at these hospitals have evaluated thousands of

Standardized surveillance among young children for

patients.  Of 1,690 meningitis patients evaluated

pathogens associated with severe diarrhea was conduct 

between October 2000 and August 2001, 8% had posi 

ed at two hospitals in Egypt:  Benha Fever Hospital

tive bacterial cultures including 46 for Streptococcus

and Abu Homos District Hospital, both in the Nile

pneumoniae, 30 for Haemophilus influenzae, 29 for

Delta.  Between May 2000 and September 2001, 980

Neisseria meningitides, and 16 for Mycobacterium

children were studied, most of whom were under one

tuberculosis. Among children H. influenzae was the

year of age.  ETEC was the most common pathogen

number one cause of meningitis.  These data have

(22%). Giardia, rotavirus, and Cryptosporidium were

been used to build a cost effectiveness model for the

also important etiologies. Campylobacter and Shigella

introduction of the Hib vaccine into the Expanded

each accounted for only 2% of the episodes.  No Vibrio

Program on Immunization.  Of 1,589 patients evaluated

were identified and only two Aeromonas. Entamoeba

for acute febrile illnesses, 90 were classified with

histolytica also seemed uncommon. Shigella and

confirmed and 274 with probable typhoid fever.  In

ETEC were sensitive to both naladixic acid and

addition, 42 were classified with confirmed and 188

ciprofloxacin but inconsistently sensitive to other

with probable brucellosis.  Consumption of dairy

antibiotics. Campylobacter was sensitive to erythro 

products (raw milk and soft cheese) appears to be a

mycin but not to naladixic acid or ciprofloxacin. 

risk factor.  Testing also suggested that murine typhus

may be a common cause of acute fever in Egypt.

Further antibiotic resistance characterization data

Arboviral infections appeared to be generally uncom 

were obtained on 2,879 E. coli and Shigella isolates

mon though evidence for transmission of Rickettsia

collected between 1995 and 2000 in rural Egypt.

typhi, West Nile virus, and the viruses that cause

Among ETEC strains, multiple antibiotic resistance

Sinbis, Sandfly fevers (Naples and Sicilian), and Rift

was noted in 27.4% vs. 40.3% among non ETEC

Valley fever was found.  Dysentery surveillance was

strains though across time upward trends were not

only recently implemented but Shigella spp. were the

particularly evident.  About 20% of Shigella spp.

most commonly identified pathogens. In the course

demonstrated multiple antibiotic resistance.

of hepatitis surveillance at four sites, evidence for

hepatitis C virus infection was found in 24%, for

The NAMRU 3 DoD GEIS program provided support

hepatitis B virus in 17%, and for hepatitis A virus

to CENTCOM by conducting enteric disease surveil 

in 15%.  The WHO has asked NAMRU 3's assis 

lance of roughly 15,000 active duty U.S. military

tance in developing similar surveillance networks

personnel during the Brightstar Exercise held in Egypt

elsewhere in the region.  

between 24 September 2001 and 7 November 2001.

Over 200 stool samples on 128 troops were collected.

NAMRU 3 also conducted standardized population 

E. coli was by far the most common organism isolated,

based surveillance of 473,472 persons in the Bilbeis

accounting for 78 of the enrollees.  Resistance to

district.  This included surveillance at the Bilbeis

ciprofloxacin and naladixic acid was universal

Fever Hospital, the private clinic of a fever specialist,

among the 9 Campylobacter isolates.  Complete

and in the offices of selected primary care providers.

results are pending.

Of 466 patients evaluated, 4.2% had positive blood

cultures for Salmonella typhi and 3.1% were positive

Surveillance for arboviruses, including West Nile

for Brucella spp.  Brucellosis was the most common

virus, began in the Sinai through cross sectional

cause of febrile illness.  Most brucellosis patients

serosurveys of 877 Bedouins (254 families), monthly

were initially misdiagnosed as having typhoid fever.

arthropod surveillance, and sentinel chicken surveil 

Less than 33% of typhoid infections were seen in the

lance.  In the El Arish area (on the north coast), West

fever hospital.  

Nile antibody prevalence rates varied from about 5%

in persons 4 to 10 years of age to about 20% for those

27