Jordan/H5N1: First Human Case Arrives by Ferry from

UNCLAS AMMAN 002358

SIPDIS

SIPDIS

STATE PASS USAID FOR GLOBAL HEALTH/K HILL, D CARROLL
USDA FOR APHIS
STATE FOR M/MED DASHO DR. TRIPLET
GENEVA FOR WHO REPRESENTATIVE
ROME PASS US MISSION FAO
OES FOR SINGER, DALEY
NEA FOR RA/LAWSON
STATE FOR CA/OCS/ACS/NESA

E.O. 12958: N/A
TAGS: TBIO CASC KFLU JO
SUBJECT: Jordan/H5N1: First Human Case Arrives by Ferry from
Egypt

REF: A) Amman 2326, B) Amman 2176, C) Amman 2156


1. Summary: A 31 year-old Egyptian who arrived on March 27
in Jordan already sick from H5N1 avian flu is Jordan's first
human case. The man raises poultry at his home in Egypt,
the presumed source of the infection. The man's medical
condition on April 2 is stable. No other human cases are
reported, and no new cases in poultry in Jordan have been
reported since the March 23 poultry outbreak. End summary.

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Initial Test Negative; Followup PCR Confirms H5N1
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2. Jordan's Minister of Health Saeed Darwazeh said in a
Friday, March 31 press conference that a 31 year-old
Egyptian man arrived in Aqaba on Monday, March 27 by ferry
from Nuweiba, Egypt, apparently already sick from H5N1 avian
flu. The man, who works in Jordan's construction industry
and has a home in Kerak, Jordan (one hour south of Amman by
car),checked himself into a Ministry of Health hospital in
Kerak on Thursday, March 30. He told health workers that he
has chickens at his home in Fayyoum, Egypt, and this fact -
combined with his symptoms - made him and hospital workers
suspicious that he might have avian flu. An initial "rapid"
test was negative, but because of the strong clinical
symptoms and the history of exposure to poultry, a second
test by PCR was done, which confirmed H5N1. Samples have
been sent to the USG's NAMRU-3 lab in Cairo for further
testing.

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Patient Had Clear Symptoms - Tamiflu Given
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3. AID FSN participated in the GOJ's Avian Flu Technical
Committee meeting on Sunday, April 2. The meeting was
chaired by Ministry of Health (MOH) Secretary General for
Technical Affairs Dr. Ali As'ad. As of 1300 local time, the
patient's medical condition was stable, although doctors are
watching carefully as the patient reaches what they feel is
a critical stage at 5-7 days after becoming symptomatic.
Doctors reported at the meeting that the patient had
symptoms of cough, high fever, congestion in the upper
respiratory tract and around the eyes, and that his chest x-
ray clearly showed evidence of disease in the lower lungs.


4. The MOH hospital in Kerak has put the man and a
traveling companion in isolation, and is treating both with
double dosages of Tamiflu. Health authorities haven also
given Tamiflu to eleven health workers with whom the
Egyptian man had direct contact at the hospital. Health
authorities are monitoring the temperature and symptoms of
the people at the patient's home in Kerak. The Health
Subcommittee of Jordan's Avian Flu Technical Committee has
developed protocols for use of Tamiflu and is sticking with
them, despite pressure for wider use of Tamiflu. The GOJ's
"golden rule" is direct exposure to confirmed cases in
either birds or people. No further human or avian cases of
H5N1 in Jordan have been reported, and officials said that
the situation in Ajloun in northern Jordan, where there were
confirmed cases in turkeys in March, is under control (ref
C).


5. GOJ officials are investigating why the initial "rapid"
test was negative. Three possible scenarios were discussed
at the April 2 meeting: a bad or inadequate sample, poor lab

procedures, or a bad test kit. For the time being, GOJ
protocols are that if the history and symptoms are strong
indicators of avian flu, they will immediately do a PCR
test.

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Fine-tuning the Response
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6. The AI Technical Committee meeting gathered
representatives from the Agriculture Ministry, the Health
Ministry, Royal Medical Services and universities. Chairman
As'ad noted to attendees that the human case in Kerak is a
"real test" of Jordan's capacity, and that the committee
should use the opportunity to address the inevitable
shortcomings and problems that emerge. One such shortcoming
was a delay in getting Tamiflu to Kerak; supplies are now
being distributed around the country. Another mid-course
correction is to minimize the number of health workers (such
as lab technicians) with direct exposure to H5N1. There was
discussion about continuing with plans to cull all backyard
flocks around Jordan, and the decision was ultimately made
to stand by that decision (ref B). Compensation to farmers
(ref A) is still an evolving issue, but the latest
information from the Ministry of Agriculture is that the GOJ
will compensate for all poultry that the GOJ itself culls,
but not for any culling done by farmers themselves.

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Industrial Poultry Operations Continuing
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7. On the economic side, the committee agreed not to close
Amman's large central slaughterhouse to poultry. MOA and
MOH officials agreed that closing the slaughterhouse would
be a tacit admission that sick birds could get through their
screening procedures. They feel that their monitoring and
other food safety procedures ensure that this will not
happen. Due to a drop in demand for chicken, big industrial
poultry producers are freezing their product in preparation
for a rebound in demand.

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Public Outreach Campaign Shifting Gears
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8. The press has covered the Egyptian's case widely in a
straight-forward and factual manner. Although the GOJ's
initial press strategy focused on agriculture, it is now
shifting gears to get out the message on human health.
USAID is working with Johns Hopkins University to release
immediately some television announcements, originally done
for Egypt, on avian flu. The GOJ's public affairs program
on avian flu is also on a fast track, but may require a week
or two to get its television announcements off the ground.
Press placements are being done already.

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Embassy Outreach and Response
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9. The Embassy's Avian Influenza Task Force met on April 2
to discuss the case, review the tripwires and plan the next
steps. The Task Force agreed to take the following actions:
the Ambassador will lead a discussion of avian flu at Town
Hall meetings on the morning of April 6 for American staff,
family members and locally-engaged staff. A Management

Notice will be circulated to all staff on April 2, and a
warden message following similar lines will be distributed
shortly after that. A public informational event on avian
flu for all concerned members of the larger Embassy
community, including DOD contractors, AID contractors and
staff at the American Language Center will be held on the
afternoon of April 6. Embassy ESTH Officer will participate
in a webchat about avian flu on Tuesday, April 4.

HALE