cairo 31Aug02
02E85V1 Cairo 26Jun02

• 2002
• Environment
• Single genotype of WTPV1
• WPV detected from 11 / 18 governorates
• 6 clusters (A-F)
• Cluster D not seen since May (Fayoum)
• Cluster F-Alex, Giza, Cairo, Asyut, Menofia
• 3 non-clustering isolates (not seen since June
  from Assuit Beni Suef)
• AFP surveillance
• 4 clusters (A, B, C, F)
• Cluster E (Beni Suef) not detected by AFP
• 1 AFP case from Assuit (24 Sept) related to
  Assuit non-clustering isolate (June)

02E154K39 Sharkia 21Dec02
02E154V1 Sharkia 21Dec02
01E67V1
01E76K3745
01E58K69
01E10K1781
01E64K98
01E116K12
01E115V1
2003705307 EGY/566/02 Montazah 27Dec02
AFP-Alexandria
2003703354 EGY/455/02 Giza 02Oct02 AFP-Giza
01E131V2
01E131K382
2002011765
02E01K5500 Qena 01Jan02
2002012061
AFP 2002
01E121K21
C
01E121V1
01E118K16
02E20K5475 Fayum 13Feb02
01E108K91
02E53V2 Fayum 14Apr02
02E70K37 Fayum 14May02
02E70V2 Fayum 14May02
02E02K28 Sohag City 05Jan02
D
01E116V1
02E20K5484 Fayum 13Feb02
01E91K81
01E91K82
01E66K111
01E78K3740
01E66V1
02E78K7506 Asyut City 9Jun02
2003703370 EGY/442/02 Abu Teig Asyut 24Sep02
AFP-Asyut
01E53V1
2001012829
00E18V1
00E32K7
01E57K2967
00E32K6
01E16K15
01E7K17795
00E32V2
01E32K89
01E68V2
01E81K26
01E48V2
01E68K129
01E99V1
01E44K66
01E44K2932
01E38K2922
01E64K99
01E65K102
01E76K3735
01E24V1
01E53V2
01E23K75
2001022324
2001022327
2001022326
2001022323
2001022322
01E121V2
01E88V1
01E96V2
01E87K3043
01E69V1
01E64V1
01E63K94
01E52K29
01E63V2
02E14V2 Beni Suif 04Feb02
01E39K2928
01E69K134
9899010264
9899010259
01E37K2715
01E50V1
01E47K2935
01E56K2984
01E50K2987
9999010251
2000023372
01E35K2714
2000022226
PAL02-5816
02E31K6745 Qena 4Mar02
Red ENV 2002 Blue AFP 2002 Green ENV 2003 Pink
PAL-GAZA ENV Samples
01E72K17
Beni Suif Cairo
02E150K31 Beni Suif 2Dec02
E
2003703382 02E109V1 Beni Suif 2Sep02
2003703382 02E109V1 Beni Suif 2Sep02
02E109K26 Beni Suif 2Sep02
02E119K234 Cairo 26Sep02
02E114K60 Damanhour Behire 18Sep02
02E150V2 Beni Suif 2Dec02
02E136V1 Alexandria 03Nov02
F
2003703372 EGY/444/02 Ashmoon Menofia 26Sep02
AFP-Menofia
03E10V1-Sharkia 26 Jan 03
2003705227 02E144V2 Shebeen Elkoum 20Nov02
02E142V2 Cairo 20Nov02
02E125K232 Giza 9Oct02
2003704464 02E125V2 Giza 9Oct02
02E86K3978 Fayum 30Jun02
02E86K3978 Fayum 30Jun02
02E108V1 Cairo 31Aug02
02E13K53 Asyut City 3Feb02
01E52V1
01E70K2991
01E111K108
01E14K31
01E49V2
01E40K31
01E65K103
01E112V1
01E70K138
02E63V2 Asyut City 04May02
01E76K3734
01E71K3727
01E89K70
01E86K45
01E77K45
01E92K85
01E88V2
01E88K58
0.01
01E103K64
01E54K2974
01E81K3036
01E77V1
01E127V1
01E132V1
01E132K372
01E96V1
01E46K78
01E109V2
01E102V1
45
EGYPT PV1 WILD AFP Cases and Environmental
Isolates VP1 sequences (906 nt) 10 June 2003
01E44V1
01E83S33
AFP 2002
01E79K16
01E61K83
A
01E72V2
01E69K131
2003703860 EGY/467/02 Manshet El Kanater
13Oct02 AFP-Giza
01E75K33
01E72K3730
02E54K6609-As City 14 Apr 02
02E54V2-As City 14 Apr 02
01E107K88
01E68K128
01E49K14
01E53K35
01E49V1
02E85K7617 Cairo 26Jun02
Cairo Sharkia
AFP 2002
2003705309 EGY/574/02 Mashtool 31Dec02
AFP-Sharkia
PAL02-5763
02E152K34 Cairo 17Dec02
02E97K4384 Cairo 01Aug02
Cairo
02E97V2 Cairo 1Aug02
B
02E85V1 Cairo 26Jun02
02E154V1 Sharkia 21Dec02
02E108K24 Cairo 31Aug02
02E154K39 Sharkia 21Dec02
2003705262 EGY/528/02 Belbis 26Nov02 AFP-Sharkia
03E18K2832 Sharkia Belbais, 2 February 2003
01E58K69
01E76K3745
01E67V1
01E10K1781
D
02E02K28 Sohag City 05Jan02
01E116V1
02E20K5484 Fayum 13Feb02
01E91K82
01E91K81
01E66K111
01E66V1
01E78K3740
AFP 2002
01E64K98
02E53V2 Fayum 14Apr02
02E70V2 Fayum 14May02

• 2003
• Environment
• Single genotype of WTPV1
• WPV detected from 2 /18 governorates
• Only 2 clusters (B-F) are active
• Cluster F-Cairo, Sharkia
• Remaining clusters not seen since
• A - April02 Asuit
• C - Jan02 Qena, May02 Fayoum
• D - Jan02 Sohag, Feb.02 Fayoum
• E - Sept02 Cairo, Oct02 B. Seuf
• Sept02 Behira

01E121V1
02E70K37 Fayum 14May02
01E118K16
01E108K91
02E20K5475 Fayum 13Feb02
2003705307 EGY/566/02 Montazah 27Dec02
AFP-Alexandria
2003703354 EGY/455/02 Giza 02Oct02 AFP-Giza
01E116K12
01E115V1
01E115K51
C
01E131K382
01E131V2
2002011765
02E01K5500 Qena 01Jan02
01E127K63
AFP 2002
2003703370 EGY/442/02 Abu Teig Asyut 24Sep02
AFP-Asyut
02E78K7506 Asyut City 9Jun02
02E14V2 Beni Suif 04Feb02
01E47K2935
01E50K2987
01E56K2984
9999010251
2000022226
2000023372
01E35K2714
02E31K6745 Qena 4Mar02
PAL02-5816
01E72K17
02E13K53
01E52V1
01E111K108
02E114K60 Damanhour Behire 18Sep02
Red ENV 2003 Blue ENV 2003 Green AFP 2002
01E70K2991
E
02E119K234 Cairo 26Sep02
02E150K31 Beni Suif 2Dec02
2003703382
2003703382 02E109V1 Beni Suif 2Sep02
2003703382 02E109V1 Beni Suif 2Sep02
02E136V1 Alexandria 03Nov02
AFP 2002
2003705231 02E150V2 Beni Suif 2Dec02
02E125K232 Giza 9Oct02
2003704464 02E125V2 Giza 9Oct02
02E86K3978 Fayum 30Jun02
02E108V1 Cairo 31Aug02
AFP 2002
02E139K53 Asyut City 10Nov02
2003703372 EGY/444/02 Ashmoon Menofia 26Sep02
AFP-Menofia
F
03E10V1 Sharkia Zakazeek, 26 January 2003
03E65K2143 Cairo, 20 April 2003
02E142V2 Cairo 20Nov02
01E14K31
2003705227 02E144V2 Shebeen Elkoum 20Nov02
01E40K31
01E49V2
01E65K103
01E112V1
01E70K138
02E63V2 Asyut City 04May02
01E71K3727
01E76K3734
01E89K70
01E77K45
01E86K45
01E109K98
01E92K85
01E88V2
01E88K58
01E103K64
01E54K2974
01E77V1
01E81K3036
01E127V1
01E132K372
01E132V1
01E102V1
01E109V2
01E46K78
01E96V1
01E108V1
46
2003703382 02E109V1 Beni Suif 2Sep02
2003705231 02E150V2 Beni Suif 2Dec02
AFP case03
Egy03-e108-K35- Minya 13 June 2003
2003704464 02E125V2 Giza 9Oct02
F
02E108V1 Cairo 31Aug02
2003705227 02E144V2 Shebeen Elkoum 20Nov02
AFP case02

• Environment and AFP surveillance
• Single genotype of WTPV1
• WPV detected from 3 /18 governorates
• Only 2 clusters (B-F) are active
• Cluster F-Cairo, Sharkia, Minya
• Remaining clusters not seen since September 2002
• WPV detected in Minya after 18 months
• One WPV case in Minya related to chains in
  cluster F

47
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