In late September, Sameh Abu Zeid, a teacher and resident of Al-Qaraya village in Esna district, Luxor governorate, developed a high fever, acute joint and bone pain, and severe fatigue. His wife and four children soon developed the same symptoms, prompting doctors to give them antibiotic injections and intravenous fluids to lower their temperatures and stop their vomiting. Their recovery took about two weeks.
But Sameh’s family was not the only one in their village and neighbouring villages struck by these symptoms. Cases began appearing about two months earlier in several hamlets in southern Esna, specifically Al-Numeirat and Al-Qawareb, before the infection gradually spread from one hamlet to another, reaching Al-Qaraya, Al-Namsa and Al-Masawiya. Almost no household in that area was left without an infected family member, he tells Zawia3.
In October, symptoms returned in two of Sameh’s children after they had recovered. This time, however, he resorted to what he called “the dose”: intravenous fluids dispensed by pharmacists in Esna’s villages to patients unable to afford examinations at hospitals or doctors’ clinics. He says village pharmacies are noticeably crowded because of the growing number of patients, who have to hang their IV bags from trees or other makeshift supports.
“Residents are used to changes in the weather and seasonal respiratory infections, but they never spread in the way we are now seeing in Esna’s villages,” he says. “The spread of infections we have witnessed over the past two months is more severe than what our district experienced during the coronavirus pandemic.”
He explains that most patients do not go directly to health units and hospitals. Instead, they prefer pharmacies or private clinics to avoid long waits or because medicines are missing from health-unit pharmacies. He stresses that Esna General Hospital alone is insufficient to provide healthcare for the district’s population, which numbers about 370,730 across an area of approximately 109.62 km.
Since October 2026, villages in southern Esna and the town centre, in southern Luxor governorate, have seen growing complaints about the spread of similar symptoms among many residents: high temperatures, severe body and bone pain, headaches and general exhaustion lasting between ten days and two weeks. This has raised fears about the nature and source of the infections.
Lawyer Mohamed Atef, a resident of Esna district in Luxor, was among those infected with the virus last month. He recalls that his symptoms began with a sudden, high temperature ranging from 40 to 42 degrees, lasting about three or four days. The fever then subsided and other symptoms appeared, including body aches, extreme fatigue, difficulty speaking, loss of appetite, changes in the taste of food and water, low blood pressure, diarrhoea, nausea and vomiting. At the same time, he experienced a sharp drop in blood pressure.
Mohamed went to a private clinic, where the doctor diagnosed him with dengue, a viral infection transmitted to humans through bites from Aedes aegypti mosquitoes that causes a sudden high fever, severe headaches, acute muscle, joint and bone pain, nausea, vomiting and a rash. The doctor prescribed antibiotic injections, IV fluids and paracetamol.
He tells Zawia3 that friends went to Esna General Hospital after developing symptoms. They were given only IV fluids and then told to leave, without being informed of a diagnosis.
Over recent weeks, numerous residents have posted appeals to the Ministry of Health and Population on social media about increasing cases in Esna district and town involving high fever, diarrhoea, vomiting, rashes, and abdominal and body pain. They describe a severe shortage of medical resources in village health units and their inability to accommodate the number of patients or accurately diagnose them, endangering residents’ lives.
Residents have called for a fully equipped medical convoy to be sent to Esna district and town to diagnose cases and provide treatment. They have also requested preventive medicine teams to investigate, identify and contain the source of the outbreak, whether contaminated water, food or something else, and called for medicines, emergency medical supplies and ambulances to transfer critical cases to hospital.
Over the past two years, residents have demanded improvements to basic utilities, particularly drinking water, action on rising groundwater levels and leaks from private sewage tanks, and better public sanitation. Their demands include cleaning canals and drains and intensifying mosquito and flying-insect control campaigns, with pesticide spraying in streets and areas around canals and drains to reduce environmental and health risks.
Awaiting epidemiological surveillance results
The symptoms reported by residents of Esna’s villages, including fever, high temperatures, abdominal pain, nausea and body aches, are not enough on their own to establish the nature of the infection or its causative agent. These symptoms overlap with many viral and bacterial infections and protozoan infections, including some diseases transmitted through contaminated water, according to Dr Islam Anany, a professor of health economics and the spread of diseases and epidemics.
He explains that the symptoms could be caused by viruses, bacteria or protozoa such as amoebae, resulting from sewage mixing with drinking water or from food contamination. But Esna’s situation cannot be determined without epidemiological data and laboratory test results, after preventive and therapeutic medicine teams visit affected areas, examine health and environmental conditions, and issue reports based on investigations and analyses.
At the same time, he considers it unlikely that the symptoms are due to the emergence of a new COVID-19 variant. He notes that the Stratus variant was present in autumn 2025 and remains in circulation in autumn 2026. Its symptoms resemble those of Omicron, including fever, coughing and a sore throat, alongside some gastrointestinal symptoms such as abdominal pain and nausea, while loss of smell and taste has become less common.
“The procedures that should be taken when an infectious disease outbreak is suspected in a local community begin with collecting drinking-water samples to establish their safety and absence of pathogens,” he tells Zawia3. “They also include examining wastewater and sewers, inspecting waste and rubbish accumulations, and collecting and analysing mosquitoes from affected areas to identify their species and whether they carry pathogens.”
He emphasises the importance of wastewater analysis as an epidemiological surveillance tool, since it can detect some viruses and bacteria within a community. Testing drinking water is particularly important when waterborne parasites or bacteria are suspected, he adds, alongside polymerase chain reaction (PCR) tests to identify the causes of viral infections.
The health economics professor explains that females of certain mosquito species transmit various viral and parasitic diseases. An increase in mosquitoes in villages, alongside rubbish accumulations, stagnant water and sewage problems, calls for field investigations to identify insect species and breeding sites, rather than relying solely on spraying without a comprehensive environmental investigation.
An academic specialising in microbiology, virology and immunology, who declined to be named, believes that the symptoms reported by residents of Esna’s villages may resemble those of several viral diseases, including dengue. However, an accurate diagnosis requires patient samples and laboratory analysis within epidemiological surveillance and preventive medicine protocols.
The academic notes that dengue is transmitted mainly by particular mosquito species, not directly from person to person. Its arrival in an area may be linked to infected people entering it, followed by transmission through mosquito vectors if suitable environmental conditions exist.
“Rubbish accumulations, sewage problems and stagnant water may provide environmental conditions that help disease-carrying insects, including mosquitoes, breed, if the area has the species that transmits the virus,” the academic tells Zawia3, describing examination of the environment around affected villages as an essential part of epidemiological investigation.
The academic stresses that responding to community outbreaks is not solely the responsibility of local health bodies. It requires intervention by central health authorities, including epidemic-control and preventive medicine departments, alongside environmental and veterinary specialists, to collect samples from different locations, analyse them, identify sources of infection and transmission routes, and take measures to prevent spread to other areas.
Dr Mohamed Ahmed Ali, a professor of virology at the National Research Centre, likewise stresses that determining the nature of infections spreading in Esna’s villages remains the responsibility of the Ministry of Health and epidemiological surveillance authorities. They are responsible for collecting and testing patient samples, as well as investigating environmental conditions in affected areas.
The virology professor tells Zawia3 that winter brings the spread of many respiratory viruses and influenza. He also points to a decline in the severity of the effects associated with coronavirus compared with the pandemic’s beginning, as antibody formation has given people a degree of immunity.
He warns of the health consequences of environmental pollution, rubbish accumulation and sewage pools. These conditions may help spread different pathogens, including bacteria, fungi and viruses. Transmission routes vary by pathogen: some spread between people, others from animals to humans or vice versa, while others are associated with contaminated food and water.
“Mosquitoes can transmit a number of diseases and viruses by biting an infected person and then passing the pathogen to another,” he says. “The insect does not create the virus itself; it acts as a vector between infected and susceptible hosts.”
He recommends attention to personal hygiene and reducing contact and gatherings as much as possible, particularly when symptoms appear. Children should also be taught behaviours that limit transmission, such as using tissues when coughing or sneezing, washing their hands after touching their mouths or noses, and following everyday hygiene practices.
Authorities deny an epidemic outbreak
Amid growing complaints, MP Ahmed Ramadan Ibrahim urged the minister of health and population to form preventive medicine committees to visit Esna’s villages, examine patients and collect samples for laboratory testing. He also called for drinking-water samples to be taken to verify safety and rule out a link between the infections and water contamination. He demanded publication of test results and clarification of the nature of the infections to curb rumours and residents’ fears.
In response, the Luxor Drinking Water and Sanitation Company announced that it was collecting samples every two hours from treatment stations, network endpoints and homes across Esna to ensure compliance with health standards.
Meanwhile, surveillance and preventive medicine teams in Luxor intensified their work in areas where residents had complained of symptoms. They implemented precautions including insect and disease-vector control campaigns and surveys of stagnant-water accumulations, as part of efforts to reduce potential health risks.
Luxor Governor Abdel Mottaleb Amara, however, denied the existence of health problems or an epidemic in Esna, asserting that the situation was stable and there was no cause for concern. He said that any detected epidemic would be announced officially and immediately by the governorate and the Ministry of Health.
The Ministry of Health and Population also denied an unidentified epidemic outbreak or mysterious disease in Esna. It said surveillance and preventive medicine teams were continuously monitoring the situation, and that recorded cases were associated with familiar seasonal respiratory viral infections that recur at this time of year as seasons change and temperatures fluctuate.
The ministry said there was no link between the infections and drinking water or food contamination. It indicated that the vast majority of cases were mild, improved with conservative treatment, and did not require hospitalisation or isolation.
Dr Hossam Abdel Ghaffar, the Ministry of Health and Population’s official spokesperson, says an integrated preventive medicine team is monitoring the health situation in Esna district, Luxor. He stresses that the ministry classifies the infections as seasonal viral infections not transmitted through contact, food or drinking water.
“The Ministry of Health is monitoring disease vectors, including insects and rodents, as part of measures aimed at limiting the spread of infection,” he tells Zawia3. “The ministry has taken samples and knows the nature and source of the problem.” He did not specify the infectious agent or the test results on which this determination was based.
He says the health situation is stable, case numbers are declining and, under the ministry’s description, the infection does not warrant suspending school because it is not transmitted through contact. He notes coordination between the Ministry of Health, Luxor governorate, the Ministry of Environment and local authorities to address the situation in affected villages.
While the Ministry of Health maintains that cases are declining and the situation is stable, the causative agent remains undisclosed, despite its confirmation that samples have been collected and the source of the problem identified. Without published laboratory results, and with residents’ accounts differing from the official description, establishing the causes of the symptoms and their transmission routes remains dependent on announcing surveillance results. It also requires clarification of measures taken to ensure patients receive medical care and to address the environmental problems residents have demanded action on for years.
