Study of the effectiveness of a supported intervention package in reducing the risk of avian influenza human exposure through the reduction of infections in poultry: Egypt, 2006-2021

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 Chi ² 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.