No. The same proof is used as in the case where $\Omega$ is countable and uncountable.
If $\cal B$ is an infinite $\sigma$-algebra, then $\cal B$ has at least the cardinality of the continuum.
The proof is as follows, since $\cal B$ is infinite, it has a countable subset $\{A_i\mid i\in\Bbb N\}$. If this countable set is a $\subseteq$-chain (without loss of generality, it's increasing) take $B_i=A_i\setminus\bigcup_{j<i}A_j$, and this is an infinite family of pairwise disjoint sets. Otherwise, it's not a chain, and without loss of generality doesn't contain an infinite chain either, and by similar a induction (although now it's gonna be slightly dirtier, you might have to skip a few indices, between $B_i$ and $B_{i+1}$) create an infinite family $B_i$ of pairwise disjoint non-empty sets.
Now it's easy to show that $\cal B$ has at least the cardinality of the continuum. If $D\subseteq\Bbb N$, take $B_D=\bigcup_{i\in D}B_i$. And it's quite easy to see that $D\neq D'$ implies that $B_D\neq B_{D'}$. $\quad \square$
A word on choice. $\tiny\textsf{(with regards to tomasz)}$
Note that this proof uses the axiom of choice. We used the fact that if $\cal B$ is infinite, then it has a countably infinite subset. In fact it is consistent that there is a $\sigma$-algebra which is infinite, but has no countably infinite subset. Of course this $\sigma$-algebra is not countable either.
If we are only interested in the answer to the original question, then the axiom of choice is not used anywhere. If there is a countably infinite subset, then the proof follows (note that all the choices above, except the $A_i$'s, are done by induction on the chosen sequence, so they are in fact AC-free); and if there is no countably infinite subset, then certainly $\cal B$ is not countable!
(One example of such $\sigma$-algebra that has no countably infinite subset, is the power set of an amorphous set; where amorphous means that every subset is finite or its complement is finite. Why is this a $\sigma$-algebra? From a countably infinite collection of subsets we can define an infinite co-infinite subset, in a way similar to the above induction from $A_i$ to $B_i$.)